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Thomson SM, Bornstein RF. Toward a More Nuanced Perspective on Detachment: Differentiating Schizoid and Avoidant Personality Styles through Qualities of the Self-Representation. J Pers Assess 2024; 106:496-508. [PMID: 38084879 DOI: 10.1080/00223891.2023.2289468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/17/2023] [Indexed: 06/13/2024]
Abstract
Avoidant personality disorder was introduced in DSM-III (American Psychiatric Association [APA], 1980), and debate persists regarding the utility of having two separate variants of the "detached personality." The present study addressed this issue through ratings of open-ended self-descriptions provided by community adults with high scores on schizoid versus avoidant personality traits (N = 229). The self-concept of individuals with avoidant personality style reflected a lack of positive self-regard and low self-efficacy/agency. Regarding schizoid personalities, neither positive nor negative self-regard, self-complexity, or self-efficacy/agency was found. Examination of specific variables yielded a relationship between avoidant personality styles, depression, and anxiety, consistent with literature noting simultaneous desire and fear of interpersonal relationships in avoidant patients (APA, 1980; Sheldon & West, 1990). Similarly, examination of individual variables yielded a negative association between schizoid personality styles and tolerance for contradictory aspects of the self, consistent with theoretical writings in this area (Kernberg, 1976; McWilliams, 2006). Results support the argument that these two personality styles represent distinct constructs. Findings support the utility of self-concept assessment to assist treatment planning and differential diagnosis. Treatment implications include using open-ended descriptions of patients' self-concepts to explore changes that may not be accessible via more structured forms of patient self-report.
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Bornstein RF, Thomson SM. Intrapersonal dynamics of closeness versus distance: Qualities of the self-concept distinguish destructive overdependence, dysfunctional detachment, and healthy dependency. J Clin Psychol 2024; 80:306-322. [PMID: 37882635 DOI: 10.1002/jclp.23611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/28/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION People vary in the degree to which they affiliate with others; exaggerated efforts maintain interpersonal closeness versus distance are codified in longstanding categorical models of personality pathology, and in contemporary dimensional frameworks as well. OBJECTIVE To examine associations between destructive overdependence (DO), dysfuntional detachment (DD), and healthy dependency (HD) and qualities of the self-concept. METHOD A mixed-sex sample of 229 adults completed the Relationship Profile Test to assess DO, DD, and HD, and the Object Relations Inventory (ORI) to assess qualities of the self-concept. RESULTS AND CONCLUSION Analyses indicated that (1) the ORI Strong dimension was uniquely predictive of DO (inversely related); (2) ORI Warm and Nurturing were unique predictors of DD (both inversely related); and (3) ORI Nurturing and Successful were unique predictors of HD. This study illuminates key intrapersonal features of these three personality styles.
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Affiliation(s)
- Robert F Bornstein
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Shannon M Thomson
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
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3
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Adams BE, Porcerelli JH, Abell S, Huprich SK. Malevolent object relations: A multimethod study of female survivors of childhood abuse. Personal Ment Health 2021; 15:252-260. [PMID: 33871184 DOI: 10.1002/pmh.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 04/09/2021] [Indexed: 11/09/2022]
Abstract
Although childhood victimization is associated with impairments in object relations, it is not clear how different measures comparatively perform in assessing this relationship. This study examined the connection between emotional, physical, and sexual abuse in childhood and three methods of assessing malevolent object representations. Sixty adult women, recruited from an urban primary-care clinic, were administered the Thematic Apperception Test (TAT), the Object Relations Inventory (ORI) interview, and a version of the Early Memories Test (EMT)/interview. Ratings of malevolent object relations were obtained using the affect-tone dimension from the Social Cognition and Object Relations (SCORS-G) scale with both TAT and early memory narratives and through Malevolence ratings from the ORI interview. It was found that, outside of emotional abuse, ORI interview ratings of malevolence consistently differentiated adult childhood abuse groups and nonabuse groups, whereas early memory ratings of malevolence differentiated groups in two of four analyses. Malevolence ratings based upon TAT ratings failed to differentiate any type of abuse from nonabuse. These findings suggest that the use of malevolence ratings from the ORI and early memory narratives are preferred methods for assessing malevolent object relations in urban-dwelling women who have been victimized as children.
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Affiliation(s)
- Brett E Adams
- Psychology Department, University of Detroit Mercy, Detroit, Michigan, USA
| | - John H Porcerelli
- Psychology Department, University of Detroit Mercy, Detroit, Michigan, USA
| | - Steven Abell
- Psychology Department, University of Detroit Mercy, Detroit, Michigan, USA
| | - Steven K Huprich
- Psychology Department, University of Detroit Mercy, Detroit, Michigan, USA
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Borroni S, Scalabrini A, Masci E, Mucci C, Diamond D, Somma A, Fossati A. Assessing Mental Representation as an Indicator of Self and Interpersonal Functioning in Psychotherapy Patients. J Psychiatr Pract 2020; 26:349-359. [PMID: 32936582 DOI: 10.1097/pra.0000000000000498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The goal of this study was to test in a clinical sample the interrater reliability and convergent validity of the Differentiation-Relatedness Scale (D-RS), a measure that evaluates mental representations based on open-ended descriptions of self and significant others. The study also investigated the ability of the D-RS to predict personality disorders (PDs) from Section II of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the dysfunctional trait domains presented in the Alternative DSM-5 Model for Personality Disorders Criterion B in Section III of the DSM-5. We also evaluated if the D-RS predicts observed Section II PDs over and above Criterion B of the Alternative DSM-5 Model for Personality Disorders. We found that the interrater reliability of the D-RS was good on the basis of the mean scores of 6 independent raters and that it showed moderate convergent validity. Results of dominance analyses indicated that the D-RS is a significant predictor of Section II borderline PD and of the overall number of DSM-5 PDs. When we considered the Section III Criterion B for PDs, the D-RS was not able to predict any of the Personality Inventory for DSM-5 domains, suggesting that the D-RS may be more related to personality functioning behind mental representations than to maladaptive personality traits. Finally, results of hierarchical regression analyses suggested that the D-RS produced a significant but modest increase in the prediction of borderline PD traits and the overall number of PDs traits even when the effect of the Personality Inventory for DSM-5 domains were controlled for.
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5
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Stulp HP, Koelen J, Glas GG, Eurelings-Bontekoe L. Validation of the apperception test God representations, an implicit measure to assess God representations. Part 3: associations between implicit and explicit measures of God representations and self-reported level of personality functioning. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2019. [DOI: 10.1080/19349637.2019.1700475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Jurrijn Koelen
- GGZ Centraal De Meregaard, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
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6
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Stulp HP, Koelen J, Schep-Akkerman A, Glas GG, Eurelings-Bontekoe L. God representations and aspects of psychological functioning: A meta-analysis. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1647926] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Henk P. Stulp
- Lectorate Health Care and Spirituality, Viaa University of Applied Sciences, Zwolle, The Netherlands
| | - Jurrijn Koelen
- Lectorate Health Care and Spirituality, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemiek Schep-Akkerman
- Lectorate Health Care and Spirituality, Viaa University of Applied Sciences, Zwolle, The Netherlands
- Lectorate Health Care and Spirituality, Dutch College of General Practitioners, Utrecht, Amsterdam, The Netherlands
| | - Gerrit G. Glas
- Lectorate Health Care and Spirituality, Dimence Groep and VUmc Amsterdam, Amsterdam
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7
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Aafjes-van Doorn K, Kealy D, Ehrenthal JC, Ogrodniczuk JS, Joyce AS, Weber R. Improving self-esteem through integrative group therapy for personality dysfunction: Investigating the role of the therapeutic alliance and quality of object relations. J Clin Psychol 2019; 75:2079-2094. [PMID: 31332799 DOI: 10.1002/jclp.22832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aimed to investigate change in self-esteem through intensive group treatment for personality dysfunction, by exploring: (a) the relationship between patients' experience of therapeutic alliance and improvement in self-esteem during treatment, including patients' quality of object-relations (QOR) as a possible moderator; and (b) the association between improvement in self-esteem during treatment, and depressive symptoms 9 months later. METHOD Eighty patients with personality dysfunction, consecutively enrolled in a group-oriented treatment program, were assessed at pretreatment, posttreatment, and 9 months follow-up. RESULTS Especially for patients with lower QOR, alliance predicted self-esteem change during treatment. In addition, change in self-esteem during treatment predicted follow-up depression severity, even when controlling for within-treatment symptom change. CONCLUSIONS Patients with impoverished inner relational representations may benefit more from a secure alliance in terms of improving their self-esteem. Change in self-esteem may also be important in preventing relapse of depressive symptoms in people with personality dysfunction.
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Affiliation(s)
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Anthony S Joyce
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Rainer Weber
- Clinic for Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
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Pad RA, Huprich SK, Porcerelli J. Convergent and Discriminant Validity of Self-Report and Performance-Based Assessment of Object Relations. J Pers Assess 2019; 102:858-865. [PMID: 31305156 DOI: 10.1080/00223891.2019.1625909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study evaluated the Social Cognition and Object Relations Global Rating Method (SCORS-G; Stein, Hilsenroth, Mulford, & Pinkser, 2011; Stein and Mulford, 2018; Westen, 1995) and the Bell Object Relation and Reality Testing Inventory (BORRTI; Bell, 1995) to determine the extent to which the measures were correlated with each other and their relationships with 2 disorders characterized by disrupted object relations: borderline personality disorder (BPD) and depressive personality disorder (DPD). One hundred sixty-nine psychiatric outpatients and 171 undergraduate students were assessed with the Personality Disorder Interview for DSM-IV (Widiger, Corbett, Ellis, Mangine, & Tomas, 1995) and the Structured Clinical Interview for DSM-IV Axis II Disorders (First et al., 1997) for BPD and DPD. Modest correlations were observed among the diagnostic interviews with the BORRTI and the SCORS-G. An exploratory factor analysis yielded 3 distinct factors, 1 of which was mainly comprised of the BORRTI scales, whereas the 2 other factors were comprised of SCORS-G dimensions. Hierarchical multiple regressions demonstrated that the BORRTI accounted for greater variance among interview scores for both groups. However, the addition of SCORS-G variables incremented the variance accounted for in the BORRTI.
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Affiliation(s)
- Rachel A Pad
- Department of Psychology, University of Detroit Mercy
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9
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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
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10
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Comparing the Effectiveness of the Treatment of a Monotheistic Fabric and the Treatment of Thematic Relationships on Marital Violence and Couples’ Coping Strategies. CONTEMPORARY FAMILY THERAPY 2018. [DOI: 10.1007/s10591-018-9465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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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
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Haggerty G, Stein M, Siefert C, Zodan J, Mehra A, Ogbuji K, Sangha J, Habib M, Sinclair SJ, Blais MA. Dimensional measure of self and interpersonal functioning: Comparisons with treatment alliance and readiness for inpatient psychotherapy. Clin Psychol Psychother 2018; 25:575-582. [PMID: 29667270 DOI: 10.1002/cpp.2193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/08/2022]
Abstract
The social cognition and object relations scale-global rating method is a clinical rating system assessing 8 domains of self and interpersonal functioning. It can be applied to score numerous forms of narrative data. In this study, we investigate the SCORS-G relationship to measures of alliance and readiness for psychotherapy with an adolescent inpatient sample. Seventy-two psychiatrically hospitalized adolescents were consented and subsequently rated by their individual and group therapist using the SCORS-G. The unit psychiatrist also completed an assessment of patients' readiness for inpatient psychotherapy. The patients completed a self-report of their alliance with the inpatient treatment team as a whole. SCORS-G ratings were positively correlated with assessments of readiness for inpatient psychotherapy and patient-reported alliance. This study further demonstrates the clinical utility of the SCORS-G with adolescents.
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Affiliation(s)
- Greg Haggerty
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | - Michelle Stein
- Psychiatry Department, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Caleb Siefert
- Psychology, University of Michigan-Dearborn, Dearborn, MI, USA
| | - Jennifer Zodan
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | - Ashwin Mehra
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | - Kelechi Ogbuji
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | - Jaspreet Sangha
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | - Michael Habib
- Psychiatry Department, Nassau University Medical Center, East Meadow, NY, USA
| | | | - Mark A Blais
- Psychiatry Department, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Hinrichs J, Dauphin VB, Munday CC, Porcerelli JH, Kamoo R, Christian-Kliger P. Assessing Level of Personality Organization With the Psychodiagnostic Chart: A Validity Study. J Pers Assess 2018; 101:181-190. [PMID: 29505294 DOI: 10.1080/00223891.2018.1436062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Heterogeneity within diagnostic types and comorbidity across diagnostic groups render a specific personality disorder anything but specific, leading researchers and clinicians to increasingly focus on the general severity of personality pathology. Personality pathology severity is reflected in one's level of personality organization (LPO) and research has demonstrated that LPO is a significant predictor of treatment response. This investigation examined the reliability and validity of the Psychodiagnostic Chart (PDC) in assessing the LPO dimension of the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006). Among a sample of 88 urban-dwelling women seeking primary medical care, the LPO dimension of the PDC received fair to good interrater reliability among 6 psychodynamic psychologists. Convergent validity was demonstrated with contrast analysis and individual correlations that yielded statistically significant associations between LPO scores and conceptually related psychodynamic variables (e.g., defensive functioning, object relations) and self-reported personality pathology scores. Support for discriminant validity was limited by the modest power associated with the sample size. Exploratory analyses examining LPO scores and measures of physical health and intimate partner violence were conducted. Our results supported the reliability, validity, and practical use of the LPO dimension of the PDC.
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Siefert CJ, Stein M, Slavin-Mulford J, Haggerty G, Sinclair SJ, Funke D, Blais MA. Exploring the Factor Structure of the Social Cognition and Object Relations-Global Rating Method: Support for Two- and Three-Factor Models. J Pers Assess 2017. [PMID: 28644680 DOI: 10.1080/00223891.2017.1336716] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Social Cognition and Object Relations Scales-Global Rating Method (SCORS-G) contains 8 scales for coding narrative content. This study explores the factor structure of this measure using college (n = 171), outpatient (n = 239), and inpatient (n = 78) samples. Participants told stories to the Thematic Apperception Test (TAT; Murray, 1943) cards. Stories were transcribed and coded by blind raters using the SCORS-G. Cases were randomly assigned to an exploratory or validation group. Exploratory factor analysis with the exploratory group suggested 2- and 3-factor models. The Emotional Investment in Relationships (EIR) scale did not obtain a primary loading on any factor and was not included in subsequentmodels. After modifications, confirmatory factor analysis indicated good-to-adequate fit for 2- and 3-factor models. Both models showed good fit in the validation group and met criteria for invariance across models. Findings indicated that some SCORS-G scales tap cognitive-structural elements, whereas others assess affective-relational components of narratives. We found mild support separating the affective-relational scales in terms of internal representations for the self and others and relationships. The results reported here indicate that clinicians and researchers can calculate a separate cognitive-structural composite score and an affective-relational composite score when using the SCORS-G to rate TAT stories.
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Affiliation(s)
- Caleb J Siefert
- a Department of Behavioral Sciences , University of Michigan-Dearborn
| | - Michelle Stein
- b Psychological Evaluation and Research Laboratory (PEaRL) , Massachusetts General Hospital and Harvard Medical School
| | | | - Greg Haggerty
- d Van Tauber Institute for Global Psychiatry , Nassau University Medical Center
| | - Samuel J Sinclair
- b Psychological Evaluation and Research Laboratory (PEaRL) , Massachusetts General Hospital and Harvard Medical School
| | - Danielle Funke
- a Department of Behavioral Sciences , University of Michigan-Dearborn
| | - Mark A Blais
- b Psychological Evaluation and Research Laboratory (PEaRL) , Massachusetts General Hospital and Harvard Medical School
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Abstract
The focus on recent advances in the neurobiology of schizophrenia has pushed aside the psychological understanding of the person with schizophrenia for several decades. However, a useful functional psychology of schizophrenia (in distinction to a psychological approach to symptoms) remains clinically important for several reasons: it is a core part of the bio-psycho-social formulation; it helps us understand and connect with persons with schizophrenia; and it provides a framework by which to organize our treatment efforts (both psychotherapeutic and particularly biological), which can improve adherence and outcomes. A coherent psychological model (the deficit model) based on object relations theory best explains all the biological, psychological, clinical, and sociocultural factors relevant to the understanding and treatment of persons with schizophrenia. A better understanding of a coherent psychology of persons with schizophrenia and provision of psychotherapies improves both the biological and psychotherapeutic treatment of persons with schizophrenia.
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Huprich SK, Auerbach JS, Porcerelli JH, Bupp LL. Sidney Blatt's Object Relations Inventory: Contributions and Future Directions. J Pers Assess 2015; 98:30-43. [DOI: 10.1080/00223891.2015.1099539] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Luyten P, Blatt SJ. A Hierarchical Multiple-Level Approach to the Assessment of Interpersonal Relatedness and Self-Definition: Implications for Research, Clinical Practice, andDSMPlanning. J Pers Assess 2015; 98:5-13. [DOI: 10.1080/00223891.2015.1091773] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tibon Czopp S, Rothschild-Yakar L. A Review of Huprich,Personality Disorders: Toward Theoretical and Empirical Integration in Diagnosis and Assessment. J Pers Assess 2015. [DOI: 10.1080/00223891.2015.1068175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Sanders A, Hilsenroth M, Fowler JC. Object representation quality, therapeutic alliance, and psychotherapy process. Bull Menninger Clin 2015; 78:197-227. [PMID: 25247741 DOI: 10.1521/bumc.2014.78.3.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This is the first study to demonstrate the existence of a relationship between patient pretreatment object relations functioning as measured by the Mutuality of Autonomy (MOA) Scale and patient-rated therapeutic alliance. Specifically, MOA scores were related to a patient-rated alliance Bond score (lower, more adaptive object-relations representations were associated with a stronger alliance). In addition, higher MOA scores indicating more malevolent object relations were related to a greater use of psychodynamic techniques. Specific psychodynamic techniques focused on the patient's relationships with the therapist as well as cyclical patterns in actions, feelings, and experiences. Implications for clinical practice and future research are discussed.
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Errázuriz P, Constantino MJ, Calvo E. The relationship between patient object relations and the therapeutic alliance in a naturalistic psychotherapy sample. Psychol Psychother 2015; 88:254-69. [PMID: 25409621 DOI: 10.1111/papt.12046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 10/15/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study examined the relationship between patients' object relations and interpersonal process in psychotherapy. Namely, we tested the hypothesis that the quality of patients' object relations is positively associated with both patient- and therapist-rated alliance quality. DESIGN Psychotherapy was administered naturalistically, with quantitative data collection before and during treatment. METHODS Participants included 73 adult outpatients and 23 therapists at two mental health clinics. Using the Bell Object Relations and Reality Testing Inventory, we measured four dimensions of patients' object relations at baseline-alienation, insecure attachment, egocentricity, and social incompetence. Using the Working Alliance Inventory, we measured alliance from patient and therapist perspectives. Control variables included time, patient demographics, symptom severity, and clinic. We employed hierarchical linear modelling to analyse data with a nested structure, with 138 sessions at Level 1, 73 patients at Level 2, and 23 therapists at Level 3. RESULTS Patient alienation and insecure attachment were associated with lower patient-rated alliance, while egocentricity was associated with higher patient-rated alliance. Patients' object relations were not significantly associated with therapist-rated alliance. On average, patients perceived the alliance more positively than their therapists, with a weak positive correlation between the alliance perspectives. CONCLUSIONS The results suggest that object relation dimensions may be important patient characteristics for forecasting therapeutic relationship quality. They also call for more attention to differences between alliance rating perspectives. PRACTITIONER POINTS Treatment may benefit from more attention to the quality of patients' object relations. If patients present with high levels of alienation and insecure attachment, therapists may need to pay especially close attention to the therapeutic alliance, and prudently address any ruptures in its quality. When monitoring the alliance quality, it is important to consider that patients and therapists may have different perspectives. Therapists relying solely on their own perceptions are at risk of missing alliance difficulties, and patients' object relations may be uniquely predictive of their own sense of the alliance. Therefore, it may be helpful to ask patients in session and through standardized measures for feedback on how they perceive the goals and tasks of treatment and the emotional bond with their therapist. Again, any alliance tensions could then be addressed directly as a means to maintaining engagement in the service of better outcome.
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Affiliation(s)
- Paula Errázuriz
- Psychology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Esteban Calvo
- Public Policy Institute, School of Business and Economics, Universidad Diego Portales, Santiago, Chile
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Calamaras MR, Reviere SL, Gallagher KE, Kaslow NJ. Changes in Differentiation-Relatedness During Psychoanalysis. J Pers Assess 2015; 98:44-50. [DOI: 10.1080/00223891.2015.1064439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Huprich SK, Pouliot GS, Nelson SM, Pouliot SK, Porcerelli JH, Cawood CD, Albright JJ. Factor Structure of the Assessment of Qualitative and Structural Dimensions of Object Representations (AOR) Scale. J Pers Assess 2015; 97:605-15. [PMID: 26046828 DOI: 10.1080/00223891.2015.1046989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Assessment of Qualitative and Structural Dimensions of Object Representations assessment instrument (AOR; Blatt, Chevron, Quinlan, Schaffer, & Wein, 1992 ) is one measure of parental representations used in the literature that assesses nonconscious processes while minimizing self-presentation biases. However, only 2 studies have considered the latent factor structure, with mixed findings reported that raise questions about the constructs being assessed. This study used archival data from 4 previous studies containing clinical and nonclinical samples, totaling 722 participants. Individuals were divided into 2 groups in which an exploratory factor analysis (EFA) was followed by a confirmatory factor analysis (CFA). Results of both the EFA and CFA suggested that a 3-factor solution was best, with factors that were labeled Agency, Communion, and Punitive based on previous research. The implications of these findings are explored, particularly with regard to the punitive aspect of maternal representations, as well as a possible revision to the scoring rubric.
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Affiliation(s)
| | - Gregory S Pouliot
- b Department of Psychology , Eastern Michigan University.,c McLaren-Flint Hospital , Flint , Michigan
| | | | - Sarah K Pouliot
- d Department of Psychology , University of Detroit Mercy.,e Pouliot Psychological Services, PLLC , Birmingham , Michigan
| | - John H Porcerelli
- f Department of Family Medicine & Public Health Sciences , Wayne State University
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Kealy D, Ogrodniczuk JS, Joyce AS, Steinberg PI, Piper WE. Narcissism and relational representations among psychiatric outpatients. J Pers Disord 2015; 29:393-407. [PMID: 23398104 DOI: 10.1521/pedi_2013_27_084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pathological narcissism is associated with maladaptive interpersonal behavior, although less is known regarding the internal relational representations of narcissistic patients. The authors examined the relationship between pathological narcissism and two constructs that reflect internal representations of relational patterns: quality of object relations and attachment style. Patients attending a psychiatric day treatment program (N = 218) completed measures of narcissism, general psychiatric distress, and attachment style in terms of attachment avoidance and anxiety. A semistructured interview was used to assess quality of object relations. Multiple regression analysis was conducted, controlling for general psychiatric distress. Pathological narcissism was associated with anxious attachment, but not with avoidant attachment. Narcissism was also associated with lower levels of quality of object relations. The implications of these results are discussed in terms of internal representations of self-other relations.
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Affiliation(s)
- David Kealy
- 1 Department of Psychiatry, University of British Columbia
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DeFife JA, Goldberg M, Westen D. Dimensional assessment of self- and interpersonal functioning in adolescents: implications for DSM-5's general definition of personality disorder. J Pers Disord 2015; 29:248-60. [PMID: 23398103 DOI: 10.1521/pedi_2013_27_085] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Central to the proposed DSM-5 general definition of personality disorder (PD) are features of self- and interpersonal functioning. The Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) is a coding system that assesses eight dimensions of self- and relational experience that can be applied to narrative data or used by clinically experienced observers to quantify observations of patients in ongoing psychotherapy. This study aims to evaluate the relationship of SCORS-G dimensions to personality pathology in adolescents and their incremental validity for predicting multiple domains of adaptive functioning. A total of 294 randomly sampled doctoral-level clinical psychologists and psychiatrists described an adolescent patient in their care based on all available data. Individual SCORS-G variables demonstrated medium-to-large effect size differences for PD versus non-PD identified adolescents (d = .49-1.05). A summary SCORS-Composite rating was significantly related to composite measurements of global adaptive functioning (r = .66), school functioning (r = .47), externalizing behavior (r = -.49), and prior psychiatric history (r = -.31). The SCORS-Composite significantly predicted variance in domains of adaptive functioning above and beyond age and DSM-IV PD diagnosis (ΔR(2)s = .07-.32). As applied to adolescents, the SCORS-G offers a framework for a clinically meaningful and empirically sound dimensional assessment of self- and other representations and interpersonal functioning capacities. Our findings support the inclusion of self- and interpersonal capacities in the DSM-5 general definition of personality disorder as an improvement to existing PD diagnosis for capturing varied domains of adaptive functioning and psychopathology.
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Stein MB, Slavin-Mulford J, Siefert CJ, Justin Sinclair S, Smith M, Chung WJ, Liebman R, Blais MA. External Validity of SCORS-G Ratings of Thematic Apperception Test Narratives in a Sample of Outpatients and Inpatients. ACTA ACUST UNITED AC 2015. [DOI: 10.1027/1192-5604/a000057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The Social Cognition and Object Relations Scale-Global Ratings Method (SCORS-G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker-Aspen, 2011 ) is a reliable system for coding narrative data, such as Thematic Apperception Test (TAT) stories. This study employs a cross-sectional, correlational design to examine associations between SCORS-G dimensions and life events in two clinical samples. Samples were composed of 177 outpatients and 57 inpatients who completed TAT protocols as part of routine clinical care. Two experienced raters coded narratives with the SCORS-G. Data on the following clinically relevant life events were collected: history of psychiatric hospitalization, suicidality, self-harming behavior, drug/alcohol abuse, conduct-disordered behavior, trauma, and education level. As expected, the clinical life event variable associated with the largest number of SCORS-G dimensions was Suicidality. Identity and Coherence of Self was related to self-harm history across samples. Emotional Investment in Relationships and Complexity of Representations were also associated with several life events. Clinical applications, limitations of the study, and future directions are reviewed.
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Affiliation(s)
- Michelle B. Stein
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Michaela Smith
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Wei-Jean Chung
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rachel Liebman
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mark A. Blais
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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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]
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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.
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Affiliation(s)
- Greg Haggerty
- a Von Tauber Institute for Global Psychiatry , Nassau University Medical Center
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Fetterman AK, Robinson MD, Gilbertson EP. Implicit Self-Importance in an Interpersonal Pronoun Categorization Task. CURRENT PSYCHOLOGY 2014; 33:185-198. [DOI: 10.1007/s12144-014-9205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Graceffo RA, Mihura JL, Meyer GJ. A Meta-Analysis of an Implicit Measure of Personality Functioning: The Mutuality of Autonomy Scale. J Pers Assess 2014; 96:581-95. [DOI: 10.1080/00223891.2014.919299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Social cognition and levels of personality organization in patients with somatoform disorders: a case-control study. J Nerv Ment Dis 2014; 202:217-23. [PMID: 24566507 DOI: 10.1097/nmd.0000000000000097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Social cognition and its association with level of personality organization (PO) were examined in 163 patients with severe somatoform disorders (SFDs) and 151 psychiatric (PSA) control patients. Social cognition was measured with the Social Cognition and Object Relations Scale, which assessed both affective and cognitive facets of social cognition. Levels of PO were assessed using theory-driven profiles of the Dutch Short Form of the Minnesota Multiphasic Personality Inventory (MMPI). The SFD patients exhibited impairments in the cognitive facets of social cognition but not more so than the PSA controls. The results for the affective aspects indicated that the SFD patients exhibited lower levels of emotional investment yet higher affect tone in interactions than the PSA controls. In contrast to the control group, level of PO was not associated with social cognition in SFD. Together, the results indicated that impairments in complexity of mental representations are not specific to SFD patients, yet impairments in emotional investment may be specific to SFD.
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Handelzalts JE, Fisher S, Naot R. Object relations and real life relationships: A cross method assessment. Scand J Psychol 2014; 55:160-7. [DOI: 10.1111/sjop.12102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan E. Handelzalts
- The Academic College of Tel Aviv Yaffo; Tel-Aviv; Israel
- Tel-Aviv University; Tel-Aviv; Israel
| | - Shimrit Fisher
- The Academic College of Tel Aviv Yaffo; Tel-Aviv; Israel
| | - Rachel Naot
- The Academic College of Tel Aviv Yaffo; Tel-Aviv; Israel
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Sochos A. Couple attachment and relationship duration in psychotherapy patients: exploring a new methodology of assessment. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2013. [DOI: 10.1080/03069885.2013.852160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Miano A, Fertuck EA, Arntz A, Stanley B. Rejection sensitivity is a mediator between borderline personality disorder features and facial trust appraisal. J Pers Disord 2013; 27:442-56. [PMID: 23586933 DOI: 10.1521/pedi_2013_27_096] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals with borderline personality disorder (BPD) fear abandonment and exhibit instability in their close relationships. These interpersonal difficulties may be influenced by the propensity to interpret neutral social stimuli (e.g., nonemotional faces) as untrustworthy. This study evaluated the hypothesis that BPD features are associated with attributions of untrustworthiness to neutral faces. Additionally, the authors hypothesized that the trait of rejection sensitivity (RS) is also associated with BPD features and mediates the relationship between BPD features and untrustworthy facial trait appraisal. An undergraduate, nonclinical sample (N = 95) was assessed for BPD features, RS, and trust appraisal of neutral faces. Higher BPD features were associated with lower ratings of trustworthiness of the faces and higher scores on RS. Furthermore, as hypothesized, the association between BPD features and trust appraisal was mediated by RS. Results are discussed in the context of a proposed model of the social cognitive mechanisms of interpersonal hypersensitivity in BPD.
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Affiliation(s)
- Annemarie Miano
- Department of Clinical Psychological Science, Maastricht University, The Netherlands
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Ortigo KM, Westen D, Defife JA, Bradley B. Attachment, social cognition, and posttraumatic stress symptoms in a traumatized, urban population: evidence for the mediating role of object relations. J Trauma Stress 2013; 26:361-8. [PMID: 23696470 DOI: 10.1002/jts.21815] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Kile M Ortigo
- VA Palo Alto Health Care System, Palo Alto, California, USA; Department of Psychology, Emory University, Atlanta, Georgia 30322, USA.
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Lowyck B, Luyten P, Verhaest Y, Vandeneede B, Vermote R. Levels of personality functioning and their association with clinical features and interpersonal functioning in patients with personality disorders. J Pers Disord 2013; 27:320-36. [PMID: 23735041 DOI: 10.1521/pedi.2013.27.3.320] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recently, the DSM-5 Personality and Personality Disorders Work Group has proposed a multiple level approach toward the classification and diagnosis of personality disorders (PDs), with the first level entailing a rating of impairments in levels of personality functioning. Although a number of measures that assess levels of personality functioning have been validated, given its prominent status in the DSM-5 proposal and contemporary theories of personality pathology, the Work Group has called for more research in this area (e.g., Bender, Morey, & Skodol, 2011). In response to this call, this study investigates the relationship between two major, well-validated dimensional measures of levels of personality functioning, that is, the Differentiation-Relatedness Scale (DR-S; Diamond, Blatt, Stayner, & Kaslow, 1991), as scored on the Object Relations Inventory (ORI; Blatt, Wein, Chevron, & Quinlan, 1979), and the Inventory of Personality Organization (IPO; Lenzenweger, Clarkin, Kernberg, & Foelsch, 2001), a self-report instrument, and their relationship with different measures of clinical and interpersonal functioning in 70 patients with a PD. First, results showed that higher levels of differentiation and relatedness of descriptions of self and significant others, and of the self in particular, were negatively related to indices of personality functioning as assessed by the IPO. Lower levels of personality functioning, as measured with both the DR-S and the IPO, were positively related to severity of depression, symptomatic distress, self-harm, and interpersonal problems. Finally, results showed that the DR-S and the IPO independently predicted clinical features and interpersonal functioning. Hence, this study lends further support for the concurrent and predictive validity of the DR-S and the IPO in assessing levels of personality functioning. However, more research concerning the validity of these measures in assessing levels of personality functioning is needed. Suggestions for further research are formulated.
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Affiliation(s)
- Benedicte Lowyck
- University Psychiatric Centre, University of Leuven, Campus Kortenberg, Kortenberg, Belgium.
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Lindfors O, Knekt P, Virtala E, Haaramo P. Concurrent validity of the Quality of Object Relations Scale (QORS) in relation to proxy assessment of the theoretical scale constituents. Psychopathology 2013; 46:111-9. [PMID: 22906923 DOI: 10.1159/000339385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 04/29/2012] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland.
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Morey LC, Berghuis H, Bender DS, Verheul R, Krueger RF, Skodol AE. Toward a model for assessing level of personality functioning in DSM-5, part II: empirical articulation of a core dimension of personality pathology. J Pers Assess 2012; 93:347-53. [PMID: 22804673 DOI: 10.1080/00223891.2011.577853] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The extensive comorbidity among Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994 ) personality disorders might be compelling evidence of essential commonalities among these disorders reflective of a general level of personality functioning that in itself is highly relevant to clinical decision making. This study sought to identify key markers of such a level, thought to reflect a core dimension of personality pathology involving impairments in the capacities of self and interpersonal functioning, and to empirically articulate a continuum of severity of these problems for DSM-5. Using measures of hypothesized core dimensions of personality pathology, a description of a continuum of severity of personality pathology was developed. Potential markers at various levels of severity of personality pathology were identified using item response theory (IRT) in 2 samples of psychiatric patients. IRT-based estimates of participants' standings on a latent dimension of personality pathology were significantly related to the diagnosis of DSM-IV personality disorder, as well as to personality disorder comorbidity. Further analyses indicated that this continuum could be used to capture the distribution of pathology severity across the range of DSM-IV personality disorders. The identification of a continuum of personality pathology consisting of impairments in self and interpersonal functioning provides an empirical foundation for a "levels of personality functioning" rating proposed as part of a DSM-5 personality disorder diagnostic formulation.
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Affiliation(s)
- Leslie C Morey
- Department of Psychology, Texas A&M University, College Station, TX 77843–4235, USA.
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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.
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Affiliation(s)
- Donna S Bender
- Department of Psychiatry, University of Arizona College of Medicine, USA.
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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]
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Interpersonal problems and cognitive characteristics of interpersonal representations in alexithymia: a study using a self-report and interview-based measure of alexithymia. J Nerv Ment Dis 2012; 200:607-13. [PMID: 22759939 DOI: 10.1097/nmd.0b013e31825bfad9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this study, associations between alexithymia, interpersonal problems, and cognitive-structural aspects of internal interpersonal representations were examined. Alexithymia was measured using the Toronto Structured Interview for Alexithymia (TSIA) and the 20-item Toronto Alexithymia Scale (TAS-20). To measure interpersonal problems, the dominance and affiliation dimension scores of the Inventory of Interpersonal Problems were used, and cognitive-structural characteristics of interpersonal representations were measured using the Social Cognition and Object Relations Scale (SCORS). As hypothesized, alexithymia was related to cold and withdrawn, but not to dominant or submissive, interpersonal functioning. In terms of the SCORS, alexithymia was negatively related to complexity of interpersonal representations, both in TAT and in interview narratives, indicating a link between alexithymia and mentalization. However, alexithymia was related only to the dimension of social causality when this dimension was scored on TAT narratives. Overall, the TSIA provides the most consistent and stable results after controlling for negative affectivity.
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Inslegers R, Vanheule S, Meganck R, Debaere V, Trenson E, Desmet M, Roelstraete B. The Assessment of the Social Cognition and Object Relations Scale on TAT and Interview Data. J Pers Assess 2012; 94:372-9. [DOI: 10.1080/00223891.2012.662187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Diguer L, Gamache D, Laverdière O. Development and initial validity of the Object Relations Rating Scale. Psychother Res 2012; 22:402-16. [PMID: 22417116 DOI: 10.1080/10503307.2012.662606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The aim of this study was to report on the development and the initial validation of the Object Relations Rating Scale (ORRS), which is a measure of in-session enactments of object relations that draws on a psychodynamic conceptualization of personality organization. Forty participants were included in the study, distributed among neurotic, borderline and psychotic personality organizations (PO). Results showed that the interrater reliability of this new measure is good. Two tests of criterion validity support the validity of the measure: the ORRS discriminates well between the three PO groups and it correlates in expected ways with five PO dimensions. Finally, ORRS scales that pertain to the degree of in-session object relation enactments correlated with a measure of transference intensity (convergent validity), and correlations with therapists experience were low as expected (discriminant validity).
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Affiliation(s)
- Louis Diguer
- École de Psychologie, Université Laval, Pav. Félix-Antoine Savard, Québec, Canada.
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Ulberg R, Høglend P, Marble A, Johansson P. Women respond more favorably to transference intervention than men: a randomized study of long-term effects. J Nerv Ment Dis 2012; 200:223-9. [PMID: 22373759 DOI: 10.1097/nmd.0b013e318247cb6d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study focuses on whether there is a sustained difference in treatment response to transference interventions between women and men. Data from the First Experimental Study of Transference Interpretations were used. One hundred patients were randomized to receive dynamic psychotherapy in 1 year with either a moderate level of transference intervention or no transference intervention. Follow-ups were 1 year and 3 years after treatment termination. The two primary outcome measures were the Psychodynamic Functioning Scales (PFS) and Inventory of Interpersonal Problems-Circumplex Version. Change was assessed using linear mixed models. In the moderator analyses, using the primary outcome measure (PFS) and controlling for the effect of the level of relational functioning (Quality of Object Relations Scale), women and men differed significantly in their response to transference intervention. The average relational functioning female patients showed a significant positive long-term effect of transference intervention.
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Affiliation(s)
- Randi Ulberg
- Research Unit, Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.
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Koelen JA, Luyten P, Eurelings-Bontekoe LHM, Diguer L, Vermote R, Lowyck B, Bühring MEF. The impact of level of personality organization on treatment response: a systematic review. Psychiatry 2012; 75:355-74. [PMID: 23244013 DOI: 10.1521/psyc.2012.75.4.355] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper provides a systematic review of extant research concerning the association between level of personality organization (PO) and psychotherapy response. Psychotherapy studies that reported a quantifiable association between level of PO and treatment outcome were examined for eligibility. Based on stringent inclusion and exclusion criteria, we identified 18 studies from 13 original data sources. Participants in these studies had a variety of mental disorders, of which mood, anxiety, and personality disorders were the most common. The results of this systematic review converge to suggest that higher initial levels of PO are moderately to strongly associated with better treatment outcome. Some studies indicate that level of PO may interact with the type of intervention (i.e., interpretive versus supportive) in predicting treatment outcome, which suggests the importance of tailoring the level of interpretive work to the level of PO. Yet, at the same time, the limited number of studies available and the heterogeneity of measures used to assess PO in existing research stress the need for further research. Potential implications for clinical practice and guidelines for future research are discussed.
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Huprich SK, Pouliot GS, Bruner R. Self-other representations mediate the relationship between Five-Factor Model depression and depressive states. Psychiatry 2012; 75:176-89. [PMID: 22642436 DOI: 10.1521/psyc.2012.75.2.176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While it is well established that trait depression is a risk factor for experiencing increased rates of episodes of depression, it is also the case that the ways in which the self and others are perceived, and nature of the relationship between self and other, predispose individuals to frequent depressive episodes. In this study, 182 psychiatric outpatients at three treatment facilities were evaluated for Five-Factor Model depressive traits, depressive states, and self-other representations (object relations). It was hypothesized that object relations would mediate the relationship between trait and state depression. Results partially confirmed this hypothesis. While trait depression significantly predicted variance in the Beck Depression Inventory-II (BDI-II; Beck et al., 1988), two dimensions of the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995)--Alienation and Insecure Attachment--partially mediated the relationship between trait and state depression. Similarly, trait depression predicted tendencies to experience frequent shifts toward depressive episodes, although the Insecure Attachment and Egocentricity scales of the BORRTI fully mediated the relationship between trait depression and depressive lability. Knowledge of self-other representations, which is being considered for inclusion in the DSM-5, allows for a more refined understanding of those factors that contribute shifts in depressive mood.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology, Eastern Michigan University, Science Complex, Ypsilanti, MI 48197, USA.
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Arvidsson D, Sikström S, Werbart A. Changes in self and object representations following psychotherapy measured by a theory-free, computational, semantic space method. Psychother Res 2011; 21:430-46. [DOI: 10.1080/10503307.2011.577824] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Krueger RF, Eaton NR, Clark LA, Watson D, Markon KE, Derringer J, Skodol A, Livesley WJ. Deriving an empirical structure of personality pathology for DSM-5. J Pers Disord 2011; 25:170-91. [PMID: 21466248 DOI: 10.1521/pedi.2011.25.2.170] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The DSM-IV model of personality disorders is composed of trait sets arranged into 10 theoretically distinct, polythetically assessed categories, with little regard for how the traits comprising these disorders are interrelated and structured. Research since the publication of DSM-III has shown that this model is untenable. The question is not whether this model needs revision; rather, the question is how to move from the existing DSM-IV framework to a model better connected with data. Empirically-based models of personality trait variation provide a starting point for DSM-5, and ongoing research will be used to delineate further the empirical structure of personality traits in the pathological range. The ultimate goal is to frame future DSMs in a way that is maximally useful for clinicians as well as researchers. It is also critical to understand that the DSM-5 is intended to be a living document that will facilitate novel inquiry and clinical applications, as opposed to a document designed to promote and perpetuate a fixed set of constructs. Thus, we view a proposed trait system as a first step on a path to a well-validated, clinically-useful structure.
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Affiliation(s)
- Robert F Krueger
- Psychology Department, University of Minnesota,75 East River Road, Minneapolis, MN 55455-0344, USA.
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Porcerelli JH, Cogan R, Markova T, Miller K, Mickens L. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Defensive Functioning Scale: a validity study. Compr Psychiatry 2011; 52:225-30. [PMID: 21295230 DOI: 10.1016/j.comppsych.2010.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/14/2010] [Accepted: 06/21/2010] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We assess the convergent and predictive validity of the Defensive Functioning Scale (DFS) with measures of life events, including childhood abuse and adult partner victimization; dimensions of psychopathology, including axis I (depressive) and axis II (borderline personality disorder) symptoms; and quality of object relations. METHOD One hundred and ten women from a university-based urban primary care clinic completed a research interview from which defense mechanisms were assessed. The quality of object relations was also assessed from interview data. The women completed self-report measures assessing depression, borderline personality disorder symptoms, childhood physical and sexual abuse, and adult partner physical and sexual victimization. RESULTS Inter-rater reliability of the scoring of the DFS levels was good. High adaptive defenses were positively correlated with the quality of object relations and pathological defenses were positively correlated with childhood and adult victimization and symptom measures. Although major image distorting defenses were infrequently used, they were robustly correlated with all study variables. In a stepwise multiple regression analysis, major image distorting defenses, depressive symptoms, and minor image distorting defenses significantly predict childhood victimization, accounting for 37% of the variance. In a second stepwise multiple regression analysis, borderline personality disorder symptoms and disavowal defenses combined to significantly predict adult victimization, accounting for 16% of the variance. CONCLUSIONS The DFS demonstrates good convergent validity with axis I and axis II symptoms, as well as with measures of childhood and adult victimization and object relations. The DFS levels add nonredundant information to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition beyond axis I and axis II.
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Affiliation(s)
- John H Porcerelli
- Department of Family Medicine & Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA.
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