A scale for the assessment of object relations: reliability, validity, and factorial invariance

Ego Defense Mechanisms and Types of Object Relations in Adults With ADHD

OBJECTIVE

This research evaluates the personality structure of adults with ADHD from a psychodynamic perspective. The hypothesis was that possible structural characteristics in personality could be correlated with this syndrome.

METHOD

Assessment tools for ego functions (Bell Object Relations and Reality Testing Inventory [BORRTI-Form O], Defense Style Questionnaire ( DSQ-40)) were applied to a sample of 90 adults with ADHD, recruited in a specialized clinic.

RESULTS

Among the ADHD sample, 84.4% of the participants were identified as having object relations pathologies. Pathological elevations were observed mainly in the Alienation, Egocentricity, and Insecure Attachment subscales. Statistically, significant differences were found especially in the use of immature and neurotic defense mechanisms, compared with normative data.

CONCLUSION

The findings indicate that adults with ADHD make more use of immature and neurotic defense mechanisms, and presented pathological internalized object relations that are typical of an archaic and poorly structured egoic structure.

Measuring Continued Attachment to Parents: The Continued Attachment Scale—Parent Version

Continued attachment to parents has correlated with measures of adjustment in both school and peer situations at least through the transition to college. The measurement of parental attachment has relied primarily on self-reports of the quality of the parental relationship in terms of support, encouragement, autonomy, and dependency. Bowlby's original theory and research relied more on reactions to separation, which Berman called “attachment distress” in adults. The present study examined the psychometric properties of the Continued Attachment Scale—Parent version which measures cognitive and emotional responses to the perceived separation from parents. Data from 216 college students were collected on the scale as well as several scales selected to evaluate convergent and construct validities. The scale showed good reliability. Scores were highly correlated with attachment scale scores that measure support, encouragement, and closeness. Correlations with measures of emotional state and personality differed for men and women but generally suggested that the scale assesses a distinct domain of experience related to continued closeness to parents and to depression.

Do subfertile women adjust their habits when trying to conceive?

AIM

The aim of this study was to investigate lifestyle habits and lifestyle adjustments among subfertile women trying to conceive.

MATERIALS AND METHODS

Women (n = 747) were recruited consecutively at their first visit to fertility clinics in mid-Sweden. Participants completed a questionnaire. Data were analyzed using logistic regression, t tests, and chi-square tests.

RESULTS

The response rate was 62% (n = 466). Mean duration of infertility was 1.9 years. During this time 13.2% used tobacco daily, 13.6% drank more than three cups of coffee per day, and 11.6% consumed more than two glasses of alcohol weekly. In this sample, 23.9% of the women were overweight (body mass index, BMI 25-29.9 kg/m(2)), and 12.5% were obese (BMI ≥30 kg/m(2)). Obese women exercised more and changed to healthy diets more frequently than normal-weight women (odds ratio 7.43; 95% confidence interval 3.7-14.9). Six out of ten women (n = 266) took folic acid when they started trying to conceive, but 11% stopped taking folic acid after some time. Taking folic acid was associated with a higher level of education (p < 0.001).

CONCLUSIONS

Among subfertile women, one-third were overweight or obese, and some had other lifestyle factors with known adverse effects on fertility such as use of tobacco. Overweight and obese women adjusted their habits but did not reduce their body mass index. Women of fertile age would benefit from preconception counseling, and the treatment of infertility should routinely offer interventions for lifestyle changes.

Impairments in Object Relations and Chronicity of Suicidal Behavior in Individuals With Borderline Personality Disorder

While studies have demonstrated connections between impairments in object relations and self-destructive behaviors in individuals with borderline personality disorder (BPD), few have investigated whether these impairments relate to actual suicidal behaviors. The current study utilized the Social Cognition and Object Relations Scale-Global Method to investigate object relational functioning and suicidal behaviors in 131 residential treatment patients. Cognitive but not affective aspects of internalized representations predicted past suicidal behavior in BPD subjects; no relationships were found between quality of object representations and suicide in other-PD subjects. Implications of these findings for research, theory, and treatment of suicidal individuals are discussed.

Second-generation Holocaust survivors: Psychological, theological, and moral challenges

Drawing from trauma theory, psychodynamic conceptualization, developmental psychology, clinical data, and personal experience, this article portrays a life haunted by tragedy predating its victims. Healthy child development is outlined, with particular attention to socialization and theological perspectives. Key characteristics of trauma are delineated, highlighting the nuances of trauma that are most harmful. As is the case with general trauma, Holocaust survivors are described as evincing survivor's guilt and paranoia in response to their experiences. Divergent disorders resulting from the Holocaust are described for 1st-generation and 2nd-generation survivors, respectively. Primary trauma responses and pervasive attitudes of survivors are shown to have harmful ramifications on their children's personality and worldview as well as on their interpersonal and theistic object relations. These limitations translate into problems in the adult lives of second generation survivors.

The relationship between post-traumatic symptom severity and object relations deficits in persons with schizophrenia

OBJECTIVE

The aim of this study was to determine if object relations deficits in people with schizophrenia spectrum disorders (i.e., schizophrenia and schizoaffective disorder) are related to co-morbid post-traumatic stress disorder (PTSD).

DESIGN

Cross-sectional and correlational.

METHOD

Positive and Negative Syndrome Scale, Post-Traumatic Stress Disorder Checklist, and Bell Object Relations Inventory were administered to 60 people with schizophrenia in an outpatient setting. With four hierarchical regressions, we hypothesized that, controlling for schizophrenia symptoms, diagnosis type, and potential demographic features, PTSD symptoms would correlate with each of the four types of object relations deficits.

RESULTS

All participants reported experiencing at least one traumatic experience. As predicted, PTSD symptoms were a significant predictor of alienation, insecure attachment, and egocentricity controlling for schizophrenia symptoms, diagnosis type, and demographic features. Against prediction, PTSD was not associated with Social Incompetence.

CONCLUSION

If PTSD symptoms contribute to object relations deficits in persons with schizophrenia spectrum disorders, then interventions such as psychotherapy need to be developed to address PTSD symptoms in the treatment of these interpersonal deficits.

Attachment, social cognition, and posttraumatic stress symptoms in a traumatized, urban population: evidence for the mediating role of object relations

Research has linked multiple risk and resiliency factors to developing posttraumatic stress disorder (PTSD). One potentially important construct for understanding connections between trauma and PTSD is attachment. Although relationships between attachment and risk for PTSD have been described theoretically, limited research has addressed these relationships empirically. Furthermore, aspects of object relations overlap with attachment and PTSD, but have not been adequately incorporated in empirical research. One proposed pathway between attachment and PTSD involves the mediating role of object relations, particularly views of self and others. Present data were from a larger study investigating environmental and genetic risk factors for PTSD in an impoverished, primarily African American sample seeking care at a public urban hospital. Correlations indicated that adult attachment (with the exception of dismissing) and object relations relate to childhood traumas, (|r|s = .19-.29), adult traumas (|r|s = .14-.20), and self-reported PTSD symptoms (|r|s = .20-.36). Analyses also found support for mediational roles of object relations in relationships between attachment and PTSD symptoms (Model R(2) range = .136-.160). These data have theoretical, clinical, and research implications for understanding how particular aspects of attachment, specifically its effects on object relations, may protect against or predispose one to develop PTSD.

Concurrent validity of the Quality of Object Relations Scale (QORS) in relation to proxy assessment of the theoretical scale constituents

BACKGROUND/AIMS

Clinical assessment of object relations is essential when evaluating treatability by different types of psychotherapy. The Quality of Object Relations Scale (QORS) is an established interview measure used for assessing object relations, but the validity of the QORS in relation to its theoretical constituents has not been examined. Our aim was to study the concurrent validity of the QORS.

METHODS

Trained interviewers assessed 263 outpatients seeking psychotherapy due to mood or anxiety disorder, with the QORS and with selected proxy criterion measures representing constituents of object-relational maturity.

RESULTS

Discontinuity in relationships and the use of devaluation in relationships were the main determinants of low Quality of Object Relations (low-QOR). Patients with discontinuity in relationships had a four-fold and patients with devaluation in relationships a three-fold risk of belonging to the low-QOR group (p = 0.001) in comparison to those without these relational characteristics. Also poor self-confidence and major separations in childhood predicted the low- versus high-QOR category.

CONCLUSION

The results indicate adequate concurrent validity of the QORS and support its credibility in assessing personality pathology, beyond axis II diagnosis, by trained clinicians.

Object relations and reality testing in schizophrenia, bipolar disorders, and healthy controls: differences in profiles and clinical correlates

OBJECTIVE

Deficits in object relations (OR) and reality testing (RT) functions are found in schizophrenia but have never been investigated in bipolar disorder. In the current study, we examine if there are OR and RT differences in schizophrenia and bipolar disorder compared to healthy controls and to what extent differences in clinical characteristics mediates the putative effect of diagnosis.

METHODS

We used the Bell Object Relation and Reality Testing Inventory (BORRTI) to measure OR and RT in schizophrenia (n = 55), bipolar disorder (n = 51) and healthy controls (n = 158). Diagnoses and the life time presence of psychotic symptoms were evaluated based on the Structured Clinical Interview for DSM-IV. We used the Positive And Negative Symptom Scale to measure current symptoms.

RESULTS

Analyses of variance with post hoc tests showed statistically significant differences in OR and RT between the Schizophrenia (SCZ), Bipolar Disorder (BD), and Healthy Control (HC) groups. Multiple regression analyses indicated that a lifetime history of psychotic symptoms contributed significantly to the variance in one BORRTI subscale (Social Incompetence) while Positive And Negative Symptom Scale components (either the positive component and emotional discomfort component) contributed significantly to the variance in all BORRTI subscales except one (Uncertainty of Perception).

CONCLUSIONS

OR and RT deficits are present both in SCZ and BD, but differences appears to be mediated by differences in current positive and depressive symptoms.

Predictive value of object relations for therapeutic alliance and outcome in psychotherapy for depression: an exploratory study

The concept of object relations has been shown to be relevant for the process and outcome of psychodynamic psychotherapies. However, little is known about its relevance for the psychotherapeutic treatment of depression. In this study, we explored the predictive value of object relational functioning (ORF) for the therapeutic alliance and outcome of short-term psychodynamic supportive psychotherapy in patients with mild to moderately severe depression. The ORF of 81 patients was rated by using the Developmental Profile. The overall maturity of ORF measured at baseline was higher in patients who showed a better treatment response. In multiple regression analysis, the adaptive level of individuation appeared to be specifically predictive of outcome. Patients with a recurrent depression showed less mature levels of ORF, lower adaptive levels and a higher score on the symbiotic level. No association was found between ORF and therapeutic alliance during treatment. In contrast to the single measure of alliance early in therapy, the growth of the alliance was related to outcome. The study indicated the relevance of ORF for depression and established that it is distinctive from the actual therapeutic alliance.

The object relations of bulimic women in context: an integration of two studies

The purpose of this paper is to investigate and contextualize the object relations of bulimic women. Two independent studies, one quantitative and one qualitative, were conducted. In the quantitative study, 77 undergraduate women completed self-report measures of eating behavior, interpersonal dependency, and object relations. In the qualitative study, four bulimic women participated in semi-structured interviews that were coded for relational themes and contextualized through a feminist socio-cultural analysis. Results supported the strong association between dependency and eating disorders and demonstrated that the object relationships of the participants were characterized by both insecure attachment and egocentricity. Socio-cultural analysis suggests that the development of these object relations can be partially accounted for by conflicting cultural expectations for women.

Advances in the assessment of object relations in the 1990s

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.

Bell object relations inventory for adolescents and children: reliability, validity, and factorial invariance

The Bell Object Relations Inventory (BORI; Bell,1995) is a self-report instrument that measures deficits in object relations ego functioning. It has demonstrated clinical and research utility in adult populations. This article reports the development of a version of the BORI for children ages 11 to 17, including studies of reliability, validity, and factorial invariance. Data of 705 children from public schools and 110 children from clinics and residential treatments were used. Of the 45 original BORI true/false items, 3 were dropped as inappropriate and most others were rewritten for easier reading. An additional 16 items were created to capture unique features of adolescent experiences in relationships. Items were tested in focus groups and revised accordingly. Eight items were dropped because of low communalities, so that 50 items were included in the final factor analysis. Assessments using self-report items from Behavioral Assessment Scale for Children (BASC; Reynolds & Camphaus, 1992) and the Personality Inventory for Youth (PIY) were also obtained to test concurrent validity. Oblique rotation yielded 5 factors. Four were very similar to the 4 from the adult version and were named accordingly: Alienation, Insecure Attachment, Egocentricity, and Social Incompetence. The fifth scale was comprised mostly of new items and was called Positive Attachment. Scales showed excellent factorial invariance and good internal consistency. Scales generally had very low intercorrelations reflecting their relative independence. Although differences were found for gender and race, the effect sizes were small. Support for construct validity came from moderate correlations with concurrent BASC and PIA scores, analyses of variance showing greater deficits in object relations in pathological subgroups compared with normals, and a trend analysis showed that Alienation scores followed a lawful relationship with increasing severity of psychopathology. These initial findings support the psychometric integrity of the instrument and its construct validity. Results indicate continuity of constructs between the adult and adolescent versions. The Positive Attachment subscale may prove a valuable addition for clinical and research applications.

The prediction of violent and nonviolent criminal behavior in a methadone maintenance population

The utility of traits associated with Antisocial Personality Disorder in making risk assessments of violent and nonviolent crimes was examined in 254 subjects sampled from a methadone maintenance population. A factor analysis of a number of baseline measures resulted in five factors measuring hostility, insecure attachment, impaired reality testing, antisocial personality, and empathy. These factors were used in logistic regression analysis to predict charges for violent and nonviolent crimes over a 2-year period. Individuals with high scores on the antisocial personality factor had an increased risk of both violent and nonviolent criminal charges. Individuals with low scores on the empathy factor were at high risk for violent crimes. In an analysis using the factor components rather than the factors, the measures of perspective-taking and a socialization were associated with violent criminal charges, and the measure of psychopathy, but not antisocial behavior, was associated with nonviolent criminal charges. The results support the use of measures of personality traits in addition to measures of a history of antisocial behavior in making violence risk assessments in substance-dependent patients. The DSM construct and diagnosis of Antisocial Personality Disorder may be enhanced by greater emphasis on personality traits associated with antisocial behavior.

Object relations in criminal psychopaths

Although many empirical studies have documented the range and severity of problems caused by psychopaths, considerably less attention has focused on understanding its origins. Efforts to treat this potentially dangerous population have been equally frustrating, as psychotherapeutic approaches have almost always proven ineffectual. Because of the limited understanding of the psychological and interpersonal dynamics underlying psychopathy, the authors sought to assess the extent to which object relations theory could inform our understanding of psychopathy. In addition to eliciting background information, 74 men sentenced to probation following a criminal conviction were assessed using the Psychopathy Checklist: Screening Version, a clinician-rated measure of psychopathy, and were administered the BORI, a self-report measure of object relations. Results showed significant correlations between object relations dimensions, psychopathy scores, and childhood environment data. Furthermore, object relations scores added to the prediction of psychopathy even after demographic and behavioral variables were considered, suggesting that object relations deficits comprise a significant component of psychopathy. Results suggest that psychopaths harbor profound underlying psychosocial damage including intense anxiety, anger, bitterness, and resentment. Implications for interventions and future research are discussed.

Social anxiety as a barrier to treatment for eating disorders

BACKGROUND

The goal of this pilot investigation is to determine the relationship between social anxiety and treatment-seeking behavior for eating disorders in an outpatient psychiatric clinic.

METHOD

Twenty-eight patients seeking treatment for anorexia or bulimia at an outpatient eating disorders clinic completed a battery of self-report measures on eating pathology, attachment style and functioning, and social anxiety at initial intake appointment. Levels of eating pathology and social anxiety at consult were compared with service utilization records on entry into treatment.

RESULTS

Individuals who did not engage in treatment had significantly higher levels of social anxiety (F = 8.29, df = 1, p < .05) compared with those who did engage in treatment. There were no differences in demographic characteristics, diagnoses, or level of eating pathology at intake.

CONCLUSIONS

Social anxiety may act as a barrier to effective help-seeking and utilization of mental health treatment among individuals with eating disorders. Replication of these findings in a larger sample and more in-depth study of the mechanism of the observed association between use of services and social anxiety may be useful in planning more effective outreach in the community to underserved populations in need of treatment for eating disorders.

Object relations deficits in schizophrenia: a cross-cultural comparison between Brazil and the United States

Object relations deficits are commonly found in schizophrenia samples from the United States, but it is unknown whether these deficits are a reliable finding in other cultures. The Bell Object Relations Inventory was translated into Brazilian Portuguese and administered to 61 stable outpatients with schizophrenia from Sao Paolo, Brazil. Their scores were compared with a Brazilian normal sample and with a matched U.S. schizophrenia sample. The Brazilian normal sample showed a pattern of scores within the normal range when compared with U.S. norms. The Brazilian schizophrenia sample had significantly greater pathology than the Brazilian normal sample on Alienation, Egocentricity, and Social Incompetence. Their mean scores on Alienation were similar to the matched U.S. schizophrenia sample, and they had significantly greater pathology on Insecure Attachment, Egocentricity, and Social Incompetence with 85.6% showing some type of object relations deficit. Findings support the cross-cultural validity of the Bell Object Relations Inventory and the ubiquity of object relations deficits in schizophrenia. The most common profiles for both schizophrenia samples were the Psychotically Egocentric and the Socially Withdrawn object relations types.

Patterns of object relations and reality testing deficits in schizophrenia: clusters and their symptom and personality correlates

Bell Object Relations Reality Testing Inventory (BORRTI) profile scores were used to cluster 222 outpatients with schizophrenia or schizoaffective disorder. An eight-cluster solution was subjected to replication analysis, and six clusters were found valid and replicable. These clusters were sorted into three pairs that were interpreted as follows: Residually Impaired consisted of Sealed-Over Recovery and Integrated Recovery; Socially Withdrawn consisted of Socially Withdrawn and Socially Withdrawn-Autistic; and Psychotically Egocentric consisted of Psychotically Egocentric and Psychotically Egocentric-Severe. Clusters were compared on Positive and Negative Syndrome Scale ratings and on subscales from the Eysenck Personality Questionnaire. MANOVAs indicated significant differences among clusters. These differences provided further interpretations of cluster membership. Implications for the use of BORRTI profiles for treatment and rehabilitation planning are discussed.

Validation of the Comprehensive Assessment of Defense Style (CADS): mothers' and children's responses to the stresses of missile attacks

This study furthers the validation of the Comprehensive Assessment of Defense Style (CADS) as a measure of children's defensive behavior. Participants were 81 mothers who assessed the defense style (CADS) of their 8- to 10-year-old children, as well as their own defense style and level of object relations. Five years earlier, the mothers had rated their children's symptom level and personality after the missile attacks during the Gulf War. The original factor structure of the CADS was replicated for the most part. Self-oriented and other-oriented defenses were related to the children's early personality and symptomatic reaction, as well as to their mother's defense style and level of object relations. The CADS factors correlated with the defenses of the Defense Mechanisms Manual. The results provide further validation of the CADS and suggest possible areas of implementation, such as longitudinal examination of defenses, psychopathology screening, and therapeutic improvement.

Forensic and correctional applications of the personality assessment inventory

The relative utility of psychological tests for addressing legal issues is an area of considerable debate in the field. Regardless of the merits of psychological testing, it is apparent that such instruments are used widely both to address specific psycholegal issues and to evaluate offender populations more generally. One instrument gaining prominence in terms of its use in both forensic and correctional settings is the Personality Assessment Inventory (PAI; Morey, 1991), which was developed to assess various constructs relevant to clinical settings (e.g. psychopathology, response distortion, and personality traits). This paper reviews the psychometric properties of the PAI specifically in reference to its ability to assess factors relevant to forensic decision-making, as well as its utility to provide clinically relevant information about offender populations more generally.

Validade e confiabilidade da versão brasileira de um inventário de avaliação de relações objetais

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.

Human responses in assessing object relations subscales of the Psychoanalytic Rorschach Profile

The Rorschach test is often used to assess object relations. This research examined whether human responses are necessary for a valid assessment.

Object relations and reality testing in early- and late-onset schizophrenia

One hundred fifty-seven U.S. military veterans with schizophrenia were divided into early-onset (i.e., onset at age 20 or before, n = 36) and late-onset (i.e., onset after age 30, n = 28) groups and completed the Bell Object Relations and Reality Testing Inventory (BORRTI), the Positive and Negative Syndrome Scale, and several representative neuropsychological instruments. Participants were compared on background characteristics and test measures. The early-onset group demonstrated significantly more object-relations and reality-testing deficits than the late-onset group. In contrast, no significant group differences were found on symptom or neuropsychological variables. An a posteriori three-group analysis that included the middle age of onset group (i.e., ages 21 to 30) found that the middle group had mean values that fell between early- and late-onset groups on most variables. No distinct patterns of BORRTI subscale scores distinguished the middle group. The finding that object-relations and reality-testing deficits are more pronounced in early-onset schizophrenia has implications for the treatment and rehabilitation of schizophrenia.

Altruism and the Vietnam War veteran: the relationship of helping to symptomatology

This study examines the relationships among demographic factors, combat experiences, personality characteristics, altruism, and posttraumatic stress disorder (PTSD) symptomatology. Participants were Vietnam War veterans currently undergoing treatment for PTSD. The developmental level of internalized schemas of interpersonal relations (object relatedness) and the altruistic intent to help were significant predictors of PTSD symptomatology, with lower levels of symptomatology associated with higher levels of altruism. Results indicated that predispositional variables and altruistic intentions may be important factors to consider in designing and implementing treatment programs for chronically impaired veterans with PTSD.

Response to sexual assault: a relational perspective

It has been suggested that although the severity of the stressor is the primary determinant of acute posttraumatic stress disorder (PTSD) symptoms, pre-existing personality patterns may be the primary contributors to the development of chronic PTSD symptomatology. The authors postulate that of the multiple personality factors that influence behavior and response to traumatic events, relational capacity or the ability to sustain interpersonal relationships provides an overarching construct for understanding the contribution of social contextual factors to post-trauma response. The results of this exploratory study support the authors' hypothesis that relational capacity is a significant factor in explaining persistent PTSD symptoms in a sample of adult women who have been raped. Significant correlations were found between measures of relational capacity, the Bell Object Relations Inventory and the Inventory of Interpersonal Problems and measures of distress, the Posttraumatic Symptom Scale, and the Beck Depression Inventory.

Methodological issues in evaluating Rorschach validity: a comment on Burns and Viglione (1996), Weiner (1996), and Ganellen (1996)

The old controversy regarding the Rorschach Inkblot Test has recently revived. The present article suggests that the debate will be most productive if careful attention is paid to methodological issues. Three recent examples illustrate how incorrect conclusions regarding Rorschach validity may occur if methodological issues are not evaluated carefully. The present article examines (a) Burns and Viglione s (1996) conclusion that the Rorschach Human Experience Variable (HEV) is a predictor of interpersonal relatedness among adults; (b) Weiner s (1996) conclusion that the D score and Morbid Responses (MOR) are valid measures of experienced distress in Posttraumatic Stress Disorder (PTSD); and (c) Ganellen s (1996a, 1996b) conclusion that the Rorschach Depression Index (DEPI) and the Minnesota Multiphasic Personality Inventory (MMPI) are comparable in their power to identify diagnoses of depression.

Further validation for the Cramer Defense Mechanism Manual

This article presents psychometric properties of the Cramer Defense Mechanism Manual (Cramer, 1991b) for the Thematic Apperception Test (Murray, 1943). The developmental hierarchy of defenses originally postulated by Cramer was supported in this cross-sectional sample. Gender differences and the validity of distinguishing between "mature" and "immature" levels of defense were also investigated. Findings for gender differences largely replicate those previously reported by Cramer (1987, 1991a). Results also support the view of a developmental hierarchy of defenses and the validity of distinguishing between mature and immature levels of two of the three types of defenses.

A comprehensive investigation of putative correlates of bulimia among college-age women: object relations, dependency, ego defenses, trait anxiety, and depression

This study investigated putative correlates of bulimia, which included measures of object relations impairment, dependency, ego defenses, trait anxiety and depression. Subjects were college-age women drawn from a larger sample (n = 417) and selected on the basis of their scores on the revised version of the Bulimia Test. The bulimia group was composed of those scoring in the top 5% (n = 23), concordant with the base rate of bulimia in this population, whereas controls (n = 23) were conservatively selected from those scoring around the mean (56th-61st percentile). A multivariate analysis of variance revealed a significant group difference across dependent variables (p < .05), and univariate Fs uniformly demonstrate predicted group differences. A stepwise discriminant analysis was performed to assess the relative contribution of these variables toward the differentiation between psychometrically defined, bulimic and nonbulimic women, revealing that trait anxiety, dependency, and depression reliably differentiated these groups, accounting for 37% of between-groups variance. In replicating and extending prior research, the results have implications for elucidating the phenomenology and potential etiologic factors associated with bulimia and for informing treatment and future research.

Strengthening child compliance through positive parenting practices: what works?

Examined the laboratory playroom behavior of 36 normal mother-child dyads during a competitive game in which the mothers gave periodic instructions to their children. The dyads were equally divided into a control group, and two experimental groups in which mothers were taught to use positive parenting in the form of mirroring or praise. The game activity was videotaped and observers coded rates of child compliance, maternal instructions, mirroring and praise, and the mothers' overall responsiveness to their children's full repertoire of behaviors. After the game, mothers and children were interviewed separately to assess their satisfaction with the game interaction. Results showed higher percentages of child compliance and higher ratings of dyadic satisfaction for the experimental groups. However, maternal responsiveness proved to be the only significant predictor of these dependent measures, suggesting that mirroring and praise are specific markers for a more complex parenting process. Implications of these results for parenting practices and parent training are discussed.

Axis II comorbidity and developmental adversity in bulimia nervosa

Using data from 61 bulimic patients, we evaluated associations among axis II disturbances, psychopathological traits, eating symptoms, and adverse developmental experiences (e.g., childhood sexual and physical abuse). Findings showed likelihood of childhood abuse to increase markedly in function of comorbid personality pathology. In addition, comorbid borderline personality disorder was found to be a better predictor of object-relations disturbances, primitive defenses, and hostility than developmental adversity was. Although marked trait disturbances were strongly associated with borderline personality disorder (more than with severity of childhood adversity), the converse seemed true of severity of bulimic symptoms (i.e., comorbid personality disorder had no predictive effects, whereas developmental variables had inconsistent effects). Bulimic and general psychopathological symptoms, thus, seemed to have intriguingly independent determinants. We interpret these findings as showing that the observed association between developmental adversity and bulimic syndromes may, in large part, be attributable to comorbid personality pathology.

Five Scales in Search of a Construct: Exploring Continued Attachment to Parents in College Students

The multitude of measures and differences across self-report indices of continued parental attachment raise questions regarding the validity and meaning of these scales. The purpose of this study was to examine the convergent and construct validity of 5 measures of continued parental attachment. Five attachment scales and 6 personality scales were administered to 216 undergraduate students. Factor analyses and correlational analyses indicate that the 5 attachment measures differentiate healthy from pathological bonding with parents, the construct being assessed has multiple dimensions, and scores on these attachment measures are correlated with personify variables as would be expected. These attachment scales appear to assess a construct that is related to attachment, although they may be more illustrative of the general affective quality of relationships. Subsequent assessment efforts should employ more specific ratings and measure concrete behavioral manifestations of attachment to most effectively examine the construct.

A New Measure for an Important Construct: The Attachment and Object Relations Inventory

This article describes the development of the Attachment and Object Relations Inventory (AORI). The AORI, a dimensional measure based on factor structure, was developed in response to the psychometric problems typical to attachment style measures that are categorical in nature. Test-retest reliability and internal consistency were high. A factor analysis of the 75 AORI items confirmed the existence of at least 6 factors and explained approximately 50% of the item variance. Convergent and discriminant validity of the AORI was supported through appropriate relationships with measures of depression, anxiety, and personality, and other measures of attachment and object relations.

Effect of early life experiences and personality on the reporting of psychosocial distress in general practice. A preliminary investigation

BACKGROUND

About 25% of primary care attenders are 'somatic presenters'; individuals consulting for physically-attributed somatic symptoms in the presence of psychiatric morbidity. We tested the hypothesis that somatic presenters differed from psychological presenters on measures of personality ad childhood experience.

METHOD

Case-control study of 'psychological presenter' and 'somatic presenters'.

RESULTS

Psychological presenter reported significantly greater insecurity in intimate relationships, and recalled their fathers as significantly less caring and more over-protective, than somatic presenters. These difference remained after adjusting for differences in the severity and duration of psychiatric symptoms.

CONCLUSIONS

Personality and childhood experiences may be associated with specific types of adult illness behaviour, independent of associations with the prevalence of psychiatric disorder.

Are adult children of alcoholics unique? A study of object relations and reality testing

This self-report questionnaire study revealed that adult children of alcoholics (ACAs, n = 49) were significantly different from adult children from normal families (ACNs, (n = 55) on five of nine Bell Object Relations Reality Testing Inventory (BORRTI; Bell, 1988) scales and from adult children from dysfunctional families (ACDs, n = 48) on the Reality Testing summary score. Both ACAs and ACDs were similar to each other and different from ACNs on Insecure Attachment and on two family background ratings- perceived quality of paternal and maternal caregiving. Discussion of these results plus separate exploratory regression analyses followed.

Agreement between patient self-report and clinician rating: concurrence between the BSI and the GAF among psychiatric inpatients

Two rating scales were compared for 200 adult psychiatric inpatients at admission to, and discharge from, the hospital. Patients rated their own psychological symptoms on the Brief Symptom Inventory (BSI), and clinicians rated patients' psychological, social, and occupational functioning on the Global Assessment of Functioning (GAF) Scale. Analyses indicated no significant relationships between symptom distress reported by patients and global functioning rated by clinicians. These findings support previous research that has shown minimal congruence among criterion measures that differ in rating source.

Psychological correlates of codependency in women

This study examined several potential psychological correlates of codependency to determine the parameters and feasibility of the codependency construct. Subjects were 171 adult female volunteers from a university. Results indicated significant relationships between codependency and: object relations and reality testing (p = .01), intensity of depression (p < .01), introjective depression (p < .001), and history of abuse (p < .001). The results are supportive of codependency as a useful construct which involves a cluster of difficulties in interpersonal relationships, reality testing, and introjective depression. An association was demonstrated between codependency and parental alcoholism, or history of childhood abuse, or both.

Prognostic value of pretreatment social adaptation in bulimia nervosa

We evaluated several indices of pretreatment social adaptation (social and vocational adjustment, DSM-III-R Axis-V ratings, and "object-relations" capacities) as predictors of the response of 44 completers of a multimodal therapy for bulimia nervosa. Response was assessed using standard measures of eating and psychiatric symptoms. Hierarchical regressions revealed that pretreatment social adjustment explained substantial (and significant) proportions of variance in posttreatment binge/purge symptoms, after variance associated with (a) initial severity of eating symptoms and (b) concurrent psychiatric symptoms (at posttreatment) was accounted for. Hence, social adjustment emerged as a somewhat specific predictor of response of bulimic behaviors. Possible clinical implications of this apparent predictive effect are discussed.