Defense Mechanism Test (DMT) and Kernberg's theory of personality organization related to adolescents in psychiatric care

75 adolescent psychiatric patients were diagnosed with the perceptual projective test the Defense Mechanism Test (DMT) and also according to Kernberg's theory of personality organization (PO). The test protocols were scored in respect of 130DMT variables and analyzed by means of partial least squares (PLS) discriminant analysis. The objective was to try to separate the three types of PO, psychotic (PPO), borderline (BPO) and neurotic (NPO) by means of the DMT and also to compare the results with a similar study on adult psychiatric patients. The results showed that it is possible to separate significantly the three groups of PO. The BPO group seemed to be heterogeneous. The results were fairly similar to those obtained with adult psychiatric patients. The overall results supported the concurrent validity of Kernberg's theory of PO and for the DMT as well. The DMT seems to be a useful diagnostic method in respect of adolescent psychiatric patients.     

A new objectively scored version of the Defence Mechanism Test

Kragh's Defence Mechanism Test has proved its worth in a number of applied settings but has hitherto required skilled time-consuming interpretation. Two studies are reported which validate an "objectively scored" version of the test developed using G-analysis. In the first, it was found that this version of the test could successfully predict the performance of trainee pilots. The second study examined the construct validity of this version of the test. It was found that the predictive factor from Study I re-emerged within a sample of students, where it correlated positively with scores on a test of perceptual defence and the Shrewdness (N) scale of the 16PF, and negatively with two of the identification scales of the Defence Mechanism Test. This factor was tentatively identified as one of general defensiveness. It is concluded that this form of the test deserves consideration when selecting individuals for stressful occupations.     

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.     

Multivariate modelling and personality organization: A comparative study of the Defense Mechanism Test and linguistic expressions

The main aim of the study is to establish an empirical connection between perceptual defences as measured by the Defense Mechanism Test (DMT)–a projective percept-genetic method–and manifest linguistic expressions based on word pattern analyses. The subjects were 25 psychiatric patients with the diagnoses neurotic personality organization (NPO), borderline personality organization (BPO) and psychotic personality organization (PPO) in accordance with Kernberg's theory. A set of 130 DMT variables and 40 linguistic variables were analyzed by means of partial least squares (PLS) discriminant analysis separately and then pooled together. The overall hypothesis was that it would be possible to define the personality organization of the patients in terms of an amalgam of perceptual defences and word patterns, and that these two kinds of data would confirm each other. The result of the combined PLS analysis revealed a very good separation between the diagnostic groups as measured by the pooled variable sets. Among other things, it was shown that NPO patients are principally characterized by linguistic variables, whereas BPO and PPO patients are better defined by perceptual defences as measured by the DMT method.     

Personality organization defined by DMT and the Structural Interview

The psychoanalytic concept of Personality Organization (PO) may be operationalized by means of a Structural Interview as well as by means of psychological tests. The present study utilized the Structural Interview and a projective test called the Defence Mechanism Test (DMT) to operationalize the PO concept on a sample of 50 psychiatric inpatients. The reliability of the PO judgements were found to be acceptable for both the Structural Interview and the DMT. The validity, which was estimated as the correlation between the two methods, was also found to be substantial. The conclusion is that the concept of PO may be reliably operationalized for psychiatric patients and seems to have concurrent validity. Both the DMT and the Structural Interview may be used for differential diagnosis of PO.     

Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder

A central component of Dialectical Behavior Therapy (DBT) is the teaching of specific behavioral skills with the aim of helping individuals with Borderline Personality Disorder (BPD) replace maladaptive behaviors with skillful behavior. Although existing evidence indirectly supports this proposed mechanism of action, no study to date has directly tested it. Therefore, we examined the skills use of 108 women with BPD participating in one of three randomized control trials throughout one year of treatment and four months of follow-up. Using a hierarchical linear modeling approach we found that although all participants reported using some DBT skills before treatment started, participants treated with DBT reported using three times more skills at the end of treatment than participants treated with a control treatment. Significant mediation effects also indicated that DBT skills use fully mediated the decrease in suicide attempts and depression and the increase in control of anger over time. DBT skills use also partially mediated the decrease of nonsuicidal self-injury over time. Anger suppression and expression were not mediated. This study is the first to clearly support the skills deficit model for BPD by indicating that increasing skills use is a mechanism of change for suicidal behavior, depression, and anger control.     

Emotionally controlled decision-making and a gene variant related to serotonin synthesis in women with borderline personality disorder

The Iowa Gambling Task (IGT) was used to examine (i) social decision-making in women with borderline personality disorder (BPD), and (ii) the relationship between impaired decision-making and the tryptophan hydroxylase-1 (TPH-1) gene, involved in serotonin synthesis. Forty-two women with BPD and a history of suicide attempts were genotyped, and the frequency of a TPH-1 haplotype previously uniquely associated with BPD was calculated. The BPD group scored significantly lower than a control group in the IGT. Furthermore, the TPH-1 haplotype displayed a significantly higher frequency in BPD participants with impaired decision making, compared to BPD participants with normal scores. These findings suggest that impaired decision-making as determined by the IGT is a feature of BPD and may be (i) associated with serotonin dysfunction, and (ii) possibly relevant for suicidal behavior.     

Comparison of different strategies to decrease negative affect and increase positive affect in women with borderline personality disorder

Background

In this study we compared the effect of different emotion regulation strategies on positive and negative emotions in patients with borderline personality disorder.

Methods

Emotion regulation strategies were a distracting task, individual positive memory imagery, individual soothing imagery, and a neutral comparison condition. During two separate sessions, 17 participants watched either neutral or negative movie segments before using these strategies.

Results

All three strategies influenced emotions into a favorable direction as compared to the neutral comparison condition. The positive memory image increased positive emotions significantly stronger than counting colors and distracting.

Discussion

Different strategies seem to have similar effects in decreasing negative emotions. Positive emotions may be affected in particular by positive and soothing imagery techniques.     

Personality, birth order and attachment styles as related to various types of jealousy

The relationships between jealousy, personality, attachment styles and birth order were examined in a sample of 100 Dutch men and 100 Dutch women. Three types of jealousy were examined: reactive jealousy (a negative response to the emotional or sexual involvement of the partner with someone else), preventive jealousy (efforts to prevent intimate contact of the partner with a third person), and anxious jealousy (obsessive anxiety, upset, and worrying about the possibility of infidelity of the partner). The three types of jealousy were not at all related to egoism and dominance, but significantly correlated with neuroticism, social anxiety, rigidity and hostility. Only among women was a low self-esteem correlated with jealousy. On all three jealousy measures, those with an anxious-ambivalent attachment style were more jealous than those with an avoidant style, with those with a secure attachment style being the least jealous. Attachment style was strongly related to most personality dimensions, but the effects of attachment style upon jealousy stayed virtually the same when controlling for personality factors. The most important finding in the present study was that laterborns were more jealous according to all three measures than firstborns, a finding that was not due to personality differences between first- and laterborns, nor to differences in attachment style, gender or occupational level of the father. Because some evidence was found that only borns were slightly less jealous than firstborns, it is suggested that the experience of exclusive love and attention in one's childhood, leads to a lower level of jealousy among firstborns.