Presentation on theme: "Monika Marszał Adam Mickiewicz University Poznań, Poland"— Presentation transcript:
1Monika Marszał Adam Mickiewicz University Poznań, Poland Psychotic, borderline and neurotic personality organization – fact or artifact?Monika MarszałAdam Mickiewicz UniversityPoznań, Poland
2Over the past few decades, object relation theories have become a central topic in conceptualization of personality disorders. One of them, Otto Kernberg’s theory is considered to be the most interesting, but also the most controversial one. When we are analyzing the psychodynamic literature it is hard not to claim that many of its assumptions should have been verified and described in an empirical way, based on well planned research.
3aimto recognize the etiology and describe the essence of intrapsychic structure, what is believed to be the source of a specific patterns of thinking, behaving and experiencing
4personality development … is based on an intrapsychic transformations of positive and negative self- object- affect representations. It can be inhibited as a consequence of a biological factor (ex. disharmonized temperament) and/or psychological factor connected with the lack of possibility to relate to the object (mother).If the fixation takes place in a symbiotic phase, we observe the psychotic POwhen in a self/ object differentiation phase there’s borderline POand when in a consolidation phase- neurotic PO
5structural modelThe differences between three levels of POs concerning 3 basic dimensions:level of defense mechanisms maturitylevel of identity integrationcapacity to reality testingBPO is similar to PPO in case of domination of primitive defense mechanisms and identity disturbances but is different in case of reality testing, what makes it more similar to NPO.
6defense mechanismsBPO and PPO are constructed by the primitive defense mechanisms like: splitting, projection and projective identification. The maintenance of those mechanisms results in the lack of integration between libidinal and aggressive aspects of self and object. This integration is achieved in NPO, where splitting is replaced by the more mature mechanisms: repression, denial, reversal.
7identityIn NPO we can observe high level of stability and continuity of self/object representations, what results in identity integration. In PPO and BPO identity is diffused, unstable, or connected with foreclosure identity (Kernberg, 2004, 2004, 1970, 1967).
8Reality testingA broad deficit in PPO, but individuals with BPO may present some disturbances as well. In general, we can assume that reality testing is seriously impaired only in PPO, when patients suffer from hallucinations, delusions, and confusion about their own existence (Kernberg, 2004b, 1970, 1967; McWilliams, 2009). Reality testing is not disturbed in NPO.
9Aim of the studyConcerning this brief theoretical description, in our research we decided to empirically verify the assumptions about the differences in capacity to reality testing, level of identity integration and predominance of certain defense mechanisms in neurotic, borderline and psychotic PO.
10Participants90 individuals: 30 individuals with the BPO, 30 individuals with the PPO and 30 individuals with the NPO. The criteria of selection to the groups were psychiatric and/or psychological evaluation.years old (M=32.9), 46 women and 44 men. 70% of the participants had high school degree, 24.5% of the participants had college/university degree and 5.5% had elementary school degree. Among the participants with the BPO and NPO there were more women than men, but in the case of the participants with the PPO there were considerably more men.
11MethodsDefense Mechanisms Inventory (1969) by C. Gleser and D. Ihilevich.Objective Measure of Ego-Identity Status Bennion i Adams (1986).Ego Strength (Es) F. Barron from MMPI (Barron, 1953).
13Ego strength post hoc T3 Dunnet Ego strength F(2,85)= 16,057; P< .001NPO48,1BPO41,4PPO36,4
14Only patients with NPO are characterized by undisturbed reality testing, what means that there are no situations when they have problems with self/ other, inner/ outer differentiation.PPO is the most disturbed, in BPO problems probably can appear in times of regression (ex. due to severe stress)
15Defence mechanisms Test Kruskala- Wallisa Test U Manna- Whitneya Turning against objectχ2 (2)= 25,974; P< .001BPO61,22PPO36,08NPO30,55Pojectionχ2 (2)= 20,322; P< .00157,646,6828,35Turning against selfχ2 (2)= 10,590; P< .0555,1239,7434,63Pχ2 (2)= 21,902; P< .00160,5740,2530,48Reversalχ2 (2)= 27,191; P< .00158,1651,9825,30
17in accordance with the previous assumptions Mature principalization used by neurotic individuals to a greater degree than by borderline and psychotic individuals (there has been no differences between those two groups)Primitive projection was used less frequently by neurotic individuals. The differences were statistically significant.In the case of this two subscales the assumption that mature defenses are more often used by the NPO individuals has been confirmed, with the simultaneous lack of differences between the PPO and the BPO groups.
18Mature reversal- borderline individuals obtained significantly lower scores than the PPO and NPO groups between which there were no differences (possible impact of social approval variable) (Dudley, 1978)Primitive turning against the object- borderline individuals obtained statistically significant higher scores in this scale than the two other groupsPrimitive turning against self- the most surprising results, significant differences were observed between the high NPO scores and the two other groups
19Identity Kruskala- Wallis test U Mann- Whitney test Achieved χ2 (2)= 16,139; P< .001PPO55,18NPO47,21BPO29,33Moratoriumχ2 (2)= 18,398; P< .00156,650,7519,15Difussedχ2 (2)= 13,810; P< .00158,6242,9333,90Foreclosuredχ2 (2)= 20,723; P< .00161,2742,2331,03
20Diffused identity was used more frequently by individuals with PPO than any other organization Moratorium (currently experiencing an identity crisis) is observed significantly more frequent in PPO and BPO than NPOForeclosured identity status is more frequently observed in PPO (seems to be consistent with the clinical characteristics of psychotic disorders, this identity status is described as a rather stable structure, but determined entirely by other people (parents) and not confirmed in an individual way)Achieved identity- higher performance of psychotic and neurotic patients in achieved identity status. As expected, the psychotic person should present lower results on the scale relating to an integrated identity, while a high score of the neurotic is consistent with the previous assumptions.
21To what extent does the organization of personality pathology can be explained by the variables in the model indicated by O. Kernberg?
22Logisic regression NEUROTIC BORDERLINE PSYCHOTIC Variable B SE Exp (B) TAO-0,70*,03,93Achieved Identity-,07*,94TAS-,15*,06,87,10*,051,10F Identity-,07**REV,12**,041,12Ego Strength,13**1,14,14**1,16-,12*,89Moratorium Identity-,09**,91Diffused Identity,08*1,08** p < .01. * p < .05.
23Logistic regressionneurotic personality organization is explained by the high score on reality testing (ego strength) and turning against self mechanism, and low scores on the moratorium identity status and aggression against the object. borderline personality organization is explained by the low scores on the achieved (A) and foreclosed (F) identity and high scores on agression against object scale.psychotic personality organization is explained by the high scores on reversal (REV) and identity diffusion (D) scale and low scores on reality testing and a turning against self.
24ConclusionOn the basis of the study we can not clearly answer the question of whether proposed by Otto Kernberg personality characteristics of different PO is in line with reality. The results seem to be interesting, especially when we consider the qualitative differences between compared groups in the analyzed variables. It appears that testing on a larger group of subjects, using a more diverse and accurate methods could result in a more unambiguous results. Certainly, this study may serve as a good starting point for further research in this very interesting area.
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