Rorschach Assessment of Primitive Defenses: A Review

The Lerner & Lerner Scale for assessing primitive defenses is reviewed, According to its conceptual roots, initial studies assessed the scale's efficacy in distinguishing groups of borderline patients from groups of other diagnostic entities. Later studies extended the use of the scale to assess various clinical groups assumed to have a borderline personality structure. Results from several studies indicate a high level of reliability as judged by degree of interrater agreement. In a host of studies, the scale was found to be valid in distinguishing borderline patients from other types of patients, eating disordered patients from normal controls, and gender disturbed children from normal controls. Another Rorschach scale for assessing primitive defenses was also reviewed and compared.     

A note on the assessment of idealization

In a series of studies using the Lerner Defense Scale (H. Lerner & P. Lerner, 1980) for assessing primitive defenses, inconsistent and at times perplexing findings have been reported regarding the defense of idealization. A major study examining personality variables, including defense, in a nonclinical population-ballet students-and comparing them to those of patients suffering eating disorders, yielded findings related to the defense of idealization and its assessment. Herein, the results of that study are reviewed and then discussed in light of recent psychoanalytic formulations regarding idealization.     

The rorschach assessment of borderline defenses: a concurrent validity study

This study assesses the concurrent validity of two Rorschach defense scales designed to identify borderline defensive structure. A Rorschach scale designed by Cooper and his colleagues was systematically compared to a defense scale constructed by Lerner and Lerner. Despite considerable overlap on a conceptual and operational level, the scales are based on divergent theoretical models (developmental arrest and fixation) and Rorschach units of analysis (all responses and human responses). Our results are based on the capacity of each scale to discriminate between independently diagnosed samples (neurotic, outpatient borderline, inpatient borderline, schizophrenic) and the relative discriminatory power of particular defenses within each scale to differentiate between groups.     

Eleventh Annual Meeting of the Society for Projective Techniques

This study assesses the concurrent validity of two Rorschach defense scales designed to identify borderline defensive structure. A Rorschach scale designed by Cooper and his colleagues was systematically compared to a defense scale constructed by Lerner and Lerner. Despite considerable overlap on a conceptual and operational level, the scales are based on divergent theoretical models (developmental arrest and fixation) and Rorschach units of analysis (all responses and human responses). Our results are based on the capacity of each scale to discriminate between independently diagnosed samples (neurotic, outpatient borderline, inpatient borderline, schizophrenic) and the relative discriminatory power of particular defenses within each scale to differentiate between groups.     

A Rorschach Study of Narcissism Defense,and Aggression in Borderline,Narcissistic, and Cluster C Personality Disorders

We examined the differences between narcissism, mode of defense, and level of aggression on the Rorschach. We also investigated differences in borderline, narcissistic, and Cluster C personality disorders by examining responses to Rorschach content variables. The Lerner Defense Scale (P. Lerner & H. Lerner, 1980), the aggressive content section of the Holt (1977) method for assessing primary process manifestations, a modified version of Exner's (1986a) Egocentricity Index, Wagner's (1965) exhibitionistic M score, and grandiosity were scored on the Rorschach protocols of 17 borderline, I7 narcissistic, and 17 Cluster C personality disorders. Borderlines were found to employ primitive defensive structures to a greater degree and severity, show more intense and overall aggression as welt as more responses on the three forms of aggression in the Holt method, and have higher levels of grandiosity. Narcissists evinced significantly higher levels of egocentricity than borderlines and higher levels of idealization than the Cluster C group. Convergent validity was found on the measures of defense and aggression, which showed a strong relationship between primitive aggression and primitive defense.     

An empirical study of object relations and defensive operations in antisocial personality disorder

This study assessed the object relations, defensive operations, and level of psychopathy and narcissism in a group of antisocial personality disordered offenders. The Rorschach protocols of 33 subjects who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R], American Psychiatric Association, 1987) criteria for antisocial personality disorder were analyzed utilizing Kwawer's (1980) criteria for borderline object relations categories (borderline phenomena), the Lerner and Lerner (1980) Defense Scale, and a number of experimental criteria including Cooper and Arnow's (1986) defense criteria. Level of narcissism was assessed utilizing Exner's (1973) Self-Focus Sentence Completion Test. Hare's Psychopathy Checklist was used as an independent variable to determine a subject's level of psychopathy. Those subjects scoring 30 or more on the psychopathy checklist were compared to subjects scoring less than 30. The level of narcissism or proportion of defenses did not differ significantly between the severe psychopaths (greater than or equal to 30) and the moderate psychopaths (less than 30). The severe psychopaths produced a significantly greater number of borderline object relations. I conclude that antisocial individuals tend to be highly egocentric, and that narcissism is one component of psychopathy. Severe psychopaths, as a group, tend to be more borderline in their functioning than those exhibiting moderate levels of psychopathic disturbance. I also conclude that individuals who are incarcerated for felony offenses and also meet the DSM-III-R criteria for antisocial personality disorder exhibit degrees of borderline personality organization.     

Group psychotherapy of the characterologically difficult patient

A broad range of characterologically difficult patients present for treatment in psychotherapy groups. Despite different clinical presentations, including features of the schizoid, borderline, and narcissistic personality disorders, these patients share a common developmental failing. Specifically, these individuals have failed to attain object constancy and the associated stable internalization of tolerably ambivalent representations of the self, and of the other, in relationship with one another. Splitting mechanisms predominate over integrative ones, as primitive defenses are utilized to deal with the individual's powerful needs and fears related to engagement and intimacy. These maladaptive interpersonal styles are clearly illuminated in group therapy, but often to the exclusion of the latent, intrapsychic derivatives of this behavior, with detrimental effects. This paper examines the group therapy of such patients from the perspective of object relations and self psychology theories, models that provide the essential link between the interpersonal and the intrapsychic worlds.     

An Empirical Study of Object Relations and Defensive Operations in Antisocial Personality Disorder

This study assessed the object relations, defensive operations, and level of psychopathy and narcissism in a group of antisocial personality disordered offenders. The Rorschach protocols of 33 subjects who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-111-R], American Psychiatric Association, 1987) criteria for antisocial personality disorder were analyzed utilizing Kwawer's (1980) criteria for borderline object relations categories (borderline phenomena), the Lerner and Lerner (1980) Defense Scale, and a number of experimental criteria including Cooper and Arnow's (1986) defense criteria. Level of narcissism was assessed utilizing Exner's (1973) Self-Focus Sentence Completion Test. Hare's Psychopathy Checklist was used as an independent variable to determine a subject's level of psychopathy. Those subjects scoring 30 or more on the psychopathy checklist were compared to subjects scoring less than 30. The level of narcissism or proportion of defenses did not differ significantly between the severe psychopaths (230) and the moderate psychopaths (< 30). The severe psychopaths produced a significantly greater number of borderline object relations. I conclude that antisocial individuals tend to be highly egocentric, and that narcissism is one component of psychopathy. Severe psychopaths, as a group, tend to be more borderline in their functioning than those exhibiting moderate levels of psychopathic disturbance. I also conclude that individuals who are incarcerated for felony offenses and also meet the DSM-111-R criteria for antisocial personality disorder exhibit degrees of borderline personality organization.     

MMPI-2 Findings of Primitive Defenses in Alienating Parents

To test the involvement of primitive defenses in Parental Alienation Syndrome (PAS), we collected 158 MMPI-2s from court ordered custody evaluations from 7 forensic psychology practices; 76 were PAS cases and 82 were custody cases without PAS (controls). We used two MMPI-2 indexes to measure primitive defenses: L + K ? F and (L + Pa + Sc) ? (Hy + Pt). We found that mothers and fathers who were alienators had higher (clinical range) scores indicating primitive defenses such as splitting and projective identification, than control mothers and fathers (normal range scores) in both our indexes. Target parents were mostly similar to the control parents. The results showed strong support for Gardner's definition of PAS.     

Discussion: The Narcissism of Small Differences — and Some Big Ones

A broad range of characterologically difficult patients present for treatment in psychotherapy groups. Despite different clinical presentations, including features of the schizoid, borderline, and narcissistic personality disorders, these patients share a common developmental failing. Specifically, these individuals have failed to attain object constancy and the associated stable internalization of tolerably ambivalent representations of the self, and of the other, in relationship with one another. Splitting mechanisms predominate over integrative ones, as primitive defenses are utilized to deal with the individual's powerful needs and fears related to engagement and intimacy. These maladaptive interpersonal styles are clearly illuminated in group therapy, but often to the exclusion of the latent, intrapsychic derivatives of this behavior, with detrimental effects. This paper examines the group therapy of such patients from the perspective of object relations and self psychology theories, models that provide the essential link between the interpersonal and the intrapsychic worlds.     

COCAINE ADDICTS AND THEIR FAMILIES: AN EMPIRICAL STUDY OF THE PROCESSES OF IDENTIFICATION

The processes of identification between adolescent cocaine addicts and their parents were studied in 402 subjects, in total 134 familial triads (father"mother"son), subdivided into two groups of 67 triads, one of these groups having as the child an adolescent of masculine sex dependent on cocaine and the other, equal in number, being a control group, duly matched for age and socio-economic status. The instrument employed was the Rorschach test (1922), limited to the application of the Lerner Defense Scale (LDS; Lerner & Lerner, 1980). The findings in the affected triads showed up as consistent statistically for the presence of intense processes of pathological identification, especially between father and son, a sign of the importance of the presence of disturbances of paternal function in the development of this addiction. The utilisation of very regressive defence mechanisms, above all of projective identification, was the predominant mode of procedure in triads with a dependent child. In comparisons between the fathers the odds ratio (OR) for projective identification was 8.66 to 1, which points to the association between cocaine addiction and the primitive mental functioning of the fathers. With empirical methodology these findings serve to corroborate the psychoanalytical conclusions based on studies of single case studies, testifying that the dysfunctions of identificatory phenomena in familial functioning are predominant in the mental organisation of cocaine addicts.     

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.     

Borderline defenses and Rorschach responses: a critique of Lerner, Albert, and Walsh

Collapsing DSM-III schizotypal and borderline groups to form a borderline population is unwarranted when the results are then related to borderline personality organization. In a comparison of overlapping scoring systems for inferring defensive operations, Lerner, Albert, and Walsh intertwine fact and theory extravagantly and are not justified by their chosen populations nor their assumptions about the theories involved.     

Development and first results of the Borderline Personality Inventory: a self-report instrument for assessing borderline personality organization.

This article reports the development of a short 53-item true-false self-report instrument, the Borderline Personality Inventory (BPI). The BPI is based on Kernberg's (1984) concept of borderline personality organization. However, the diagnostic criteria are compatible with both the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) and Gunderson's (Gunderson & Kolb, 1978) concept of borderline personality disorder (BPD). The BPI contains scales for assessing identity diffusion, primitive defense mechanisms, and reality testing. Another scale refers to the fear of closeness. The construction of the scales is based on the results of a factor analysis. As a result of several studies, a cutoff score is proposed to make the diagnosis of a BPD. Thus, the BPI combines dimensional and categorical models of BPD. The BPI was tested in several studies. According to the results, internal consistency and retest reliability are satisfactory (Cronbach's alpha = .68-.91, rtt = .73-.89). Results for sensitivity are .85 to .89, and results for specificity .78 to .89. The BPI identifies borderline patients in high agreement with Kernberg's criteria of borderline personality organization, Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria of BPD and Gunderson's criteria of BPD. The BPI is recommended as a screening instrument for borderline personality organization and BPD and for dimensional research of borderline features in Axis I and Axis II disorders.     

Projection and Behavior: A Rorschach Study of Assaultive Mental Hospital Patients

Collapsing DSM-III schizotypal and borderline groups to form a borderline population is unwarranted when the results are then related to borderline personality organization. In a comparison of overlapping scoring systems for inferring defensive operations, Lerner, Albert, and Walsh intertwine fact and theory extravagantly and are not justified by their chosen populations nor their assumptions about the theories involved.     

Emotions as wishes and beliefs

Emotions can be assessed by means of different diagnostic methods, for example, by self-report instruments, ratings of facial expressions, or by projective techniques. This study presents an alternative approach: a computerized investigation of verbally expressed emotions by means of the Affective Dictionary Ulm (ADU; Dahl, H?lzer, & Berry, 1992), which was applied to responses in the Holtzman Inkblot Technique (HIT; Holtzman, 1988; Holtzman, Thorpe, Swartz, & Herron, 1961). A normal group (n = 30), patients with neurotic disorders (n = 30), borderline patients (n = 30), acute schizophrenics (n = 25), and chronic schizophrenics (n = 25) were compared in regard to verbally expressed emotions. According to the results, patients with neurotic disorders did not differ from the normal group in regard to verbally expressed emotions. Borderline patients expressed fear and emotions in general significantly more frequently than all other diagnostic groups. Furthermore, borderline patients differed in regard to specific emotions from patients with neurotic disorders, acute schizophrenics, and chronic schizophrenics. Acute schizophrenics did not differ from the normal group in regard to the expression of emotions, whereas chronic schizophrenics expressed anger, fear, anxiety, and emotions in general significantly less frequently than normals. By a discriminant analysis using verbally expressed emotions as predictors of the diagnosis, hit rates between 87% and 100% could be achieved. Furthermore, hypotheses about correlations between emotions on the one hand and internalized primitive object relations and bizarre-idiosyncratic thinking were tested empirically. Significant correlations could be demonstrated. These results support the validity of assessing emotions through a lexical content analysis of the HIT by use of the ADU.     

Assessing the link between stalking and domestic violence

Stalking may be defined as repeated following, communicating, and contacting a person in a threatening manner that causes the person to fear, on a reasonable basis, for his or her safety. Stalking is a recent legal construct, and social scientific research on stalking is in an early stage. Given that the most common victim of stalking is an ex-intimate partner, there may be an association between stalking and domestic violence. This paper evaluates this potential link. Specifically, the literature on stalking is reviewed by means of comparing it to existing literature on typologies of domestically violent persons. It is proposed that most stalkers who target ex-intimate partners are characterologically similar to a type of batterer labeled “borderline/cyclical.” Both domestic stalkers and borderline/cyclical batterers possess traits of Cluster B personality disorders. These traits include emotional volatility, attachment dysfunction, primitive defenses, weak ego strength, jealousy, anger, substance abuse, and early childhood trauma. Further, both groups have been observed to react with rage to perceived or actual rejection or abandonment. It is suggested that applying what is known about borderline/cyclical batterers to stalkers may aid in the investigation of this phenomenon. Implications for research are discussed.     

Abusive families and character formation

Family research studies confirm that abusive parents tend to be undifferentiated partners who compete with each other and with their children for attention and nurturance. More or less healthy parents make demands on children to counteract their own injured narcissism, but they do so largely without devaluation and the sadistic use of projective identification. Under sufficient stress abusive parents attack the child who fails to gratify their needs, thereby giving vent to longstanding frustrations and feelings of being threatened by the child's individuation and competency. The emotional atmosphere in such families facilitates ego deficits like those of the borderline personality as it molds the child's efforts to avoid anxiety. Devaluation, loss, and defenses against mourning partially account for depression and paranoid traits in abused youngsters. Early neglect and abuse exposes them to influential models who act out rage and primitive defenses. Some abused individuals project their rage and later become paranoid or antisocial, whereas others fragment or retain infantile defenses. The destructiveness of severe psychological abuse lies in the constriction of the experiencing self and healthy character development, together with the conditioning to repeat abusive relationships and to avoid intimacy. Achieving individuation under these circumstances entails overcoming the internalized abusive relationships and relinquishing the unconscious wish to be transformed from the abused into the abuser.     

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.     

Defense Mechanisms in Mania,Bipolar Depression and Unipolar Depression

The present study compared the use of defense mechanisms in ten bipolar manic, ten bipolar depressed and ten unipolar depressed patients. The defense mechanisms were assessed by two methods: TAT stories scored by Defense Mechanism Manual and Defense Mechanism Rating Scale ratings of psychodynamic interviews. The severity of symptoms was assessed by Beck Depression Inventory for depressed patients and Young’s Manic Rating Scale for manic patients. Both bipolar manic and depressed groups used the defense mechanism of denial, borderline level defenses and immature defenses significantly more than the unipolar depression group. The manic group showed greater dependence on narcissistic level defenses as compared to the other two groups. Positive relationships were found between severity of manic symptoms and the defense mechanisms of denial as well as the narcissistic level defenses. The bipolar depression group also used more action level defenses as compared to the unipolar depression group. The unipolar depression group scored higher on the defense mechanism of identification and adaptive level defenses as compared to the manic group. A negative correlation was found between the severity of depressive symptoms for unipolar depression group and the defense mechanism of identification. The neurotic level defenses were used most frequently by unipolar depression group, followed by the bipolar depression group and manic group. Some of these findings are in consonance with the psychoanalytic understanding of mania and depression.