1. object relations and social cognition_westen_psych assessment 1990

8/10/2019 1. Object Relations and Social Cognition_Westen_psych Assessment 1990

1/10

Psychological Asse ssme nt : Copy r ight 1990 by the Am er ica n Psychological Asso cia t ion, Inc .

A Journa l of Cons ul t ing and Cl inical Psychology 1040-3590/90/ 00.75

1990, Vol . 2 , No. 4 , 355-3 64

O bject Relat ions and Socia l C ogn it ion in Borderl ines M ajor Dep ress ives

and Norm als : A T hem at ic Apperception Test Analys is

Drew Westen and Naomi Lohr

D e p a r t m e n t s o f P s y c h o l o g y a n d P s y c h i a t ry

U n i v e rs i ty o f M i c h i g a n

Kenneth R. Silk Laura Gold and Kevin Kerber

D e p a r t m e n t o f P s y c h ia t ry

U n i v e rs i ty o f M i c h i g a n

This study com par ed reliably diagnosed borderline personality d isorder patients (n = 35) with

majo r depressives (n = 25) and norm als (n = 30) on 4 dimensions o f object relations and social

cognition code d from Them atic Apperception Test (TAT) responses: Complexity of Representa-

tions o f People, Affect-Tone of Relationship Paradigms (malevolent to benevolent), Capacity for

Em otional Investment in Relationships, and U nderstanding of Social Causality. As predicted,

borderlines scored s ignificantly lower on all 4 scales than did normals a nd lower on Affect-Tone

and C apacity for Emotional Investment than did nonborderline majo r depressives. Borderlines

also produced mor e pathological responses than did both groups on every scale, indicating more

poorly differentiated representations, grossly illogical attributions, malevolent expectations, and

need-gratifying relationship paradigm s. Th e results suggest the imp ortance of distinguishing sev-

eral interdependent but distinct cog nitive-affective dimensions of object relations and the poten-

tial utility o f assessing object relations and social cognition from TAT responses.

T h e p s y c h o l o g ic a l p r o c e s s e s u n d e r l y i n g t h e i n t e r p e r s o n a l p a -

t h o l o g y o f p a t i en t s w i t h b o r d e r l i n e p e r s o n a l i t y d i s o r d e r ( B P D ) ,

th a t i s , t h e i r d i s to r t e d o b je c t r e l a t io n s , h a v e b e e n c o n c e p tu a l -

i z e d in v a r io u s w a y s b y d i f f e re n t t h e o r i s t s . Mo s t a rg u e th a t a

d i s tu rb a n c e in th e f i r s t 3 y e a r s o f l i fe l e a d s to th e c o n t in u e d u s e

o f d e v e l o p m e n t a l l y p r i m i ti v e m o d e s o f r el a t in g i n a d u l t h o o d

(K e rn b e rg , 1 9 7 5 ; M a s te r s o n , 1 9 76 ) . A l th o u g h th e o r i s t s a n d c l i -

n i c i a n s ( se e G re e n b e rg Mi tc h e l l , 1 9 8 3) o f t e n s p e a k o f l ev el s o f

o b j e c t r e l a ti o n s as u n i t a r y p h e n o m e n a , f r o m d e v e l o p m e n t a l l y

i m m a t u r e t o m a t u r e, t h e t e r m object rel t ions r e fe rs t o a c o n g e r -

i e s o f c o g n i t iv e a n d a f f e ct iv e fu n c t io n s a n d s t ru c tu re s , i n c lu d -

in g w a y s o f r e p re s e n t in g p e o p le a n d r e l a t io n s h ip s , ru l e s o f i n fe r -

e n c e fo r i n t e rp re t in g th e c a u s e s o f p e o p le ' s f e e lin g s , b e h a v io r s ,

in t e rp e r s o n a l w i s h e s , c o n f l i c t s , a n d s o fo r th . T h e c o n c e p t o f

g e n e ra l l e v el s o f o b je c t r e l a t io n s i s c l in i ca l ly a n in d i s p e n s a b le

h e u r is t ic , b u t t h e s e l e v e ls s h o u l d b e u n d e r s t o o d a s b e i n g c o m -

p o s e d o f s e v e ra l i n t e r d e p e n d e n t b u t d i s t i n c t d e v e l o p m e n t a l

l i n e s t h a t d i ff e r in t h e i r m a t u r i t y a n d q u a l i ty a m o n g i n d i v i d -

u a l s a s w e l l a s w i th in a s in g le in d iv id u a l a t a n y g iv e n t im e (W e s -

t e n , 1 9 8 9 , 1 9 9 0 , i n p res s-b ). T h e a im o f th e p re s e n t s tu d y i s t o

e x p l o re t h e n a t u r e o f d if f e re n t d i m e n s i o n s o f t h e c o g n i t i v e -a f -

This research was supported by a grant from the Departm ent of

Psychiatry, University of Michigan.

We thank Alfred Kellam, Natasha Lifton, and John Boekamp for

help in codin g the data .

Correspondence concern ing th is a r t ic le shou ld be addressed to

Drew W esten, University of Michigan, D epartm ent o f Psychology,580

Union D rive, Ann Arbor, Michigan 48109-1346

355

fe c t iv e p ro c e s s e s u n d e r ly in g in t e rp e r s o n a l fu n c t io n in g in p a -

t i e n t s w i th B P D .

M a n y o f th e s e d i m e n s i o n s h a v e b e e n s t u d i e d e m p i r i c a l l y b y

d e v e lo p m e n ta l r e s e a rc h e r s, p a r t i c u la r ly th o s e in t e re s t e d in s o -

c ia l cogn i t ion (fo r a rev iew, see Shan tz , 1983). L ike ob jec t re la -

t i o n s t h e o r i s t s , s o c i a l - c o g n i t i o n r e s e a r c h e r s h a v e f o c u s e d o n

re p re s e n ta t io n a l p ro c e s s e s u n d e r ly in g in t e rp e r s o n a l fu n c t io n -

in g ( se e H o ro w i tz , 1 98 7 ; S in g e r K o l l ig i a n , 1 9 87 ; W e s te n , i n

p res s-a) . S o c ia l - c o g n i t io n r e s e a rc h c o m e s f ro m a d i f f e re n t i n t e l-

l e c tu a l t r a d i t io n , s tu d ie s n o rm a t iv e r a th e r t h a n p a th o lo g ic a l

p ro c e s s e s , u se s e x p e r im e n ta l r a th e r t h a n c l in i c a l m e th o d s , fo -

c u s e s o n m o l e c u l a r r a t h e r t h a n m o l a r p r o c e ss e s, a n d r e li e s o n

d i f fe r e n t m e t a p h o r s o f t h e m i n d t h a n d o e s p s y c h o a n a l y t i c o b -

jec t- re la t ions theory . Neverthe less , th is l i te ra tu re addresses is -

s u e s su c h a s t h e n a t u r e a n d d e v e l o p m e n t o f c a u sa l a t t r i b u t io n s

(R u b le R h o le s , 1 9 8 1 ) a n d p e r s o n - s c h e m a s (H o ro w i tz , 1 9 8 7 ;

L iv e s le y B ro m le y , 1 9 7 3 ; M a rk u s Wu r f , 1 9 8 7 ; S in g e r K o l -

l ig i a n , 1 9 8 7 ) in w a y s th a t a re l i k e ly to l e a d to r e f in e m e n t s o f

ob jec t-re la t ions mode ls (Wes ten , 1989; in p ress -a , in p ress -b) .

U n t i l r e c e n t ly ( se e B e l l , B i l l i n g to n , C ic c h e t t i , G ib b o n s ,

1 9 8 8 ; B u rk e , S u m m e rs , S e l in g e r , P o lo n u s , 1 9 8 6 ; We s te n , L u -

d o lp h , L e rn e r , R u ff in s, Wis s , 1 9 90 ) , e m p i r i c a l s tu d ie s o f o b -

jec t re la t ions in border l ine pa t ien ts have re l ied exc lus ive ly on

h u m a n - f i g u r e r e s p o n s e s o n t h e R o r s c h a c h t e s t . N e a r l y a l l o f

th o s e s tu d ie s h a v e c o m p a re d b o rd e r l in e p a t i e n t s (o f t e n d i a g -

n o s e d w i t h u n r e p o r t e d o r m a r g i n a l r e l i a b i l i t y a n d v a l i d i ty )

w i th s c h iz o p h re n ic s . B y a n d l a rg e, b o rd e r l in e s ty p ic a l ly s c o re

h ig h e r th a n s c h iz o p h re n ic s o n o v e ra l l d e v e lo p m e n ta l l e v e l a s

m e a s u r e d o n B l a tt 's R o r s c h a c h m e a s u r e f o r o b j e c t r el a t io n s

(B la t t, B re n n e i s , S h im e k , 1 9 76 ) , t h o u g h f in d in g s o n p a r t i c u -


2/10

3 5 6 WE S T E N , L O H R , S ILK , G O L D , K E R B E R

l a r s u b s c a l e s h a v e b e e n l e ss c o n s i s t e n t ( G a r t n e r , H u r t , &

G a r tn e r , 1 9 8 9 ; H y m o w i tz , H u n t , C a r t , H u r t , & S pe a r , 1 9 8 3 ;

L e r n e r & S t. P e te r , 1 98 4 ; S p e a r & S u g a rm a n , 1 9 84 ) . L e rn e r a n d

St . Pe te r (1984) and S tua r t e t a l . (1990) found tha t border l ines

t e n d to p ro d u c e m a le v o le n t , i d io s y n c ra t i c , b u t c o g n i t iv e -d e v e l -

o p m e n ta l ly a d v a n c e d r e p re s e n ta t io n s o f p e o p le 's i n t e n t io n s o n

th e R o rs c h a c h . T h i s f in d in g i s n o t e n t i r e ly c o n s i s t e n t w i th d e v e l -

o p m e n ta l o b je c t - r e l a t io n s th e o ry : Ma le v o le n c e i s n o t l i k e ly to

re f l ec t a n o rm a l d e v e lo p m e n ta l s t a g e , a n d c o g n i t iv e ly a d v a n c e d

re p re s e n ta t io n s , e v e n i f p e rc e iv e d in a m a n n e r s u g g e s t iv e o f

m a rg in a l r e a l i t y t e s t in g , a re n o t e a s i ly c o n s t ru e d a s r e f l e c t in g

p re o e d ip a l r e g re s s io n o r f ix a tio n .

W h e n m u l t ip l e f a c e t s o f o b je c t r e l a t io n s a re c l e a r ly d i ff e re n -

t i at e d , m a n y h y p o t h e s e s a b o u t t h e i r d e v e l o p m e n t a l c o u r s e a n d

th e i r q u a l i ty in se v e re c h a ra c te r p a th o lo g y c a n b e s tu d ie d e m -

p i r ic a l ly . T h i s s tu d y fo c u s e s o n fo u r d im e n s io n s o f o b je c t r e la -

t i o n s a n d s o c i al c o g n it i o n , a s m e a s u r e d f r o m T h e m a t i c A p p e r -

c e p t io n T e s t (T A T ; Mu r ra y , 1 9 3 8 ) r e sp o n s e s : C o m p le x i ty o f R e p -

r e s e n t a t i o n s o f P e o p l e ( t e n d e n c y t o r e p r e s e n t p e o p l e i n

c o m p le x w a y s a n d to d i s t in g u i s h c l e a r ly th e i r s u b jec t iv e e x p e r i -

e n c e a n d p o in t s o f v ie w ) , A f fe c t -T o n e o f R e la t io n s h ip P a ra -

d ig m s (a ff ec tive q u a l i ty o f t h e o b je c t w o r ld o r i n t e rp e r s o n a l

e x p e c t a t i o n s , f r o m m a l e v o l e n t t o b e n e v o l e n t ) , C a p a c i t y f o r

E m o t i o n a l I n v e s t m e n t i n R e l a t i o n s h i p s a n d M o r a l S t a n d a r d s

(n e e d -g ra t i fy in g o r i e n ta t io n to th e s o c ia l w o r ld v e r s u s in v e s t -

m e n t in v a lu e s , i d e a l s , a n d c o m m i t t e d r e l a t io n s h ip s ) , a n d U n -

d e r s t a n d i n g o f S o c i al C a u s a l i t y ( t e n d en c y t o a t t r i b u t e c a u s es o f

b e h a v io r s , t h o u g h t s , a n d e m o t io n s in a c o m p le x , a c c u ra t e , a n d

p s y c h o lo g ic a l ly m i n d e d w a y ). E a c h d im e n s io n i s a s s e s s e d w i th

a f ive -leve l sca le (W es ten , L ohr , S i lk , & Kerber , 1985). W ith th e

e x c e p t io n o f A f fe c t -T o n e , t h e s c a l e s a t t e m p t to m e a s u re d e v e l -

o p m e n ta l d im e n s io n s ; L e v e l I i s relatively prim itive, a n d L e v e l 5

is mature .

T h e T A T i s a n e x c e l l e n t t e s t fo r a ss e s s in g o b je c t r e l a t io n s a n d

s o c ia l c o g n i t io n b e c a u s e , u n l ik e th e R o rs c h a c h (1 94 2 ) b lo ts , t h e

s t im u lu s i s u n a m b ig u o u s ly s o c ia l, a n d s u b je c t s a re l i k e ly to p ro -

v id e e n o u g h d e ta i l i n d e s c r ib in g c h a ra c te r s a n d r e l a t io n s h ip s a s

to p ro v id e c o n s id e ra b le a c c e s s to c o g n i t iv e -a f fe c t iv e p a t t e rn s

re l a t e d to in t e rp e r s o n a l fu n c t io n in g . T h e m e a s u re s u s e d h e re

w e re d e r iv e d f ro m c l in i c a l o b s e rv a t io n , o b je c t - r e l a t io n s th e o ry

a n d re s e a rc h ( s ee B la t t & L e rn e r , 1 9 8 3 ; G re e n b e rg & M i tc h e ll ,

1 9 8 3 ; T h o m p s o n , 1 9 8 1 ; U r i s t , 1 9 8 0 ) , a n d r e s e a rc h in d e v e lo p -

m e n ta l s o c ia l c o g n i t io n (B o g e n , 1 9 8 2 ; D a m o n , 1 9 7 7 ; S e lm a n ,

1 9 80 ; S h a n tz , 1 98 3 ). R e c e n t ly c o m p le te d r e s e a rc h h a s b e g u n

v a l i d at i n g t h e m e a s u r e s w i t h b o t h n o r m a l a n d c l in i c a l p o p u l a -

t i o n s . R e s e a r c h w i t h u n d e r g r a d u a t e s h a s f o u n d s i g n i f i ca n t

c o r r e l a t i o n s b e t w e e n t h e T A T m e a s u r e s a n d a n a l o g o u s m e a -

s u re s d e v i s e d fo r u s e w i th in t e rv ie w d a ta , s u c h a s p s y c h o th e r -

a p y t r a n s c r ip t s a n d r e s e a rc h in t e rv ie w s ( e. g. , c o m p le x i ty o f T A T

c h a ra c te r s c o r re l a t e s w i th c o m p le x i ty o f p e o p le in d e s c r ip t io n s

o f a c tu a l i n t e rp e r s o n a l e p i s o d e s ; s e e B a re n d s , W e s te n , L e ig h ,

S i l b e r t , & B y e r s , 1 9 9 0 ; L e i g h , W e s t e n , B a r e n d s , & M e n d e l ,

1 9 89 ). T h i s r e s e a rc h h a s a l s o fo u n d p re d ic t e d c o r re l a t io n s b e -

tw e e n th e fo u r T A T s c a le s a n d v a l id a t e d in s t ru m e n t s , s u c h a s

B la t t, W e in , C h e v ro n , & Q u in la n ' s (19 7 9) m e a s u re s o f c o m p le x -

i ty a n d a f f ec t iv e q u a l i ty o f p a re n ta l r e p re s e n ta t io n s a p p l i e d to

d e s c r ip t io n s o f s ig n i f ic a n t o th e r s. F o r e x a m p le , a s p re d ic t e d ,

B la t t 's c o n c e p tu a l l e v e l m e a s u re c o r re la t e s w i th C o m p le x i ty

a n d S o c ia l C a u s a li t y b u t n o t w i t h A f f e c t- T o n e o r E m o t i o n a l

In v e s tm e n t . T h e s c a l e s w e re a l s o a b le to p re d ic t s o c ia l a d ju s t -

m e n t a s m e a s u r e d b y W e i s s m a n ' s S o c i a l A d j u s t m e n t S c a l e

(We is s m a n & B o th w e l l , 1 9 7 6 ) in b o th c l in i c a l a n d n o n c l in i c a l

s a m p l es . T w o d e v e l o p m e n t a l s t u d i e s h a v e d o c u m e n t e d d e v e l o p -

m e n ta l d i f f e re n c e s u s in g b o th T A T a n d in t e rv ie w re s p o n s e s in

a l l m e a s u re s e x c e p t A f fe c t -T o n e , w i th o n e s tu d y c o m p a r in g

s e c o n d a n d f i ft h g r a d e rs a n d t h e o t h e r c o m p a r i n g e a r ly a n d l a t e

ado lescen ts (Wes ten , Klepse r , e t a l . , 1989) . Border l ine ado les -

c e n t s h av e b e e n s h o w n t o d i f fe r f r o m p s y c h i at r i c a n d n o r m a l

c o m p a r i s o n s u b j e c t s o n t h e f o u r s c a l e s ( W e s t e n , L u d o l p h ,

L e rn e r , e t a l ., 1 9 90 ), a n d b o rd e r l in e a d u l t s a n d a d o le s c e n t s h a v e

b e e n s h o w n to d i f f e r f ro m e a c h o th e r i n w a y s s u g g e s t iv e o f

n e e d e d r e f in e m e n t s in th e o ry (We s te n , L u d o lp h , S i lk , e t a l . ,

1 9 90 ) . S c h n e id e r (1 9 9 0) h a s r e c e n t ly a s se s s e d th e s e d im e n s io n s

f r o m p s y c h o t h e r a p y t r a n s c ri p t s u s i n g a n a n a l o g o u s i n s t r u m e n t

fo r n a r ra t iv e d a ta a n d fo u n d in c re a s e s in c o m p le x i ty o f r e p re s e n -

t a t i o n s a n d c a p a c i t y f o r e m o t i o n a l i n v e s t m e n t o v e r t h e c o u r s e

o f b r i e f p s y c h o a n a ly t i c p s y c h o th e ra p y a n d a t fo l lo w -u p . In t e r -

n a l c o n s i s t e n c y (C ro n b a c h ' s a lp h a ) h a s v a r i e d d e p e n d in g o n th e

n u m b e r o f T A T r e sp o n s e s a n d b e t w e e n - s u b je c t v a r i a n ce , r a n g -

in g f ro m . 5 9 to . 7 7 in c l in i c a l s a m p le s u s in g f iv e to s e v e n c a rd s .

I n t h e p r e s e n t s tu d y , w e c o m p a r e d t h e T A T r e s p o n s e s o f a

s a m p l e o f B P D p a t ie n t s w i t h r e s p o n s e s o f p a ti e n ts w i t h m a j o r

d e p r es s iv e d i s o r d e r ( M D D ) a n d n o r m a l s . H y p o t h e s e s w e r e t h e

fo l lo w in g . B o rd e d in e s s h o u ld h a v e lo w e r m e a n s c o re s a n d a

h ig h e r p e rc e n ta g e o f p a th o lo g ic a l (L e v e l 1 r e s p o n s e s o n a l l fo u r

s c a l e s t h a n n o r m a l s . O n A f f e c t - T o n e o f R e l a t i o n s h i p P a r a -

d i g m s a n d C a p a c i t y f o r E m o t i o n a l I n v e s t m e n t , b o r d e r l i n e s

s h o u l d h a v e l o w e r m e a n s c o r e s t h a n m a j o r d e p r e s si v e s a n d

s h o u ld h a v e a h ig h e r p e rc e n ta g e o f L e v e l 1 s c o re s, r e f l e c t in g

e x p e c t a t io n s o f m a l e v o l e n c e a n d a n e e d - g r a t i f y in g o r i e n t a ti o n

t o t h e s o c i a l w o r l d . A l t h o u g h m a j o r d e p r e s s i v e s s h o u l d n o t

d i f fe r f r o m b o r d e r l i n e s i n m e a n C o m p l e x i t y o f R e p r es e n t a-

t io n s o f P e o p le o r S o c ia l C a u s a l i ty b e c a u s e o f t h e c o g n i tiv e

c o n s t r i c t io n c h a ra c te r i s t i c o f d e pre s s iv e s , w h ic h s h o u ld a p p ly

to th e i r r e p re s e n ta t io n s o f p e o p le a s w e ll , b o rd e r l in e s s h o u ld

h a v e m o re p o o r ly d i f f e re n t i a t e d c h a ra c te r s ( s c o re d L e v e l 1 o n

C o m p le x i ty o f R e p re s e n ta t io n s ) a n d g ro s s ly i l l o g ic al c a u s a l s e -

q u e n c e s ( s c o re d L e v e l I o n S o c ia l C a u s a li ty ) t h a n m a jo r d e p re s -

s iv e s. T h i s p a t t e rn i s e x p e c te d to h o ld fo r b o rd e r l in e s w h o a re

c o n c u r r e n t l y i n a m a j o r d e p r e s si v e e p i s o d e a s c o m p a r e d w i t h

n o n b o rd e r l in e m a jo r d e p re s s iv e s a s w el l.

M e t h o d

S u b j e c t s

The patients used as subjects for this s tudy w ere drawn from two

inpatient units of the University of Michigan M edical Center. To be

considered for inclusion in the study , as an initial screening proced ure,

potential subjects had to me et at least two criteria o f the thir d edition

o f th e Diagnostic and Statis tical M anual of Mental Disorders DSM -II1

o r DSM-111-R [revised ]; Am erican Psychiatric Association, 1980,

1987) for BPD or schizotypal personality disorder o r three such criteria

for major depressive episode o n admission. Exclusion criteria included

chronic psychosis or medical problems that would prohibit a 2-week

drug-free period or would confound biological test results.

Ninety-two percent of eligible subjects consented to be considered


3/10

O B J E C T R E L A T I O N S I N B O R D E R L I N E S 57

fo r inc lus ion in the resea rch . W hi le con sen t ing sub jec ts were d rug- free ,

t h e y w e r e a d m i n i s t e r e d t h e D i a g n o s t i c I n t e r v i e w f o r B o r d e r l in e s ( D I B ;

Gunderson , Ko lb , & Aus t in , 1981) , wh ich has been shown in severa l

s t u d i e s t o p r e d i c t c l i n ic i a n d i a g n o s is o f B P D u s i n g D S M - I I I o r D S M -

II1-R cr i te r ia wi th sens i t iv i ty and spec i f ic i ty above 80% (Armel ius ,

Ju l lg ran , & Renberg , 1985) . In te r ra te r re l iab i l i ty (K = .78) by our g roup

has been desc r ibed e lsewhere (Corne l l , S i lk , Ludo lph , & Lohr , 1983) ,

a n d r e l i a b i l it y h a s b e e n m a i n t a i n e d t h r o u g h p e r i o d i c r e t r a i n in g a n d

a s s e ss m e n t . D i a g n o s i s o f d ep r e s s i o n w a s m a d e b y R e s e a r c h D i a g n o s -

t ic C r i te r ia (RD C; Sp i tze r , End ico t t , G ibbon , & Robb ins , 1975), a p re -

c u r s o r t o D S M - I I I f o r re s e a r c h p u r p o s e s , b y a m e m b e r o f t h e r e s e a r c h

t e a m , b a s e d o n i n t e rv i e w s w i t h t h e p a t i e n t a n d t h e p a t i en t ' s p r i m a r y

the rap is t . In te r ra te r re l iab i l i ty on th e d iagnos is o f depress ion w as .92

(weigh ted kappa ; C ohen , 1968) , wi th a range o f pa i rw ise re l iab i l i ty o f

.88 to .94. As in p rev ious resea rch us ing the DIB , pa t ien ts w ere admi t -

t e d t o t h e B P D c o h o r t b y o b t a i n i n g a D I B s c o r e of >~ 7 . N o n b o r d e d i n e

M D D c o m p a r i s o n s u b je c ts s c o r e d ~


4/10

58 W E S T E N , L O H R , S I L K , G O L D , K E R B E R

T a b l e

Means and Stand ard Deviations o f Subject Characteristics

A g e H D R S s c o r e S E S

ex

G r o u p

n M SD

(% female)

M SD M SD

BPD total 37 28.24 9.03 73.00 13.65 7.43 4.24 2.57

BP D /no n-M DD 19 25.68 7.96 68.40 10.29 6.08 3.18 2.56

BP D /M D D 18 30.94 9.50 77.80 17.00 7.27 5.07 2.34

M D D 25 40,20 11.93 72.00 17.24 5.57 6.17 1.98

N or m al 30 32,30 11.35 60.00 1.25 1.35 6.77 1.48

Note H D R S = H a m i l t o n D e p r e s s io n R a t i n g S c al e (H a m i l t o n , 1 96 0 ); S E S = s o c i o e c o n o m i c s t at u s ( H o l -

l ingshead & Red l ich , 1958) ; BPD = bo rder l ine pe rsona l i ty d iso rder ; M D D = majo r depressive d iso rder .

t ionsh ips w i th o the rs a re va lued p r im ar i ly fo r the g ra t i f ica t ion , secu-

rity , or benefits they afford, to m ature o bject relations base d on m utual

love , re spec t , and con cern fo r o the rs wh o a re va lued fo r the i r spec i f ic

a t t r ibu tes (e .g. , Fa i rba i rn , 1954) . Resea rch in deve lop menta l psycho l -

ogy on ch i ld ren ' s concep t ions o f f r iendsh ip , ju s t ice , conven t ion , au thor -

i ty , and mora l i ty tend to suppor t th is v iew; aga in , however , these l i te ra -

tu res sugges t a much longer matu ra t iona l p rocess than desc r ibed by

psychoana ly t ic theory , wh ich p roposes tha t need-g ra t i fy ing ob jec t re la -

t i o n s a re t r a n s c e n d e d b y t h e e n d o f t h e o e d i p a l p e r i o d ( se e D a m o n ,

1977; Rest, 1983; Selman, 1980; Shantz, 1983; Westen, 1989,1990). The

measu re fo r a ssess ing capac i ty fo r emot iona l inves tmen t in re la t ion -

sh ips and mora l s tandards re f lec ts a deve lopme nta l mode l a imed a t

in teg ra t ing cogn i t iv e -deve lopm enta l theor ies and resea rch wi th ob-

jec t - re la t ions theory and c l in ica l obse rva t ion (Wes ten , 1985) . I t a t -

tempts to assess inves tmen t in re la t ionsh ips and va lues ra the r than

s imply knowledge o f them ; many soc iopa ths , fo r example , kno w so -

c ia l ru les bu t lack an a f fec t ive -mot iva t io na l inves tmen t in them.

Understanding ofSocial Causality Clin ica l exper ience wi th pa t ien ts

wi th BP D sugges ts tha t these pa t ien ts tend to m ake h igh ly id iosyncra -

t ic , i l log ica l , and inaccura te a t t r ibu t ions o f peop le ' s in ten t ions . One

c o u l d p r o b a b ly p o s it a b o r d e r l i n e a t t r i b u t i o n a l s t y le ( W e s t e n , i n

p ress -c ) , cha rac te r ized by egocen t r ic a t t r ibu t ions , expe c ta t ions o f m a-

levo lence in in te rpe rsona l re la tions , a tendency to make pecu l ia r and

inaccura te a t t r ibu t ions , and a tenden cy to make a f fec t -cen te red a t t r i -

bu t ions ( i .e ., a t t r ibu t ions tha t a re congrue n t w i th m ood o r a f fec tive

va lence o f rep resen ta t ions , ra the r than more cogn i t ive ly based a t t r ibu -

t ions) . Ex tens ive resea rch in the deve lop men t o f unders ta nd ing o f so -

cial causa lity in children (C handler, Pa get, & Koch, 1978; Piaget, 1951;

Rub le & Rh o les , 1981 ; Se lman , 1980) sugges ts a numbe r o f deve lopmen -

ta l sh i f t s in the w ay ch i ld ren in fe r causa l i ty in the soc ia l rea lm. These

includ e increase d complexity, abstractnes s, accuracy, intern ality ( i .e . ,

focus on in te rna l psycho log ica l p rocesses ra the r th an o n su r face - leve l ,

o b s e r v a b l e , b e h a v i o r a l c a u se s ) , a n d u n d e r s t a n d i n g o f u n c o n s c i o u s

processes . Bogen (1982) assessed d im ens ions such as under s tand ing o f

rec ip roca l causa l in f luences o f charac te rs in s to r ies ch i ld ren te l l . The

m e a s u r e o f u n d e r s t a n d i n g o f s o c i a l c a u s al i t y f o r u s e w i t h T A T r e-

sponses was des igned to assess the log ic , complex i ty , and accuracy o f

a t t r ibu t ions .

Coding and Interrater Reliability All ca rds were coded indepen-

den t ly by two ra te rs on each sca le . Two advanced g radua te s tuden ts in

c l in ica l psycho logy and two B .A.- level re sea rch ass is tan ts , who had

been t ra ined ex tens ive ly us ing de ta i led sco r ing manua ls , coded the

da ta fo r the study . Coders m et a t regu la r in te rva ls to d iscuss indepen-

den t ly sco red responses in o rde r to p reven t coder d r i f t and to reso lve

d i s c r e p a n c i e s . B e c a u s e c o d i n g e x t e n d e d o v e r s e v e r a l m o n t h s , a n d

c o d e r s ' t i m e c o m m i t m e n t s v a r i e d , e a c h c o d e r w a s t r a i n e d t o c o d e a l l

four sca les ; d i f fe ren t pa i r s o f coders thus sco red d i f fe ren t subse ts o f the

da ta on the va r iou s scales .

Coders rece ived the s to r ies typed one to a page in random order , so

tha t ra t ing mul t ip le s to r ies in the same p ro toco l wou ld be en t i re ly

independen t . Re l iab i l i ty was compu ted us ing Pearson 's r , wi th Spear -

man-Brown cor rec t ion fo r doub le cod ing . Uncor rec ted pa i rwise re l i -

ab i l i t ie s ranged f rom .88 to .95 . Correc te d average re l iab i li t ie s fo r the

four sca les were as fo llows: C omp lex i ty o f Represen ta t ions , . 94 ; Af-

fect-Tone, .97; Em otio nal Inv estm ent, .94; Social Causality , .95. lntra -

c lass co r re la t ion coef f ic ien ts y ie lded s imi la r re l iab i l i ty e s tima tes .

R e s u l t s

A l l g r ou p s ( B P D / n o n - M D D , B P D / M D D , M D D , a n d n o r-

m a l ) w e r e p r i m a r i l y f e m a l e , w i t h n o s i g n i f i c a n t s e x d i f f e r e n c e s

a m o n g t h e m . A s c o u l d b e e x p e c t e d f r o m d i f f e re n c e s in ( a) a g e

o f o n s e t o f t h e d i s o r d e r s , ( b ) t h e d i s o r d e r s ' r e l a t i v e e f f e c ts o n

o c c u p a t i o n a l f u n c t i o n i n g , a n d (c) d i a g n o s t i c c r i t e r ia , t h e g r o u p s

d i f f e r e d s i g n i f i c a n t l y i n a g e , F ( 3 , 8 8 ) = 7 . 1 6 , p = . 0 0 0 2 , s o c i o e c o -

n o m i c s t a t u s ( S E S ; H o l l i n g s h e a d & R e d l i c h , 1 9 5 8 ) , F ( 3 , 6 1 ) =

8 . 5 1 , p = . 0 0 0 1 , a n d s e v e r i t y o f d e p r e s s i o n a s a s s e s s e d b y t h e

H a m i l t o n R a t i n g Sc a l e f or D e p r e s s io n ( H R S D ; H a m i l t o n ,

t 9 6 0 ) , F ( 3 , 6 3 ) = 2 4 . 4 3 , p = . 0 0 0 1 . A s w i l l b e a d d r e s s e d b e l o w ,

t h e s e g r o u p d i f f e r e n c e s d i d n o t a c c o u n t f o r s i g n i f i c a n t f i n d -

ings .

T o a v o i d t h e p o s s i b i l i t y o f s p u r i o u s f i n d i n g s r e f l e c t i n g p o -

t e n t i al l y i n t e r c o r r e l a t e d m e a s u r e s , T A T s c o r es w e r e e n t e r e d

i n t o a m u l t i v a r ia t e A N O V A . M e a n s c o r e s o n e a c h s c a l e w e r e

t h e n a n a l y z ed b y A N O V A , w i th p l a n n e d p a i r w i se c o m p a r i s o n s

b y t t e s t w i t h B o n f e r r o n i c o r r e c t i o n f o r t h e n u m b e r o f te s t s o n

e a c h v a r i a b le . P r e s e n c e o r a b s e n c e o f p a t h o lo g i c a l r e s p o n s e s

( L e v e l 1 w a s a ls o c o d e d a s a d i c h o t o m o u s v a r i a b l e o n e a c h T A T

r e s p o n s e f o r e a c h s c a l e ; t o a g g r e g a t e t h e d a t a a n d c o n t r o l f o r

m i s s i n g d a t a p o i n t s , p e r c e n t a g e o f p a t h o l o g i c a l r e s p o n s e s p e r

s u b j e c t w a s c a l c u l a t e d f o r e a c h v a r i a b l e . T h e s e d a t a w e r e t h e n

t r e a t e d a s c o n t i n u o u s a n d a n a l y z e d b y A N O V A .

A m u l t i v a r i a t e a n a l ys i s u s i n g T A T s c o r e s a s d e p e n d e n t v a r i -

a b l e s w a s s i g n i f i c a n t , F ( 8 , 1 7 2 ) = 2 . 7 4 , p = . 0 0 7 . T a b l e 3 r e p o r t s

t h e r e s u l ts o f u n i v a r i a te A N O V A s f o r m e a n s c o r e s o n a l l fo u r

v a r i a b l e s . A s c a n b e s e e n , t h e t h r e e g r o u p s d i f f e r e d o n a l l f o u r

v a r i a b le s a s p r e d i c te d . P l a n n e d c o m p a r i s o n s ( o n e - t a i l ed t t e s ts

w i t h B o n f e r r o n i a d j u s t m e n t ) d e m o n s t r a t e d h i g h ly s i g n if i c a n t

d i f f e r en c e s b e t w e e n b o r d e r l i n e s a n d n o r m a l s o n a l l f o u r s c a le s ,

a n d c l e a r d i f fe r e n c e s b e t w e e n t h e b o r d e r l i n e s a n d m a j o r d e -

p r e ss i v es o n t h e t w o s c a l e s o n w h i c h t h e y w e r e h y p o t h e s i z e d t o

d i f f e r - - A f f e c t - T o n e a n d E m o t i o n a l I n v e s t m e n t .


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OBJECT RELATIONS IN BORDERLINES

Table 2

r ie f Synposis o f Measures of Object Relations a nd Social Cogni t ion

359

Scale

Complexity of Affect-Tone of Relationship Capacity for Emotional Understanding of Social

Le vel Representations of People Paradigms Investment Causality

1 People are not clearly Malevolent representations; Need-gratifying orientation; Noncausal or grossly illogical

differentiated; gratuitous violence or gross profound self- depictions of psychological

confusion of points of negligence by significant preoccupation, and interpersonal events.

view. others.

2 Simple, unidimensional Representation of relationships

representations; focus as hostile, empty, or

on actions; traits are capricious but not

global and univalent, profoundly malevolent;

profound loneliness or

disappointment in

relationships.

3 Minor elaboration of Mixed representations with

mental life or mildly negative tone.

personality.

Expanded appreciation of

complexity of

subjective experience

and personality

dispositions; absence of

representations

integrating life history,

complex subjectivity,

and personality

processes.

Complex representations,

indicating

understanding of

interaction of enduring

and momentary

psychological

experience;

understanding of

personality as system

of processes interacting

with each other and the

environment.

Mixed representations with

neutral or balanced tone.

Predominantly positive

representations; benign and

enriching interactions.

Limited investment in people,

relationships, and moral

standards; conflicting

interests recognized, but

gratification remains

primary aim; moral

standards minimally

developed or followed to

avoid punishment.

Conventional investment in

people and moral

standards; stereotypic

compassion, mutuality, or

helping orientation; guilt

at moral transgressions.

Mature, committed

investment in relationships

and values; mutual empathy

and concern; commitment

to abstract values.

Autonomous self hood in the

context of committed

relationships; recognition

of conventional nature of

moral rules in the context

of carefully considered

standards or concern for

concrete people or

relationships.

Rudimentary understanding

of social causality; minor

logic errors or unexplained

transitions; simple

stimulus-response

causality.

Complex, accurate situational

causality and rudimentary

understandingof the role

of thoughts and feelings in

mediating action.

Expanded appreciation o f the

role of mental processes

in generating thoughts,

feelings, behaviors, and

interpersonal interactions.

Complex appreciation of the

role of mental processes

in generating thoughts,

feelings, behaviors, and

interpersonal interactions;

understanding of

unconscious motivational

processes.

Table 4 reports the per centage of Level I hypothesized to be

pathological) responses per protocol by diagnosis. As can be

seen in the table, again the gro ups differed significantly on all

four variables, with significant differences found between the

borderlines and both comparis on groups on every variable ex-

cept Complexity, on which the bo rderlines produced more

poorly differentiated responses than major depressives, but the

differences did not reach a significant level. The significance

values reported here r epresent relatively conservative estimates,

because the Bonferroni correction was technically not neces-

sary due to the highly significant multivariat e analysis.

An even more conservative test of the differences between

the borderlines and the major depressives would control for

depression by comparing only those BPDs who were comorbid

for major depression with MDDs; such a comparison would

contras t patients who share an Axis I diagnosis and differ only

on Axis II and do not differ significantly in HRS D depression

scores). To test this hypothesis, we first ran a multivar iate analy -

sis to det ermi ne whether differences on the TAT measure still

emerge when dividing the sample into four groups: borderlines

without major depression, borderlines with major depression,

nonbo rderline major depressives, and normals. The multivar-

iate analysis was significant, F 12, 225.2) = 1.97, p = .03, and

the general pattern of ANOVA findings was similar to the

three-group analysis. The specific comparison of borderline

patients comorbid for major depression with nonborderline

majo r depressives one-ta iled t tests) is presen ted in Table 5. As

can be seen, the basic pattern found with the entire borderline

sample, in which borderlines have lower mean scores on Af-

fect-Tone and Emotional In vestment and a higher percentage of

pathological responses on all four scales, was largely con-

firmed. The significance values are, of course, slightly lower


6/10

36

Table 3

M e a n S c o r e s b y D i a g n o s i s

WESTEN, LOHR, SILK, GOLD, KERBER

Diagnosis

Planned comparisons

Borderlines

Major vs. major Borderlines vs.

Borderlines de pr es si ves Normals depressives normals

Scale M S D M S D M S D F stat d f T stat d f T stat d f

Complexity of Representations 2.80 .59 2.76 .57 3.16 .57 4.48** 2,89 .01 60 2.58** 65

Affect-Toneof Relationship

Paradigms 2.53 .59 2.83 .53 2.97 .39 6.22*** 2,89 2.20* 60 3.44**** 65

Capacity for Emotional

Investment 2.18 .54 2.42 .40 2.61 .48 6.31 ** 2,89 1.88t 60 3.53**** 65

Understanding of Social

Causality 2.49 .60 2.58 .48 2.90 .54 4.79** 2,89 .07 61 3.01 ** 65

Note.

Data analyzed by analysis of variance. Planned comparisons analyzed by one-tailed T tests with Bonferroni adjustment for number of

comparisons.

*=p


7/10

O B J E C T R E L A TI O NS I N B O R D E R L I N E S

T a b le 5

Mean Scores and Percentage of Level 1 Pathological) Responses for Major

Depressives With and Without BPD

Percentage of Level 1

Mean scores responses

B P D / M D D B P D / M D D

MD D o n ly MD D o n ly

Scale

M SD

Mean

SD T stat M SD M SD T stat

Affect-Tone of Relationship

Paradigms 2.52 .52 2. 87 .52 2.20** 18 1.54 06 1 .0 9 2.86***

Com plexity o f Representations 2 .86 .61 2.75 .58 .62 06 1.62 03 .71 .93

Capacity for Em otional

Investment 2.22 .46 2.42 .41 1.51t 23 1.99 14 1 .5 8 1.71

Understanding of Social

Causality 2.63 .67 2.57 .49 .35 13 2.0 9 05 1 .1 7 1.64

Note.

Data (planned comparisons) analyzed by t test (one-tailed),

dr=

41. BPD = borderline personality

disorder; M DD = m ajor depressive disorder.

* = p _ < . 0 5 , * * = p < . 0 1 , * * * = p _ < . 0 0 5 , t = t r e n d ( p < . 0 7 ) .

3 6 1

T o a d d re s s r iv al h y p o th e s e s th a t t h e r e s u l t s re f l e c t d e g re e o f

p s y c h o p a t h o l o g y r a t h e r t h a n b o r d e r l i n e p a t h o l o g y p e r s e , o r

th a t t h e f in d in g s r e f l e ct c h a ra c te r i s t i c s o f t h e n o rm a l s r a th e r

t h a n o f t h e b o r d e r li n e s , t h e f o l lo w i n g a n al y s e s w e re c o n d u c t e d .

B o r d e r l i n e s a n d d e p r e s s i v e s w e r e c o m p a r e d o n t h e G e n e r a l

S y m p t o m a t o l o g y In d e x o f t h e R e v is e d S y m p t o m s C h e c k l i s t -

90 .

SCL-90-R;

D e ro g a t i s , 1 9 7 7 ; t h e tw o g r o u p s d id n o t d i f f e r

s ign ifican t ly , t [29] = .52 , p = .61) , sugg es t ing tha t degr ee o f

p s y c h o p a th o lo g y d o e s n o t e x p la in th e f in d in g s . A d d i t io n a l ly ,

w e t e s t e d f o r d i f fe r e n c es o n t h e d e p e n d e n t v a r i a b le s b e t w e e n

t h e d e p r e ss i v es a n d t h e n o r m a l s . W h e r e a s t h e b o r d e r l i n e s w e r e

s i g ni f ic a n tl y m o r e p a t h o l o g i c a l t h a n t h e n o r m a l s o n a l l ei g h t

v a r i a b le s t e s t e d , d e p re s s iv e s d i f f e re d f ro m n o rm a l s o n ly o n th e

t w o v a r i a b l es e x p e c t e d t o d i s t in g u i s h t h e t w o g r o u p s b e c a u s e o f

t h e c o g n it iv e c o n s t ri c t io n o f th e M D D g r o u p : m e a n C o m p l e x -

i t y a n d m e a n S o c i a l C a u sa li ty . T h e t w o B P D g r o u p s ( w i th a n d

w i t h o u t M D D ) d i d n o t d i f f e r s i gn i f ic a n tl y f r o m e a c h o t h e r o n

a n y T A T v a r i a b le .

A n o t h e r p o t e n t i a l c o n f o u n d i s th a t , a l t h o u g h t h e t e st e r s w e r e

u n a w a r e o f d i a g n o s i s ( as d u r i n g t h e a d m i n i s t r a t i o n o f t h e T A T ) ,

t h e y m a y h a v e b e e n a b l e t o i n t u it t h e g r o u p t o w h i c h t h e s u b j ec t

b e lo n g e d (p a r t i c u la r ly th e n o rm a l s ) a n d th u s a b le to in f lu e n c e

r e s p o n s e s b y a d d i t io n a l p r o m p t i n g . T o t e s t f o r p r o m p t i n g e f -

f e ct s, w e c o m p a r e d s u b j ec t s w h o w e r e t e s t e d b y a d m i n i s t r a t o r s

a c q u a i n t e d w i t h t h e m e a s u r e s w i t h t h o s e u n a c q u a i n t e d . B o t h

a c ro s s a n d w i th in d i a g n o s t i c g ro u p s , o n e - t a i l e d t t e s ts r e v e a le d

n o s ig n i f i c a n t d i f f e re n c e s o n a n y m e a s u re . A s e c o n d a n a ly s i s

c o m p a r i n g s u b j e ct s t e st e d b y m e m b e r s o f t h e r es e a r c h t e a m

w i t h t h o s e n o t t e s t e d b y m e m b e r s o f t h e r e s e a r ch t e a m s i m i -

l a r ly y i e ld e d n o d i f f e re n c e s a p p ro a c h in g s ig n i f ic a n c e .

D i s c u s s i o n

In g e n e ra l , t h e r e s u l t s o f t h i s s tu d y s u g g e s t t h a t p a t i e n t s w i th

B P D c a n b e s u c c es s f u ll y d i s c r i m i n a t e d f r o m m a j o r d e pr e ss i v es

a n d n o r m a l s o n t h e b a s i s o f t h e i r o b j e c t r el a t io n s a n d s o c ia l

c o g n i t io n . T h e o v e r al l p a t t e r n o f f i n d i n g s su g g e s t s t h a t B P D s

a re d i s t in g u i s h e d b y p o o r ly d i f f e re n t ia t e d , e g o c e n t r i c r e p re s e n -

t a t io n s o f p e o p le ; m a le v o le n t e x p e c ta t io n s o f r e l at io n s h ip s ; d i f -

f i c u l t y i n v e s t i n g i n r e l a t i o n s h i p s a n d m o r a l s t a n d a r d s ; a n d

id io s y n c ra t i c a n d g ro s s ly i l l o g ic a l a t t r i b u t io n s . I t i s l i k e ly th a t

th e s e c h a ra c te r i s t i c s o f t h e o b je c t r e l a t io n s a n d s o c ia l c o g n i t io n

o f b o r d e r l i n e p a t i e n t s u n d e r l i e m a n y o f t h e i n t e r p e r so n a l d i ff i-

c u l t i e s o f t h e s e p a t i e n t s .

A p a r t i cu l a r l y s t r o n g f i n d i n g i s t h a t B P D s h a v e a t e n d e n c y t o

v i e w t h e w o r l d o f p e o p l e a s m a l e v o l e n t , w h i c h w a s r e p l i c at e d i n

a s t u d y c o m p a r i n g b o r d e r l i n e a d o l e s c e n t s t o p s y c h i a t r i c a n d

n o r m a l c o m p a r i s o n s u b j e c ts ( W e s te n , L u d o l p h , L e r n e r , et a L

1 9 9 0 ) . T h i s f in d in g h a s e m e rg e d c o n s i s t e n t ly in s tu d ie s u s in g

v a r i o u s s o u rc e s o f d a t a , i n c l u d i n g R o r s c h a c h r e s p o n s e s ( L e r n e r

& St . Pe te r , 1984; Spe ar & Sug arm an , 1984; S tu a r t e t a l ., 1990) ,

e a r ly m e m o r ie s (N ig g , L o h r , W e s te n , G o ld , & S i lk , 1 9 89 ) , s to -

r i e s t o l d i n r e s p o n s e t o t h e P i c t u r e A r r a n g e m e n t s u b t e s t o f t h e

W A IS -R (S e g al , W e s te n , L o h r , S i lk , & C o h e n , 1 9 89 ), a n d th e

SCL-90-R

(n o ta b ly th e P a ra n o ia a n d In t e rp e r s o n a l S e n s it i v i ty

s u b s c a le s ; B e n ja m in , S i lk , L o h r , & We s te n , 1 9 8 9 ) . T o g e th e r

t h e s e f i n d i n g s su g g e s t t h a t m a l e v o l e n t e x p e c ta t i o n s a p p e a r t o

b e c h a r a c t e r i st i c o f b o r d e r l i n e p a t i en t s a n d t h u s s h o u l d b e c o n -

s id e re d fo r i n c lu s io n a s a d i a g n o s t i c c r i t e r io n fo r B P D .

D e s p i t e a t e n d e n c y a m o n g t h e B P D s u b je c t s i n t h i s st u d y t o

p ro d u c e p o o r ly d if f e re n t i a t e d , e x t r e m e ly e g o c e n t r i c r e p re s e n ta -

t io n s , a s u b s t a n t i a l p e rc e n ta g e o f b o rd e r l in e s u b je c t s (4 5. 9%)

s h o w e d e v i d e n c e o f a c a p a c it y t o f o r m m o r e c o m p l e x r e p r e s e n -

t a t io n s (L e v e l 4 o r 5 ) o n a t l e a s t tw o o f t h e s e v e n T A T c a rd s . T h i s

f i n d i n g p o i n t s t o t h e i m p o r t a n c e o f f o c u s in g o n t h e d y n a m i c

f lu x a n d f lo w o f o b je c t r e l at i o ns a n d o n t h e c o n d i t i o n s u n d e r

w h ic h p a th o lo g ic a l p ro c e s s e s a re e v o k e d , r a th e r t h a n s t r i c t ly o n

le v e ls o f o b je c t r e l a t io n s a s m o n o l i th i c s t ru c tu re s . T h i s s h i f t i n

fo c u s w o u ld r e q u i re a g re a t e r i n t e g ra t io n o f m o re c l a s s i ca l p s y -

c h o a n a ly t i c t hi n k i n g a b o u t m o m e n t a r y d y n a m i c p r o c e ss e s a n d

c o m p r o m i s e f o r m a t i o n s i n t o o b j e c t- r e la t io n s c o n c e p t s. I t w o u l d

a l s o s u g g es t t h e i m p o r t a n c e f o r p s y c h o a n a l y t i c t h e o r y o f w r e s-

t l in g w i t h c o n t e m p o r a r y i ss u e s i n p e r s o n a l i ty p s y c h o l o g y re -


8/10

36 WESTEN, LOHR , S ILK, GOLD, KERBER

g a r d i n g p e r s o n - s i t u a t i o n i n t e r ac t i o n s a n d t h e i m p o r t a n c e o f

s p e c i fy i n g c o n d i t i o n s u n d e r w h i c h t r a i t -l i k e p h e n o m e n a b e -

c o m e m a n i f e s t . F u t u r e r e s e a rc h s h o u l d b e d i r e c t e d t o w a r d u n -

d e r s t a n d i n g t h e c ond i t i ons u n d e r w h i c h B P D s m a n i f e s t p ro b -

l e m a t i c o b j e c t r e l a ti o n s . N o o n e i s b o r d e r l i n e a l l t h e t i m e , y e t

w e k n o w l i t tl e a b o u t t h e a c t i v a t i n g c o n d i t i o n s f o r p a t h o l o g i c a l

p r o c e s s e s . F u t u r e r e s e a r c h w i l l a l s o n e e d t o e x p l o r e t h e p o s s i b i l -

i t y t h a t d i f f e r e n t d i m e n s i o n s o f o b j e c t r e l a t i o n s m a y b e i n -

f l u e n c e d b y d i f f e r e n t e x p e r i e n c e s a n d t h a t p a t h o g e n i c e x p e r i -

e n c e s m a y n o t a l l o c c u r d u r i n g t h e p r e o e d i p a l p e r i o d ( W e s t e n ,

i n p r e s s - b ; W e s t e n , L u d o l p h , B l o c k , W i x o m & W i s s , 1 99 0) .

T h e d a t a a l s o s u g g e s t t h a t i f B P D i s a v a r i a n t o f a m o o d

d i s o r d e r , t h e r e l a t i o n s h i p i s n o t s i m p l e . B P D s w i t h m a j o r d e -

p r e s s i o n d i d n o t s i g n i f i c a n t ly d i f f e r f r o m B P D s w i t h o u t m a j o r

d e p r e s s i o n o n a n y s c a l e ; i n c o n t r a s t , t h e B P D g r o u p a s a w h o l e

d i f fe r e d f r o m t h e M D D g r o u p , a s d i d t h e B P D / M D D s u b -

g r o u p , i n n e a r l y e v e r y c o m p a r i s o n w h e r e p r e d i c t e d . I n o t h e r

w o r d s , b o r d e r l i n e s w i t h m a j o r d e p r e s s i o n l o o k l i k e b o r d e r l i n e s ,

n o t l i k e m a j o r d e p r e s s i v e s. A l t h o u g h t h e r e i s l i k e l y t o b e a b i o -

l o g i c a l s u b s t r a t e t o s o m e s u b g r o u p s o f p a t i e n t s w i t h B P D , t h i s

s u b s t r a t e i s n o t a s i m p l e v u l n e r a b i l i t y t o m a j o r d e p r e s s i o n .

F i n a l ly , t h i s s t u d y s u p p o r t s t h e u t i l i t y o f p r o j e c t iv e t e s t s, a n d

p a r t i c u l a r l y t h e T A T , i n a s s e s s i n g d i m e n s i o n s o f o b j e c t r e la -

t i o n s a n d s o c i a l c o g n i t io n . S i n c e M i s c h e l ' s ( 1 96 8 ) s o p h i s t i c a t e d

c r i t i q u e o f t r a i t p s y c h o l o g y a n d p r o j e c t i v e t e s t i n g , g e n e r a t i o n s

o f p s y c h o l o g i s t s , i n c l u d i n g p e r s o n a l i t y a n d c l i n i c a l p s y c h o l o -

g i s t s , h a v e b e e n t r a i n e d w i t h a d e e p l y i n g r a i n e d a s s u m p t i o n

t h a t p r o j e c t i v e te c h n i q u e s a r e i n h e r e n t l y i n v a l i d a n d u n r e l i a b l e .

I n t h e p r e s e n t s t u d y , h o w e v e r , f o u r c o m p l e x c o d i n g s c h e m e s

w e r e a p p l i e d t o T A T d a t a w i t h h i g h i n t e r r a t e r r e l i a b i li t y , a n d

t h e s e w e r e a b l e to d o c u m e n t s o m e r e l a t iv e l y s u b t l e p r e d i c t e d

d i f f e r e nc e s .

T h i s s t u d y h a s t h e f o l l o w i n g l i m i t a t i o n s . F i r s t , th e s t u d y i n -

v o lv e s t h e u s e o f T A T m e a s u r e s w h o s e v a l i d i t y a n d p s y c h o m e t -

r i c p r o p e r t i e s a r e o n l y b e g i n n i n g t o b e e s t a b l i s h e d , a n d c l e a r l y

r e s u l ts m u s t b e i n t e r p r e t e d c a u t i o u sl y , C o n v e r g e n t f i n d i n g s u s -

i n g o t h e r m e t h o d s a n d s a m p l e s h av e , h o w e v e r , b e e n v e r y c o n -

s is te nt (Bel l e t a l. , 1988; Be nja m in e t a l . , 1989; B urke e t a l . , 1986;

Ni g g e t a l. , 1989 ; W e s t e n , L udo l ph , L e r ne r , e t a l . , 1990 ). Fu r -

t h e r , w e m a d e s o m e v e r y s p e c if i c p r e d i c t i o n s i n t h i s s t ud y , a l l

b u t o n e o f w h i c h w e r e b o r n e o u t , a n d i t is d if f i c u lt t o c o n c e i v e

o f a ri v a l h y p o t h e s i s b a s e d o n p r o b l e m s w i t h th e m e a s u r e s t h a t

c o u l d a c c o u n t f o r t h is s e t o f f i n d i n g s a s p a r s i m o n i o u s l y .

A s e c o n d l i m i t a t i o n i s t h a t t h e g r o u p s d i f f e r e d i n a g e a n d

S E S , r e f le c t i n g g r o u p d i f f e r e n c e s i n h e r e n t i n t h e p o p u l a t i o n .

N e i t h e r a g e n o r S E S , h o w e v e r , c o r r e l a t e d w i t h a n y d e p e n d e n t

v a r i a b l e e x c e p t f o r a l o w c o r r e l a t i o n b e t w e e n c o m p l e x i t y a n d

S E S , s u g g e s t in g t h a t t h e f i n d i n g s a r e n o t r e d u c i b l e t o g r o u p

d i f f e r e n c e s o n t h e s e v a r i a b l e s . A s t u d y c o m p a r i n g b o r d e r l i n e

a d o l e s c en t s t o n o r m a l a n d p s y c h i a tr i c c o m p a r i s o n s u b j ec t s in

w h i c h a ge a n d S E S w e r e m a t c h e d p r o d u c e d a v e r y s i m i l a r p a t-

t e r n o f r e s u l t s ( W e s t e n , Lu do l p h , Le r n e r , e t a l . , 1990 ). T he f i nd -

i n g s w e r e a ls o n o t r e d u c i b l e t o d e g r e e o f p s y c h o p a t h o l o g y a s

a s s e s s e d b y t h e

S C L - 9 0 - R ;

i t w o u l d b e d i f f ic u l t t o a r g u e t h a t

p a t i en t s h o s p i t a l i z e d f or M D D , w h o a r e t y p i c a l l y d e b i l i t a t e d b y

t h e i r i l l n e s s a n d r e c e i v e m u l t i p l e d i s c h a r g e d i a g n o s e s o n b o t h

A x i s a n d A x i s I I ( e.g ., a v o i d a n t o r d e p e n d e n t p e r s o n a l i t y d i s -

o r d e r ), h a v e l es s s e v e r e p s y c h o p a t h o l o g y t h a n p a t i e n t s h o s p i t a l -

i z e d f o r BPD.

A n o t h e r p o s s i b l e o b j e c t i o n i s t h a t t h e f i n d i n g s r e fl e c t c h a r -

a c t e r is t i c s o f t h e n o r m a l s a m p l e , r a t h e r t h a n o f t h e b o r d e r l i n e

s a m p l e . D i f fe r e n ce s b et w e e n t h e B P D a n d M D D g r o u p s , ho w -

e v e r, c a n n o t b e e x p l a i n e d w i t h t h i s r i v a l h y p o t h e s i s , n o r c a n i t

e x p l a i n w h y m u l t i p le d i f fe r e n ce s b e tw e e n B P D s a n d n o r m a l s

w e r e n o t a l s o p r e s e n t b e t w e e n M D D s a n d n o r m a l s . F r o m a

p s y c h o a n a l y t i c p e r s p e c t iv e , a s u b s t a n t i a l p e r c e n t a g e o f p e o p l e

w h o a r e t y p i c a l l y u s e d a s n o r m a l s i n p s y c h o l o g i c a l r e s e a r c h

h a v e c o n s i d e r a b l e c h a r a c t e r p a t h o l o g y , s o t h a t a s a m p l e r e p r e -

s e n ta t iv e o f th e p o p u l a t i o n o f A m e r i c a n a d u l t s w o u l d n o t b e a n

a p p r o p r i a t e c o m p a r i s o n g r o u p f o r a s t u d y o f p a t ie n t s w i th p e r -

s o n a l i ty d i s o rd e r s . W h a t w e h a d h o p e d t o s e le c t w i t h a b r i e f

s c r e e n i n g i n t e rv i e w , a s e l f - e s t e e m i n ve n t o r y , a n d t h e M M P I w a s

a s a m p l e o f p e o p l e w h o s e e m e d r e l a ti v e l y i n t a c t c l i n ic a l ly , r e -

p o r t e d t h e s a m e , a n d w e r e s t a t i s t i c a l l y n o r m a l o n a l l s ca l e s o f a

p s y c h o m e t r i c a l l y v a l id a n d r e l ia b l e i n s t ru m e n t .

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R e c e i v e d N o v e m b e r 1 3 , 19 8 9

R e v i s i o n r e c e i v e d F e b r u a r y 1 4 , 1 9 9 0

A c c e p t e d M a r c h 6 , 1 9 9 0

I n s t r u c t i o n s t o A u t h o r s

P r e p a r i n g M a n u s c r i p t s A u t h o r s s h o u l d p r e p a r e

m a n u s c r i p t s a c c o r d i n g t o t h e Publication Manual of he

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