Psychodiagnosis of personality structure: psychotic personality organization.

Recent developments in Rorschach psychology, including nomothetic approaches focused on scores, ratios, and indices and idiographic approaches focused on content emerging from psychoanalytic theory, offer the Rorschach clinician a rich and potent interpretive methodology. This article examines the structural diagnosis of personality organization with a focus on psychotic personality structure. Rorschach approaches to the differential diagnosis of psychotic personality organization are presented. The Rorschach is viewed as indispensible in the differential diagnosis of personality organization, especially in the so-called "borderline" cases.     

The relationship between personality organization as assessed by theory-driven profiles of the Dutch Short Form of the MMPI and self-reported features of personality organization

In this study, we investigated the relationships between features of personality organization (PO) as assessed by theory driven profiles of the Dutch Short Form of the MMPI (DSFM; Luteijn & Kok, 1985) and 2 self-report measures of personality pathology, that is, the Dutch Inventory of Personality Organization (Berghuis, Kamphuis, Boedijn, & Verheul, 2009) and the Dutch Schizotypy Personality Questionnaire-Revised (Vollema & Hoijtink, 2000), in a sample of 190 outpatient psychiatric patients. Results showed that the single scales of all 3 measures segregated into 2 theoretically expected and meaningful dimensions, that is, a dimension assessing severity of personality pathology and an introversion/extraversion dimension. Theory-driven combinations of single DSFM subscales as a measure of level of PO distinguished characteristics of patients at various levels of PO in theoretically predicted ways. Results also suggest that structural personality pathology may not be fully captured by self-report measures.     

The masochistic personality organization: Dynamic,etiological, and psychotherapeutic factors

Individuals with a masochistic personality are both very common and very frustrating to work with in psychotherapy. The purpose of this paper is to introduce the reader to this complex personality style by discussing a brief history of the term, its dynamics, etiology, and techniques in psychotherapy. The paper combines theoretical material from the literature with personal clinical observations and specific techniques for psychotherapy with these individuals.     

The relationship between personality organization and sexual life in a community sample of men

Contemporary object-relation theory of personality postulates that the level of severity of personality organization parallels the nature and extent of problems in the patient’s sexual life. The study aims at exploring the relationship between dimensions of Borderline Personality Organization (BPO) (as assessed according to Otto Kernberg’s model), sexual functioning, quality of sexual life and paraphilias in a community sample of men. One-hundred and thirty-six healthy men were asked to complete a set of questionnaires including the Inventory of Personality Organization (IPO), the International Index of Erectile Function, the Sexual Quality of Life Questionnaire, and a checklist to assess the prevalence of paraphilias. High scores on IPO subscales were significantly associated with low overall satisfaction in sexual functioning, low quality of sexual life, and the presence of paraphilias. Results expand previous findings on the relationship between features of BPO and core components of sexual life and support the need for an assessment of personality functioning in subjects reporting sexual problems.     

Linguistic characteristics of neurotic, borderline and psychotic personality organization

Thirty patients were subjected to a Structural Interview by means of which 10 of them received the diagnosis NPO (Neurotic Personality Organization), 10 BPO (Borderline Personality Organization) and 10 PPO (Psychotic Personality Organization). About 2500 words and groups of words were extracted from the patients' utterances for analysis. The word-frequencies thus found were analyzed by a PLS discriminant analysis which yielded two significant principal components (main dimensions) explaining 57% of the variance. This analysis showed that the three groups of patients are well separated from one another and that there is a definite correlation between personality organization and linguistic variables. The main features of the BPO-patients in this study seem to be that they refer to positions outside themselves and their language is impersonal; we see this as an exemple of a vacillating identity. The NPO-group is characterized by an intense and rich language, signs of a more advanced symbolizing ability, deixis and high level defenses. The language of the PPO-patients is poor and its predominant feature is a lack of words; in our interpretation this indicates foreclosure and a lack of identity.     

Reciprocal unconditional-conditional organization of the fundamental emotions and paraadaptive personality reactions

Paraadaptive personality reactions (PPR) are modes of behavior and experience on the borderline of normal psychology and psychopathology. In them the thinking is overdetermined or obsessive. Overdetermined PPR are well illustrated in common proverbs. The people’s wisdom has also knowledge of the obsessive (or “magic”) paraadaptive rituals for prevention of possible misfortunes (such as touching wood, keeping away from a black cat,etc.). One part of the PPR is described in the psychoanalytical literature as defense mechanisms. The analysis of thought dissociation in schizophrenia shows that the reciprocal relations could be considered as a basic principle of functional organization on all levels of nervous and psychic activity. Proceeding from this assumption, the author proposes the conception of a reciprocal neuropsychological unconditional-conditional affect-behavioral system (ABS). It consists of ten subsystems corresponding to the basic emotions. Each subsystem stimulates the personality toward predetermined forms of thinking and behavior. In adequate conditions the reciprocal processes in the ABS are well counterweighted and integrated. In some persons and in situations of greater affective “loading” this reciprocal balance is disorganized, which leads to PPR. In this paper a neuropsychological analysis is made of the overdetermined PPR, reflected in such proverbs as “Not being able to beat the donkey, he beats the packsaddle” and “The thief cries catch the thief.”     

Motivation, personality organization, and the four psychologies of psychoanalysis

Four psychologies currently significant in psychoanalytic thinking are described. An attempt is made to (a) advance developmental proposals describing how the phenomena of each of the four achieve motivational status in the intrapsychic life of the individual and (b) develop a model for the understanding of personality organization across the four psychologies, based on the development of personal hierarchies that establish which issues are superordinate and which subordinate. Taken together, these two points are used to suggest that the four psychologies may not simply represent differing perspectives on intrapsychic phenomena (though they do that, in part) but that they also, simultaneously, represent relatively independent ways in which intrapsychic life is organized.     

Reactions to DMT as related to psychotic and borderline personality organization

Thirty-one inpatients in a psychiatric clinic were assessed with DMT and the Structural Interview. In order to assemble every relevant reaction that an individual might have to a percept-genesis, 130 DMT variables were formed. The results were first subjected to a quality control of the DMT-scores and then subjected to partial least squares in latent variables (PLS) discriminant analysis. The analysis showed that it is possible to separate patients with psychotic PO (PPO) from those with borderline PO (BPO) by means of the 130 variables. The BPO group is characterized by aggressive manifestations, sensitivity to threat, identity lability and various transformations of the Hero gestalt. The PPO group, on the other hand, is characterized by high threshold values for perception, lack of identity, denial and repression of the peripheral person at a late-phase level. There are other perceptual reactions that are important predictors of PO than the defence categories of the manual. These perceptual reactions do not correspond to the traditional psychodynamic defence mechanisms. Our conclusion is that principal component analysis (PCA) and PLS are useful methods of finding discriminating patterns of perceptual reactions to the DMT for patients with different PO.     

Lateralized perceptual organization deficits on the global-local task in schizotypal personality disorder

Right and left hemisphere contributions to perceptual organization functions were examined using a divided-attention version of the global-local task in a sample of 21 unmedicated participants diagnosed with schizotypal personality disorder (SPD) and 20 controls. The SPD participants showed an abnormal global processing advantage. When the visual angle of the hierarchical stimuli was increased from 3 degrees to 9 degrees, the controls showed an increasing local processing advantage, but the SPD participants continued to show an abnormal global processing advantage. These findings suggest a local processing deficit on divided-attention versions of the global-local task in schizophrenia spectrum disorders. Female SPD participants, who had less severe interpersonal deficit symptoms, showed a more abnormal global processing advantage. Hemispheric and processing resource mechanisms that might explain these findings are discussed.     

The architecture of personality

This article presents a theoretical framework for analyzing psychological systems that contribute to the variability, consistency, and cross-situational coherence of personality functioning. In the proposed knowledge-and-appraisal personality architecture (KAPA), personality structures and processes are delineated by combining 2 principles: distinctions (a) between knowledge structures and appraisal processes and (b) among intentional cognitions with varying directions of fit, with the latter distinction differentiating among beliefs, evaluative standards, and aims. Basic principles of knowledge activation and use illuminate relations between knowledge and appraisal, yielding a synthetic account of personality structures and processes. Novel empirical data illustrate the heuristic value of the knowledge/appraisal distinction by showing how self-referent and situational knowledge combine to foster cross-situational coherence in appraisals of self-efficacy.     

Autoerotism in patients with borderline personality organization: A case of wristcutting and bulimia

This paper is an investigation of some manifestations of autoerotism in patients with borderline personality organization. Symptoms involving somatic sensations and experiences are prominent in Kernberg's list of presumptive diagnostic elements for borderline conditions. It is postulated here that many such symptoms are autoerotic attempts to represent and resolve the difficulties around primitive aggression and associated lack of self-other differentiation that are central to borderline pathology. This is illustrated using case material from the treatment of a young woman who presented with symptoms of wristcutting and bulimia.Early versions of this paper were presented at the Eleventh Annual Symposium of the New York Center for Psychoanalytic Training in April, 1986, and the Mid-Winter Meeting of the Division of Psychoanalysis, American Psychological Association, April, 1987.