Axis I

1 Bell Object Relations and Reality Testing Inventory Bibliography July 2008 Snow Li Princeton University Morris Bell, Ph.D. Yale University 2 Table of Contents Axis I Abuse and Trauma Studies Depression Studies Eating Disorder Studies Ketamine Studies Methadone Studies Substance Abuse Studies Schizophrenia Studies Miscellaneous Axis I Studies Axis II Alexithymia Studies Criminology Studies Personality Disorder Studies Non-Psychiatric Studies Attachment Studies Family Studies Parent-Child Relationship Studies Personality Studies Psychoanalysis Studies Sexuality Studies Spiritual and Religious Studies Miscellaneous Non-Psychiatric Studies Measures and Inventories Reviews Annotated Bibliography Introduction: The Bell Object Relations Reality Testing Inventory is a 90 item self-report instrument rooted in the assessment of ego functioning pioneered by Bellak, Hurvich, and Gediman in 1976. The instrument was first developed in 1979 and the seminal articles were published in 1985 and 1986. Originally developed to measure the clinical effects of longterm psychoanalytic therapy for schizophrenia, the instrument has been applied to many areas of research in psychopathology and normal behavior. In 2008, a search was performed using Medline, PsychInfor, Proquest, and Google Scholar that yielded 176 publicly available journal articles and publications. These have been organized into 5 main categories and 19 sub-categories and cross-referenced producing 240 listings. Each listing contains the citation, the topic of research, number and types of subjects, measures used, findings related to the BORI/BORRTI, and additional comments. The complete citation and abstract are available in the companion document. 3 3 11 15 21 23 26 33 37 39 39 40 43 50 50 58 62 69 72 75 78 85 92 96 3 Axis I Studies Abuse and Trauma Augusto, K. W. (1995). Factors contributing to the long-term adjustment of college women abused as children. Virginia Polytechnic Institute and State University, US. The current study examines psychological correlates of childhood maltreatment, including adult attachment, attributional style, perceived family environment, and current social support and demonstrates their main effects and interactions for predicting longterm psychological distress. Further, this study expands upon past research by broadly defining childhood maltreatment, to include sexual, physical, and psychological aspects of maltreatment. This perspective enables the examination of abuse main effects as well as the interactional effect of the various types of abuse. Three hundred and twenty college women completed the Family Experiences Survey, Conflict Tactics Scale, Childhood Maltreatment Interview-Revised, Social Support Questionnaire, Insecure Attachment Inventory, Bell Object Relations Reality Testing Inventory, Mental Health Inventory, and Brief Symptom Inventory. One hundred and twenty eight women reported a history of maltreatment. Multiple regressions and a discriminant analysis showed attributional style, attachment, and specific maltreatment experiences significantly contributed to the prediction of psychological distress in adulthood. A significant interaction was noted for psychological abuse and attributional style. Further, the unique combinations of specific maltreatment experiences significantly predicted differences in paranoia and depression in the group of maltreated women. Bar-lev, A. (2005). Object relations as a mediator between childhood traumas, parental caregiving, and young adult adjustment. Michigan State University, East Lansing. This study investigated the role of object relations as a mediator between childhood traumas and young adult adjustment as well as parental caregiving and young adult adjustment in 320 undergraduate students in a large Midwestern state university (217 females and 103 males). Childhood traumas and parental caregiving are incorporated into one's development of object relations (Fairbairn, 1952; Kernberg, 1976). Childhood abuse as well as overly neglectful, rejecting or overly controlling parenting contribute to object relations deficits. Object relations deficits were measured by the Bell Object Relations Inventory (BORI; Bell, 1995; Bell, Billington, & Becker, 1986). Object relations deficits mediated the relationship between childhood abuse and young adult adjustment. Participants' lack of basic trust as well as difficulty in relationships, fully mediated the relationship between childhood abuse and depression, childhood abuse and anxiety, and partially mediated the relationship between childhood abuse and dissociation in college students. As predicted, object relations mediated the impact of parental caregiving on psychopathology in young adults. Levels of lack of basic trust and satisfaction in relationships mediated the relationship between father care and depression. Furthermore, struggles in interpersonal relationships as well as oversensitivity to separations and rejections mediated the impact of encouragement of dependence by mothers on depression, and partially mediated the impact of mother dependence on 4 anxiety and dissociation. Perceived social support from friends and family did not impact young adult adjustment significantly. Perceived social support from family was found to be a buffer against high levels of alienation and social incompetence. Centeno, L. K. (2001). Object relations of a young adult nonclinical sample with self-reported histories of childhood maltreatment. Long Island University, The Brooklyn Center, New York. Although recent studies have examined the short-term impact of maltreatment on the object relations of children (Henderson, 1990; Ornduff, Freedenfeld, Kelsey, & Critelli, 1994, Ornduff & Kelsey, 1996; Stovall & Craig, 1990), little is known about the longterm effects of child maltreatment on the interpersonal functioning of adults. In the present study, the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995) and selected Thematic Apperception Test (Murray, 1943) stories were administered to a group of 55 undergraduate females (22 victims of child maltreatment and 33 nonmaltreated participants). Results indicated that the maltreated group differed significantly from their nonmaltreated counterparts on overall object relations on the BORRTI. A second level of analysis examined the relationship between two widely known measures of object relations and personality functioning. Results failed to show a significant convergent relationship between the objective and projective assessment measures. Como Kepler, D. (1998). Childhood sexual trauma in men and subsequent substance abuse. Dissertation Abstracts International: Section B: The Sciences and Engineering, 58(11B).*** Substance abuse is conceptualized, in part, as a symptom reflecting underlying dynamics in a person's psyche. One such contribution is thought to emanate from early childhood experiences, including sexual abuse. This connection to sexual abuse has not been directly addressed in traditional substance abuse treatment and is thought, by van der Kolk (1996), Miller (1994), Carnes (1994) and Evans and Sullivan (1995) to contribute to chronic relapsing by the substance abuser. In this study, childhood sexual trauma is viewed through the lens of psychodynamic theories that consider substance abuse in the context of psychopathology. In this study, two groups of 10 male substance abusers were compared: one group with a childhood history of sexual abuse and the other without a history of childhood sexual abuse. Both groups were administered the Bell Object Relations and Reality Inventory (BORRTI), which measures object relations. A semistructured interview also was used to gather data about the subjects' interpersonal relationships, and substance and sexual abuse. The BORRTI reached no significant differences on the object relations between both groups. However, an analysis of the interviews indicated that the sexually abused group did have substantially more relapses than the group that had not been sexually abused. Farber, B. A., & Sacco, M. (1999). The relationship of repression to reality testing in adult women who report childhood sexual and physical abuse. Journal of the American Academy of Psychoanalysis, 27, 205-220.*** 5 According to classical psychoanalytic theory, individuals use repression to block out unacceptable thoughts, feelings, ideas, or memories (Freud, 1915/1989). A further assumption inherent in this view is that the use of repression engenders problems in other domains of psychic functioning, specifically in the area of reality testing. That is, repression is seen as necessarily interfering with a full, conscious apprehension of reality. Hysterics, for example, as a consequence of their supposed repression of incestuous oepidal wishes, are said to suffer from defective reality testing and an inability to distinguish what is imagined and what has actually occurred. Issues related to the relationship between repression and reality testing have occupied a primary position in psychoanalysis since Freud began writing about the actual and fantasized history of abused women at the turn of the century (e.g., Masson, 1984). The primary aim of the present study is to examine the relationship Haviland, M. G., Sonne, J. L., & Woods, L. R. (1995). Beyond posttraumatic stress disorder: object relations and reality testing disturbances in physically and sexually abused adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 34(8), 1054-1059. OBJECTIVE: To evaluate posttraumatic stress disorder (PTSD) symptom severity, object (interpersonal) relations disturbances, and reality testing disturbances in a sample of physically and sexually abused adolescents. METHOD: Subjects were 37 students, 16 boys and 21 girls, enrolled at a private, residential school for children with various conduct problems. Students completed several psychological tests, including the Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI) and the Bell Object Relations and Reality Testing Inventory. RESULTS: Of the 37 students, 22 (59.5%) had CPTSD-RI scores in the severe and the very severe ranges. The most common object relations and reality testing disturbances were insecure attachment and uncertainty of perception, respectively. CPTSD-RI scores were positively correlated with two of the four object relations scores (insecure attachment and egocentricity) and with all three reality testing scores (reality distortion, uncertainty of perception, and hallucinations/delusions). Mean CPTSD-RI scores were higher for students whose abuse had involved sex (sexual and physical abuse, sexual abuse only) than they were for students whose abuse had been physical only. Alienation and social incompetence, the two object relations disturbances not correlated with PTSD symptom severity, were associated with having experienced abuse at an early age and having been abused by a parent or stepparent (versus a nonparent). CONCLUSION: To address more effectively the long-term difficulties associated with child maltreatment, clinicians and clinicianinvestigators ought to evaluate interpersonal and reality testing disturbances, as well as PTSD symptom severity. Kishon-Barash, R., Midlarsky, E., & Johnson, D. R. (1999). Altruism and the Vietnam War veteran: the relationship of helping to symptomatology. Journal of Traumatic Stress, 12(4), 655-662. 6 This study examines the relationships among demographic factors, combat experiences, personality characteristics, altruism, and posttraumatic stress disorder (PTSD) symptomatology. Participants were Vietnam War veterans currently undergoing treatment for PTSD. The developmental level of internalized schemas of interpersonal relations (object relatedness) and the altruistic intent to help were significant predictors of PTSD symptomatology, with lower levels of symptomatology associated with higher levels of altruism. Results indicated that predispositional variables and altruistic intentions may be important factors to consider in designing and implementing treatment programs for chronically impaired veterans with PTSD. Morrell, B., Mendel, M. P., & Fischer, L. (2001). Object relations disturbances in sexually abused males. Journal of Interpersonal Violence, 16(9), 851-864. The relationship between object relations and child sexual abuse, physical abuse, and separation from parents was investigated in a clinical sample of 120 18-60 yr old males with a history of sexual abuse, using the Bell Object Relations Reality Testing Inventory. Variables included gender of and relationship to perpetrator, age of onset, severity, frequency, duration, and number of abusers. Results indicate that males with a history of abuse demonstrated greater object relations disturbances than the norm, scoring significantly higher on all object relations subscales. Disturbances in object relations were predicted by several sexual abuse variables, including abuse by a male, by both a male and female, by a relative, and by a stranger; and duration, frequency, and severity of abuse. Specific object relations problems were predicted by different patterns of sexual abuse. The implications of findings are discussed in relation to object relations theory, clinical applications for male victims, and future research. Regehr, C., Goldberg, G., Glancy, G. D., & Knott, T. (2002). Posttraumatic symptoms and disability in paramedics. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 47(10), 953-958. OBJECTIVE: The concern that secondary gain may result in an overreporting of trauma symptoms in those seeking compensation or taking stress leave from work has raised questions about the relation between posttraumatic stress and disability. This study attempts to examine the relation between traumatic stress symptoms and the use of work leave in an anonymous sample of emergency-service workers who are not currently seeking compensation. METHOD: A total of 86 paramedics completed questionnaires that addressed exposure to traumatic events, use of mental health stress leave, social support, current level of distress, and personality patterns. Comparisons were made between groups who had used mental health stress (MHS) leave and those who had not. Logistic regression was used to determine the best predictors of using leaves. RESULTS: Current levels of social support were associated with previous use of mental health stress leave. In addition, significantly more individuals who had taken MHS leave in the past reported posttraumatic stress symptoms in the high or severe range. People with personality patterns characterized by suspiciousness, hostility, and isolation and having a tendency toward demanding, controlling, and manipulative behavior in relationships were also more likely to have taken an MHS leave. CONCLUSION: Although social support 7 and trauma symptoms were associated with the use of MHS leave, in this study, personality style was the strongest factor differentiating those individuals who took MHS leave from those who did not. Regehr, C., Hemsworth, D., & Hill, J. (2001). Individual predictors of posttraumatic distress: A structural equation model. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 46(2), 156-161. Objective: Recent research has called into question the ―dose-effect‖ model of under standing response to trauma and has turned attention to the contribution of personality and environmental factors. This research seeks to model the interrelation of relational capacity (a component of personality), perceptions of social support, and posttraumatic distress. Method: A group of firefighters (n = 164) completed questionnaires that addressed exposure to traumatic events, social support, current level of distress, and relational capacity. Structural equation modeling was used to develop a framework for understanding traumatic reactions. Results: The overall fit of the hypothesized model was excellent. Relational capacity had a significant negative effect on support indicating that perceived social support decreased as disturbances in relational capacity increased. Perceived social support had a significant negative effect on level of distress. Conclusion: While some emotional response to disturbing events may be normal, the severity of symptoms covaries with the ability of the individual to develop and sustain supportive relationships to buffer the impact of events. Regehr, C., Hemsworth, D., Leslie, B., Howe, P., & Chau, S. (2004). Predictors of posttraumatic distress in child welfare workers: a linear structural equation model. Children and Youth Services Review, 26(4), 331-346. Two important bodies of literature explore the issue of stress in social workers, that investigating the impact of burnout and that investigating the impact of traumatic events. This study integrates these two concepts and tests a hypothesized model for predicting post-traumatic distress in child welfare workers. In this model, individual, incident and organizational factors combined to produce post-traumatic stress distress in child welfare workers. That is, individuals with a greater sense of control over their lives and a better ability to engage in meaningful relationships with others reported lower levels of distress. In addition, those who had less recent and less frequent exposures reported lower levels of distress. However, the strongest predictor was the organizational environment one aspect of which was ongoing, chronic stressors. It thus appears that critical events in child welfare practice are encountered by individuals whose resources may already be taxed through coping on an ongoing basis with high levels of challenge and stress, thereby increasing the intensity of trauma reactions. Regehr, C., Hill, J., & Clancy, G. D. (2000). Individual predictors of traumatic reactions in firefighters. Journal of Nervous and Mental Disease, 188(6), 333-339.*** Increasingly, theorists and researchers in the area of trauma are pointing to the importance of individual differences in resilience and vulnerability as key determinants 8 of the intensity and duration of trauma-related symptoms. Determining the relative influence of individual predictors is important for the further development of theoretical models for understanding trauma responses and for the subsequent development of intervention strategies that are sensitive to individual differences. This study explores the influence of individual factors and social support on traumatic reactions in firefighters exposed to tragic events in the line of duty. A total of 164 Australian firefighters completed questionnaires targeting locus of control, self-efficacy, patterns of interpersonal relating, social support and level of emotional distress. Results indicate that individuals with feelings of insecurity, lack of personal control, and alienation from others were more likely to experience higher levels of depression and posttraumatic stress symptoms subsequent to exposure to traumatic events on the job. Regehr, C., & Marziali, E. (1999). Responses to sexual assault: a relational perspective. The Journal of Nervous and Mental Disease, 187(10), 618-623. It has been suggested that although the severity of the stressor is the primary determinant of acute posttraumatic stress disorder (PTSD) symptoms, pre-existing personality patterns may be the primary contributors to the development of chronic PTSD symptomatology. The authors postulate that of the multiple personality factors that influence behavior and response to traumatic events, relational capacity or the ability to sustain interpersonal relationships provides an overarching construct for understanding the contribution of social contextual factors to post-trauma response. The results of this exploratory study support the authors' hypothesis that relational capacity is a significant factor in explaining persistent PTSD symptoms in a sample of adult women who have been raped. Significant correlations were found between measures of relational capacity, the Bell Object Relations Inventory and the Inventory of Interpersonal Problems and measures of distress, the Posttraumatic Symptom Scale, and the Beck Depression Inventory. Roche, D. N. (2000). Attachment and object relations: Mediators between child sexual abuse and women's adjustment. University of Victoria, Canada.*** This study investigated the nature of the relationship among child sexual abuse, interpersonal relationship capacity and psychological adjustment. Interpersonal relationship capacity included the constructs of attachment, measured by the Relationship Questionnaire, and object relations functioning, measured by the Bell Object Relations and Reality Testing Inventory. Psychological adjustment included the constructs of trauma-related symptoms, measured by the Trauma Symptom Inventory and supplemented by the Posttraumatic Sum Diagnostic Scale, and interpersonal problems, measured by the Inventory of Interpersonal Problems. Participants were 118 women from a clinical and community sample, including 58 women who reported a history of child sexual abuse and 60 women who reported no such history. Thirty-three women reported a history of intrafamilial child sexual abuse or both intrafamilial and extrafamilial child sexual abuse and 26 women reported a history of extrafamilial child sexual abuse only. The pattern of results indicated that child sexual abuse predicted both interpersonal relationship capacity and psychological adjustment and that interpersonal relationship capacity predicted psychological adjustment. In addition, a mediational model in which 9 interpersonal relationship capacity mediates the relationship between child sexual abuse and psychological adjustment was supported. This suggests that relationship capacity may be a process through which the impact of child sexual abuse influences later psychological adjustment. No differences were found between women who had experienced intrafamilial child sexual abuse and women who had experienced extrafamilial child sexual abuse. When the separate components of each construct in the model were considered, attachment mediated the relationship between child sexual abuse and trauma-related symptoms and also mediated the relationship between child sexual abuse and interpersonal problems. Object relations functioning mediated the relationship between child sexual abuse and trauma-related symptoms, but did not mediate the relationship between child sexual abuse and interpersonal problems. Again, no differences were found between women who had experienced intrafamilial child sexual abuse and women who had experienced extrafamilial child sexual abuse. Results are discussed in terms of the implications for appropriate therapy approaches with survivors of child sexual abuse. Sacco, M. L., & Farber, B. A. (1999). Reality testing in adult women who report childhood sexual and physical abuse. Child Abuse & Neglect, 23(11), 1193-1203. Objective: The primary aim of this study was to investigate the differential effects of sexual and physical abuse in childhood on the quality of reality testing (perceptual disorders and dissociative symptoms) in later adult life. Method: Two hundred and fiftynine female volunteers between the ages of 18 and 30 recruited from college campuses completed self-report measures assessing sexual and physical abuse in childhood as well as current perceptual impairments (reality distortion, uncertainty of perceptions, hallucinations and delusions, and psychoticism) and dissociation (amnesia, absorption and imaginative involvement, and depersonalization and derealization). Results: Women who report abuse in childhood dissociate more than nonabused women, although they do not experience more perceptual distortions. Duration of abuse, age of onset of abuse, number of perpetrators, and relationship of perpetrator to victim predicted difficulties in many aspects of reality testing. Women who report both childhood sexual and physical abuse are especially prone to acknowledge dissociative phenomena. Conclusions: These findings suggest that college women who report abuse continue to experience acceptable accuracy in their reality testing but, in comparison to their cohorts who have not been abused, more often become ―distant‖ from the world and their own sensory experiences. Sayer, P. C. (2002). Responses of individuals with posttraumatic stress disorder to eye movement desensitization and reprocessing or a cognitive-behavioral treatment as mediated by attachment status. Alliant International University, Fresno. The primary focus of this investigation was to evaluate the responses of individuals diagnosed with Posttraumatic Stress Disorder (PTSD) to treatment with Eye Movement 10 Desensitization and Reprocessing (EMDR). In the event that a participant was unable to tolerate the EMDR approach, an alternative cognitive-behavioral treatment approach was offered. It was anticipated that individuals exhibiting Secure Attachment status as revealed on administration of the Bell Object Relations and Reality Testing Inventory (BORRTI) would experience lower scores between pre- and post-intervention administrations of the Symptom Checklist-90-Revised (SCL-90-R). Six individuals took part in the study; five completed the EMDR protocol and one completed an alternative cognitive-behavioral therapy program due to problems tolerating the EMDR treatments. Subjects met with the researcher/therapist from 1 to 12 sessions, participating in the assessment, psychoeducational, and treatment components of the protocol. The application of the BORRTI Insecure Attachment (IA) measure resulted in five of the participants receiving a designation Secure Attachment status and one person an Insecure Attachment status classification. Thus, comparison groups according to attachment status designation could not be formed. Comparisons of group mean differences between the pre- and post-intervention administrations of the SCL-90-R did not reveal statistically significant differences with regard to the five individuals completing the EMDR protocol. Limitations of the study are discussed, as well as implications for future research on the mediating influences of attachment status on the treatment of PTSD. Twomey, H. B. (1998). Childhood maltreatment, object relations and suicidal behavior in women. Miami University, Miami. This investigation was conducted in order to empirically test a mediational model proposing that object relations mediate the link between childhood maltreatment and suicidal behavior in women. From an object relational perspective, the assumption that experiences of childhood maltreatment adversely influence object relations development which in turn increases the risk for subsequent difficulties including suicidal behaviors is broadly accepted; yet there is a paucity of empirical validation of these concepts. A sample of predominantly low income African American women consisting of fifty three suicide attempters and one hundred and six control participants seeking services at a public city hospital completed the Childhood Trauma Questionnaire (CTQ), the Bell Object Relations Inventory (BORI), and the Blatt Object Relations Inventory (ORI). Highly significant associations between childhood maltreatment and suicide attempt status, childhood maltreatment and object relations deficits, and object relations deficits and suicide attempt status were found, satisfying Barron and Kenny's (1986) criteria for testing mediation. Several logistic regression analyses were conducted to examine mediation and revealed that each of the object relations dimensions fully, yet differentially, mediated specific links between the various types of childhood maltreatment and suicide attempt status. Specifically, the Alienation subscale (BORI) fully mediated the links between all five types of childhood maltreatment and suicide attempt status, constituting the most robust mediator. In the case of both childhood sexual abuse and childhood physical neglect, the links with suicide attempt status were fully mediated by five of the six object relations measured; whereas the other childhood maltreatment types (physical abuse, emotional abuse, and emotional neglect) were fully mediated by just one or two object relations dimensions. Future directions for research, as well as the clinical implications of the findings are discussed. 11 Williams, B. A. (1997). Effects of object relations and psychological defenses in partnerassaultive men: A controlled empirical study. Ohio University, Athens. The purpose of this study is to examine personality characteristics of men who physically assault female partners from an object relations theoretical perspective. The men identified as partner-assaultive are compared to both a non-violent offender control group and a community control group on personality measures. This was accomplished by using existing self-report instruments that are reported to assess characteristics related to object relations. The instruments used were the Bell Object Relations and Reality-Testing Inventory (Alienation, Insecure Attachment, Egocentricity, Reality Distortion, and Uncertain Perception subscales), the Depressive Experiences Questionnaire (the Anaclitic/Dependency subscale), the Narcissistic Personality Inventory, and the Defense Styles Questionnaire (Mature and Primitive Defenses subscales). Since trauma during development would predict interpersonal deficits according to object relations theory, a retrospective measure of childhood trauma, the Childhood Trauma Questionnaire, was also used. Subjects consisted of 96 males, with three subgroups of 40 (partner-assaultive), 30 (non-violent offender control), and 26 (community control). The subjects were primarily rural white men with little education. The target group were men who have been arrested for domestic violence. There were two control groups, one consisting of men who have been arrested for nonviolent crime only, and the other group a nonviolent community control group. To eliminate the inclusion of men who batter their partners in the two control groups, the Conflict Tactics Scale was used as a screening device. The partner-assaultive men demonstrated increased object relations and reality testing deficits, decreased use of mature defenses, and increased use of primitive defenses, compared to the community control group. It is very important to note that there were no significant differences between the offender (nonviolent) control group and the partner-assaultive men. No differences were found between any of the three subject groups on the Childhood Trauma Questionnaire, or anaclitic depression (dependency). The results of this study suggest that while partner-assaultive men do have significant object relations and reality testing deficits compared to the community sample, they do not appear to be unique in this as the nonviolent offender control group demonstrated similar deficits. This indicates that it is imperative that future research examining partner-assaultive men include a clinical control group for comparison as well as a community (normal) sample. Depression Balestri, M. (1999). Overt and covert narcissism and their relationship to object relations, depression, Machiavellianism, and the five factor model of personality. Boston University, Massimo.*** 12 The DSM-IV provides a set of criteria for the diagnosis of Narcissistic Personality Disorder. Clinical theorists (Glen Gabbard, 1990; James Masterson, 1993) have indicated these criteria are inadequate because they fail to provide a comprehensive picture of narcissistic disturbances. The DSM-IV diagnostic criteria account for only the overt subtype of narcissism (characterized by grandiosity and exhibitionism) but omit a second narcissistic subtype, namely, covert narcissism (characterized by a tendency to be shame sensitive, quietly grandiose, inhibited and depleted). The purpose of this study was to provide empirical support for the distinction between two putative narcissistic subtypes, the overt and the covert. In the first phase of the study, a sample of 149 college students were administered a battery of self-report inventories which included four measures of narcissism: the Narcissistic Personality Inventory, the Narcissistic Personality Disorder Scale, the Ego-Sensitivity Scale and the Narcissism-Hypersensitivity Scale. To assess the factor structure of these four measures of narcissism, a Principal-Components analysis was performed and as predicted, two orthogonal factors (overt and covert) were extracted, confirming Paul Wink's findings (1991). Overt and covert factor scores were calculated for each subject. The second phase of the research was designed to compare the relationships between the overt and covert factors and subjects' scores on the Beck Depression Inventory, the Bell Object Relations and Reality Testing Inventory (BORRTI), the Machiavellian-IV scale, and the NEO Five-Factor Inventory. Results indicated that both overt and covert narcissism were positively correlated with Machiavellianism and negatively correlated with the Agreeableness Factor, reflecting the narcissistic proclivity toward manipulation, exploitation and lack of empathy. Covert narcissism was related to object relations deficits, depression and the Neuroticism Factor, reflecting more dysfunction than overt narcissism. Gender differences were found. Overtly narcissistic males showed object relations deficits on BORRTI-Insecure Attachment, while overtly narcissistic females showed fewer deficits in object relations. This study provides further empirical support for the distinction between overt and covert narcissism and suggests additional criteria to better distinguish covert from overt narcissism. Gibbs, P. L. (1989). Object relations capacity and reported childhood background in adult depressed patients. Graduate School of Wayne State University, Detroit. (no abstract available) Huprich, S. K. (2003). Depressive personality and its relationship to depressed mood, interpersonal loss, negative parental perceptions, and perfectionism. The Chicago Journal of Nervous & Mental Disease, 191(2), 73-79. *** Eighty veteran psychiatric outpatients were evaluated for depressive personality disorder on the Depressive Personality Disorder Inventory (DPDI). It was predicted that those classified with depressive personality would report higher levels of interpersonal loss, negative perceptions of their parents, and higher levels of perfectionism than psychiatric control subjects. Nine of the 12 measures of these variables were significantly greater in those with depressive personality compared with psychiatric control subjects. When statelike depression was controlled for, seven of the nine variables still significantly 13 differed between the two groups. Hierarchical regression analysis and discriminant function analysis found that these variables predicted 9% of the variance in the DPDI above and beyond statelike depression, and that a combination of these variables correctly classified 91% of the depressive personalities and 88% of the psychiatric control subjects. It is concluded that, as hypothesized, depressive personality disorder is associated with loss, negative parental perceptions, and perfectionism, and that these relationships are not accounted for exclusively by a depressed mood. Huprich, S. K., Sanford, K., & Smith, M. (2002). Psychometric evaluation of the depressive personality disorder inventory. Journal of Personality Disorders, 16(3), 255-269. *** The purpose of this study was to evaluate the psychometric properties of the Depressive Personality Disorder Inventory (DPDI; Huprich, Margrett, Barthelemy, & Fine, 1996). The DPDI was found to have strong internal consistency in both an undergraduate and a veteran, psychiatric outpatient population. The DPDI had significant, positive correlations with other measures of depressive personality, supporting its convergent validity. These relationships remained even after controlling for state-like depression, suggesting that the DPDI has incremental validity. The DPDI also significantly predicted scores on measures of interpersonal loss, even after controlling for state-like depression, suggesting that the DPDI has good construct validity. In support of discriminant validity, the DPDI was more correlated with another measure of depressive personality than it was with measures of other personality disorders. Finally, the DPDI had strong diagnostic efficiency statistics: (a) Sensitivity = .82, (b) Specificity = .80, (c) Positive Predictive Power = .75, (d) Negative Predictive Power = .86, and (e) Overall Diagnostic Power = .81. It appears that the DPDI has good psychometric properties. Regehr , C., Hill, J., & Clancy, G. D. (2000). Individual predictors of traumatic reactions in firefighters. The Journal of Nervous and Mental Disease, 188(6), 333-339.1 Sharifah, S. (1995). The quality of object relations in borderline and major depressed patients as displayed on psychological tests. California School of Professional Psychology, Los Angeles. The major purpose of this study was to determine whether the quality of object relations in borderline and major depressed subjects can differentiate these diagnostic groups. Subjects were 40 nonhospitalized patients with the diagnosis of borderline and/or major depressive disorder. Borderline patients were divided into two subgroups of depressed and pure borderline subjects. The quality of object relations in borderline and major depressed subjects were assessed by the Bell Object Relations Reality Testing Inventory, the Social Cognition and Object Relations Scale Score (SCORS) for the TAT, the Comprehensive System for the Rorschach, and the Developmental Analysis of the Concept of the Object Scale (DACOS) for the Rorschach. Analysis of data suggested that the quality of object relationships of borderline patients is significantly different from those with major depressive disorder. Overall, borderline subjects had a greater tendency to view human figures in a distorted fashion than major depressed patients. These figures 1 For abstract, see citation listing in Axis I: Abuse and Trauma Studies 14 were often extensively elaborated and they were perceived as being engaged in malevolent, dependent, and passive interactions with others. In addition, the borderline group was more likely to present intense fears of abandonment and object loss, while the major depressed sample had a greater difficulty in establishing trusting relationships with others. This study also examined the construct validity of SCORS and DACOS variables. Analysis of data provided partial support for the convergent and discriminant validity of these measures. Finally, the correlation between the Beck Depression Inventory (BDI) and the Depression Index (DEPI) of the Comprehensive System for the Rorschach yielded insignificant results. The implications of these findings and suggestions for future research were discussed. Smith, D. S. (2001). Object relations and depression. University of Detroit Mercy, Detroit. The research was a retrospective archival field study with an incomplete factorial design. The study was done to predict diagnostic groups from object relations scores. The Bell Object Relations Reality Testing Inventory (BORRTI) measured the degree of severity of four Object Relations subscales Alienation (ALN), Insecure Attachment (IA), Egocentricity (EGC), and Social Introversion (SI). The other three scales pertain to Reality Testing and are Reality Distortion (RD), Uncertainty of Perception (UP), and Hallucinations and Delusions (ED). The Bell Object Relations Reality Testing Inventory (BORRTI) was administered to 131 males and females, African American and Caucasians, in an inpatient state hospital and a nearby private practice. The three diagnostic categories used were Bipolar Disorder, Major Depression, and Paranoid schizophrenia (inpatient only). This study explored the relationship between the object relations concepts on the BORRTI and the diagnostic categories. All three categories were discriminated at an alpha of <.05. The diagnostic groups were representative of severe disorders, and scored mostly above the 85% or cutoff score of t > 60. The highest scoring group (most severe or deficient object relations) was that of paranoid schizophrenia, followed by the Bipolar Disorders, and the Major Depressive group. The bipolar group scores were most similar to the major depressive group, but differed in severity. The dimensions of the BORRTI subscales did not appear to be applicable to the major depressive disorder. Watkins, K. E. (2002). Stress and depression in single African-American mothers as a function of their sons’ second separation in adolescence. Alliant International University, Fresno. *** The need to cope with the realistic demands of being a single African-American parent, whose children are at risk in this society, and to live up to the unrealistic image of the always strong and nurturing African-American woman is always filled with all sorts of stressors that may eventually lead to mental and physical health problems. This study was designed to assess the level of stress and depression in single African-American mothers whose sons are experiencing a second separation-individuation in adolescence. Data were gathered from 90 volunteer African-American mothers from various agencies and organizations. Instruments included a demographic questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Separation-Individuation Test of Adolescence, 15 and the Bell Object Relations and Reality Testing Instrument. Data were analyzed using a one-way analysis of variance and a multivariate analysis of variance. Although the hypotheses were not supported, there was a significant difference between the groups of mothers. A trend was found in married mothers in relationship to depression. Future research calls for studies with stress and depression to include single African-American fathers whose sons or daughters are experiencing a second separation in adolescence. Studies are needed to assess test instruments that are geared toward African-Americans and other ethnic groups. Eating Disorders Appledorn, K. (2000). Object relations and identity disturbances in bulimic women. Andrews University, Berrien Springs. Problem. Although diagnostic criteria of bulimia center on weight- and food-related issues, eating disorders may be viewed as a response to deficits in self-regulatory functions. The purpose of this study was to investigate the relationship between the severity of bulimia, object relations, and identity. This study tested the hypotheses that women with a more severe eating pathology have high scores on object-relations disturbance as well as identity disturbance. It was postulated that women who have been assessed as having a more cohesive ego might respond to cognitive behavioral therapy while those who are assessed as having less intact ego resources may require more intensive psychodynamic approaches. Method. The study involved the administration of three tests by therapists who were treating women diagnosed with bulimia nervosa according to DSM-IV criteria. The test instruments included the following: Bulimia TestRevised, Bell Object Relations Inventory, and the Erwin Identity Scale. An interview was conducted on a selected group of 12 subjects. Results. There were statistically significant correlations between the severity of bulimia and the severity of object relations and identity disturbance. Specifically, the Alienation subscale of the Bell Object Relations Inventory and the Confidence subscale of the Erwin Identity Scale had the strongest correlation with the BULIT-R. The qualitative results indicated that a number of themes were strongly identified by both "High Bulimics" and "Low Bulimics." Conclusions. The quantitative analysis indicated there was a relationship between the severity of object relations, identity disturbance, and bulimia. However, the qualitative analysis identified that many of the women, in the "Low Bulimic" group, had significant disturbances in their relationships as well as their opinion of their body. It was concluded that both groups exhibited significant object relations and identity disturbances. Therefore, it is suggested that a more psychodynamic approach is useful for understanding the adaptive functions of bulimia. Becker, B., Bell, M., & Billington, R. (1987). Object relations ego deficits in bulimic college women. Journal of Clinical Psychology, 43(1), 92-95. Two types of bulimic (purging and restricting) and two types of non-bulimic (binging or normal) eating patterns were reported by 547 undergraduate women who also were 16 assessed for ego function deficits on the four subscales of the Bell Object Relations Inventory. As predicted by psychoanalytic theory, the two bulimic subgroups appeared significantly more pathological on the Insecure Attachment subscale, which identifies ambivalent interpersonal relations and fear of object loss. When the four groups were ranked according to severity of type of eating disorder, a linear increase in group means and in the proportion of high scoring subjects was found on Insecure Attachment and also on the Egocentricity subscale, which indicates suspicious and manipulative attitudes toward others. Results are interpreted to support theories that relate eating disorders to disturbances in object relations ego functioning. Celec, M. J. (1995). Attachment and affect motivated eating behavior in an obese population: Maintenance versus relapse. Dissertation Abstracts International: Section B: The Sciences and Engineering, 55(12-B). This dissertation explored object relations characteristics in an obese population by comparing those who relapse following treatment with those who maintain their weight losses following treatment. The impetus for this study came from the proliferation, in recent years, of weight loss programs whose long-term results have been dismal. This alltoo-common trend of relapse only serves to perpetuate the negative physical and psychological concominants of obesity. This dissertation presented a psychodynamic approach to conceptualizing relapse in weight loss and conducted a preliminary exploration in an effort to glean some information to confirm or disconfirm the usefulness of this approach. Theoretically, disruptions in early attachment, through empathic failures on the part of the selfobject, interfere with internalization of self-soothing structures. Consequently, when the self experiences intolerable affect, the self initiates some action to ameliorate it. In the case of obesity, the self eats compulsively. This dynamic plays a role in relapse. Assessing the theoretical concepts presented through the Bell Object Relations Inventory with particular attention to the Insecure Attachment subscale, this study proposed that those who relapsed would show greater object relations deficits than those who maintained their weight losses and that those who reported emotional eating would show greater deficits on the Insecure Attachment subscale than those who did not. The subjects included in this study were thirty-nine caucasian females who had participated in a modified fasting diet. The study contacted the subjects through mailed surveys. It analyzed the data collected through the use of a t-test. Results did not show a significant difference between the relapse and maintenance groups. However, a significant difference appeared on the Insecure Attachment subscale when it compared emotional eaters to non-emotional eaters. This finding was consistent with the theoretical link between affect motivated eating behavior and the quality of object relations. Goodwin, R. D., & Fitzgibbon, M. L. (2002). Social anxiety as a barrier to treatment for eating disorders. International Journal of Eating Disorders, 32(1), 103-106. 17 Background: The goal of this pilot investigation is to determine the relationship between social anxiety and treatment-seeking behavior for eating disorders in an outpatient psychiatric clinic. Method: Twenty-eight patients seeking treatment for anorexia or bulimia at an outpatient eating disorders clinic completed a battery of self-report measures on eating pathology, attachment style and functioning, and social anxiety at initial intake appointment. Levels of eating pathology and social anxiety at consult were compared with service utilization records on entry into treatment. Results: Individuals who did not engage in treatment had significantly higher levels of social anxiety (F = 8.29, df = 1, p < .05) compared with those who did engage in treatment. There were no differences in demographic characteristics, diagnoses, or level of eating pathology at intake. Conclusions: Social anxiety may act as a barrier to effective help-seeking and utilization of mental health treatment among individuals with eating disorders. Replication of these findings in a larger sample and more in-depth study of the mechanism of the observed association between use of services and social anxiety may be useful in planning more effective outreach in the community to underserved populations in need of treatment for eating disorders. Heesacker, R. S., & Neimeyer, G. J. (1990). Assessing object relations and social cognitive correlates of eating disorder. Journal of Counseling Psychology, 37(4), 419-426. The relation between eating disorder and disturbances in object relations and cognitive structure was investigated. 183 undergraduate women were assessed for eating disorder on 2 measures and for object relations deficits on the 4 subscales of the Bell Object Relations Inventory of M. Bell et al (see record 1987-02849-001). Cognitive structure was assessed using an interpersonal repertory grid. Canonical correlation analyses revealed that eating disorder was predicted by measures of object relations disturbance and cognitive structure. Women with higher levels of eating disorder showed higher levels of object relations disturbances along 2 of the 4 subscales (Insecure Attachment and Social Incompetence), and more simplistic and rigid social cognitive schemata. Hierarchical multiple regression analyses indicated that object relations disturbance and cognitive structure made independent contributions to the predictions of disordered eating. The implications of these findings for counseling are discussed. Herald, C. (1995). Bulimic behavior and the problem of female self-identity: Sense of self in relation, family environment, and the superwoman ideal. Dissertation Abstracts International: Section B: The Sciences and Engineering, 56(5-B). The present study explored the relation of selected individual, family, and sociocultural factors, associated theoretically with the problem of contemporary female self-identity, to bulimic behavior (measured by the Bulimia Test-Revised) in a nonclinical sample of undergraduate women (N = 178) located developmentally at the transition to adulthood. Predictive models of bulimic behavior and three psychological features commonly associated with bulimia nervosa (interoceptive awareness, ineffectiveness, and body dissatisfaction, measured by the Eating Disorder Inventory), were constructed, with and without a statistical control for depression. 18 The best predictive model of bulimic behavior, without controlling for depression, consisted of object relations disturbance in the dimension of insecure attachment (measured by the Insecure Attachment scale of the Bell Object Relations Inventory); a recalled active and negative parental focus on the subject's eating, weight, and body shape (Family Focus on Weight and Shape-Parental Focus); low non-food-related selfnurturance and high food-related self nurturance (Self-Nurturance scales of the Nurturance Rating Task); and aspiration to the superwoman ideal (Superwoman Scale). Parental focus, food-related self-nurturance, and superwoman added to bulimic behavior as a symptom choice over and above depression (measured by the short form of the Beck Depression Inventory). A poorly differentiated sense of self (measured by the Self-Other Differentiation Scale) and insecure attachment were intercorrelated, and related to all of the selected psychological characteristics of bulimia nervosa, as well as to depression. Contrary to previous findings, family cohesion (measured by the Family Adaptability and Cohesion Scales III) showed no significant relationship, linear or nonlinear, to level of bulimic behavior. Maladaptive family structure (total score on the Family Structure Survey) was associated with insecure attachment, low interoceptive awareness, ineffectiveness, and depression, but only mildly related to bulimic behavior. Results are discussed in the light of theories linking bulimia to cultural constructions of women and to the broad problem of female self-identity. Huprich, S. K., Stepp, S. D., Graham, A., & Johnson, L. (2004). Gender differences in dependency, separation, object relations and pathological eating behavior and attitudes. Personality and Individual Differences, 36(4), 801-811.*** The purpose of this study was to examine gender differences in eating behaviors and attitudes and the related constructs of dependency, separation, object relations, and eating disorder behavior. One hundred and forty-one undergraduate students were recruited from introductory psychology courses and completed measures of the aforementioned constructs. Females had significantly higher scores on the Eating Attitude Test and Eating Self-Efficacy Scale. For males, the Eating Self-Efficacy Scale was also positively correlated with measures of Alienation and Social Incompetence, and the Eating Attitude Test was positively correlated with the Separation Individuation Process Inventory. For females, the Eating Questionnaire Revised was significantly correlated with the Interpersonal Dependency Inventory, the Eating Attitude Test, and Insecure Attachment and Egocentricity scales. There was also a significant positive correlation between the Eating Attitude Test and the Insecure Attachment and Egocentricity scales for females. These findings suggest that certain personality variables differentially are related to pathological eating behaviors and attitudes between gender. Johnson, S. H. (1995). Attachment and object relations among bulimic college women. California School of Professional Psychology, Berkeley/Alameda. This study investigates the relationship between attachment and eating pathology among female college students. The study is based on the idea that leaving home precipitates eating pathology among insecurely attached women. Sixty-five freshmen and sophomore 19 college women, 18 years or older, participated. Using DSM-III-R criteria, the sample included 30 bulimic and 35 nonbulimic women. Eating pathology is operationalized by scores on 11 Eating Disorder Inventory-2 (EDI-2) (Garner, 1991) scales. Attachment is operationalized as scores on three measures: the Inventory of Parental and Peer Attachment (Armsden & Greenberg, 1987), Parental Attachment Questionnaire (Kenny, 1987), and Bell Object Relations and Reality Testing Inventory (Bell, 1991). Concurrent validity between the attachment measures is established. There are significant differences between bulimic and nonbulimic women on all attachment measures. The most powerful differences are on mother-daughter attachment and bulimia; less powerful differences occur on father-daughter attachment measures. There is a significant difference between the proportion of bulimic and nonbulimic women who use food as a source of comfort. Eating pathology is significantly associated with attachment. All mother-attachment measures are significantly correlated with EDI-2 scales that directly measure eating pathology, such as bulimia, drive for thinness, and body dissatisfaction; only one fatherattachment scale is significantly associated with eating pathology. Attachment is also significantly related to EDI-2 scales measuring ineffectiveness, interpersonal distrust, impulse regulation and social insecurity. Finally, eating pathology is significantly associated with subject history of abuse; and, parental depression. Attachment is significantly negatively associated with physical and emotional abuse; there is no relationship with sexual abuse. Emotional abuse is also significantly negatively associated with object relations. Parrent, M. F. (1997). Binge eating disorder and dimensions of object relations. University of Detroit Mercy, Detroit. The purpose of this study was to explore the relationship between object relations and level of eating disorders pathology. It hypothesized that when eating disorder groups were ranked by severity of eating disturbances (normal, obese, obese binge eater, and bulimic) there would be a significant difference amongst the group means measuring severity of object relations disturbance with normals < obese, 60) on the Alienation and Insecure Attachment scales. It may be that these variables are not associated with alcoholism to the degree that was theorized. However, the difference observed in the full sample suggests that there may be a relationship. False sibling pairs were constructed by matching unrelated individuals and maintaining the proportion of pairs concordant and discordant for gender and alcoholism diagnosis. These false sibling pairs were compared to the real sibling pairs, and there were no differences between pairs. The real sibling pairs were no more similar than the false sibling pairs, suggesting that these variables may be more influenced by nonshared environment than by shared environment. Intercorrelations between measures were high, suggesting that these measures tap into a similar dimension of personality, or capture different aspects of personality that are highly correlated with one another. Schizophrenia Bell, M., Fiszdon, J., Richardson, R., Lysaker, P., & Bryson, G. (2007). Are self-reports valid for schizophrenia patients with poor insight? Relationship of unawareness of illness to psychological self-report instruments. Psychiatry Research, 151(1-2), 37-46. This investigation aimed to determine whether impaired insight influences the validity of self-report test scores in schizophrenia and schizoaffective disorder. 274 outpatients enrolled in work rehabilitation completed the Beck Depression Inventory (BDI), Eysenck Personality Questionnaire (EPQ), Bell Object Relations and Reality Testing Inventory (BORRTI), and NEO-Five Factor Inventory (NEO-FFI). Self-report scores were compared to clinician's ratings on comparable personality and symptom dimensions on the Positive and Negative Syndrome Scale (PANSS), the Work Behavior Inventory (WBI), and the Quality of Life Scale (QLS). The influence of insight was determined using the Scale for Unawareness of Mental Disorder (SUMD). In the first analysis, clinician SUMD ratings of patient insight were associated with self-report accuracy. In a second analysis, patients were categorized into good and poor insight groups based on SUMD ratings and compared on self-report and clinician report variables. Results suggest that poor insight patients accurately report less Neuroticism and Agreeableness, and more Psychoticism than good insight patients, but individuals with poor insight wish to present themselves as more extraverted than they actually are, and they are likely to be more certain of their perceptions than they should be. It appears that self-report measures may be valid for most personality and symptom domains. 34 Bell, M., & Bruscato, W. (2002). Object relations deficits in schizophrenia: A cross-cultural comparison between Brazil and the United States. Journal of Nervous and Mental Disease, 190(2), 73-79. Notes that object relations deficits are commonly found in schizophrenia samples from the US, but it is unknown whether these deficits are a reliable finding in other cultures. The Bell Object Relations Inventory was translated into Brazilian Portuguese and administered to 61 stable outpatients (mean age 31.8 yrs) with schizophrenia from Sao Paolo, Brazil. Their scores were compared with a Brazilian normal sample (mean age 19.6 yrs) and with a matched US schizophrenia sample. The Brazilian normal sample showed a pattern of scores within the normal range when compared with US norms. The Brazilian schizophrenia sample had significantly greater pathology than the Brazilian normal sample on Alienation, Egocentricity, and Social Incompetence. Their mean scores on Alienation were similar to the matched US schizophrenia sample, and they had significantly greater pathology on Insecure Attachment, Egocentricity, and Social Incompetence with 85.6% showing some type of object relations deficit. Findings support the cross-cultural validity of the Bell Object Relations Inventory and the ubiquity of object relations deficits in schizophrenia. The most common profiles for both schizophrenia samples were the Psychotically Egocentric and the Socially Withdrawn object relations types. Bell, M., Lysaker, P., & Milstein, R. (1992). Object relations deficits in subtypes of schizophrenia. Journal of Clinical Psychology, 48(4), 433-444. Forty-eight subjects with diagnoses of schizophrenia were assessed with the Bell Object Relations Inventory (BORI), the Positive and Negative Syndrome Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), and the Premorbid Adjustment Scale (PAS) to determine the distribution of object relations deficits in the whole sample and four subtypes: paranoid, schizoaffective, poor premorbid, and prominent negative symptoms. Results indicate that 92% of the sample had object relations deficits; 85% showed elevations on the BORI Alienation scale. Subjects with prominent negative symptoms produced lower values on Insecure Attachment and higher values on Egocentricity. This suggests that negative symptoms are associated with a reduction in perceived painfulness of attachment and increased egocentric investment. Other subtyping schemes showed no reliable pattern of object relations deficits. Bell, M. D. (2001). Object-relations and reality-testing deficits in schizophrenia. In P. W. Corrigan & D. L. Penn (Eds.), Social cognition and schizophrenia (pp. 285-311). Washington, DC: American Psychological Association. This chapter begins with the discussion of a case, Diana, that represents many people with schizophrenia who recover sufficiently to lead productive lives. The authors note that Diana demonstrates no serious object-relations deficits, although her relationships were adversely affected by her illness and she has enough observing ego to be aware of her reality-testing deficits. Main topics discussed in this chapter are (1) ego functions: the highest level of organization for human thought and behavior; (2) assessment of object- 35 relations and reality-testing ego functioning: the Bell Object Relations Reality Testing Inventory (BORRTI): (3) BORRTI profiles from a large sample of people with schizophrenia; and (4) Diana's BORRTI. Bell, M. D., Greig, T. C., Bryson, G., & Kaplan, E. (2001). Patterns of object relations and reality testing deficits in schizophrenia: clusters and their symptom and personality correlates. Journal of Clinical Psychology, 57(12), 1353-1367.*** Bell Object Relations Reality Testing Inventory (BORRTI) profile scores were used to cluster 222 outpatients with schizophrenia or schizoaffective disorder. An eight-cluster solution was subjected to replication analysis, and six clusters were found valid and replicable. These clusters were sorted into three pairs that were interpreted as follows: Residually Impaired consisted of Sealed-Over Recovery and Integrated Recovery; Socially Withdrawn consisted of Socially Withdrawn and Socially Withdrawn-Autistic; and Psychotically Egocentric consisted of Psychotically Egocentric and Psychotically Egocentric-Severe. Clusters were compared on Positive and Negative Syndrome Scale ratings and on subscales from the Eysenck Personality Questionnaire. MANOVAs indicated significant differences among clusters. These differences provided further interpretations of cluster membership. Implications for the use of BORRTI profiles for treatment and rehabilitation planning are discussed. Bell, M. D., & Zito, W. (2005). Integrated versus sealed-over recovery in schizophrenia: BORRTI and executive function. Journal of Nervous and Mental Disease, 193(1), 3-8. Ego functioning of 222 outpatients with a diagnosis of schizophrenia or schizoaffective disorder was evaluated using the Bell Object Relations and Reality Testing Inventory (BORRTI). Sixty-one of these had BORRTI profiles identified as sealed-over recovery style, and 36 had profiles interpreted as integrated recovery style. Groups were compared on demographic characteristics, symptom profiles, and the Wisconsin Card Sorting Test, a performance measure of executive function. Groups had comparably low levels of positive symptoms, but the integrated recovery group had higher scores on the BORRTI uncertainty of perception scale. The integrated recovery group had significantly fewer minority patients, higher IQ, and higher levels of emotional discomfort. The sealed-over recovery group had higher levels of cognitive disorganization. When differences in ethnicity and IQ were controlled for, the integrated recovery group had better executive functioning. Wisconsin Card Sorting Test categories completed emerged as the significant predictor in a logistic regression, explaining 19% of the variance. These findings support the discriminant validity of these two recovery styles and reveal the importance of executive function in a recovery style that allows for investment in relationships, affect tolerance, and acknowledgment of symptoms. Frey, J. F. (1998). Personality configuration, social cognition and change in well-being in schizophrenia. Dissertation Abstracts International: Section B: The Sciences and Engineering, 59(6-B). 36 Innovative research is needed to further identify the factors responsible for the high recidivism rate in schizophrenia that reflects the failure to adjust to community living. Three interrelated factors in this phenomenon that have been particularly unexplored are sense of well-being, personality and social cognition. This study was an attempt to explore the correlational relationship between changes in schizophrenics' sense of wellbeing following hospitalization and their personality configuration and social cognition, specifically, construal of self-in-the-world and object relations. Schizophrenic patients were assessed during the termination phase of their hospitalization and 10 days posthospitalization using The Quality of Life Interview (QLI) to measure changes in general and specific domains of well-being. A Semantic Differential form (SD; Osgood, Suci, & Tannenbaum, 1957) was used to assess construal of self-in-the-world or perceptions of self and the social environment. The Bell Object Relations Inventory (BORI; Bell 1986) was used to measure enduring attitudes about self and others. Patients' personality configurations (i.e. anaclitic vs. introjective) were classified based on chart reviews using the descriptions of anaclitic and introjective personality configurations by Blatt and Shichman (1983). Personality configuration, construal of self-in-the-world and object relations were predictive of change in well-being in the specific domains of social relationships and family relationships. Greig, T. C., Bell, M. D., Kaplan, E., & Bryson, G. (2000). Object relations and reality testing in early and late-onset schizophrenia. Journal of Clinical Psychology, 56(4), 505-517. One hundred fifty-seven U.S. military veterans with schizophrenia were divided into early-onset (i.e., onset at age 20 or before, n = 36) and late- onset (i.e., onset after age 30, n = 28) groups and completed the Bell Object Relations and Reality Testing Inventory (BORRTI), the Positive and Negative Syndrome Scale, and several representative neuropsychological instruments. Participants were compared on background characteristics and test measures. The early-onset group demonstrated significantly more object-relations and reality-testing deficits than the late-onset group. In contrast, no significant group differences were found on symptom or neuropsychological variables. An a posteriori three-group analysis that included the middle age of onset group (i.e., ages 21 to 30) found that the middle group had mean values that fell between early- and late-onset groups on most variables. No distinct patterns of BORRTI subscale scores distinguished the middle group. The finding that object-relations and reality-testing deficits are more pronounced in early-onset schizophrenia has implications for the treatment and rehabilitation of schizophrenia Kimhy, D. (2003). The relationship between mental representations, premorbid adjustment, and symptom patterns in schizophrenia. Long Island U, The Brooklyn Center, New York. The construct of mental representations provide a frame work in which psychopathology may be characterized. Blatt (1991, 1995) proposed a theory of psychopathology and development rooted in the quality of mental representations. Blatt (1991, 1995) also contended that the quality of mental representations reflects the quality of past and present interpersonal interactions. Sixty-one subjects with DSM-IV diagnoses of schizophrenia and schizoaffective disorders were assessed with the Bell Object Relations 37 and Reality Testing Inventory (BORRTI), the Differentiation-Relatedness Scale (DRS), the Rorschach Comprehensive System, the Positive and Negative Syndrome Scale (PANSS), and the Premorbid Adjustment Scale (PAS) to determine the relationship between mental representations, premorbid adjustment and symptom patterns in schizophrenia. Factor analysis was used on the object relations measures to reduce redundancy of measures. Results indicate that as a whole, both the three extracted object relations factors and the ratings of premorbid adjustment independently predicted predominance of symptom profiles. The results are discussed with reference to Blatt's theoretical model, along with discussion of the role of object relations deficits in schizophrenia. Axis I: Miscellaneous Angus, J. M. (2007). Parents of children with Asperger Syndrome: Relationships between early attachment, ego functioning, and parenting behaviors. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68(4-B).*** Parents of children with Asperger Syndrome (AS) were studied to determine the relationship between the parents' personalities, their perceptions of their child's illness, and their parenting behavior. Two-hundred sixty-two subjects, recruited via AS advocacy websites, completed an internet protocol consisting of the Parental Bonding Instrument, the Bell Object Relations and Reality Inventory (Form O), the Autism Spectrum Screening Questionnaire, and the Parenting Behavior Inventory. Results confirm that subjects' attachment to their own parents correlated with parenting behaviors. Relationships were found between object relatedness and parenting. The hypothesized relationship between AS symptoms and parenting behavior was not supported. Relationships were found between demographic variables (especially income and marital status) and parenting behavior. Findings are discussed from the perspective of professional contributions to social policy and working with this population. Crawford, M. E. (2007). Object relations and self-representations in women with attention deficit disorders. Fielding Graduate University, Santa Barbara. It has been speculated that ADHD predisposes females to emerge with a false self that often leads to vulnerability and depression in adulthood (Quinn & Nadeau, 2002). Similarly, it has been proposed that serious difficulties in the parent-child relationship frequently arise due to the presence of ADHD (Baker & Baker, 1996; Everett & Everett, 1999; Gavshon, 2001; Morrel, 1998). Lastly, attachment research has confirmed that individuals with biological vulnerabilities are at risk for experiencing conflicting and strained interactions within the parent-child dyad (Cassidy, 1994; Field, 1994; Fonagy, 2000). Object relations theory and self psychology offer insight into the development of the self structure brought about through early developmental experiences within the parent-child relationship. The purpose of this correlational study was to examine the differences in aspects of object relations and self representations between women with and without ADHD. Object relations and self representations were assessed using the Bell Object Relations and Reality Testing Inventory (BORRTI), the Internalized Shame 38 Scale (ISS), and the Self-Expression Inventory (SEI). Participants included 136 women with and without ADHD, obtained from various settings across the United States. Each participant completed a series of self-report measures, which included a background questionnaire, the Revised NEO-Personality Inventory (NEO-PI-R), and the Conner's Adult ADHD Rating Scale (CAARS). Results of this study indicate that ADHD is significantly associated with internalized shame, object relations impairment, and selfdeficits in women. The study suggests that clinical interventions based on object relations and attachment theories may be particularly useful with women with ADHD. Lear, S. A. S. (2002). Pathological stock market gamblers: An object relations measure. California Inst Integral Studies, San Francisco. Purpose. The purpose of the present study was to determine whether pathological stock market gamblers and pathological gamblers differ from non-gamblers on a measure of object relations. This was accomplished by comparing three groups: pathological gamblers (PG), pathological stock market gamblers (PSMG), and non-gamblers (NG) on levels of object relations deficits. Method. Fifty-one subjects volunteered as participants in this study. Subjects were assigned to groups based on their score on the South Oaks Gambling Screen and self-identification as gambling in the stock market. Forty-one subjects met inclusion criteria to be assigned to a participant group. The pathological stock market gambler's group consisted of eight participants. The pathological gambler's group also had eight participants and the non-gambling group consisted of twenty-five participants. The object relations portion of the Bell Object Relations and Reality Testing Inventory was employed to measure levels of object relations deficits. The hypothesis of the study were as follows: Hypothesis I. Pathological stock market gamblers and pathological gamblers when compared to non-gamblers will be significantly different with respect to object relations deficits on the alienation subscale of the BORRTI. Hypothesis II. Pathological stock market gamblers and pathological gamblers when compared to non-gamblers will be significantly different with respect to object relations deficits on the insecure attachment subscale of the BORRTI. Hypothesis III. Pathological stock market gamblers and pathological gamblers when compared to non-gamblers will be significantly different with respect to object relations deficits on the egocentricity subscale of the BORRTI. Hypothesis IV. Pathological stock market gamblers and pathological gamblers when compared to non-gamblers will be significantly different with respect to object relations deficits on the social incompetence subscale of the BORRTI. Results. Results indicate that pathological gamblers and pathological stock market gamblers differ from non-gamblers with respect to their means on the subscales of alienation and insecure attachment though the differences did not meet the level of statistical significance. Treatment implications and suggestions for further research with pathological stock market gamblers were proposed. Ostroth, A. C. (1995). The influence of object relations and social skills on compliance with outpatient mental health treatment. Dissertation Abstracts International: Section B: The Sciences and Engineering, 56(5-B). 39 The purpose of this study was to explore the influence of object relations and social skills on patient compliance with outpatient mental health treatment. It was hypothesized that both of these factors would prove to be independent significant predictors of compliance, with object relations providing additional influence indirectly through its relationship with social skills. This study was conducted at an outpatient suburban community mental health clinic with two sites. A total of 112 patients were invited to participate in this study by providing data on the independent variables of object relations and social skills. Of these 112 patients, 74 chose to participate and 38 declined. Compliance data were obtained for all patients invited to participate in the study. The subject pool consisted of 61 females and 51 males between the ages of 21 and 68 with a mean age of 40.2. This population was found to be quite homogenous in regard to the variables being studied. Pearson product moment correlation coefficients were computed to determine the intercorrelations between demographics, object relations, social skills, and treatment compliance. Multiple regression and path analytic procedures were used to analyze the data. Treatment compliance was measured by the Compliance Check List (CCL), designed for use in this study. Object relations were measured by the Bell Object Relations Inventory (BORI). Social skills were measured by the Social Skills Inventory, Research Edition (SSI). The results of this study indicate that neither object relations nor social skills, independently or in combination with each other were significant predictors of compliance. However, some subscales of the BORI and some subscales of the SSI were found to significantly predict some aspects of compliance as measured by the CCL. Overall, demographics were found to be unrelated to compliance. No significant difference was found between participants and non-participants in regard to overall treatment. Axis II Alexithymia Inkeles, P. M. (1996). The role of alexithymia in substance abuse and substance abuse relapse. Miami Institute of Psychology of the Caribbean Ctr For Advanced Studies, Miami. 4 Krause, E. W. (1996). Chronic pain, Alexithymia, and object relations. U Tennessee, Knoxville. In the treatment of chronic neck and back pain patients, the influence of early life experiences, or object relations, and the inability to verbalize feelings, or alexithymia, have not been explored. This study investigated the object relations and presence of alexithymia in chronic pain patients in comparison to a sample of non-pain workers. In addition, a comparison was made of the level of object relations and presence of alexithymia in chronic pain patients who returned to work versus chronic pain patients who did not return to work at six months following a prototypical work-hardening program. One hundred patients diagnosed with chronic pain following a neck or back 4 For abstract, see citation listing in Axis I: Substance Abuse Studies 40 injury and one hundred non-injured individuals in similar job categories completed the Toronto Alexithymia Scale (TAS) and the Bell Object Relations Inventory (BORI). Discriminant analysis was used to test two hypotheses: (a) Neither Object Relations scores as measured by the BORI four scales of Alienation, Insecure Attachment, Egocentricity, and Social Incompetence, nor Alexithymia as measured by the TAS differentiate chronic pain patients from non-pain individuals. (b) Neither Object Relations scores as measured by the BORI four scales of Alienation, Insecure Attachment, Egocentricity, and Social Incompetence, nor Alexithymia as measured by the TAS predict whether chronic pain patients return to work at six months following treatment for chronic pain. Results of the discriminant analyses indicated that all five of the predictor variables were significant (<) in classifying individuals as being members of the chronic pain or non-injured group (at the rate of 86%) and in classifying chronic pain patients who return to work versus chronic pain patients who do not (at the rate of 92%). In comparing individuals with and without chronic pain, alexithymia had the highest correlation to chronic pain patients, followed by alienation, insecure attachment, egocentricity, and social incompetence. Wood, S. A. (2000). Object relations, alexithymia, symptoms of psychological distress and methadone treatment outcome. Smith College School For Social Work, Northampton.5 Criminology Studies Bovasso, G. B., Alterman, A. I., Cacciola, J. S., & Rutherford, M. J. (2002). The Prediction of violent and nonviolent criminal behavior in a methadone maintenance population. Journal of Personality Disorders, 16(4), 360-373.6 Brown, B. M. (1997). An examination of severe psychopathy in a female offender. California School of Professional Psychology, San Diego. Much of what we know of psychopathic behavior is based on research on male offenders. In most cultures men are typically viewed as more violent and aggressive by nature, and until recently, the rate of male versus female offenders in this country has supported this notion. Currently, there is a lack of relevant research in the area of female criminality. This project is an attempt to provide some of this missing information regarding the study of female offenders, specifically psychopathic antisocial women, and includes a case study which provides relevant clinical data to this topic area. Initially, the rate of female offending was discussed, leading into the history of theories of female criminality as well as psychopathy, and includes a discussion regarding the lack of relevant research in this area. Secondly, theories concerning defensive structure and dynamic formulations were considered primarily from an object-relations perspective. Issues surrounding the assessment and diagnosis of psychopathy were addressed, including a discussion of the psychometric tests utilized in this study, specifically what they add to an understanding of 5 6 For abstract, see citation listing in Axis I: Methadone Studies For abstract, see citation listing in Axis I: Methadone Studies 41 psychopathy and how psychopathically disturbed individuals might present on these measures. Finally, a case study was presented for review which includes a clinical description of a female psychopath based on historical information, psychological testing and current psychodynamic theories regarding the development of the psychopathic personality. The subject of this case study, Tracy, was 38 years old at the time of this study. She is a Caucasian woman of average build and at the time of her evaluation was serving a sentence for possession of an illegal substance which was her fourteenth conviction for this charge. Tracy's arrest history dated back to 1976 and included over 46 arrests and or convictions. She had 36 aliases on record and had used 15 different social security numbers. Tracy scored 32 on the Hare Psychopathy Checklist - Revised, placing her in the range of severe psychopathic disturbance, she produced a 4-8 profile on the MMPI-II and a MCMI-III which indicated severe personality disturbance. Tracy was also administered the Bell Object Relations Reality Testing Inventory and the Rorschach both of which further supported severe personality pathology, poor object relations and poor reality testing. Treatment strategies as well as relevant countertransference issues were addressed. Fullard, D. A. (1999). The personality characteristics and treatment outcomes for thirty-three (33) adult male inmates in a high-impact incarceration program. The Union Institution, Cincinnati. The objective of this research was to determine the treatment outcome for a group of adult male city-sentenced inmates and parole violators in a High Impact Incarceration Program (HIIP, "boot camp"). The research design for the dissertation was a quasiexperimental, one-group, pretest/posttest design without a control group. The setting for the study was the New York City Department of Correction High Impact Incarceration Program (HIIP) on Rikers Island. The participants consisted of thirty-three (33) adult male city-sentenced inmates and parole violators who volunteered to participate in the rigorous boot camp program and the treatment outcome study. The High Impact Incarceration Program (HIIP) was the experimental/independent variable for this study as well as the treatment intervention that was utilized in this research. The main outcome measures for this study was a battery of objective psychological tests. The research question for this study was: "What, if any, change(s) in personality disorder and its comorbid factors (dependent variable) take place in the inmate subjects after a period of high impact incarceration?" The intervention (HIIP) fostered a significant change on the following psychological tests and questionnaires: Anomia Scale (ANS), Beliefs About Substance Use (BASU), Bell Object Relations and Reality Testing Inventory (BORRTI), two of the five (2 of 5) scales on the Carlson Psychological Survey (CPS), Coping Responses Inventory(CRI), Craving Beliefs Questionnaire (CBQ), Firestone Assessment of Self-Destructive Thoughts (FAST), Firestone Voice Scale for Violence (FVSV), Posttraumatic Stress Diagnostic Scale (PSDS), Relapse Prediction Scales (RPS), StateTrait Anger Expression Inventory (STAXI), one of the nine (1 of 9) scales on the Substance Abuse Subtle Screening Inventory (SASSI), ten of the twelve (10 of 12) scales on the Symptom Checklist-90-Revised (SCL-90-R), and seven of the fifteen (7 of 15) scales on the Tennessee Self-Concept Scale-2 (TSCS-2). The intervention had no statistical significance on Attention-Deficit Scales for Adults (ADSA), Eysenck 42 Personality Questionnaire-Revised (EPQ-R), Lifesfyle Index (LSI), Rust Inventory of Schizotypal Cognitions (RISC), and Young Schema Questionnaire-Short Form (YSQSF). HIIP appears to be effective in changing certain personality factors and their comorbid factors while the teammates (inmates) are within this intensive, rigorous, and highly structured program. Further research is necessary to determine what effect this personality change has on the rate of recidivism, and if this change in personality is permanent or temporary. Leguizamo, A. (2000). Juvenile sex offenders: an object relations approach. University of Michigan, Ann Arbor. (Abstract not available) Wolkenhauer, M. (1996). Male adolescents' object relatedness to their fathers: A comparison of adolescent sex offenders and a general adolescent population. California School of Professional Psychology, Fresno. This study explored male adolescents' object relatedness to their fathers. A review of the literature examined the history of object relations' understanding of the primary object, the behavioral research on fathers and infants, father absence studies, the father imago and adolescent development, adolescent sex offenders, and the multiple dimensions of familial object relatedness. The present exploration compared adolescent sex offenders in treatment with other male adolescents on two measures of object relatedness. One measure, The Assessment of Qualitative and Structural Dimensions of Object Representations (AQSDOR), assessed object relatedness specifically in terms of the adolescent's primary father figure. The other measure, the Bell Object Relations and Reality Testing Inventory (BORRTI) assessed the adolescent's overall object relatedness. Only one of the hypotheses was partially confirmed, suggesting that, except for one scale, the measures selected did not differentiate between these two groups. Specifically, the mean level of the two groups' descriptions of their father figures on the AQSDOR were both in the Concrete Perceptual-Level II range and not significantly different. However, on the four object relations scales of the BORRTI, one scale measuring insecure attachment differentiated between the two groups. This finding suggests that adolescent sex offenders have more insecure attachments than do adolescents in the general population. Although not predicted, 63% of the subjects scored in the pathological range on a scale measuring egocentricity, suggesting that a higher percentage of male adolescents have attitudes characterized as egocentric on this scale, when compared to a cross-section of adults. Finally, the limitations of the study and suggestions for future research are discussed, both in terms of the instruments (the AQSDOR and the BORRTI) and the variables (fathers, adolescents, adolescent sex offenders, and object relatedness), of which much is still unknown. The clinical relevance of understanding male adolescents' object relatedness to their fathers is explored. 43 Personality Disorder Alpher, V. S. (1991). Assessment of ego functioning in multiple personality disorder. Journal of Personality Assessment, 56(3), 373-387. The dissociative disorder known as multiple personality disorder (MPD) presents a diagnostic challenge to psychological assessment techniques. A case example is presented in which a new self-report, multifactorial measure of ego functioning discriminated distinct profiles for four personalities within one multiple personality organization. Interpretations of characteristics of the primary and secondary personalities based on the Bell Object Relations Reality Testing Inventory (BORRTI) are presented. The relationship between these findings and other approaches to psychological testing for dissociation and MPD are discussed. It is suggested that this approach will facilitate the clinical assessment of suspected MPD subjects and contribute to affording appropriate treatment to this population. Alpher, V. S. (1992). "Changes in Identity and Self-Organization in Psychotherapy of Multiple Personality Disorder." Psychotherapy: Theory, Research, Practice, Training 29, 570-79. Studied change in client identity and self-organization during the treatment of a 38-yr-old man with multiple personality disorder. Assessment measures were administered to the host personality and 2 secondary personalities before and after 12 wks of intensive treatment. Measures included the MMPI and the Bell Object Relations Reality Testing Inventory (BORRTI). Therapy focused on the posttraumatic aspects of the patient's early childhood sexual abuse. A cognitive-affective approach combined psychoanalytically informed psychotherapy with abreactive-hypnotic work for recovering and reexamining traumatic memories. A greater degree of intrapsychic awareness and interpersonal sensitivity was suggested by changes in BORRTI ratings. The magnitude of observed changes in self-organization was substantial. Armbrust, C. A. (1997). Measurement of the defensive use of splitting and related object relations deficits in a clinical population. University of Texas, Austin. *** The purpose of this study was twofold. First, the validity of the Splitting Index (Gould, Prentice, and Ainslie, in press) was examined. Second, Kernberg's (1984) theory of organizational levels of pathology linked to the type of defensive function and the developmental level of object relations was investigated. The Splitting Index (SI) is a 24item self-report measure based upon Kernberg's writings that is designed to measure the extent to which an individual utilizes the defense of splitting. The SI demonstrated predictive validity by differentiating a group of patients with borderline personality characteristics and a group with other severe psychopathology from a group with less severe pathology and a nonclinical control group. Convergent validity was provided with a strong correlation between the SI and the Separation-Individuation Index (Christenson and Wilson, 1985) and moderate correlations between the SI and two subscales-- 44 Alienation and Insecure Attachment--of the Bell Object Relations Inventory (BORI; Bell, Billington, and Becker, 1986). Contrary to predictions, the SI was not significantly correlated to the Egocentricity subscale of the BORI. The SI was also able to distinguish between a therapist-identified group of patients that rely extensively on the defense of splitting and a therapist-identified group that did not rely primarily on splitting. Supporting Kernberg's theory, subjects reporting borderline and other severe pathology reported significantly higher mean scores on the SI, Separation-Individuation Index, and the Alienation and Insecure Attachment subscales of the BORI. Contrary to predictions, the BORI Egocentricity subscale did not differentiate between these groups. Additional research was suggested to determine the relationship of splitting to specific diagnostic categories and to determine if one of the three subfactors of the Splitting Index, the Splitting of Family Images subfactor, should be eliminated from the index. Bell, M.D., Billington, R., Cicchetti, D., & Gibbons, J. (1988). ―Do object relations deficits distinguish BPD from other diagnostic groups?‖ Journal of Clinical Psychology. 44, 511-16. Two independent samples that met DSM-III criteria for borderline personality disorder (BPD) were found to have similar patterns of object relations deficits as measured by group means and percentage of high scoring subjects on the four subscales of the Bell Objects Relation (OR) Inventory. Statistical comparison of the composite BPD group with affective, schizoaffective, and schizophrenic groups revealed that the pattern of OR deficits in BPD was significantly different from each of the other diagnostic groups. On the basis of scores from the Alienation subscale alone, BPD subjects could be distinguished from the other diagnostic groups with 77-82% predictive accuracy. The role of object relations deficits in BPD is discussed, along with potential contributions of the Bell OR Inventory to diagnostic efficiency. Bovasso, G. B., Alterman, A. I., Cacciola, J. S., & Rutherford, M. J. (2002). The Prediction of violent and nonviolent criminal behavior in a methadone maintenance population. Journal of Personality Disorders, 16(4), 360-373.7 Brown, B. M. (1997). An examination of severe psychopathy in a female offender. California School of Professional Psychology, San Diego.8 Dahl, E. E. (1996). The development of a scale to measure separation-individuation themes in borderline adolescent TAT protocols. California School of Professional Psychology, Fresno. The present study was done in order to develop a scale to measure SeparationIndividuation themes as developed by Mahler, Pine and Bergman (1975) in borderline adolescent Thematic Apperception Test (TAT) protocols. The investigator presents a theme scale, the Separation-Individuation Scale for Use with the TAT (SISTAT) that parallels the theory of Separation-Individuation (Mahler et al., 1975). Subjects for the 7 8 For abstract, see citation listing in Axis I: Methadone Studies For abstract, see citation listing in Axis II: Criminology 45 study were adolescents aged 12 to 18. Two groups were gathered from inpatient adolescent units in the Fresno and Los Angeles areas. One group comprised 11 adolescents diagnosed with Borderline Personality Disorder. The other group of 20 subjects was diagnosed with Major Depression. A control group of 19 adolescents with no diagnosis were gathered from a high school in the Fresno area. All 50 subjects were administered both the TAT and the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, Billington, & Becker, 1985, 1986). Given Masterson's (1972) belief that borderline pathology arises out of an arrest in the Rapprochement subphase of Separation-Individuation, it was expected that the borderline group would manifest more Rapprochement themes on the SISTAT than either the Major Depression or Control groups. Three trained raters scored the TAT stories on the SISTAT. These ratings were then analyzed for interrater reliability and construct and concurrent validity. Among the findings was that rater's scoring on the SISTAT was highly inconsistent. This produced very poor interrater reliability and also negatively affected subsequent analyses. The implications of these findings including a discussion about the problems with the collection of data and the general status of doing research at inpatient facilities are presented. Revisions of both the SISTAT and the rater training session are introduced for future research in this area. Huprich, S. K. (2003). Depressive personality and its relationship to depressed mood, interpersonal loss, negative parental perceptions, and perfectionism. Journal of Nervous & Mental Disease, 191(2), 73-79.9 Huprich, S. K. (2003). Depressive personality and its relationship to depressed mood, interpersonal loss, negative parental perceptions, and perfectionism. Journal of Nervous & Mental Disease, 191(2), 73-79.10 Kurtz, J. E., Morey, L. C., & Tomarken, A. J. (1993). The concurrent validity of three self-report measures of borderline personality. Journal of Psychopathology and Behavioral Assessment, 15(3), 255-266. The recent accumulation of self-report measures of borderline personality disorder (BPD) affords the opportunity to evaluate both the construct validity of the concept and the quality of these measures. This study examines the relationship among three recently developed self-report instruments for assessing BPD from the Personality Assessment Inventory (PAI; Morey, 1991), the MMPI Personality Disorders Scales (MPD; Morey, Waugh, & Blashfield, 1985), and the Bell Object Relations Inventory (BORI: Bell, Billington, & Becker, 1986). Data on the three measures were provided by 119 undergraduate subjects from a southeastern university. A correlational analysis addresses the convergence of these measures of BPD, their divergence from measures of different but related traits, and their independence from variance due to method. Application of the Campbell-Fiske (1959) criteria indicates adequate convergence for all the BPD measures but a lack of discriminant validity for the BORI scales. The fit of the data to a structural model of construct validity is tested using confirmatory factor analysis, and these results 9 10 For abstract see citation listing in Axis I: Depression Studies For abstract, see citation listing in Axis I: Depression Studies 46 are consistent with the hypothesis of a latent borderline trait factor independent of measurement method factors. In sum, the construct validity of the borderline personality concept using self-report methodologies receives support, and a strong association between borderline personality and paranoid phenomena is also suggested. Leerer, C. G. (1996). Outcomes of inpatient cognitive-behavioral treatment of borderline personality disorder. Northeastern University, Boston. The current study investigated the efficacy of Dialectical Behavior Therapy (DBT) for severely ill, parasuicidal, female borderline inpatients, diagnosed by a structure interview in reducing parasuicidal, aggressive behaviors, and milieu interventions, psychopathology, and improving global functioning. Participants were 14 state hospital inpatients with BPD and severe Axis I diagnoses who completed (71%) or dropped out (29%) of a DBT Skills Training Group which was 25% intensity of the DBT model. Groups were compared on parasuicidal, aggressive behaviors, and milieu interventions using a chart review of the same one-month periods before, half-way and after completing DBT Skills Training. Groups were also compared on self-reported psychopathology and global functioning. The effect of DBT individual therapy was studied by comparing outcomes between patients with and those without individual DBT therapy. The effect of patients‘ experience of an individual empathic therapeutic alliance was studied by comparing outcomes between patients who experienced their therapeutic alliance as positive, and those who did not. There were no baseline differences between groups. The outcomes suggested support for the hypotheses that DBT Skills Training was more effective than other inpatient treatments in reducing parasuicidal and aggressive behaviors. The most powerful finding confirmed the primary importance of patients‘ experiences of an empathic individual therapeutic alliance in predicting better treatment outcomes in aggressive behaviors, milieu interventions, psychopathology, and global function. Patients‘ experience of an empathic therapeutic alliance was also associated with reductions in parasuicidal behaviors in conjunction with DBT Skills Training. The data did not support the effectiveness of DBT Skills Training in reducing milieu interventions and psychopathology, or in improving global function. Data suggested that some milieu interventions effectively replaced parasuicidal behavior in an inpatient milieu. The findings did not confirm that DBT individual therapy is a necessary adjunct to Skills Training to reduce parasuicidal behaviors. Previous studies found DBT reduced parasuicidal behavior for borderline outpatients; this study extended generalizability to severely ill borderline inpatients receiving less intensive DBT treatment. Replication with a larger inpatient sample is needed. Middleton, A. E. (2004). Differentiating adolescents with borderline personality disorder from normal adolescents and adolescents with other disorders. University of Texas, Austin. This research investigates whether adolescents with Borderline Personality Disorder (BPD) can be reliably differentiated from normal and other-disordered adolescents. 47 Psychoanalytic theory describes borderline psychopathology as deriving from difficulties in the separation/individuation phase of early development. Mahler (1946) portrays the rapprochement subphase of this period as a time when the child is vulnerable to the nascent of personality disorders. Blos (1967) elaborated this theory positing adolescence as a “second individuation” where earlier separation/individuation difficulties reemerge. Difficulties in the rapprochement stage make the second individuation problematic, leaving the adolescent at risk for borderline pathology. Pomerantz, M. (1996). Relationships between borderline and narcissistic personality traits, and tolerance of ambiguity, aggression and assertion. California School of Professional Psychology, Los Angeles. *** The purpose of this study was to explore the relationship between the following variables: borderline personality characteristics, narcissistic personality characteristics, tolerance or intolerance of ambiguity, aggression and assertion. These variables were selected in order to investigate whether there is a connection between dysfunctional styles of interaction, such as those seen in those with personality disorders, and aggressive behavior. It was hypothesized that perhaps an inability to tolerate ambiguity is a relevant factor for the selected population. The instruments used were Budner's Tolerance/Intolerance of Ambiguity, subtests of the Interpersonal Behavior Survey (General Aggressiveness, General Assertiveness), subtests of the Bell Object Relations and Reality Testing Inventory (Insecure Attachment, Alienation), and subtests of the Narcissistic Personality Inventory (Exhibitionism, Exploitativeness, Entitlement). Results indicate that aggression seems related to insecure attachment in those with borderline traits, and to exhibitionism in those with narcissistic traits. Assertiveness was discerned in those with either borderline or narcissistic traits if paired with age. Tolerance of ambiguity as assessed by Budner's Tolerance/Intolerance of Ambiguity questionnaire was discerned in those of Caucasian ethnicity. Implications of these findings and suggestions for further research were discussed. Roberts, K. K. (1998). The relationship between adult attachment styles and Masterson's delineation of personality disorders. George Fox University, Newberg. The present study addresses the degree of relationship between adult attachment styles, as assigned by attachment theory, and personality disorders, as delineated by Masterson's developmental self and object relations theory. Relationships between the avoidantdismissive attachment style and characteristics of the exhibiting narcissistic personality disorder, between the preoccupied attachment style and the borderline personality disorder, and between the avoidant-fearful attachment style and the schizoid and avoidant personality disorders were anticipated. Eighty-six individuals involved in the Access Program in Spokane, Washington participated in the study. Thirty-four psychology students at George Fox University also participated in the study as a control group. Participants were asked to complete a packet of materials including a brief demographic questionnaire, the Relationship Questionnaire (Bartholomew & Horowitz, 1991), the Relationship Scales Questionnaire (Griffin and Bartholomew, 1994), the Bell Object Relations and Reality Testing Inventory (Bell, 1995), and the Roberts Relationship 48 Inventory, (D. Roberts personal communication, July, 1996) an instrument developed by graduates of the Masterson Institute's post graduate training program. Results supported this study's hypotheses most prominently in the relationship between attachment theory's "secure" style and Masterson's "healthy" response style, and attachment theory's fearful style and Masterson's schizoid personality disorder. A thorough discussion of the findings is included. Rutherford, M. J., Alterman, A. I., Cacciola, J. S., McKay, J. R., & Cook, T. G. (1996). Object relations and reality testing in psychopathic and antisocial methadone patients. Journal of Personality Disorders, 10(4), 312-320.11 Sack, A., Sperling, M. B., Fagen, G., & Foelsch, P. (1996). Attachment style, history, and behavioral contrasts for a borderline and normal sample. Journal of Personality Disorders, 10(1), 88-102. Borderline pathology has been characterized by intense, unstable interpersonal relations, which has been associated with deficits in object relations as well as insecure styles of attachment. This study explores the degree and nature of differences in attachment behavioral manifestations, attachment style, and attachment history between two differing samples, inpatient borderline and college normal. The two groups were compared on five measures assessing behavioral and representational aspects of attachment related phenomena: the Bell Object Relations Reality Testing Inventory (BORRTI), Sperling's Attachment Style Inventory (ASI), West and Sheldon's Reciprocal Attachment Questionnaire (RAQ), Hazan and Shaver's Attachment Self-Report (HS), and a newly constructed Attachment History Adjective Sort (AHAS). Significant differences emerged on all measures, supporting the hypothesis that the maladaptive interpersonal relations associated with BPD can be usefully understood from an attachment perspective that offers some unique contributions over an object relations perspective, particularly in the area of attachment styles. Variations on subscales of the attachment measures were further investigated in order to more specifically identify those aspects of insecure attachment that are unique to BPD. Sharifha, S. (1995). The quality of object relations in borderline and major depressed patients as displayed on psychological tests. California School of Professional Psychology, Los Angeles.12 Snyder, J. B. (1999). The relationship of psychopathy and antisocial personality disorder to the object relations and reality testing of alcoholic men. Temple University, Philadelphia.13 Stuppy, L. J. (1996). The relationship between dissociation and object-relations impairment in adult female incest survivor clients with and without personality splitting. Andrews University, Berrien Springs. 11 12 For abstract, see citation listing in Axis I: Methadone Studies For abstract, see citation listing in Axis I: Depression Studies 13 For abstract, see citation listing in Axis I: Substance Abuse Studies 49 Problem. Childhood incest appears to play a role in the formation of Dissociative Identity Disorder (DID) (formerly Multiple Personality Disorder). This study investigated whether a relationship exists between dissociation and object-relations impairment in incest survivors and whether DID incest survivors have higher levels of these characteristics than non-DID incest survivors. Method. The Dissociative Experience Scale, Bell Object Relations Reality Testing Inventory and Childhood Maltreatment Interview Schedule-Short Form were completed by a sample of 60 adult female incest survivor clients, 29 who met the diagnosis for DID and 31 who did not. The results. All three hypotheses were supported at a .05 level. A significant relationship between dissociation and object-relations impairment was found. The DID group reported significantly higher levels of dissociation and object-relations impairment than the nonDID group and higher incidences of childhood maltreatment and adult traumas. A discriminant analysis found that DID clients can be differentiated from non-DID clients based on dissociative experiences and object-relations scores. The DID group consistently reported higher incidences of childhood maltreatment, psychological abuse, and adult traumatization than the non-DID group. Conclusions. The findings support an object-relations model for incest and suggest that personality splitting found in DID clients may be related to a developmental arrest in early-life intrapsychic splitting mechanisms described by Kernberg (1966, 1975, 1976) and others. It is possible that therapists may serve as "transitional objects" for incest survivors with object-relations deficits. Past research has viewed incest as leading to a variety of PTSD symptoms, however some effects, especially personality splitting, may originate even before the incest occurs when very young children are exposed to harsh or psychologically overwhelming situations. Tramantano, G., Javier, R. A., & Colon, M. (2003). Discriminating among subgroups of borderline personality disorder: an assessment of object representations. American Journal of Psychoanalysis, 63(2), 149-175. The purpose of this study was to identify subgroups of borderline personality disorder (BPD) by examining internalized object relations. It was predicted: (a) that the internalized object relations of borderline patients as a group can be differentiated from psychiatric patients (comparison group N = 15), and (b) that BPD subgroups significantly differ in their object-relational profiles. Fifty-seven adult borderline subjects (28 male and 29 female) were separated into three groups based on Horney's description of interpersonal styles (moving away, against, and toward). Object relations were assessed using the Bell Object Relations Inventory and from early memories. Four written early memories were scored using the Social Cognition and Object Relations Scale (SCORS). The results suggest that the malevolent inner object world of borderline patients is fundamentally different from nonborderline psychiatric patients; and that the defined BPD subgroups of moving toward, against, and away differed significantly on specific structural and thematic object-relational dimensions. Aspects from Fairbairn's object relations theory and contributions from the self/representational, ego deficit, and Kernberg's models of borderline psychopathology are used to help interpret the findings. Identifying subtypes of BPD may allow for more precise discriminations in separating 50 BPD from other disorders and may provide meaningful therapeutic and prognostic information for the different subgroups of borderline patients. Non-Psychiatric Studies Attachment Studies Aylor, A. R. (1995). The relationship between maternal object representations, infant temperament and security of attachment. Dissertation Abstracts International: Section B: The Sciences and Engineering, 56(5-B). This study hypothesized a relationship between maternal object representations and secure attachments. It was hypothesized that there would be an interaction between maternal levels of object representations and infant temperament such that these two factors would influence the quality of the attachment relationships. Social support was anticipated to facilitate attachments in mothers with less mature object representations. New methods of compensating for the effect of maternal representations on self-report measures using test-retest reliability and paternal convergent measures were implemented. Methods for translating temperament category variables into score data were also explored. This research improves on past research by controlling for mothers' unique perceptions of their children and themselves by implementing convergent validation measures provided by the fathers. Eighty-seven mothers and their children of both sexes between 11- and 14-months old were evaluated. Subjects were primarily Caucasian, well-educated, maritally intact and of upper socioeconomic status. This study evaluated maternal representational capacities through the use of two separate measures, the Structural Representation of the Object (Blatt's Parental Descriptions Test) and the Bell Object Relations Inventory. Neither of these measures alone successfully predicted attachment security. Two subscales of the Bell Object Relations Inventory did predict attachment security at a statistically significant level. Mothers with mature object representations on both measures were compared to mothers with less mature scores on both measures. The incidence of anxious attachment in mothers demonstrating low representational abilities was twice that observed among mothers with high representational abilities. The incidence of anxious attachments among mothers with high representational capacities was roughly equivalent to previously obtained normative samples. Mothers with less mature object representations also rated their children as more difficult and rated their social supports lower. Low scores on the Marlowe-Crowne Social Desirability Scale and the number of hours in childcare both predicted attachment security in this study. Unexpectedly, children in childcare a greater number of hours per week were more likely to be securely attached. Attributes of the mothers' stability in emotional functioning and a nondefensive approach 51 to testing in this population played a greater role in facilitating attachment relationships than attributes of the child or the environment. Celec, M. J. (1995). Attachment and affect motivated eating behavior in an obese population: Maintenance versus relapse. Dissertation Abstracts International: Section B: The Sciences and Engineering, 55(12-B).14 Deason, D. M. (1998). A systemic look at the self: The relationship between family organization, interpersonal attachment and identity. University of Southern Mississippi, Hattiesburg. The emergence of systems theories has challenged the individualistic perspective that psychological difficulties are solely intrapersonal in nature. These theories have even challenged modern psychodynamic theories to incorporate the influence of environmental factors on the development of intrapersonal processes. Systemic theories have even proposed that the individual is psychologically a systemic organization of different parts. This theory also proposes that the psychological functionality of an individual depends on the functionality of his or her systemic organization of the different psychological parts of himself or herself. Systemic organization of an individual's family of origin has been hypothesized to serve as a template for systemic organization of the parts of one's self. The purpose of this study is to examine the relationship between factors of family functioning, interpersonal attachment and identity as measured by family role behavior. One hundred fourteen undergraduate students in a southern state university were assessed for functionality of family of origin using the Family Functioning Scale, interpersonal attachment using the Bell Object-Relations Inventory, and identity using the Children's Roles Inventory. A significant relationship was predicted. Scores were also compared for gender differences. Significant differences were, again, expected. A canonical correlation revealed a significant relationship between family role behavior, interpersonal attachment and family functioning. One significant factor was observed (R2 = .81, chi2 (N = 114) = 134.07, df = 40, p < .0001). Four separate multiple linear regression equations were then employed to determine the predictive ability of factors of family functioning and interpersonal attachment on each family role (hero, scapegoat, mascot and lost child). All four equations were found to be significant (p < .01). MANOVA revealed no significant differences between gender on any scores. Results and implications are discussed. Deason, D. M., & Randolph, D. L. (1998). A systematic look at the self: The relationship between family organization, interpersonal attachment, and identity. Journal of Social Behavior & Personality, 13(3), 465-478. Questioned whether a relationship exist between (1) family role behavior as measured by the Children's Role Inventory and (2) family functioning as measured by the Family Functioning Scale (FFS), interpersonal attachment characteristics as measured by the Bell Object Relations Inventory (BORI), and gender. 114 college students (mean age 24.17 yrs) completed the above instruments. One canonical root was found to be significant. All 4 family-role factors of the CRT, all 4 interpersonal attachment variables of the BORI, and 3 interpersonal attachment variables of the FFS were highly correlated with the 14 For abstract, see citation listing in Axis I: Eating Disorder Studies 52 canonical variable. A multivariate analysis of variance (MANOVA) for CRT subscales scores revealed no gender differences. Goldman, G. A. (2005). Quality of object relations, security of attachment, and interpersonal style as predictors of the early therapeutic alliance. College of Arts and Sciences at Ohio University, Athens. The therapeutic alliance is consistently related to treatment outcome, and therefore represents an important aspect of how and why psychotherapy is effective. In the present study, security of attachment, quality of object relations, and interpersonal style were measured as predictors of the alliance early in treatment. Forty-eight individual psychotherapy clients were administered the Revised Adult Attachment Scale (AAS), the Bell Object Relations and Reality Testing Inventory (BORRTI), and the Interpersonal Adjective Scales-Revised (IAS-R) prior to their initial therapy session. Participants completed the Working Alliance Inventory (WAI) following their first, second, and third sessions. Security of attachment and quality of object relations were related to the alliance at session one, while quality of object relations was no longer related to the alliance at session two, and none of the predictors were related to the alliance at session three. Early therapeutic alliance appears to be influenced by interpersonal attachment and object relations. Goldman, G. A., & Anderson, T. (2007). Quality of Object Relations and Security of Attachment as Predictors of Early Therapeutic Alliance. Journal of Counseling Psychology, 54(2), 111-117. Security of attachment and quality of object relations were measured as predictors of initial impressions of the therapeutic alliance as well as dropout. Fifty-five individual psychotherapy clients were administered the Revised Adult Attachment Scale and the Bell Object Relations and Reality Testing Inventory prior to their initial therapy session. Thirty of these participants completed the Working Alliance Inventory following their 1st, 2nd, and 3rd sessions. Security of attachment and quality of object relations were strongly related. Security of attachment and quality of object relations showed relations to early alliance that decreased over time. Attachment and object relations were not related to dropout. Limitations include small sample size and low research compliance rate. Gussoni-Leone, F. M. A. (2003). Relationships of object relations functioning, attachment security and self-representations to the adult relatedness of college students. Dissertation Abstracts International: Section B: The Sciences and Engineering, 64(2-B). This study examined the relationships of Adult Relatedness variables (Liking/Respect, Trust in Partner's Devotion, Intimate Disclosure, Emotional Attachment, Negativity) to Object Relations Functioning (Alienation, Insecure Attachment, Egocentricity, Social Incompetence), Attachment security (IPPA Mother, IPPA Father), and Continuity and Integration of Self. Participants consisted of 340 first and second year male and female undergraduate psychology students from three universities in suburban New Jersey. The 53 Bell Object Relations Inventory (BORI, Bell et al., 1984, 1985, 1986) was employed to measure object relations functioning. The Inventory of Parent and Peer Attachment (IPPA, Armsden and Greenberg, 1987) was utilized to measure secure attachment. In this study, secure attachment was measured by the participants' perceived relationship to both their mother and father, not to their peers. The Relationship Experience Scale (RES; Cooke, 1996) was used to measure adult relatedness. The Continuity and Integration of Self (CISS; Wiss, 1991) was used to measure continuity and integration of self. Stepwise multiple regression analysis was used to analyze the hypotheses. To analyze these hypotheses, 5 separate regression analyses were conducted, one for each component of Adult Relatedness (Liking/Respect, Trust in Partner's Devotion, Intimate Disclosure, Emotional Attachment, and Negativity). In each regression, the Adult Relatedness component was the dependent variable and the Object Relations scales (Alienation, Insecure Attachment, Egocentricity, Social Incompetence), Attachment Security scales (IPPA Mother, IPPA Father) and the Continuity and Integration of Self scale scores were the independent variables. To determine whether or not gender differences exist on the Adult Relatedness, Object Relations, Attachment Security, and Continuity and Integration of Self variables, a Multivariate Analysis of variance was conducted. The findings of this present study demonstrated that an individual's way of relating with others, the degree or level of maturity of one's object relations functioning, and level of identity integration (Bell et al., 1987) showed significant zero-order correlations which cross-validated Cooke's (1996) and Wiss' (1991) study but the direction of the relationships were different. These findings were less supported in the multivariate analyses. Heiss, G. E., & Berman, W. H. (1996). Five scales in search of a construct: exploring continued attachment to parents in college students. Journal of Personality Assessment, 67(1), 102115. *** The multitude of measures and differences across self-report indices of continued parental attachment raise questions regarding the validity and meaning of these scales. The purpose of this study was to examine the convergent and construct validity of 5 measures of continued parental attachment. Five attachment scales and 6 personality scales were administered to 216 undergraduate students. Factor analyses and correlational analyses indicate that the 5 attachment measures differentiate healthy from pathological bonding with parents, the construct being assessed has multiple dimensions, and scores on these attachment measures are correlated with personality variables as would be expected. These attachment scales appear to assess a construct that is related to attachment, although they may be more illustrative of the general affective quality of relationships. Subsequent assessment efforts should employ more specific ratings and measure concrete behavioral manifestations of attachment to most effectively examine the construct. Jason, K. A. (1998). The effect of positive sibling relationships on object relations and attachment styles of adult children of divorce. Adelphi University, the Inst of Advanced Psychological Studies, New York. 54 This study focused on the effect of positive sibling relationships on the adult children of divorce as measured in terms of object relations and attachment styles. The 130 respondents were all undergraduate students at a small northeastern college. All subjects received renumeration for their time. Four measures were used: (1) The Bell Object Relations and Reality Testing Inventory (2) The Relationship Scales Questionnaire (3) The Brother-Sister Questionnaire and (4) a Demographic Questionnaire. It was hypothesized that those subjects with positive sibling relationships whose parents were divorced would have more secure attachment styles and better object relations than those subjects whose parents had divorced and who did not have positive sibling relationships. Differences were not expected for subjects from intact families regardless of the quality of their sibling relationship. While none of the hypotheses addressing how the relationship between sibling relationships, intact family status and more secure attachment styles and object relations were substantiated in a significant way, trends in the hypothesized direction suggest that further research into this area is indicated. Perhaps even more significant are the ancillary findings which provide evidence that both quality of sibling relationship and family status, when looked at as single entities, rather than in interaction with each other, are predictive of secure attachment styles. Johnson, S. H. (1995). Attachment and object relations among bulimic college women. California School of Professional Psychology, Berkeley/Alameda.15 Mallinckrodt, B., Porter, M. J., & Kivlighan, D. M., Jr. (2005). Client Attachment to therapist, depth of in-session exploration, and object relations in brief psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 42(1), 85-100. Two studies explored attachment in psychotherapy. In the 1st study, clients (N=38) in time-limited therapy completed the Experiences in Close Relationships Scale as a measure of adult attachment, the Client Attachment to Therapist Scale (CATS), Working Alliance Inventory (WAI), and measures of session depth and smoothness. Consistent with J. Bowlby's (1988) concept of a secure base promoting greater exploration, secure attachment to therapist was significantly associated with greater session depth and smoothness. Insecure adult attachment was associated with insecure therapeutic attachment. CATS subscales predicted unique variance in session experience not accounted for by the WAI alone. The 2nd study was a new analysis of data originally reported by B. Mallinckrodt, D. L. Gantt, and H. M. Coble (1995). Among women clients (N=44) who completed the CATS, WAI, and the Bell Object Relations and Reality Testing Inventory, 2 CATS subscales predicted unique variance in object relations deficits not accounted for by the WAI alone. McLaughlin, J. T. (1992). Relationship of God-construct complexity, God-image, emotional attachment, and worldview orientation to psychological health. University of Southern Mississippi, Hattiesburg. Relationship between the quality of personal regard for one‘s God and psychological status on a measure of symptomatic severity of mental distress indicators were explored 15 For abstract, see citation listing in Axis I: Eating Disorder Studies 55 in two separate samples: university students (N=214) and Veterans Administration patients (N=42). The divine relationship, assumed to be oriented primarily by the nature of one‘s ―God-construct‖, was construed as a multi-dimensional feature having philosophical, affective, conceptual, and structural components. Regression and correlational analyses revealed that human affective dimension (emotional attachment style) varied significantly with psychological status, such that greater insecurity was associated with psychological distress. Philosophical (worldview orientation) and divine affective (God-image) dimensions also associated with psychological status, but weakly so. Additionally, worldview orientation was hypothesized to be moderated on psychological status by God-construct structural complexity, God-image, and human emotional attachment, respectively, but results revealed that the emotional attachment block of subscales alone mediated – rather than moderated – its association. Because human emotional attachment contributed independently among the predictor variables to psychological status variance, it was concluded that affective regard for one‘s god and human emotional attachment style function relatively independent of one another. Implications of these findings for counseling and psychotherapy are offered. McNamara, P., Andresen, J., Clark, J., Zborowski, M., & Duffy, C. A. (2001). Impact of attachment styles on dream recall and dream content: a test of the attachment hypothesis of REM sleep. Journal of Sleep Research, 10(2), 117-127. We tested the hypothesis (McNamara 1996;Zborowski and McNamara 1998) that dream recall and dream content would pattern with interpersonal attachment styles. In study I, college student volunteers were assessed on measures of attachment, dream recall, dream content and other psychologic measures. Results showed that participants who were classified as ‗high‘ on an ‗insecure attachment‘ scale were significantly more likely to (a) report a dream, (b) dream ‗frequently‘, and (c) evidence more intense images that contextualize strong emotions in their dreams as compared with participants who scored low on the insecure attachment scale. In study II, 76 community dwelling elderly volunteers completed measures of attachment, and dream recall. Participants whose attachment style was classified as ‗preoccupied‘ were significantly more likely to report a dream and to report dreams with higher mean number of words per dream as compared with participants classified as ‗securely‘ attached or as ‗avoidant‘ or as ‗dismissing.‘ Dream recall was lowest for the avoidant subjects and highest for the preoccupied subjects. These data support the view that rapid eye movement (REM) sleep and/or dreaming function, in part, to promote attachment. Nilsson, K. E. (1995). Relation of adult attachment style, object relations, and therapeutic factors to early indications of group cohesiveness. University of Oregon, Eugene. This study examined the relationships among individuals' expectations regarding personal relationships, endorsements of group therapeutic factors, and perceptions of group cohesiveness in the first week of therapy group development. Expectations regarding personal relationships were measured using the Adult Attachment Scale (AAS) and the object relations subscales of the Bell Object Relations--Reality Testing Inventory (BORRTI). Indications of group cohesiveness were measured using the Group Climate 56 Questionnaire--Short Form (GCQ-S) and the Group Attitude Scale (GAS). Therapeutic factors were assessed through self-reports using a critical incident methodology. Critical incidents were sorted into three classes--cognitive, affective, and behavioral--using the taxonomy developed by Bloch and Reibstein. Survey data were collected from 38 student clients as they began attending therapy groups at three university counseling centers. Results indicate no significant relationships between class of therapeutic factor and individual attachment style or object relations capacity. Similarly, no significant relationship was found between class of therapeutic factor and perceived group climate. Results indicate a trend in the data (p <), with perceived attraction-to-group, as measured by the GAS, related to class of therapeutic factor. Specifically, attraction-to-group may be lowest when behavioral therapeutic factors were reported. In addition, therapy groups were classified into two types depending on whether they had an identified topic (e.g., eating disorders, dysfunctional families) or were general therapy groups. Findings suggest a trend in the data (p <), with topical groups possibly perceived as more attractive than general groups. Test-retest reliabilities of the AAS and BORRTI are also reported. Finally, research results relating to the construct validity of the survey instruments used in this study are reported and discussed. Reese, R. J., Kieffer, K. M., & Briggs, B. K. (2002). A reliability generalization study of select measures of adult attachment style. Educational and Psychological Measurement, 62(4), 619-646.*** The concept of attachment has been discussed and debated in the psychological literature for quite some time. More recently, the concept of attachment has been extended to adults, and several measures that purport to measure attachment style have been developed. The purpose of the present study was to provide a reliability generalization study of five of the most prominent adult attachment style measures. Reliability generalization, a relatively new meta-analytic reliability procedure, was used to (a) identify the typical reliability of scores across instruments and studies and (b) examine sources of measurement error across instruments and studies. Results from this investigation of 154 previously published research studies indicated that the average score reliability across studies varied considerably across instruments and subscales. Implications for the use of self-report measures of adult attachment style are offered. Roberts, K. K. (1998). The relationship between adult attachment styles and Masterson's delineation of personality disorders. George Fox University, Newberg.16 Roche, D. N. (2000). Attachment and object relations: Mediators between child sexual abuse and women's adjustment. University of Victoria, Canada.17 Sack, A., Sperling, M. B., Fagen, G., & Foelsch, P. (1996). Attachment style, history, and behavioral contrasts for a borderline and normal sample. Journal of Personality Disorders, 10(1), 88-102. 18 16 17 For abstract, see citation listing in Axis II: Personality Disorders For abstract, see citation listing in Axis I: Abuse and Trauma Studies 18 For abstract, see citation listing in Axis II: Personality Disorders 57 Sayer, P. C. (2002). Responses of individuals with posttraumatic stress disorder to eye movement desensitization and reprocessing or a cognitive-behavioral treatment as mediated by attachment status. Alliant International University, Fresno.19 Selby, C. L. B. (2000). The relationship of false self behavior to object relations, attachment, and adjustment. Unpublished Dissertation, University of North Texas, Denton. The focus of this investigation is to assess the relationship between false self behavior, object relations and attachment variables, and adjustment. Theory suggests that object relations and attachment are interrelated, and have been independently linked to psychological consequences. Theory also postulates a relationship between false self behavior and object relations theory. Given the interrelatedness of object relations and attachment theory it is possible that false self behavior may also be linked to attachment variables. While the relationship between object relations and false self behavior seems to have been established object relations theory and attachment theory have not been studied in tandem as related to false self behavior. In addition, this investigation will explore the relationship of adjustment variables to attachment and object relations variables. Undergraduate males and females will be solicited for participation, and will be asked to complete self-report questionnaires measuring false self behavior, object relations, attachment, and adjustment. The primary research hypothesis is that less false self behavior will be related to mature object relations, secure attachment, and fewer symptoms. Terletzky, D. L. (1995). Attachment quality and attachment style as predictors of level of hopelessness among inpatients in a pacific northwest private psychiatric hospital. George Fox College, Newberg. Attachment theory was used to evaluate the concepts of attachment quality and attachment style in predicting level of hopelessness in an adult inpatient population sample utilizing multiple linear regression analysis. In addition, a previous study was replicated for comparison purposes using the same sample, where nine demographic variables were used to attempt to predict level of hopelessness, also utilizing multiple linear regression analysis. From a private psychiatric hospital in the Pacific northwest, 94 newly admitted patients were administered instruments to measure level of hopelessness, attachment quality, and attachment style. The Beck Hopelessness Scale (HS), Bell Object Relations Inventory (BORI), and Adult Attachment Types (AAT) were used as measurements respectively. Through the use of stepwise multiple linear regression analyses, two significant regression equations were produced. Alienation, secure attachment, and sex combined to predict 52% of the variance of the hopelessness measure from theory-based variables, while sex, living with children only, and level of education combined to predict 12% of the variance of the hopelessness measure from demographicbased variables. Analogous statistical results were reported for each regression equation, as well as the unique contribution and statistical significance for each variable which remained in the equations. The results of the two equations were compared, and indicate 19 For abstract see citation listing in Axis I: Abuse and Trauma Studies 58 that attachment theory concepts are better able to predict level of hopelessness than are demographics alone. Further, attachment theory was supported in that a reflection of one's internalized working models from early development were greatly able to predict level of hopelessness during crisis, specifically that a poorer quality of attachment experience was synonymous with a higher level of hopelessness. Implications and suggested future research were discussed. Family Studies Deason, D. M. (1998). A systemic look at the self: The relationship between family organization, interpersonal attachment and identity. University of Southern Mississippi, Hattiesburg.20 Deason, D. M., & Randolph, D. L. (1998). A systematic look at the self: The relationship between family organization, interpersonal attachment, and identity. Journal of Social Behavior & Personality, 13(3), 465-478.21 Farrar, V. (1996). Object relations of incest survivors. Adelphi U, the Inst of Advanced Psychological Studies, New York. This project was undertaken in an effort to contribute to the understanding of the effects of father/daughter incest on object relations. Sixty adult female outpatients made up the sample for this study, 29 who had experienced father/daughter incest in childhood and 31 who had experienced no incest in childhood. Each participant completed the Rorschach and a set of self-report measures, including demographic and sexual history questionnaires, as well as a revision of the McMaster Family Assessment Device (FAD) (Epstein, Baldwin, & Bishop, 1982), the Brief Symptom Inventory (BSI) (Derogatis, 1975), and the Bell Object Relations and Reality Testing Inventory (BORRTI) (Bell, 1991). The Rorschach was scored using the Developmental Analysis of the Concept of the Object Scale (DACOS), as developed by Blatt, Brennis, and Schimek (1976a). This study found that the incest survivors experienced significantly more difficulty than the controls with issues of trust in intimate relationships, as measured by the Alienation subscale of the BORRTI. Because of this, they may have more unstable and/or superficial relationships and they may remain more isolated than controls. Their level of current distress is higher (as measured by the BSI) and they describe their family's functioning (FAD) as more pathological. Level of object relations, as operationalized by the Alienation subscale on the BORRTI, was predictive of subjects' report of family pathology. And level of object relations, as measured by Alienation and Insecure Attachment on the BORRTI, was predictive of level of overall current distress. Results indicating investment in fantasied rather than realistic relationships 20 21 For abstract, see citation listing in Non-Psychiatric: Attachment Studies For abstract, see citation listing in Non-Psychiatric: Attachment Studies 59 Hadley, J. A., Holloway, E. L., & Mallinckrodt, B. (1993). Common aspects of object relations and self-representations in offspring from disparate dysfunctional families. Journal of Counseling Psychology, 40(3), 348-356. Surveyed 97 adults self-identified as coming from dysfunctional families. Although level of family dysfunction was generally high, no significant differences were observed between adult children of alcoholics and adults from families whose dysfunction was not due to substance abuse. Degree of family dysfunction was significantly associated with internalized shame, object relations deficits, and presence of addictions and emotional problems. Hansen, J. T. (2000). Human responses in assessing object relations subscales of the Psychoanalytic Rorschach Profile. Psychological Reports, 87(2), 675-676. *** Notes that the Rorschach test is often used to assess object relations. This study examined whether human responses are necessary for a valid assessment. 15 inpatients with paranoid schizophrenia, 15 inpatients with major depressive disorder, and 15 nonhospitalized Ss were administered the Rorschach test, which was scored using the Psychoanalytic Rorschach Profile and the Bell Object Relations Reality Testing Inventory. Results show that the object relations subscales on the Psychoanalytic Rorschach Profile did not discriminate diagnostic groups known to have distinctive patterns of object relations. No correlation was found between these subscales and scores on the Bell inventory. It is concluded that the Psychoanalytic Rorschach Profile object relations scales are probably not valid measures of object relations. Jason, K. A. (1998). The effect of positive sibling relationships on object relations and attachment styles of adult children of divorce. Adelphi University, the Inst of Advanced Psychological Studies, New York.22 Kossar, M. D. (1999). Interpersonal issues of nonhospitalized adult adoptees: The influence of age at time of adoption on the perception of relationships. Allegheny U Health Sciences, US. The present study was designed to investigate the role of age at adoption in nonhospitalized adult adoptees on several measures of interpersonal relating and psychological functioning. Two groups of adult adoptees, those adopted before the age of 6 months (n = 50) and those adopted after the age of 1 year (n = 49), were utilized. Subjects ranged in age from 25 to 67 years old. It was first hypothesized that on a measure of interpersonal relatedness, the Bell Object Relations and Reality Testing Inventory (BORRTI), those adoptees adopted before the age of 6 months would have more adaptive or flexible views of others than those adopted after the age of 1 year. Adoptees adopted after 1 year may have experienced more adverse early attachment histories, which then may lead to less flexible or developed perceptions of relationships as adults. A one-way MANOVA revealed that the two groups of adoptees were significantly different on two of the four subscales of the BORRTI. On both the 22 For abstract, see citation listing in Non-Psychiatric: Attachment Studies 60 Alienation and Egocentricity subscales of the BORRTI, the adopted-after-1-year-group demonstrated less flexible and less developed object relations functioning than the adopted-before-6-months group. It was also hypothesized that the two adoptee groups would differ on two measures of attachment. Most of the analyses indicated a lack of differences on the attachment measures. Finally, it was hypothesized that on a measure of psychological distress, the Global Severity Index (GSI) of the Symptom Checklist-90Revised (SCL-90-R), that those adopted after 1 year would be more distressed than those adopted before 6 months. T-tests performed separately on the GSI for both males and females revealed that there were differences between the two adoptee groups only for the male adoptees, with the adopted after 1 year male adoptees reporting more psychological distress than those males adopted before 6 months. Research should be conducted to further examine the interpersonal repercussions of adoption with larger, more diverse samples of adoptees. Riebeling, C. L. (1997). Perceptions of relatedness: Patterns of association between appraisals of childhood and contemporary relationships. University of Virginia, Charlottesville. Previous research suggests that people maintain internal working models of relationships (IWM's), which are influenced by earlier relationship experiences and which impact contemporary ones. This study examined self-report measures of early relationships (Parental Bonding Instrument and Maltreatment Scales) and contemporary relationships (Bell Object Relations Inventory, Reciprocal Attachment Questionnaire, and Adult Attachment Scale) to develop a composite measure of IWM's and to map the variance among subjects' relationship appraisals. Ninety-seven subjects reported their appraisals of: childhood relationship with parents, current relatedness, and marital status (Quality of Relationships Inventory and Parenting Alliance Inventory). A composite measure of subjects' IWM's was developed from appraisals of current relatedness and was found to be related to appraisals of both childhood and marital relationships. Mixed model regression analyses were conducted to examine the explanatory power of subjects' IWM's and appraisals of childhood relationships in association with marital status. The results suggest that subjects' IWM's and relationships with same-sex parent were significantly associated with their appraisals of their marital relationship. Parallel regression analyses were also conducted to examine the predictive power of one spouse's IWM and appraisals of childhood relationships in relation to his or her partner's assessment of the marriage. Husbands' reported maternal care was a statistically significant predictor of their wives' appraisals of the marriage. For men, their marital appraisals co-varied with their wives' IWM's and reported maternal care. These findings suggest that appraisals of both childhood and contemporary relationship experiences make significant contributions to explaining the variance associated with marital status. Schwartz, L. S. (1995). Parental divorce, conflict, and bonding: Impact on object relations and intimacy in men and women. Dissertation Abstracts International: Section B: The Sciences and Engineering, 56(3-B). The impact of childhood parental divorce, family conflict, and parental bonding on interpersonal relatedness was investigated in 209 females and 99 males (204 from intact 61 families, 104 from divorced families) who completed four measures, two of interpersonal relatedness: the (1) Bell Object Relations Inventory (Bell, 1991) consisting of four subscales, Alienation (ALN), Insecure Attachment (IA), Egocentricity (EGC), and Social Incompetence (SI), and (2) Fear-of-Intimacy Scale (Descutner & Thelen, 1991), and two measures of family process; the (1) Family Environment Scale Conflict Subscale (Moos & Moos, 1986), a measure of family conflict, and (2) Parental Bonding Instrument (Parker, Tupling, & Brown, 1979), consisting of four subscales, Mother Care and Protection, Father Care and Protection. A 2 (Family Structure--intact or divorced) x 2 (Family Conflict--low or high) x 2 (Gender) multivariate analysis of variance (MANOVA) was performed on the five dependent measures (ALN, IA, EGC, SI, FOI). The MANOVA results revealed that high family conflict subjects had statistically significant higher scores on all dependent measures than low family conflict subjects, whereas divorced and intact family subjects did not differ on any of the dependent measures. In addition, the significant family structure by family conflict interactions revealed that high conflict divorced family subjects scored significantly higher on: (1) ALN than high conflict intact, low conflict intact, and low conflict divorced family subjects, (2) SI than low conflict intact and low conflict divorced family subjects, and (3) FOI than low conflict divorced family subjects. The only significant gender differences were that females were lower than males in SI and FOI. To assess the effect of parental bonding, Mother Care and Protection, and Father Care and Protection were included with the previously mentioned variables in multiple regression analyses on the five dependent variables. Simpao, E. B. (2000). Parent-child separation and family cohesion amongst immigrants: Impact on object relations, intimacy, and story themes. Long Island University, Brookville.*** The impact of parent-child separation due to immigration and family cohesion on object relations, motivation for intimacy, and narrative themes of parental absence and rejection was investigated. Eighty-nine females and 35 males were recruited from universities and colleges and categorized into four groups: (a) immigrants who experienced parent-child separation (n = 31); (b) immigrants who came to the U.S. with parents (n = 32); (c) U.S.born subjects from divorced families (n = 31); and (d) U.S.-born subjects from nondivorced families (n = 30). Subjects completed five measures: (1) the Bell Object Relations and Reality Testing Inventory - Form O (Bell, 1991); (2) the Family Environment Scale (Moos & Moo s, 1986); (3) the Schedule of Recent Events (Holmes & Rahe, 1967); (4) a demographics survey; and (5) six stories based on the Thematic Apperception Test (Murray, 1943). The stories were analyzed according to the Motivation for Intimacy Scale (McAdams, 1980), the "Moving Away From" subscale from Fine (1955), and the "Absence of Parent" subscale from Murray (1938). It was hypothesized that immigrants who experienced parent-child separation would report lower object relations, lower intimacy, and more rejection and absence themes as compared to immigrants who came to the U.S. with their parents. No significant differences were found. It was also hypothesized that immigrants from families in which parent-child separation occurred would report less family cohesion. This was not supported. However, a third hypothesis stating that immigrant subjects who experienced higher family cohesion would report higher object relations and motivation for intimacy 62 was partially supported. Subjects from cohesive families reported better object relations. The U.S. born groups allowed comparisons that highlighted the impact of separation and immigration. Additional analyses that explored the effect of demographic variables, such as sex and race, did not reveal significant differences. Results were discussed in relation to current theory and research on the effects of parent-child separation. Presumptions that such early separations would lead to impaired adult personality structures were not borne out. It appears that adults who immigrated when they were children are not affected by immigration pattern. Stuppy, L. J. (1996). The relationship between dissociation and object-relations impairment in adult female incest survivor clients with and without personality splitting. Andrews University, Berrien Springs.23 Parent-Child Relationships Abrams, S. A. (1995). Breast feeding duration and object representations. Dissertation Abstracts International: Section B: The Sciences and Engineering, 56(3-B). This study examined the relationship between breast feeding duration periods and object relations and representations. Subjects in this study were 200 female college and graduate students and their mothers. Participants responded to a series of questionnaires. Mothers completed the following instruments: The Bell Object Relations Inventory, Maryland Parent Attitude Survey and a Breast Feeding Questionnaire constructed by the author. Subjects completed the Bell Object Relations Inventory and the TAT. They were also asked to complete a paragraph describing their mothers. The results of this study suggest that individuals breast fed from 6-12 months evidenced a significantly higher level of complexity of object relations than those breast fed for 13 or more months. Also, individuals fed on a flexible schedule evidenced a significantly higher level of complexity of object relations than those breast fed on a more rigid schedule. No other significant relationships between object relations and breast feeding were demonstrated. Nor was there a significant correlation between the object relations of mothers and daughters. Angus, J. M. (2007). Parents of children with Asperger Syndrome: Relationships between early attachment, ego functioning, and parenting behaviors. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68(4-B).24 Aylor, A. R. (1995). The relationship between maternal object representations, infant temperament and security of attachment. Dissertation Abstracts International: Section B: The Sciences and Engineering, 56(5-B).25 23 24 For abstract, see citation listing in Axis II: Personality Disorder For abstract, see citation listing in Axis I: Miscellaneous 25 For abstract, see citation listing in Non-Psychiatric: Attachment Studies 63 Barlev, A. (2005). Object relations as a mediator between childhood traumas, parental caregiving and young adult adjustment. Michigan State University, East Lansing.26 Blank, L. W. (1996). The relationship between the holocaust and object relations in adult children of holocaust survivors. Adelphi U, the Inst of Advanced Psychological Studies, New York. Given the wide variety and quantity of opinions put forth regarding the effects of the holocaust on both survivors and their children, this study attempted to examine the effects of the holocaust on object relations in children of holocaust survivors. Measures included a Demographic Questionnaire and Semantic Differential, both developed by the researcher, as well as the Bell Object Relations Reality Testing Inventory and the Rorschach. The Rorschach was scored using the Mutuality of Autonomy Scoring System, an object relations system developed by Urist. Sixty-eight subjects (35 children of survivors and 33 controls) participated in the study. All target groups subjects were required to have either both parents, or mothers only, as holocaust survivors. Most target groups subjects were children of two holocaust survivor parents (N = 30). As predicted, subtle differences in object relations were found on the Rorschach, with children of survivors reporting greater dependency on objects than controls. Children of survivors also saw a greater number of pathological objects on the Rorschach, reflecting a more intimate relationship with evil and disturbed objects. There were no differences between the two groups in their perception of themselves in social relationships and interactions, nor were any differences found in overall levels of psychopathology. These findings are believed to reflect not the children of survivors' greater dependency on objects, but rather their parents greater reliance on them for emotional support throughout their childhoods. This caused children of survivors to assume a caretaking position in relation to their parents, feeling greater responsibility for their emotional health and well being. Brooks, S. D. (2005). An investigation into the object relations, self-esteem and separationindividuation process of black females from father present and father absent backgrounds. City University of New York, New York. This study examined the effects that black fathers, either through their presence or absence, have on their daughters' psychological functioning in late adolescence and early adulthood. The psychological phenomena understudy were levels of object relations, selfesteem and separation-individuation, which were measured using the Bell Object Relations Inventory (BORI), the Separation Individuation Test of Adolescence (SITA) and the Rosenberg Self-Esteem Scale (RSES). It was hypothesized that women from father absent backgrounds would have poorer object relations, lower self-esteem and be less separated and individuated. Subjects consisted of 35 black females, assigned to either a father present group (N = 25) or a father absent group (N = 10) based on the amount of contact they had with their fathers in childhood. All subjects in the father present group had at least biweekly contact with their fathers. Subjects in the father absent group had only monthly or less frequent contact with their fathers. All subjects had low to minimum levels of family violence which was a study criterion. Biological, step and surrogate 26 For abstract, see citation listing in Axis I: Abuse and Trauma Studies 64 fathers were all included in this study. Both multivariate and univariate t-tests were performed as well as a statistical test of effect size (partial eta squared) on the three dependent measures. No hypothesis was found to be significant and no significant difference was determined between the two groups at the p < .05 level. However, the test of effect size did find one meaningful difference between the two groups' means on the SITA dimension of rejection expectancy, suggesting that a father's absence from his daughter's life in childhood may cause her to have a higher expectation of being rejected by others later in life. This result, though, must be weighed against the fact that no other dimension of the SITA showed meaningful differences and the possibility that it was due to chance because of the small sample size. Discussion of the findings attributes the outcome of the study to the very small sample size. Given the importance of this topic, this study should be repeated using a much larger sample size. Cohen, J. S. (1997). Separating memory from hope: Patterns of object representation among adults who lost a parent in childhood or adolescence. Long Island U, Brooklyn Center, New York. This exploratory study examined the connection between the experience of losing a parent to death in childhood or adolescence and adult object relations. Variables were chosen and hypotheses formulated to acknowledge the contributions of the contrasting literatures of psychoanalysis and attachment. The sample consisted of 39 men and women (at least 19 years of age) who had lost at least one parent to death between the ages of 3 and 18. Subjects were administered a Demographic Information Sheet, the Parental Bonding Instrument (Parker, Tupling & Brown, 1979), a modified version of the Mourning Behavior Checklist (Murphy, 1986), a Bereavement Experience Questionnaire developed for this study, the Bell Object Relations and Reality Testing Inventory (Bell, 1991) and the Thematic Apperception Test (Murray, 1943, 1971), which was scored using the Social Cognition and Object Relations Scale: Q-Sort for Projective Stories (Westen, 1993). Stepwise multiple regression analysis identified the level of prompt and accurate information with which subjects recalled being told about their parents' death as the most significant correlate with increasingly mature object relations, as measured by the BORRTI. The memory of the quality of the relationship with the deceased parent correlated most significantly with the attribution of positive affect-tone to object representations, as assessed with the SCORS-Q. Contrary to expectations suggested by psychoanalytic theory, no effects were found for the age at which subjects were bereaved. A consideration of the narrative of bereavement and mourning in a cultural context was offered, along with a discussion of implications for clinical intervention with bereaved children and their families. Girard, C. (1997). Separation-individuation and affiliation in adult women: The impact of the early mother-daughter relationship on the quality of interpersonal relationships. Dissertation Abstracts International: Section B: The Sciences and Engineering, 57(9-B). Aiming at a fuller understanding of female psychological development, this study attempted an integration of two traditionally competing views of psychological development--relatedness versus autonomy--and thus examined the respective and 65 combined contributions of affiliation and separation--individuation to the quality of interpersonal relationships of adult women. Quality of interpersonal relationships was operationalized in two ways, as interpersonal closeness and perceived mutuality of the relationship. The sample consisted of 50 women between the ages of 30-45 whose mothers were still living, and who were screened with the Bell Object Relations Reality Testing Inventory (BORRTI) to be free of Axis-I and borderline psychopathology. In addition to taking the BORRTI, subjects completed a background questionnaire and four other self-report measures: the Psychological Separation Inventory, the Affiliative Tendency Scale, the Relationship Closeness Inventory, and the Mutual Psychological Development Questionnaire. Subjects then sat with the examiner to take the Rorschach test. The Separation-Individuation Theme Scale was applied to the Rorschach protocols. Findings indicated that non-white women reported their closest relationship to be more mutual than white women did. Married women reported their closest relationship to be closer than either single or divorced/separated women did. However, the findings failed to support both models of development. Separation-individuation and affiliation, either separately or combined, did not significantly predict either aspect of interpersonal relationships, over and above the effect of the demographic factors of ethnicity and marital status. Findings failed to support the predictions that greater affiliative tendency, greater conflictual independence from mother, and higher level of separationindividuation development would be positively related to a better quality of interpersonal relationship. Secondarily, it was determined that single women were more likely to have a more pronounced affiliative tendency than separated/divorced women. Also, older women were found to have greater independence from mother (less angry or resentful or anxious or guilty towards mother) than younger women. Methodological limitations were discussed especially in terms of the difficulties involved in measuring subtle differences among non-clinical individuals. Further research also seems warranted to explore further the link between the internal dimension of object relations and their behavioral expression. The lack of support for either view of development for adult women still represents valuable information as it may motivate further exploration of the validity and robustness of developmental theories elaborated from data gathered with the traditional and younger college student population. The need for future studies conducted with the larger dual theoretical framework was pointed out. Further exploration of the patterns of intercorrelations between measures of affiliation/attachment and measures of object relations stands out as a prime focus for further research and should lead to a better understanding of adult and female development. Hardwick, C. J., Hansen, N. D., & Bairnsfather, L. (1995). Are adult children of alcoholics unique? A study of object relations and reality testing. International Journal of the Addictions, 30(5), 525-539.27 Heiss, G. E., Berman, W. H., & Sperling, M.B. (1996). Five scales in search of a construct: Exploring continued attachment to parents in college students. Journal of Personality Assessment, 67(1), 102-115.28 27 28 For abstract, see citation listing in Axis I: Substance Abuse For abstract, see citation listing in Non-Psychiatric: Attachment Studies 66 Nikulainen-Levine, H. T. (1997). The impact of paternal suicide in childhood on women's adult love relationships. The Wright Inst, Berkeley. This study examined the impact of paternal suicide in childhood (between the ages of 2 and 12) on women's adult love relationships. The subjects were 27 heterosexual women whose fathers committed suicide and, as control groups, 31 women who lost their fathers through natural or accidental death (Natural Loss Group), and 26 women who grew up in intact families (Intact Family Group). It was hypothesized that women survivors of paternal suicide in childhood (1) have a perception of their fathers as more rejecting, (2) report more depressive experiences, and (3) experience more difficulties in adult love relationships with men than either the women who lost their fathers in childhood through natural death or the women from intact families. The daughters of fathers who committed suicide were hypothesized to (3a) have more difficulty with closeness in adult love relationships, (3b) be less able to depend on others, and (3c) be more sensitive to rejection and manifest more anxiety about abandonment. It was also predicted that the women who lost their fathers through natural death would report more depressive experiences and experience more difficulties in adult love relationships than the women from intact families. The following measures were used: the Parental Bonding Instrument (Parker, Tupling, & Brown, 1979), the Depressive Experiences Questionnaire (Blatt, D'Afflitti, Quinlan, 1976), the Bell Object Relations Inventory (Bell, Billington, & Becker, 1986), and the Adult Attachment Scale (Collins & Read, 1990). The results did not support the principal hypotheses in that no significant differences were found between the women in the Suicide Loss Group and the Intact Family Group on any of the variables selected for comparison. However, the results indicated that the women in the Natural Loss Group reported more depressive experiences, had more difficulty with closeness and dependency in relationships, and were more sensitive to rejection than either the women in the Suicide Loss Group or the Intact Family Group. The findings of this study suggest that early father loss by suicide has different implications for women's adult relationships than father loss by natural death. Schneider, G. K. (1997). Transgenerational effects of the Holocaust: Levels of object relatedness and intimacy in adult children of survivors. Adelphi University, the Inst of Advanced Psychological Studies, New York. It is almost universally acknowledged that the aftermath of World War II has left enduring wounds on Holocaust Survivors and that they continue to suffer from their experiences. The effects of the Survivor's past traumatization on their relationship with their children is believed to have deeply effected their children. In this study, 57 daughters of Holocaust Survivors (DOS) were compared with 45 daughters of parents who did not experience the Holocaust in any direct way (Controls) to see whether differences in levels of object relatedness, perception of parents, and fear of intimacy would be found. Subjects completed a demographic questionnaire, the Bell Object Relations Inventory, the Parent-Child Relations Questionnaire II (PCR-II) for each parent, and the Fear of Intimacy Scale. 67 Significant differences were found between the two groups on the Alienation and Insecure Attachment Subscales of the Bell, with DOS showing significantly more Alienation and Insecure Attachment. All subjects were, however, within normal range of functioning. No significant differences were found between groups on the Fear of Intimacy Scale. On the PCR-II, DOS perceived their fathers as significantly less loving and more rejecting than Controls. No significant differences were found between the two groups on any other factor of the PCRII. For DOS only, all of the Bell subscales correlated significantly with the Love/Reject factor for fathers of the PCRII; the more rejecting their perception of their fathers' behavior, the lower their levels of object relatedness. For both groups, only the Love/Reject factor of the PCRII for perception of mothers' correlated significantly with levels of object relatedness. A significant correlation between DOS' perception of their fathers as rejecting and fear of intimacy was found. This did not hold true for controls. No differences were found between groups on self-report ratings of relationships with their significant other or husband, their father, mother, children, or friends, suggesting that DOS are as able as Controls to form meaningful, satisfying relationships in their lives. Additionally, although they perceived their fathers as being rejecting towards them while they were growing up, their relationships with their fathers appear to have undergone a healing process. Simpao, E. B. (2000). Parent-child separation and family cohesion amongst immigrants: Impact on object relations, intimacy, and story themes. Long Island University, Brookville.29 Simnowitz, L. B. (1999). The relations among parental identification, levels of separationindividuation, and object relations among female adolescents. New York University, New York. The purpose of this study was to explore the relationships between parental identification, separation-individuation, and level of object relations for female adolescents. It was hypothesized that along with mothers, fathers have an important direct and indirect impact on a daughter's separation-individuation and on her level of object relations. Furthermore, this researcher hypothesized that a daughter's emulation, similarity, and admiration of each parent is a factor related to parental identification; that separation anxiety, engulfment anxiety and dependency denial form a factor that relates to separation-individuation; and that insecure attachment and alienation are a factor related to one's level of object relations. Thus the research consisted of both measurement and structural hypotheses. Subjects were 188 middle school females who participated by completing questionnaires. Parents completed demographic questionnaires. LISREL method of data analysis was used to explore the extent to which all measures were indicative of their latent variables (measurement model) and to explore the relationship 29 For abstract, see citation listing in Non-Psychiatric: Family Studies 68 between all latent variables (structural model). Parental identification was measured by the daughter's perception of her similarity to, admiration of, and emulation of each parent. Separation-individuation was measured by the Separation Individuation Test of Adolescence, and level of object relations was measured by scores on the Bell Object Relations Scale. Results showed that all of the measurement hypotheses were supported. However, only Mother-identification was found to have a significant direct impact on daughters' separation-individuation and a significant indirect impact on object relations. Additionally, Mother-identification had a small mediating effect when combined with Father-identification to indirectly influence daughters' separation-individuation levels. Though no support for a father's direct influence on his daughter's development was found, this study suggested that his indirect effect through the mother, appears to have some influence on his daughter's development. The results supported the notion that mothers still play a crucial role in female adolescent development, while a father's role appears to be indirect by supporting the original mother-child dyad. Future suggestions for research involving methodological changes and broadening the study to include marital relationship factors and parental-child relationship factors are proposed. Vendryes, D. M. (1999). When mothers decide whether or not to forego life-sustaining treatments for their children: A preliminary study of psychological correlates. University Miami, Miami. The purpose of this study was to determine whether intrapsychic factors could be identified that distinguished mothers who agreed to a Do-Not-Resuscitate (DNR) order from those who refused, and whether the model provided by object relations was a useful way to examine these factors. Twenty mothers volunteered to participate in a study that examined the presence of alienation and attachment insecurity, parental bonding, and the presence of a social support network. These mothers were recruited from a large pediatric hospital and from a long-term pediatric nursing facility. Alienation and insecure attachment were assessed by the Bell Object Relations and Reality Testing Inventory (Bell, 1991). Parental bonding was measured by the Parental Bonding Instrument (Parker, Tupling & Brown, 1979). The presence and adequacy of a social support network was measured by the Social Support Questionnaire (Sarason, Levine, Basham & Sarason, 1983). Analysis including t-tests, chi-square and discriminant function were performed on the data to determine differences between groups. Results indicated that significant differences existed on scales that measure alienation (an object relations concept) and uncertainty of perception (a reality-testing concept). Mothers who had refused the DNR had significantly higher scores on the alienation scale and on the uncertainty of perception scale than the mothers who agreed to the DNR. Conviction to religious beliefs also emerged as a significant difference between the groups, with the mothers who refused the DNR being more religious. The results do not support object relations theory. Watkins, K. E. (2002). Stress and depression in single African-American mothers as a function of their sons’ second separation in adolescence. Alliant International University, Fresno.30 30 For abstract, see citation listing in Axis I: Depression Studies 69 Personality Balestri, M. (1999). Overt and covert narcissism and their relationship to object relations, depression, Machiavellianism, and the five factor model of personality. Boston University, Massimo.31 Bell, M. D., Greig, T. C., Bryson, G., & Kaplan, E. (2001). Patterns of object relations and reality testing deficits in schizophrenia: Clusters and their symptom and personality correlates. Journal of Clinical Psychology, 57(12), 1353-1367.32 Bornstein, R. F., & Huprich, S. K. (2006). Construct validity of the Relationship Profile Test: Three-year retest reliability and links with core personality traits, object relations, and interpersonal problems. Journal of Personality Assessment, 86(2), 162-171. The Relationship Profile Test (RPT; Bornstein & Languirand, 2003) is a 30-item selfreport measure of destructive overdependence, dysfunctional detachment, and healthy dependency. Previous research has shown that the 3 RPT subscales have adequate internal consistency, good retest reliability over 23 and 85 weeks, and good convergent and discriminant validity with respect to measures of attachment style, relatedness, gender role, self-concept, alexithymia, locus of control, need for approval, and life satisfaction. In this investigation, we assessed the 3-year retest reliability of RPT scores in a northeastern liberal arts college student sample (Study 1) and evaluated the convergent and discriminant validity of RPT scores in a southern university sample (Study 2). Results generally supported the long-term stability and convergent and discriminant validity of RPT scores but also pointed to some limitations of the measure. We discuss implications of these results and describe future research directions. Hibbard, S. (1994). An empirical study of the differential roles of libidinous and aggressive shame components in normality and pathology. Psychoanalytic Psychology, 11(4), 449474. Eleven items from the Adapted Shame Rating Scale (Hobltizelle, 1987) and the Personal Feelings Questionnaire (Harder & Lewis, 1987) survived internal consistency analysis to construct a reliable (α = .96, Spearman-Brown corrected), two-factor (Disgraced/Humiliated and Bashful/Shy) Brief Shame Rating Scale. The first factor seemed to be a more malignant, aggressively determined form of shame; the second was a more benign, libidinously determined form. The two subscales significantly interact in predicting concomitant levels of psychopathology, level of shame, and narcissism. Consistent with psychoanalytic theory, dominance of the more aggressive Humiliated/Disgraced subscale is associated with psychopathology, shame, and narcissism. The findings suggest that healthy superego integration and identity formation are associated with a greater balance of libido and aggression. 31 32 For abstract, see citation listing in Axis I: Depression Studies For abstract, see citation listing in Axis I: Schizophrenia Studies 70 Hibbarb, S., & Porcerelli, J. (1998). Further validation for the Cramer Defense Mechanism Manual. Journal of Personality Assessment, 70(3), 460-483. This article presents psychometric properties of the Cramer Defense Mechanism Manual (Cramer, 1991b) for the Thematic Apperception Test (Murray, 1943). The developmental hierarchy of defenses originally postulated by Cramer was supported in this crosssectional sample. Gender differences and the validity of distinguishing between "mature" and "immature" levels of defense were also investigated. Findings for gender differences largely replicate those previously reported by Cramer (1987, 1991a). Results also support the view of a developmental hierarchy of defenses and the validity of distinguishing between mature and immature levels of two of the three types of defenses. Huprich, S. K., Stepp, S. D., Graham, A., & Johnson, L. (2004). Gender differences in dependency, separation, object relations and pathological eating behavior and attitudes. Personality and Individual Differences, 36(4), 801-811.33 Kelsey, R. M., Ornduff, S. R., Reiff, S., & Arthur, C. M. (2002). Psychophysiological correlates of narcissistic traits in women during active coping. Psychophysiology, 39, 322-332. Two dimensions of narcissism were related to psychophysiological responses to stress in 50 young women. Cardiovascular, electrodermal, task performance, and stress appraisal measures were recorded during rest, mental arithmetic, and a computerized Thematic Appreciation Test (Murray, 1943). The Egocentricity and Alienation scales of the Bell Object Relations and Reality Testing Inventory (Bell, 1995) served as measures of overt/inflated and covert/deflated narcissism. Egocentricity correlated consistently with heightened preejection period reactivity, whereas Alienation correlated consistently with diminished electrodermal reactivity (all p<.05). Multivariate analyses supported specific relationships between Egocentricity and preejection period hyperreactivity, and between Alienation and electrodermal hyporeactivity. These results have implications for narcissism, cardiovascular disease risk, and a variety of psychiatric disorders. Pomerantz, M. (1996). Relationships between borderline and narcissistic personality traits, and tolerance of ambiguity, aggression and assertion. California School of Professional Psychology, Los Angeles.34 Stiens, R. E. (1995). An assessment of the clinical utility of the Bell Object Relations-Reality Testing Inventory. California School of Professional Psychology, Fresno. The study investigated the clinical utility of the BORRTI administered in the context of additional MMPI-2 data. A primary objective of the study was to determine whether the combined use of the BORRTI and MMPI-2 provided a more comprehensive understanding of patient functioning. The clinical utility of the BORRTI was assessed by an evaluation of the relationship between profile elevations on the MMPI-2 clinical scales 33 34 For abstract, see citation listing in Axis I: Eating Disorders For abstract, see citation listing in Axis II: Personality Disorder Studies 71 and the BORRTI's object relations reality testing subscales. The BORRTI and MMPI-2 were administered to 90 subjects who presented for psychotherapy services at a private, outpatient clinic in Bakersfield, California. The inventories were administered to all subjects who provided consent as part of a standardized assessment protocol prior to assignment for an intake appointment. All completed inventories were computer scored and were available at the intake appointment to assist the clinician in assessing presenting concerns and establishing treatment goals. The results of the current study substantiated the potential clinical utility of administering the BORRTI in conjunction with the MMPI2 as a means of obtaining a more comprehensive understanding of an individual's personality functioning. The study found that an abnormal BORRTI was not predictive of a clinically significant MMPI-2, nor was a normal BORRTI predictive of a normal MMPI-2. These results suggest that the MMPI-2 and BORRTI provide mutually exclusive information and could not be used as screening instruments to restrict the administration of each other. While the current study did not find any definitive correlation between elevated MMPI-2 and BORRTI profiles, multiple correlations between MMPI-2 clinical scales and BORRTI subscales were noted. All seven of the BORRTI subscales were found to be correlated with MMPI-2 Scales 4, 6, 7, and 8. All of the BORRTI subscales, with the exception of the Hallucinations and Delusions subscale, were correlated with the MMPI-2 Scale 2 (Depression). Weich, S., Lewis, G., & Mann, A. (1996). Effect of early life experiences and personality on the reporting of psychosocial distress in general practice: A preliminary investigation. British Journal of Psychiatry, 168(1), 116-120. Tested the hypotheses that somatic presenters (SPs) report more difficulty with intimate relationships than psychological presenters (PPs), and that SPs describe their parents as less caring and more over-protective than the parents of PPs. 177 patients with a psychiatric disorder (aged 17-66 yrs), identified as SPs, PPs, and mixed Ss, were interviewed to assess their psychiatric morbidity. They completed the Parental Bonding Instrument to assess maternal and paternal behavior towards the Ss, and the Bell Object Relations Inventory to evaluate attitudes to intimate relationships with others. PPs reported greater insecurity in intimate relationships, and recalled their fathers as significantly less caring and more over-protective than SPs. These differences remained after adjusting for differences in the severity and duration of psychiatric symptoms. These findings do not support the hypotheses. Zborowski, M. J., Hartmann, E., Newsom, M. A., & Banar, M. (2003-2004). The Hartmann Boundary Questionnaire: Two studies examining personality correlates and interpersonal behavior. Imagination, Congnition and Personality, 23(1), 45-62. *** These studies investigated the relationship between the Boundary Questionnaire (BQ) [1] and measures of object relations (e.g., insecure attachment), interpersonal dependency, trait affect, and interpersonal behavior among undergraduate students. Study 1 (N = 300) examined the association between the BQ and four dimensions of object relations and two dimensions of interpersonal dependency, revealing predicted correlations with thin boundaries. Subsequent stepwise multiple regression revealed that insecure attachment 72 was singly predictive of thinner boundary score. Study 2 (N = 75) was designed as a replication and extension, assessing the same dimensions along with measures of trait affect. Results revealed that thinness was related to trait anxiety, insecure attachment, and interpersonal dependency, respectively. Subjects also participated in a semi-structured interview assessing three dimensions of interpersonal behavior, demonstrating an association between thinner boundary score and interviewer-rated openness, comfort, and positive valence. Stepwise multiple regression revealed that openness and insecure attachment respectively predicted boundary score, accounting for 31% of the variance. These data provide further construct validation for the BQ, and for the concept of thick vs. thin boundaries as a broad personality dimension. Psychoanalysis Armbrust, C. A. (1997). Measurement of the defensive use of splitting and related object relations deficits in a clinical population. University of Texas, Austin.35 Bell M.D., & Stiens, R.E. (1991). Ego function change through rehabilitation: A pilot study. Psychosocial Rehabilitation Journal, 14(3), 97-100. Does psychosocial rehabilitation affect underlying ego deficits? Twenty-five psychiatric patients were evaluated at the beginning of a 6-month inpatient rehabilitation program, the Veterans Resource Program, and again a year later, using the Bell Object Relations Reality Testing Inventory (BORRTI) and the Symptom Checklist-90 (SCL-90). No changes were found on SCL-90 indices of global symptom distress, though somatization, paranoia, and hostility symptoms increased. In the BORRTI, a significant improvement in the object relations dimension of social incompetence was found. Results suggest that rehabilitation may have remedial effects on specific ego deficits and that further study is warranted. Benveniste, P. S., Papouchis, N., Allen, R., & Hurvich, M. (1998). Rorschach assessment of annihilation anxiety and ego functioning. Psychoanalytic Psychology, 15, 536-566. *** This work illustrates the development, validation, and application of the Rorschach Content Scale (RCS; Hurvich, Benveniste, Howard, & Coonerty, 1993) for annihilation anxiety. Annihilation anxiety is defined here as the fear of one's impending psychic or physical destruction. Results reflected adequate RCS interrater reliability, content validity, construct validity, criterion validity, and divergent validity. Patient groups scored significantly higher on annihilation anxiety measures than did controls. Findings also demonstrated that certain aspects of RCS annihilation anxiety appeared more frequently than did others and may be more central to the construct. Results supported the contention that annihilation anxiety is associated with compromised ego functioning, when both are measured on the Rorschach. 35 For abstract, see citation listing in Axis II: Personality Disorder 73 Burns, B., & Viglione, D. J., Jr. (1996). The Rorschach Human Experience Variable, interpersonal relatedness, and object representation in nonpatients. Psychological Assessment, 8(1), 92-99. *** W. Perry and D. J. Viglione (1991) combined human representational variables from J. E. Exner's (1993) Comprehensive System in their Ego Impairment Index to create the Human Experience Variable (HEV). To validate the HEV, 105 nonpatient women completed the Bell Object Relations Inventory (M. Bell, 1991) and the Rorschach. Their spouses also rated the quality of these women's interpersonal relatedness by completing a modified Bell Object Relations Inventory and the Emotional Maturity Rating Form (H. Bessell, 1984). The HEV was significantly related to the quality of interpersonal relatedness, after considering Rorschach measures of psychopathology and "nonhuman" Rorschach images. Results indicate that representations of self and other accessed through the Rorschach account for unique variance in the prediction of the quality of interpersonal relationships, thus supporting the validity of the Rorschach and the concept of object relations. Farber, B. A., & Sacco, M. (1999). The relationship of repression to reality testing in adult women who report childhood sexual and physical abuse. Journal of the American Academy of Psychoanalysis, 27, 205-220.36 Hall, T. W., Brokaw, B. F., Edwards, K. J., & Pike, P. L. (1998). An empirical exploration of psychoanalysis and religion: Spiritual maturity and object relations development. Journal for the Scientific Study of Religion, 37(2), 303-313. The present study builds on the emerging body of empirical literature examining religion from a contemporary psychoanalytic perspective that is particularly informed by object relations theory. Such a perspective leads to the hypothesis of a positive relationship between spiritual maturity, defined relationally, and level of object relations development. In other words, it is proposed that the developmental maturity of one's faith and relationship with God is associated with the developmental maturity of one's relationship with others. Spiritual maturity was measured by the Spiritual Assessment Inventory and the Religious Status Inventory. Level of object relations development was measured by the Bell Object Relations Inventory. Results revealed 19 out of 20 significant correlations in the predicted direction between both measures of spiritual maturity and the measure of level of object relations development. Research and clinical implications are discussed. Hansen, J. T. (2000). Human responses in assessing object relations subscales of the Psychoanalytic Rorschach Profile. Psychological Reports, 87(2), 675-676. Notes that the Rorschach test is often used to assess object relations. This study examined whether human responses are necessary for a valid assessment. 15 inpatients with paranoid schizophrenia, 15 inpatients with major depressive disorder, and 15 nonhospitalized Ss were administered the Rorschach test, which was scored using the 36 For abstract, see citation listing in Axis I: Abuse and Trauma Studies 74 Psychoanalytic Rorschach Profile and the Bell Object Relations Reality Testing Inventory. Results show that the object relations subscales on the Psychoanalytic Rorschach Profile did not discriminate diagnostic groups known to have distinctive patterns of object relations. No correlation was found between these subscales and scores on the Bell inventory. It is concluded that the Psychoanalytic Rorschach Profile object relations scales are probably not valid measures of object relations. Hibbard, S. (1994). An empirical study of the differential roles of libidinous and aggressive shame components in normality and pathology. Psychoanalytic Psychology, 11(4), 449474.37 Sousa, S. (1997). The relationship between boundary permeability of psychoanalysts and their attitudes toward countertransference. Adelphi U, the Inst of Advanced Psychological Studies, New York. The present study investigated the relationship between boundary permeability of psychoanalysts and the ways in which they think of and use countertransference. An overview of past and current definitions of countertransference is presented. Kernberg's (1965) definitions of the "classicist" and "totalist" positions are discussed. A classicist is one who views countertransference as the analyst's unconscious reactions to a patient's transference, and feels that it is a hindrance to analysis. A totalist defines countertransference as encompassing all the analyst's feelings, conscious and unconscious, and feels that these feelings are a valuable source of information to the analyst about the patient. The concept of ego boundaries is, similarly, discussed. The present study correlated scores on the Attitudes Toward Countertransference questionnaire, (Mendelsohn, Bucci, & Chouhy, 1992), with scores on the Boundary Questionnaire, (Hartmann, 1991). Additionally, scores on the Insecure Attachment Scale of the Bell Object Relations - Reality Testing Inventory were correlated, as well as demographic variables. The following major predictions were made: (1) analysts with less permeability of boundaries would score consistently as "classicists" with regard to countertransference, (2) analysts with greater permeability of boundaries would score inconsistently with regard to their views versus their actual usage of countertransference, and (3) analysts with moderate permeability of boundaries would score consistently as "totalists". Although the major results were non-significant, a significant positive correlation was found between boundary permeability and attitudes toward countertransference. The correlation indicates that analysts with more permeable boundaries view and use countertransference from a more totalistic perspective than do analysts with little permeability. Implications for future research are discussed. Sexuality Studies 37 For abstract, see citation listing in Non-Psychiatric: Personality Studies 75 Deleonardo, L. A. (2000). An investigation of identity development, ego strength, and dyadic adjustment in lesbian women. Dissertation Abstracts International: Section B: The Sciences and Engineering, 61(2-B). Seventy-seven self-identified lesbian women currently in a romantic same-sex relationship completed the Stage Allocation Measure (Cass, 1984b), the Bell Object Relations Reality Testing Inventory (Bell, 1995), and the Dyadic Adjustment Scale (Spanier, 1976). Respectively, these measures ascertained each respondent's stage of lesbian identity development, level of ego strength, and level of dyadic adjustment. Statistical analyses of these three factors revealed that there is no support for the prevalent assumption in the psychological literature that women at higher stages of lesbian identity development demonstrate better psychological health or participate in more well-adjusted romantic relationships. Regression analysis demonstrated that ego strength and the age of first identifying self as lesbian uniquely predicted a significant amount of the variance in the dyadic adjustment scores in this study. This supported the hypothesis that higher levels of psychological health are predictive of higher levels of adjustment in romantic relationships. Models of lesbian identity development, specifically the model of Vivienne Cass (1984a), are looked at as transtheoretical devices that allow for explication of the process of coming out. These models emphasize increasing levels of disclosure of sexual orientation as progress through stages is made. Difficulties arise when these models are literally transposed onto clinical situations without a mediating clinical theory. The trends in the literature to elevate disclosure as the sine qua non of homosexual identity acquisition and to assert that secrecy is associated with less than optimal levels of psychological health and dyadic adjustment are seen as a result of this error. A subsequent risk is that lesbian women seeking psychotherapy will be urged to disclose their sexual orientation without careful clinical decisions being made about the appropriateness of that course of action. A psychodynamic theoretical orientation, which places ego functioning at the center of healthy psychological life, is described as the framework through which information from transtheoretical models should be examined. Additionally, implications for psychotherapy with lesbian women and future research directions are discussed. Ehlert, D. K. (2003). A comparison of psychologists who engage in nonsexual and sexual dual relationships with psychologists who do not. Dissertation Abstracts International: Section B: The Sciences and Engineering, 63(9-B). The purpose of this study was to examine and understand potential differences between psychologists who have engaged in a nonsexual and sexual dual relationship and psychologists who have not. Psychologists from across the United States (N = 59) completed questionnaires concerning object relations, parentification, narcissistic injury, self-esteem, and ethical judgment. Measures included a demographic questionnaire, the Bell Object Relations Inventory (BORI) with four subscales of alienation, insecure attachment, egocentricity, and social incompetence, the Parentification Questionnaire (PQ), the Narcissistic Injury Scale (NIS), the Rosenberg Self-Esteem Scale (RSE), the Ethical Judgment Scale (EJS), and four open-ended questions regarding the experience of being sanctioned. In regard to demographic characteristics, two significant differences 76 were found for the sanctioned groups. One, more males than females engaged in nonsexual and sexual dual relationships and two, there were more female than male client victims. Other notable demographic characteristics of the sanctioned groups include a mean age range at the time of the ethical violation of 45.6 years, 77% of the participants worked in private solo practice at the time of the ethical violation, and 25% of the nonsexual dual relationship group and 53% of the sexual dual relationship group were experiencing the loss of a significant relationship at the time of the ethical violation. A multivariate analysis of variance revealed no significant differences between group membership and the Bell Object Relations Inventory subscales. A multivariate analysis of variance revealed a significant main effect for group membership and the remaining measures (PQ, NIS, RSE, EJS). Subsequent analyses of variance revealed significant differences on the Narcissistic Injury Scale and Rosenberg Self Esteem Scale. Thus, the dual relationship groups reported more narcissistic injury in childhood and lower selfesteem than the control group. Multiple regression analyses revealed emotional, physical, and/or sexual abuse as important predictors for the dual relationship groups. Pearson product moment correlations were computed for each group to assess the relationship between the measures. Responses to the open-ended questions for the sanctioned groups were analyzed for themes. Finally, recommendations are offered for practice, training, licensing boards, and future research. Randolph, B. J., & Winstead, B. (1988). Sexual decision making and object relations theory. Archives of Sexual Behavior, 17(5), 389-409. The Sexual Decision-Making Inventory (SDMI) was developed to measure levels of sexual decision making based on the developmental concepts of Object Relations Theory. The inventory asks subjects to report on their thoughts and feelings at the time they decided to have sex in their most recent sexual relationship. The inventory was tested in a pilot study involving 45 male and 49 female undergraduates. A factor analysis was performed on the SDMI and six levels of sexual decision making were defined: Object Constancy, Ambivalence, Need for Merger, Need Gratification, Low Self-esteem, and Narcissistic Gratification. Endorsement of items on these subscales was related to perceptions of the relationship. In a second study involving 79 male and 135 female undergraduates, subjects completed the SDMI, the Bell Object Relations Self-report Inventory, and a questionnaire concerning perceptions of the relationship in which the sexual decision was made. Object Constancy was positively correlated to object relations, satisfaction with the relationship, and durability of the relationship; Ambivalence, Need Gratification, and Low Self-esteem were negatively correlated with object relations, satisfaction with the relationship, and durability of the relationship; Narcissistic Gratification was negatively correlated with object relations and most aspects of the relationship with interesting exceptions such as sexual satisfaction. Sex differences demonstrated that females were more likely to endorse items on the Object Constancy subscale; whereas males were more likely to endorse items on the Ambivalence, Need Gratification, and Narcissistic Gratification subscales. There were no sex differences, however, in quality of general object relations. 77 Smith, C. Y. (2007). Celibacy in marriage: Female object relations and their adult manifestations. Fielding Graduate University, Santa Barbara. This study was designed to identify early, internalized, object relationship experiences, and how they impact the emergence of celibacy in marriage when combined with certain aspects of social processes in adult relationships. Celibacy was defined as sexually inactive marriages, void of coitus, during the 6 months prior to the interview. This study was grounded in the object relations theories of Fairbairn (1941) and R.S. Klein (1990). Aspects of these theories were tested in each of the five hypotheses. Data were collected using a personal data questionnaire, the Bell Object Relations and Reality Testing Inventory, Sexuality Experience Scales, the Defense mechanism manual, the Psychiatric Diagnostic Screening Questionnaire, and the Social Cognition and Object Relations Scales-Revised. The study sample consisted of 45 married women aged 27-63. Thirtyfive percent of this sample was celibate. The findings identified alienation, egocentricity, sexual aversion, decreased marital cohesion, social phobia, and panic attacks as important variables that differentiate celibate and noncelibate women. Results supported the hypothesis that object relations are important intra-psychic processes that are associated with the onset of celibacy in marriage. The results also supported aspects of the Fairbairn and the R. Klein theories of object relations that identified the processes in three etiologies of celibacy among married women. Spiritual and Religious Studies Albert, G. (2005). Exploring self-transformation through the spiritually positive resolution of mental health crises. Inst Transpersonal Psychology, Palo Alto. This phenomenological study investigated the spiritually positive self-transformation resulting from the experience and resolution of a mental health crisis. The research was conducted in 2 phases: 35 adult participants in the assessment phase and 23 in the interview phase. Phase 1 participants met 4 criteria: They (a) experienced a crisis affecting self-concept and reality testing, which (b) resulted in a transformation that (c) was spiritually positive, and (d) their current mental health status was devoid of acute conditions. Four instruments verified these criteria respectively: the SelfTransformational Crisis Assessment (STCA), the Life Changes Questionnaire (LCQ; Ring, 1984), the Spirituality Assessment Scale (SAS; Howden, 1993), and the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995). Phase 2 participants were selected from the Phase 1 sample for semistructured interviews investigating the experience from precrisis to the present; a composite statement of the self-transformational experience was created from the interview data. The research design was diagnostically nave: Participants identified their crises by whatever semantics and symptoms. All had experienced a spiritually positive resolution, that is, a transformational growth or metanoia. Though transformational crises have been documented as, for instance, Kundalini awakening and shamanic crisis in the crosscultural and anthropological literature, and by spiritual emergency in the transpersonal literature, they are most often symptomatologically delimited. This study considered 78 crises of varying symptomatology as the challenging aspects of developmental processes, where spiritual development, marked by acceptance, purpose, connectedness, and transcendence, was the primary measure of growth. Results highlight the importance of developing people's ruminative capacity (sense of awareness) as well as accepting the interplay of unitive and destructive forces in the web of existence and therefore in the human experience. Nosological systems and transpersonal theory can benefit by viewing mental health crises as disintegrative constituents of a greater, potentially integrative developmental process. Bauman, P. J. (1995). Correlations among marital intimacy, object relations, mental representations of God and spiritual well-being. Bauman, Philip John: Boston U, US. The purpose of this dissertation was to investigate whether a person's experience of marital intimacy was related to his or her quality of interpersonal relationships, images of God, and spiritual well-being. While the ideas encompassed by intimacy have long been a concern in the study of religion and theology, this is the first empirical investigation to explore their interrelationships. Drawing upon theory and research in the fields of religion, theology, philosophy, and psychology, this study asked: For married and religiously oriented individuals, are there statistically significant relationships among their perceived marital intimacy, quality of object relations, mental representations of God, and sense of spiritual well-being? The 47 women and 46 men, ages 27 to 70, who volunteered to participate in this study belonged to five different groups. Four of the groups which the volunteers comprised represented denominations within the Christian Tradition: Liberal Protestant (10 men and 10 women); Conservative Protestant (7 men and 7 women); Greek Orthodox (9 men and 10 women); and Roman Catholic (10 men and 10 women). The members of the fifth group, selected without regard to religious orientation, were parents of children who attended a private school (10 men and 10 women). The participants completed the Waring Intimacy Questionnaire, the Bell Object Relations and Reality Testing Inventory, the Adjective Ratings of God Scale, and the Spiritual Well-Being Scale. A demographics questionnaire yielded additional data pertaining to the participants' personal religiousness. Results of product moment correlational analyses confirmed that increased marital intimacy is related to healthy object relations and increased spiritual well-being. They also confirmed that loving God images are related to increased spiritual well-being. They did not confirm a relationship between marital intimacy and God images, nor did they confirm that wrathful God images are related to decreased spiritual well-being. More specifically, two hypotheses of this study were supported: a negative correlation exists between marital intimacy and unhealthy object relations (p <.001), and a positive correlation exists between marital intimacy and spiritual well-being (p <.05). One hypothesis was partially supported: beneficent God representations were positively correlated with spiritual well-being (p <.001), but wrathful God representations were not negatively correlated with spiritual well-being. One hypothesis was not confirmed: 79 neither beneficent God representations demonstrated a significant positive correlation nor wrathful God representations a significant negative correlation with marital intimacy. Men's overall marital intimacy scores were equivalent to women's scores with a couple of variations of subscales: men scored significantly higher than women on commitment to the marriage (p <.05), and significantly lower than women on self-disclosure (p <.01). Cox, R. J. (2000). Relating different types of Christian prayer to religious and psychological measures of well-being. Boston University, Boston. This research explores whether persons who practice different types of Christian prayer can be differentiated according to measures of spiritual and clinical well-being. Building upon Poloma and Gallup's study (1991), this research conceptualizes prayer as a means of relating to the divine with increasing health related benefits occurring as one progresses spiritually through prayer-types (from conversational to meditative to contemplative). A theoretical paradigm for understanding the relationship among Christian prayer types and well-being is developed using relevant literature in psychology, medicine, biblical studies, theology, history of Christian spirituality, and psychology of religion. In an empirical phase, 264 adults completed these nine measures assessing religious and psychological factors that might correlate with prayer type: the Prayer Questionnaire (Poloma and Gallup, 1991), the Spiritual Well-Being Scale (Ellison, 1983), the Mysticism Scale (Hood et al. 1993), the Richness of Prayer Experience Index (Poloma and Pendleton, 1989), the Bell Object Relations and Reality Testing Inventory (Bell, 1989), the Narcissistic Personality Inventory (Raskin and Hall, 1979), the Defense Mechanisms Inventory (Ihilevich and Gleser, 1986), the State-Trait Anxiety Inventory (Speilberger et al. 1983), and a demographic and religious questionnaire. The findings partially support the hypothesis that there is a progression of prayer types. Conversational prayer, in comparison to meditation and contemplative prayer, was less highly correlated with existential well-being, mystical experience, and richness of prayer experience and most highly correlated with anxiety and unhealthy internal representations of relationships, namely insecure attachment and social incompetence. Meditation and contemplative prayer, in comparison to conversational prayer, were more highly correlated with existential well-being, mystical experience (meditation prayer with extrovertive mysticism and contemplation with introvertive mysticism), and richness of prayer experience and less highly correlated with anxiety and unhealthy internal representations of relationships. This interdisciplinary study suggests that future research on prayer needs to specify which types of prayer are being studied. This cross-sectional study further suggests that longitudinal studies can clarify whether people with lower levels of well-being are drawn toward lower levels of prayer type, or whether, over time, prayer type moves in a progression from lower to higher, with similar changes in well-being. Hall, T. W. (1997). The relationship of spiritual maturity to level of object relations development and God image and the impact of spiritual direction on these variables. Rosemead School of Psychology, Biola University, La Mirada. 80 The present study grew out of the theoretical assumption that spiritual maturity, defined relationally, parallels psychological maturity from an object relations perspective. It was designed to investigate the relationship of spiritual maturity to level of object relations development and God image, and the impact of spiritual direction on these three variables. A general hypothesis of the study was that spiritual maturity is positively related to level of object relations development and God image. A second hypothesis was that spiritual direction improves spiritual maturity, level of object relations development, and God image. Seventy-six subjects consisting of undergraduate students, participants in a local spiritual direction program, and psychotherapy clients from a local counseling center were used for correlational data. Two measures of spiritual maturity (Spiritual Assessment Inventory and Religious Status Inventory) and two measures of God image (God Image Scales and Gorsuch Adjective Checklist) were correlated with a measure of level of object relations development (Bell Object Relations Inventory). Twenty-two of 26 subjects completed pretest and posttest measures before and after six months of spiritual direction. The differences between mean pretest and posttest scores were analyzed using t-tests. Results yielded 19 out of 20 significant correlations in the predicted direction between both measures of spiritual maturity and the measure of object relations. In addition, 31 of the 35 correlations between both measures of spiritual maturity and various God image subscales were significant in the predicted direction. Significant gains were found on one of the object relations subscales (Social Incompetence) for the spiritual direction participants. No significant gains were found on any of the spiritual maturity or God image measures. The strongest findings of this study were (a) consistent positive correlations between spiritual maturity and level of object relations development, and (b) the significant impact of a spiritual intervention on level of object relations development. Hall, T. W., Brokaw, B. F., Edwards, K. J., & Pike, P. L. (1998). An empirical exploration of psychoanalysis and religion: Spiritual maturity and object relations development. Journal for the Scientific Study of Religion, 37(2), 303-313.38 Hall, T. W., & Edwards, K. J. (1996). The initial development and factor analysis of the Spiritual Assessment Inventory. Journal of Psychology and Theology, 24(3), 233-246. Reports the development and factor analyses of a Judeo-Christian theory-based measure of spiritual maturity. The Spiritual Assessment Inventory (SAI) integrates relational maturity from an object relations perspective and experiential God-awareness based on New Testament teaching and contemplative spirituality principles. A pool of items was developed to measure hypothesized dimensions of spiritual maturity related to awareness and quality of relationship with God. Two factor analytic construct validity studies were conducted. Based on the first study with 193 undergraduates, the SAI was revised and expanded. In the second study with 470 undregraduates, 5 factors were identified: Awareness, Instability, Grandiosity, Realistic Acceptance, and Defensiveness/Disappointment. Results of the factor analyses and correlations of the factors with the Bell Object Relations Inventory support the underlying theory and validity of the SAI and its potential usefulness for clinical assessment and research. 38 For abstract, see citation listing in Non-Psychiatric: Psychoanalysis Studies 81 Hall, T. W., & Edwards, K. J. (2002). The Spiritual Assessment Inventory: A theistic model and measure for assessing spiritual development. Journal for the Scientific Study of Religion, 41(2), 341-357. The Spiritual Assessment Inventory (SAI) is a relationally-based measure designed to assess 2 dimensions of spiritual development: Awareness of God and Quality of Relationship with God. The present article reports the results of 2 studies: exploratory and confirmatory factor analyses of a revised SAI, which replicated 5 factors, and a factor analysis of a revised SAI with a new Impression Management (IM) subscale. 79 items, based on the items from the 2nd factor analysis and additional items written for this study, were administered to a sample of 438 university students (18-22 yrs old). Results support the factor structure of the SAI and the homogeneity of the IM scale. Correlations of the SAI subscales with the Spiritual Well-Being Scale, the Intrinsic/Extrinsic-Revised, the Bell Object Relations Inventory, the Defense Styles Questionnaire, and the Narcissistic Personality Inventory also support the construct validity of the SAI. Twostep multiple regressions support the incremental validity of the SAI. Suggestions for future research and implications for clinical use of the instrument are discussed. Key, T. L. (1995). Impact of inpatient psychiatric treatment on object relations maturity, selfesteem and God image. Dissertation Abstracts International: Section B: The Sciences and Engineering, 55(12-B). The current study explored the impact of inpatient psychiatric treatment on self-esteem, object relations maturity and God image. It was hypothesized that there would be improvement in self-esteem, object relations maturity and God image during inpatient treatment. It was also hypothesized that the three variables would show further improvement during outpatient treatment. In addition, it was thought that there would be a significant relationship between improvement in self-esteem, object relations maturity and God image and number of inpatient days and number of outpatient sessions. Finally, it was hypothesized that there would be a relationship between self-esteem, object relations maturity and God image. Sixty-seven adult psychiatric inpatient subjects completed a battery of tests including the following: the Bell Object Relations Inventory (BORI); the personal self subscale of the Tennessee Self Concept Scale (TSCS-PS); the Religious Experience Questionnaire (REQ); and the God Image Scales (GIS) of Presence, Challenge and Acceptance. These were administered at four different time periods: admission, discharge, six months following discharge and twelve months following discharge. The number of subjects at twelve months following discharge decreased to thirty because of attrition. Inpatient treatment was found to have a significant positive impact on self-esteem, object relations maturity, and God image, and these gains were, in general, maintained through six month and twelve month follow-up measures. However, there was no significant gain in these three variables during outpatient treatment. Neither number of days in inpatient treatments nor number of outpatient sessions was correlated with improvement in self-esteem, object relations maturity and God image. As hypothesized, self-esteem was related to object relations maturity and God image at all 82 four time periods. The hypothesis that object relations maturity was related to God image was generally supported. McLaughlin, J. T. (1992). Relationship of God-construct complexity, God-image, emotional attachment, and worldview orientation to psychological health. University of Southern Mississippi, Hattiesburg.39 Peterson, D. L. (1999). The relationship of birth order to religious experience and object relations functioning. Rosemead School of Psychology, Biola University, La Mirada. This study was conducted to investigate the relationship of birth order to God image and object relations functioning. One goal of the project was to extend the literature in the area of religious experience and functioning as well as in the area of birth order. One hundred and forty-nine undergraduate students from a small, private, Christian university participated. Two birth order groups, firstborns and laterborns, were used. Given the findings of different relational experiences and personality dynamics found between firstborn and laterborn children, and the researched link between object relations functioning and religious functioning, it was hypothesized that firstborns and laterborns would also differ in their religious experiences. The instruments used were the God Image Scales (GIS; Lawrence, 1991), the Gorsuch Adjective Checklist (GAC; Gorsuch, 1968), the Loving and Controlling God Scale (LCGC), the Spiritual Awareness Inventory (SAI; Hall, 1996), the Religious Status Inventory (RSIn; Hadlock, 1988), the Bell Object Relations Inventory (BORI; Bell, Billington & Becker, 1985), and the Forgiveness of Other and Forgiveness of Self Scale (FOFS; Mauger, Freeman, McBride, Perry, Grove, & McKinney, 1992). The experimental Experience of God Scale (EGS; Brokaw, 1999) was introduced for initial analysis. Statistical procedures used to test the hypotheses included t tests, Pearson correlations, one-way analyses of variance, and factor analysis. Results did not support the initial hypotheses; no significant differences were found between birth order groups when considering the means of the variables tested. However, post hoc z tests for independent correlations revealed significant differences between firstborns and laterborns when correlations were compared. Many findings supported the theoretical underpinnings of the original hypotheses. The strongest findings of this study were that some of the variables that comprise an individual's experience of God and object relations functioning are related in significantly different ways depending upon birth order. For example, a sense of God's control was negatively correlated in firstborns and positively correlated in laterborns with awareness of God, acceptance of God's leadership, participation in religious fellowship, and ethical behavior. The limitations of the study are discussed. Implications for both therapists and clergy, as well as suggestions for future research, are also offered. Reiber, M. R. (2005). The interrelationship of God representations, object relations, and the individual capacity for intimacy. Alliant International University, Fresno. This study examined the interrelationship between God representations, early object relations experiences, and the individual capacity to experience an adult intimate 39 For abstract, see citation listing in Non-Psychiatric: Attachment Studies 83 relationship. Community college students ( N = 95) completed the Adjective Ratings of God Scale (ARGS), the Bell Object Relations and Reality Testing Inventory Form-O (BORRTI-O), and the Fear of Intimacy Scale (FIS). Two hypotheses of the study were partially supported. There was a weak positive correlation between wrathful God representations and the Alienation ( p < .05) and Egocentricity ( p < .01) subscales of the BORRTI-0. There was also a weak positive correlation between Deistic (impersonal) God representations and the Alienation ( p < .05) and Egocentricity subscales of the BORRTI-O ( p < .05). In addition, there was a weak negative correlation between benevolent God representations and the Alienation subscale of the BORRTI-O ( p < .05). The results supported the hypothesis that there would be a significant positive correlation between the individual capacity for intimacy, as measured by the FIS, and the Alienation ( p < .01), Insecure Attachment ( p < .01), Egocentricity ( p < .01), and Social Incompetence ( p < .05) subscales of the BORRTI-O. Two hypotheses were not supported by the findings. Neither wrathful God representations nor Deistic God representations were significantly correlated with an individual capacity for intimacy as measured by the FIS. Benevolent God representations were not found to be significantly, negatively correlated with an increased capacity for intimacy as measured on the FIS. This study has made an important contribution to the literature because it focused on the intrapsychic, individual aspect of intimacy, as opposed to an experiential, interpersonal aspect of intimate relationships, which has been a common focus in other studies (Cooke, 1997; Mills & Turnbull, 2001; Moss & Schwebel, 1993; Robinson, 2000; Scott, 1997; Tilden, 1990; Tolstedt & Stokes, 1983). Smith, L. L. (2004). Object relations in the dynamics of spiritual and psychological well-being. Alliant International University, Fresno. The view that Freudian psychoanalytic psychology and a healthy spirituality would one day converge seems contradictory to the basic historical philosophy of both paradigms. However, the evolution of psychoanalysis in the form of object relations theory has shifted the Freudian position from a libidinal-driven energy to a more relational-driven energy. This has opened new doors for the integration of the two seemingly divergent perspectives. Object relations theory proposes that early childhood interactions mold the self-concept and form representations of others. Within this normal relational development, a representation of God also forms. These childhood relationships influence the quality of connection with others and with God throughout life. This study attempted to replicate the findings of prior research demonstrating that quality of relationship with others is highly correlated to quality of relationship with God. It also investigated the possibility that these relationships significantly contribute to a sense of psychological well-being. Self-report inventories were administered to attendees at a health fair at a private university. Assessments measured quality of object relationships (Bell Object Relations and Reality Testing Inventory, Object Relations Form), spiritual maturity in the form of awareness and relationship to God (Spiritual Assessment Inventory), and 84 psychological well-being (Schwarz Outcome Scale-10). Correlations and a confirmatory factor analysis revealed, as previously found, that relationship with God and others is highly correlated. Multiple regression analyses confirmed the impact of both types of relationships on psychological well-being to be significant, with some forms of relationship being more important than others. Tisdale, T. C. (1998). A comparison of Jewish, Muslim, and Protestant faith groups on the relationship between level of object relations development and experience of God and self. Rosemead School of Psychology, Biola University, La Mirada. This study was conducted to extend the literature investigating the relationship between level of object relations development and experience of God and self. This study sought to investigate whether significant correlations, which have been observed between these variables in Christian samples, would be found in Jewish and Muslim faith groups. This study also sought to compare these groups with respect to their unique experience of God. One hundred and fifty Jewish, Muslim, and Protestant undergraduate students from the University of California at Los Angeles participated in the study. The hypotheses were: (1) Within each of the groups, there will be significant correlations between level of object relations development and experience of God and self; (2) When comparing the groups, there will be no significant differences between level of object relations development or perceived self-efficacy; and (3) When comparing the groups, there will be significant differences between how the groups experience God. Object relations was assessed using the Bell Object Relations Inventory (BORI), a subtest of the Bell Object Relations and Reality Testing Inventory, (BORRTI). Experience of God was assessed using the Religious Experience Questionnaire (REQ), The Gorsuch Adjective Checklist (GAC), the revised Intrinsic/Extrinsic Religiosity Scale (IE-R), the Religious Problem Solving Scale (RPSC), the Loving/Controlling God Scale (LCGC), and the Spiritual Assessment Inventory (SAI). Experience of self was measured using the personal self subscale of the Tennessee Self-Concept Scale (TSCS). Statistical procedures used to test the hypotheses included correlations, t-tests, and one- and two-way analyses of variance. Results supported all three hypotheses. Significant correlations were found between level of object relations development and experience of God and self for all faith groups. The groups did not differ on level of object relations development or perceived self-adequacy, but the groups differed significantly on experience of God. For all three groups, lower levels of object relations development were significantly, negatively correlated with experience of God as benevolent, close, and loving; with awareness of God; with realistic acceptance of God; with intrinsic religiosity, with a collaborative and deferring religious coping style; and with higher perceived self-adequacy. Lower levels of object relations development were significantly, positively correlated with experience of God as wrathful, irrelevant, distant, impersonal, and controlling; with a relationship with God marked by instability, grandiosity, and defensiveness; with external religiosity; and with a selfdirecting religious coping style. When viewing differences between the groups, the various aspects of object relations correlated similarly with experience of God for Protestants. For Cultural Jews, experience of God was most related to social and interpersonal health. No clear pattern emerged for Observant Jews. For Muslims, experience of God was most related to factors specific to connection with others. Post 85 hoc analyses examining gender differences yielded significant results. Strength of religious belief, attendance at religious meetings, importance of religion to the respondent, and religious tone in the home growing up were also correlated with experience of God, which yielded significant findings. Clinical implications and suggestions for future research are offered. Non-Psychiatric: Miscellaneous Bassman, L. E. (1991). Object relations and self-reported AIDS self-care behavior. Psychological Reports, 68(3), 915-23. This study examined the relationship between object relations and AIDS self-care behavior among 509 urban college students. The literature indicates that maturity of object relations is related to comfort in interpersonal relations and to taking responsibility for self-care. These concepts are widely accepted by psychoanalytic psychologists but have rarely been tested empirically. Object relations, measured by the Bell Object Relations and Reality Testing Inventory, was significantly related to AIDS knowledge as measured by the AIDS Prevention Survey of Thomas and to self-reported safer sex behavior, measured by Bassman's HIV Infection Prevention Scale. Knowledge about AIDS correlated with self-reported sexual risk behavior, and with a low level of selfreported social behavior aimed at preventing AIDS. Implications of these findings for public health education policy are discussed. Bassman, L. E. (1992). Reality testing and self-reported AIDS self-care behavior. Psychological Reports, 70(1), 59-65. This investigation examined the relationship between reality testing and AIDS self-care behavior for 509 urban college students. It was hypothesized that reality testing may become impaired in sexual interactions that carry the risk of HIV infection, leading to imperfect adoption of safer sex practices. Reality testing, measured by the Bell Object Relations and Reality Testing Inventory, was significantly related to AIDS knowledge as measured by the AIDS Prevention Survey of Thomas and not significantly related to selfreported safer sex behavior, measured by Bassman's HIV Infection Prevention Scale. Cooke, A. M. (1997). Object relations and self-representations: Implications for adult relatedness and mental health. University North Carolina at Chapel Hill, Chapel Hill. Object relations theory views the need for human relatedness as the driving force behind personality development and predicts that pathological representations of the self in relationship to others will be manifested in immature and unstable interpersonal relationships, and in a variety of psychological symptoms and disturbances. However, there has been little empirical research to date that directly examines the theorized links between object relations, quality of intimate relationships and psychopathology within a nonpatient sample. This study was devised to explore the links between these constructs and examine specific patterns of interrelations. As part of the study, a Relationship 86 Experience Scale was constructed and factor analyzed to provide information about participants' reported quality of relationship experiences. Scores on these factors were then correlated with the Bell Object Relations Inventory, the Continuity and Integration of Self Scale, and the MMPI-2. A pattern of wide intercorrelations were found between various dimensions of object relations, integration of self, relationship experiences, and psychopathology. Further examination of these patterns of intercorrelations found that the object relations dimensions of Alienation (lack of trust in relationships, difficulties with intimacy) and Insecure Attachment (excessive worries about being accepted and fears about abandonment) explained the greatest amount of variance in subjects' quality of relationship experiences across a number of domains. The pattern of interrelationships differed for the MMPI-2 variables--individuals with a more fragmented sense of self and women with exaggerated fears of abandonment tended to report much more psychological distress. In summary, the results of this exploratory study appeared to support the theorized links between object relations, self representations, quality of relationship experiences, and psychopathology. It is consistent with existing research in these areas and serves to fill a substantial gap in the empirical literature. Crown, N. J. (1995). The impact of profound, prelingual deafness and aspects of early communication experience on deaf adults' symbolic functioning. Adelphi U, the Inst of Advanced Psychological Studies, New York. Profound, prelingual deafness and the presence or absence of Sign Language during early childhood were explored as to their impact on symbolic functioning in two groups of deaf college students with hearing parents. Three groups of college students born to hearing parents were recruited for the study. One group of deaf adults, (the oral group, n = 27) described their early communication with their families as having been primarily through speech, whereas the other deaf group (the signing group, n = 21) described using a combination of speech and manual communication. A comparison group of 29 hearing college students made up the third group. Participants were screened using a background questionnaire. Those who met criteria for the study were seen in groups of five to ten to complete the following measures: The Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, Billington & Becker, 1985), The Inventory of Parent and Peer Attachment (IPPA; Greenberg, Siegel & Leitch, 1984), Figure Drawings, and a written account of Early Memories (EM) which were scored for Referential Activity (R.A.; Bucci, 1984) and thematic content. Signed interpretations of both self-report measures were video-taped by a certified Sign Language interpreter for use in running all deaf subjects. Chi Square analyses were applied to the demographic variables and to categorical drawings variables. ANOVAs were conducted on the BORRTI, IPPA, EM (thematic content and R.A.), and global characteristics of drawings. The findings indicate significant differences between deaf and hearing groups on all measures of symbolic functioning, and differences between the oral and signing deaf sub-groups on EM themes and Figure Drawings. These results reflect the powerful impact of early deafness on symbolic functioning and lend support to the hypothesis that presence of Sign Language between a deaf child and hearing parents may exert some mitigating influence. 87 Cruice, G. E. (1996). Contextual integration of personal and consensual time and self-object relations. Cruice, Gloria Ellen: U Detroit Mercy, US. This study investigates the relationship between individuals' experiences of time and selfobject relations. It was hypothesized that relationships would be found between feelings of mastery with regard to time and reports of satisfaction in self-object relations. It was also hypothesized that an integrated sense of personal and consensual time would be associated with greater maturity of object relations. Variables in the study were nine time factors, five object relations factors, age, and loss. Subjects were 141 male and female undergraduate and graduate university students. Two time measures were utilized: the Personality and Time Attitudes Inventory (adapted from Calabresi and Cohen, 1968) which identifies four personality variables (Restless Dysphoria, Extraversive Adjustment, Tense Dependency, and Excitement Seeking) and four time variables (Time Anxiety, Time Possessiveness, Time Submissiveness, Time Flexibility); and the Temporal Experience Questionnaire (Wessman, 1973) which identifies four time variables (Relaxed Mastery, Continuity, Consistency, and Time Efficiency). Self-object relations were measured utilizing the Bell Object Relations and Reality Testing Inventory (Bell, 1991) which identifies four dimensions of object relations (Alienation, Insecure Attachment, Egocentricity, and Social Incompetence). Based on face validity, two scales were also derived from the time and object relations items to measure Time Integration and Object Constancy. Multiple regression analyses suggested that Time Anxiety and Relaxed Mastery were significantly associated with Insecure Attachment and Social Incompetence. Continuity was associated with Alienation and Egocentricity while Consistency was associated with Insecure Attachment, Egocentricity, and Social Incompetence. Time Integration was significantly correlated with Object Constancy, as predicted. Time Integration and object relations scores were also significantly associated with age. Humphrey, G. W. (1989). Cross-dressing in males: The attempt to retain the comforting object. Alliant International University, Fresno. The present study investigated an alternative understanding of cross-dressing in males. Transvestism has traditionally been viewed as an oedipal problem, vix., anxieties associated with fear of bodily injury (castration anxiety) yield a compromised sexuality where erotic stimulation is safely achieved through a representation of the object (female clothing). Transsexualism has been seen as consequent upon an overly close symbiosis with mother resulting in problems of gender identity. Taking an object relations perspective, the present research conceptualizes both transvestism and transsexualism as related, preoedipal phenomena. Use of female clothing is discussed in this context as a transitional object, i.e., assisting the cross-dressed individual to evoke a sense of soothing. Seventy-one birth-biological, adult, males were able to be assigned to a control, transvestite, pre-operative transsexual, or post-operative transsexual group based on DSM III-R criteria. Individuals completed a demographic questionnaire, an instrument developed by the researcher to assess stimulation versus calming function of female clothing, the Hansburg Separation Anxiety Test (SAT), and the Bell Object Relations 88 Reality Testing Inventory (BORRTI). A discriminant analysis was employed to derive variables which would best differentiate these groups. Results suggest both transvestites and transsexuals may use female clothing as a transitional object to dissipate anxiety, lift depression, and generally enhance feelings of calm and soothing. High scores on a clothing-to-soothe variable by post-op transsexuals (in the same range as transvestites), suggests an underlying sense of insecurity has not been assuaged by SRS. Lower scores of pre-op transsexuals on this calming variable are interpreted as failure of the transitional object resulting in a merger fantast (SRS) seen as the antidote to insecurity. Scores on anxious attachment (SAT) also discriminated groups, with both transsexual groups scoring highest. Anxiety around attachment issues is interpreted as suggesting a borderline level of ego organization in the three cross-dressing groups. Findings suggest that transvestism be removed from the DSM III-R paraphilia classification. Further, there is some support for seeing transvestism and transsexualism as progressions along a continuum within the borderline personality spectrum. Lastly, further support is offered to the growing evidence that STS may serve as a momentary palliative, but does not resolve the transsexual‘s elusive search for security. Lennon, S. (1997). Death anxiety, object relations, and self-actualization: A comparison between middle-aged women and college-aged women. Adelphi University, the Inst of Advanced Psychological Studies, New York. According to existential/psychoanalytic theories, death anxiety plays a pivotal role in character structure, psychopathology, and well-being. This study carries forward an exploration of the vicissitudes of death anxiety, conscious and unconscious, in two groups of women: middle-aged and college-aged. In addition, this work looks at the role played by age, object relational pathology, and self-actualization in mitigating conscious and unconscious death anxiety. The sample consisted of 40 women between 18 and 25 years old, and 39 women between 40 and 55 years old. The participants were randomly drawn from a larger pool of women. All participants completed three self-report questionnaires: (1) Templer's Death Anxiety Scale; (2) the Bell Object Relations Reality Testing Inventory; and (3) the Personal Orientation Inventory. Unconscious death anxiety was measured using the Stroop Color-Word Interference Test where reaction times to the color of death-related and neutral words are measured. The findings suggest that older women tend to experience less conscious death anxiety and are generally better able to maintain close relationships. While no differences were detected in unconscious death anxiety between the two groups, it was found that all subjects experience it to some extent. It was also found that for the whole sample, those women who have difficulty maintaining trusting relationships and feel disconnected from the world experience a greater degree of conscious death anxiety. In addition, results indicate that those subjects, regardless of age, who are present-oriented and flexible in the face of external circumstance also experience less conscious death anxiety. Finally, it appears that a certain degree of conscious death anxiety is necessary to maintain a sense of well-being. The results of this study bring into relief the complexity of death attitudes and question the proposition that the denial of death anxiety is the sole driving force behind human motivation. 89 Meszaros, D. M. D. (1996). Delusion formation: Understanding the role of social factors. University Detroit Mercy, Detroit. The relationships between ambiguity tolerance, various dimensions of social skill, and magical ideation were investigated in a non-clinical population. Also investigated were relationships between social skill, parental bonding, and object relatedness. Participants (N = 99) completed the Parental Bonding Instrument, the Bell Object Relations Reality Testing Inventory, the Magical Ideation Scale, the Social Skills Inventory, the Physical Anhedonia Scale, and the Intolerance of Ambiguity Scale. Parental bonding was found to be related to object relatedness, with those experiencing greater degrees of alienation perceiving parental figures as less caring and more overprotective than those identified as less alienated. Perception of parental care emerged as a significant predictor of social skill. In addition, magical ideation was found to be related to intolerance for ambiguity and to lower levels of object relatedness. Results support speculations that intolerance of ambiguity is related to delusion formation and that the variables under investigation are appropriately studied in non-clinical populations. Mills, B., & Aldag, R. J. (1999). Exploring the relationships between object relations/reality testing functioning, coping styles, and somatic tension. Journal of Business and Psychology, 14(1), 5-24. In view of the importance of coping and of the apparent impact of individual differences on coping styles, it seems appropriate to examine relationships of coping with deeper and more complex psychological constructs such as those described in object relations psychology. Discovery of psychological predispositions to coping should have significant implications for both organizational and interpersonal intervention mechanisms. This study examined the relationships among six object relations/reality testing constructs and the coping styles of positive thinking coping, interpersonal coping, avoidance coping, direct action coping, and symptom-management coping, as well as somatic tension. Several significant relationships were evidenced. Implications and suggestions for future research are presented. Pizana, M. D. L. (1997). An initial investigation of the relative effect of object relations on acculturation among Mexican-Americans. St Mary's University, San Antonio. Recently, there has been growing interest in exploring the relationship between the psychological functioning of individuals and their capacity to adapt into a new culture. Acculturation is a natural process of change, struggle, and adaptation involving learning new language norms and values as well as maintaining some aspect of the original culture. Acculturation involves the capacity for adaptation, retaining and internalizing some aspect of new and old culture, both cultural experiences. This study examined the relative influence of four dimensions of psychological functioning derived from object relations theory on acculturation. This study used stepwise multiple regression to investigate the degree of relationship between psychological functioning and acculturation in Mexican-Americans. For the purpose of this study, psychological functioning is defined in terms of individual capacity on object relations as measured by 90 the Bell Object Relations Inventory (BORI) scale which is comprised of four scales: alienation, egocentricity, insecure attachment, and social incompetence and the Personal Attitudes Inventory (PAI) which consists of demographics, behavior, and attitude. For the purpose of the study, only attitude scales were regressive with the four scales of BORI using generational level and socioeconomic status as covariance. Results of the study do not corroborate a strong relationship between level of psychological functioning as measured by BORI and acculturation status as measured by PAI. There were not statistically significant correlations between any of the Four Bell Object Relations Inventory subscales scores and the Attitudinal Acculturation scores on the Personal Attitudes Inventory when controlling for socioeconomic status and generational levels. Exploratory analysis of variance (ANOVA) procedures were used to determine the influence of demographic functioning on object relations scale scores or acculturation attitudes and values scores. Scott, C. N. (1998). Object relations development as a predictor of interpersonal problems. The Florida State University, Tallahassee. According to object relations theory, personality develops through early childhood relations that produce internal self-other representations. These representations, or object relations, serve as an intrapsychic template or schema for all subsequent interpersonal relationships. Research into psychoanalytic concepts such as this has been limited. This study explored the relationship between certain object relations deficits and types of interpersonal problems. The two instruments used in this study were the Bell Object Relations Inventory (BORI: Bell, 1992; Bell, 1995), and the Inventory of Interpersonal Problems (IIP; Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988). Data were collected from members of the jury pool of a large southeastern city (N=196). The results of the study indicated that object relations development significantly predicted interpersonal problems. All eight of the interpersonal problematic styles measured by the IIP were significantly predicted by the BORI. There were no significant differences between males (n=82) and females (n=114) in terms of the ability of object relations to predict interpersonal style, although there were some sizable differences in the amounts of variability accounted for by object relations between men and women. There were significant differences between Caucasians (n=133) and African Americans (n=63) in the degree to which object relations predicted interpersonal problems in two interpersonal styles, Vindictive and Exploitable. It was suggested that the results be interpreted with caution due to the exploratory nature of the study, the self report format of both instruments, and the similarity between the instruments in the focus of their questions. Suggested areas for additional research included (1) the exploration of racial, ethnic, and sociocultural differences in object relations development, (2) the use of the BORI in research with a homosexual population in an effort to expand the exclusionary heterosexist language of the test, (3) research with normal and clinical subjects, and (4) outcome research following object relations vs. interpersonal skills treatment approaches. Skrila, D. (2001). Aggressiveness and characteristics of object-relations in students at risk of migrainous headaches. Psiholoska Obzorja/Horizons of Psychology, 10(2), 33-50. 91 Studied the negative influence of migraine headaches on the behavior of 598 students (174 males and 423 females, and 2 Ss who did not reveal their gender) from universities in Ljubljana, Slovenia, and Maribor, Croatia. The existence of migraine was assessed by the UCSD Migraine Questionnaire (T. Tom, et al., 1994), aggressiveness by the BussDurke Hostility Guilt Inventory (Buss & Durke, 1957; modified by T. Lamovec, 1988), and the characteristics of object relationships by the Bell Object Relations and Reality Testing Inventory form O (M. D. Bell, 1995). Data were obtained by using the SPSS 8.0 for Windows. The results show that Ss with migraines expressed significantly more negativism, indirect aggression, irritability, hostility, suspicion, feelings of guilt, and disturbed object relations compared to Ss without recurrent headaches. There were no differences in physical and verbal aggressiveness. Stout, K. L. (2002). Object relations and Winnicott's conception of creativity: A study of their relationship (D. W. Winnicott). Adelphi U, Inst Advanced Psychological Studies, New York. One hundred and twenty individuals drawn from the general population and spanning the adult age range participated in this study, which examined the relationship between object relations and creativity. A creativity measure devised for this study, the Attributes of Creativity Scale, was based upon Winnicott's concept of the creative self, which is fostered by positive early object relations, specifically, the experience of good enough mothering, and is evident in the true self personality. Individuals who had higher scores on the Attributes of Creativity Scale demonstrated a significantly healthier level of object relations, as assessed by the Bell Object Relations Inventory (Bell, Billington, & Becker, 1986), than individuals with lower creativity scores. The Attributes of Creativity Scale demonstrated no significant relationship to two standardized measures of creativity, and, interestingly, the two standardized creativity measures did not demonstrate any association. The results point to the difficulty inherent in measuring creativity but lend some support to Winnicott's theory of a relationship between creativity and healthy object relations. Tabatabaee, L. (2005). Creative expression and object relations. Alliant International University, Los Angeles, US. The purpose of this study was to assess the effect of creative expression on self-esteem, level of depression and maturity of object relations. The researcher utilized a static group comparison, in which 89 volunteers were recruited via the internet and divided into two groups whether they reported participation in creative expression activities. Both groups completed the Rosenberg Self-esteem Scale (RSES), the Beck Depression Inventory-III (BDI), and four scales of the Bell Object Relations Reality Testing Inventory (BORRTI). Participants also filled out a demographic questionnaire, which included a face valid question assessing the participant's perception of having experienced childhood trauma. The study hypothesized that participants in creative expression activities would have a higher level of self-esteem, lower level of depression and more mature object relations than participants who did not participate in creative expression activities. The researcher found that participants in creative expression activities had experienced childhood trauma 92 significantly more than participants in the non-creative expression group. This confound was controlled for in the analyses of the hypotheses. Results indicated that the two groups did not differ on RSES scores, BDI scores or BORRTI scores. It is possible that the data's failure in supporting the researcher's hypotheses may be the result of insufficient power in the analyses, inappropriate research design, inadequate separation of participants into groups, or may reflect the actual relationship among the variables. These results were discussed in light of previous research and problems with the design. Willens, L. E. (1995). Object relations as a mediating variable in the experience of stress and somatic reactions. Dissertation Abstracts International: Section B: The Sciences and Engineering, 55(9-B). The purpose of this study was to explore the relationships between object relations, stress, and physiological reactions. It hypothesized that object relations will have a direct effect on somatic reactions and also function as a mediating variable that determines the stressfulness of an event. A large and diverse sample of non-clinical adult subjects representative of a cross-section of the normal population was obtained. Subject pool consisted of 169 females and 60 males between the ages of 19 and 83 with a mean age of 39.6. Pearson product moment correlation coefficients were computed to determine the intercorrelations between demographics, object relations, hassles, and somatic measures. Multiple regression and path analytic procedures were employed to analyze the obtained scores. Somatic reaction was measured by the Somatic Response Survey (SRS). Object relations were measured by the Bell Object Relations Inventory (BORI) and stress was measured by the Daily Hassles Scale. Empirical evidence of the theoretical model was provided. In every instance, disturbed object relations were positively correlated with somatic outcome. With 3 exceptions out of 64 equations, object relations maintained a direct effect on somatic symptoms regardless of the introduction of a particular hassle, confirming its impact as a significant mediating factor in physiological reactions. Object relations were unrelated to gender and age. Age was significantly and negatively correlated with somatic response for both males and females. Females experienced a significantly greater amount of hassles and somatic reactions than males. Implications and areas for further research were proposed. Measures and Inventories Alterman, A. I., McDermott, P. A., Cacciola, J. S., & Rutherford, M. J. (2004). Latent structure of the Davis Interpersonal Reactivity Index in methadone maintenance. Journal of Psychopathology and Behavioral Assessment, 25(4), 257-265.40 Bell, M.D., Billington, R., & Becker, B. (1986). A scale for the assessment of object relations: Reliability, validity, and factorial invariance. Journal of Clinical Psychology, 42, 733-741. 40 For abstract, see citation listing in Axis I: Methadone Studies 93 Factor analysis of the Bell Object Relations Inventory items produced four subscales interpreted to be underlying dimensions of object relations. Replication factor analysis confirmed the factor structure. Subscales had high internal consistency and were free of age, sex, or social desirability response bias. Subscales had low intercorrelations with Brief Psychiatric Rating Scale (BPRS) sum scores, Global Assessment Scale scores, and most BPRS symptoms. Subscales appear to represent common features of personality and to sample a domain that is distinct from symptomatology, but related to variations in psychopathology. Percentage of high scoring subjects and subscale mean values are compared for seven criterion groups. High scores were least frequent among community active adults and most frequent among borderlines. Selected findings from the group comparisons are discussed to illustrate the potential of the instrument for empirical examination of theoretical assumptions about the object relations ego function and its components. Bell, M.D., Billington, R., & Becker, B. (1985). A scale for the assessment of reality testing: Reliability, validity, and factorial invariance. Journal of Consulting and Clinical Psychology, 53, 506-511. Factor analysis of the Bell Reality Testing Inventory items produced three subscales interpreted as dimensions of the reality testing ego function. Replication factor analysis confirmed the factor structure. Subscales were assessed for internal consistency and for age, gender, and social desirability biases. Two subscales, Reality Distortion and Uncertainty of Perception, had low correlations with most Brief Psychiatric Rating Scales (BPRS) symptom scales. The third, Hallucinations and Delusions, correlated significantly with the Hallucinatory Behavior and Unusual Thought Content scales of the BPRS and with BPRS sum scores and Global Assessment Scale scores. Seven criterion groups are compared for percentage of high-scoring subjects and subscale mean values. Schizophrenics, schizoaffectives, and borderlines were most pathological on Reality Distortion and on Hallucinations and Delusions. Borderlines were highest on Uncertainty of Perception. Discriminant analysis differentiated inpatient schizophrenics from inpatients with major affective disorders with 92% classification accuracy. Subscales appear sensitive to variations in psychopathology and may further investigations involving reality testing ego functioning. Bell, M. (2003). Bell object relations inventory for adolescents and children: Reliability, validity, and factorial invariance. Journal of Personality Assessment, 80(1), 19-25. The Bell Object Relations Inventory (BORI; Bell,1995) is a self-report instrument that measures deficits in object relations ego functioning. It has demonstrated clinical and research utility in adult populations. This article reports the development of a version of the BORI for children ages 11 to 17, including studies of reliability, validity, and factorial invariance. Data of 705 children from public schools and 110 children from clinics and residential treatments were used. Of the 45 original BORI true/false items, 3 were dropped as inappropriate and most others were rewritten for easier reading. An additional 16 items were created to capture unique features of adolescent experiences in relationships. Items were tested in focus groups and revised accordingly. Eight items 94 were dropped because of low communalities, so that 50 items were included in the final factor analysis. Assessments using self-report items from the Behavioral Assessment Scale for Children (BASC; Reynolds & Camphaus, 1992) and the Personality Inventory for Youth (PIY) were also obtained to test concurrent validity. Oblique rotation yielded 5 factors. Four were very similar to the 4 from the adult version and were named accordingly: Alienation, Insecure Attachment, Egocentricity, and Social Incompetence. The fifth scale was comprised mostly of new items and was called Positive Attachment. Scales showed excellent factorial invariance and good internal consistency. Scales generally had very low intercorrelations reflecting their relative independence. Although differences were found for gender and race, the effect sizes were small. Support for construct validity came from moderate correlations with concurrent BASC and PIA scores, analyses of variance showing greater deficits in object relations in pathological subgroups compared with normals, and a trend analysis showing that Alienation scores followed a lawful relationship with increasing severity of psychopathology. These initial findings support the psychometric integrity of the instrument and its construct validity. Results indicate continuity of constructs between the adult and adolescent versions. The Positive Attachment subscale may prove a valuable addition for clinical and research applications. Benveniste, P. S., Papouchis, N., Allen, R., & Hurvich, M. (1998). Rorschach assessment of annihilation anxiety and ego functioning. Psychoanalytic Psychology, 15, 536-566.41 Bornstein, R. F., & Huprich, S. K. (2006). Construct validity of the Relationship Profile Test: Three-year retest reliability and links with core personality traits, object relations, and interpersonal problems. Journal of Personality Assessment, 86(2), 162-171.42 Bruscato, W. L., & Iacoponi, E. (2000). Validity and reliability of the Brazilian version of an inventory for the evaluation of object relations. Revista Brasileira de Psiquiatria, 22(4), 172-177. Studied the validity and reliability of the Brazilian version of the Bell Object Relations and Reality Testing Inventory (M. D. Bell et al, 1986) in 218 male and female university students (aged 17-40 yrs). Data on sociodemographic variables relationships, bonding, social skills, and self-concept were obtained by questionnaire. Factorial analysis and other statistical tests were used. Factor structure, internal consistency, and test-retest reliability were determined. Four factors were identified: alienation, insecure attachment, egocentrism, and social incompetence. The results were compared to normative US data. Test factor structure and reliability is considered good. Burns, B., & Viglione, D. J., Jr. (1996). The Rorschach Human Experience Variable, interpersonal relatedness, and object representation in nonpatients. Psychological Assessment, 8(1), 92-99.43 41 42 For abstract, see citation listing in Non-Psychiatric: Psychoanalysis Studies For abstract, see citation listing in Non-Psychiatric: Personality Studies 43 For abstract, see citation listing in Non-Psychiatric: Psychoanalysis Studies 95 Dahl, E. E. (2006 or 1996). The development of a scale to measure separation-individuation themes in borderline adolescent TAT protocols. California School of Professional Psychology, Fresno.44 Hall, T. W., & Edwards, K. J. (1996). The initial development and factor analysis of the Spiritual Assessment Inventory. Journal of Psychology & Theology, 24(3), 233-246.45 Hall, T. W., & Edwards, K. J. (2002). The Spiritual Assessment Inventory: A theistic model and measure for assessing spiritual development. Journal for the Scientific Study of Religion, 41(2), 341-357.46 Hansen, J. T. (2000). Human responses in assessing object relations subscales of the Psychoanalytic Rorschach Profile. Psychological Reports, 87(2), 675-676.47 Heiss, G. E., & Berman, W. H., & Sperling, M.B. (2006 or 1996). Five scales in search of a construct: exploring continued attachment to parents in college students. Journal of Personality Assessment, 67(1), 102-115.48 Huprich, S. K., Stanford, K., & Smith, M. (2002). Psychometric evaluation of the Depressive Personality Disorder Inventory. Journal of Personality Disorders, 16(3), 255-269.49 Kurtz, J. E., Morey, L. C., & Tomarken, A. J. (1993). The concurrent validity of 3 self-report measures of borderline personality. Journal of Psychopathology and Behavioral Assessment, 15(3), 255-266.50 Miripol, P. P. (1982). Clinical and statistical validation of current object relations measures. Illinois Institute of Technology, Chicago. A sample of 106 psychiatric patients was administered the MMPI and a set of nine object relations measures for the purpose of validation of the object relations measures. An initial factor analysis of the object relations measures found three underlying factors. A second factor analysis of the object relations measures with 11 MMPI factors found seven underlying factors. A linear combination of object relations measures and demographic variables to predict MMPI severity of illness in the entire sample resulted in a small but statistically significant proportion of variance accounted for by the independent variables. When applied to a screening sample of 70 cases, the proportion of variance accounted for by the linear combination was no longer statistically significant. The best of the object relations measures was found to be the RT/OR which was inversely related to Neuroticism and Depression factors on the MMPI and positively associated with Social extroversion and 44 45 For abstract, see citation listing in Axis II: Personality Disorders For abstract, see citation listing in Non-Psychiatric: Spiritual and Religious Studies 46 For abstract, see citation listing in Non-Psychiatric: Spiritual and Religious Studies 47 For abstract, see citation listing in Non-Psychiatric: Psychoanalysis Studies 48 For abstract, see citation listing in Non-Psychiatric: Attachment Studies 49 For abstract, see citation listing in Axis I: Depression Studies 50 Fro abstract, see citation listing in Axis II: Personality Disorder Studies 96 Family Attachment on the MMPI. The RT/OR was not significantly related to the severity of illness rating from the MMPI. Reese, R. J., Kieffer, K. M., & Briggs, B. K. (2002). A reliability generalization study of select measures of adult attachment style. Educational and Psychological Measurement, 62(4), 619-646.51 Stiens, R. E. (1995). An assessment of the clinical utility of the Bell Object Relations-Reality Testing Inventory. California School of Professional Psychology, Fresno.52 Zborowski, M. J., Hartmann, E., Newsom, M. A., & Banar, M. (2003-2004). The Hartmann Boundary Questionnaire: Two studies examining personality correlates and interpersonal behavior. Imagination, Congnition and Personality, 23(1), 45-62.53 Reviews Bornstein, R. F. (2006). A Freudian construct lost and reclaimed: The psychodynamics of personality pathology. Psychoanalytic Psychology, 23(2), 339-353. Although many early 20th-century descriptions of personality pathology were unabashedly psychoanalytic, recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have attempted to frame personality disorders (PDs) in atheoretical terms. This article discusses the continuing relevance of psychoanalytic theory for PD diagnosis, research, and treatment. After reviewing the evolution of the PD concept since Freud's time, 3 psychodynamic constructs central to a contemporary understanding of personality pathology are described: ego strength, defense style, and mental representations of self and others. Research in each area is briefly reviewed, the heuristic value of the psychodynamic perspective is discussed, and unresolved questions and future directions in the psychodynamics of personality pathology are addressed. Briere, J., & Scott, C. (2007). Assessment of Trauma Symptoms in Eating-Disordered Populations. Eating Disorders, 15(4), 347 – 358. Research suggests that individuals with eating disorders (EDs) are relatively likely to have been abused or neglected as children, or to have been victimized in adolescence or adulthood. These experiences, in turn, are often associated with a range of psychological symptoms, as well as, in some cases, a more severe or complex ED presentation. In this article, we review both generic and more trauma-specific psychological tests that can be used to (a) identify clinically relevant trauma histories in the ED patient and (b) uncover trauma-relevant symptoms that may complicate or intensify a given instance of ED. We 51 52 For abstract, see citation listing in Non-Psychiatric: Attachment Studies For abstract, see citation listing in Non-Psychiatric: Personality Studies 53 For abstract, see citation listing in Non-Psychiatric: Personality Studies 97 also discuss the clinical implications of a detailed trauma assessment, including its usefulness in guiding treatment for ED-trauma patients. Edens, J. F., Cruise, K. R., & Buffington-Vollum, J. K. (2001). Forensic and correctional applications of the Personality Assessment Inventory. Behavioral Sciences & the Law, 19(4), 519-543. The relative utility of psychological tests for addressing legal issues is an area of considerable debate in the field. Regardless of the merits of psychological testing, it is apparent that such instruments are used widely both to address specific psycholegal issues and to evaluate offender populations more generally. One instrument gaining prominence in terms of its use in both forensic and correctional settings is the Personality Assessment Inventory (PAI; Morey, 1991), which was developed to assess various constructs relevant to clinical settings (e.g. psychopathology, response distortion, and personality traits). This paper reviews the psychometric properties of the PAI specifically in reference to its ability to assess factors relevant to forensic decision-making, as well as its utility to provide clinically relevant information about offender populations more generally. Fishler, P. H., Sperling, M. B., & Carr, A. C. (1990). Assessment of adult relatedness: a review of empirical findings from object relations and attachment theories. Journal of Personality Assessment, 53(3&4), 499-520. Assessment techniques designed to measure adult behavior and mental representation that emphasize relatedness constructs are reviewed. These measures grow out of two traditions, object relations and attachment theories. Although these two paradigms are fairly well elucidated theoretically, the relevant assessment literature is only more recently expanding, especially that focusing directly on adult attachment as opposed to childhood attachment, in addition to a presentation of various projective and objective measures. This review highlights the clinical and research implications for integration of these two paradigms around the cognitive, affective, and behavioral vicissitudes of adult relatedness. Huprich, S. K., & Greenberg, R. P. (2003). Advances in the assessment of object relations in the 1990s. Clinical Psychology Review, 23(5), 665-698. In this paper, we review the empirical publications from the 1990s on the assessment of object relations (OR). Twelve different measures are referenced. Major findings of studies, conclusions, and evaluations of each measure are provided. In general, it was found that the most recent empirical literature has compared OR across diagnostic groups or evaluated therapy process and outcome by the quality of one's OR. Current strengths and limitations of the extant OR literature are provided, along with methodological recommendations to expand the utility and validity of OR assessment. 98 Lyddon, W. J., Bradford, E., & Nelson, J. P. (1993). Assessing adolescent and adult attachment: A review of current self-report measures. Journal of Counseling and Development, 71(4), 390-395. Reviews basic concepts and infant patterns of attachment (ATM) theory as formulated by J. Bowlby (1988) and M. D. Ainsworth (1979), and discusses 4 measures of adolescent and adult ATM. Included in the discussion are C. Hazan and P. Shaver's (see record 1987-21950-001) measure designed to classify persons into secure, avoidant, or anxious/ambivalent ATM styles; M. West and A. E. Sheldon's (see record 1990-11352001) self-report measure based on Bowlby's (1973, 1977) descriptions of insecure ATM; G. C. Armsden and M. T. Greenberg's (see record 1988-12586-001) Inventory of Parent and Peer Attachment; and the Bell Object Relations Inventory (M. Bell et al; see record 1987-02849-001). Several other measures are mentioned in brief. Pipe, W. E., & Duncan, S. C. (1999). Object relations theory and short-term dynamic psychotherapy findings from the Quality of Object Relations Scale. Clinical Psychology Review, 19(6), 669-685. This review focuses on the relevance of object relations theory to short-term dynamic psychotherapy (STDP). From diverse theoretical and research literatures, a small number of core theoretical concepts and assessment dimensions are identified. Specific assessment methods are also highlighted. Research evidence concerning a particular object relations concept (quality of object relations) and a corresponding interview scale (Quality of Object Relations Scale) that has emerged from a series of psychotherapy clinical trials is presented in support of the relevance of object relations theory to STDP. Clinical implications and future research directions are considered. Tishler, C. L., & Gordon, L. B. (1999). Ethical parameters of challenge studies inducing psychosis with ketamine. Ethics & Behavior, 9(3), 211-217. Researchers routinely induce psychosis in healthy volunteers via ketamine infusion to expand their knowledge of schizophrenia. We question the ethics of the nature and procedures of such studies. We also address safeguards for ethically conducting and reporting such pursuits, including recruitment, screening, available treatment, and followup. Westen, D. (1995). A clinical-empirical model of personality: Life after the Mischelian Ice Age and the NEO-Lithic Era. Journal of Personality, 63(3), 495-524. A theory of personality should lead to both accurate prediction and interpretive understanding. Aside from its empirical uses, a personality theory should provide a grammar that allows personality psychologists to infer meaning from overt behavior with more sophistication than a layperson, and the best laboratory for testing the interpretive utility of a personality theory remains the clinic. With respect to the appropriate data for constructing and evaluating theories of personality, an overreliance on questionnaire data is problematic for several reasons: It assumes that understanding people requires no 99 training, it mistakes research on the conscious self-concept for research on personality, it conflates implicit and explicit knowledge, it fails to address defensive biases, and it lacks interrater reliability. Consideration of both empirical and clinical data points to three questions that define the elements of personality necessary for a comprehensive assessment of an individual: (a) What psychological resources–cognitive, affective, and behavioral dispositions–does the individual have at his or her disposal? (b) What does the person wish for, fear, and value, and how do these motives combine and conflict? (c) How does the person experience the self and others, and to what extent can the individual enter into intimate relationships?