Transitional object use and borderline psychopathology

Level of Structural Integration and Its Association with Intersession Experiences and Outcomes: A Pilot Study

The level of structural integration (LSI), a psychodynamic/psychoanalytic concept originally developed by the Operationalized Psychodynamic Diagnosis (OPD), provides a promising empirical approach that is recognized beyond the boundaries of psychoanalysis and is highly relevant for therapy and research. The aim of our study was to investigate the intersession experiences of patients in psychotherapy with different levels of structural integration. The sample consisted of 69 inpatients who were undergoing psychotherapeutic treatment. The patients were asked to complete the German version of the Intersession Experience Questionnaire (IEQ), the short version of the OPD Structure Questionnaire (OPD-SQS) and the Brief-Symptom Inventory (BSI). LSI is associated with the situations, contents and negative emotions in the intersession experiences of patients, as well as their symptom distress over the course of therapy. Furthermore, the level of structural integration is a significant predictor of outcomes. Patients with different LSI had different intersession experiences.

Please Don't Leave Me-Separation Anxiety and Related Traits in Borderline Personality Disorder

PURPOSE OF REVIEW

In light of the apparent symptomatic resemblance of separation anxiety disorder (SAD) symptoms on the one hand and abandonment fears, anxiousness, and separation insecurity central to borderline personality disorder (BPD) on the other hand, a comprehensive overview of separation anxiety and related traits in BPD is provided.

RECENT FINDINGS

Epidemiological, environmental, psychological, and neurobiological data connecting BPD to separation events, feelings of loneliness, insecure attachment styles, dimensional separation anxiety as well as SAD per se suggest a partly shared etiological pathway model underlying BPD and SAD. Differential diagnostic aspects and implications for treatment are discussed, highlighting separation anxiety as a promising transdiagnostic target for specific psychotherapeutic and pharmacological treatment approaches in BPD. This innovative angle on cross-disorder symptomatology might carry potential for novel preventive and therapeutic avenues in clinical practice by guiding the development of interventions specifically targeting separation anxiety and attachment-related issues in BPD.

Relationship between transitional objects and personality disorders in female psychiatric inpatients: a prospective study

Patients often bring transitional objects (TO) to inpatient units. The authors quantified the frequency of TO possession in an inpatient psychiatric setting and assessed whether TO use is specific to a personality disorder (PD) diagnosis, focusing on borderline PD (BPD). TO possession was assessed using the Transitional Objects Questionnaire, and PD diagnosis was established using standard DSM-IV clinical interviews. Of the 104 female patients assessed, 57.7% showed TO use; 84% of BPD patients, 71% of BPD-trait patients, 65% of patients with PD traits (other than BPD), and 56% of PD patients (other than BPD) displayed TO use, whereas 30.6% of patients without PD showed TO use. Patients with TOs were significantly younger and had significantly longer hospital stays. The specificity and sensitivity for TO use in the BPD group were 0.506 and 0.84, respectively. The authors conclude that TO use is closely related to PD diagnosis, but is not specific to BPD.

Does the teddy bear sign predict psychogenic nonepileptic seizures?

This study evaluated whether adults and older teenagers who bring toy stuffed animals to an epilepsy monitoring unit (EMU), i.e., the "teddy bear sign," were more likely to be diagnosed to have psychogenic nonepileptic seizures (PNES) than to have epilepsy. We prospectively evaluated 335 patients, aged 15 years and older, admitted to our EMU over a 19-month period, assessing age at seizure onset, duration of seizures, gender, seizure diagnosis, presence of intellectual disabilities, presence of psychiatric illness, and possession of a toy stuffed animal in the EMU. Among all ages, patients who brought toy stuffed animals were not more likely to have PNES or both PNES and epilepsy than to have epilepsy alone. For those 18 and over, there was a significant difference but only after adjusting for all other patient characteristics, and absolute differences were small. Patients 18 and older with stuffed animals had a 3.21 (95% confidence interval = 1.58, 8.90) times greater odds of being diagnosed to have PNES or both PNES and epilepsy than to have epilepsy alone after adjusting for other patient characteristics (p = 0.022). We conclude that patient possession of toy stuffed animals in the EMU is not a reliable sign of PNES.

Adult attachment to transitional objects and borderline personality disorder

Borderline personality disorder (BPD) is characterized by tumultuous, unstable personal relationships, difficulty being alone, and an inability to self-soothe. This may explain why patients with BPD tend to develop strong attachments to transitional objects such as stuffed animals. Research in hospital settings has linked the use of transitional objects to the presence of BPD. Using a nonclinical community sample (N = 80) we explored the link between attachments to transitional objects and various aspects of personality pathology, as well as to childhood trauma, and parental rearing styles. People who reported intense current attachments to transitional objects were significantly more likely to meet criteria for a BPD diagnosis than those who did not; they also reported more childhood trauma, rated their early caregivers as less supportive, and had more attachment problems as adults. Heavy emotional reliance on transitional objects in adulthood may be an indicator of underlying pathology, particularly BPD.

The prevalence of transitional object use in adolescence: is there a connection between the existence of a transitional object and depressive symptoms?

OBJECTIVE

The purpose of the study was to investigate the prevalence of the use of a transitional object (TO) in adolescence and its connection with depressive symptoms and mental distress in youth by gender.

METHOD

The study group consisted of 1,054 adolescents (465 boys, 589 girls) from normal comprehensive schools in Turku, a Finnish town with approximately 175,000 inhabitants. The mean age of both gender groups was 14.5 years (SD 0.5); respondents came from all social classes. Background and TO information was collected with questionnaires. Depressive symptoms and mental distress were explored by the children's depression inventory (CDI) and its subscales: low self-confidence, anhedonia and sadness.

RESULTS

Of all respondents, 29% (n = 285) had a TO: 37% of girls and 18% of boys. The difference between genders was statistically significant. There was also a statistically significant gender difference in the character of the TO reported: 72 % of girls with a TO had a soft toy, whereas 49% of boys with a TO used hard objects, such as pens, hard toys or books. TO-users showed more depressive symptoms than non-users, but the difference was not statistically significant (P = 0.053). Significant differences were found in the CDI subscales: TO-users had more sadness than non-users and girls using a TO showed more sadness than non-using girls. TO-using boys did not differ from non-using boys with regard to sadness or the other CDI-subscales.

CONCLUSIONS

The use of a TO seems to be common in adolescence. Adolescents with more depressive symptoms more often used a TO. The sadness of girls using TOs requires attention.

The borderline diagnosis I: psychopathology, comorbidity, and personality structure

Borderline personality disorder (BPD) is a complex and serious mental disorder associated with severe functional impairment, substantial treatment utilization, and a high rate of mortality by suicide. Recently, BPD has become a focus of intensifying study. In Part I of this three-part article meant to provide a foundation to researchers on the current status of the borderline diagnosis and prospects for its future development, we examine the psychopathology, comorbidity, and personality structure of BPD. Although the descriptive characteristics of BPD are well-represented by DSM-IV diagnostic criteria, other important aspects of BPD psychopathology are not included. The descriptive criteria in conjunction with semistructured interviews have, however, increased the ability of investigators to diagnose BPD as reliably as many Axis I disorders. Frequent comorbidity of BPD with Axis I disorders necessitates a broad assessment of psychopathology to help account for clinical heterogeneity. Because of the absence of evidence of the validity of the diagnostic threshold for a categorical diagnosis of BPD, and because of the heterogeneity within the diagnosis, investigators should also supplement their DSM-IV diagnoses with assessments of underlying personality trait structures. Although there are a number of competing models of personality structure, they have remarkable convergence on a set of three to five basic personality dimensions.

Attachment and borderline personality disorder. A theory and some evidence

An attachment theory approach to severe personality disorder is described. Evidence is presented that suggests that representations of attachment relationships and attachment behaviors of patients with this diagnosis are commonly disorganized in character. It is argued that the capacity to develop mental representations of mental states in self and other (reflective function) develops in the context of attachment relationships and that disorganization of attachment undermines this process. Such disorganization can be associated with trauma but may also be linked to other biological and psychosocial deficits. Many of the clinical characteristics of patients with borderline personality disorder may be seen as consequences of disordered self-organization and a limited rudimentary capacity to think about behavior in mental state terms. The relevance of this model for the practice of psychotherapy with this group of patients is discussed.

Childhood vs. adolescence transitional object attachment, and its relation to mental health and parental bonding

871 participants, 375 boys and 496 girls, mean age 16.7 + 1, were administered the Parental Bonding Instrument (P.B.I.), the Brief Symptom Inventory (B.S.I.), the General Well-Being Questionnaire (G.W.B.) and the Chestnut Lodge Transitional Object Scale. Results supported Winnicott's theory: participants reporting attachment to a Transitional Object (T.O.) in their childhood reported significantly more optimal maternal bonding than participants who were not attached to a T.O. Participants reporting attachment to a T.O. in adolescence had significantly more psychiatric symptoms and less general well-being. Adolescence T.O. attachment might be considered a marker of mental distress in the general, normal population.

Transitional objects: a review of the literature

The author provides a historical overview of the literature on the topic of transitional objects and transitional phenomena. Specific attention is given to the literature that has focused on: (a) the meaning and significance of the concept, (b) its relation to psychological development, and (c) an exploration of cultural and gender differences among users of the transitional object. Implications for therapy and suggestions for further research in this area are also be addressed.

Temperament and the transitional object

The transitional object attachments and persistent oral habits of 37 three-year-olds were examined in relation to their present and retrospectively rated infantile temperament. Children attached to a transitional object were differentiable from unattached children on infantile but not early childhood temperament, and the predictive temperament pattern differed from the pattern predicting oral habits. Transitional object attachments were independent from oral habits and were interpreted to serve distinct non-pathological developmental functions. The study suggests that temperament plays an etiological role in transitional object attachments, but that the status of the object as a developmental marker is ambiguous.

An empirical examination of soothing tactics in borderline personality disorder

Little empirical information is available regarding the process of self-soothing in borderline individuals, as well as in normal subjects. This study examined the frequency of used of soothing "things," soothing "behaviors," and soothing "psychological activities" in three groups: borderline personality disorder, major depressive disorder without concurrent personality disorder, and college students. Results indicated that: (1) borderline individuals reported using soothing things at comparable levels to the other two groups; (2) borderline subjects and those with major depressive disorders used more adaptive soothing behaviors than did college students; (3) borderline subjects used more maladaptive soothing behaviors than the other two groups; and (4) borderline individuals used psychologically soothing activities at frequencies comparable to the other two groups. These results are intended to begin the process of developing a soothing profile for individuals with borderline personality disorder.