Personality disorders and the interpersonal octagon.

The interpersonal octagon is a theoretical structure, similar to the interpersonal circle, within which a person's relating tendencies can be defined. It is constructed around a horizontal axis, concerning relating either closely or distantly, and a vertical one, concerning relating either downwardly or upwardly. The Person's Relating to Others Questionnaire--Revised Version (PROQ2) was designed to measure relating within the octagon. To test the validity of the proposed location of the 10 DSM-IV personality disorders within the octagon, the PROQ2 was administered, together with the DSM-IV version of the Personality Diagnostic Questionnaire (PDQ-IV), to a series of 107 men admitted to a therapeutic prison. The mean PROQ2 scores of the prisoners fell mid-way between those of male students and psychotherapy patients. High intercorrelations were found between the scale scores of both the PROQ2 and the PDQ, and there was a high correlation between total scores of the two instruments. All disorders were highly correlated with the lower close scale of the PROQ2. The locations of some disorders corresponded well with the pre-study predictions, and those of others came close. Those of a few came far from what was predicted, and some explanations for this are offered.

Attachment in an interpersonal context.

Attachment theory is essentially a child-centred theory which is not readily adaptable to the relating of adults. Dependence is proposed as the adult equivalent of attachment. Both attachment and dependence have both a closeness-seeking component and an upwardly directed component. From this observation emerges a theory of relating constructed around a horizontal axis concerning closeness seeking versus distance seeking and a vertical axis concerning upwardly directed behaviour versus downwardly directed behaviour. By the insertion of four intermediate positions, an octagonal arrangement of relating objectives is created which resembles the interpersonal circle. The theory differs from orthodox interpersonal theory in the clear distinction which is drawn between positive relating and negative relating. Three classes of negative relating are described. As in attachment theory, continuities are established between the relating of animals and the relating of humans. It is tentatively shown how the 10 DSM-IV personality disorders might be accommodated within the structure of the octagon. Psychotherapy based upon interpersonal theory is described. Two instruments for measuring negative relating are described: the Person's Relating to Others Questionnaire, which is a general measure of relating, and the Couple's Relating to Each Other Questionnaire, which measures specifically interrelating within couples. The usefulness of these in measuring change in psychotherapy is illustrated.

Does recollection of exposure to poor maternal care in childhood affect later ability to relate?

The study tested Bowlby's hypothesis that experiencing the poor relating of parents in childhood predisposes the individual to poor relating in adult life. Data were drawn from two community samples: a younger sample of 25-34-year-old married women, and an older one of 40-49-year-old women. Data were also drawn from the husbands of the women in the younger sample. It focused on the single childhood variable of the recollection of poor maternal care. To avoid the effect of this on depression or other psychopathology, groups who were depressed and not depressed, or who were at different levels of psychopathology, were examined separately. Recollection of poor early care was associated with poor relating, lower age at marriage, poor-quality marriage and divorce from first marriage. There was a suggestion that the effects of the recollection of poor early care of marital partners summate.

The negative relating of depressed patients: a new approach.

A new instrument, the Person's Relating to Others Questionnaire (PROQ), based upon a circular ordering of eight modes of relating, constructed around the two dimensions of Closeness-Distance and Upperness-Lowerness, is used to measure the negative and positive relating of depressed patients. It is shown that patients, compared with population subjects, score significantly higher on Negative Closeness, Distance and Lowerness, but that population subjects score significantly higher on Positive Upperness. There is suggestive evidence that the negative scores of patients who fully recover return to the levels of population subjects, indicating that negative relating is part of the depressive state.

Further exploration of the relationship between depression and dependence.

Two instruments, the Self Rating Questionnaire and the Interpersonal Dependency Inventory, were used to examine further the relationship between dependence and depression. Dependence scores on both measures correlated highly with scores on measures of neuroticism, self-esteem, depressive cognition and depression. Dependence scores were significantly higher in samples of depressed subjects than in samples of non-depressed subjects. The scores of depressives who fully recovered dropped, but those of depressives who remained depressed or who only partially recovered remained high. In non-depressed subjects there was no relationship between dependence and gender. There was no support for the use of subscales of dependence.

Negative modes of relating, marital quality and depression.

Young married couples, with or without a depressed wife, were divided into three groups according to marital quality. Negative modes of relating were assessed by self-rating and partner-rating questionnaires. The intercorrelation of scores for different modes of relating was higher on partner-rating than on self-rating scales. There was a significant gradient of mean negative-relating scores across the three levels of marital quality. The partner-ratings of depressives and their husbands were higher on all negative-relating scales than those of non-depressed women and their husbands. The self-ratings of the depressives corresponded with these negative ratings while those of their husbands did not. The partner-rating scores differentiated between the depressives with poor marriages and those with better marriages.

Poverty and depression.

Depression is often associated with financial difficulties. Helping to resolve money problems may be an important factor in treating depression.

Is living in a slab block depressing?

The level of depression in 25 to 34-year-old, married women was assessed in relation to type of accommodation. The highest depression ratings were in women living in slab blocks and the lowest were in those living in brick houses in conventional streets.

The Depression Screening Instrument (DSI): a device for the detection of depressive disorders in general practice.

The paper describes the design, application and psychometric properties of a 16-item depression screening questionnaire for use in community surveys carried out in general practice. The instrument was shown to have a satisfactory factorial structure and a high internal reliability. All 16 items showed very significant discrimination between a patient and a population sample and the total score correlated highly with that of two other widely used instruments. When measured against the PSE CATEGO-ID ratings the instrument was shown to have a high degree of validity and the value of the area under the receiver operating characteristic curve was high. Sensitivity and specificity levels were presented for a range of cutting points.

Depression and family relationships. A study of young, married women on a London housing estate.

The study was carried out on 25-34-year-old, British-born, married women, living on a south-east London housing estate. The reported early and current family relationships of 50 depressed and 40 non-depressed women were compared. Significantly more of the depressed women reported a poor early relationship with their mothers, but not with their fathers. This finding was confirmed by corresponding low care and high overprotection scores (for mothers only) on the Parental Bonding Instrument. On the basis of what the women and their husbands said, the marriages of the depressed women were rated as much poorer. This was confirmed by the women's and their husbands' scores on a Partner Rating Questionnaire and the Ryle-Scott-Heyes Marital Patterns Questionnaire. The depressed women reported a poorer current relationship with their mothers and a much poorer relationship with their husbands' mothers and fathers. Significantly more depressed women reported four or more poor family relationships.

The total score of the Crown-Crisp Experiential Index: a useful and valid measure of psychoneurotic pathology.

The Crown-Crisp Experiential Index (CCEI) was designed as a measure of neurotic symptomatology. The tendency has been to report upon its six separate scales and to ignore the total score. We report on the use of the CCEI in a detailed interview study of 208 40-49-year-old women from a local community and 40 patients of the same age range and sex from a psychiatric hospital. In this study, scores on the six scales of the CCEI were shown to be highly intercorrelated. A case is made for combining the six scale scores to form an overall score of neurotic pathology. This score was validated against a number of variables. It was shown to be significantly related to psychiatric patient status, negative self-evaluation, level of severity of current symptoms, evidence of previous psychiatric episodes, previous psychiatric treatment and psychiatric symptoms in childhood. These validation variables were themselves intercorrelated but severity of current symptoms, self-evaluation and childhood symptoms had significant independent effects. It is concluded that scores on the six scales of the CCEI may be less important than the total score which provides a useful and valid measure of psychoneurotic pathology and has particular application as a screening instrument in community surveys.

Depression and the physical environment. A study of young married women on a London housing estate.

A depression-screening instrument (DSI) was administered to all 25-34-year-old, British-born, married women registered with a health centre on a south-east London housing estate. A disproportionate number of high scorers lived in those dwellings with the highest disadvantagement score. The dwelling interiors of the high DSI scorers were significantly poorer in appearance compared with those of the low scorers. Significantly more of the high scorers (and of their husbands) described the estate as unpleasant, and bad for their children. They raised significantly more objections to other residents' (including children's) behaviour. Their complaints were only partly explicable in terms of their less favourable accommodation.

Defining dependence.

The need to define dependence arises out of accumulating evidence that it contributes to depression-proneness. Its accurate definition is therefore a prerequisite for the development of valid methods of measuring it. Because dependence is more a feature of childhood than of adulthood, a dependent person may usefully be viewed as an adult behaving as though he were a child. Dependence is best understood therefore in terms of those developmental deficiencies from which it results. These are failure to separate successfully from the principal parent figure and from the family as a whole, failure to establish a secure personal identity, failure to acquire a general feeling of competence and a realistic assessment of self-worth and failure to feel deserving of the status of adult and to feel on equal terms with other adults. Consequently, adult dependence is characterized by the need to stay close to others, the inclination to be primarily the recipient in interpersonal transactions and the tendency to relate to others from a position of inferiority and humility. The dependent person receives from others a borrowed identity, guidance and direction, compensation for those areas in which he is incompetent and, most important of all, acceptance, approval and affirmation of worth.

Life history factors associated with neurotic symptomatology in a rural community sample of 40-49-year-old women.

Associations between a range of life history variables and neurotic pathology (measured by the Crown-Crisp Experiential Index) were examined in a rural community sample of 208 women aged 40-49. Significant childhood associations were a poor maternal relationship, parental discord, nervousness and not liking school. Significant later associations were a poor marital relationship and emotional and behavioural problems in children. There were significant intercorrelations between the significant childhood variables and between the later significant variables but not between the early and later variables. The predictor equations derived from multiple regression analysis fitted significantly a small replication patient sample.

Attachment-detachment, directiveness-receptiveness: a system for classifying interpersonal attitudes and behaviour.

A system of describing attitudes towards others and ways of relating to others is presented. The system is constructed around two dimensions, the one concerned with closeness vs. separateness, the other concerned with dominance vs. submissiveness. Each dimension has two extreme positions and each of these incorporates a range of attitudes and types of behaviour which are systematically described. The two extremes of the closeness-separateness dimension are attachment and detachment. Attachment is a need for proximity and a fear of being alone. Detachment is a need to remain distant and a fear of closeness. The two extremes of the dominance-submissiveness dimension are directiveness and receptiveness. Directiveness is an inclination for giving or doing things to others. It is characterized by a fear of being controlled or taken over. Receptiveness is an inclination to assume a recipient attitude towards others and is characterized by a fear of assuming responsibility. This system lends itself to the development of measures which place an individual on each of the two dimensions. It also provides a conceptual framework within which to frame hypotheses which will have relevance both to clinicians and to researchers. An important consideration is the effect which a person occupying a particular position within the system has upon the attitude and behaviour of others.

Psychiatric disorders in marriage.

In marriage, whatever happens to one partner inevitably has its effect upon the other. Sometimes, when one overbalances the other partner is brought down also. At other times it is as though one is able to stay upright at the expense of the other remaining down.

The relationship between scores on Ryle's Marital Patterns Test and independent ratings of marital quality.

This study concerns 250 marriages of 40-49 year-old women from a psychiatric patient and general population series. Psychiatric patients' marriages involved less exchange of affection, were husband-dominated, and were of poor quality. In general population marriages, poor quality was related to wife domination. Affection given (AG) and affection received (AR) scores were significantly associated, being high in good marriages and low in bad ones. Zero or near-zero domination was associated with high AG and AR scores and with good quality marriages. Husband domination was linked with wives having high (MMPI) dependency scores. Terminated marriages, compared with bad but non-terminated marriages, had significantly lower AR scores.