Prestage versus defensive splitting and the borderline personality: A Rorschach analysis.

This paper reviews theoretical contributions by Kernberg (1975) and by Stolorow and Lachmann (1980) regarding defensive modes of splitting and suggests possible Rorschach manifestations for a variety of levels of defensive organization among borderline patients. Defensive operations vary among patients with different levels of severity of borderline psychopathology. Specifically, it is proposed that some borderline patients rely on splitting as an active attempt to mitigate the experience of intense ambivalence conflicts toward others, as described by Kernberg; another group of borderline patients is seen as having pathology that revolves around a weakly integrated representational world, poor self-object differentiation, and prestage developmental levels of defense, as described by Stolorow and Lachmann. The Rorschach is a valuable diagnostic tool in distinguishing between psychopathology involving defenses against structural conflict and psychopathology based on an arrest in development at the level of prestage defensive operations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians.

[Correction Notice: An erratum for this article was reported in Vol 1(3) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2009-18612-003). Author Ruth Lanius’s name was misspelled as Ruth Lanins; author Scot McNary’s name was misspelled Scott McNary; author Clare Pain’s name was misspelled Claire Pain; and the affiliation for Richard Loewenstein should have read Sheppard Pratt Health System.] The goals of this naturalistic, cross-sectional study were to describe the patient, therapist, and therapeutic conditions of an international sample of dissociative disorder (DD) patients treated by community therapists and to determine if community treatment for DD appears to be as effective as treatment for chronic PTSD and conditions comorbid with DD. Analyses found that across both patient (N = 280) and therapist (N = 292) reports, patients in the later stages of treatment engaged in fewer self-injurious behaviors, had fewer hospitalizations, and showed higher levels of various measures of adaptive functioning (e.g., GAF) than those in the initial stage of treatment. Additionally, patients in the later stages of treatment reported lower symptoms of dissociation, posttraumatic stress disorder, and distress than patients in the initial stage of treatment. The effect sizes for Stage 5 versus Stage 1 differences in DD treatment were comparable to those published for chronic PTSD associated with childhood trauma and depression comorbid with borderline personality disorder. Given the prevalence, severity, chronicity, and high health care costs associated with DD, these results suggest that extended treatment for DD may be beneficial and merits further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Questioning premorbid dissociative symptomatology in dissociative identity disorder: Comment on Gleaves, Hernandez and Warner (1999).

Comments on an article by D. H. Gleaves et al (see record 1999-03012-003) which purported to refute the sociocognitive model (SCM) of dissociative identity disorder by showing that many of the symptoms associated with dissociative identity disorder are displayed by patients before entering therapy or prior to diagnosis. The present authors argue that Gleaves et al's results do not refute the SCM and are in fact supportive of that model. The present authors also argue that the Gleaves et al study suffers from several deficiencies, including a misunderstanding of the SCM and its predictions concerning iatrogenesis, deficiencies in the manner in which the survey was conducted, and a failure to note some disturbing trends in the results that were obtained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interidentity memory transfer in dissociative identity disorder.

Controversy surrounding dissociative identity disorder (DID) has focused on conflicting findings regarding the validity and nature of interidentity amnesia, illustrating the need for objective methods of examining amnesia that can discriminate between explicit and implicit memory transfer. In the present study, the authors used a cross-modal manipulation designed to mitigate implicit memory effects. Explicit memory transfer between identities was examined in 7 DID participants and 34 matched control participants. After words were presented to one identity auditorily, the authors tested another identity for memory of those words in the visual modality using an exclusion paradigm. Despite self-reported interidentity amnesia, memory for experimental stimuli transferred between identities. DID patients showed no superior ability to compartmentalize information, as would be expected with interidentity amnesia. The cross-modal nature of the test makes it unlikely that memory transfer was implicit. These findings demonstrate that subjective reports of interidentity amnesia are not necessarily corroborated by objective tests of explicit memory transfer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians": Correction to Brand et al. (2009).

Reports an error in A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians by Bethany Brand, Catherine Classen, Ruth Lanins, Richard Loewenstein, Scott McNary, Claire Pain and Frank Putnam (Psychological Trauma: Theory, Research, Practice, and Policy, 2009[Jun], Vol 1[2], 153-171). Author Ruth Lanius’s name was misspelled as Ruth Lanins; author Scot McNary’s name was misspelled Scott McNary; author Clare Pain’s name was misspelled Claire Pain; and the affiliation for Richard Loewenstein should have read Sheppard Pratt Health System. (The following abstract of the original article appeared in record 2009-08949-005.) The goals of this naturalistic, cross-sectional study were to describe the patient, therapist, and therapeutic conditions of an international sample of dissociative disorder (DD) patients treated by community therapists and to determine if community treatment for DD appears to be as effective as treatment for chronic PTSD and conditions comorbid with DD. Analyses found that across both patient (N = 280) and therapist (N = 292) reports, patients in the later stages of treatment engaged in fewer self-injurious behaviors, had fewer hospitalizations, and showed higher levels of various measures of adaptive functioning (e.g., GAF) than those in the initial stage of treatment. Additionally, patients in the later stages of treatment reported lower symptoms of dissociation, posttraumatic stress disorder, and distress than patients in the initial stage of treatment. The effect sizes for Stage 5 versus Stage 1 differences in DD treatment were comparable to those published for chronic PTSD associated with childhood trauma and depression comorbid with borderline personality disorder. Given the prevalence, severity, chronicity, and high health care costs associated with DD, these results suggest that extended treatment for DD may be beneficial and merits further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional granularity and borderline personality disorder.

This study examined the affective dysregulation component of borderline personality disorder (BPD) from an emotional granularity perspective, which refers to the specificity in which one represents emotions. Forty-six female participants meeting criteria for BPD and 51 female control participants without BPD and Axis I pathology completed tasks that assessed the degree to which participants incorporated information about valence (pleasant–unpleasant) and arousal (calm–activated) in their semantic/conceptual representations of emotions and in using labels to represent emotional reactions. As hypothesized, participants with BPD emphasized valence more and arousal less than control participants did when using emotion terms to label their emotional reactions. Implications and future research directions are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Transitional relatedness and borderline personality disorder.

This study examined various aspects of transitional relatedness among individuals diagnosed as borderline or antisocial personality disorder. This study was a follow-up to an earlier report (Cooper, 1983) using the Rorschach Transitional Object Scale, which found only marginal support for Modell's clinical hypothesis that the borderline personality disorder involves a developmental arrest at the stage of the transitional object. The authors approached the concept of transitional relatedness as a series of external and internalized modes of relating including the perceptual capacity to distinguish between object and symbol on the Rorschach as well as self-reported current and past reliance on transitional objects and self-soothing activities. The study failed to provide evidence to suggest that reliance on a past or present transitional object per se is a unique or diagnostic feature of the borderline personality disorder. Particular aspects of current transitional relatedness, however, were strongly associated with borderline psychopathology. The clinical and research implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rorschach images of symbiosis and separation in eating-disordered and in borderline and nonborderline subjects.

The Rorschach protocols of 62 eating-disordered women were analyzed for content expressing symbiotic, separation, and counter-symbiotic strivings. Subjects were grouped into three symptom pattern groups and into borderline and nonborderline groups as measured by Gunderson's Diagnostic Interview for Borderlines (DIB). Very few differences in this content were found among the three symptom-based groups. Consistent and significant differences were found among these groups in the relation between overall Rorschach response productivity and the production of responses with this content. This suggests that the symptom patterns may reflect differing modes of self-regulation. Consistent and significant differences in the production of this content were also found between borderline and nonborderline groups, supporting clinically based claims that symbiotic Rorschach responses are diagnostic of borderline functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nontraumatic pathways to borderline personality disorder.

Clinicians who treat borderline personality disorder (BPD) generally assume that this disorder is caused by childhood abuse. This assumption is strongly supported in the BPD literature, which indicates that the majority of individuals with BPD have suffered emotional, physical, and sexual abuse. What is often missed or simply ignored in discussions of BPD is that this same body of research also suggests that a significant minority of borderline individuals have not suffered childhood abuse. This article reviewed the literature on the prevalence of childhood abuse and BPD, offered a number of hypotheses about nontraumatic pathways to BPD, and briefly considered treatment implications for nontraumatized BPD individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Specifying the impulsivity of female inmates with borderline personality disorder.

Impulsivity is regarded as a core feature of borderline personality disorder (BPD; M. C. Zanarini, J. G. Gunderson, & F. R. Frankenburg, 1989) despite lack of evidence from laboratory research (D. M. Dougherty, J. M Bjork, H. C. G. Huckabee, F. G. Moeller, & A. C. Swann, 1999). This study examined impulsivity in incarcerated women with BPD using a passive avoidance task (J. P. Newman & W. A. Schmitt, 1998) and the Impulsiveness-Monotony Avoidance-Detachment inventory (IMD; D. Schalling, 1978). As predicted, incarcerated women diagnosed with BPD committed more passive avoidance errors and reported more impulsivity on the IMI than controls. These findings identify disinhibition as a potentially important component of the impulsivity that characterizes BPD. Specifying the impulsive behavior identified with BPD may contribute to the effective assessment and management of the disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The etiology of dissociative identity disorder: Reply to Gee, Allen and Powell (2003).

Responds to a comment by T. Gee et al (see record 2003-04125-019) about the authors' original article (see record 1999-03012-003) which studied how clinicians treating dissociative identity disorder (DID) were or were not gathering and utilizing corroborative data. Results of this study show that many of the symptoms associated with DID were displayed by patients before entering therapy or prior to diagnosis. Gee et al argue that these results do not refute the sociocognitive model (a modified iatrogenesis model) of DID, but actually support it. The present authors maintain that their data did clearly contradict the iatrogenesis position. It is asserted that Gee et al's comment illustrates many important flaws of the iatrogenic DID argument, primarily that it is unscientific by virtue of being nondisconfirmable, and that it can only be maintained by adhering to false assumptions about DID and by misinterpreting data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interidentity amnesia for neutral, episodic information in dissociative identity disorder.

Interidentity amnesia is considered a hallmark of dissociative identity disorder (DID) in clinical practice. In this study, objective methods of testing episodic memory transfer between identities were used. Tests of both recall (interference paradigm) and recognition were used. A sample of 31 DID patients was included. Additionally, 50 control subjects participated, half functioning as normal controls and the other half simulating interidentity amnesia. Twenty-one patients subjectively reported complete one-way amnesia for the learning episode. However, objectively, neither recall nor recognition scores of patients were different from those of normal controls. It is suggested that clinical models of amnesia in DID may be specified to exclude episodic memory impairments for emotionally neutral material. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploring associations between borderline personality disorder, crack/cocaine dependence, gender, and risky sexual behavior among substance-dependent inpatients.

Engagement in self-destructive and impulsive behaviors is considered to be a cardinal symptom of borderline personality disorder (BPD), and many of the behaviors enumerated in this criterion have been the focus of extensive empirical research. However, very few studies have examined risky sexual behavior (RSB) in particular in BPD. Given evidence that BPD patients with a co-occurring substance use disorder (SUD) may be at increased risk for RSB relative to BPD patients without a SUD, the present study examined the association between BPD and past-year engagement in RSB (particularly, penetrative sex and nonuse of condoms with casual and commercial partners) within a mixed-gender sample of 94 SUD patients in residential treatment, as well as the moderating role of gender in this association. Given past findings of an association between crack/cocaine use and RSB, we also examined the moderating role of lifetime crack/cocaine dependence on the relationship between BPD and RSB. Results demonstrated a significant main effect of BPD on past-year penetrative sex with casual and commercial partners. Significant 3-way interactions between BPD status, lifetime crack/cocaine dependence, and gender were also found for past-year penetrative sex with casual and commercial partners, as well as the likelihood of not using a condom during sex with a casual partner. Post hoc analyses indicated that women with co-occurring BPD and lifetime crack/cocaine dependence were at greatest risk for RSB. Findings replicate extant findings pertaining to the association between BPD and RSB and extend research by identifying relevant factors that may moderate this association. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The stability of personality traits in individuals with borderline personality disorder.

Although stability and pervasive inflexibility are general criteria for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994) personality disorders (PDs), borderline PD (BPD) is characterized by instability in several domains, including interpersonal behavior, affect, and identity. The authors hypothesized that such inconsistencies notable in BPD may relate to instability at the level of the basic personality traits that are associated with this disorder. Five types of personality trait stability across 4 assessments over 6 years were compared for BPD patients (N = 130 at first interval) and patients with other PDs (N = 302). Structural stability did not differ across groups. Differential stability tended to be lower for 5-factor model (FFM) traits in the BPD group, with the strongest and most consistent effects observed for Neuroticism and Conscientiousness. Growth curve models suggested that these 2 traits also showed greater mean-level change, with Neuroticism declining faster and Conscientiousness increasing faster, in the BPD group. The BPD group was further characterized by greater individual-level instability for Neuroticism and Conscientiousness in these models. Finally, the BPD group was less stable in terms of the ipsative configuration of FFM facet-level profiles than was the other PD group over time. Results point to the importance of personality trait instability in characterizing BPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinician bias in the diagnosis of posttraumatic stress disorder and borderline personality disorder.

[Correction Notice: An erratum for this article was reported in Vol 2(2) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2010-12181-005). In this article, the copyright attribution is incorrect. The article is in the public domain.] A sample of volunteers from a group of randomly selected psychologists in New York State (N = 119) provided a primary diagnosis and rule-out diagnoses for a case vignette that included balanced criteria for borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) in a mail survey. Vignettes portrayed a male or a female client, and history of childhood sexual abuse was presented either first or last. Results indicated that cognitive–behavioral therapy (CBT) clinicians were more likely to diagnose PTSD than BPD or other disorders, and psychodynamic clinicians were more likely to diagnose BPD or other disorders than PTSD. An anchoring effect (i.e., evidence that one regards initial information as an anchor that may or may not be adjusted upon exposure to subsequent information) of abuse history presentation was found. Findings did not support a patient or clinician gender bias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A manual-based psychodynamic therapy for treatment-resistant borderline personality disorder.

The authors introduce a manual-based treatment, labeled dynamic deconstructive psychotherapy, developed for those patients with borderline personality disorder who are most difficult to engage in therapy, such as those having co-occurring substance use disorders. This treatment model is based on the hypothesis that borderline pathology and related behaviors reflect impairment in specific neurocognitive functions, including association, attribution, and alterity that form the basis for a coherent and differentiated self. Dynamic deconstructive psychotherapy aims to activate and remediate neurocognitive self-capacities by facilitating elaboration of affect-laden interpersonal experiences and integration of attributions, as well as providing novel experiences in the patient-therapist relationship that promote self-other differentiation. Treatment involves weekly individual sessions for a predetermined period of time and follows sequential stages. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The heterogeneous structure of schizotypal personality disorder: Item-level factors of the schizotypal personality questionnaire and their associations with obsessive-compulsive disorder symptoms, dissociative tendencies, and normal personality.

A. Raine et al.'s (1994) 3-factor scheme is currently the most widely accepted model of schizotypal personality disorder (SPD). Factor analytic studies of the Schizotypal Personality Questionnaire (SPQ; A. Raine, 1991) subscales, which represent the 9 Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for SPD, have provided the model's primary support. The use of only 9 modeled variables, however, limits the number of factors that can be extracted. To explicate this structure more fully, the authors conducted item-level factor analyses of the SPQ in a large student sample that completed the instrument twice within a 2-week interval. The authors' analyses failed to support either the 3-factor model of SPD or the 9 existing DSM-based subscales of the SPQ. Instead, 5 replicable dimensions emerged that capture recurrent symptom pairings found in the broader SPD literature: Social Anhedonia, Unusual Beliefs and Experiences, Social Anxiety, Mistrust, and Eccentricity/Oddity. These factors are only weakly correlated with each other and show differential correlational patterns with the Big Five personality traits, dissociative tendencies, and symptoms of obsessive-compulsive disorder. Moreover, they are congruent with dimensional models of personality psychopathology. Implications for SPD in DSM-V are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)