Object representations and their relationship to psychopathology and physical health status in African-American women in primary care

Malevolent object relations: A multimethod study of female survivors of childhood abuse

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.

Factor Structure of the Assessment of Qualitative and Structural Dimensions of Object Representations (AOR) Scale

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.

Mentalizing in self vs. parent representations and working models of parents as risk and protective factors from distress and eating disorders

This study examined whether low developmental level of mentalization and symbolization, manifested as low ability to represent and reflect on mental states of the self and parents as well as malevolent working models of parents, may be risk factors in the genesis of eating disorders (EDs). We examined 71 female adolescent inpatients with ED and 45 controls without ED using the Object Representation Inventory and self-report measures assessing emotional distress and ED symptoms. The results indicated that the patients with ED presented with a significantly lower level of mentalization and symbolization and with more malevolent working models of their parents in comparison with the controls without ED. A more benevolent parental representation, specifically with the father, combined with better mentalization abilities, was found to indirectly predict lower ED symptoms, via the reduction of distress levels. These findings suggest that adequate mentalization and benevolent working models of parents may serve as a protective factor reducing the level of ED symptoms.

The impact of level of personality organization on treatment response: a systematic review

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.

Self-other representations mediate the relationship between Five-Factor Model depression and depressive states

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.

Mental representations in women with panic disorder: an urban African-American sample

Psychodynamic theories of panic disorder (PD) suggest an association between PD and impairments in mental representations. This study tested this hypothesis by comparing mental representations of 25 African-American women recruited from an urban primary care clinic with PD with a group of 25 women without PD and matched on race, age, marital status, education, and income. Mental representations were assessed through spontaneous descriptions of mothers and reliably coded with the Qualitative and Structural Dimensions of Object Representations scale (Blatt et al., Unpublished manual, 1992). Results essentially supported the hypotheses for impaired mental representations (lower benevolence, higher ambivalence, and lower conceptual level) for women with PD as compared with women without PD. No differences in mental representations were found between women with PD with major depression and women with only PD. The findings provide preliminary support for a psychodynamic theory of PD in a sample of African-American women.

Defense mechanisms and Major Depressive Disorder in African American women

This study explored differences in defense use between a group of predominantly African American women diagnosed with Major Depressive Disorder (MDD; n = 20) and a healthy control sample (n = 20), both from a primary care medical clinic. Patients completed the Patient Health Questionnaire to assess DSM-IV diagnoses and underwent video-recorded interviews, which were assessed for defenses using the Defensive Functioning Scale from the DSM-IV. Groups were compared for differences in overall defensive functioning, defense levels, and individual defenses using independent samples t tests. Results showed that the MDD group scored higher on mental inhibition, minor image distorting, and major image distorting defense levels as well as the individual defenses devaluation, dissociation, and isolation. The control group scored higher on the overall defensive functioning and the individual defense anticipation. The results also showed a trend toward the MDD group scoring higher on the disavowal defense level and the individual defense splitting.