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Psychodynamic features in borderline personality disorder identified by a subliminal test, the Defense Mechanism Test.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
1989 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 80, no 1, 101-5 p.Article in journal (Refereed) Published
Abstract [en]

Twenty-seven psychiatric inpatients, diagnosed according to DSM-III and the Diagnostic Interview for Borderline (DIB), and 7 healthy controls were tested with the Defense Mechanism Test (DMT), a test of subliminal perception based on psychoanalytic theory. In the test a specific stimulus is presented subliminally in a tachistoscope and the patient's perceptual distortions are registered. Patients with borderline personality disorder (BPD) were compared with patients with other personality disorders, patients with schizophrenic disorders and healthy controls. Specific perceptual distortions were identified among patients with BPD. Some individual DMT signs correlated with some deviant behaviors as identified by the DIB. The findings supported the psychodynamic validity of the concept of borderline personality disorder. It is concluded that DMT is a promising research instrument that provides an empirical approach to crucial psychodynamic phenomena.

Place, publisher, year, edition, pages
1989. Vol. 80, no 1, 101-5 p.
Identifiers
URN: urn:nbn:se:umu:diva-36467PubMedID: 2669443OAI: oai:DiVA.org:umu-36467DiVA: diva2:354239
Available from: 2010-09-30 Created: 2010-09-30 Last updated: 2017-12-12
In thesis
1. Clinical studies on the borderline concept with special reference to suicidal behavior
Open this publication in new window or tab >>Clinical studies on the borderline concept with special reference to suicidal behavior
1987 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The diagnostic concept of borderline personality has had various meanings throughout the last decades. From current clinical practice and research two principally different concepts have emerged: The syndrome concept of borderline personality disorder ( BPD ) as identified by the DSM-III or the Diagnostic Interview for Borderline (DIB) and the psychodynamic concept of borderline personality organization (BPO) as defined from the structural Interview (SI) by Otto Kernberg.

In the first part of the present study, the DIB, the SI and a percept-genetic test called Defense Mechanism test (DMT) have been utilized in a clinical study on psychiatric inpatients. In the second part completed suicides are studied among patients with borderline personality disorder.

Inter-rater reliability was satisfactory for the DIB both when utilized as a clinical interview and as a chart scoring instrument. Previous research findings concerning descriptive validity of the BPD concept were further supported. Fairly reliable scorings of personality organization could be made from the SI. BPO turned out to be a very inclusive concept and a subgroup (46%) also met criteria for BPD. By means of the DMT specific psychodynamic features were identified among patients with BPD which discriminated them from patients with other personality disorders or schizophrenic disorder. It is concluded, that there is empirical support to consider BPD a valid diagnostic entity. BPO should be conceptualized as a level of personality functioning rather than a diagnostic category and its validity remains to be proven.

Patients with BPD were not seriously overrepresented in a material of 145 psychiatric patients, suicided during inpatient care or shortly after discharge 1961 to 1980. The number and proportion of borderline patients, however, increased for every five- years-period. In an analysis of cases suicided during inpatient treatment, repressive/rejective behavior from staff was frequently observed. Risk factors were identified in comparative studies. Male sex, extensive earlier hospitalization, repressive/rejective staff behavior and frequent previous suicide attempts were associated with completed suicides. A specific pattern of psychological variables was identified among suicided borderline patients including antisocial traits, drug abuse and a less intense interpersonal attachment.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 1987. 51 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 204
Keyword
borderline
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-100571 (URN)
Public defence
1987-12-18, Psykiatriska klinikens föreläsningssal, KV, Regionsjukhuset i Umeå, Umeå universitet, Umeå, 09:15
Projects
digitalisering@umu
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 1987, härtill 7 uppsatser.

Available from: 2015-03-16 Created: 2015-03-04 Last updated: 2015-04-09Bibliographically approved
2. Borderline psychopathology and the defense mechanism test
Open this publication in new window or tab >>Borderline psychopathology and the defense mechanism test
1992 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main purpose of the present studies has been to develop the Defense Mechanism Test (DM1) for clinical assessment of severe psychopathology with the focus on the concept of Borderline Personality Organization (BPO) according to Kemberg. By relating the DMT and the Structural Interview to each other, the concurrent validity of the concept of Personality Organization (PO) for psychiatric inpatients has been investigated. Two different assessment approaches have been used for this purpose. One has been to take a theoretical perspective as the starting-point for the classification of PO by means of the DMT. The other has been a purely empirical approach designed to discern natural and discriminating patterns of DMT distortions for different diagnostic groups. A dialogue is also in progress between DMT and current research on the Rorschach test in order to increase understanding of borderline phenomena and pathology.

The overall results support Kemberg's idea that borderline patients are characterized by specific intrapsychic constellations different from those of both psychotic and neurotic patients. Both the DMT and the Structural Interview provide reliable and consistent judgements of PO. Patients with the syndrome diagnosis Borderline Personality Disorder exhibit different perceptual distortions from patients suffering from other personality disorders. The classic borderline theory is a one-dimensional developmental model, where BPO constitutes a stable intermediate form between neurosis and psychosis. The present results suggest that a two-dimensional model might be more powerful. Hence, the level of self- and object representations and reality orientation might be considered both from a developmental gad an affective perspective across varying forms of pathology.

Kemberg suggests that borderline and psychotic patients share a common defensive constellation, centered around splitting, organizing self- and object representations. This view did not find support. The defensive pattem of the BPO patients is significantly different from the PPO defensive pattern. The BPO patients form their self- and object images affectively and thus the self- and object representations would seem to influence the defensive organization and not the other way around. The results have implications for the procedure and the interpretation of the DMT e.g. one and the same DMT picture can discern different kinds of personality; reactions other than the operationalized defense categories in the DMT manual can be valid predictors of PO; some of the DMT defenses described in the manual have to be reconceptualized such as isolation, repression and to some degree denial. Multivariate models are powerful tools for the integration of reactions to DMT into diagnostic patterns.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 1992. 65 p.
Keyword
Defense Mechanism Test, defense mechanisms, percept-genetics, Structural Interview, Borderline Personality Organization, Borderline Personality Disorder, Principal Component Analysis, PLS-discriminant analysis
National Category
Applied Psychology
Identifiers
urn:nbn:se:umu:diva-100698 (URN)91-7174-643-9 (ISBN)
Public defence
1992-02-28, Hörsal E, Humanisthuset, Umeå universitet, Umeå, 13:15
Supervisors
Projects
digitalisering@umu
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 1992, härtill 4 uppsatser.

Available from: 2015-03-19 Created: 2015-03-06 Last updated: 2015-04-10Bibliographically approved

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