Table of Contents
The Generalized Interpersonal Theory of Personality, Psychopathology, and Psychotherapy
Completion of the Human Genome Project signaled the beginning of a new era in understanding the contributions of genes to human behavior, yet this understanding will never eliminate the importance of environments, for genes invariably work in combination with environments. Interpersonal theorists' great contributions to human enviromics (Anthony, 2001; Anthony, Eaton, & Henderson, 1995; Eaton, 2001; Eaton & Harrison, 1998) are a structural model of the interpersonal domain and an understanding of dyadic interactions.
The Structural Model: Individual Differences and PsychopathologyIn recent years, a consensus has been building on the structure of personality traits. It appears that five broad dimensions--extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience--are necessary to describe personality across many cultures (e.g., Digman, 1990; Goldberg, 1993; McCrae & Costa, 1997; Wiggins, 1996). In addition, recent studies have converged on a common structure of psychological disorders. It appears that two broad dimensions, internalization (feeling bad) and externalization (making others feel bad), are necessary to describe psychopathology in many large-scale epidemiological and treatment-seeking samples in multiple cultures (e.g., Acton, 2003; Acton, Kunz, Wilson, & Hall, 2005; Bienvenu et al., 2004; Burt, Krueger, McGue, & Iacono, 2001, 2003; Cooper, Wood, Orcutt, & Albino, 2003; Hicks, Krueger, Iacono, McGue, & Patrick, 2004; Hudson et al., 2003; Hudson & Pope, 1990; Iacono, Carlson, Malone, & McGue, 2002; Kendler, Neale, Kessler, Heath, & Eaves, 1992a, 1992b; Kendler, Prescott, Myers, & Neale, 2003; Kendler et al., 1995; Krueger, 1999; Krueger, Caspi, Moffitt, & Silva, 1998; Krueger, Chentsova-Dutton, Markon, Goldberg, & Ormel, 2003; Krueger et al., 2002; Krueger & Finger, 2001; Lahey et al., 2004; Nestadt et al., 2001; Vollebergh et al., 2001). In order to provide a framework for understanding these robust findings, the GIPT draws upon several theoretical traditions. Chief among these is the interpersonal theory of personality (e.g., Acton & Revelle, 2002, 2004; Carson, 1969; Kiesler, 1983; Leary, 1957; Wiggins, 1979). The GIPT expands and reformulates key elements of classical interpersonal theory while preserving other important elements.
For example, the GIPT expands the definition of what is considered interpersonal. Formerly, only the traits of extraversion and agreeableness were included in the interpersonal circle (McCrae & Costa, 1989). The GIPT includes a structural model with an extraversion-neuroticism circle (the Generalized Interpersonal Circumplex A, GIPC-A) and an agreeableness-conscientiousness circle (the Generalized Interpersonal Circumplex B, GIPC-B) (Figure 1) (cf. Hofstee, de Raad, & Goldberg, 1992). This structural model comprises a construct map (Wilson, 2005) for the interpersonal domain. Because openness is more cognitive in nature and does not appear to have direct affective consequences (Watson, 2000), because it is the least consistently found cross-culturally of the Big Five (De Raad, Perugini, Hrebickova, & Szarota, 1998; Saucier & Goldberg, 2001), and because it appears to have limited relevance to psychopathology (O'Connor & Dyce, 1998; Widiger, 1993), it is not included in the structural model.
The GIPT proposes that common mental disorders can be conceptualized as extreme manifestations of normal personality dimensions (e.g., Acton, 1998; Acton & Zodda, in press). Because of the influence of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994), psychological disorders are usually conceptualized as categories (but see, e.g., Mirowsky & Ross, 1989, 2002). Nevertheless, dimensional models of personality disorders have increasingly inspired considerable enthusiasm among psychopathology researchers (e.g., Costa & Widiger, 2002; O'Connor & Dyce, 1998; Widiger, 1993; Widiger & Costa, 1994). Only recently, however, have dimensional models of syndromal (Axis I) disorders such as major depression and drug dependence been proposed and tested empirically. Using confirmatory factor analysis and item response theory, researchers have shown that unipolar mood and anxiety disorders form a common dimension of internalization (e.g., Acton et al., 2005; Bienvenu et al., 2004; Hudson et al., 2003; Hudson & Pope, 1990; Kendler et al., 1992a, 1992b; Kendler et al., 1995; Kendler et al., 2003; Krueger, 1999; Krueger et al., 1998; Krueger et al., 2003; Krueger & Finger, 2001; Lahey et al., 2004; Nestadt et al., 2001; Vollebergh et al., 2001) and that antisocial behavior, substance use disorders, and impulsivity/disinhibition form a common dimension of externalization (e.g., Acton, 2003; Burt et al., 2001, 2003; Cooper et al., 2003; Hicks et al., 2004; Iacono et al., 2002; Kendler et al., 2003; Krueger, 1999; Krueger et al., 1998; Krueger et al., 2002; Krueger et al., 2003; Lahey et al., 2004; Vollebergh et al., 2001) (cf. Table 1).
Research on internalizing and externalizing disorders is important (a) because it shows what the most important dimensions of psychopathology might be, and (b) because it is consistent across many diverse large-scale data sets. What it does not show, however, is that these disorders are in fact dimensional--because factor analysis and item response theory will always find dimensions, and thus it is trivially true that internalization and externalization are descriptive dimensions. To examine the next step in this research program requires a conceptual and psychometric framework in which both dimension-likeness and category-likeness are possible and can be tested empirically. The dimension/category framework (Dimcat) (De Boeck, Wilson, & Acton, 2005) is such a framework. Dimcat specifies a method by which manifest categories, such as a diagnosis of major depression versus its complement (another diagnosis or the absence of a diagnosis), can be shown to be dimensional or categorical with respect to an underlying descriptive dimension, such as internalization.
The first distinction in Dimcat is among levels of within-category homogeneity on the indicators as measured by Cronbach's alpha. A population that was maximally heterogeneous on the risk-factors for a disorder would warrant a universal preventive intervention, a population that was moderately homogeneous would warrant a selective preventive intervention, a population that was highly homogeneous would warrant an indicated preventive intervention, and a population that was maximally homogeneous would warrant an evidence-based treatment (cf. Mrazek & Haggerty, 1994).
The second distinction in Dimcat is between between-category qualitative versus quantitative differences on the indicators as measured by differential item functioning (DIF). It has been suggested that the boundary demarcating mental disorder is fuzzy (e.g., Lilienfeld & Marino, 1995) and expanding (e.g., Blashfield & Fuller, 1996). Although part of the discussion has centered on professional and economic issues, the basic question--is mental illness qualitatively distinct from mental health?--is both empirical and tractable using Dimcat, assuming merely that fallible indicators of this distinction can be identified, along with groups representing the mentally ill and healthy.
A longitudinal perspective on this question concerns premorbid risk-factors for a given disorder: Is there a qualitatively distinct type of individual who is particularly at risk? If so, then preventive interventions should focus on all and only individuals of that type. Here, as elsewhere, the categories chosen are everything. In a cohort study of adolescents in the community, for example, an eventual DSM-IV diagnosis of nicotine dependence may differ on the risk-factors (e.g., impulsivity items) at baseline only quantitatively (e.g., Acton, 2003), but more socially potent categories (e.g., peer group, social roles) at baseline may indeed be qualitatively distinct. Later, a diagnosis may become qualitatively distinct as it begins to exert a social influence all its own (e.g., Link, Cullen, Struening, Shrout, & Dohrenwend, 1989; Scheff, 1999) in the manner of a self-fulfilling prophesy, wherein the diagnostic label becomes a social role that evokes certain types of responses from others and may even be used for manipulation (Buss, 1987). Goffman (1961, 1963) was one of the first to describe the process of association between deviance and stigma, which Castro and Farmer (2005) included under the rubric structural violence. Hypotheses concerning the processes of forming qualitatively distinct categories could be tested through a conception-to-death cohort study (Eaton, 2002).
The Dynamic Model: Personality Processes and PsychotherapyThe strongest aspect of classical interpersonal theory is its specification of patterns of dyadic interactions. An unpublished meta-analysis indicated that state-level specifications of dyadic interactions as sequences of behaviors had large effect sizes, much more so than trait-level specifications of dyadic interactions as global or summative ratings. According to the most common model for interpersonal complementarity (e.g., Carson, 1969; Kiesler, 1983; Markey, Funder, & Ozer, 2003) when understood in relation to the five-factor model (McCrae & Costa, 1989), agreeable behaviors probabilistically cause extraverted behaviors in others, and vice versa, whereas disagreeable behaviors probabilistically cause introverted behaviors in others, and vice versa.
In the dynamic model of the GIPT, the classical interpersonal principle of complementarity is preserved, expanded, and reformulated. In Figure 1, complementary traits are located at similar positions on each circle. For example, the complement of low conscientiousness is high neuroticism--that is, non-conscientious behavior (e.g., not completing one's duties in a timely manner) causes others to feel distress. In contrast to complementarity, anticomplementarity, or the antidote, can be defined as the opposite of the complement. An anticomplementary response is the treatment for an unwanted trait. For example, high conscientiousness is the antidote for high neuroticism. To help reduce the expression of the unwanted trait of high neuroticism, people in the social environment--friends, family, even strangers--would need to act in a highly conscientious manner, being very careful of their words and actions, walking on eggshells, so to speak.
Lewin's (1936) classic formulation assumed that Behavior = f(Person, Environment); the present model, by contrast, is explicitly probabilistic: Pr(Behavior) = f(Person, Environment). Rasch (1960), best known for his one-parameter logistic model, formulated a family of Rasch models such that Pr(X = 1) = f(q + b) (see also Mellenbergh, 1994). In this model, X = 1 can be understood as a target individual's exhibiting a particular state (i.e., behavior or affect), q can be understood as the target's own corresponding trait, and b can be understood as a partner's complementary state.
This model can be used to test all of the competing formulations of interpersonal complementarity (e.g., Carson, 1969; Myllyniemi, 1997; Strong et al., 1988; Wiggins, 1979), including Acton and Zodda's (in press) generalized interpersonal principle of complementarity. First, a pool of unidimensional items measuring the states of a generalized partner must be calibrated. Second, the target individual's level on the complementary trait must be measured. Third, the target and partner must be observed over time in an experience-sampling study, cohort study, or clinical trial. Fourth, the correlations among the target's actually exhibited states over time can be tested for circumplex structure (e.g., Acton & Revelle, 2002, 2004). In epidemiolgic terms, complementarity is a model for incidence or initiating a new behavior, and circumplex structure is a model interrelating the prevalences of different behaviors over a given time (Eaton, 1975; see also Moskowitz & Zuroff, 2004). In addition to the circumplex, a competing model for the structure of behavior is a hierarchial model (Markon, Krueger, & Watson, 2005). The relative fit of these structures can be tested using randomization tests of hypothesized order relations (Hubert & Arabie, 1987; see also Tracey & Rounds, 1993), but the principle of complementarity as formulated here does not depend on one structure fitting better than the other.
This model can be expanded to include anticomplementary social roles, in which the target's exhibited state departs from complementarity owing to rigidity (including role disputes, role transitions, and therapeutic noncompliance with a patient's problematic states) (e.g., Eagly & Karau, 2002; Weissman, Markowitz, & Klerman, 2000) or residual deviance for which no term exists (including interpersonal skills deficits and bizarre noncomformity) (e.g., Cannon, 1942; Estroff, Lachicotte, & Illingworth, 1991; Link, Cullen, Struening, Shrout, & Dohrenwend, 1989; Scheff, 1999; Weissman et al., 2000). Rigidity can be described as being firm and unyielding in the face of the interpersonal situation, whereas residual deviance can be described as acting out a social role that is utterly out of context. Rigidity can be modeled as uniform DIF: Pr(X = 1) = f(q + b + z), where z is the effect of the anticomplementary role. Residual deviance can be modeled as nonuniform DIF: Pr(X = 1) = f(q + b + z + z*q) (cf. Mellenbergh, 1994).
This model can be expanded still further by regressing q and b onto their causes (De Boeck & Wilson, 2004; Rijmen, Tuerlinckx, De Boeck, & Kuppens, 2003). For example, interdependence theory models the causes of a partner's state as a function of the partner's outcome expectancies relative to the target's, based on which Kelley et al. (2003) constructed an entire atlas of interpersonal situations. Similarly, a target's personality trait is likely caused by a number of fixed (genome and intrafamilial environment) and latent (peer group) effects (e.g., Harris, 1995).
The dynamic model provides a framework for understanding how psychopathology can be relieved. Warmth and empathy plus consistency and setting limits may be among the nonspecific elements--reflecting agreeable and conscientious behavior, respectively--that provide new interpersonal experiences that Linehan (1993) identified as the dialectic between acceptance and change. These new interpersonal experiences may be chief ingredients that make most forms of psychotherapy substantially and about equally effective (e.g., Frank & Frank, 1991; Strupp & Hadley, 1979; Wampold, 2001; Wampold et al., 1997). In some cases, relationship-focused psychotherapy, for example, precipitates sudden relief of depressive symptoms (Tang, Luborsky, & Andrusyna, 2002). One form of psychotherapy with demonstrated efficacy for internalizing disorders—namely, interpersonal psychotherapy—was developed as a manualized form of nonspecific elements (Weissman et al., 2000). The efficacy of interpersonal psychotherapy proved so robust that it relieved depressive symptoms and improved functioning even when delivered after 2-weeks' training by indiginous, nonprofessional residents of rural Uganda (Bolton et al., 2003). Indeed, interventions that improve interpersonal relationships may immunize the population against onset of mental disorders (Mrazek & Haggerty, 1994) and physical disorders such as HIV (Castro & Farmer, 2005; Peace Corps, 2001).
The dynamic model provides a framework for understanding how psychopathology can be relieved. Warmth and empathy plus consistency and setting limits may be among the nonspecific elements--reflecting agreeable and conscientious behavior, respectively--that provide new interpersonal experiences that Linehan (1993) identified as the dialectic between acceptance and change. These new interpersonal experiences may be chief ingredients that make most forms of psychotherapy substantially and about equally effective (e.g., Frank & Frank, 1991; Strupp & Hadley, 1979; Wampold, 2001; Wampold et al., 1997). In some cases, relationship-focused psychotherapy, for example, precipitates sudden relief of depressive symptoms (Tang, Luborsky, & Andrusyna, 2002). One form of psychotherapy with demonstrated efficacy for internalizing disorders--namely, interpersonal psychotherapy--was developed as a manualized form of nonspecific elements (Weissman et al., 2000). The efficacy of interpersonal psychotherapy proved so robust that it relieved depressive symptoms and improved functioning even when delivered after 2-weeks' training by indiginous, nonprofessional residents of rural Uganda (Bolton et al., 2003). Indeed, interventions that improve interpersonal relationships may immunize the population against onset of mental disorders (cf. Mrazek & Haggerty, 1994).
The dynamic model also provides a framework for understanding how psychopathology is perpetuated. Depression and anxiety (internalizing disorders) tend to elicit rejection (externalizing behavior) (e.g., Coyne, 1976a, 1976b; Joiner & Coyne, 1999; Nolan, Flynn, & Garber, 2003; Pineles, Mineka, & Nolan, 2004), and maternal depression predicts childhood externalizing behaviors (Akse, Hale, Engles, Raaijmakers, & Meeus, 2004; Kim-Cohen, Moffitt, Taylor, Pawlby, & Caspi, 2005; Nelson, Hammen, Brennan, & Ullman, 2003). Moreover, expressed emotion (criticalness, hostility, or emotional overinvolvement--all externalizing behaviors) in family or friends is associated with relapse in mood disorders and eating disorders (internalizing disorders) (e.g., Butzlaff & Hooley, 1998; Hooley, 1986; Hooley, Orley, & Teasdale, 1986; Hooley & Teasdale, 1989) and with social phobia (an internalizing disorder) (Lieb et al., 2000). These lines of research are consistent with the contention that internalization is the complement of externalization.
Overall, the GIPT generalizes classical interpersonal theory by including two additional traits from the Big Five personality dimensions, and it provides a method for testing whether common mental disorders are extreme manifestations of these personality dimensions. It also provides a framework for predicting affect and behavior in interpersonal interactions based on the same predisposing personality dimensions, and this framework explains why psychopathology persists and how it can be relieved.
Table 1. Theorists Table
Feeling Bad Feeling Good Making Others Feel Bad Making Others Feel Good Elliot & Thrash (2002) Low Approach Temperament High Approach Temperament Elliot & Thrash (2002) High Avoidance Temperament Low Avoidance Temperament Watson et al. (1999) Low PA High PA Watson et al. (1999) High NA Low NA McCrae & Costa (1997) Low Extraversion High Extraversion Low Agreeableness High Agreeableness McCrae & Costa (1997) High Neuroticism Low Neuroticism Low Conscientiousness High Conscientiousness Hofstee et al. (1992) I- I- (Shyness) I+ I+ (Gregariousness) II- II- (Unsympatheticness) II+ II+ (Understanding) Hofstee et al. (1992) I- IV- (Lack of Poise) I+ IV+ (Poise) II- III- (Immorality) II+ III+ (Morality) Hofstee et al. (1992) IV- I- (Unhappiness) IV+ I+ (Happiness) III- II- (Unreliability) III+ II+ (Dutifulness) Hofstee et al. (1992) IV- IV- (Instability) IV+ IV+ (Stability) III- III- (Unconscientiousness) III+ III+ (Conscientiousness) Eysenck (1992) High Psychoticism Low Psychoticism Eysenck & Eysenck (1985) Low Extraversion High Extraversion Eysenck & Eysenck (1985) High Neuroticism Low Neuroticism Wiggins (1991) Low Agency High Agency Low Communion High Communion Bartholomew & Horowitz (1991) High Dependence / Negative Model of Self Low Dependence / Positive Model of Self High Avoidance / Negative Model of Other Low Avoidance / Positive Model of Other Scheff (1990) Shame Pride Rage Deference Spielberger et al. (1988) High Anger-In Low Anger-In High Anger-Out Low Anger-Out Caspi et al. (1987, 1988) High Shyness Low Shyness High Explosiveness Low Explosiveness Cloninger (1987) High Harm Avoidance Low Harm Avoidance High Novelty Seeking Low Novelty Seeking McAdams (1985) Low Power Motivation High Power Motivation Low Intimacy Motivation High Intimacy Motivation Beck (1983) High Sociotropy Low Sociotropy Low Sociotropy High Sociotropy Beck (1983) High Autonomy Low Autonomy High Autonomy Low Autonomy Gray (1982) High Anxiety / High Behavioral Inhibition Low Anxiety / Low Behavioral Inhibition Hogan (1982) Low Achieving Status High Achieving Status Low Maintaining Popularity High Maintaining Popularity Blatt et al. (1976) High Dependency Low Dependency Low Dependency High Dependency Blatt et al. (1976) High Self-Criticism Low Self-Criticism High Self-Criticism Low Self-Criticism Bem (1974) Low Masculinity High Masculinity Low Femininity High Femininity Skinner (1971) Low Socialization High Socialization Maslow (1962) Low Self-Actualization High Self-Actualization Rogers (1961) Low Personal Growth High Personal Growth Leary (1957) Low Dominance High Dominance Low Love High Love Sullivan (1953) Low Need for Power High Need for Power Low Need for Tenderness High Need for Tenderness Erickson (1950) Low Autonomy High Autonomy Low Basic Trust High Basic Trust Horney (1945) High Moving Away Low Moving Away High Moving Against Low Moving Against Rank (1945) Low Individualization High Individualization Low Union High Union Fromm (1941) Low Separate Identity High Separate Identity Low Oneness With World High Oneness With World Adler (1939) Low Superiority Striving High Superiority Striving Low Social Interest High Social Interest Freud (1930) Problems With Work Able to Work Problems With Love Able to Love Durkheim (1897/1951) High Anomie Low Anomie Low Integration High Integration Darwin (1872) High Shame Low Shame Bienvenu et al. (2004) Major Depressive Disorder Bienvenu et al. (2004) Dysthymia Bienvenu et al. (2004) Generalized Anxiety Disorder Bienvenu et al. (2004) Obsessive-Compulsive Disorder Bienvenu et al. (2004) Panic Disorder Bienvenu et al. (2004) Agoraphobia Bienvenu et al. (2004) Social Phobia Bienvenu et al. (2004) Simple Phobia Lahey et al. (2004) Depression Conduct Disorder Lahey et al. (2004) Overanxious Disorder Lahey et al. (2004) Social Anxiety Lahey et al. (2004) Separation Anxiety Disorder Hicks et al. (2004) Conduct Disorder Hicks et al. (2004) Antisocial Personality Disorder Hicks et al. (2004) Alcohol Dependence Hicks et al. (2004) Drug Dependence Cooper et al. (2003) Substance Use Cooper et al. (2003) Delinquency Cooper et al. (2003) Problematic Sexual Behavior Cooper et al. (2003) Educational Underachievement Kendler et al. (2003) Major Depression Alcohol Dependence Kendler et al. (2003) Generalized Anxiety Disorder Other Drug Abuse or Dependence Kendler et al. (2003) Panic Disorder Adult Antisocial Behavior Kendler et al. (2003) Animal Phobia Conduct Disorder Kendler et al. (2003) Situational Phobia Krueger et al. (2003) Depression Hazardous Use of Alcohol Krueger et al. (2003) Anxious Worry Krueger et al. (2003) Anxious Arousal Krueger et al. (2003) Neurasthenia Krueger et al. (2003) Somatization Krueger et al. (2003) Hypochondriasis Burt et al. (2001, 2003) Attention-Deficit Hyperactivity Disorder Burt et al. (2001, 2003) Oppositional Defiant Disorder Burt et al. (2001, 2003) Conduct Disorder Hudson et al. (2003),
Hudson & Pope (1990)
Major Depressive Disorder Hudson et al. (2003),
Hudson & Pope (1990)
Dysthymia Hudson et al. (2003),
Hudson & Pope (1990)
Generalized Anxiety Disorder Hudson et al. (2003),
Hudson & Pope (1990)
Obsessive-Compulsive Disoder Hudson et al. (2003),
Hudson & Pope (1990)
Panic Disorder Hudson et al. (2003),
Hudson & Pope (1990)
Social Phobia Hudson et al. (2003),
Hudson & Pope (1990)
Bulimia Nervosa Hudson et al. (2003),
Hudson & Pope (1990)
Attention-Deficit/Hyperactivity Disoder Hudson et al. (2003),
Hudson & Pope (1990)
Posttraumatic Stress Disorder Hudson et al. (2003),
Hudson & Pope (1990)
Cataplexy Hudson et al. (2003),
Hudson & Pope (1990)
Fibromyalgia Hudson et al. (2003),
Hudson & Pope (1990)
Migraine Hudson et al. (2003),
Hudson & Pope (1990)
Irritable Bowel Syndrome Hudson et al. (2003),
Hudson & Pope (1990)
Premenstrual Dysphoric Disorder Krueger et al. (2002) Alcohol Dependence Krueger et al. (2002) Drug Dependence Krueger et al. (2002) Adolescent Antisocial Behavior Krueger et al. (2002) Conduct Disorder Krueger et al. (2002) Low Constraint High Constraint Vollebergh et al. (2001) Major Depressive Episode Alcohol Dependency Vollebergh et al. (2001) Dysthymia Drug Dependency Vollebergh et al. (2001) Generalized Anxiety Disorder Vollebergh et al. (2001) Social Phobia Vollebergh et al. (2001) Simple Phobia Vollebergh et al. (2001) Agoraphobia Vollebergh et al. (2001) Panic Disorder Krueger (1999) Major Depressive Episode Alcohol Dependence Krueger (1999) Dysthymia Drug Dependence Krueger (1999) Generalized Anxiety Disorder Antisocial Personality Disorder Krueger (1999) Simple Phobia Krueger (1999) Social Phobia Krueger (1999) Agoraphobia Krueger (1999) Panic Disorder Krueger et al. (1998) Major Depressive Episode Alcohol Dependence Krueger et al. (1998) Dysthymia Marijuana Dependence Krueger et al. (1998) Generalized Anxiety Disorder Conduct Disorder Krueger et al. (1998) Agoraphobia Krueger et al. (1998) Social Phobia Krueger et al. (1998) Simple Phobia Krueger et al. (1998) Obsessive-Compulsive Disorder O'Connor & Dyce (1998) Avoidant Personality Disorder Histrionic Personality Disorder Antisocial Personality Disorder Compulsive Personality Disorder O'Connor & Dyce (1998) Dependent Personality Disorder Narcissistic Personality Disorder O'Connor & Dyce (1998) Schizoid Personality Disorder O'Connor & Dyce (1998) Schizotypal Personality Disorder Schizotypal Personality Disorder O'Connor & Dyce (1998) Paranoid Personality Disoder Paranoid Personality Disoder O'Connor & Dyce (1998) Borderline Personality Disorder Borderline Personality Disorder O'Connor & Dyce (1998) Passive-Aggressive Personality Disorder Passive-Aggressive Personality Disorder Kim-Cohen et al. (2005) Maternal Depression Child Antisocial Behavior Nelson et al. (2003) Maternal Depression Child Externalizing Symptoms Lieb et al. (2000) Adolescent Social Phobia Parental Overprotection Lieb et al. (2000) Adolescent Social Phobia Parental Rejection Butzlaff & Hooley (1998) Mood Disoders Expressed Emotion Butzlaff & Hooley (1998) Eating Disorders Expressed Emotion Coyne (1976a, 1976b) Depression Interpersonal Rejection
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