Low levels of personality functioning are associated with affect dysregulation in dreams

Abstract

The association between psychopathology and dreaming has been investigated for various mental disorders. As for dream reports of patients with severe impairments in personality functioning (IPF), however, with a few exceptions, these contributions are mostly based on conceptual considerations or clinical case studies. As a core component of both personality functioning and contemporary psychodynamic dream theory, the construct of affect regulation is of specific significance in this context. The aim of this study was to compare affect regulation in dream reports as a marker of the level of personality functioning of patients with and without IPF. Affect regulation in N = 77 unsolicited dream reports by twenty psychotherapy outpatients with and without IPF was compared. Dream reports were transcribed from recordings of the first parts of Psychotherapy. Capacity for affect regulation was assessed using the Zurich Dream Process Coding System (ZDPCS). Level of Personality Functioning was assessed using the Scales of Psychological Capacities (expert-rating). Group differences were tested for with linear mixed-models controlling for dream length as well as the nested structure of this data set. Results: ZDPCS parameters, such as the extent of involvement of the dream ego or the complexity of the dream elements, indicated that patients with IPF use more preventive affect avoidance strategies when compared to patients without IPF. In addition, the IPF group demonstrated less flexibility in dream-inherent affect regulation as well as a higher frequency of disruptive states. Parallel to waking symptomatology, dreams of patients with IPF reflect an increased need for security, less affective involvement, and impaired affect regulation. Based on these findings, a model of affect regulation in the dreams of patients with IPF is suggested and implications for clinical practice are highlighted.