The psychological organization of depression

Arieti, Silvano; Bemporad, Jules R.

doi:10.1176/ajp.137.11.1360

Cited by 271 publications

(18 citation statements)

References 10 publications

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“…Our findings are broadly congruent with a typology of major depression developed from a psychoanalytic perspective by Blatt (61), who noted similarities between his system and those proposed from cognitive-behavioral (62, 63), attachment (64), and interpersonal perspectives (65). Blatt proposed that major depression takes two forms: “anaclitic” and “introjective.” The former arises from deficiencies in caring relationships and unmet dependency needs (e.g., “I am unlovable”), and the latter emerges from the inability to meet internal demands for self-worth and achievement (e.g., “I am a failure”) (61).…”

Section: Discussionsupporting

confidence: 90%

Sex Differences in the Pathways to Major Depression: A Study of Opposite-Sex Twin Pairs

Kendler¹,

Gardner²

2014

AJP

275

207

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Objective The authors sought to clarify the nature of sex differences in the etiologic pathways to major depression. Method Retrospective and prospective assessments of 20 developmentally organized risk factors and the occurrence of past-year major depression were conducted at two waves of personal interviews at least 12 months apart in 1,057 opposite-sex dizygotic twin pairs from a population-based register. Analyses were conducted by structural modeling, examining within-pair differences. Results Sixty percent of all paths in the best-fit model exhibited sex differences. Eleven of the 20 risk factors differed across sexes in their impact on liability to major depression. Five had a greater impact in women: parental warmth, neuroticism, divorce, social support, and marital satisfaction. Six had a greater impact in men: childhood sexual abuse, conduct disorder, drug abuse, prior history of major depression, and distal and dependent proximal stressful life events. The life event categories responsible for the stronger effect in males were financial, occupational, and legal in nature. Conclusions In a co-twin control design, which matches sisters and brothers on genetic and familial-environmental background, personality and failures in interpersonal relationships played a stronger etiologic role in major depression for women than for men. Externalizing psychopathology, prior depression, and specific “instrumental” classes of acute stressors were more important in the etiologic pathway to major depression for men. The results are consistent with previously proposed typologies of major depression that suggest two subtypes that differ in prevalence in women (deficiencies in caring relationships and interpersonal loss) and men (failures to achieve expected goals, with lowered self-worth).

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Section: Discussionsupporting

confidence: 90%

Sex Differences in the Pathways to Major Depression: A Study of Opposite-Sex Twin Pairs

Kendler¹,

Gardner²

2014

AJP

275

207

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“…The initial levels of two hypothesized depressive conflicts were among the highest in the sample. The levels of DO are consistent with Arieti and Bemporad's (1980) assertion that this conflict is prominent in many of those with major depression. Individuals with DO require a nurturing and supportive relationship with particular dominant individuals in their lives.…”

Section: Prevalence Of Three Hypothesized Conflictssupporting

confidence: 86%

Dynamic conflicts in recurrent major depression: Does combined short-term psychotherapy and antidepressive medication lead to healthy dynamic functioning?

Perry¹,

Constantinides²,

Simmonds³

2017

Psychoanalytic Psychology

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After Malan, Heath, Bacal, and Balfour's (1975) pioneering empirical work, there has been a growing interest in studying whether psychotherapy improves dynamic conflicts. We examined whether dynamic conflicts and adaptation to conflicts improve following short-term psychotherapy. Twelve patients with acute recurrent major depression were randomized to receive antidepressive medications plus 20 sessions of either cognitive-behavioral or dynamic psychotherapy. The Psychodynamic Conflict Rating Scales (PCRS) assessed conflicts and adaptation to conflicts at intake and 1-year follow-up. The Hamilton and Beck Depression Scales assessed depression, and defenses were rated at intake and at 1 year. Significant change was found on measures of depression. Dynamic conflicts showed significant improvement in levels of adaptation (median/mean effect size ϭ 1.41/.92, 95% confidence interval [CI] [.03, 1.81]). However, change in Overall Pathological Conflict scores was not significant (median/mean effect size ϭ 1.23/.85, 95% CI [Ϫ.28, 1.99]), principally because 1/3 of subjects failed to progress in this time frame. At 1 year, change in Overall Pathological Conflict scores correlated with self-report (r s ϭ Ϫ.72, 95% CI [Ϫ94, .01]) but not observer-rated depression. At 1 year, PCRS Conflict scores were correlated with defensive functioning (r s ϭ .77, 95% CI [Ϫ.95, Ϫ.10]). Short-term psychotherapy was associated with improvement in depression and adaptation to conflict, but there was more heterogeneity in improvement in conflict pathology. The PCRS showed convergent validity with defensive functioning. Longer term therapies and follow-up may be required to develop dynamic recovery and resistance to recurrences of major depression.

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“…Several psychoanalytic and cognitive theorists have proposed that the risk of psychopathology in adulthood may have roots in adverse childhood experiences (Beck, 1976; Arieti and Bemporad, 1980; Brewin, 1989; Safran, 1990; Blatt and Homann, 1992). The “stress diathesis” model proposes that if genetic dispositions and stress from life experiences exceed a certain threshold, mental disorders are likely to develop (Brietzke et al, 2012).…”

Section: Background and Theoretical Considerationsmentioning

confidence: 99%

Differential Recall Bias, Intermediate Confounding, and Mediation Analysis in Life Course Epidemiology: An Analytic Framework with Empirical Example

2016

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The mechanisms by which childhood socioeconomic status (CSES) affects adult mental health, general health, and well-being are not clear. Moreover, the analytical assumptions employed when assessing mediation in social and psychiatric epidemiology are rarely explained. The aim of this paper was to explain the intermediate confounding assumption, and to quantify differential recall bias in the association between CSES, childhood abuse, and mental health (SCL-10), general health (EQ-5D), and subjective well-being (SWLS). Furthermore, we assessed the mediating role of psychological and physical abuse in the association between CSES and mental health, general health, and well-being; and the influence of differential recall bias in the estimation of total effects, direct effects, and proportion of mediated effects. The assumptions employed when assessing mediation are explained with reference to a causal diagram. Poisson regression models (relative risk, RR and 99% CIs) were used to assess the association between CSES and psychological and physical abuse in childhood. Mediation analysis (difference method) was used to assess the indirect effect of CSES (through psychological and physical abuse in childhood) on mental health, general health, and well-being. Exposure (CSES) was measured at two time points. Mediation was assessed with both cross-sectional and longitudinal data. Psychological abuse and physical abuse mediated the association between CSES and adult mental health, general health, and well-being (6–16% among men and 7–14% among women, p < 0.001). The results suggest that up to 27% of the association between CSES and childhood abuse, 23% of the association between childhood abuse, and adult mental health, general health, and well-being, and 44% of the association between CSES and adult mental health, general health, and well-being is driven by differential recall bias. Assessing mediation with cross-sectional data (exposure, mediator, and outcome measured at the same time) showed that the total effects and direct effects were vastly overestimated (biased upwards). Consequently, the proportion of mediated effects were underestimated (biased downwards). If there is a true (unobserved) direct or indirect effect, and the direction of the differential recall bias is predictable, then the results of cross-sectional analyses should be discussed in light of that.

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The psychological organization of depression

Cited by 271 publications

References 10 publications

Sex Differences in the Pathways to Major Depression: A Study of Opposite-Sex Twin Pairs

Sex Differences in the Pathways to Major Depression: A Study of Opposite-Sex Twin Pairs

Dynamic conflicts in recurrent major depression: Does combined short-term psychotherapy and antidepressive medication lead to healthy dynamic functioning?

Differential Recall Bias, Intermediate Confounding, and Mediation Analysis in Life Course Epidemiology: An Analytic Framework with Empirical Example

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