A greater amount of emphasis on either self-definition or relatedness during one’s personality development may increase the individual’s vulnerability for specific types of depression. In fact, there is a great amount of empirical research that suggests that high levels of self-criticism or dependency are vulnerability dimensions for depression. Individuals with a dependent personality style may experience depressive states in response to disruptive interpersonal events and their experience an “anaclitic” form of depression, centered on feelings of loneliness, abandonment, and being unloved.

Blatt & Shichman (1983) comprehensively articulate that those with anaclitic
disorders are plagued by feelings of helplessness and weakness; they have fears of being abandoned, and they have strong wishes to be cared for, protected, and loved. Within the anaclitic configuration, neurotic-level pathology ranges from the infantile personality, in which pre-oedipal, dyadic issues predominate (e.g., anaclitic depression), to hysteria, in which more oedipal, triadic issues are found. Borderline-level pathology is of an anaclitic, or hysteroid type. Psychotic-level pathology includes nonparanoid schizophrenia, characterized by more diffuse—and less rigid—qualities (Ibid). If we are mapping anaclitic personality pathology onto a DSM-III-R nosology, we find the Dependent, Histrionic, and Borderline personality disorders(Ouimette, Klein, Anderson, Riso, & Lizardi, 1994). Blatt & Shichman (1983) go on to explain that what is common among anaclitic pathologies is the preoccupation with libidinal themes of closeness, intimacy, giving and receiving care, love, and sexuality. In the pathologically anaclitic, the development of a sense of self is neglected as these individuals are inordinately preoccupied with establishing and maintaining satisfying interpersonal relationships (Ibid). Indeed, as the authors note, the pathologically anaclitic individual’s symptoms “…are expressions of exaggerated attempts to compensate for disruptions in interpersonal relations. These disturbances are manifested in conflicts around establishing satisfactory intimate relationships and around feeling loved and being able to love. The basic wish is wanting to be loved” (1983, p. 200) (italics added). They go on to suggest that this preoccupation stems, in part, from a past in which important others have been depriving, rejecting, overindulging, inconsistent, or unpredictable—thus creating an environment in which closeness was precarious
(Ibid). Regarding defensive maneuvers, the anaclitic tends to use avoidant ones, such as denial, repression, and displacement (Blatt & Shichman, 1983). The cognitive processes of the anaclitic tend to be more figurative, focusing on images and affects.

They tend to think less critically, and more simultaneously as opposed to sequentially.

On the other side of the personality dialectic, individuals with a self-critical personality style may be more vulnerable to depressive states in response to disruptions in self-definition and personal achievement. These individuals may experience “introjective” depressive states around feelings of failure and guilt centered on self-worth. In “Levels of Object Representation in Anaclitic and Introjective Depression,” Sidney Blatt reviews Fenichel and Bibring’s theories of development and extrapolates that introjective depression is considered more developmentally advanced than anaclitic depression. This conclusion is supported by both Bibring and Fenichel’s discussions that one source of depression (anaclitic) is primarily oral in nature, originating from unmet needs from an omnipotent caretaker; while another source is related to the (more developmentally advanced) formation of the superego and involves the more developmentally advanced phenomena of guilt and loss of self-esteem during the oedipal stage.

Patients with introjective disorders are plagued by feelings of guilt, self-criticism, inferiority, and worthlessness. They tend to be more perfectionistic, duty-bound, and competitive individuals, who often feel like they have to compensate for failing to live up to the perceived expectations of others. Within the introjective configuration, neurotic-level pathology ranges from paranoia, at the more primitive end of this spectrum, to obsessive compulsive disorders in the middle of the spectrum, to phallic narcissism and guilt-laden depression (i.e., introjective depression) at the higher end. Borderlinelevel pathology is of an introjective, or over-ideational type. Psychotic-level pathology includes paranoid schizophrenia, characterized by more rigid and fragmented-functioning compared with their more amorphous anaclitic counterparts (Ibid). If we are mapping introjective personality pathology onto DSM-III-R nosology, we find the Paranoid, Schizoid, Schizotypic, Antisocial, Narcissistic, Avoidant, Obsessive-Compulsive, and Self-Defeating personality disorders.

What is common among introjective pathologies is the preoccupation with more aggressive themes (as opposed to libidinal) of identity, self-definition, self-worth, and self-control. In the pathologically-introjective, development of satisfying interpersonal relationships is neglected as these individuals are inordinately preoccupied with establishing an acceptable identity (Ibid). As the authors note well, “The focus . . . is not on sharing affection—of loving and being loved—but rather on defining the self as an entity separate from and different than another, with a sense of autonomy and control of one’s mind and body, and with feelings of self-worth and integrity . . . The basic wish is to be acknowledged, respected, and admired.” It is suggested this preoccupation stems, in part, from a past in which important others have been controlling, overly-critical, punitive, judgmental, and intrusive—thus creating an environment in which independence and separation was made difficult.

The introjective tends to use counteractive defenses (as a means of controlling the conflict or impulse, as opposed to avoiding it), such as projection, doing and undoing, reaction formation, intellectualization, rationalization, isolation, identification-with the-aggressor, and overcompensation. The cognitive processes of the introjective tend to be more literal, focusing on thoughts, rationality, and things, as opposed to relationships. They tend to think more critically, and more linearly as opposed to simultaneously.

Many of my therapists say to me: “You are lonely. You need friends. You need to make an effort to make friends.” I always say in response: “If I had friends, I’d just be a miserable person with friends.” They have no idea what I’m talking about. They think I’m crazy. But I now see the sense of what I have been saying. If I had friends that would take care of the issue of relatedness, but I would still struggle with my need for self definition, my introjective problems.

Drew Westen talks about this in his “high functioning” group of anorexic patients. Westen’s observations about high functioning anorexics seem to apply to my lack of social affiliation (“social anorexia”) and my high perfectionistic (introjective) needs. He says, “You can persuade them to eat, but if they don’t address the underlying psychological issues, you end up with people who are well-fed but miserable.” — Here’s what Drew Westen says: “Patients in the high-functioning/perfectionistic cluster generally lacked diagnosable axis II pathology; indeed, in our study (as in the other studies that have isolated a similar cluster), they were defined by the absence of such pathology. These patients are articulate, conscientious, and empathic, and they tend to elicit liking in others. Yet they clearly have personality pathology—that is, enduring, problematic patterns of thought, feeling, motivation, and behavior. They are self-critical, perfectionistic, competitive, anxious, and guilt-ridden, and these aspects of their personality require clinical attention. The data reported here make sense in light of other findings that roughly 60% of patients treated for clinically significant personality pathology do not have problems severe enough to be diagnosable on axis II and that their personality problems (e.g., perfectionism and chronic feelings of guilt) generally are not reducible to any axis I syndrome. Available data suggest that these patients represent the majority of patients treated in clinical practice and are not simply the ‘worried well.'”

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