Interpersonal Relatedness and Self-Definition in

Normal and Disrupted Personality Development

Retrospect and Prospect
Patrick Luyten University of Leuven and University College London
Sidney J. Blatt Yale University
Two-polarities models of personality propose that person-
ality development evolves through a dialectic synergistic
interaction between two fundamental developmental psy-
chological processes across the life spanthe development
of interpersonal relatedness on the one hand and of self-
denition on the other. This article offers a broad review of
extant research concerning these models, discusses their
implications for psychology and psychiatry, and addresses
future research perspectives deriving from these models.
We rst consider the implications of ndings in this area
for clinical research and practice. This is followed by a
discussion of emerging research ndings concerning the
role of developmental, cross-cultural, evolutionary, and
neurobiological factors inuencing the development of
these two fundamental personality dimensions. Taken to-
gether, this body of research suggests that theoretical
formulations that focus on interpersonal relatedness and
self-denition as central coordinates in personality devel-
opment and psychopathology provide a comprehensive
conceptual paradigm for future research in psychology and
psychiatry exploring the interactions among neurobiolog-
ical, psychological, and sociocultural factors in adaptive
and disrupted personality development across the life span.
Keywords: personality, attachment, psychopathology,
cross-cultural, neurobiology
I
nterpersonal relatedness and self-denition have been
central developmental dimensions in a large number of
diverse theoretical and empirical contributions con-
cerning normal and disrupted personality development (Ba-
kan, 1966; Blatt, 2008; Freud, 1930; Wiggins, 1991). Re-
latedness and self-denition refer to fundamental
psychological developmental issues and processes in-
volved in the development of the capacity to establish and
maintain, respectively, (a) reciprocal, meaningful, and per-
sonally satisfying interpersonal relationships and (b) a co-
herent, realistic, differentiated, and essentially positive
sense of self, or an identity. These two developmental
dimensions have been central in personality theories across
a wide variety of disciplines, ranging from philosophy and
evolutionary and cross-cultural psychology to personality
and social psychology and psychoanalysis (for an extensive
review, see Blatt, 2008). Various personality theories have
referred to these dimensions as surrender and autonomy
(Angyal, 1951); communion and agency (Bakan, 1966;
Pincus, 2005); afliation (or intimacy) and achievement (or
power) (McAdams, 1985; McClelland, 1985); anaclitic
and introjective (Blatt, 1974, 2008); relatedness and au-
tonomy/competence (Deci & Ryan, 2012; Ryan & Deci,
2000); and, more recently, attachment anxiety and attach-
ment avoidance (Mikulincer & Shaver, 2007; Sibley, 2007)
and sociotropy and autonomy (Beck, 1983; Clark & Beck,
1999). As several authors have pointed out before (Luyten
& Blatt, 2011; Mikulincer & Shaver, 2007; Pincus, 2005),
these so-called two-polarities models of personality share
an emphasis on the dialectic interaction between issues of
relatedness and self-denition in personality development
as well as a number of other key assumptions concerning
the nature of adaptive and disrupted personality devel-
opment.
The centrality of these two fundamental psychological
dimensions of relatedness and self-denition in theories of
personality development across different disciplines calls
for a review of relevant empirical research concerning
them. This review is all the more timely given the inuence
of these theories on the planning for the upcoming fth
edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) (Bender, Morey, & Skodol, 2011;
Lowyck, Luyten, Verhaest, Vandeneede, & Vermote, in
press) and particularly given a newly emerging body of
research demonstrating the role of cross-cultural, biologi-
cal, and evolutionary factors, and their interactions, in the
development of these dimensions.
Here we rst discuss research concerning the conver-
gence among the most prominent current two-polarities
models and their implications for understanding personal-
ity development and for conceptualizing, classifying, and
treating psychopathology. Next, we take a broader perspec-
tive and consider the impact of developmental factors,
gender, and sociocultural issues on the development of
Patrick Luyten, Faculty of Psychology and Educational Sciences, Univer-
sity of Leuven, Leuven, Belgium, and Research Department of Clinical,
Educational and Health Psychology, University College London, London,
England; Sidney J. Blatt, Department of Psychiatry (professor emeritus),
Yale University.
Correspondence concerning this article should be addressed to
Patrick Luyten, University of Leuven, Tiensestraat 102, P.O. Box
3722, 3000 Leuven, Belgium, or Sidney J. Blatt, Department of Psy-
chiatry, Yale University, New Haven, CT 06511. E-mail:
patrick.luyten@psy.kuleuven.be or sidney.blatt@yale.edu
172 April 2013

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2013 American Psychological Association 0003-066X/13/$12.00
Vol. 68, No. 3, 172183 DOI: 10.1037/a0032243
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these dimensions, and we present evidence concerning
their neurobiological and evolutionary foundations. In each
section, we consider the implications of these views for
contemporary psychology and psychiatry. We argue that a
focus on these two fundamental developmental psycholog-
ical processes has considerable theoretical and empirical
utility by providing a comprehensive conceptual matrix
that integrates views concerning normal and disrupted per-
sonality development and the respective inuence of evo-
lutionary, biological, and sociocultural factors, and their
interactions, on personality development.
Two-Polarities Models of Personality
Development
Adaptive Personality Development
As described in detail elsewhere (Luyten & Blatt, 2011),
current research efforts concerning two-polarities models
of personality development derive primarily from the fol-
lowing approaches: (a) Blatts (2008) two-congurations
model, (b) Becks (1983) cognitive personality model, (c)
contemporary interpersonal formulations, (d) current at-
tachment approaches, and (e) Deci and Ryans (2012)
self-determination theory. These models share the assump-
tion that adaptive personality development proceeds
through a continuous dialectic interaction between issues of
relatedness and self-denition (Blatt & Luyten, 2009; Mi-
kulincer & Shaver, 2007). Beginning in early infancy,
interpersonal relatedness is thought to contribute to the
development of the sense of self, which then in turn con-
tributes to the development of more mature levels of inter-
personal relatedness.
From psychodynamic and cognitive developmental
perspectives, Blatt and colleagues (Blatt, 2008; Blatt &
Luyten, 2009; Blatt & Shichman, 1983) have argued that
development of the sense of self leads to increasingly
mature levels of interpersonal relatedness that, in turn,
facilitate further differentiation and integration in the de-
velopment of the self. Beck (1983, Clark & Beck, 1999)
similarly distinguished sociotropy and autonomy. Auton-
omy refers to an achievement-oriented personality style
associated with attempts to maximize control over the
environment. Sociotropy involves investment in and at-
tachment to others. Beck similarly proposed that a balance
between autonomy and sociotropy characterizes adaptive
personality development. Studies have shown consistent
differences associated with these two personality dimen-
sions in current and early life experiences (Blatt &
Homann, 1992; Blatt & Luyten, 2009; Soenens, Vansteen-
kiste, & Luyten, 2010), stress responsivity (Luyten, Corve-
leyn, & Blatt, 2005; Luyten et al., 2011), and interpersonal
and attachment styles (Luyten et al., 2005; Zuroff, Mon-
grain, & Santor, 2004).
Current interpersonal models have proposed similar
dimensions that underlie personality development: agency
(or social dominance) and communion (or nurturance or
afliation) (Benjamin, 2005; Horowitz & Strack, 2011;
Horowitz et al., 2006; Kiesler, 1983; Leary, 1957; Pincus,
2005; Wiggins, 1991, 2003). These dimensions have been
shown to overlap both theoretically and empirically with
self-denition/autonomy and relatedness/sociotropy, re-
spectively (Luyten & Blatt, 2011). Contemporary attach-
ment theory, in turn, equally emphasizes the importance of
a balance between relatedness and self-denition in per-
sonality development (Mikulincer & Shaver, 2007). An
increasing consensus now views two dimensions as under-
lying attachment behaviorattachment avoidance and at-
tachment anxiety (Meyer & Pilkonis, 2005; Mikulincer &
Shaver, 2007; Roisman et al., 2007)that are expressed in
differences in internal working models (IWMs) of self and
of others (Bartholomew & Horowitz, 1991), that is, the set
of expectations, beliefs, and feelings with regard to self and
others that individuals develop as a result of interactions
with attachment gures. Attachment avoidance, expressed
in IWMs characterized by discomfort with closeness and
discomfort with depending on others (Mikulincer &
Shaver, 2007, p. 87), overlaps conceptually and empirically
with the self-denition/autonomy/dominance dimension
(Luyten & Blatt, 2011; Sibley, 2007; Sibley & Overall,
2007, 2008, 2010). Attachment anxiety, expressed in
IWMs characterized by fear of rejection and abandon-
ment (Mikulincer & Shaver, 2007, p. 155), overlaps with
the relatedness/sociotropy/warmth dimension. Adaptive
personality functioning in contemporary attachment formu-
lations is similarly conceptualized as a balance between
relatedness and self-denition, expressed in low to moder-
ate levels of attachment anxiety and avoidance typical of
securely attached individuals (Mikulincer & Shaver, 2007).
Self-determination theory (Deci & Ryan, 2012; Ryan
& Deci, 2000, 2006) advanced very similar views about
personality development from a motivational perspective.
Intrinsic or autonomous motivation, characteristic of adap-
tive personality development, is assumed to involve a bal-
ance between autonomy and competence on the one hand
and relatedness on the other. Autonomy and competence
reect strivings toward control over the initiation and out-
come of ones activities, while relatedness refers to the
need to feel related to others. Again, empirical research has
provided evidence for the conceptual and empirical overlap
of self-determination theorys focus on autonomy/compe-
tence and relatedness with the other two-polarities models
(Luyten & Blatt, 2011; Shahar, Henrich, Blatt, Ryan, &
Little, 2003; Shahar, Kalnitzki, Shulman, & Blatt, 2006;
Soenens, Park, Vansteenkiste, & Mouratidis, 2012; Zuroff,
Koestner, Moskowitz, McBride, & Bagby, 2012).
Although a detailed discussion of these ndings is
beyond the scope of this article, relatedness and self-de-
nition have also been theoretically and empirically related
to major empirically derived personality models such as the
ve factor model and other multivariate personality mod-
els, including the tripartite personality model and internal-
izing/externalizing spectrum models (Blatt & Luyten,
2010; Luyten & Blatt, 2011). In addition, expressions of
relatedness and self-denition have been shown to be as-
sociated with a host of variables beyond more basic per-
sonality dimensions such as negative affectivity/neuroti-
cism and extraversion (see Luyten & Blatt, 2011, for an
173 April 2013

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extensive overview), further emphasizing their explanatory
power.
Disruptions in Personality Development:
Implications for the Conceptualization,
Classification, and Treatment of
Psychopathology
Two-polarities models also converge to suggest that differ-
ent forms of psychopathology are best conceptualized in
terms of distorted modes of adaptation that derive, at dif-
ferent developmental levels, from variations and disrup-
tions in the synergistic interaction between aspects of re-
latedness and self-denition throughout the life span.
Different forms of psychopathology are thus viewed as
distorted attempts to maintain a balance, however maladap-
tive, between relatedness and self-denition, resulting in an
excessive emphasis on one developmental line to the ne-
glect of the other (Blatt, 2008; Luyten & Blatt, 2011;
Meyer & Pilkonis, 2005; Mikulincer & Shaver, 2007).
Congruent with these assumptions, studies indicate
that various personality disorders can be organized into two
congurationsone focused around issues of relatedness
(an anaclitic conguration) and the other focused around
issues of self-denition (an introjective conguration;
see summary in Blatt & Luyten, 2010). For instance, re-
search has shown that individuals with features of DSM-IV
(Diagnostic and Statistical Manual of Mental Disorders,
4th edition; American Psychiatric Association, 1994) de-
pendent, histrionic, and borderline personality disorders
tend to have signicantly greater concern with issues of
interpersonal relatedness than with issues of self-denition.
Individuals with features of antisocial, narcissistic, para-
noid, schizoid, schizotypic, avoidant, and obsessive-com-
pulsive disorders, by contrast, are more preoccupied with
issues of self-denition (Blatt & Luyten, 2010; Luyten &
Blatt, 2011).
Inuenced by Livesleys (2008) seminal work and by
two-polarities models (for a discussion, see Bender et al.,
2011), the DSM-5 Personality and Personality Disorders
Work Group (Skodol & Bender, 2009) has recently em-
phasized the centrality of interpersonal relatedness and
self-denition in understanding and classifying personality
disorders (Skodol & Bender, 2009; Skodol et al., 2011; and
see http://www.dsm5.org). The central scientic and phil-
osophical principles guiding the revisions (Skodol, 2011,
p. 97) by this work group have been based on the funda-
mental assumption that personality disorders are associ-
ated with distorted thinking about self and others and that
maladaptive patterns of mentally representing the self and
others serve as substrates for personality pathology
(Skodol, 2011, p. 99). Specically, the DSM-5 Personality
and Personality Disorders Work Group proposed that dif-
ferent levels of impairments in levels of self-denition and
interpersonal functioning are central to dening personality
disorders, which range from no impairment to extreme
impairments as expressed in a profound inability to reect
on the self together with severe impairments in selfother
boundaries (self-impairments) and in signicant impair-
ments in the awareness and understanding of the thoughts,
feelings, and motivations of others (interpersonal impair-
ments) (Skodol, 2012). These proposals have now been
included in Section 3 of the forthcoming DSM-5, meaning
that they will be the subject of considerable further research
and eld trials in the near future and will inform subsequent
editions of the DSM (Skodol, 2012).
It is noteworthy that studies in this context have gen-
erally not found evidence for a one-to-one relationship
between these two personality dimensions and current de-
scriptive DSM diagnoses (Ouimette & Klein, 1993). Hence,
the same issues with relatedness and self-denition may
be expressed in different ways at different ages and in
different contexts, a phenomenon consistent with the de-
velopmental principles of equinality and multinality
(Cicchetti & Rogosch, 1996) (Luyten & Blatt, 2011, p.
60). Levy, Edell, and McGlashan (2007), for example,
found that patients with a DSM-IV diagnosis of borderline
personality disorder (BPD) showed substantial symptom-
atic heterogeneity. Yet these authors were able to identify
within this symptomatically heterogeneous group a more
interpersonally oriented (anaclitic) type and a more self-
critical (introjective) type of BPD patient, in whom is-
sues with relatedness and self-denition, respectively, pre-
dominated.
Finding such as these have very important implica-
tions for conceptualizing, classifying, and treating psycho-
pathology. Indeed, fundamental differences in underlying
personality organization may provide a more coherent way
of differentiating both within and between various disor-
ders than a classication system based on manifest symp-
toms, as in the DSM-IV. Congruent with this view, the
DSM-5 Personality and Personality Disorders Work Group
suggested dropping the dependent, histrionic, and schizoid
personality disorders because of insufcient evidence sup-
porting the distinctive nature of these disorders and thus
their clinical utility (Skodol, 2012). Two-polarities models
can contribute substantially to this discussion by providing
a rigorous and empirically supported theoretical framework
for evaluating the distinctiveness of specic personality
disorders (Horowitz et al., 2006; Locke, 2010; Meyer &
Pilkonis, 2005). As we have explained in more detail
elsewhere (Luyten & Blatt, 2011), personality disorders (or
clusters of personality disorder features) that are situated
near each other in a two-dimensional space dened by
relatedness and self-denition (see Figure 1) probably
overlap to such an extent that clinically it may no longer be
useful to distinguish between them (i.e., they are charac-
terized by similar disturbances in relatedness and self-
denition, despite potential differences in their symptom-
atic expression). This could be the case for the histrionic,
dependent, and anaclitic subgroups of borderline person-
ality disorder because they have considerable overlap in
terms of underlying disturbances in relatedness (Kernberg
& Caligor, 2005; Luyten & Blatt, 2011). In contrast, per-
sonality disorders (or clusters of personality disorder fea-
tures) situated further apart in the two-dimensional space
probably warrant consideration as separate disorders be-
cause they have different underlying features (i.e., different
types of disturbances in relatedness and self-denition).
174 April 2013

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Figure 1 presents such a prototype approach based on a
two-dimensional space spanned by maladaptive expres-
sions of relatedness and self-denition, using three com-
mon personality disorders to illustrate this approach
(Luyten & Blatt, 2011). Plotting personality disorder fea-
tures in this two-dimensional space promises to clarify the
distinctiveness as well as the notable comorbidity of per-
sonality disorders in the DSM-IV based on their positioning
in this two-dimensional space.
The DSM-5 Personality and Personality Disorders
Work Group has also questioned the distinction between
Axis I (symptom) disorders and Axis II (personality)
disorders. Again, ndings derived from research based on
two-polarities models can inform this discussion. Studies
have shown that various symptom disorders, currently
subsumed under Axis I (i.e., mood disorders, several anx-
iety disorders, substance abuse disorders, eating disorders,
and somatoform disorders), are characterized by (tempo-
rary or chronic) impairments in the sense of self and
relatedness (for reviews, see Blatt, 2008; Blatt & Luyten,
2010; Egan, Wade, & Shafran, 2011; Zuroff et al., 2004).
Hence, these ndings suggest that maladaptive expressions
of relatedness and self-denition (such as dependency and
self-critical perfectionism) can, therefore, best be concep-
tualized as transdiagnostic vulnerability factors, which
may also partly explain the high comorbidity among
symptom and personality disorders and the longitudi-
nal relationships among both types of disorders (Blatt &
Luyten, 2010; Egan et al., 2011).
From this perspective, it might also be more produc-
tive for future research to investigate the efcacy and
effectiveness of broad transdiagnostic treatments that ad-
dress basic underlying personality issues (Egan et al., 2011;
Kazdin, 2011; Luyten & Blatt, 2007, 2011; McHugh, Mur-
ray, & Barlow, 2009) rather than continuing to focus on
developing specic treatments for specic disorders. This
assumption is further reinforced by research indicating that
patients who are primarily preoccupied with issues of re-
latedness or self-denition are differentially responsive to
different aspects of the treatment process regardless of their
specic diagnosis. Patients primarily preoccupied with is-
sues of relatedness (i.e., anaclitic patients) are responsive
mainly to supportive dimensions of interventions. Patients
primarily preoccupied with issues of self-denition (i.e.,
introjective patients) have been shown to be more respon-
sive to interpretiveexploratory dimensions (Blatt, Zuroff,
Hawley, & Auerbach, 2010). Research in this context in
fact suggests a parallel between normal psychological de-
velopment and the processes of therapeutic change
(Luyten, Blatt, & Mayes, 2012). Studies suggest that, just
as in normal personality development, therapeutic change
seems to result from a synergistic interaction of experi-
ences of interpersonal relatedness and self-denition. Ther-
apeutic change may thus result from the reactivation of a
normal synergistic developmental process in which inter-
personal experiences in the therapeutic relationship con-
tribute to the development of the sense of self, leading to
more mature expressions of interpersonal relatedness,
which, in turn, further foster the development of the self
(Safran, Muran, & Eubanks-Carter, 2011; Safran, Muran,
Samstag, & Steven, 2002). Although further research is
needed to explore more fully the factors that contribute to
sustained therapeutic change, these ndings demonstrate
the advantages of a theoretical model that proposes a par-
allel between normal personality development and thera-
peutic change.
In summary, in contrast to a more static symptom- or
disorder-centered approach, two-polarities models suggest
that psychopathology reects attempts to achieve some
stability or equilibrium in response to developmental dis-
ruptions by becoming preoccupied, in exaggerated and
distorted ways, at different developmental levels, with one
or the other of these developmental dimensions of inter-
personal relatedness and self-denition (Blatt, 2008;
Luyten, Mayes, Target, & Fonagy, 2012). This approach,
which links normal and pathological personality develop-
ment with therapeutic processes, has considerable clinical
utility, particularly as it furthers our understanding of the
structure of psychopathology and the mechanisms of ther-
apeutic change (Luyten & Blatt, 2011).
Relatedness and Self-Definition
Across the Life Span
It is hard to imagine thinking about psychopathology in any
way other than developmentally (Gluckman et al., 2009;
Munir & Beardslee, 1999). From the perspective of two-
polarities models, as discussed earlier, personality devel-
opment evolves from infancy to senescence through a
complex synergistic interaction between experiences of
interpersonal relatedness and self-denition (Blatt, 2008).
A large body of research supports the value of two-
polarities models for understanding both normal and dis-
rupted psychological development from childhood to ado-
Figure 1
A Prototype Approach to Personality Disorder (PD)
Based on Two-Polarities Models
High self-criticism/
Attachment avoidance/
Dominance
Low self-criticism/
Attachment avoidance/
Dominance
High dependency/
Attachment anxiety/
Warmth
Avoidant
PD

Dependent PD
Antisocial
PD
Low dependency/
Attachment anxiety/
Warmth
Note. This approach is based on the work of Luyten and Blatt (2011), Pincus
(2005), Meyer and Pilkonis (2005), and Horowitz et al. (2006).
175 April 2013

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lescence and adulthood (Blatt & Luyten, 2009; Mikulincer
& Shaver, 2007; Sroufe, 1997; Sroufe, Carlson, Levy, &
Egeland, 1999). For instance, two-polarities models have
helped to elucidate the extensive comorbidity between in-
ternalizing and externalizing disorders in childhood and
adolescence (Krueger, Skodol, Livesley, Shrout, & Huang,
2007; Lahey et al., 2008) and their links to two types of
depression (i.e., dependent and self-critical) in adolescence.
For example, an excessive emphasis on and/or preoccupa-
tion with issues concerning relatedness has been closely
associated with the development of internalizing problems,
especially in adolescent females (Besser, Vliegen, Luyten,
& Blatt, 2008; Leadbeater, Kuperminc, Blatt, & Hertzog,
1999; Soenens et al., 2005). Excessive preoccupation with
issues concerning self-denition, in turn, has been linked to
the development of externalizing problems (e.g., delin-
quency and aggression), especially in adolescent males
(Leadbeater et al., 1999). Thus, two-polarities models have
contributed to elucidating developmental pathways in-
volved in internalizing and externalizing disorders in ado-
lescence and the emergence of gender differences in these
disorders.
Studies based on two-polarities models have also in-
creased our understanding of the intergenerational trans-
mission of vulnerabilities for psychopathology. Attachment
research, for example, has found considerable evidence for
the role of early attachment disruptions in explaining vul-
nerability for psychopathology across the life span
(Cassidy & Shaver, 2008; Gunnar & Quevedo, 2007;
Sroufe, 1997;Sroufe et al., 1999). As noted, studies in this
context suggest that secure attachment involves a balance
between relatedness and self-denition that contributes to
the development of mature levels of interpersonal related-
ness and an essentially positive sense of self and identity
(Beebe et al., 2007; Blatt & Luyten, 2009). Attachment
disruptions, however, seem to result in an overemphasis on
issues of either relatedness or self-denition, expressed in
anxious resistant (or enmeshed/preoccupied) or dismissing
avoidant attachment patterns, respectively. It is common
knowledge that these patterns were rst identied in chil-
dren in research employing the Strange Situation procedure
(Ainsworth, Blehar, Waters, & Wall, 1978) and were later
replicated in adolescents and adults using the Adult Attach-
ment Interview (George, Kaplan, & Main, 1985) and self-
report measures (Mikulincer & Shaver, 2007). More re-
cently, Beebe et al. (2007) found evidence for the very
early emergence of these patterns in a study analyzing the
moment-to-moment play interactions of 126 parentinfant
dyads. They found that mothers who were overly preoccu-
pied with issues concerning self-denition experienced dif-
culties in engaging their 4-month-old infants attention
and emotions. In an attempt to compensate for this rela-
tional mismatch, these mothers had a tendency to touch
their infants more, but their infants tended to withdraw and
become more avoidant. Mothers preoccupied by related-
ness issues, in contrast, showed excessive concern about
emotional availability and tended to become overinvolved
with their infants, leading to lowered self-regulation capac-
ities in their infants. Similar ndings have been reported
concerning parentchild interactions in adolescence
(Soenens et al., 2010, 2012), suggesting that disproportion-
ate concerns with relatedness and self-denition are trans-
mitted across the generations. Congruent with this assump-
tion, a study by Besser and Priel (2005), with a community
sample of 300 participants (100 three-generation triads of
women), reported evidence for the intergenerational trans-
mission of excessive preoccupation with issues of related-
ness and self-denition from mothers to their daughters and
granddaughters.
These studies demonstrate that two-polarities models
facilitate a more detailed analysis of psychological pro-
cesses involved in the intergenerational transmission of
vulnerability for psychopathology from infancy to adoles-
cence and adulthood. Moreover, these studies clearly imply
that relatedness and self-denition do not develop in a
sociocultural vacuum but are inuenced by gender and
sociocultural issues.
Gender and Sociocultural Influences
on Relatedness and Self-Definition
Issues of gender, culture, and environmental factors more
generally are often neglected in the study of personality
development, despite their importance (DiBartolo &
Rendn, 2012; Fraley & Roberts, 2005). Two-polarities
models have furthered our insights into the complex inter-
actions among these factors, although much work remains
to be done in this area.
Two-polarities models view a balance between inter-
personal relatedness and self-denition as a key feature of
adaptive psychological functioning. Rather than patholo-
gizing dependency, these models, and attachment research
in particular, have thus played an important role in the
recognition of interpersonal relatedness as a fundamental
personality dimension and in recognizing differences
among adaptive and maladaptive expressions of depen-
dency (Blatt, 2008; Bornstein & Languirand, 2003). Fur-
thermore, both Blatt (2008) and Beck (1983) have sug-
gested that, at least within Western societies (which tend to
value autonomy and self-denition in men, and relatedness
and attachment in women), women place somewhat greater
emphasis on relatedness, while men place more emphasis
on self-denition. As a result, gender incongruence (i.e.,
high levels of dependency in men and a strong emphasis on
self-denition in women) is devalued and has been hypoth-
esized to be associated with increased risk for maladjust-
ment, at least in Western cultures.
In Western samples, women indeed report somewhat
higher investment than men in issues of relatedness, but not
on implicit measures, suggesting that men may overtly
deny investment in relatedness (for reviews, see Blatt,
2008; Bornstein, 1992). In contrast, studies typically do not
nd gender differences concerning the importance of self-
denition, at least not in Western societies, which may
reect cultural changes in gender roles in the West (Luyten
et al., 2005). Moreover, although some evidence indicates
the role of gender incongruence in explaining vulnerability
for psychopathology, more research is denitely needed
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(Luyten et al., 2007). However, some evidence suggests
gender differences in the nature of psychopathology that
are congruent with predictions made by two-polarities
models. For instance, men are more prone to externalizing
disorders and internalizing types of psychopathology that
involve preoccupation with self-denition, while women
are more prone to internalizing disorders such as somatic
depression (i.e., depression characterized by anxious and
somatic concerns) and functional somatic and personality
disorders involving preoccupation with issues of related-
ness (such as BPD; Besser, Luyten, Vliegen, & Blatt,
2008). Epidemiological studies, for example, suggest that
somatic depression is twice as prevalent in women (Silver-
stein, 2002) and may be related to sociocultural limitations
placed upon womens striving for achievement (Silver-
stein, Clauson, Perdue, Carpman, & Cimarolli, 1998). Sim-
ilarly, hostile/irritable depression (Parker et al., 1999) and
antisocial personality disorder (Beauchaine, Klein, Crow-
ell, Derbidge, & Gatzke-Kopp, 2009), which involve in-
tense preoccupation with self-denition, are typically more
prevalent in men.
It is important to bear in mind that these ndings are
based on research in Western samples and that cultures
differ in the extent to which they emphasize and value
relatedness and self-denition. These differences may have
a profound impact on the meaning and consequences of
these dimensions across cultures (Soenens et al., 2012). It
is often hypothesized in this context that relatedness is
emphasized in collectivistic or interdependent cultures,
while individualistic or independent cultures emphasize
self-denition (Kagitcibasi, 2005; Kitayama, Markus, Ma-
tsumoto, & Norasakkunkit, 1997; Markus & Kitayama,
1991; Triandis, 2001). Research has indeed provided evi-
dence for mean level differences across cultures in empha-
sis on issues of relatedness and self-denition (Matsumoto
& Van de Vijver, 2011) as well as in maladaptive expres-
sions of these dimensions. For example, Asian Americans
have consistently been found to have higher levels of
maladaptive perfectionisman expression of intense pre-
occupation with self-denitionon self-report question-
naires, compared with Caucasian Americans (DiBartolo &
Rendn, 2012). These differences probably result from
complex interactions among sociocultural factors such as
levels of individualism versus collectivism in the social
context, which may inuence parenting styles (Ahmad &
Soenens, 2010; Chang & Asakawa, 2003; Kitayama et al.,
1997). For instance, because of the relative emphasis on
collectivism in interdependent cultures, parents in these
cultures may place greater emphasis on relatedness in re-
lation to their children than do parents in more individual-
istic cultures.
Yet caution is needed in this context. Although Asian
cultures, for example, are often depicted as collectivist,
research shows that this is an overly simplied view be-
cause individualistic and collectivistic values often co-
occur within the same culture (Ahmad & Soenens, 2010).
Indeed, studies suggest that the strong emphasis on educa-
tion and achievement by Asian American parents often
coexists with parental concern and involvement (e.g., the
Chinese concept of guanto love and care for in addition
to govern; DiBartolo & Rendn, 2012; Soenens et al.,
2012). Hence, both dimensions, relatedness and self-de-
nition, need to be considered simultaneously (DiBartolo &
Rendn, 2012). Two-polarities models open up interesting
avenues for the study of the balance and interplay between
relatedness and self-denition across cultures, particularly
as increasing globalization is likely to affect this balance.
For instance, the emphasis on interdependency in many
so-called collectivist cultures is rapidly shifting toward a
strong focus on achievement and independence, which has
been related to an increase in internalizing problem behav-
iors and disorders (e.g., depression and suicide) in these
cultures (Im et al., 2011; Kwon, Chun, & Cho, 2009;
Ministerio de Salud, Gobierno de Chile, 2010; Organisa-
tion for Economic Co-Operation and Development, 2013).
Rather than the new emphasis on achievement, it may be
the disturbance in the deeply embedded cultural balance
between relatedness and self-denition that may disorga-
nize individuals and families within these cultures, leading
to higher levels of maladjustment.
While universalist positions in this context argue that
high levels of dependency are maladaptive regardless of
cultural context, a relativistic or cultural congruence per-
spective argues that this may depend on the cultural context
(Soenens et al., 2012). High levels of interdependency, for
instance, are often seen as less maladaptive, or even as
adaptive, in collectivistic cultures, whereas the emphasis on
self-denition and personal achievement is often consid-
ered normative and adaptive in individualistic cultures. It is
important in this research not to conate adaptive with
more maladaptive expressions of relatedness and self-def-
inition (Soenens et al., 2012). For instance, studies suggest
considerable structural invariance of measures of self-crit-
ical perfectionism, a maladaptive expression of self-deni-
tion, as well as similar patterns of negative relationships
between self-critical perfectionism and mental health out-
comes, across cultures (DiBartolo & Rendn, 2012).
Hence, although self-critical perfectionism may be more
congruent with predominant values in some cultures, it
seems to confer risk for psychopathology across cultures,
which is inconsistent with a relativistic or cultural con-
gruence model. Likewise, person-centered approaches
have identied similar subgroups of perfectionists across
different ethnic groups, although research indicates subtle
yet potentially important differences in the phenomenology
and correlates of self-critical perfectionism in different
ethnic groups. For example, congruent with research in
Caucasian American samples, Herman, Trotter, Reinke,
and Ialongo (2011) found evidence for noncritical/adap-
tive, critical/maladaptive, and nonperfectionist clusters of
children in a large sample of African American adoles-
cents. However, they also identied an additional cluster of
children who were characterized by extremely low levels of
self-striving. Further analyses suggested that these low-
striving children failed to develop healthy levels of self-
striving because they grew up in poor, deprived neighbor-
hoods, were the victim of racial and cultural prejudices, and
thus had very limited prospects in life. Findings such as
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these thus suggest both universal and culture-specic ori-
gins of concerns with and expressions of self-denition.
With regard to relatedness, studies have similarly reported
factorial invariance of measures of relatedness and similar
patterns of relationships with other variables in different
cultures (e.g., high levels of dependency are associated
with maladjustment regardless of culture; Ahmad &
Soenens, 2010; Otani et al., 2012; Soenens et al., 2012) but
also some important differences (e.g., in the distribution of
preoccupied attachment) across cultures (Grossmann,
Grossmann, Spangler, Suess, & Unzner, 1985; van IJzen-
doorn & Sagi-Schwartz, 2008).
More research is clearly needed across cultures, as
well as in the identication and investigation of subgroups
within cultures. Religious factors can also be important in
this context, as they may differentially emphasize related-
ness and self-denition and reinforce or weaken cultural
patterns (Cohen & Hill, 2007). Cross-cultural studies have
also typically been limited to Asian American and African
American samples (Ahmad & Soenens, 2010; DiBartolo &
Rendn, 2012). More research is also needed on the role of
other environmental factors, such as early adversity, and
the interaction of cultural factors with neurobiological and
genetic factors, as discussed in the next section.
Neurobiological and Evolutionary
Basis of Relatedness and
Self-Definition
A recently emerging body of evidence concerning the
neurobiological and evolutionary basis of issues of relat-
edness and self-denition promises to lead to considerable
advances in our understanding of normal and disrupted
personality development across the life cycle, including the
role of relatively stable versus stochastic and person-de-
pendent (Fraley & Roberts, 2005) environmental factors
and geneenvironment correlations and interactions. As
noted, studies have found that parental preoccupations with
issues of relatedness and self-denition are related to self-
regulation and interactive regulation capacities in infants as
young as 4 months of age (Beebe et al., 2007). These
ndings are congruent with emerging evidence in both
animals and humans concerning the central role of attach-
ment experiences in programming the development of the
hypothalamicpituitaryadrenal axis, the main human
stress system (Gunnar, Quevedo, De Kloet, Oitzl, & Eric,
2008; Lupien, McEwen, Gunnar, & Heim, 2009; Neumann,
2008; Sbarra & Hazan, 2008). These ndings have led to
the so-called developmental origins of health and disease
paradigm (e.g., Gluckman et al., 2009), which essentially
proposes that early programming effects play an important
role in explaining vulnerability to both psychiatric and
(functional) somatic disorders across the life span (Lupien
et al., 2009). Studies in this eld promise to shed more light
on interactions among genetic, physiological, neurobiolog-
ical, and neural factors in the development of relatedness
and self-denition and their purported evolutionary under-
pinnings.
A growing body of research has documented the neu-
robiological circuits underlying relatedness (Bartz, Zaki,
Bolger, & Ochsner, 2011; Gunnar & Quevedo, 2007; Insel
& Young, 2001). These studies, based on both animal and
human research, have implicated relatively distinct neural
circuits in attachment and caregiving behaviors. These neu-
ral circuits primarily involve a mesocorticolimbic dopami-
nergic reward circuit and hypothalamic-midbrain-limbic-
paralimbic-cortical circuits (Fonagy, Luyten, & Strathearn,
2011; Rutherford, Williams, Moy, Mayes, & Johns, 2011;
Swain, Lorberbaum, Kose, & Strathearn, 2007). On the
neurobiological level, the neuropeptides oxytocin and va-
sopressin have been shown to play a key role in afliative
behaviors ranging from parental care to pair bonding and
sexual behavior (Insel & Young, 2001; Neumann, 2008).
These neuropeptides are also involved in social cognition
and social support (Feldman, Weller, Zagoory-Sharon, &
Levine, 2007) as well as in regulating behavioral and
neuroendocrinological responses to stress (Neumann,
2008). These ndings suggest that the ability to relate to
others has an evolutionary advantage because of its close
relationship with brain reward neurocircuitry, which rein-
forces afliative behavior, resulting in broaden and build
cycles (Fredrickson, 2001) that have been associated with
high levels of relatedness and attachment security (Fonagy
& Luyten, 2009; Mikulincer & Shaver, 2007). Indeed,
effective stress regulation broadens ones awareness and
encourages explorative behavior, broadening ones per-
spective and building skills and resources (Fredrickson,
2001).
Importantly, oxytocin also fosters positive feelings
about the self, effective stress regulation, and explorative
behavior (Insel & Young, 2001; Neumann, 2008), thus
linking experiences of relatedness to opportunities to de-
velop feelings of autonomy, competence, and identity,
which in turn enhance coping and affect regulation (Fonagy
& Luyten, 2009; Fredrickson, 2001; Mikulincer & Shaver,
2007). Hence, research in this area provides important
neurobiological evidence for the view of two-polarities
models that disruptions in the developmental dialectic in-
teraction between relatedness and self-denition lead to
disruptions in the development of these dimensions and in
their underlying neural circuits (Simeon et al., 2011).
Social and cognitive neuroscience has also delineated
the neural circuits involved in the development of the self
and self-representations. These mainly involve cortical
midline structures, including the medial prefrontal cortex,
posterior cingulate, precuneus, and temporal parietal junc-
tion (Lieberman, 2007; Lombardo, Chakrabarti, Bullmore,
& Baron-Cohen, 2011; Lombardo et al., 2010; for a meta-
analysis, see Northoff et al., 2006), the same neural areas
that have been shown to underlie social cognition with
regard to others and theory of mind and mentalization in
particular (DArgembeau et al., 2012; Fonagy & Luyten,
2009; Lieberman, 2007; Lombardo et al., 2010). Hence,
congruent with the emphasis in two-polarities models on
the synergistic interaction between relatedness and self-
denition, studies in this area suggest overlap between
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neural circuits involved in social cognition with regard to
the self and others (Lombardo et al., 2010). From an
evolutionary perspective, we may speculate that the emer-
gence of the capacity to envision and reect upon the
mental states (i.e., desires, feelings, values, and goals) of
both self and others may have had an enormous advantage
for survival by enabling the development of increasingly
complex group and social structures (Allen, Fonagy, &
Bateman, 2008).
Recent research has also begun to explore the devel-
opmental interaction of cultural and biological factors in
this regard. Kim et al. (2010, 2011), for instance, found
interactions among culture, stress, emotion regulation, and
the G allele of the oxytocin receptor polymorphism
rs53576 (which is implicated in the attachment system),
providing support for the assumption of culturegene
coevolution (Chiao & Blizinsky, 2010). For example, Kim
and colleagues (2010) reported that distressed American
participants with the oxytocin receptor GG/AG genotype
sought more emotional social support, a culturally rein-
forced and valued help-seeking pattern, compared with
those with the AA genotype. In Korean participants, how-
ever, within whose culture social support seeking is not a
normative response under stress, social support seeking did
not differ by genotype. A recent review found a robust
cross-national correlation between the relative frequency of
genes implicated in social sensitivity (e.g., 5-HTTLPR,
MAOA-uVNTR, and OPRM1 A118G) and the degree of
individualism versus collectivism (Way & Lieberman,
2010). Moreover, there was also a negative correlation
between the frequency of these alleles and depression that
was mediated by collectivism, suggesting that collectivism
is related to reduced levels of depression in populations
with a high proportion of social sensitivity alleles. While
these ndings suggest that collectivism has developed in
populations that are more sensitive to social inuences, and
that these inuences buffer against depression, current
changes in cultural patterns that disturb the balance be-
tween relatedness and self-denition within a given culture,
as discussed earlier, may have a dramatic impact on the
prevalence of maladjustment and psychopathology. As
many of these societies shift toward a greater emphasis on
achievement and self-denition (individualism), with less
emphasis on social ties and social support, it can be ex-
pected that the prevalence of psychopathology will increase
as the moderating inuence of social support and collec-
tivistic attitudes more generally in these socially sensitive
populations decreasesa grim prediction that is increas-
ingly borne out by recent research ndings showing dra-
matically increased rates of depression and suicide in these
cultures (Im et al., 2011; Kwon et al., 2009; Ministerio de
Salud, Gobierno de Chile, 2010; Organisation for Eco-
nomic Co-Operation and Development, 2013).
Conclusions
The review presented in this article demonstrates that two-
polarities models provide a comprehensive theoretical
framework in which to investigate developmental continu-
ities between normal and disrupted personality develop-
ment, vulnerability for psychopathology, and responsive-
ness to psychosocial interventions. Moreover, these models
provide a theoretically informed basis for the exploration of
interactions among biological, psychological, and social
(environmental) factors in normal as well as disrupted
personality development.
Future research, rather than attempting to identify the
universal causes of specic psychiatric disorders (Blatt &
Luyten, 2009), should investigate how the interaction be-
tween sociocultural and biological factors, including neural
systems underlying the capacity for relatedness and self-
denition, are implicated in the causation and treatment of
spectra of disorders in different cultures (Cicchetti & Ro-
gosch, 1996; Luyten, Vliegen, Van Houdenhove, & Blatt,
2008). Recent work, for instance, has explored the role of
the neuropeptide oxytocin in the treatment of disorders that
are marked by severe problems in relatedness, such as
autism, schizophrenia, social phobia, and BPD (Striepens,
Kendrick, Maier, & Hurlemann, 2011). Although based on
very different assumptions, the Research Domain Criteria
initiative of the National Institute of Mental Health has
similarly proposed that future research should concentrate
on different neurobiological systems that underlie basic
psychological capacities (such as reward neurocircuity and
neural systems implicated in self-representation, theory of
mind, attachment/separation fear, and positive valence sys-
tems) rather than on discrete disorders. As one author aptly
remarked recently, it is highly unlikely that neurodevelop-
mental genes have read the DSM (Eapen, 2012). More
generally, more research on interactions between sociocul-
tural factors and neural systems underlying the normal and
disrupted development of relatedness and self-denition is
needed.
This proposed change in perspective will also require
rather dramatic changes in the strategy of scientic journals
and funding agencies. Current funding agencies and scien-
tic journals are still mainly monodisciplinary in that
despite notable attempts to foster interdisciplinary re-
searchthey still focus on a single specic discipline (e.g.,
psychology, neuroscience, anthropology, etc.) and often on
specic disorders. The views proposed in this article, how-
ever, require by denition an interdisciplinary approach,
with research focusing on the dynamics of both adaptive
and disrupted personality development across the life span
and on how disruptions in these dynamics may give rise to
different disorders and problem behaviors, at different lev-
els of analysis, from the molecular to the sociocultural
level. Similarly, with regard to intervention and prevention,
the views proposed in this article entail a shift from a
largely disorder-centered focus to a more person-centered
approach. Indeed, in the end, what is at stake is our under-
standing of how biological predispositions in interaction
with environmental inuences allow us to engage in
what makes us quintessentially human: the development
of the self and of interpersonal relationships.
179 April 2013

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