Object Relations in Borderlines,Depressives, and Normals: An Examination of Human Responses on the Rorschach

Recently, researchers and clinicians have become increasingly interested in diagnostic distinctions between borderline and mood disorders. Object relations theory provides a useful framework for the comparison of these two overlapping diagnostic categories. In our study, a measure of object relations as represented on the Rorschach, developed by Blatt, Brenneis, Schimeck, and Glick (1976), was applied to data produced by borderline and depressive inpatients and by normal comparison subjects. Portions of the Blatt measure that tap the subject's experience of human action and interaction distinguish among the three diagnostic groups. Specifically, borderlines tend to understand human action as more highly motivated and human interaction as more malevolent in nature than do either depressives or normals. The data indicate that borderlines experience the object-relational world in a way that is fundamentally different from the way normals and depressives perceive it. implications are discussed for theories of borderline object relations.     

Borderline manifestations in the Rorschachs of male transsexuals

It was hypothesized that male transsexuals manifest a character structure consistent with Kernberg's criteria for borderline personality organization. Exploring this hypothesis, Kernberg's criteria for borderline personality organization were operationalized using Rorschach measures. The following variables were examined: aggression (Holt System Aggressive Content Section), object relations (Urist's Mutuality of Autonomy Scale), reality testing (Exner System X + %), and self/object differentiation (Exner System Special Scorings). A group of male college students, a group of male borderlines, and a group of male transsexuals were compared on the above variables. Compared to the normals, the transsexuals and borderlines displayed significantly more intense levels of aggression, a lower level of object relations, poorer reality testing, and impaired boundary differentiation. The transsexuals and borderlines did not differ significantly. The results were taken as suggesting that male gender dysphorics may be a sub-group of the wider borderline diagnostic category.     

Neediness and connectedness and the five‐factor model of personality

This study examined maladaptive and relatively more adaptive forms of dependency, as measured by the neediness and connectedness factors of the Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976 ), within a comprehensive scheme of personality provided by the revised NEO Personality Inventory (NEO‐PI‐R; Costa & McCrae, 1992 ). University students (n = 475) completed the DEQ, NEO‐PI‐R, and a measure of depressive symptoms. Results indicated that neediness reflected anxiety, self‐consciousness, vulnerability, unassertiveness, and inactivity, whereas connectedness reflected anxiety, warmth, agreeableness, and valuing of relationships. Neediness demonstrated stronger relations than connectedness with depressive symptoms. These results support the validity of DEQ neediness and connectedness as measures of maladaptive and relatively more adaptive forms of dependency. Copyright © 2006 John Wiley & Sons, Ltd.     

Malevolent object representations in borderline personality disorder and major depression.

To study malevolent representations, earliest memories were reliably coded on scales of affect tone. Ss were diagnosed with borderline personality disorder: 31 without and 30 with concurrent major depression. Nonborderline comparison subjects had either major depressive disorder (n = 26) or no psychiatric diagnosis (n = 30). Borderline subjects were discriminated from comparison subjects by their more malevolent representations; they more frequently produced memories involving deliberate injury; and they portrayed potential helpers as less helpful. Results suggest the diagnostic significance of malevolent representations, which need to be explained by any theory of borderline personality disorder.     

Emptiness as defense in severe regressive states

This paper examines the empty states experienced by severely ill borderline patients. At times of stressful regression, these patients use complaints of emptiness to describe profound disturbances of affect, cognition, object relations, and bodily experience. Empty states may be seen as complex defensive configurations which protect a borderline level of psychic structure from the impact of aggressively charged object relations, and ward off further regression to states of fragmentation or fusion. Severely ill borderline patients consolidate an empty screen by means of a characteristic repertoire of primitive defenses consisting of various forms of projective identification, including bitriangulation and projective identification of psychic agencies, somatization, acting out, and specific alterations in cognition. The author describes the highly deviant organizations of the object world seen in empty states, and the complex and disturbing countertransferences which these states evoke.     

Brief Report: Utilization of the Patient-Examiner Relationship in Intelligence Testing of Children

Rorschach scales were used to examine the quality of thought disturbance and object relations in boys meeting the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III American Psychiatric Association, 1980) criteria for separation anxiety disorder (SAD). Nineteen urban, middle and tow socioeconomic status (SES). SAD boys were compared to a group of 14 male control subjects. The hypotheses of the study were that SAD boys as compared to controls would: (a) have significantly more thought disordered responses as measured by Korschach Thought Disorder Scale (Blatt &; Rizzier, 1974), and (b) evidence significantly less adaptive object relations scale scores as measured by the Mutuality of Autonomy Scale (Urist, 1977). Results confirmed both hypotheses, The SAD group had more thought disordered responses and more disrupted object relations scores than the controls. Ideas and images of these boys were found to generally be more unstable, boundary compromised, fluid, idiosyncratic, tangential, and psychotic like than the controls. It was concluded that these boys possess a significant potential to have thinking abnormalities that wilt interfere with their independent functioning. Concerning their object relations scores, the SAD subjects were found to have significantly fewer benign, adaptive object interactional percepts, and a greater number of dependent and/or clinging interactional object representations (imagery) than the controls. This study supports the viewpoint that SAD boys are deeply psychologically troubled.     

Boyhood separation anxiety disorder: thought disorder and object relations psychopathology as manifested in Rorschach imagery

Rorschach scales were used to examine the quality of thought disturbance and object relations in boys meeting the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III; American Psychiatric Association, 1980) criteria for separation anxiety disorder (SAD). Nineteen urban, middle and low socioeconomic status (SES), SAD boys were compared to a group of 14 male control subjects. The hypotheses of the study were that SAD boys as compared to controls would: (a) have significantly more thought disordered responses as measured by a Rorschach Thought Disorder Scale (Blatt & Ritzler, 1974), and (b) evidence significantly less adaptive object relations scale scores as measured by the Mutuality of Autonomy Scale (Urist, 1977). Results confirmed both hypotheses. The SAD group had more thought disordered responses and more disrupted object relations scores than the controls. Ideas and images of these boys were found to generally be more unstable, boundary compromised, fluid, idiosyncratic, tangential, and psychotic-like than the controls. It was concluded that these boys possess a significant potential to have thinking abnormalities that will interfere with their independent functioning. Concerning their object relations scores, the SAD subjects were found to have significantly fewer benign, adaptive object interactional percepts, and a greater number of dependent and/or clinging interactional object representations (imagery) than the controls. This study supports the viewpoint that SAD boys are deeply psychologically troubled.     

Attachment Theory,Psychoanalysis, Personality Development,and Psychopathology

Blatt and Levy place attachment theory and research in a broad theoretical matrix by considering the relationship of attachment patterns to personality development and to different types of psychopathology in adults. Thus Blatt and Levy construct conceptual bridges between the two configurations of personality development and psychopathology that Blatt and colleagues have developed over the past quarter century (e.g., Behrends and Blatt, 1985; Blatt, 1974, 1995; Blatt and Behrends, 1987; Blatt and Blass, 1990, 1996; Blatt and Shichman, 1983) and attachment theory and research. Blatt and Levy identify a polarity that is central to attachment theory and research, the polarity of attachment and separation, and they note that this polarity has also been central in much of classic psychoanalytic theory (e.g., Freud, 1930; Loewald, 1962). This polarity is expressed in attachment theory and research in the differences between avoidant and anxious-preoccupied insecure attachment patterns as well in the distinction between two types of disorganized attachment, helpless-withdrawn and negative intrusive, identified by Lyons-Ruth (1999, 2001).

This polarity of attachment and separation, or relatedness and self-definition is also fundamental to personality development that occurs in the hierarchical dialectic transaction of two basic developmental lines—interpersonal relatedness and self-definition (Blatt and Blass, 1990, 1996). This polarity is also inherent in the conception of two fundamental configurations of psychopathology—anaclitic psychopathology, the dependent (or infantile) and hysterical personality disorders—that are preoccupied with issues of interpersonal relatedness, and introjective psychopathology, the paranoid, obsessive-compulsive and depressive personality disorders, in which issues of self-definition and self-worth are dominant (Blatt, 1974, 1995; Blatt and Shichman, 1983). Thus, the identification of this fundamental polarity provides the basis for establishing links between attachment patterns, personality development, and adult psychopathology. Blatt and Levy also attempt to integrate psychoanalytic concepts of the representational world (e.g., Sandler and Rosenblatt, 1965)—the development of concepts of self and significant others—with the internal working models (IWMs) of attachment relationships. This integration enabled Blatt and Levy to bring a fuller developmental perspective to the IWMs of attachment theory and to note that, based on differences in the content and structural organization of the IWMs or mental representation of self and significant others, several developmental levels can be identified in both avoidant and anxious preoccupied attachment. These developmental levels within each attachment style also identifies less and more adaptive forms of both types of insecure attachment. Thus, the integration of the psychoanalytic concepts of mental representation with concepts of the IWM of attachment theory and research enables Blatt and Levy to create a fuller developmental perspective in the study of insecure attachment patterns.     

Comparison of Beck Depression Inventories-IA and-II in Psychiatric Outpatients

The study of mental representations on projective tests such as the Rorschach has made substantial contributions to our understanding of psychopathology. It is not clear, however, whether the representations of paranoid schizophrenics can be differentiated from those of normals and whether the Rorschach is the best test for such comparison. Object representations on the Rorschach and a role-playing (Johnson & Quinlan, 1980, 1985) test were studied in groups of normal (n = 31) and schizophrenic subjects (divided into paranoid [n = 16], intermediate [n = 11], and nonparanoid groups [n = 16]). Developmental levels of representation on both tests were measured with the widely used system of Blatt, Brenneis, Schimek, and Glick (1976), derived from Werner's concepts of differentiation, articulation, and integration. Generally the groups were not differentiated on these measures on the Rorschach. The role-playing test showed greater discriminatory power than the Rorschach, possibly due to its explicit demand to produce representations of humans in interaction. Results of the role-playing test showed differentiation and integration scores were negatively correlated with measures of psychotic symptoms. Nonparanoids differed from the other three groups on differentiation measures, and paranoid and normal groups scored higher on integration measures than did the intermediate and nonparanoid groups. Paranoid subjects scored higher than nonparanoids on functional articulation and higher than intermediates on perceptual articulation; however, paranoid subjects were not differentiated from normals on any developmental measure. Differences between the schizophrenic sample and normals were explained entirely by the nonparanoid subgroup, supporting the paranoid-nonparanoid distinction and raising questions regarding the nature of the deficit in paranoid schizophrenia.     

A preliminary report on defenses and conflicts associated with borderline personality disorder

The authors present preliminary psychodynamic findings from a naturalistic study of borderline personality disorder compared to antisocial personality disorder and bipolar type II (depression with hypomania) affective disorder. An independent psychodynamic interview of each subject was videotaped from which ratings were made of the presence of 22 defense mechanisms and 11 psychodynamic conflicts. A factor analysis of ratings from 81 subjects supported the separation of borderline (splitting, projective identification) from narcissistic defenses (devaluation, omnipotence, idealization, mood-incongruent denial). While certain groups of defenses were associated with each diagnosis, defense ratings did not significantly discriminate the three diagnostic groups, suggesting a limit to their diagnostic value. Among 27 subjects rated, borderline personality was strongly associated with two conflicts: separation-abandonment, and a global conflict over the experience and expression of emotional needs and anger. Antisocial personality was psychodynamically distinct and more heterogeneous. Bipolar type II was associated with two hypothesized depressive conflicts: dominant other and dominant goal. Chronic depression, which was more common in both personality disorder groups than in bipolar type II, was associated with a third depressive conflict, overall gratification inhibition. Overall, conflicts were powerful discriminators of the three diagnostic groups. The heuristic value of these findings is discussed.     

The Depressive Experiences Questionnaire: A Critical Review

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) is critically reviewed. First the developmental, object representations theory differentiating depression into anaclitic and introjective subtypes is presented. The DEQ factors of Dependency and Self-Criticism were initially found to be consistent with these clinically meaningful depressive subtypes. Subsequent research has generally demonstrated that these subtypes, at least as measured by the DEQ, do not hold up well in clinical populations. Furthermore, the validity of the developmental theory of these subtypes is weak. We suggest that more internally consistent and distinct factors should be developed from clinical populations because of their potential clinical usefulness.     

The Depressive Experiences Questionnaire: a critical review

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) is critically reviewed. First the developmental, object representations theory differentiating depression into anaclitic and introjective subtypes is presented. The DEQ factors of Dependency and Self-Criticism were initially found to be consistent with these clinically meaningful depressive subtypes. Subsequent research has generally demonstrated that these subtypes, at least as measured by the DEQ, do not hold up well in clinical populations. Furthermore, the validity of the developmental theory of these subtypes is weak. We suggest that more internally consistent and distinct factors should be developed from clinical populations because of their potential clinical usefulness.