Relational attitudes in adolescent girls with and without a diagnosis of anorexia nervosa or atypical anorexia nervosa.

BACKGROUND: People with eating disorders experience interpersonal difficulties, but little research explores relational attitudes in this population. We examined sense of relational entitlement towards parents, pathological concern, and psychological distress in adolescent girls with and without anorexia nervosa (AN) or atypical anorexia nervosa (AAN). METHODS: Questionnaires assessing sense of entitlement towards parents, pathological concern, and symptoms of depression and anxiety were completed by 85 girls with and 100 girls without AN/AAN (mean age 15.06 ± 1.41). The AN/AAN group also completed a measure of ED pathology. RESULTS: Eating pathology, pathological concern and symptoms of depression and anxiety were positively associated with both restricted and inflated sense of entitlement towards parents. AN/AAN participants scored significantly higher than controls on restricted and inflated sense of entitlement, pathological concern and symptoms of depression and anxiety. Restricted sense of entitlement and pathological concern partially mediation the association between AN/AAN and symptoms of depression and fully mediated the association between AN/AAN and anxiety. Within the AN/AAN group, pathological concern and symptoms of depression explained a large proportion of the variance in ED pathology. CONCLUSIONS: Adolescent AN/AAN takes a heavy toll on emotional and social health, perhaps in part because crucial aspects of relational mutuality fail to develop. Teens with AN/AAN tend to over-focus on their parents' needs at the expense of their own needs. They also have impaired capacity to realistically appraise expectations from their parents, tending to feel over- and/or under-entitled to need fulfillment. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.

In healthy relationships people trust another person to fulfill some but not all their needs. It is maladaptive to expect the fulfillment of all needs (inflated entitlement) or of no needs (restricted entitlement). Restricted entitlement generally masks frustration and an unconscious wish for need fulfillment, so that restricted and inflated entitlement can co-occur. We examined to what degree 85 adolescent girls with a restricting ED and 100 without an ED felt entitled to need fulfillment by their parents, and to what extent they sacrificed their own needs for their parents'. Girls with an ED reported higher levels of both restricted and inflated entitlement from their parents than the other girls, and reported placing their parents' needs before their own more often. The more restricted and/or inflated their entitlement was, the more they tended to place their parents' needs before their own, to have severe ED symptoms and to feel depressed and anxious. Teens with EDs may over-focus on their parents' needs at the expense of their own and feel they deserve to have all or none of their needs fulfilled by their parents. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.

Sense of Relationship Entitlement of Aging Parents Toward Their Offspring (SRE-ao)-A New Concept and Measurement Tool.

Our sense of entitlement influences our interactions and attitudes in a range of specific relational contexts, one of them being aging parents' relationships with their adult children. This study aimed to examine the factor structure of the Sense of Relational Entitlement-aging parents toward their offspring (SRE-ao), an 11-item questionnaire that assesses aging people's sense of relational entitlement toward their children, and examine the associations of its subscales with related personality and mental health constructs. One thousand and six participants (24.6% men), aged 65-99, with at least one child, completed the SRE-ao, Brief Symptom Inventory, Loneliness Scale, and General Belongingness scale. The SRE-ao demonstrated good construct structure using confirmatory factor analysis. Both SRE-ao subscales (restricted and inflated sense of entitlement) were significantly and positively associated with anxiety, depression, somatization and sense of loneliness and negatively with sense of belonging. When all variables were entered into a regression model, age, anxiety, and low sense of belonging, but not sense of loneliness, positively predicted both restricted and inflated sense of entitlement. Somatization negatively predicted inflated sense of entitlement. The SRE-ao is a reliable and valid scale that can be used in clinical practice and research to enhance our understanding of parent-child relationships throughout the lifespan.

Associations between pathological eating, relational attitudes and satisfaction in romantic relationships.

OBJECTIVE: Women with disordered eating report low satisfaction from romantic relationships. We wished to examine whether this may be explained in part by a restricted or inflated sense of relational entitlement, pathological concern and low authenticity levels. METHOD: A community sample of 170 women aged 18-60 (M = 24.89 + 6.22), who had experienced a meaningful romantic relationship, completed questionnaires online. These included measures of disordered eating (EDE-Q), sense of relational entitlement (SRE-R), pathological concern (PCQ), relational authenticity (AIRS) and basic relational needs satisfaction (BNSRS). Structural equation model (SEM) was employed to assess the mediating effect of the SRE-R, PCQ and AIRS on the association between ED symptoms and BNSRS. RESULTS: Participants with high EDE-Q scores tended to score high on inflated and restricted SRE-R, PCQ, AIRS and BNSRS. SRE-R, PCQ and AIRS scores mediated the negative association between EDE-Q and BNSRS scores. CONCLUSIONS: An imbalanced sense of relational entitlement, pathological concern and inauthenticity seem to underlie the dissatisfaction that women with disordered eating experience from romantic relationships. Since these relational characteristics seem to take a high toll on the intimate relationships, it is important to encourage healthy eating attitudes and assertiveness within romantic relationships, in life and in therapy. LEVEL OF EVIDENCE: Level III: evidence obtained from well-designed cohort or case-control analytic studies.

Refining the Assessment of Entitlement in Romantic Relationships: The Sense of Relational Entitlement Scale-Revised (SRE-R).

Objective: A subjective sense of entitlement is strongly evoked in the context of romantic relationships. A pathological sense of entitlement results from believing a partner should fulfill all one's needs and wishes (inflated) or that the expression of genuine needs is illegitimate (restricted). This study aimed to validate a revised, improved version of the Sense of Relational Entitlement scale entitled the Sense of Relational Entitlement scale-Revised (SRE-R). We hypothesized it would have good factor structure and convergent validity, and that attachment dimensions and relationship indices would predict both inflated and restricted subscales. Method: The SRE-R was completed by 854 Israeli adults (8.3% males) aged 31.94 ± 8.02. A subset (n = 629) also completed measures of attachment (ECR-S) and 447 completed measures of relational authenticity, pathological concern, and relational obsessions and compulsions. Results: CFA confirmed two factors, inflated and restricted sense of relational entitlement. Relational obsessive-compulsive symptoms and pathological concern predicted an inflated sense of entitlement, and attachment avoidance, pathological concern, and authenticity in relationships predicted a restricted sense of entitlement. Discussion: The SRE-R is a valid and useful tool to assess sense of entitlement in romantic relationships and should be examined in diverse samples and cultures.

Attachment, Sense of Entitlement in Romantic Relationships, and Sexual Revictimization Among Adult CSA Survivors.

Insecure attachment orientations are disproportionately frequent in child sexual abuse (CSA) survivors and have been found to mediate some of the effects of CSA on adult interpersonal and romantic difficulties, including sexual revictimization (SR). A sense of relational entitlement (SRE) has received growing attention in psychological discourse and research in recent years. It reflects both adaptive (assertive) and pathological (restricted or inflated) attitudes to the assertion of needs and rights and has not been studied in adult CSA survivors. The purpose of this study was to examine associations between CSA, attachment orientations, SR, and SRE. Sixty-seven Israeli women aged 25 ± 3.95 years (30 adult CSA survivors and 37 healthy female controls with no history of CSA) completed a demographic questionnaire and self-reported measures of adult attachment orientations, sense of entitlement in romantic relationships, and adult SR. CSA survivors reported greater attachment anxiety and attachment avoidance, more restricted SRE, and higher revictimization rates than control women. No difference was found between the groups in inflated SRE. In the CSA but not the control group, anxious and avoidant attachment orientations were significantly and negatively associated with assertive SRE. Insecure (anxious and avoidant) attachment fully mediated the association between CSA and restricted SRE. Our findings suggest that the interplay between insecure attachment and CSA is related to a sense of impaired assertive entitlement and elevated restricted entitlement in adult CSA survivors. This entitlement pattern can be destructive to survivors' romantic relationships and should be addressed in therapy.

The Relation of Intra-Psychic and Relational Aspects of the Self to Compulsive Sexual Behavior.

Background and Aims: Research has indicated that addictions include not only the consumption of psychoactive substances but also behavioral addictions such as compulsive sexual behavior (CSB). In the current study we examine differences in the "addictive personality" of people with CSB as well as drug addicts. Methods: The sample sized included 160 Israeli men, of whom 67 were members of Sexaholics Anonymous (SA) support groups, 48 were members of Narcotics Anonymous (NA) support groups, and 45 were from the general community. Self-report measures of intra-psychic (narcissism, self-compassion, self-efficacy) and relational-related (sense of entitlement, pathological concern) measures were administrated. Results: Results indicate that SA groups had higher narcissism, lacked self-compassion and efficacy, and had greater pathological senses of entitlement and concern than drug addicts and control individuals. Conclusion: A theoretical conceptualization of these results is presented as a basis for future research directions and clinical intervention.

The sense of relational entitlement among adolescents toward their parents (SREap) - Testing an adaptation of the SRE.

The quality of the adolescent-parent relationship is closely related to the adolescent's sense of entitlement. Study 1 (458 central-Israel adolescents, 69% girls, ages: 11-16) developed the sense of relational entitlement among adolescents toward their parents (SREap, adapted from the original SRE on adults' romantic relationships) and provided initial validity evidence of its three-factor structure: exaggerated, restricted and assertive - replicating the SRE's factor structure. Studies 2-5 (1237 adolescents, 56% girls) examined the link between the SREap factors and relevant psychological measures. Exaggerated and restricted SREap factors were associated with attachment insecurities. Restricted and exaggerated entitlement factors were related to higher levels of emotional problems, and lower levels of: wellbeing, positive mood and life satisfaction. Conversely, assertive entitlement was related to higher life satisfaction and self-efficacy and lower levels of emotional problems. The findings also indicate that SREap is not merely a form of narcissism. The implications of SREap are discussed.

"It takes two to take": Caregiving style, relational entitlement, and medication adherence.

Partners' support has been associated with both patients' increased and decreased inclination toward health-promoting behaviors. Our hypothesis for understanding this enigma is that it is the interplay between partners' manner of care provision and patients' ability to accept these care efforts that may best predict patients' adherence. Thus, the current study's main goal was to examine the contribution of the interaction between caregivers' support style (sensitive and compulsive) and cardiac patients' sense of relational entitlement (restricted, excessive, assertive, entitlement expectations) to patients' medication adherence. The Adult Caregiving Questionnaire, the Sense of Relational Entitlement Scale, and the Medication Adherence Report Scale were administered to 114 cardiac patients and their partners, during patients' hospitalizations and 6 months later. The lowest levels of medication adherence were detected among patients high on restricted entitlement who were married to partners high on compulsive caregiving style. These findings strengthen our claim that it is the interaction between recipients' personality and providers' support style which explain self-regulatory processes that arise during times of family medical crises. (PsycINFO Database Record

NARCISSISM AND CONCERN: THE RELATIONSHIP OF SELF-OBJECT NEEDS AND NARCISSISTIC SYMPTOMS WITH HEALTHY AND PATHOLOGICAL CONCERN.

While concern and narcissism seem to be contradictory in nature, clinical evidence and theoretical writings on pathological forms of concern--tracing their origin to deficiencies in early relationships with primary caretakers--suggest that the actual relationship between these two characteristics might be much more complicated. We respond to a study aimed to add empirical data to the clinical and theoretical knowledge examined the relationships between self-object functions, types of narcissism and pathological concern. The findings of the study showed that pathological concern was positively associated with self-object needs and that this association was mediated by covert narcissism. Our discussion focuses on the developmental and psychodynamic sources of pathological concern, as well as its significance in the intrapersonal and interpersonal domains.

Testing the concept of relational entitlement in the dyadic context: further validation and associations with relationship satisfaction.

The sense of relational entitlement is the perception one has of what one deserves from one's partner, and it may play a crucial role in determining the quality of a couple's relationship. However, the concept was only recently subjected to empirical examination. The main goals of the current study were to continue the work initiated by the scale developers (Tolmacz & Mikulincer, 2011) by (1) further validating the Sense of Relational Entitlement Scale (SRE) in a sample of adult couples; and (2) examining the contribution of each partner's sense of relational entitlement to his or her own and his or her partner's relationship satisfaction. A sample of 120 Israeli, heterosexual, older couples (age = 58 years) in long-term relationships completed the study measurements. Factor analyses revealed that the SRE scale consisted of two major dimensions: conflicted entitlement and assertive entitlement. Applying an Actor-Partner-Interdependence Model (APIM) analysis indicated that the more conflicted one felt with regard to what one was entitled to, the less satisfaction one felt with the relationship. Additionally, the higher one's entitlement expectations were of one's partner (a subfactor of the assertive entitlement dimension), the more one's partner was satisfied with the relationship. The sense of entitlement construct seems to be relevant to the context of dyadic relationships and, as such, is worthy of further attention and investigation.

Forms of concern: toward an intersubjective perspective.

The growing interest in the issue of concern, which appeared relatively late in psychoanalytical literature, resulted in several distinctions. Winnicott distinguished between concern as an expression of guilt and concern as a manifestation of joy, Brenman Pick distinguished between real concern and spurious concern, and Bowlby distinguished between sensitive and compulsive caregiving. The basic concepts of Buber's dialogical philosophy and intersubjective approaches in psychoanalysis have created fertile ground for the study of concern, and enabled us to conceptualize these distinctions in a way that has heretofore been lacking in psychoanalytical thought.

Sense of entitlement in couple relationships: an attachment theory perspective.

Our sense of entitlement is activated and influences our interactions and attitudes in a wide range of contexts, but it seems to have special relevance to couple relationships, as these intimate relationships serve as a unique meeting point between needs, wishes, and expectations. Emphasis is placed on the connection between one's sense of entitlement in a romantic relationship and early experiences of entitlement in the context of relationships with primary caregivers. An understanding of the development of normal and pathological senses of entitlement is suggested based on attachment theory; according to this understanding, one's sense of entitlement is conceived as part of internal working models and thus is closely related to one's specific attachment style. Two clinical illustrations that show the effects of the partners' sense of entitlement on their relationship are presented and discussed in connection with early attachments.

Concern and empathy: two concepts or one?

For years, concern was treated as a marginal concept in psychoanalytic thought. Awareness of its importance increased due to the rise of object-relations theories: Suttie's description of the inborn impulse to give, attachment theory and the behavioral system of caregiving, and of course the emphasis on concern in the theoretical thinking of Winnicott, who even wanted to change the Kleinian term depressive position to stage of concern. However, the centrality that empathy took on with the appearance of self psychology made it seem unnecessary to pay separate attention to concern. The relational approach sheds new light on the concept of concern. This paper proposes distinguishing between empathy and concern as two different mental functions that affect each other. Under normal conditions they are intertwined and produce the unique way in which the individual relates to others.