title: Preparing for DSM 5 - assessment of personality pathology during psychoanalytic and psychiatric treatments.
abstract: BACKGROUND
  Currently, the conceptualization and treatment of personality pathologies are mainly theory driven. The resulting categorical classification of personality disorders leads to inaccurate diagnoses and is therefore being criticized by many researchers and clinicians. A consensus exists that in the upcoming edition of the DSM (DSM 5), the classification of personality disorders should rather adopt a dimensional approach, where patients are assessed depending on their character traits, inner-defense mechanisms, and interpersonal functioning. However, the basis (theoretical or empirical) of this classification-system is still a topic of dispute. This study presents assessment methods based on both theoretical and empirical assumptions.
  
  
  OBJECTIVE
  To determine whether psychodynamic instruments employed in psychoanalytic settings are also useful for measuring changes in personality pathology in psychiatric inpatient settings.
  
  
  METHODS
  Matched pairs between two groups of patients, one receiving outpatient psychoanalytic care (n = 10; mean age 36 ± 11), the other inpatient social-psychiatric treatment (n = 10; mean age 27 ± 6), were created and subsequently analyzed (mean observation period 20 ± 11 days). Patients were assessed using psychodynamic instruments measuring changes in quality of object relations (QORS) and affect regulation and experience (AREQ). To allow conclusions concerning the respective mechanisms of change, the influence of the therapeutic relationship, measured by using instruments evaluating transference (PRQ) and countertransference (CTQ) patterns, was also assessed.
  
  
  RESULTS
  The instruments aforementioned were shown to be suited for both psychoanalytic and psychiatric patients. Typical short-term developments of the distinctive therapeutic procedures were evident; however, in both settings a positive working alliance was shown to be crucial for therapeutic progress.
  
  
  CONCLUSIONS
  The psychodynamic instruments introduced in this study proved to be effective in measuring personality pathology in psychiatric inpatients and in helping clinicians throughout the indication and recommendation process during transition from inpatient to outpatient treatment. Since components of such assessment methods are being considered for DSM 5, their practical utility is shown in this study.
authors.affiliation: Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria. henriette.loeffler-stastka@meduniwien.ac.at
authors.forename: Henriette
authors.initials: H
authors.lastname: Löffler-Stastka
authors.forename: Matthias
authors.initials: M
authors.lastname: Bartenstein
authors.forename: Golda
authors.initials: G
authors.lastname: Schlaff
mesh_terms: D000328:Adult; D000339:Affect; D000553:Ambulatory Care; D001317:Austria; D002605:Character; D003379:Countertransference; D003674:Defense Mechanisms; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006760:Hospitalization; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D009769:Object Attachment; D010552:Personality Assessment / Q000706:statistics & numerical data*; D010554:Personality Disorders / Q000145:classification* / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011575:Psychoanalytic Therapy; D011594:Psychometrics / Q000706:statistics & numerical data; D011779:Q-Sort / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D014167:Transference, Psychology; D055815:Young Adult