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