Sociotropy Dependency and Autonomy SelfCriticism

The psychoanalytic theorist Blatt and the cognitive theorist Beck have proposed that highly dependent (Blatt, 1974) or sociotropic (Beck, 1983) individuals have a strong need to develop and maintain close relationships and the approval ofothers, which leaves them vulnerable to depression following interpersonal losses, rejections, or disruptions, and that highly self-critical (Blatt, 1974) or autonomous (Beck, 1983) individuals have a strong need to meet their own high standards and to avoid being controlled by other people or circumstances, which leaves them vulnerable to depression following perceived failure or lack of control. These two dimensions, and their associated beliefs and behavioral strategies, also may be related to particular personality disorders, including BPD (Beck et al., 1990; Blatt & Shichman, 1983). Unlike most personality disorders, BPD may be characterized by both sociotropic/dependent themes (e.g., fears of abandonment) and autonomous/self-critical themes (e.g., fears of being controlled, core sense of badness).

Empirical studies have found that patients with both BPD and MDD or dysthymia, and those with BPD alone scored higher than patients with pure MDD or dysthymia on both dependency and self-criticism (e.g., Westen et al., 1992) or only on self-criticism (Southwick, Yehuda, & Giller, 1995). In other clinical studies, BPD diagnosis and dimensional scores were related to self-criticism and to autonomy but not to dependency or sociotropy (Ouimette, Klein, Anderson, Riso, & Lizardi, 1994), or were related to both (Morse, Robins, & Gittes-Fox, 2002). Collectively, these studies suggest that sociotropy/dependency and autonomy/self-criticism may be important dimensions for understanding BPD, and that some psy-

chodynamic accounts of BPD have overemphasized dependency concerns (e.g., Blatt & Shichman, 1983; Gunderson & Elliott, 1985), whereas concerns with self-worth and autonomy are at least as prominent, if not more so.

BPD may be characterized by ambivalence and conflict between these two sets ofconcerns, leading to dramatic shifts in behavioral strategies, such as between being interpersonally mistrustful or distant and being too trusting or intimate. Alternatively, there may be two different subsets ofindividuals with BPD, with predominantly sociotropic or autonomous concerns. Linehan (1993a) described "attached" patients, who seek closeness and support from the therapist, and "butterfly" patients, who are more distant and likely to drop out or have frequent absences from therapy. Consistent with this, Leihener et al. (2003) reported that, based on a measure of interpersonal problems, inpa-tients with BPD could be divided into two clusters, stable over 4 months, that they labeled "dependent" (73%) and "autonomous" (27%).

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