A Romantic-Partner Model of Mental Health South, Susan C.
Current directions in psychological science : a journal of the American Psychological Society,
06/2023, Volume:
32, Issue:
3
Journal Article
Peer reviewed
Romantic relationships are ubiquitous among adolescents and adults the world over. More than 90% of adults in the United States will marry at some point, and cohabitation is increasingly common among ...unmarried adults. Intimate relationships are arguably the main way that we fulfill our fundamental need for connection. In the United States and many other countries, for individuals in a committed monogamous romantic relationship, the relationship itself becomes one of the key contexts for mental health. The association between relationship distress and various forms of psychopathology is as strong as many other well-known predictors of mental illness. In this article, I discuss how relationships that become unsatisfying, distressed, or conflicted are a precursor to the experience of mental illness. I also discuss how the romantic relationship may trigger a diathesis for psychopathology. That diathesis may be biological (e.g., genetic) or psychological (e.g., cognitive, emotional).
The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and ...normality, disorder co‐occurrence in the modal case, heterogeneity of presentation within disorders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and “Cluster B” personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self‐assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.
Pathology in Relationships South, Susan C
Annual review of clinical psychology,
05/2021, Volume:
17, Issue:
1
Journal Article
Peer reviewed
Open access
Committed, long-term romantic relationships are ubiquitous among modern society. They are one of the most important contexts for the development, maintenance, and treatment of psychopathology. In ...this review, I first place psychopathology within the most commonly cited theoretical model of marital satisfaction and stability and then discuss how relationship satisfaction is conceptualized and assessed in this literature. In the second half of the review, I describe the theories regarding how romantic relationships may be connected to psychopathology. Relationship distress is easily incorporated into a diathesis-stress model as an important trigger for psychopathology. Next, I review cross-sectional research, longitudinal research, and treatment efficacy research linking relationship quality and psychopathology. I provide evidence for the robustness of these effects and areas where research must expand. I finish with a summary section that synthesizes what is known about the mechanisms linking relationship distress and psychopathology.
The aim of this work was to better understand the role of personality as it relates to psychopathology, with satisfaction as a mediating variable.
Personality is an important determinant of many life ...outcomes including relationship satisfaction and psychopathology. Previous work has demonstrated that broad domains of normal personality have low-to-moderate associations with various forms of psychopathology. Research has primarily focused on mechanisms that might explain how common personality traits put one at risk for common forms of psychopathology; this work builds upon existing work in examining relationship satisfaction as one possible mechanism. No study to date has examined whether relationship satisfaction mediates the connection between personality and psychopathology.
We utilized multilevel modeling in a longitudinal sample of 100 newlywed couples to test the hypothesis that major domains of personality (positive temperament, negative temperament, disinhibition) have a significant effect on relationship satisfaction which, in turn, is significantly associated with internalizing and externalizing forms of psychopathology.
We found no evidence for the mediating role of relationship satisfaction; however, in exploratory analyses, we did find evidence for both between-person and within-person effects of personality on psychopathology.
This study confirms the role of personality as an important factor in consideration of dyadic processes, though not entirely deterministic for downstream functioning. Thus, separate factors in addition to personality may be worth examining in consideration of how low relationship satisfaction may be associated with psychopathology.
Risky sexual behaviors (RSBs) incur large societal and personal costs. Despite widespread prevention efforts, RSBs and associated consequences (e.g., sexually transmitted infections) continue to ...rise. A proliferation of research has emerged on situational (e.g., alcohol use) and individual difference (e.g., impulsivity) factors to explain this rise, but these approaches assume an unrealistically static mechanism underlying RSB. Because this prior research has resulted in few compelling effects, we sought to innovate by examining the interaction of situation and individual differences in explaining RSBs. A large sample (
N
= 105) completed baseline reports of psychopathology and 30 daily diary reports of RSBs and associated contexts. These data were submitted to multilevel models including cross-level interactions to test a person-by-situation conceptualization of RSBs. Results suggested that RSBs are most strongly predicted from interactions of person- and situation-level factors in both protective and facilitative directions. These interactions outnumbered main effects and commonly included partner commitment as a central mechanism. These results point to theoretical and clinical gaps in preventing RSB and urge a departure from prior ways of conceptualizing sexual risk as a static outcome.
Insecure attachment and personality pathology are parallel frameworks for representing interpersonal dysfunction. Although research to date has revealed strong bivariate associations between these ...constructs, the current state of the science is nonspecific and leaves piecemeal guidance for clinical and empirical efforts. The goal of the present study was to determine the magnitude of the associations between attachment and personality pathology across two conceptualizations of maladaptivity and across three waves of time, thereby satisfying repeated calls for empirical innovation in this area. A sample of newlywed heterosexual couples (N = 202 individuals) completed longitudinal assessments of personality pathology and romantic attachment insecurity. Results suggested that the covariation of attachment and personality pathology may be marred by measurement problems related to distress saturation in attachment and personality disorder instruments. Latent curve modeling further suggested that attachment insecurity and personality disorders fluctuate concurrently within persons. Future research should work toward validating unity models of attachment and personality pathology, correcting key measures, and documenting specific mechanisms of association between these constructs.
Lilienfeld and colleagues (this issue) propose that some personality disorders can be conceptualized as emergent interpersonal syndromes (EIS). An EIS elicits negative interpersonal reactions in ...others. Further, an EIS results from statistical interactions between symptom dimensions that are uncorrelated. As a prototypical EIS, psychopathy is an interaction between boldness (or fearlessness) and interpersonal antagonism. The authors marshal many threads of research to develop an intriguing idea that suggests the "whole" of psychopathy is more than the sum of its parts. Unfortunately, the authors focus primarily on psychopathy, and fail to provide convincing quantitative data for the statistical interaction that forms the basis for their theory. Also missing from this model of personality pathology is a consideration of what function boldness serves; viewing boldness as a means to accomplish the (maladaptive) rewarding goals that motivate the individual high in antagonism and disinhibition may serve to flesh out this theory and our conceptualization of personality pathology more broadly.
Objective
Social anhedonia is associated with disinterest in social interactions and poor relationship functioning, yet little is known about the specific mechanisms underlying associations between ...social anhedonia and romantic relationship behaviors and satisfaction. We examined the links between social anhedonia, perceptions of conflict communication patterns, and marital satisfaction.
Method
The current research examined the role of social anhedonia on marital quality and functioning longitudinally across a year in a sample of 100 newlywed couples using an actor‐partner interdependence framework.
Results
Social anhedonia was negatively associated with own and partner's marital satisfaction. It was also negatively associated with constructive communication and positively associated with destructive communication. Furthermore, cross‐sectional mediation analyses showed that communication patterns mediated the social anhedonia‐satisfaction link.
Conclusions
Taken together, these findings suggest that social anhedonia is likely to lead to lower marital satisfaction, partly through its effect on communication between partners.
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between ...psychopathology and normality, frequent disorder co‐occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis‐related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.
There is little research on personality disorder (PD) onset in older age. Many studies have shown that normative personality traits change across the life span, even into later life. This study aimed ...to investigate the onset of PDs in later adulthood (>age 55), and the possible influence of major life events on predicting this late onset. The current analysis was conducted with data from the St. Louis Personality and Aging Network (SPAN). Structured diagnostic interviews were administered three times over five years. Logistic regressions were conducted predicting late onset PD from baseline to FU5 and from FU5 to FU10 as a function of each major life event. 75 PD onsets occurred from baseline to FU5, and 39 PD onsets occurred from FU5 to FU10. Personal illness predicted the onset of PDs from FU5 to FU10.
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