Mullen L S, Blanco C, Vaughan S C, Vaughan R, Roose S P
Department of Psychiatry, College of Physicians & Surgeons, New York, New York, USA.
Depress Anxiety. 1999;10(4):168-74. doi: 10.1002/(sici)1520-6394(1999)10:4<168::aid-da5>3.0.co;2-5.
There is a longstanding belief that personality represents a structure that is stable over time, and changes, if at all, very slowly. Nonetheless, clinical and empirical evidence suggests that in patients with some Axis I disorders, the rate of personality disorders using DSM criteria decreases after treatment, suggesting that personality as assessed by phenomenological systems is state-dependent. An alternative to the DSM phenomenological system of conceptualizing personality is the dynamic concept of character, that is, a predictable pattern of both adaptive and pathological defense mechanisms, and personality organization comprised of object relations, ego strengths, and superego development. Data from this study address the hypothesis that defense mechanisms and personality organization remain relatively stable in patients treated for Axis I disorders, irrespective of clinical improvement. Patients meeting DSM-IV criteria for major depressive disorder (MDD) entered randomized, controlled medication trials. Defensive functioning was evaluated with the Defense Style Questionnaire (DSQ) [Bond et al., 1983: Arch Gen Psychiatry 40:333-338], and personality organization was assessed with the Inventory of Personality Organization (IPO; Clarkin et al., unpublished), both at baseline and at the completion of the clinical trial. Data were analyzed for whether an individual's pattern of defense mechanisms and personality organization were stable over time regardless of response to treatment of MDD. The question was also asked whether a predominant pattern of defense mechanisms or level of personality organization predicts response to treatment or dropout rate. Among treatment responders, nonresponders and drop-outs, baseline DSQ scores were similar except for "image-distorting" defenses, which were significantly more prevalent among drop-outs compared to responders (P = .016). Post-treatment DSQ values revealed a significant decrease in "maladaptive" defenses (P = .01) in the entire sample, while intermediate and "adaptive" defenses remained unchanged. This same pattern was found to hold true in treatment responders. When comparing treatment responders and nonresponders at the end of the trial, medication responders used significantly less "maladaptive" defenses than did nonresponders (P = .003), and had a significantly higher, or healthier level of "overall defensive functioning" (P = .04). Baseline and post-treatment IPO values did not show significant differences. Results of the study address the question of whether there are personality characteristics that are enduring and that can be appreciated irrespective of an Axis I disorder.
长期以来，人们一直认为人格代表着一种随时间推移而稳定的结构，即便有变化，也是非常缓慢的。然而，临床和实证证据表明，在一些患有轴I障碍的患者中，使用《精神疾病诊断与统计手册》（DSM）标准诊断的人格障碍发生率在治疗后会降低，这表明现象学系统所评估的人格是依赖于状态的。DSM用于概念化人格的现象学系统的一种替代方案是性格的动态概念，即由适应性和病理性防御机制组成的可预测模式，以及由客体关系、自我力量和超我发展构成的人格组织。本研究的数据探讨了这样一个假设：对于接受轴I障碍治疗的患者，无论临床症状是否改善，防御机制和人格组织都保持相对稳定。符合DSM-IV重度抑郁症（MDD）标准的患者进入随机对照药物试验。在基线和临床试验结束时，分别使用防御方式问卷（DSQ）[邦德等人，1983年：《美国精神病学杂志》40:333 - 338]评估防御功能，使用人格组织量表（IPO；克拉克因等人，未发表）评估人格组织。分析数据以确定个体的防御机制和人格组织模式是否随时间稳定，而不考虑对MDD治疗的反应。还提出了一个问题，即防御机制的主要模式或人格组织水平是否能预测治疗反应或脱落率。在治疗有反应者、无反应者和脱落者中，除了“形象扭曲”防御外，基线DSQ评分相似，与有反应者相比，“形象扭曲”防御在脱落者中更为普遍（P = 0.016）。治疗后DSQ值显示，整个样本中“适应不良”防御显著减少（P = 0.01），而中间型和“适应性”防御保持不变。在治疗有反应者中也发现了同样的模式。在试验结束时比较治疗有反应者和无反应者，药物治疗有反应者使用的“适应不良”防御明显少于无反应者（P = 0.003），且“总体防御功能”水平显著更高，或更健康（P = 0.04）。基线和治疗后IPO值没有显示出显著差异。该研究结果探讨了是否存在无论轴I障碍如何都持久且可识别的人格特征这一问题。
