Extending Blatt’s two-polarity model of personality development to dissociative identity disorder: a theory-building case study


In this theory-building case study, we investigate Blatt’s two-polarity model of personality development according to which psychopathology is a consequence of an unbalance between the two developmental lines of interpersonal relatedness and self-definition. Anaclitic psychopathology, such as schizophrenia, histrionic, dependent, and borderline personality disorders, is associated with an excessive and rigid emphasis on interpersonal relatedness. In this theory-building case study, we examine whether this model can be extended to dissociative identity disorder (DID). The patient is a 23-year old Caucasian man who suffers from periodic episodes of dissociation. Consensual qualitative research for case studies is used to quantitatively and qualitatively describe the interplay between symptomatic and interpersonal evolutions throughout 41 sessions of supportive-expressive psychoanalytic psychotherapy. In line with the two-polarity model of personality development, close associations between symptoms of dissociation and dependent interpersonal dynamics were observed. Psychoanalytic interventions focusing on elaboration of the subjective meanings of (past and anticipated) dissociations, and on working through core interpersonal conflicts, are followed by transformations in the patient’s interpersonal stances and subjective well-being. No new dissociative episodes were reported during the follow-up assessment three and a half years after the completion of treatment. This case study demonstrates that DID is a form of anaclitic psychopathology as it is associated with a predominant tendency to interpersonal relatedness.



PlumX Metrics


Download data is not yet available.


American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. Washington, DC: American Psychiatric Association.

Blatt, S. J. (2008). Polarities of experience: Relatedness and self-definition in personality development, psychopathology, and the therapeutic process. Washington, DC: American Psychological Association.

Blatt, S. J., Shahar, G., & Zuroff, D. C. (2001). Anaclitic (sociotropic) and introjective (autonomous) dimensions. Psychotherapy Theory Research & Practice, 38(4), 449-454. http://dx.doi.org/10.1037/0033-3204.38.4.449

Blatt, S. J., & Zuroff, D. C. (1992). Interpersonal relatedness and self-definition: Two prototypes for depression. Clinical Psychology Review, 12(5), 527-562. https://doi.org/10.1016/0272-7358(92)90070-O

Brown, G. S., Simon, A., Cameron, J., & Minami, T. (2015). A collaborative outcome resource network (ACORN): tools for increasing the value of psychotherapy. Psychotherapy, 52(4), 412-421. https://doi.org/10.1037/pst0000033

Cornelis, S., Desmet, M., Meganck, R., Cauwe, J., Inslegers, R., Willemsen, J., Van Nieuwenhove, K., Vanheule, S., Feyaerts, J., & Vandenbergen, J. (2017a). Interactions between obsessional symptoms and interpersonal dynamics: An empirical single case study. Psychoanalytic Psychology, 34(4), 446-460. https://doi.org/10.1037/pap0000078

Cornelis, S., Desmet, M., Van Nieuwenhove, K., Meganck, R., Willemsen, J., Inslegers, R., & Feyaerts, J. (2017b). Interactions between obsessional symptoms and interpersonal ambivalences in psychodynamic therapy: An empirical single case study. Frontiers in Psychology, 8, 960. https://doi.org/10.3389/fpsyg.2017.00960

Dattilio, F. M., Edwards, D. J., & Fishman, D. B. (2010). Case studies within a mixed methods paradigm: toward a resolution of the alienation between researcher and practitioner in psychotherapy research. Psychotherapy, 47(4), 427-441. https://doi.org/10.1037/a0021181

Derogatis, L. R. (1994). SCL-90-R: Administration, scoring and procedures manual (3rd ed.). Minneapolis, MN: National Computer Systems.

Derogatis, L. R., Lipman, R. S., & Covi, L. (1973). The SCL-90: An outpatient psychiatric rating scale-Preliminary report. Psychopharmacology Bulletin, 9(1), 13-28.

Desmet, M. (2018). The pursuit of objectivity in psychology. Ghent: Owl Press.

Desmet, M., Meganck, R., & Vanheule, S. (2013). Hysterical and obsessive-compulsive symptom patterns: Are they associated with anaclitic and introjective interpersonal profiles? Journal of the American Psychoanalytic Association, 61(6), 1-7. https://doi.org/10.1177/0003065113516363

Elliott, R. (1999). Client Change Interview protocol (CSEP, 9/99). Retrieved from: http://experiential-researchers.org/instruments/elliott/changei.html

Elliott, R., Slatick, E., & Urman, M. (2001). Qualitative change process research on psychotherapy: alternative strategies. In J. Frommer & D.L. Rennie (Eds.), Qualitative psychotherapy research: Methods and methodology (pp. 69-111). Lengerich, Germany: Pabst Science.

Grenyer, F. S., & Luborsky, L. (1996). Dynamic change in psychotherapy: mastery of interpersonal conflicts. Journal of Consulting and Clinical Psychology, 64(2), 411-416. https://doi.org/10.1037/0022-006X.64.2.411

Hill, C. E. (Ed.) (2012). Consensual qualitative research: A practical resource for investigating social science phenomena. Washington DC: American Psychological Association.

Horowitz, L., Alden, L., Wiggins, J., & Pincus, A. (2000). Inventory of interpersonal problems. San Antonio, TX: The Psychological Corporation.

Jackson, J. L., Chui, H. T., & Hill, C. E. (2011). The modification of consensual qualitative research for case study research: An introduction to CQR-C. In C. E. Hill (Ed.), Consensual qualitative research. A practical resource for investigating social science phenomena (pp. 820-844). Washington, DC: American Psychological Association.

Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12-19. http://dx.doi.org/10.1037/0022-006X.59.1.12

Kaluzeviciute, G., & Willemsen, J. (2020). Scientific thinking styles: The different ways of thinking in psychoanalytic case studies. The International Journal of Psychoanalysis, 101(5), 900-922. https://doi.org/10.1080/00207578.2020.1796491

Kirschbaum, C., Bartussek, D., & Strasburger, C. J. (1992). Cortisol responses to psychological stress and correlations with personality-traits. Personality and Individual Differences, 13(12), 1353-1357. https://doi.org/10.1016/0191-8869(92)90181-N

Koeter, M. W. J., & Ormel, J. (1991). General Health Questionnaire, Nederlandse bewerking: Handleiding. Lisse: Swets, Test Services.

Luborsky, L. (1984) Principles of psychoanalytic psychotherapy: A manual for supportive-expressive treatment. USA: Basic Books.

Luborsky, L., & Crits-Cristoph, P. (1998). Understanding transference (2nd ed.). Washington, DC: American Psychological Association.

Luyten, P. (2017). Personality, Psychopathology, and Health Through the Lens of Interpersonal Relatedness and Self-Definition. Journal of the American Psychoanalytic Association, 65(3), 473-489. https://doi.org/10.1177/0003065117712518

Meganck, R. (2017). Beyond the impasse - reflections on dissociative identity disorder from a Freudian-Lacanian perspective. Frontiers in Psychology, 8, 789. http://doi.org/10.3389/fpsyg.2017.00789

Merskey, H. (1995). The analysis of hysteria. Understanding conversion and dissociation. Glasgow: Bell & Bain.

Miller, G. E., Chen, E., & Zhou, E. S. (2007). If it goes up, must it come down? Chronic stress and the Hypothalamic-Pituitary-Adrenocortical Axis in Humans. Psychological Bulletin, 133(1), 25-45. https://doi.org/10.1037/0033-2909.133.1.25

Oasi, O., Buonarrivo, L., Codazzi, A., Passalacqua, M., Ricci, G. M. R., Straccamore, F., & Bezzi, R. (2017). Assessing personality change with Blatt’s anaclitic and introjective configurations and Shedler-Westen assessment procedure profiles: Two case studies in psychodynamic treatment. Research in Psychotherapy: Psychopathology, Process and Outcome. 20(1): 231. https://doi.org/10.4081/ripppo.2017.231

Pontoretto, J. G., & Grieger, I. (2007). Effectively communicating qualitative research. The Counseling Psychologist, 35(3), 404-430. https://doi.org/10.1177/0011000006287443

Stiles, W. B. (2015). Theory-building, enriching, and fact-gathering: Alternative purposes of psychotherapy research. In O. Gelo, A. Pritz, & B. Rieken (Eds.), Psychotherapy research: General issues, process, and outcome (pp. 159-179). New York: Springer-Verlag. https://doi.org/10.1007/978-3-7091-1382-0_8

Stiles, W. B. (2017). Theory-building case studies. In D. Murphy (Ed.), Counselling Psychology: A Textbook for Study and Practice (pp. 439-452). Chichester, UK: Wiley.

Vanheule, S. (2014). Diagnosis and the DSM: A Critical Review. London and New York: Palgrave Macmillan.

Vanheule, S., & Bogaerts, S. (2005). Short communication: The factorial structure of the GHQ-12. Stress and Health, 21(4), 217-222. https://doi.org/10.1002/smi.1058

Vanheule, S., Desmet, M., & Rosseel, Y. (2006). The factorial structure of the Dutch translation of the inventory of interpersonal problems: a test of the long and short versions. Psychological Assessment, 18(1), 112-117. https://doi.org/10.1037/1040-3590.18.1.112

Van Nieuwenhove, K., Meganck R., Cornelis, S., & Desmet, M. (2018). Core conflictual relationship patterns in complex trauma: a single-case study. Psychodynamic Practice, 24(3), 245-260. https://doi.org/10.1080/14753634.2018.1498801

Verhaeghe, P. (2004). On being normal and other disorders: A manual for clinical psychodiagnostics. New York: Other Press.

Wilczek, A., Weinryb, R.M., Barber, J.P., Gustavsson, J.P., Asberg, M. (2000). The core conflictual relationship theme (CCRT) and psychopathology in patients selected for dynamic psychotherapy. Psychotherapy Research, 10(1), 100-113. https://doi.org/10.1093/ptr/10.1.100

Willemsen, J., Della Rosa, E., & Kegerreis, S. (2017). Clinical case studies in psychoanalytic and psychodynamic treatment. Frontiers in Psychology, 8, 108. https://doi.org/10.3389/fpsyg.2017.00108

Willemsen, J., Inslegers, R., Meganck, R., Geerardyn, F., Desmet, M., Vanheule, S. (2015). A metasynthesis of published case studies through Lacan’s L-schema: Transference in perversion. The International Journal of Psychoanalysis, 96(3), 773-795. https://doi.org/10.1111/1745-8315.12179

Yin, R. K. (2014). Case study research: Design and methods (5th ed.). Thousand Oaks, CA: Sage.

Case Studies
Two-polarity model of personality development, theory-building case study, dissociation, interpersonal relatedness.
  • Abstract views: 521

  • PDF: 37
How to Cite
Cornelis, S., Desmet, M., Meganck, R., Van Nieuwenhove, K., & Willemsen, J. (2021). Extending Blatt’s two-polarity model of personality development to dissociative identity disorder: a theory-building case study. Research in Psychotherapy: Psychopathology, Process and Outcome, 24(1). https://doi.org/10.4081/ripppo.2021.505