The Anaclitic-Introjective Depression Assessment: Development and preliminary validity of an observer-rated measure

Rost, Felicitas; Luyten, Patrick and Fonagy, Peter (2018). The Anaclitic-Introjective Depression Assessment: Development and preliminary validity of an observer-rated measure. Clinical Psychology & Psychotherapy, 25(2) pp. 195–209.

DOI: https://doi.org/10.1002/cpp.2153

Abstract

Background
The two-configurations model developed by Blatt and colleagues offers a comprehensive conceptual and empirical framework for understanding depression. This model suggests that depressed patients struggle, at different developmental levels, with issues related to dependency (anaclitic issues) or self-definition (introjective issues), or a combination of both.

Aims
This paper reports three studies on the development and preliminary validation of the Anaclitic–Introjective Depression Assessment, an observer-rated assessment tool of impairments in relatedness and self-definition in clinical depression based on the item pool of the Shedler–Westen Assessment Procedure.

Method
Study 1 describes the development of the measure using expert consensus rating and Q-methodology. Studies 2 and 3 report the assessment of its psychometric properties, preliminary reliability, and validity in a sample of 128 patients diagnosed with treatment-resistant depression.

Results
Four naturally occurring clusters of depressed patients were identified using Q-factor analysis, which, overall, showed meaningful and theoretically expected relationships with anaclitic/introjective prototypes as formulated by experts, as well as with clinical, social, occupational, global, and relational functioning.

Conclusion
Taken together, findings reported in this paper provide preliminary evidence for the reliability and validity of the Anaclitic–Introjective Depression Assessment, an observer-rated measure that allows the detection of important nuanced differentiations between and within anaclitic and introjective depression.