Stability over time of character assessment using a-psychodynamic instrument and personality inventories Weinryb RM, Gustavsson JP, Asberg M, Rossel RJ. Stability over time of character assessment using a psychodynamic instrument and personality inventories. Acta Psychiatr Scand 1992: 86: 179-184.

1

In a group of patients with a preoperative diagnosis of ulcerative colitis, the stability of character traits and modes of mental functioning were studied after a major life event, major abdominal surgery, using the Karolinska Psychodynamic Profile (KAPP), an interview-based assessment instrument founded upon psychoanalytic theory. In addition, different personality and temperamental variables were assessed with 2 self-report instruments. The patients were assessed before surgery, and follow-up was made at least 1 year after their final scheduled surgery. Although the patients had undergone major abdominal surgery and convalescence between the assessments, the correlations between the scores before and after surgery were very high, and the levels of the scores were very similar. This was true for all the instruments, indicating that they assessed stable characteristics in the patients. The changes that did occur were mainly in the predicted direction. The results of this study suggest that the KAPP can assess modes of mental functioning and character traits that are relatively stable and only slowly variable.

In everyday language, the word character, when attributed to an individual, denotes a constellation of behaviour and attitudes that are typical for the individual and that tend to remain stable over time and to some extent predict his or her future behaviour. Within the psychoanalytic frame of reference the term character is used for such characteristics, whereas researchers within the academic field of psychology (1) use the term personality for a similar concept. These concepts are controversial within both frames of reference (2, 3). In the psychoanalytic literature, the concept of character is more controversial than the concept of character traits, which is more widely accepted (2,4). The two concepts are conceptualized at different levels of abstraction, character traits closely reflecting the data of observations, and character as organization, representing a more abstract level (Baudry, in panel) (2). There is no generally accepted psychoanalytic theory on character as organization. Some authors consider it a useful concept (5), whereas others regard it as superfluous (4,6), owing to its ambiguity and the difficulties in reconciling it with psychoanalytic theory, particularly with the tripartite structural model: ego, id and superego.

1

R. M. Weinryb, J. P. Gustavsson, M. Asberg, R. J. Rossel Departments of Internal Medicine and Psychiatry & Psychology, Karolinska Institute, Stockholm, Sweden

Key words: personality assessment; ulcerative colitis; inventory; longitudinal study; psychodynamic profile; character Robert M. Weinryb, M.D., Department of Internal Medicine, Karolinska Hospital, S- 10401 Stockholm, Sweden

I

Accepted for publication March 27, 1992

Character traits is a shorthand term embracing certain major aspects of an individual’s stable repetitive patterns of functioning and behaviour from the standpoint of an outside observer, and as such they are only partly accessible to introspection and conscious awareness. “They describe generally either ways of relating to people or reacting to situations, or ways of being (attitudes)”. ( 5 , p. 462) Psychoanalysis has in itself a longitudinal approach, both in theory and clinical practice, which makes it suitable for the study of stable modes of mental functioning and character traits and the way they change. In clinical practice this is already done, and reported in the traditional way, such as in case studies. But in contrast to the multitude of instruments developed within academic psychology for assessing personality traits, there are few instruments for assessing psychoanalytically based constructs (7-9). For a review of more recent psychoanalytically based instruments, see Luborsky & CritsCristoph (10). The Karolinska Psychodynamic Profile (KAPP) is a recently constructed interview-based assessment instrument founded upon psychoanalytic theory (1 1- 13). High interrater reliability can be attained 179

Weinryb et al.

with modest training of the raters in the use of the profile (13). The KAPP is intended to enable relatively stable and only slowly variable modes of mental functioning and character traits to be assessed psychodynamically. Advantage was taken of a study of the possible predictive value of character traits for adaptation after major surgery. KAPP ratings were performed prior to and after ileostomy on a group of patients with the preoperative diagnosis of ulcerative colitis. This enabled us to study whether the modes of mental functioning and character traits, as they are conceptualized in the KAPP, are stable after a major life event. It was predicted that the KAPP ratings would be fairly stable, but that the ratings on some subscales would change: subscales that concern sexuality and conceptions of the body. By way of comparison, the stability of some personality traits was also tested with 2 self-report instruments. Material and methods Subjects

The subjects were 37 patients selected from a series of 65 consecutive patients with a preoperative diagnosis of ulcerative colitis who participated in a study of psychological adjustment before and after major abdominal surgery for their gastrointestinal illness. The series has been described elsewhere (12-14). This study comprised the patients who had been assessed prior to the operation and for whom at least 1 year had passed after the last planned operation, that is, they had all undergone surgery between the initial assessment and the follow-up. Of 40 patients scheduled for follow-up, 1 could not be reached and 2 declined further participation. The patient group comprised 23 men and 14 women. At follow-up, the mean age was 41 years (median 42, range 19-63). The mean age of the men was 45 years (mean 43 years, range 30-63) and that of the women 36 years (median 38 years, range 195 1). The mean interval between the initial interview and follow-up was 22 months (median 22 months, range 16-34). The mean interval between the initial psychological testing, when the self-reports were administered, and follow-up was 23 months (median 23 months, range 15-34). Psychodynamic assessment

KAPP (1 1-14) was used for the psychodynamic assessment. For a description of the KAPP, the manual and the subscales, see Weinryb & Rtjssel (11). The profile consists of 18 subscales, which have been chosen with a view to comprehensively assessing modes of mental functioning and character traits, as 180

reflected in the patient’s self-image and relationships with others; 17 of the subscales are on a low level of abstraction and could be considered to represent character traits, whereas the last subscale refers to character as organization. Psychological tests

The Karolinska Scales of Personality (KSP) (1517) is a self-assessment questionnaire designed to measure dimensions of temperament, preferentially those believed to be markers for vulnerability to psychopathology. The KSP have been used in a large number of studies on various clinical groups, diagnostic subgroups and healthy volunteers (15- 19). The constructs are derived from theories of biologically based temperament dimensions underlying vulnerability to various mental disorders (20, 2 1). For a description of the scales, see Schalling et al. (17) The Schalling-Sifneos Personality Scale (SSPS) (22) is a 20-item self-rating inventory and one of the most widely used self-rating inventories for assessing alexithymia. The scale has a four-point Likert format. The scores can range from 20 to 80 (indicating manifest and slight alexithymia, respectively). Scores of 50 or less are taken to indicate alexithymia proper (23). In this study, the scale has been reversed, scores above 50 being taken to indicate alexithymia proper. Procedure

KAPP interviews. One rater (RMW, a specialist in psychiatry and a trained psychoanalyst) conducted all KAPP interviews, both on the initial occasion and at the follow-up. The interviews were audiotaped. In addition, information was collected for ratings on diverse scales (to be reported elsewhere) and for DSM-I11 diagnosis of mental disorder (12, 14). The KAPP was scored immediately after the interview, without listening to the audiotape or using the data collected at the initial interview.

Tests. A clinical psychologist (RJR, also a trained psychoanalyst) made a parallel KAPP assessment of each patient, based on two projective techniques, the Rorschach (24) and the Draw-A-Person Test (DAP) (25). In addition, ratings were made on several scales. Three personality inventories, KSP, SSPS and a newly constructed analogue scale, were also administered. The results of KSP and the SSPS will be reported here. The testing procedure has been described elsewhere (12, 14). The interview and the psychological testing usually took place on different days.

Character assessment - stability over time

(Conceptions of bodily functioning and their significance for self-esteem) and P< 0.05 for subscales 12 (Current body image), 13 (Sexual functioning) and 14 (Sexual satisfaction). For subscale 17 (Access to advice and help), the scores were significantly increased (“less normal”) at P c 0.05.

Statistical methods

As the distributions on all the KAPP subscales are skewed, nonparametric statistical methods were used (26) to analyse the differences between the sets of ratings, as well as the correlation between them, before and after surgery (Wilcoxon signed-rank test and Spearman rank correlation coefficients). Parametric methods were used to analyse the KSP and SSPS data (Student’s t-test and Pearson productmoment correlations). Descriptive statistics (means and standard deviations) were used for describing the levels of the KAPP. the KSP and the SSPS.

Correlations between KAPP scores from the initial and the follow-up interview

The correlations were generally high (Y, = 0.3 1-OM), reaching P

Stability over time of character assessment using a psychodynamic instrument and personality inventories.

In a group of patients with a preoperative diagnosis of ulcerative colitis, the stability of character traits and modes of mental functioning were stu...
562KB Sizes 0 Downloads 0 Views