Conflict dynamics in chronic depression - Results of the conflict and structure axis using the OPD in the LAC Study

Objectives: Using the psychoanalytical theory on depression, we investigated whether the need for care conflicts and conflicts of self-worth predominate in chronically depressed patients on the conflict axes of the Operationalized Psychodynamic Diagnosis (OPD-2). Two additional questions examined whether passive modes dominate in the processing of conflicts and the extent to which the level of structure influences conflict and its processing. Methods: Inthe courseof the LACD epression Study examiningthe effectiveness of psychoanalytic and behavioral therapeutic long-termtreatments of chronically depressed patients, the axes conflict and structure of the OPD were assessed for 217 patients before the beginning of treatment. Results: The need for care dominated self-sufficiency conflict, followed by individuation versus dependency and self-worth. The conflict of self-worth occurred most frequently for the second most important conflicts. The passive mode predominated with regard to the processing of conflicts. At higher levels of structure, the need for care and self-worth conflicts appeared more frequently. A lower level of structure was accompanied by a strong passive need for care and a passive processing of the individuation versus dependency conflict. Conclusions: The results show a moderating effect of the structure on the processing of conflicts. From a clinical and theoretical perspective, the results refer to the influence of experienced losses in chronically depressed patients. This agrees with psychoanalytical concepts.