“Perrotta Affective Dependence Questionnaire (PAD-Q)”: Psychodiagnostic evidence and clinical profiles

Purpose: Starting from the concept of “affective dependence” and its international nosographic framework, the Perrotta Affective Dependence Questionnaire (PAD-Q) aims to study the phenomenon of “affective dependence”, defining it as a maladaptive model of the affective-sentimental relationship of a couple, which involves the establishment or persistence of a clinically significant bond, lasting at least six months and characterized by a functional impairment of the relational area, the emotional area and the somatic area. Affective addiction, not being a well-identified psychopathological label in the international nosographic framework, except in the general framework of behavioral addictions, in this context is identified as a maladaptive behavioral model that describes a series of personality traits afferent to several nosographically recognized psychopathological disorders [1].

Methods: Administration of the PICI-1 and PAD-Q. Clinical Interview.

Results: The present research work has demonstrated the reliability, efficiency and effectiveness of the PAD-Q, in relation to the objectives and the PICI-1. In particular, it facilitated a better diagnostic framing of current affective behavioral addiction, thus allowing to focus attention on the dysfunctional traits of patients and on the correct psychodiagnostic framing and their eventual clinical treatment.

Conclusions: The results of the PICI-1 on the selected population sample is perfectly compatible with the results of the PAD-Q, underlining also the trend according to which the higher the age of the population sample the higher the diagnosis of cluster B disorders, up to the highest psychotic percentage in the most mature age group. The same trend is visible in the PAD-Q data, which confirms the greater presence of dysfunctional traits in cluster B disorders.

Contents of the manuscript

Research objectives and methods

The present research is aimed at detecting the psychodiagnostic evidence of the “Perrotta Affective Dependence Questionnaire” (PAD-Q) [1], in the light of the conclusions found in the drafting of PICI-1 [2-5]. With 35 items, on a 0-5 scale, PAD-Q aims to study the phenomenon of “affective dependence”, defining it instead as a maladaptive model of the affective-sentimental relationship of a couple, which involves the establishment or persistence of a clinically significant bond, lasting at least six months and characterized by a functional impairment of the relational area, the emotional area and the somatic area.

This research has been structured according to the following phases:

1) “Clinical interview” on the basis of a previous certified psychopathological diagnosis, to ascertain the persistence of the symptomatology suffered.

2) Marking of the answers, by the examiner, of the clinical questionnaire “PICI-1” on the basis of the symptoms declared during the clinical interview.

3) Processing of the result after the completion of the second point.

4) Administration of the “PAD-Q”.

5) Processing of the result after the completion of the fourth point.

6) Comparison between the results of the “PAD-Q” and the “PICI-1”.

Introduction and background

Generally, when we indicate alterations in the emotional-affective tone we refer to a whole series of morbid conditions, which have a dysfunctional tone as a common basis; just think of anxiety disorders, among which we find panic, phobias, separation anxiety (at the basis of many psychotic and personality disorders) and generalized anxiety, eating disorders, obsessive-compulsive disorder, post-traumatic stress disorders, somatic syndromes, mood disorders (such as depression, dysthymia, cyclothymia, and suicidal risk), behavioral and substance addictions, bipolar disorder, paraphilic disorder and also a large part of personality disorders. And it is precisely in personality disorders that dysfunctional affectivity becomes a real addiction, often confused even by technicians and therapists (and wrongly treated in psychotherapies) as a new “behavioral addiction” (the so-called “love addiction”), according to one’s perception of reality, until it evolves into the largest form: the “personality addiction disorder”. Although affective addiction, due to a lack of experimental data, is not included among the mental disorders diagnosed in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders), it is erroneously classified among the “New Addiction”, new behavioral addictions, including Internet addiction, pathological gambling, sex addiction, sports addiction, compulsive shopping, and work addiction [6].

In clinical practice, we frequently encounter patients who are unable to break off deeply destructive intimate relationships that cause them suffering and compromise their lives on various levels; this condition is classified as “affective dependence” [7-10]. However, this behavioral expression is common to many personality disorders, such as dependent disorder [6], histrionic disorder [11], borderline disorder [12] and narcissistic disorder [13]. Indeed: in the dependent disorder, the main feature is precisely that of the toxic and destructive bond that reinforces one’s personality tendency, as in a vicious circle; in the histrionic disorder, the affective dependence is functional to its tendency to dramatize, to try to capture the impression or attention of others, to continue to feed potentially useful situations to maintain its real or fictitious bond with the third party; in the hypothesis of borderline disorder, affective dependence is necessary to continue to maintain the bond with the person on levels of high instability, favoring first a morbid attachment and then a clear separation, alternating these behaviors in synchrony; finally, in narcissistic disorder, the patient implements modes of affective dependence in the hypothesis of “covert” narcissism, that is, the form that provides low self-esteem and high sensitivity to criticism [14-21].

Starting from the concept of “affective dependence” and its international nosographic framework, the Perrotta Affective Dependence Questionnaire (PAD-Q) aims to study the phenomenon of “affective dependence”, defining it as a maladaptive model of the affective-sentimental relationship of a couple, which involves the establishment or persistence of a clinically significant bond, lasting at least six months and characterized by a functional impairment of the relational area, the emotional area and the somatic area. Affective addiction, not being a well-identified psychopathological label in the international nosographic framework, except in the general framework of behavioral addictions, in this context is identified as a maladaptive behavioral model that describes a series of personality traits afferent to several nosographically recognized psychopathological disorders [1].

Setting and participants

The selected population sample is 688 participants, divided as follows: 70 males and 618 females. All subjects have a certified psychodiagnostic background; however, for reasons of opportunity, it was preferred to learn the previous diagnosis only after the administration and processing of the MMPI-II test results and the PICI-1 clinical interview results, so as not to run the risk of influencing interpretation.

The selected setting, taking into account the protracted pandemic period (already in progress since the beginning of the present research), is the online platform via Skype and Videocall Whatsapp, both for the clinical interview and for the administration.

The present research work was carried out from May 2020 to June 2021 and focused exclusively on the clinical interview for adolescents and adults, as the theoretical differences of the model referring to children does not allow a uniform comparison with the application of MMPI-II.

The selected population sample (688 people) is divided as follows:

Results

Once the population sample had been selected (688 people), which met the required requirements (age between 16 and 65 years, confirmed psychopathological diagnosis, absence of degenerative neurological pathologies and ability to understand and want to participate in the research), the first practical phase of the research was carried out with the execution of the clinical interview, asking the participants to omit any information (at this stage) about the previous psychopathological diagnosis suffered, so as not to induce the writer into any conditioning.

The second and third phases of the research concluded with the initialling and interpretation, in the telematic presence with the interviewed subject, of the PICI-1 clinical interview (TA version).

The fourth and fifth phases of the research concluded with the initialling and interpretation, in the telematic presence with the interviewed subject, of the PAD-Q.

The last phase of the research, the sixth, ended with an informative comparison between the results of the PICI-1TA clinical interview and those of the PAD-Q, noting the following:

Conclusions, limits and possible conflicts of interest

The present research work has demonstrated the reliability, efficiency, and effectiveness of the PAD-Q, in relation to the objectives and the PICI-1. In particular, it facilitated a better diagnostic framing of current affective behavioral addiction, thus allowing to focus attention on the dysfunctional traits of patients and the correct psychodiagnostic framing [22-55] and their possible clinical treatment [56,57]. In fact, the results of the PICI-1 on the selected population sample is perfectly compatible with the results of the PAD-Q, underlining also the trend according to which the higher the age of the population sample the higher the diagnosis of cluster B disorders, up to the highest psychotic percentage in the most mature age group. The same trend is visible in the PAD-Q data, which confirms the greater presence of dysfunctional traits in cluster B disorders. In particular, the dysfunctional totality of the selected population sample is recorded, with the following specifics: if the male group between 16 and 30 years recorded only 6.7% of the total among psychotic disorders with a greater prevalence among neurotic disorders (53.3%), in the relative female group remains more or less unchanged both the psychotic (7%) and neurotic (67%) components, with a slight decrease in percentage in the remaining cluster b disorder; The same is found in the male and female groups between the ages of 31 and 50, although where the prevalence is in cluster B disorders (54.3% and 56.2%), with a slight decrease in the psychotic component (12.3% in the male group and 6.3% in the female group); Extremely different values are recorded in the age group between 51 and 65 years, where in the male group there is an exponential growth of the psychotic component (42%) compared to clusters A and B, while in the female group the psychotic component returns to be more or less at the same level (9.4%), with a significant peak in the disorders of cluster B (54.9%). Again, with respect to PAD-Q values, it clearly emerges that: in the 16-30 age group, both the male and female groups present a higher prevalence of types I and II, over 50% for both cases; in the 31-50 age group, the male group presents a higher prevalence in types IV and V, while in the female group there is a higher prevalence of types II and VI, between 40% and 50% for both cases; in the 51-65 age group, the male group presents a clear prevalence of type VII, while in the female group there is a greater prevalence of types II and VI, between 40% and 50% for both cases, confirming what was obtained from the previous data.

The limits of this research are: PICI-1 is a psychodiagnostic tool used by the therapist to organise psychotherapy aimed at individual needs, as it identifies individual dysfunctional personality traits, even if the diagnosis of DSM-V is based on the presence of specific clinically relevant symptoms; therefore, it is a tool that can be compiled and drafted only by the healthcare professional and not by the patient and only after a clinical interview aimed at diagnosis and therapy (which also includes a meeting with family members and direct subjects).

As PICI-1 and PAD-Q are a free psychodiagnostic tools, this research has no financial backer and does not present any conflicts of interest.

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