This study examines the specific kinds of interpersonal problems, including their associations with symptoms and self-image, characteristic of a general psychiatric outpatient population. The interpersonal perspective may offer valuable diagnostic information, and it is regarded as compatible with other theoretical approaches to psychopathology, as it encompass both biological, cognitive-behavioral, and psychodynamic aspects.
The clinical sample used in this study comprises 988 consecutively admitted first admission adult psychiatric outpatients to a clinic that covers a population of 60000 persons. Patients approached were sent a booklet, and asked to fill in a number of self-report instruments (IP-64, SCL-90-R and SASB Introject) before the first consultation at the clinic. The 988 patients that provided the requested data comprised approximately 80 % of the patients approached. Mean age in the sample was 35 years (range from 16 to 77 years). Women comprised 64 %.
Three specific aims were addressed. The first aim was to determine the characteristics of the clinical sample, in terms of interpersonal problems, as compared to a Norwegian normal reference sample. Profile characteristics of eight interpersonal subgroups (octant groups), corresponding to eight different forms of predominant interpersonal problem, were calculated, according to a method known as the structural summary method. This method offers measures of general interpersonal distress, as well as indicators of the specific quality and intensity of such distress. Is the distress, for instance, mainly of an intrusive, vindictive or a non-assertive kind? And how intense are the problems of that kind?
The clinical sample reported considerably more interpersonal problems than the normal reference sample. Among the eight octant groups with differing predominant interpersonal problems, the three most prevalent in the sample (comprising 56.7%), were all characterized by interpersonal submissiveness (low agency). These patients also reported the highest levels of overall interpersonal problems.
Patients with different predominant interpersonal problems have characteristic ways of relating to others, which can be important to identify and address in therapy. Patients with a vindictive interpersonal style might easily evoke countertransference reactions in the form of more or less subtle rejection. On the other hand, patients with a tendency to submit, i.e. the major part of the psychiatric outpatients, represent other therapeutic challenges, and may often result in protracted, stalemate therapies if not acknowledged and addressed,
The second aim was to study hypothesized associations between interpersonal problems and symptoms, assessed with the Symptom Check List-90 (SCL-90-R) in the same clinical sample. In general, strong associations between interpersonal problems and symptoms were found. In addition, we found associations between specific forms of interpersonal problems and specific types of symptoms, e.g. between Vindictiveness and Paranoid Ideation and between Social Inhibition and Phobic Anxiety..
The third aim was to examine, in the same sample, hypothesized associations between interpersonal problems and self-relatedness (SASB Introject). Dividing the self-relatedness variable into Self-Hostile and Self-Accepting components demonstrated that the interpersonal octant groups differed significantly on Self-Acceptance, but not on Self-Hostility. A relatively positive and Self-Accepting self-image appeared to be associated with both cold/domineering and warmer types of interpersonal problems.
In sum, the present study draws attention to the forms and intensity of interpersonal problems in a large psychiatric outpatient sample, and the specific associations between these problems and symptoms and forms of self-relatedness. The findings from these studies may be of significance for diagnostic assessment, treatment planning, and treatment delivery in mental health care.