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Lewis KC, Meehan KB, Cain NM, Wong PS, Clemence AJ, Stevens J, Tillman JG. Quality of Internalized Object Representations and Suicidality in Individuals With Anaclitic and Introjective Personality Styles. J Pers Disord 2021; 35:145-160. [PMID: 31084554 DOI: 10.1521/pedi_2019_33_435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research has shown differences in the characteristics of suicidal behavior in individuals with dependent (anaclitic) versus self-critical (introjective) personality styles. Questions remain, however, as to what factors distinguish suicidal from nonsuicidal individuals within each personality style. The current study examined clinical and interpersonal correlates of suicidality in 124 patients attending residential treatment for complex psychiatric disorders, with the aim of clarifying how social cognition and quality of internalized object representations relate to suicidality in individuals with anaclitic versus introjective personality organizations. Higher anaclitic and lower introjective traits each predicted higher frequency of prior attempts. Furthermore, higher anaclitic and lower introjective traits interacted with the affective-interpersonal quality of object representations to predict prior attempts, such that each trait was associated with more frequent past attempts in the context of poorer quality of object relations. The treatment implications of these findings are discussed, and areas for future research are considered.
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Affiliation(s)
- Katie C Lewis
- Erikson Institute for Education and Research, Austen Riggs Center, Stockbridge, Massachusetts
| | - Kevin B Meehan
- Department of Psychology, Long Island University, Brooklyn, New York
| | - Nicole M Cain
- Department of Clinical Psychology, Rutgers University, Piscataway, New Jersey
| | - Philip S Wong
- Department of Psychology, Long Island University, Brooklyn, New York
| | | | - Jennifer Stevens
- Erikson Institute for Education and Research, Austen Riggs Center, Stockbridge, Massachusetts
| | - Jane G Tillman
- Erikson Institute for Education and Research, Austen Riggs Center, Stockbridge, Massachusetts
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2
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Bahn GH, Park JS. A Multifactorial Interpretation of a Teenager's Suicide: Based on Krystal's Death in Casual Vacancy. Soa Chongsonyon Chongsin Uihak 2021; 32:3-9. [PMID: 33424236 PMCID: PMC7788669 DOI: 10.5765/jkacap.200033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/07/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives It is hard to accumulate research data on adolescents’ suicide, because friends and family of the suicide completers might be reluctant to share the experience. To overcome the lack of information on adolescent suicide victims, the authors examined the risk and protective factors for adolescents’ suicide from a character in a novel. Methods Krystal, an adolescent female in the novel The Casual Vacancy by Joanne Rowling, failed to overcome her unfortunate cir-cumstances and committed suicide. The authors analysed Krystal’s case based on the guideline for patients with suicidal behaviours to address the complicated situation of her death. Results Krystal grew up in a poor and dangerous environment. Despite the environmental hardships, she developed ego maturation with affectionate help from Mr Fairbrother, an assistant coach of the Girls’ Rowing Team and a parish councillor. The sudden passing away of Mr Fairbrother brought on a crisis of identity for Krystal. In addition, a villainous character raped her and her brother drowned to death, which brought her great sorrow. She felt helpless and committed suicide. Conclusion In spite of many risk factors for suicide, Krystal was able to keep her life with a few protective factors, a younger brother in the home, and a sense of responsibility for the family. After the loss of her brother, however, she collapsed in a moment. Krystal’s suicide might not only be a personal choice but a breakdown of the social protection system for the youth.
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Affiliation(s)
- Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
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3
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Kealy D, Laverdière O. Quality of object relations and suicidal ideation among community mental health outpatients. PSYCHOANALYTIC PSYCHOTHERAPY 2019. [DOI: 10.1080/02668734.2019.1706053] [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]
Affiliation(s)
- David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Olivier Laverdière
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, Canada
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4
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Palmieri A, Kleinbub JR, Mannarini S, Molinaro S, Castriotta C, Scocco P. Rorschach Assessment in Suicide Survivors: Focus on Suicidal Ideation. Front Public Health 2019; 6:382. [PMID: 30687692 PMCID: PMC6336920 DOI: 10.3389/fpubh.2018.00382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/21/2018] [Indexed: 12/12/2022] Open
Abstract
Background: The study of Suicidal ideation (SI) in people bereaved through suicide (Suicide Survivors, SSs) could be hampered by the person's willingness to admit it, or by their limited awareness of it. Our main hypothesis is that SI is common in these people, especially if they are parents or children of the victim. For its potential in shedding light on specific unconscious processes, Rorschach test was chosen for our investigation, for the first time in SSs literature. Rorschach suicide ideation and selected variables were further analyzed to better delineate their psychological profile. Method: Rorschach according to Exner's Comprehensive System was administered to 21 people bereaved through suicide presenting as outpatients at SOPROXI Project Service-Padova Mental Health Center- and 23 healthy controls. Beck Depression Inventory (BDI) was routinely administered to SSs and considered in the study. Results: T-tests showed significantly higher mean SI score (S-Con) as it emerged from the Rorschach test S-Con scores in SSs compared to control participants. SI found only weak correlation with the BDI item in which SSs can explicitly state the desire for their death. Within-group analysis revealed higher S-Con mean scores in bereaved children and parents of the victim compared to other kind of kinships. Morbid content (MOR) has been fund as the most characterizing variable in SSs' S-Con in terms of effect size, followed by a low number of responses with an ordinary form (X +%). Human movements (M), Special Scores related to thought slippage (ALOG, FABCOM2, INCOM2, and CONTAM) and poor human representations (PHR) have been shown to be more significantly present in SSs compared controls. Discussion: Psychodynamic interpretations of our results are provided. Clinical practice should consider Rorschach as one of eligible tools of investigation on this field.
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Affiliation(s)
- Arianna Palmieri
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Johann Roland Kleinbub
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy.,Interdepartmental Center for Family Research, University of Padova, Padova, Italy
| | - Sara Molinaro
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
| | | | - Paolo Scocco
- Soproxi Onlus, Padova, Italy.,Mental Health Center, ULSS 6 Euganea, Padova, Italy
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Scala JW, Levy KN, Johnson BN, Kivity Y, Ellison WD, Pincus AL, Wilson SJ, Newman MG. The Role of Negative Affect and Self-Concept Clarity in Predicting Self-Injurious Urges in Borderline Personality Disorder Using Ecological Momentary Assessment. J Pers Disord 2018; 32:36-57. [PMID: 29388895 DOI: 10.1521/pedi.2018.32.supp.36] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Deficits in identity as well as negative affect have been shown to predict self-injurious and suicidal behaviors in individuals with borderline personality disorder (BPD). However, less is known about the interactive effects of these two predictors. We examined the moderating effect of a particular component of identity, self-concept, on the relationship between negative affect and self-injurious urges utilizing ecological momentary assessments. Outpatients diagnosed with either BPD (n = 36) or any anxiety disorder but no BPD (n = 18) completed surveys throughout the day over a 21-day period. Higher levels of momentary negative affect predicted greater subsequent urges to self-injure, but only when self-concept clarity was low (z = -3.60, p < .01). This effect did not differ between diagnostic groups. The results suggest that self-concept clarity has a protective effect against self-injurious urges in light of high negative affect, and that this effect may be transdiagnostic.
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Affiliation(s)
- J Wesley Scala
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Kenneth N Levy
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Benjamin N Johnson
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Yogev Kivity
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | | | - Aaron L Pincus
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Stephen J Wilson
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Michelle G Newman
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
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Lewis KC. The Treacherous Path: Developmental Psychopathology and the Evolution of Risk for Suicide. PSYCHOANALYTIC STUDY OF THE CHILD 2018. [DOI: 10.1080/00797308.2017.1415070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Katie C. Lewis
- Erikson Institute for Education and Research, Austen Riggs Center
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Richardson LA, Porcerelli JH, Dauphin VB, Morris P, Murdoch W. The Use of the Social Cognition and Object Relations Scale in a Primary Care Setting. J Pers Assess 2017; 100:156-165. [DOI: 10.1080/00223891.2017.1369984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - John H. Porcerelli
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | | | - Pierre Morris
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | - William Murdoch
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
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Khosravani V, Sharifi Bastan F, Samimi Ardestani M, Jamaati Ardakani R. Early maladaptive schemas and suicidal risk in an Iranian sample of patients with obsessive-compulsive disorder. Psychiatry Res 2017; 255:441-448. [PMID: 28686949 DOI: 10.1016/j.psychres.2017.06.080] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 06/23/2017] [Accepted: 06/26/2017] [Indexed: 12/22/2022]
Abstract
There are few studies on suicidal risk and its related factors in patients diagnosed with obsessive-compulsive disorder (OCD). This study investigated the associations of early maladaptive schemas, OC symptom dimensions, OCD severity, depression and anxiety with suicidality (i.e., suicidal ideation and suicide attempts) in OCD patients. Sixty OCD outpatients completed the Scale for Suicide Ideation (SSI), the Young Schema Questionnaire-Short Form (YSQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). 51.7% of patients had lifetime suicide attempts and 75% had suicidal ideation. OCD patients with lifetime suicide attempts exhibited significantly higher scores on early maladaptive schemas than those without such attempts. Logistic regression analysis revealed that the mistrust/abuse schema and the OC symptom dimension of unacceptable thoughts explained lifetime suicide attempts. The mistrust/abuse schema, unacceptable thoughts and depression significantly predicted suicidal ideation. These findings indicated that the mistrust/abuse schema may contribute to high suicidality in OCD patients. Also, patients suffering from unacceptable thoughts need to be assessed more carefully for warning signs of suicide.
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Affiliation(s)
- Vahid Khosravani
- Clinical Research Development Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Mehdi Samimi Ardestani
- Departments of Psychiatry, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Falgares G, Marchetti D, De Santis S, Carrozzino D, Kopala-Sibley DC, Fulcheri M, Verrocchio MC. Attachment Styles and Suicide-Related Behaviors in Adolescence: The Mediating Role of Self-Criticism and Dependency. Front Psychiatry 2017; 8:36. [PMID: 28344562 PMCID: PMC5344916 DOI: 10.3389/fpsyt.2017.00036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/24/2017] [Indexed: 01/19/2023] Open
Abstract
Insecure attachment and the personality dimensions of self-criticism and dependency have been proposed as risk factors for suicide in adolescents. The present study examines whether self-criticism and dependency mediate the relationship between insecure attachment styles and suicidality. A sample of 340 high-school students (73.2% females), ranging in age from 13 to 20 years (M = 16.47, SD = 1.52), completed the Depressive Experiences Questionnaire for Adolescents, the Depressive Experiences Questionnaire for Adolescents, the Attachment Style Questionnaire, and the Suicidal Behaviors Questionnaire-Revised. The results partially support the expected mediation effects. Self-criticism, but not dependency, mediates the link between insecure attachment (anxiety and avoidance) and suicide-related behaviors. Implications for suicide risk assessment and management are discussed.
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Affiliation(s)
- Giorgio Falgares
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Palermo, Italy
| | - Daniela Marchetti
- Department of Psychological, Health and Territorial Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Sandro De Santis
- Azienda Provinciale per i Servizi Sanitari, Provincia Autonoma di Trento, Trento, Italy
| | - Danilo Carrozzino
- Department of Psychological, Health and Territorial Sciences, University of Chieti-Pescara, Chieti, Italy
| | | | - Mario Fulcheri
- Department of Psychological, Health and Territorial Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Maria Cristina Verrocchio
- Department of Psychological, Health and Territorial Sciences, University of Chieti-Pescara, Chieti, Italy
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Ching THW, Williams M, Siev J. Violent obsessions are associated with suicidality in an OCD analog sample of college students. Cogn Behav Ther 2016; 46:129-140. [PMID: 27659199 DOI: 10.1080/16506073.2016.1228084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The picture of suicide in obsessive-compulsive disorder (OCD) is unclear because previous research did not uniformly control for depressive symptoms when examining the relationship between OCD and suicidality. Specific links between OC symptom dimensions and suicidality were also not adequately studied. As such, we investigated specific associations between OC symptom dimensions and suicidality, beyond the contribution of depressive symptoms, in an OCD analog sample of college students, a group traditionally at risk for suicide. One hundred and forty-six college students (103 females; 43 males) who exceeded the clinical cut-off for OC symptoms on the Obsessive-Compulsive Inventory, Revised (OCI-R) were recruited. Participants completed an online questionnaire containing measures that assessed suicidality and OC and depressive symptom severity. Total OC symptom severity, unacceptable thoughts, and especially violent obsessions exhibited significant positive zero-order correlations with suicidality. However, analyses of part correlations indicated that only violent obsessions had a significant unique association with suicidality after controlling for depressive symptoms. Our findings support the hypothesis that violent obsessions have a specific role in suicidality beyond the influence of depressive symptoms in an OCD analog sample of college students. A strong clinical focus on suicide risk assessment and safety planning in college students reporting violent obsessions is therefore warranted. Future related research should employ longitudinal or prospective designs and control for other possible comorbid symptoms in larger and more representative samples of participants formally diagnosed with OCD in order to verify the generalizability of our findings to these groups.
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Affiliation(s)
- Terence H W Ching
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Monnica Williams
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Jedidiah Siev
- b Psychology Department , Swarthmore College , Swarthmore , PA , USA
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Lewis KC, Meehan KB, Cain NM, Wong PS, Clemence AJ, Stevens J, Tillman JG. Impairments in Object Relations and Chronicity of Suicidal Behavior in Individuals With Borderline Personality Disorder. J Pers Disord 2016; 30:19-34. [PMID: 25710732 DOI: 10.1521/pedi_2015_29_178] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While studies have demonstrated connections between impairments in object relations and self-destructive behaviors in individuals with borderline personality disorder (BPD), few have investigated whether these impairments relate to actual suicidal behaviors. The current study utilized the Social Cognition and Object Relations Scale-Global Method to investigate object relational functioning and suicidal behaviors in 131 residential treatment patients. Cognitive but not affective aspects of internalized representations predicted past suicidal behavior in BPD subjects; no relationships were found between quality of object representations and suicide in other-PD subjects. Implications of these findings for research, theory, and treatment of suicidal individuals are discussed.
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Affiliation(s)
- Katie C Lewis
- Department of Psychiatry, Albany Medical College, Albany, New York
| | - Kevin B Meehan
- Department of Psychology, Long Island University, Brooklyn, New York
| | - Nicole M Cain
- Department of Psychology, Long Island University, Brooklyn, New York
| | - Philip S Wong
- Department of Psychology, Long Island University, Brooklyn, New York
| | - A Jill Clemence
- Department of Psychiatry, Albany Medical Center, Albany, New York
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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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Lewis KC, Meehan KB, Tillman JG, Cain NM, Wong PC, Clemence AJ, Stevens J. Impact of Object Relations and Impulsivity On Persistent Suicidal Behavior. J Am Psychoanal Assoc 2014; 62:485-492. [PMID: 24973388 DOI: 10.1177/0003065114539007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Katie C Lewis
- Department of Psychology, Long Island University; Department of Psychiatry, Albany Medical Center
| | | | | | | | | | - A Jill Clemence
- Department of Psychiatry, Albany Medical Center; Erikson Institute, Austen Riggs Center
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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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Titelman D, Nilsson A, Svensson B, Karlsson H, Bruchfeld S. Suicide-nearness assessed with PORT, the Percept-genetic Object-Relation Test: A replication and a reliability study. Bull Menninger Clin 2012; 75:295-314. [PMID: 22166128 DOI: 10.1521/bumc.2011.75.4.295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To determine the reliability and validity of a previously identified "suicide cluster" in the Percept-genetic Object-Relation Test (PORT), which test documents subliminal perception of object-relation pictures, 20 suicide attempters and 70 controls were investigated. The correspondence between scores assigned by two judges was 95%-100%. The suicide-cluster signs in PORT, notably "lack of attachment relationships" and "Motor activity," were significant. Differences between the results of this and the previous study are discussed as is the role of psychiatric disorder in suicide.
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Eurelings-Bontekoe EHM, Luyten P, Snellen W. Validation of a theory-driven profile interpretation of the Dutch short form of the MMPI using the TAT Social Cognitions and Object Relations Scale (SCORS). J Pers Assess 2009; 91:155-65. [PMID: 19205936 DOI: 10.1080/00223890802634274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this study, we investigated the construct validity of the theory-driven profile interpretation of the Dutch Short Form of the MMPI (DSFM; Luteijn & Kok, 1985), an interpretation method aimed at assessing structural features of personality based on Kernberg and Caligor's (2005) views concerning personality organization. We utilized the four dimensions of the Social Cognition and Object Relations Scale (SCORS; Westen, Lohr, Silk, Gold, & Kerber, 1990) as external criteria. Results showed that, congruent with theoretical expectations, the DSFM profiles predicted structural features of personality functioning, especially identity diffusion as measured by the SCORS, after adjustment for the effect of the single scales used to construct the profiles. These findings provide further support for the construct validity of the DSFM profiles to measure structural features of personality organization. We discuss directions for future research and clinical implications.
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Parental representations, object relations and their relationship to Depressive Personality Disorder and Dysthymia. PERSONALITY AND INDIVIDUAL DIFFERENCES 2007. [DOI: 10.1016/j.paid.2007.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Orbach I. From abandonment to symbiosis: A developmental reversal in suicidal adolescents. PSYCHOANALYTIC PSYCHOLOGY 2007. [DOI: 10.1037/0736-9735.24.1.150] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brunstein Klomek A, Zalsman G, Apter A, Meged S, Har-Even D, Diller R, Orbach I. Self-object differentiation in suicidal adolescents. Compr Psychiatry 2007; 48:8-13. [PMID: 17145275 DOI: 10.1016/j.comppsych.2006.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 12/05/2005] [Accepted: 06/26/2006] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although problems in the differentiation between self and object are commonly encountered in clinical work with suicidal adolescents, empirical validation of this phenomenon is limited in the literature. The aim of this study was to use empirical methods to examine the differentiation between self and parental representations in suicidal inpatient adolescents. METHODS Ninety-six adolescents participated in the study: 32 suicidal inpatients, 32 nonsuicidal inpatients, and 32 healthy controls. The 3 groups were matched for sex, age, and education. All participants completed scales on self-object differentiation and suicidal tendencies. RESULTS Suicidal adolescents were found to be significantly different from both nonsuicidal psychiatric and healthy controls in negative self and parental descriptions (P < .001) but did not differ from the other groups when describing positive traits. Moreover, suicidal adolescents described themselves as being significantly less differentiated from both their father (P < .001) and mother (P < .01) in negative traits but not in positive traits, when compared to the 2 other groups. CONCLUSIONS Suicidal adolescents have difficulties differentiating the negative aspects of the self from the negative aspects of their parents. These results emphasize the importance of object relations theory in understanding suicidal tendencies in adolescents. A model combining negative symbiosis and suicidal tendencies offers several therapeutic intervention strategies.
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Porcerelli JH, Huprich SK, Binienda J, Karana D. Object representations and their relationship to psychopathology and physical health status in African-American women in primary care. J Nerv Ment Dis 2006; 194:838-44. [PMID: 17102708 DOI: 10.1097/01.nmd.0000244552.14073.d3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Object relations theories hypothesize a relationship between self/other representations and level of psychopathology. Research has lent support to this hypothesis. This study was conducted to examine the link between object representation and psychopathology, stress, physical health status, and alcohol abuse in 110 African-American women in primary care. Object representations were assessed through spontaneous descriptions of parents. Psychopathology and physical health status were assessed with the Patient Health Questionnaire and the Medical Outcomes Study Short-Form Health Survey, both of which were designed for medical settings. The results support the link between dimensions of object representations (developmental level, benevolence, punitiveness) and psychopathology and between object representations and aspects of health status. Punitive maternal and paternal representations were most robustly associated with psychopathology and health status and were the only representational variables associated with alcohol abuse. The findings provide additional support for the object representations-psychopathology link and extend the research by demonstrating associations among object representations, alcohol abuse, and health status.
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Affiliation(s)
- John H Porcerelli
- Division of Behavioral Science, Department of Family Medicine, Wayne State University School of Medicine, Detroit, Michigan 48235, USA
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21
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Peters EJ, Hilsenroth MJ, Eudell-Simmons EM, Blagys MD, Handler L. Reliability and validity of the Social Cognition and Object Relations Scale in clinical use. Psychother Res 2006. [DOI: 10.1080/10503300600591288] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kaslow NJ, Sherry A, Bethea K, Wyckoff S, Compton MT, Bender Grall M, Scholl L, Price AW, Kellermann A, Thompson N, Parker R. Social risk and protective factors for suicide attempts in low income African American men and women. Suicide Life Threat Behav 2005; 35:400-12. [PMID: 16178695 DOI: 10.1521/suli.2005.35.4.400] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case-control study was conducted to examine a broad array of potential social risk and protective factors for suicide attempt among 200 African American men and women receiving care at a large, public, urban hospital. Specifically, we examined the effect of the following potential risk factors for suicide attempt: life hassles, partner abuse, partner dissatisfaction, and racist events; as well as the following potential protective factors: effectiveness of obtaining resources, social embeddedness, and social support. Using logistic regression, suicide attempter status was predicted by two independently significant social variables: one risk factor (life hassles) and one protective factor (social support). Male versus female suicide attempters were not distinguished by the social variables. These findings, which support the utility of an ecological conceptualization of risk and protective factors for suicide attempt, help to clarify the independently significant social environment risk and protective factors for suicide attempts among economically disadvantaged African Americans in particular. Research on both risk factors and protective factors provide a basis for culturally competent interventions aimed at reducing both the risk of future suicide attempts and completions.
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Affiliation(s)
- Nadine J Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Grady Health System, 80 Jesse Hill Jr. Drive, Atlanta, Georgia 30303, USA.
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Montross LP, Zisook S, Kasckow J. Suicide among patients with schizophrenia: a consideration of risk and protective factors. Ann Clin Psychiatry 2005; 17:173-82. [PMID: 16433060 DOI: 10.1080/10401230591002156] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The elevated rate of suicide among patients with schizophrenia is well documented and thus frequently researched. The majority of research has focused solely on the identification of risk factors that predispose patients to attempt or commit suicide. This review serves to expand on the literature pertaining to suicide risk factors by additionally outlining how protective factors may shield against suicide within this unique patient population. METHODS A literature review of English-language publications pertaining to suicide among people with schizophrenia was completed using PsychINFO and MEDLINE databases between the years of 1960-2004 and 1950-2004 respectively. Special emphasis was given to studies of risk factors and protective factors for suicide. RESULTS Commonly supported risk factors for suicide were identified: previous attempts, severity of illness, comorbidity, social isolation, temporal relationships, and demographic characteristics. Risk factors such as a history of violence, the presence of command hallucinations, and recent tragic loss were found to warrant future study. Social support, positive coping skills, life satisfaction, and resiliency emerged as protective factors that may mitigate suicide. CONCLUSIONS Understanding why some patients wish to end their lives but also why some desire to live allows for more comprehensive suicide prevention.
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Affiliation(s)
- Lori P Montross
- University of California San Diego, Department of Psychiatry, Division of Geriatric Psychiatry, San Diego, CA 92161, USA.
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Abstract
There are few differences in the frequency or intensity of men's and women's self-reported or observed anger. Women are more likely to be angered by relationship conflicts than men. Men are more frequently the targets of anger than women. Typically, men see the expression of anger as exerting dominance, where as women view it as a loss of control. There are also sex differences in the mode of anger expression. At ages 8 and older, girls are more likely to engage in "relational" aggression (eg, deliberate social ostracism). The most consistent and salient difference in anger expression is women's tendency to cry when angry, whereas men are more likely to throw things or hit. The difference in physical aggression appears in children who are as young as 1 to 2 years of age. Despite an overall reduction in physical aggression after 2 to 3 years of age, the sex difference remains consistent into adulthood. In contrast to differences in physical aggression, differences in anger are few and inconsistent up to 4 or 5 years of age. By this age, girls tend to suppress the expression of anger consciously. By about 7 to 8 years of age, adult like differences become more consistent, with boys expressing more anger.
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Affiliation(s)
- Michael Potegal
- Department of Pediatrics, University of Minnesota Medical School, 777 Mayo, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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25
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Abstract
In this paper, we review the empirical publications from the 1990s on the assessment of object relations (OR). Twelve different measures are referenced. Major findings of studies, conclusions, and evaluations of each measure are provided. In general, it was found that the most recent empirical literature has compared OR across diagnostic groups or evaluated therapy process and outcome by the quality of one's OR. Current strengths and limitations of the extant OR literature are provided, along with methodological recommendations to expand the utility and validity of OR assessment.
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Affiliation(s)
- Steven K Huprich
- Department of Psychology and Neuroscience, Baylor University, PO Box 97334, Waco, TX 76798-7334, USA.
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Mihura JL, Nathan-Montano E, Alperin RJ. Rorschach measures of aggressive drive derivatives: a college student sample. J Pers Assess 2003; 80:41-9. [PMID: 12584066 DOI: 10.1207/s15327752jpa8001_12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study investigated measures of aggressive drive derivatives on the Rorschach and Personality Assessment Inventory with 70 college students. As predicted, (a) self-reported physical aggression potential was related to Rorschach measures of identification with the aggressor and aggressive impulses, (b) suicidal ideation with impulsivity was related to a Rorschach measure of aggressive impulses turned toward the self, and (c) the borderline features scale was related to a Rorschach pathological object relations measure. Hierarchical regression analyses showed that a Rorschach measure of emotional impulsivity added unique variance to these Rorschach aggression variables in predicting self-reported physical aggression potential, suicidal ideation with impulsivity, and borderline features. Finally, caution is advised in applying our findings when there is motivation to suppress aggressive responses
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Affiliation(s)
- Joni L Mihura
- Department of Psychology, University of Toledo, OH 43606, USA.
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De Leo D, Padoani W, Lonnqvist J, Kerkhof AJFM, Bille-Brahe U, Michel K, Salander-Renberg E, Schmidtke A, Wasserman D, Caon F, Scocco P. Repetition of suicidal behaviour in elderly Europeans: a prospective longitudinal study. J Affect Disord 2002; 72:291-5. [PMID: 12450647 DOI: 10.1016/s0165-0327(01)00454-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to assess any predictive factors for repeated attempted suicide and completed suicide in a 1-year follow-up on a sample of elderly European suicide attempters (60 years and over). From 1990 to 1993, 63 subjects completed the first interview and were recontacted after 1 year. At follow-up, eight subjects (12.7%) had taken their lives and seven (11.1%) had repeated at least one suicide attempt. On comparison of repeaters and non-repeaters, differences emerged in terms of death of the father in childhood and for mean Suicidal Intent Score. At the end of follow-up period, repeaters reported a more frequent desire to repeat suicidal behaviour and judged their mental health and social assistance received to be worse. Suicides and non-repeaters differed especially in relation to death of father during childhood and number of contacts with General Practitioner. Interpretation of the results must take into account the smallness of the test sample, the difficulties in obtaining complete data for the follow-up interview, the lack of a control group and a diagnosis formulated in a hospital consultation setting. The study confirms, however, the high risk of repetition of suicidal behaviour in the elderly. In old age suicidal ideation is often sustained over long periods of time and requests for help are addressed to relatives and GPs. An interesting finding is the more frequent death of the father during childhood among repeaters.
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Affiliation(s)
- D De Leo
- Psychogeriatric Service, University of Padova c/o Ospedale Geriatrico, Via Vendramini 7, 35137, Padova, Italy
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Abstract
The relationship of recent stressful life events with impulsiveness in triggering suicide attempts and how impulsiveness changes from one suicide attempt to another is unclear. This study used structured-interview tools and standardized measurements to examine the relationship between life stress and impulsiveness in a sample of patients who required hospitalization for a medically serious suicide attempt. After controlling for potentially confounding variables, the number of disrupted interpersonal relationships in the preceding year was a significant predictor of the impulsiveness of the suicide attempt, with three or more losses (but not other life stresses) associated with less impulsive attempts (T = 2.4, p = .02). Female gender (T = -1.98, p = .05) and lifetime DMS-III-R diagnoses (T = -2.45, p = .02) were significantly associated with more impulsive attempts. In 55 patients with at least two suicide attempts, impulsiveness, lethal intent, and communication of intent were significantly greater for the present compared to the prior attempt (p = 0.000). Certain stressful life events, gender, and total lifetime DSM-III-R diagnoses are associated with impulsiveness of failed suicide attempts; yet, impulsiveness is not necessarily consistent from one suicide attempt to another. This evidence supports and amplifies a stress-diathesis model of suicide behavior. Accordingly, efforts to increase personal resilience in individuals who have "failed suicide" may be more effective at preventing suicide morbidity than simple stress-reduction measures alone.
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Affiliation(s)
- K F Weyrauch
- Group Health Permanente, Seattle, Washington, USA.
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Abstract
Aspects of unconscious processes in a group of seriously disturbed psychiatric patients are examined in an effort to predict near-lethal suicide attempts and explore psychoanalytic formulations of suicide. The Rorschach Inkblot Test, the most widely used projective measure in suicide research (Bongar 1991), was chosen for its potential to shed light on specific unconscious processes. Psychic states commonly associated with suicide were measured by psychoanalytic Rorschach analog scales and then subjected to a progression of statistical analyses in order to predict future occurrence and lethality of suicide attempts. On the basis of a priori hypotheses, the authors developed a suicide index comprising four psychoanalytic Rorschach signs that predicted, with considerable accuracy, which patients would later make near-lethal suicide attempts. The best predictors were unconscious processes indicative of penetrating affective overstimulation, disturbance in the capacity to maintain adequate ego boundaries, and depressive affective states characterized by a morbid preoccupation with death and inner decay. These findings provide empirical support for several well-known formulations of the unconscious motivations for suicide.
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Affiliation(s)
- J C Fowler
- Austen Riggs Center, Stockbridge, MA 01262, USA.
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