Perrotta Affective Dependence Questionnaire (PAD-Q): Clinical framing of the affective-sentimental relational maladaptive model

Starting from the concept of “affective dependence”, this work has shown that this nosography cannot be reduced to a categorization in the list of behavioral dependencies, even if it has in common clinical and neurobiological aspects that could be misleading. In fact, the dependent manifestation is nothing more than a symptom that from time to time represents a specifi c element in various personality disorders, becoming the central focus of dependent personality disorder. The analytical approach must, therefore, be multidimensional, precisely to better understand all aspects of affective dependence and how it colors the manifested disorder from time to time. From affective dependence to personality disorders, in relation to the dynamics of human bonding, to the implications determined by attachment theory, in a framework of diagnostic transversality, to the best possible therapy, always integrated between psychopharmacology and psychotherapy. The Perrotta Affective Dependence Questionnaire (PAD-Q), with 35 items, on a 0-5 scale, aims to study the phenomenon of “affective dependence”, defi ning it instead as a maladaptive model of the affective-sentimental relationship of a couple, which involves the establishment or persistence of a clinically signifi cant bond, lasting at least six months and characterized by a functional impairment of the relational area, the emotional area and the somatic area. Research Article Perrotta Affective Dependence Questionnaire (PAD-Q): Clinical framing of the affective-sentimental relational maladaptive model Giulio Perrotta* Psychologist sp.ing in Strategic Psychotherapy, Forensic Criminologist, Legal Advisor sp.ed SSPL, Researcher, Essayist, Institute for the study of psychotherapies ISP, Via San Martino della Battaglia no. 31, 00185, Rome, Italy Received: 12 April, 2021 Accepted: 09 July, 2021 Published: 10 July, 2021 *Corresponding author: Dr. Giulio Perrotta, Psychologist sp.ing in Strategic Psychotherapy, Forensic Criminologist, Legal Advisor sp.ed SSPL, Researcher, Essayist, Institute for the study of psychotherapies ISP, Via San Martino della Battaglia no. 31, 00185, Rome, Italy, E-mail: ORCID: https://orcid.org/0000-0003-0229-5562 https://www.peertechzpublications.com


Contents of the manuscript
General introduction: the «affective dependence» Generally, when we indicate alterations in the emotionalaffective tone we refer to a whole series of morbid conditions, which have a dysfunctional tone as a common basis; just think of anxiety disorders, among which we fi nd panic, phobias, separation anxiety (at the basis of many psychotic and personality disorders) and generalized anxiety, eating disorders, obsessive-compulsive disorder, post-traumatic stress disorders, somatic syndromes, mood disorders (such as depression, dysthymia, cyclothymia, and suicidal risk), behavioral and substance addictions, bipolar disorder, paraphilic disorder and also a large part of personality disorders. And it is precisely in personality disorders that dysfunctional affectivity becomes a real addiction, often confused even by technicians and therapists (and wrongly treated in psychotherapies) as a new "behavioral addiction" (the so-called "love addiction"), according to one's perception of reality, until it evolves into the largest form: the "personality addiction disorder". Although affective addiction, due to a lack of experimental data, is not repeated painful love relationships characterised by insecure attachment [2]. However, he too did not consider affective dependence as a symptom of a broader picture, but simply a dependence linked to the affective, sentimental and sexual sphere, reducing it in an excessively simplistic way.
Millon also identifi ed the fi ve subtypes of dependent personality disorder: [3]: In clinical practice, we frequently encounter patients who are unable to break off deeply destructive intimate relationships that cause them suffering and compromise their lives on various levels; this condition is classifi ed as "affective dependence" [4][5][6][7] However, this behavioral expression is common to many personality disorders, such as dependent disorder [8], histrionic disorder [9], borderline disorder [10] and narcissistic disorder [11]. Indeed: in the dependent disorder, the main feature is precisely that of the toxic and destructive bond that reinforces one's personality tendency, as in a vicious circle; in the histrionic disorder, the affective dependence is functional to its tendency to dramatize, to try to capture the impression or attention of others, to continue to feed potentially useful situations to maintain its real or fi ctitious bond with the third party; in the hypothesis of borderline disorder, affective dependence is necessary to continue to maintain the bond with the person on levels of high instability, favoring fi rst a morbid attachment and then a clear separation, alternating these behaviors in synchrony; fi nally, in narcissistic disorder, the patient implements modes of affective dependence in the hypothesis of "covert" narcissism, that is, the form that provides low self-esteem and high sensitivity to criticism [12][13][14][15][16][17][18].

Perrotta Affective Dependence Questionnaire (PAD-Q)
Starting from the concept of "affective dependence" and its international nosographic framework, the Perrotta Aff ective Dependence Questionnaire (PAD-Q) aims to study the phenomenon of "affective dependence", defi ning it as a maladaptive model of the affective-sentimental relationship of a couple, which involves the establishment or persistence of a clinically signifi cant bond, lasting at least six months and characterized by a functional impairment of the relational area, the emotional area and the somatic area.
In particular, the passive subject of the relationship, suffering from emotional dependence, experiences the following symptomatological picture: a) "relational area": relational dependence/codependence, assumption of other people's responsibility with signifi cant delegation, excessive justifi cation of the partner's injurious, offensive or disparaging conduct, dynamics of psychophysical submission or subordinate relationship, excessive need for reassurance, attention or relational certainty, unfounded fear of abandonment. b) "somatic area": malaise emotional, relational, affective, sentimental and physical, excessive tolerance in relation to episodes harmful, abusive or disparaging of the partner, masochistic dynamics. c) "emotional area": inability to manage anxiety, low tolerance to frustration, emotional instability, need for control, unmotivated fears, low self-esteem, verbal and/ or physical denigration, obsessive and/or delusional episodes.
Affective addiction, not being a well-identifi ed psychopathological label in the international nosographic framework, except in the general framework of behavioral addictions, in this context is identifi ed as a maladaptive behavioral model that describes a series of personality traits afferent to several nosographically recognized psychopathological disorders. In particular, according to this excellent, the patient who will present to the proposed questionnaire the following total overall scores will receive the following diagnoses:

4)
Dysfunctional Inclination: 66 -80. The completion of the questionnaire must be done by the therapist, after the drafting of the previous history [19][20][21][22][23] and clinical interview and serves to better defi ne the general framework based on the symptoms reported and possibly found, which can range from neurotic to bordeline and psychotic .

5)
The above psychopathological types do not recall any international nosographics of mental disorders equally named but simply recall, by personality traits, such disorders, which to be diagnosed in their complexity need further psychometric investigations; complexity that can also be studied through the newly proposed PICI-1 model [53][54][55][56]. (Appendix)