1
|
McLaren V, Gallagher M, Hopwood CJ, Sharp C. Hypermentalizing and Borderline Personality Disorder: A Meta-Analytic Review. Am J Psychother 2022; 75:21-31. [PMID: 35099264 DOI: 10.1176/appi.psychotherapy.20210018] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A hypermentalizing impairment, or tendency to overattribute mental states to others, has been identified among individuals with borderline personality disorder. However, associations between hypermentalizing and other disorders call into question the specificity of this impairment to borderline personality disorder. This study aimed to evaluate the relative strength of the association between hypermentalizing and borderline personality disorder compared with other disorders and to assess the impact of moderators on the relationship between hypermentalizing and psychopathology. METHODS The authors conducted a meta-analysis of 36 studies (N=4,188 people) to investigate the relative strength of the association between hypermentalizing and borderline personality disorder, compared with other disorders, and to assess the impact of moderators on this relationship. The Movie for the Assessment of Social Cognition, an ecologically valid experimental instrument, was used to measure hypermentalizing. RESULTS Results indicated support for an association between psychopathology and hypermentalizing (r=0.24, 95% confidence interval [CI]=0.17 to 0.31), but the association was not significantly stronger for borderline personality disorder (r=0.26, 95% CI=0.12 to 0.39) than for other disorders (r=0.24, 95% CI=0.14 to 0.33). Neither age nor gender significantly moderated the association between psychopathology and hypermentalizing. CONCLUSIONS Hypermentalizing may be related to psychopathology in general rather than borderline personality disorder in particular. The findings are discussed in view of the possibility that features of borderline personality disorder associated with other psychopathology may explain the overall association between psychopathology and hypermentalizing. Clinical implications for mentalization-based treatment and concerns that the measurement used for hypermentalization may be too narrow and not representative of variations in functioning across cultures and race-ethnicity also are discussed.
Collapse
Affiliation(s)
- Veronica McLaren
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
| | - Matthew Gallagher
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
| | - Chris J Hopwood
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston (McLaren, Gallagher, Sharp); Department of Psychology, University of California, Davis (Hopwood)
| |
Collapse
|
2
|
Haggerty G, Esang M, Salaheldin K, Lima A. The relationship between prototype ratings of personality and self and interpersonal functioning with an adolescent inpatient sample. Clin Psychol Psychother 2020; 28:364-372. [PMID: 32881158 DOI: 10.1002/cpp.2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022]
Abstract
Personality pathology is conceptualized, in part, as impairments in self and interpersonal functioning. Although most of the research has focused on adult samples, fewer have looked at this relationship in adolescent samples. This paper investigates the relationship between clinician-rated personality prototypes, the Shedler-Westen Assessment Procedure-Prototype Matching Adolescent Version (SWAP-A-P) derived from the SWAP-II-A, and a measure of self and interpersonal functioning, the Social Cognition and Object Relation Scale-Global Rating (SCORS-G). Clinicians rated 66 adolescents hospitalized at a safety net teaching hospital in the northeast. The patient's individual and group therapist rated the patients at discharge using the SWAP-A-P and the SCORS-G at discharge blind to each other's ratings. Results showed that more severe personality pathology was linked with more impairments in self and interpersonal functioning.
Collapse
Affiliation(s)
- Greg Haggerty
- Graduate Medical Education, Mather Hospital/Northwell Health, Port Jefferson, New York, USA
| | - Michael Esang
- Department of Behavioral Sciences, Nassau University Medical Center, East Meadow, New York, USA
| | - Khalid Salaheldin
- Graduate Medical Education, Mather Hospital/Northwell Health, Port Jefferson, New York, USA.,Department of Psychiatry, Mather Hospital Northwell Health
| | - Ateaya Lima
- Graduate Medical Education, Mather Hospital/Northwell Health, Port Jefferson, New York, USA.,Department of Psychiatry, Mather Hospital Northwell Health
| |
Collapse
|
3
|
Stulp HP, Glas GG, Eurelings-Bontekoe L. Validation of an implicit instrument to assess God representations. Part 2: Associations between implicit and explicit measures of God representations and object-relational functioning. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2019. [DOI: 10.1080/19349637.2019.1569490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Henk P. Stulp
- Lectorate Health Care and Spirituality, Viaa University of Applied Sciences, Zwolle, The Netherlands
| | | | | |
Collapse
|
4
|
Stulp HP, Koelen J, Glas GG, Eurelings-Bontekoe L. Construction and validation of an implicit instrument to assess God representations. Part 1: Associations between implicit and explicit God representation and distress measures. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2018. [DOI: 10.1080/19349637.2018.1489750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Henk P. Stulp
- Lectorate Health Care and Spirituality, Viaa University Zwolle, Zwolle, The Netherlands
| | - Jurrijn Koelen
- GGZ Centraal De Meregaard (Outpatient Clinic for Personality Disorders), Almere, The Netherlands
| | | | | |
Collapse
|
5
|
Lilienfeld SO, Wood JM, Garb HN. The Scientific Status of Projective Techniques. Psychol Sci Public Interest 2017; 1:27-66. [DOI: 10.1111/1529-1006.002] [Citation(s) in RCA: 459] [Impact Index Per Article: 65.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although projective techniques continue to be widely used in clinical and forensic settings, their scientific status remains highly controversial. In this monograph, we review the current state of the literature concerning the psychometric properties (norms, reliability, validity, incremental validity, treatment utility) of three major projective instruments: Rorschach Inkblot Test, Thematic Apperception Test (TAT), and human figure drawings. We conclude that there is empirical support for the validity of a small number of indexes derived from the Rorschach and TAT. However, the substantial majority of Rorschach and TAT indexes are not empirically supported. The validity evidence for human figure drawings is even more limited. With a few exceptions, projective indexes have not consistently demonstrated incremental validity above and beyond other psychometric data. In addition, we summarize the results of a new meta-analysis intended to examine the capacity of these three instruments to detect child sexual abuse. Although some projective instruments were better than chance at detecting child sexual abuse, there were virtually no replicated findings across independent investigative teams. This meta-analysis also provides the first clear evidence of substantial file drawer effects in the projectives literature, as the effect sizes from published studies markedly exceeded those from unpublished studies. We conclude with recommendations regarding the (a) construction of projective techniques with adequate validity, (b) forensic and clinical use of projective techniques, and (c) education and training of future psychologists regarding projective techniques.
Collapse
Affiliation(s)
| | | | - Howard N. Garb
- Pittsburgh Veterans Administration Health Care System and University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
6
|
Sharp C, Vanwoerden S. Hypermentalizing in Borderline Personality Disorder: A Model and Data. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/15289168.2015.1004890] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
7
|
Agressions sexuelles commises par des adolescents : relations entre des dimensions de l’organisation de la personnalité et des caractéristiques du délit. EVOLUTION PSYCHIATRIQUE 2014. [DOI: 10.1016/j.evopsy.2014.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
8
|
Haggerty G, Blanchard M, Baity MR, Defife JA, Stein MB, Siefert CJ, Sinclair SJ, Zodan J. Clinical validity of a dimensional assessment of self- and interpersonal functioning in adolescent inpatients. J Pers Assess 2014; 97:3-12. [PMID: 25010080 PMCID: PMC4281494 DOI: 10.1080/00223891.2014.930744] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Social Cognition and Object Relations Scale-Global Version (SCORS-G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS-G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS-G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS-G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS-G with adolescents.
Collapse
Affiliation(s)
- Greg Haggerty
- a Von Tauber Institute for Global Psychiatry , Nassau University Medical Center
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Borum R. Psychological vulnerabilities and propensities for involvement in violent extremism. BEHAVIORAL SCIENCES & THE LAW 2014; 32:286-305. [PMID: 24652686 DOI: 10.1002/bsl.2110] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Research on the psychology of terrorism has argued against the idea that most terrorist behavior is caused by mental illness or by a terrorist personality. This article suggests an alternative line of inquiry - an individual psychology of terrorism that explores how otherwise normal mental states and processes, built on characteristic attitudes, dispositions, inclinations, and intentions, might affect a person's propensity for involvement with violent extremist groups and actions. It uses the concepts of "mindset" - a relatively enduring set of attitudes, dispositions, and inclinations - and worldview as the basis of a psychological "climate," within which various vulnerabilities and propensities shape ideas and behaviors in ways that can increase the person's risk or likelihood of involvement in violent extremism.
Collapse
|
10
|
Roepke S, Vater A, Preißler S, Heekeren HR, Dziobek I. Social cognition in borderline personality disorder. Front Neurosci 2013; 6:195. [PMID: 23335877 PMCID: PMC3543980 DOI: 10.3389/fnins.2012.00195] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 12/21/2012] [Indexed: 12/30/2022] Open
Abstract
Many typical symptoms of borderline personality disorder (BPD) occur within interpersonal contexts, suggesting that BPD is characterized by aberrant social cognition. While research consistently shows that BPD patients have biases in mental state attribution (e.g., evaluate others as malevolent), the research focusing on accuracy in inferring mental states (i.e., cognitive empathy) is less consistent. For complex and ecologically valid tasks in particular, emerging evidence suggests that individuals with BPD have impairments in the attribution of emotions, thoughts, and intentions of others (e.g., Preißler et al., 2010). A history of childhood trauma and co-morbid PTSD seem to be strong additional predictors for cognitive empathy deficits. Together with reduced emotional empathy and aberrant sending of social signals (e.g., expression of mixed and hard-to-read emotions), the deficits in mental state attribution might contribute to behavioral problems in BPD. Given the importance of social cognition on the part of both the sender and the recipient in maintaining interpersonal relationships and therapeutic alliance, these impairments deserve more attention.
Collapse
Affiliation(s)
- Stefan Roepke
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin Berlin, Germany ; Freie Universität Berlin, Cluster of Excellence Languages of Emotion Berlin, Germany
| | | | | | | | | |
Collapse
|
11
|
Bender DS, Morey LC, Skodol AE. Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods. J Pers Assess 2012; 93:332-46. [PMID: 22804672 DOI: 10.1080/00223891.2011.583808] [Citation(s) in RCA: 332] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Personality disorders are associated with fundamental disturbances of self and interpersonal relations, problems that vary in severity within and across disorders. This review surveyed clinician-rated measures of personality psychopathology that focus on self-other dimensions to explore the feasibility and utility of constructing a scale of severity of impairment in personality functioning for DSM-5. Robust elements of the instruments were considered in creating a continuum of personality functioning based on aspects of identity, self-direction, empathy, and intimacy. Building on preliminary findings (Morey et al., 2011 /this issue), the proposed Levels of Personality Functioning will be subjected to extensive empirical testing in the DSM-5 field trials and elsewhere. The resulting version of this severity measure is expected to have clinical utility in identifying personality psychopathology, planning treatment, building the therapeutic alliance, and studying treatment course and outcome.
Collapse
Affiliation(s)
- Donna S Bender
- Department of Psychiatry, University of Arizona College of Medicine, USA.
| | | | | |
Collapse
|
12
|
Gamache D, Diguer L, Laverdière O, Rousseau JP. Development of an object relation–based typology of adolescent sex offenders. Bull Menninger Clin 2012; 76:329-64. [DOI: 10.1521/bumc.2012.76.4.329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
13
|
Stein MB, Slavin-Mulford J, Sinclair SJ, Siefert CJ, Blais MA. Exploring the Construct Validity of the Social Cognition and Object Relations Scale in a Clinical Sample. J Pers Assess 2012; 94:533-40. [DOI: 10.1080/00223891.2012.668594] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
14
|
Sekiya H, Sato A, Sakai Y, Naka Y, Suzuki K, Kashima H, Mimura M. Object relations in adolescence: a comparison of normal and inpatient adolescents. Psychiatry Clin Neurosci 2012; 66:270-5. [PMID: 22624731 DOI: 10.1111/j.1440-1819.2012.02353.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS We aimed to study the development of object relations in adolescents and their correlation with their mothers' defense styles in inpatient and normal adolescents. METHODS We administered the Thematic Apperception Test to adolescents in the adolescent unit (junior high, n = 16; senior high, n = 22) and normal controls (junior high, n = 16; senior high, n = 16). Results were analyzed using the Complexity of Representations Scale (CRS). We administered the Defense Style Questionnaire (DSQ(40)) to the subjects' mothers (patients, n = 38; controls, n = 32) to determine whether adolescents' CRS scores correlated with mothers' DSQ scores. RESULTS There was a nearly significant interaction for group-by-school-year for the children's CRS scores. In the control group, senior high school students' scores (mean [SD] = 3.52 [0.49]) were significantly higher (F [1,66] = 12.3, P = 0.001) than those of junior high school students' (mean [SD] = 3.03 [0.31]). In the patient group, no significant difference was observed between senior high and junior high. For mothers' DSQ(40), mature defense scores were significantly higher in the control group than in the patient group (mean [SD] = 10.8 [1.89] vs 9.35 [1.40] in junior high, and 11.8 [1.67] vs 9.36 [1.81] in senior high, F [1,66] = 22.1, P < 0.001, two-way ANOVA). A significant, positive correlation (r = 0.37, P = 0.04) was observed between the mothers' mature defense and the children's CRS scores in the control group only. CONCLUSIONS Whatever diagnoses are provided, the problems of adolescents with non-psychotic pathologies are related to the arrest of object relations development. A patient's mother cannot employ mature mechanisms to alleviate signals of anxiety sent by her child.
Collapse
Affiliation(s)
- Hideko Sekiya
- Department of Psychiatry, Kanto Central Hospital, Tokyo, Japan.
| | | | | | | | | | | | | |
Collapse
|
15
|
Keinänen MT, Johnson JG, Richards ES, Courtney EA. A systematic review of the evidence-based psychosocial risk factors for understanding of borderline personality disorder. PSYCHOANALYTIC PSYCHOTHERAPY 2012. [DOI: 10.1080/02668734.2011.652659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
16
|
Skodol AE, Bender DS, Morey LC, Clark LA, Oldham JM, Alarcon RD, Krueger RF, Verheul R, Bell CC, Siever LJ. Personality disorder types proposed for DSM-5. J Pers Disord 2011; 25:136-69. [PMID: 21466247 DOI: 10.1521/pedi.2011.25.2.136] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The Personality and Personality Disorders Work Group has proposed five specific personality disorder (PD) types for DSM-5, to be rated on a dimension of fit: antisocial/psychopathic, avoidant, borderline, obsessive-compulsive, and schizotypal. Each type is identified by core impairments in personality functioning, pathological personality traits, and common symptomatic behaviors. The other DSM-IV-TR PDs and the large residual category of personality disorder not otherwise specified (PDNOS) will be represented solely by the core impairments combined with specification by individuals' unique sets of personality traits. This proposal has three main features: (1) a reduction in the number of specified types from 10 to 5; (2) description of the types in a narrative format that combines typical deficits in self and interpersonal functioning and particular configurations of traits and behaviors; and (3) a dimensional rating of the degree to which a patient matches each type. An explanation of these modifications in approach to diagnosing PD types and their justifications--including excessive co-morbidity among DSM-IV-TR PDs, limited validity for some existing types, lack of specificity in the definition of PD, instability of current PD criteria sets, and arbitrary diagnostic thresholds--are the subjects of this review.
Collapse
Affiliation(s)
- Andrew E Skodol
- University of Arizona College of Medicine and Sunbelt Collaborative, 6340 N. Campbell Ave., Tucson, AZ 85718, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Preißler S, Dziobek I, Ritter K, Heekeren HR, Roepke S. Social Cognition in Borderline Personality Disorder: Evidence for Disturbed Recognition of the Emotions, Thoughts, and Intentions of others. Front Behav Neurosci 2010; 4:182. [PMID: 21151817 PMCID: PMC2999836 DOI: 10.3389/fnbeh.2010.00182] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 11/16/2010] [Indexed: 01/01/2023] Open
Abstract
Disturbed relatedness is a core feature of borderline personality disorder (BPD), and impaired social cognition or deficits in "mentalization" are hypothesized to underlie this feature. To date, only weak empirical evidence argues for impairment in the recognition of emotions, thoughts, or intentions in BPD. Data from facial emotion recognition research indicate that these abilities are altered in BPD only if tasks are complex. The present study aims to assess social cognitive abilities in BPD. Sixty-four women with BPD and 38 healthy controls watched the "Movie for the Assessment of Social Cognition" (MASC), a newly developed film displaying social interactions, and asking for an assessment of the intentions, emotions, and thoughts of the characters. In addition, participants completed an established but less ecologically valid measure of social cognition ("Reading the Mind in the Eyes"; RME). In the RME task, BPD patients did not display impairment in social cognition compared to healthy controls. By contrast, on the more sensitive MASC, women with BPD showed significantly impaired abilities in social cognition compared to healthy controls in their recognition of emotions, thoughts, and intentions. Comorbid PTSD, intrusions, and sexual trauma negatively predicted social cognitive abilities on the more sensitive MASC. Thus, our results suggest impaired social cognitive abilities in BPD. Especially for comorbid PTSD, intrusive symptoms, and history of sexual trauma predicted poor outcomes on social cognition tasks.
Collapse
Affiliation(s)
- Sandra Preißler
- Department of Psychiatry, Campus Benjamin Franklin, Charité – University Medicine BerlinBerlin, Germany
| | - Isabel Dziobek
- Max-Planck-Institute for Human Development, Neurocognition of Decision Making GroupBerlin, Germany
- Cluster of Excellence Languages of Emotion, Freie Universität BerlinBerlin, Germany
| | - Kathrin Ritter
- Department of Psychiatry, Campus Benjamin Franklin, Charité – University Medicine BerlinBerlin, Germany
| | - Hauke R. Heekeren
- Max-Planck-Institute for Human Development, Neurocognition of Decision Making GroupBerlin, Germany
- Cluster of Excellence Languages of Emotion, Freie Universität BerlinBerlin, Germany
| | - Stefan Roepke
- Department of Psychiatry, Campus Benjamin Franklin, Charité – University Medicine BerlinBerlin, Germany
- Cluster of Excellence Languages of Emotion, Freie Universität BerlinBerlin, Germany
| |
Collapse
|
18
|
Abstract
Early views of borderline personality disorder (BPD) were based on the idea that patients with this pathology were "on the border" of psychosis. However, more recent studies have not supported this view, although they have found evidence of a malevolent interpersonal evaluation and a significant proportion of BPD patients showing psychotic symptoms. For example, in one study, 24% of BPD patients reported severe psychotic symptoms and about 75% had dissociative experiences and paranoid ideation. Thus, we start with an overview regarding the prevalence of psychotic symptoms in BPD patients. Furthermore, we report findings of studies investigating the role of comorbidity (eg, post-traumatic stress disorder) in the severity and frequency of psychotic symptoms in BPD patients. We then present results of genetic and neurobiological studies comparing BPD patients with patients with schizophrenia or nonschizophrenic psychotic disorders. In conclusion, this review reveals that psychotic symptoms in BPD patients may not predict the development of a psychotic disorder but are often permanent and severe and need careful consideration by clinicians. Therefore, adequate diagnosis and treatment of psychotic symptoms in BPD patients is emphasized.
Collapse
|
19
|
Abstract
Borderline Personality Disorder (BPD) is associated with interpersonal problems, such as intense, unstable relationships and fears of abandonment. It has been hypothesized that deficits in social cognitive capacities explain these difficulties. One important aspect of social cognition is theory of mind (ToM)-the capacity to infer others' mental state. We tested ToM capacities with Happé's advanced ToM-test in 16 BPD patients, 16 Cluster-C PD patient controls, and 28 nonpatients. Social reasoning (WAIS Picture Arrangement), general intelligence, and current mood were also assessed. With and without controlling for intelligence, social reasoning, and mood, no evidence for deficits in ToM in BPD patients was found. In fact, both Cluster B and Cluster C patient groups tended to show generally superior performance to the nonpatients on the subscales of Happé ToM-test. All tests correlated similarly with intelligence in the 3 groups. These findings do not support the hypothesis that BPD patients have inferior theory of mind capacities.
Collapse
|
20
|
A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol 2009; 21:1355-81. [PMID: 19825272 DOI: 10.1017/s0954579409990198] [Citation(s) in RCA: 479] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe precise nature and etiopathogenesis of borderline personality disorder (BPD) continues to elude researchers and clinicians. Yet, increasing evidence from various strands of research converges to suggest that affect dysregulation, impulsivity, and unstable relationships constitute the core features of BPD. Over the last two decades, the mentalization-based approach to BPD has attempted to provide a theoretically consistent way of conceptualizing the interrelationship between these core features of BPD, with the aim of providing clinicians with a conceptually sound and empirically supported approach to BPD and its treatment. This paper presents an extended version of this approach to BPD based on recently accumulated data. In particular, we suggest that the core features of BPD reflect impairments in different facets of mentalization, each related to impairments in relatively distinct neural circuits underlying these facets. Hence, we provide a comprehensive account of BPD by showing how its core features are related to each other in theoretically meaningful ways. More specifically, we argue that BPD is primarily associated with a low threshold for the activation of the attachment system and deactivation of controlled mentalization, linked to impairments in the ability to differentiate mental states of self and other, which lead to hypersensitivity and increased susceptibility to contagion by other people's mental states, and poor integration of cognitive and affective aspects of mentalization. The combination of these impairments may explain BPD patients' propensity for vicious interpersonal cycles, and their high levels of affect dysregulation and impulsivity. Finally, the implications of this expanded mentalization-based approach to BPD for mentalization-based treatment and treatment of BPD more generally are discussed.
Collapse
|
21
|
|
22
|
Kernhof K, Kaufhold J, Grabhorn R. Object Relations and Interpersonal Problems in Sexually Abused Female Patients: An Empirical Study With the SCORS and the IIP. J Pers Assess 2008; 90:44-51. [DOI: 10.1080/00223890701693728] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
23
|
Parental representations, object relations and their relationship to Depressive Personality Disorder and Dysthymia. PERSONALITY AND INDIVIDUAL DIFFERENCES 2007. [DOI: 10.1016/j.paid.2007.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
24
|
Lerner PM, Lerner HD. A Psychoanalytic Clinician Looks at Diagnostic Labels and Diagnostic Classification Systems. J Pers Assess 2007; 89:70-81. [PMID: 17604535 DOI: 10.1080/00223890701357340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As psychoanalytic clinicians, we do not believe that assessment should be diagnosis based. However, we are supportive of attempts to create a diagnostic classification system that reflects something essential about human nature and also serves clinical purposes. In this article, we present a psychoanalytic diagnostic scheme that combines a more descriptive characterological diagnosis with a more structural level of personality organization diagnosis. The scheme is applied to a clinical case and then we discuss it in terms of the functions such a scheme provides for assessment.
Collapse
Affiliation(s)
- Paul M Lerner
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI 48104, USA
| | | |
Collapse
|
25
|
Bradley R, Westen D. The psychodynamics of borderline personality disorder: a view from developmental psychopathology. Dev Psychopathol 2006; 17:927-57. [PMID: 16613425 DOI: 10.1017/s0954579405050443] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article provides a contemporary view of the psychodynamics of borderline personality disorder (BPD) from a developmental psychopathology perspective. We first briefly describe the evolution of the borderline construct in psychoanalysis and psychiatry. Then we provide clinically and empirically informed model of domains of personality function and dysfunction that provides a roadmap for thinking about personality pathology from a developmental psychopathology standpoint and examine the nature and phenomenology of BPD in terms of these domains of functioning. Next, we describe prominent dynamic theories of etiology of BPD and examine these in relation to the available research. Finally, we describe psychodynamic conceptions of treatment and the way BPD phenomena manifest in treatment, followed again by consideration of relevant research, particularly on transference-countertransference constellations empirically identified in the treatment of patients with BPD.
Collapse
|
26
|
Sieswerda S, Arntz A, Wolfis M. Evaluations of emotional noninterpersonal situations by patients with borderline personality disorder. J Behav Ther Exp Psychiatry 2005; 36:209-25. [PMID: 15950931 DOI: 10.1016/j.jbtep.2005.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
According to cognitive models of borderline personality disorder (BPD), an important cause for the instability of patients with BPD is dichotomous thinking (DT). Object-relation theories assume that the similar phenomenon of splitting is central in BPD. Previous studies focusing on interpersonal situations found support for DT being prominent in BPD. The aim of this study was to investigate whether patients with BPD also make use of dichotomous and schema-specific evaluations in noninterpersonal situations. An experiment was designed in which a frustrating and rewarding situation was induced by computer games that subjects had to play. Participants evaluated both themselves and the games. Patients with BPD (n=24) were characterized by somewhat more extreme game evaluations in the emotionally negative situations than normal controls (n=25), participants with a cluster C (n=10) or an anti-social personality disorder (ASPD) (n=16). Patients with BPD appeared to be characterized best by a general negative evaluative style, more than by DT or splitting. ASPD participants showed a positivity bias in both conditions.
Collapse
Affiliation(s)
- Simkje Sieswerda
- Department of Medical, Clinical and Experimental Psychology, Maastricht University, Maastricht, The Netherlands.
| | | | | |
Collapse
|
27
|
Bradley R, Zittel Conklin C, Westen D. The borderline personality diagnosis in adolescents: gender differences and subtypes. J Child Psychol Psychiatry 2005; 46:1006-19. [PMID: 16109003 DOI: 10.1111/j.1469-7610.2004.00401.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to identify personality features characterizing adolescent girls and boys with borderline personality disorder (BPD) and to see whether meaningful patterns of heterogeneity exist among adolescents diagnosed with the disorder. METHODS Two hundred and ninety-four randomly selected doctoral-level clinicians described adolescent patients using Axis II rating scales and the Shedler-Westen Assessment Procedure-200 for Adolescents (SWAP-200-A). We used the SWAP-200-A to provide empirically derived descriptions of female and male adolescents meeting DSM-IV criteria for BPD (who differed substantially in their profiles), and used Q-factor analysis to identify naturally occurring groupings of female patients based on shared personality features. RESULTS The symptoms and phenomenology of adolescent girls with BPD are similar to those of adults. Adolescent boys meeting BPD criteria have a more aggressive, disruptive, antisocial presentation. Although Ns did not permit further analysis of the data on adolescent boys, Q-analysis isolated four clinically coherent subgroups of girls with BPD: high-functioning internalizing, histrionic, depressive internalizing, and angry externalizing. CONCLUSIONS BPD in female adolescents resembles DSM-IV BPD as defined for adults. The operating characteristics of the DSM-IV criteria for adolescent boys require further investigation. Empirically derived subgroups are similar to those identified in recent research with adult females. Differences across subgroups on internalizing and externalizing Child Behavior Checklist (CBCL) scales provide preliminary data on the validity of subgroups and raise questions about the place of BPD among internalizing and externalizing spectrum disorders.
Collapse
Affiliation(s)
- Rebekah Bradley
- Department of Psychiatry, Emory University, Atlanta, GA, USA.
| | | | | |
Collapse
|
28
|
Weise KL, Tuber S. The Self and Object Representations of Narcissistically Disturbed Children: An Empirical Investigation. PSYCHOANALYTIC PSYCHOLOGY 2004. [DOI: 10.1037/0736-9735.21.2.244] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
29
|
Vellutino FR, Fletcher JM, Snowling MJ, Scanlon DM. Specific reading disability (dyslexia): what have we learned in the past four decades? J Child Psychol Psychiatry 2004; 45:2-40. [PMID: 14959801 DOI: 10.1046/j.0021-9630.2003.00305.x] [Citation(s) in RCA: 1054] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We summarize some of the most important findings from research evaluating the hypothesized causes of specific reading disability ('dyslexia') over the past four decades. After outlining components of reading ability, we discuss manifest causes of reading difficulties, in terms of deficiencies in component reading skills that might lead to such difficulties. The evidence suggests that inadequate facility in word identification due, in most cases, to more basic deficits in alphabetic coding is the basic cause of difficulties in learning to read. We next discuss hypothesized deficiencies in reading-related cognitive abilities as underlying causes of deficiencies in component reading skills. The evidence in these areas suggests that, in most cases, phonological skills deficiencies associated with phonological coding deficits are the probable causes of the disorder rather than visual, semantic, or syntactic deficits, although reading difficulties in some children may be associated with general language deficits. Hypothesized deficits in general learning abilities (e.g., attention, association learning, cross-modal transfer etc.) and low-level sensory deficits have weak validity as causal factors in specific reading disability. These inferences are, by and large, supported by research evaluating the biological foundations of dyslexia. Finally, evidence is presented in support of the idea that many poor readers are impaired because of inadequate instruction or other experiential factors. This does not mean that biological factors are not relevant, because the brain and environment interact to produce the neural networks that support reading acquisition. We conclude with a discussion of the clinical implications of the research findings, focusing on the need for enhanced instruction.
Collapse
Affiliation(s)
- Frank R Vellutino
- The State University of New York at Albany, Child Research and Study Center, Department of Educational Psychology and Statistics, New York 12222, USA.
| | | | | | | |
Collapse
|
30
|
Pessimism and failure in 6-part stories: indicators of borderline personality disorder? ARTS IN PSYCHOTHERAPY 2004. [DOI: 10.1016/j.aip.2004.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
31
|
Abstract
In this paper, we review the empirical publications from the 1990s on the assessment of object relations (OR). Twelve different measures are referenced. Major findings of studies, conclusions, and evaluations of each measure are provided. In general, it was found that the most recent empirical literature has compared OR across diagnostic groups or evaluated therapy process and outcome by the quality of one's OR. Current strengths and limitations of the extant OR literature are provided, along with methodological recommendations to expand the utility and validity of OR assessment.
Collapse
Affiliation(s)
- Steven K Huprich
- Department of Psychology and Neuroscience, Baylor University, PO Box 97334, Waco, TX 76798-7334, USA.
| | | |
Collapse
|
32
|
Hibbard S. A critique of Lilienfeld et al.'s (2000) "The scientific status of projective techniques". J Pers Assess 2003; 80:260-71. [PMID: 12763700 DOI: 10.1207/s15327752jpa8003_05] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Lilienfeld, Wood, and Garb (2000) published a largely negative critique of the validity and reliability of projective methods, concentrating on the Comprehensive System for the Rorschach (Exner, 1993), 3 systems for coding the Thematic Apperception Test (TAT; Murray, 1943) cards, and human figure drawings. This article is an effort to document and correct what I perceive as errors of omission and commission in the Lilienfeld et al. article. When projective measures are viewed in the light of these corrections, the evidence for the validity and clinical usefulness of the Rorschach and TAT methods is more robust than Lilienfeld et al. represented.
Collapse
Affiliation(s)
- Stephen Hibbard
- Department of Psychology, University of Windsor, Ontario, Canada.
| |
Collapse
|
33
|
Niec LN, Russ SW. Children's internal representations, empathy, and fantasy play: a validity study of the SCORS-Q. Psychol Assess 2002; 14:331-8. [PMID: 12214439 DOI: 10.1037/1040-3590.14.3.331] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors investigated relationships among internal representations, empathy, and affective and cognitive processes in fantasy play to test the validity of the Social Cognition and Object Relations Scale Q-Sort (SCORS-Q; D. Westen, 1995) with children. Eighty-six 8-10-year-olds were administered 8 Thematic Apperception Test cards, a standardized play task, and a self-report empathy measure. Teachers rated children's empathy and helpfulness. As predicted, internal representations were related to empathy, helpfulness, and quality of fantasy play. Developmental differences on the SCORS-Q were consistent with object relations theory and with results from the original SCORS. The findings support the value of internal representations as a means of understanding children's interpersonal functioning and contribute to the validity of the SCORS-Q for use with children.
Collapse
Affiliation(s)
- Larissa N Niec
- Department of Psychology, Central Michigan University, Mt. Pleasant, Michigan 48859, USA.
| | | |
Collapse
|
34
|
Abstract
The author investigated the extent to which self-reported early object loss and Thematic Apperception Test (TAT) measures of object relations differentiated individuals with a depressive personality from dysthymic persons and highly dependent individuals. In an undergraduate analogue sample of 54 students, those with a depressive personality reported a nonsignificantly higher proportion of object loss than did dysthymic and highly dependent participants. Those in the depressive personality and dependent groups had less complex representations of others than did those with dysthymia, and those with a depressive personalitiy and dysthymia tended to view others in a more negative, pessimistic fashion than did the highly dependent individuals. The author concludes that persons with a depressive personality can be identified, in part, by their experience of object loss and their distinctive object relations.
Collapse
Affiliation(s)
- S K Huprich
- Department of Psychology and Neuroscience, Baylor University, PO Box 97334, Waco, TX 76798-7334, USA.
| |
Collapse
|
35
|
Wood FB, Grigorenko EL. Emerging issues in the genetics of dyslexia: a methodological preview. JOURNAL OF LEARNING DISABILITIES 2001; 34:503-511. [PMID: 15503565 DOI: 10.1177/002221940103400603] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A review of the classic and recent evidence on the genetics of reading disability (RD) shows encouraging progress, and accumulating evidence of genetic risk factors that operate within families and are separately localizable to more than one chromosomal region. The accelerating pace of these findings, however, suggests the need to consider some methodological issues about the design and interpretation of current and future studies. A major issue is the shape of the distribution of reading ability in the population, and we offer three tests of increasing rigor for determining whether those distributions are categorical, and hence not suitable for analyses that depend on the assumption of a continuous normal distribution. These tests are as follows: a nonnormal preponderance of cases with RD (i.e., the hump in the lower end of the distribution); a difference in the within-group variance-covariance matrices for typical readers compared to those with RD; and a correlation between a neurogenetically relevant criterion and a categorical reading variable that is larger than the correlation between the same criterion and a continuous version of the same reading variable. We emphasize also the importance of interactive relationships between multiple genetic loci, the variations in genotypic range as well as type of affectedness, the need to account for remediation variance, and the importance of lifespan changes in the phenotypes.
Collapse
Affiliation(s)
- F B Wood
- Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1043, USA
| | | |
Collapse
|
36
|
Ackerman SJ, Hilsenroth MJ, Clemence AJ, Weatherill R, Fowler JC. Convergent validity of Rorschach and TAT scales of object relations. J Pers Assess 2001; 77:295-306. [PMID: 11693860 DOI: 10.1207/s15327752jpa7702_11] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The Rorschach Mutuality of Autonomy Scale (MOA) and the Social Cognition and Object Relations Scale (SCORS) have been shown to be reliable and valid measures of interpersonal functioning. Utilizing a sample of 57 outpatients with a Diagnostic and Statistical Manual of Mental Disorders Axis II diagnosis, this study extends the findings of previous research demonstrating the reliability and convergent validity of each measure. Analyses focused on the convergent validity between the Rorschach MOA Scale and 8 SCORS variables (complexity, affect, emotional investment in relationships, emotional investment in values and morals, understanding of social causality, management of impulses/aggression, self-esteem, identity/coherence of self) ratings of Thematic Apperception Test narratives. The conceptual nature and clinical utility of these findings are discussed in relation to psychological assessment.
Collapse
Affiliation(s)
- S J Ackerman
- Massachusetts Mental Health Center and Harvard Medical School, Boston 02115, USA.
| | | | | | | | | |
Collapse
|
37
|
Crawford TN, Cohen P, Brook JS. Dramatic-erratic personality disorder symptoms: I. Continuity from early adolescence into adulthood. J Pers Disord 2001; 15:319-35. [PMID: 11556699 DOI: 10.1521/pedi.15.4.319.19182] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This longitudinal study examined dramatic-erratic personality disorder symptoms (histrionic, borderline, and narcissistic symptoms) in a community sample of 407 adolescents to assess whether this diagnostic construct is meaningful in young people. Based on latent variable models and dimensional symptom scales, these so-called Cluster B symptoms were highly stable across an eight-year interval from early adolescence to early adulthood. Furthermore, when compared with internalizing and externalizing symptoms, dramatic-erratic symptoms were more stable over time than these well-established Axis I symptom clusters. Based on high correlations with co-occurring internalizing and externalizing symptoms, Cluster B symptoms clearly reflect emotional distress during adolescence. These analyses reinforce recent efforts to establish personality disorders as a clinically significant and valid diagnostic construct in young people.
Collapse
|
38
|
Porcerelli JH, Abramsky MF, Hibbard S, Kamoo R. Object relations and defense mechanisms of a psychopathic serial sexual homicide perpetrator: a TAT analysis. J Pers Assess 2001; 77:87-104. [PMID: 11562106 DOI: 10.1207/s15327752jpa7701_06] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The case of a 24-year-old African American man who committed serial sexual homicide and who met criteria (Hare, 1991) for psychopathy is presented. His Thematic Apperception Test (Murray, 1943) responses were used to code key aspects of personality organization--object relations and defense mechanisms--via the Social Cognition and Object Relations Scale (Westen, Lohr, Silk, & Kerber, 1989) and the Defense Mechanisms Manual (Cramer, 1991), respectively. Severe object relations pathology and a reliance on the defense mechanism of immature projection and immature denial are noted. Findings are relatively consistent with previous psychodynamic Rorschach studies of psychopathic sexual homicide perpetrators (Gacono, Meloy, & Bridges, 2000; Meloy, Gacono, & Kenney, 1994).
Collapse
Affiliation(s)
- J H Porcerelli
- Department of Family Medicine, Wayne State University School of Medicine, Detroit, MI 48235, USA.
| | | | | | | |
Collapse
|
39
|
Abstract
This study investigated evaluations of other people in specific emotional situations by patients with borderline personality disorder (BPD). BPD patients (N = 16), control patients with cluster C personality disorder (PD; N = 12) and normal controls (N = 15) saw film clips with emotional themes centering on abandonment, rejection and abuse, hypothesized to be specific for borderline pathology. Subjects wrote down their spontaneous reactions to six film personalities, divided over three clips, including what they thought to be characteristic traits of these persons. Spontaneous reactions were coded on two dimensions, based on earlier studies by Westen and colleagues: a) affect-tone of ascribed qualities and b) complexity of evaluations of people. The number of trait dimensions constituted the third scale. The overall pattern of findings suggests that the BPD group, as well as the cluster C group, show poorly differentiated evaluations with a low number of dimensions. Thus, this seems characteristic for personality disorders in general. The BPD group shows a lower affect-tone, reflecting a stronger tendency to view others negatively, compared with both control groups.
Collapse
Affiliation(s)
- A Arntz
- Department of Experimental, Clinical and Medical Psychology, University of Maastricht, The Netherlands
| | | |
Collapse
|
40
|
Bruscato WL, Iacoponi E. Validade e confiabilidade da versão brasileira de um inventário de avaliação de relações objetais . BRAZILIAN JOURNAL OF PSYCHIATRY 2000. [DOI: 10.1590/s1516-44462000000400006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introdução: Relação objetal tem sido um conceito fértil para a psicanálise e para a psiquiatria. O reconhecimento crescente do valor diagnóstico do conceito de relação objetal nos transtornos psiquiátricos tem levado ao desenvolvimento de várias escalas que pretendem mensurá-lo. O estudo teve o propósito de produzir os índices de validade e confiabilidade da versão em português de um instrumento amplamente usado, planejado para avaliar relações objetais, o Bell Object Relations and Reality Testing Inventory (BORRTI - Form O). Métodos: A amostra foi composta de 218 estudantes de graduação de psicologia. Uma análise fatorial exploratória obteve, com sucesso, as quatro dimensões descritas nos estudos originais. Resultados: Estas dimensões demonstraram boa correlação dos escores quando comparadas às respectivas dimensões da versão em inglês do BORRTI - Forma O (0,62 para alienação, 0,82 para vinculação insegura, 0,83 para egocentrismo e 0,78 para incapacidade social). Os escores de confiabilidade também foram aceitáveis, com um valor alpha de Cronbach para todos os itens de 0,59 e confiabilidade split-half Spearman-Brown de 0,63. Conclusões: Tornando estes índices disponíveis, o estudo pode contribuir para a escolha adequada de escalas que investiguem relações objetais no Brasil.
Collapse
Affiliation(s)
| | - Eduardo Iacoponi
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil
| |
Collapse
|
41
|
Ackerman SJ, Clemence AJ, Weatherill R, Hilsenroth MJ. Use of the TAT in the assessment of DSM-IV cluster B personality disorders. J Pers Assess 1999; 73:422-48. [PMID: 10689653 DOI: 10.1207/s15327752jpa7303_9] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The Social Cognition and Object Relations Scale (SCORS), developed by Western, Lohr, Silk, Kerber, and Goodrich (1985), is a diagnostic instrument used to assess an array of psychological functioning by using clinical narratives such as the Thematic Apperception Test (TAT; Murray, 1943) stories. This study investigated the utility of the SCORS to differentiate between Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) antisocial personality disorder (ANPD), borderline personality disorder (BPD), narcissistic personality disorder (NPD), and Cluster C personality disorder (CPD). A sample of 58 patients was separated into four groups: ANPD (n = 9), BPD (n = 21; 18 with a primary BPD diagnosis and 3 with prominent borderline traits who met 4 of the 5 DSM-IV criteria necessary for a BPD diagnosis), NPD (n = 16; 8 with a primary NPD diagnosis and 8 with prominent narcissistic traits who met 4 of the 5 DSM-IV criteria necessary for a NPD diagnosis), and CPD (n = 12). These groups were then compared on the 8 SCORS variables by using 5 TAT cards (1, 2, 3BM, 4, and 13MF). Spearman-Brown correction for 2-way mixed effects model of reliability for the 8 SCORS variables ranged from .70 to .95. The results of categorical and dimensional analyses indicate that (a) SCORS variables can be used to differentiate ANPD, BPD, and NPD; (b) the BPD group scored significantly lower (greater maladjustment) than did the CPD group on certain variables; (c) the BPD group scored significantly lower (greater maladjustment) than did the NPD group on all 8 SCORS variables; (d) the ANPD group scored significantly lower than did the NPD group on certain variables; (e) certain variables were found to be empirically related to the total number of DSM-IV ANPD, BPD, and NPD criteria; and (f) certain variables were found to be empirically related to Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Personality disorder scales. The results of this study are discussed in terms of clinical utility, conceptual, and theoretical implications.
Collapse
Affiliation(s)
- S J Ackerman
- Department of Psychology, University of Arkansas, USA.
| | | | | | | |
Collapse
|
42
|
|
43
|
James A, Berelowitz M, Vereker M. Borderline personality disorder: study in adolescence. Eur Child Adolesc Psychiatry 1996; 5:11-7. [PMID: 9117533 DOI: 10.1007/bf00708209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The study of the presentation, symptomatology and family characteristics of an exclusively adolescent sample of patients with borderline personality disorder (BPD) was undertaken. Twenty-four cases of borderline personality disorder, 20 females, 4 males, identified using chart review and meeting the criteria of the Diagnostic Interview for Borderlines (DIB) and DSM III-R, were matched with psychiatric controls. Adolescents with borderline personality disorder were found to have high rates of affective symptomatology with Axis I diagnosis of major depressive disorder MDD (DSM-III-R), and high rates of interpersonal psychopathology, i.e., manipulation, devaluation, and a pervasive sense of boredom. The latter seem to be characteristic as for adults with borderline personality disorder. The families were particularly angry and volatile.
Collapse
Affiliation(s)
- A James
- Highfield Family and Adolescent Unit, The Warnford Hospital, Oxford, England
| | | | | |
Collapse
|
44
|
On the thin line between connection and separation: The individuation process, from cognitive and object-relations perspectives, in kibbutz adolescents. J Youth Adolesc 1993. [DOI: 10.1007/bf01537136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Leigh J, Westen D, Barends A, Mendel MJ, Byers S. The Assessment of Complexity of Representations of People Using TAT and Interview Data. J Pers 1992. [DOI: 10.1111/j.1467-6494.1992.tb00275.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
46
|
Block MJ, Westen D, Ludolph P, Wixom J, Jackson A. Distinguishing female borderline adolescents from normal and other disturbed female adolescents. Psychiatry 1991; 54:89-103. [PMID: 2023977 DOI: 10.1080/00332747.1991.11024535] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PSYCHOANALYTIC theory would suggest that differentiating the borderline adolescent from his or her normal peers should be a difficult task. In many respects the developmental crises of adolescence dovetail with critical conflicts of Borderline Personality Disorder--e.g., identity formation and separation-individuation. Extensive semi-structured interviews (Gunderson's Diagnostic Interview for Borderlines) of normal, borderline and other disturbed adolescents provide a data base for examining the hallmarks of borderline pathology in adolescence. This paper focuses on the qualitative differences in patterns of impulsivity, affective lability, dissociative experience, and interpersonal relationships that distinguish borderline teenagers from other seriously disturbed and normal adolescents. The paper also outlines modifications in the Gunderson interview for an adolescent population.
Collapse
Affiliation(s)
- M J Block
- Department of Psychology, University of Michigan, Ann Arbor
| | | | | | | | | |
Collapse
|
47
|
Cognitive-behavioral interventions in the psychoanalytic psychotherapy of borderline personality disorders. Clin Psychol Rev 1991. [DOI: 10.1016/0272-7358(91)90101-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
48
|
Stuart J, Western D, Lohr N, Benjamin J, Becker S, Vorus N, Silk K. Object Relations in Borderlines, Depressives, and Normals: An Examination of Human Responses on the Rorschach. J Pers Assess 1990. [DOI: 10.1207/s15327752jpa5501&2_28] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|