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Bell Object Relations and Reality Testing Inventory
                   Bibliography

                     July 2008



                       Snow Li
                 Princeton University

                  Morris Bell, Ph.D.
                   Yale University
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Table of Contents
Axis I                                                                              3
          Abuse and Trauma Studies                                                  3
          Depression Studies                                                        11
          Eating Disorder Studies                                                   15
          Ketamine Studies                                                          21
          Methadone Studies                                                         23
          Substance Abuse Studies                                                   26
          Schizophrenia Studies                                                     33
          Miscellaneous Axis I Studies                                              37

Axis II                                                                             39
          Alexithymia Studies                                                       39
          Criminology Studies                                                       40
          Personality Disorder Studies                                              43

Non-Psychiatric Studies                                                             50
      Attachment Studies                                                            50
      Family Studies                                                                58
      Parent-Child Relationship Studies                                             62
      Personality Studies                                                           69
      Psychoanalysis Studies                                                        72
      Sexuality Studies                                                             75
      Spiritual and Religious Studies                                               78
      Miscellaneous Non-Psychiatric Studies                                         85

Measures and Inventories                                                            92

Reviews                                                                             96

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 long-
term 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.
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       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 long-
       term 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
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       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 long-
       term 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(11-
     B).***

       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 semi-
       structured 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.***
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       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 clinician-
       investigators 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.
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       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
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       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 post-
      traumatic 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
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       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 fifty-
       nine 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
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       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 partner-
       assaultive 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 Test-
       Revised, 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 all-
       too-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 self-
       nurturance 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 father-
       attachment 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, <obese binge eaters
       <bulimics as measured by Insecure Attachment and Egocentricity subscale scores on the
       Bell Object Relations Inventory. Subjects were 72 women between the ages of 20 and 45.
       The women were divided into four groups: normal, obese, obese binge eater, and bulimic
       on the basis of their scores on the Body Mass Index, Gormally Binge Eating Scale, and
       the Questionnaire on Eating and Weight Patterns-Revised. Results failed to indicate a
       continuum of disturbance in object relations as level of eating disorder pathology
       increased. However, significant differences amongst the group means measuring severity
       of object relations disturbance were noted between the two control groups (normal and
       obese) and the two eating disordered groups (binge eater and bulimic) on both the
       Insecure Attachment and Egocentricity subscales of the Bell Object Relations Inventory.
       There was no significant difference in object relations pathology between the normal and
       obese groups or between the binge eater and bulimic groups. While not part of the formal
       hypothesis, additional analyses of subtest scores or Alienation and Social Incompetence
       yielded similar results. Significant differences between the two control groups and the
       two eating disordered groups were noted for both Alienation and Social Incompetence.
       No significant difference was noted between normal and obese subjects or between binge
                                                                                                20


       eating and bulimic subjects. Subsequent interscale correlations and a factor analysis
       appeared to indicate that for this particular population, the Bell Object Relations Scale
       seemed to be measuring a global object relations factor rather than specific object
       relations deficits. Theoretical implications and areas for further research were proposed.

Pollack, D. L., & Keaschuk, R. A. (2008). The Object Relations of Bulimic Women in Context:
       An Integration of Two Studies. Eating Disorders, 16(1), 14 – 29.

       The purpose of this paper is to investigate and contextualize the object relations of
       bulimic women. Two independent studies, one quantitative and one qualitative, were
       conducted. In the quantitative study, 77 undergraduate women completed self-report
       measures of eating behavior, interpersonal dependency, and object relations. In the
       qualitative study, four bulimic women participated in semi-structured interviews that
       were coded for relational themes and contextualized through a feminist socio-cultural
       analysis. Results supported the strong association between dependency and eating
       disorders and demonstrated that the object relationships of the participants were
       characterized by both insecure attachment and egocentricity. Socio-cultural analysis
       suggests that the development of these object relations can be partially accounted for by
       conflicting cultural expectations for women.

Steiger, H., & Houle, L. (1991). Defense styles and object-relations disturbances among
        university women displaying varying degrees of symptomatic eating. International
        Journal of Eating Disorders, 10(2), 145-153.

       Psychodynamic theory links eating disorders to developmentally determined deficits in
       interpersonal functioning and self-regulation, and argues that eating symptoms serve
       needs for tension regulation and control, and express conflicts that are principally
       interpersonal in nature. To test such a view, we used the EAT-26 and a brief
       questionnaire tapping eating symptoms to establish the presence and severity of eating
       symptoms among 112 university women, and then compared scores of groups exhibiting
       different symptom severities on the Bell Object-Relations Inventory and the Defense
       Style Questionnaire. Results indicated that "symptomatic eaters" showed more object-
       relations problems and were more reliant on maladaptive defenses. Findings of this type
       in a population showing largely subclinical eating disturbances suggest that deficits in
       interpersonal and adaptive functioning are likely precursors to, rather than consequences
       of, eating-disorder development.

Wanlass, J. (1996). Individuation conflicts and relationship patterns of anorexic and bulimic
      women. University of Utah, Salt Lake City.

       Over the past 3 centuries, physicians, psychotherapists, and researchers have debated the
       symptom constellation, etiology, and treatment of eating disorders. Even though various
       theoretical models of anorexia and bulimia appear in the psychological literature, most
       conceptualizations of eating disorders are drawn from clinical observations rather than
       from empirical studies. These case studies highlight problems in self-development,
       interpersonal relationships, coping strategies, family systems, and emotional expression
                                                                                                21


       in addition to blatant food and weight concerns. This dissertation applied an object
       relations perspective and examined individuation conflicts and relational patterns of
       anorexic and bulimic women.

       The investigator adopted a combined methodological approach, gathering quantitative
       and qualitative data. Specifically, this study (N = 90) (a) compared students, aerobic
       participants, and anorexic and bulimic patients on a demographic survey and an objective
       measure of object relations functioning and (b) identified common themes in
       relationships described by a subset of anorexic and bulimic women. A chi-square analysis
       found higher observed than expected frequencies of pathological scores on six of the
       seven Bell Object Relations Reality Testing Inventory (BORRTI) subscales for the
       eating-disordered group (p <.001). In addition, results from a one-way analysis of
       variance (ANOVA) displayed statistically significant differences between the eating-
       disordered group and the two comparison groups on six of the seven BORRTI subscales
       (p < .001). These empirical findings suggested that the eating-disordered group showed
       substantial impairment in object relations functioning compared to students and health-
       conscious individuals.

       Nine women from the eating-disordered group were interviewed about their significant
       relationships for the qualitative portion of the study. The following descriptive categories
       emerged from the data: (a) need for acceptance, (b) fear of intimacy and vulnerability, (c)
       feelings of abandonment and betrayal, (d) individuation conflicts, (e) emotionally distant
       parents, (f) caretaker roles, and (g) emotional numbing.

       These quantitative and qualitative results supported conceptualizations of eating disorders
       proposed by object relations theorists. Anorexic and bulimic women showed
       developmental arrests in self and other representations. In addition, they described
       difficulties with separation, abandonment fears, and problematic interactions with
       parents. Implications for future research and related clinical interventions were discussed.


Ketamine Studies
Cho, H. S., D'Souza, D. C., Gueorguieva, R., Perry, E. B., Madonick, S., Karper, L. P., et al.
      (2005). Absence of behavioral sensitization in healthy human subjects following repeated
      exposure to ketamine. Psychopharmacology, 179(1), 136-143.

       Rationale: Sensitization to the effects of N-methyl-d-aspartate (NMDA) glutamate
       receptor antagonists is robust in animals. However, the applicability of this model to
       humans is unclear because it currently rests on highly confounded retrospective studies of
       individuals who experienced protracted psychoses following repeated binges with
       NMDA receptor antagonists. Objectives: The purpose of the current study was to
       determine whether there was evidence of sensitization to the behavioral effects of
       ketamine in healthy human subjects with repeated exposure to this drug. Methods: Data
       were studied from 295 healthy human subjects who participated in one or more of 11
       separate studies that involved ketamine administration over 14 years. Positive and
                                                                                                 22


       negative symptoms (Brief Psychiatric Rating Scale: BPRS), perceptual alterations
       (Clinician-Administered Dissociative States Scale: CADSS), and "high" and "anxiety"
       states (Visual Analog Scale: VAS) that were measured in all studies were included as
       outcome measures. Results: After including the number of previous exposures, number of
       previous studies, and time since first exposure as variables, repeated exposure to
       ketamine did not result in increased behavioral responses, suggestive of behavioral
       sensitization. Conclusions: The current data do not provide evidence that repeated
       exposure to ketamine, albeit limited, is associated with sensitization to the behavioral
       effects of ketamine.

Knott, V., McIntosh, J., Millar, A., Fisher, D., Villeneuve, C., Ilivitsky, V., et al. (2006).
       Nicotine and smoker status moderate brain electric and mood activation induced by
       ketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist. Pharmacology
       Biochemistry and Behavior, 85(1), 228-242.***

       As the increased smoking prevalence in schizophrenics may be interpreted as an adaptive
       response to an underlying biological defect, investigations into nicotine's actions within
       N-methyl-d-aspartate (NMDA) antagonist drug models of schizophrenia may improve
       our understanding of the role of glutamatergic neurotransmission in initiating and
       maintaining nicotine dependence in this disorder. In this double-blind, placebo-
       controlled, randomized study, the electroencephalographic (EEG) and subjective
       response to a sub-psychotomimetic intravenous dose of the NMDA antagonist ketamine
       was examined in 20 regular smokers and 20 non-smokers pretreated with placebo or
       nicotine gum. Although nicotine increased EEG arousal, ketamine produced
       electrocerebral signs of brain activation (decreased slow wave power) and sedation
       (decreased fast wave power and frequency), which were not affected by nicotine
       pretreatment and were evident only in non-smokers. Ketamine increased a number of
       self-report indices of subjective arousal, some of which were attenuated and potentiated
       by nicotine in smokers and non-smokers, respectively. These findings suggest that long-
       term (evidenced by smoker vs. non-smoker comparisons) and short-term (acute) nicotine
       exposure may alter NMDA receptor-mediated arousal and mood systems in a way that
       promotes nicotine dependence in smokers, and addresses neurobiological deficiencies in
       smokers with schizophrenia.

Krystal, J. H., D'Souza, D. C., Karper, L. P., Bennett, A., Abi-Dargham, A., Abi-Saab, D., et al.
       (1999). Interactive effects of subanesthetic ketamine and haloperidol in healthy humans.
       Psychopharmacology, 145(2), 193-204.

       Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with prominent
       psychoactive effects in humans. This study evaluated whether the oral administration of
       haloperidol 5 mg would block the effects of an intravenous ketamine infusion (bolus of
       0.26 mg/kg followed by 0.65 mg/kg per hour). Twenty healthy subjects completed 4 test
       days involving the oral administration of haloperidol or matched placebo 2 h prior to the
       intravenous infusion of ketamine or saline. Ketamine produced cognitive, behavioral,
       neuroendocrine, and physiologic effects in the healthy subjects that were similar to
       previous reports. Haloperidol pretreatment reduced impairments in executive cognitive
                                                                                                23


       functions produced by ketamine as measured by proverb interpretations and the
       Wisconsin Card Sorting Test. However, it failed to block the capacity of ketamine to
       produce psychosis, perceptual changes, negative symptoms, or euphoria in healthy
       subjects. These data outline an important, but functionally delineaeted modulation of
       ketamine effects by dopamine (2) receptors and other sites of haloperidol action.


Krystal, J. H., Karper, L. P., Bennett, A., D'Souza, D. C., Abi-Dargham, A., Morrissey, K., et al.
       (1998). Interactive effects of subanesthetic ketamine and subhypnotic lorazepam in
       humans. Psychopharmacology, 135(3), 213-229.

       Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with psychotogenic
       and dissociative effects in healthy humans. These cognitive and perceptual effects in
       humans are reportedly reduced by benzodiazepine premedication. This study assessed the
       interactive effects of a ketamine (IV bolus of 0.26 mg/kg followed by an infusion of 0.65
       mg/kg per hour) and lorazepam 2 mg., PO, in humans. Twenty-three healthy subjects
       completed 4 test days involving the oral administration of lorazepam or matched placebo
       2 h prior to the IV infusion of ketamine or placebo. Ketamine: 1) produced behaviors
       similar to the positive and negative symptoms of schizophrenia as assessed by the Brief
       Psychiatric Rating Scale (BPRS); 2) evoked perceptual alterations as measured by the
       Clinician-Administered Dissociative States Scale (CADSS); 3) impaired performance on
       the Wisconsin Card Sorting Test (WCST) and other tests sensitive to frontal cortical
       impairment; and 4) had amnestic effects. Lorazepam produced attention impairments,
       concrete proverb interpretations, and recall impairments. Lorazepam reduced ketamine-
       associated emotional distress and there was a non-significant trend for it to decrease
       perceptual alterations produced by ketamine. However, it failed to reduce many cognitive
       and behavioral effects of ketamine, including psychosis. Further, lorazepam exacerbated
       the sedative, attention-impairing, and amnestic effects of ketamine. There was no
       evidence of pharmacokinetic interaction between these medications. These data suggest
       that subhypnotic lorazepam and ketamine show a spectrum of interactive effects, ranging
       from antagonism to potentiation.


Methadone Studies
Alterman, A. I., McDermott, P. A., Cacciola, J. S., & Rutherford, M. J. (2003). Latent structure
      of the Davis Interpersonal Reactivity Index in methadone maintenance patients. Journal
      of Psychopathology and Behavioral Assessment, 25(4), 257-265. ***

       The latent structure of Davis's 28-item Interpersonal Reactivity Index (IRI) measure of
       empathy was examined in 241 methadone maintenance (MM) patients using factor
       analytic procedures and the divergent and convergent reliability of the derived structure
       was determined. Contrary to the four-factor structure determined for the IRI previously,
       three factors, comprised of 18 items, were found to best represent the construct of
       empathy in MM patients—an Empathy factor (nine items) combining the Empathic
       Concern and Perspective Taking factors originally described by Davis, and Fantasy (four
                                                                                                  24


       items) and Personal Distress (five) factors. Canonical correlation analysis undertaken to
       determine concurrent validity of the IRI's revealed latent structure supported the validity
       of the derived Empathy factor as a measure of empathy, but indicated that Personal
       Distress appeared to be associated with neuroticism. These findings are consistent with
       more recent factor analytic and validity findings for the IRI.

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.

       The utility of traits associated with Antisocial Personality Disorder in making risk
       assessments of violent and nonviolent crimes was examined in 254 subjects sampled
       from a methadone maintenance population. A factor analysis of a number of baseline
       measures resulted in five factors measuring hostility, insecure attachment, impaired
       reality testing, anti-social personality, and empathy. These factors were used in logistic
       regression analysis to predict charges for violent and nonviolent crimes over a 2-year
       period. Individuals with high scores on the antisocial personality factor had an increased
       risk of both violent and nonviolent criminal charges. Individuals with low scores on the
       empathy factor were at high risk for violent crimes. In an analysis using the factor
       components rather than the factors, the measures of perspective-taking and asocialization
       were associated with violent criminal charges, and the measure of psychopathy, but not
       antisocial behavior, was associated with nonviolent criminal charges. The results support
       the use of measures of personality traits in addition to measures of a history of antisocial
       behavior in making violent risk assessments in substance-dependent patients. The DSM
       construct and diagnosis of Antisocial Personality Disorder may be enhanced by greater
       emphasis on personality traits associated with antisocial behavior.

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. ***

       The Bell Object Relations and Reality Testing Inventory (M. Bell, 1991) was used to
       evaluate differences in object relations and reality testing in 215 male and 25 female
       methadone patients (aged 18-55 yrs) based on their degree of psychopathy, measured by
       the Psychopathy Checklist--Revised (R. D. Hare, 1991), and their degree of antisociality.
       As hypothesized, results showed that compared to non psychopaths, psychopaths
       demonstrated significantly greater impairment in object relations and, also, unexpectedly
       in reality testing. No significant differences in object relations or reality testing between
       antisocial and non-antisocial individuals were revealed. Additionally, it was hypothesized
       that differences in object relations would be found in antisocial subjects who were and
       were not considered to be psychopathic. No significant differences in object relations
       were revealed, however, but differences in reality testing were revealed between
       antisocial individuals based on their level of psychopathy.
                                                                                                 25


Rutherford, M. J., Cacciola, J. S., Alterman, A. I., & McKay, J. R. (1996). Assessment of object
       relations and reality testing in methadone patients. American Journal of Psychiatry,
       153(9), 1189-1194.

       OBJECTIVE: The authors studied methadone maintenance patients to determine the
       degree of their impairment in object relations and reality testing and the relationship of
       such impairment to comorbid axis I and axis II disorders. It was expected that deficits in
       object relations and, to a lesser degree, reality testing would be exhibited by the group as
       a whole and that they would be related to the presence of comorbid disorders. METHOD:
       The self-report Bell Object Relations Reality Testing Inventory was administered to 240
       methadone maintenance patients. The subjects were first divided into groups on the basis
       of number of comorbid axis I disorders and then on the basis of number of comorbid axis
       II disorders. Finally, the subjects were placed into one of four groups on the basis of the
       combined presence or absence of axis I and axis II disorders. RESULTS: The methadone
       patients exhibited some specific impairments in object relations, but not in reality testing.
       Bell inventory scores did not significantly differ according to the number of comorbid
       axis I disorders, but they did significantly differ according to number of axis II disorders
       diagnosed. The scores were poorest for those with axis II disorders only, while subjects
       with only axis I disorders had scores similar to those with neither axis I nor II disorders.
       CONCLUSIONS: Comorbid axis II disorders, more than axis I disorders, may be
       associated with problems in object relations and reality testing in methadone patients.

Rutherford, M. J., McKay, J. R., Alterman, A. I., Cacciola, J. S., & Cook, T. G. (1996). The
       relationship of object relations and reality testing deficits to outcome status of methadone
       maintenance patients. Comprehensive Psychiatry, 37(5), 347-354.

       Impairments in the ability to form and maintain meaningful interpersonal relationships
       and in the ability to distinguish between internal and external stimuli are related to an
       individual's psychological health. The Bell Object Relations and Reality Testing
       Inventory (BORRTI) scores of 146 methadone patients were used to evaluate whether
       transitory (TI) or chronic impairments (CIs) in object relations and reality testing were
       related to more severe drug use, family and social problems, psychological distress, as
       well as more time in treatment, seeking additional treatments, or taking psychiatric
       medication. The results showed no significant relationship between BORRTI scores and
       family or social problems, time in treatment, or the months of heroin use between follow-
       up evaluations. However, severity of drug use was related to an impairment in a specific
       dimension of object relations-egocentricity. There was a significant relationship between
       TIs and CIs in object relations and reality testing with levels of psychological distress and
       the likelihood of taking psychiatric medication.

Wood, S. A. (2000). Object relations, alexithymia, symptoms of psychological distress and
      methadone treatment outcome. Smith College School For Social Work, Northampton.***

       This study examined selected psychological characteristics of methadone clients and their
       relationship to treatment outcome. A diverse sample of 230 was drawn from five
       affiliated clinics. The Symptom Checklist 90 Revised, the Toronto Alexithymia Scale and
                                                                                                 26


       the Bell Object Relations and Reality Testing Inventory were used to measure 22 areas of
       psychological functioning and object relations factors. Multivariate analyses were used to
       examine the effects of demographic characteristics and methadone dose along with
       psychiatric symptoms and personality factors on outcome. The results showed that drug
       use dramatically decreased. There were high levels of distress for both those who did and
       did not abstain. There was directional difference in distress level between abstainers with
       and without PTSD and PTSD was much higher for minority groups. Implications for
       social policy changes and treatment matching are discussed.


Substance Abuse
Altonji, M. L. (1996). Adult daughters of alcoholics: Object relations and stress in the parenting
        role. Seton Hall University, College of Education and Human Services, South Orange.

       The purpose of this study was to investigate the usefulness of object relations variables in
       predicting parenting stress in adult daughters of alcoholics (ACOA) with a child under 4
       years of age. Thirty-eight ACOA mothers and 50 non-ACOA mothers completed the
       Parenting Stress Index (PSI) (Abidin, 1983) and the Bell Object Relations Reality Testing
       Inventory (BORRTI) (Bell, 1991). The Parent Domain of the PSI and the BORRTI object
       relations subscales of Alienation, Insecure Attachment, Egocentricity, and Social
       Incompetence were used to measure these variables.

       Hypotheses 1 and 2 compared the ACOA and non-ACOA subjects on the dependent
       variables of parenting stress and object relations. The MANCOVA used to compare the
       groups on these dependent variables found an overall significant multivariate effect (F =
       2.79, p<.02). Univariate F tests conducted indicated significant mean differences between
       the ACOA and non-ACOA groups on Alienation, Insecure Attachment, and Social
       Incompetence. For each significant result, the means for the groups indicated that the
       non-ACOA group demonstrated significantly healthier object relations score means than
       did the ACOA group. No significant differences were found between these groups on
       parenting stress or Egocentricity.

       Hypothesis 3 predicted that level of object relations would account for a significant
       increase in the level of variance in parenting stress beyond that explained by ACOA
       status alone. This hypothesis was confirmed. In the first hierarchical regression analysis,
       ACOA status was entered first and resulted in a nonsignificant F which indicates that
       ACOA status did not demonstrate a significant relationship with parenting stress. Object
       relations scores entered next as a block resulted in a significant increase in the amount of
       variance explained in parenting stress beyond that explained by ACOA status alone
       (F\sb{\rm cha} = 10.28, p<.0001). A follow up analysis using a combined hierarchical
       and stepwise regression indicated that of the 4 object relations variables, Insecure
       Attachment was most related to parenting stress (F = 19.29, p<.0001) and this
       relationship was slightly enhanced by the inclusion of Alienation (F = 14.97, p<.0001).
       These results suggest ACOA status in conjunction with object relations development is
                                                                                                    27


       more useful than ACOA status alone in understanding variations in parenting stress for
       this population.

Bladt, C. W. (2002). Towards a psychodynamic understanding of binge drinking behavior in
        first-semester college freshmen. Journal of College Student Development, 43(6), 775-
        791.

       The current exploratory study was designed to investigate the relationship between
       student characteristics and drinking behavior from a psychodynamic perspective.
       Respondents were 181 male and 196 female first-semester college students attending a
       small, private university in the northeastern United States. Subjects completed the
       following instruments: the Toronto Alexithymia Scale (Taylor Ryan, & Bagby, 1985), the
       Rosenberg Self-Esteem Scale (Rosenberg, 1965), the Bell Object Relations and Reality
       Testing Inventory (Bell, 1991), and the College Alcohol Survey (Wechsler 1997). Results
       revealed clear differences in the relationship between ego functioning and drinking
       behavior for men compared to women. Findings indicate that the meaning of alcohol use
       may differ for male and female students. Implications for methodology, theory, and
       practice are discussed.

Como Kepler, D. (1998). Childhood sexual trauma in men and subsequent substance abuse.
     Dissertation Abstracts International: Section B: The Sciences and Engineering, 58(11-
     B).2

Cubells, J. F., Feinn, R., Pearson, D., Burda, J., Tang, Y., Farrer, L. A., et al. (2005). Rating the
       severity and character of transient cocaine-induced delusions and hallucinations with a
       new instrument, the Scale for Assessment of Positive Symptoms for Cocaine-Induced
       Psychosis (SAPS-CIP). Drug and Alcohol Dependence, 80(1), 23-33.

       Background: Cocaine can induce transient psychotic symptoms. We examined the
       phenomenology of such cocaine-induced psychosis (CIP) using a modified version of the
       Scale for Assessment of Positive Symptoms (SAPS), a well-validated instrument for the
       assessment of schizophrenic psychosis. Methods: We developed a new instrument, the
       Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP),
       based on the well-validated SAPS. We interviewed 243 unrelated cocaine-dependent
       adults using both the SAPS-CIP and an instrument for the identification of cocaine-
       induced paranoia, the Cocaine Experience Questionnaire (CEQ). Results: One hundred
       and eighty-one (75%) of the subjects endorsed CIP using the CEQ. With the SAPS-CIP,
       hallucination (HAL) and delusion (DEL) scores correlated strongly, and the DEL domain
       showed excellent concurrent validity with the CEQ. We observed significant positive
       correlations, respectively, between severity of HAL and DEL, and lifetime number of
       episodes of cocaine use, and negative correlations with age at onset of cocaine use.
       Conclusions: The results suggest that CIP consists of transient delusional and
       hallucinatory symptoms, which tend to occur together and co-vary in severity. It appears
       that rating cocaine-induced paranoia alone (e.g., with the CEQ) can identify most
       subjects experiencing CIP. However, the SAPS-CIP is useful for quantifying the severity
       2
           For abstract, see citation listing in Axis I: Abuse and Trauma Studies
                                                                                                28


       of CIP according to operational criteria. Our data provide additional evidence that CIP is
       a sensitizing response.

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.***

       This self-report questionnaire study revealed that adult children of alcoholics (ACAs, n =
       49) were significantly different from adult children from normal families (ACNs, n = 55)
       on five of nine Bell Object Relations Reality Testing Inventory (BORRTI; Bell, 1988)
       scales and from adult children from dysfunctional families (ACDs, n = 48) on the Reality
       Testing summary score. Both ACAs and ACDs were similar to each other and different
       from ACNs on Insecure Attachment and on two family background ratings- perceived
       quality of paternal and maternal caregiving. Discussion of these results plus separate
       exploratory regression analyses followed.

Higgins, B. D. (1997). Situational confidence, affect intensity and object relations in alcohol and
       cocaine-dependent men. Columbia University, New York.

       The relationships among affect intensity, object relations, situational confidence and
       substance use were investigated in 47 alcohol-dependent and 46 cocaine-dependent male
       veterans. Subjects completed three measures: the Affect Intensity Measure (Larsen &
       Diener, 1987), a measure of emotional reactivity; the Bell Object Relations Inventory
       (Bell, 1991) consisting of four subscales (Alienation, Insecure Attachment, Egocentricity,
       and Social Incompetence) which measure dimensions of interpersonal relatedness; and
       the SCQ-39 (Annis & Graham, 1988) consisting of eight subscales (Unpleasant
       Emotions, Physical Discomfort, Positive Emotions, Testing Personal Control, Urges and
       Temptations, Social Problems at Work, Social Tension, and Positive Social Situations)
       that constitute three factors (Negative Situations, Positive Situations and Urges/Testing
       Personal Control). The SCQ-39 measures self-efficacy regarding situations with potential
       to induce relapse. In addition, subjects were interviewed using the Addiction Severity
       Index to assess substance use. A one-way (Cocaine dependence vs. Alcohol dependence)
       multivariate analysis of variance (MANOVA) was performed on Affect Intensity, the
       four BORI subscales, the eight SCQ subscales, three SCQ factors, and total SCQ score.
       The MANOVA revealed that the alcohol group was more confident than the cocaine
       group in their capacity to resist heavy use in response to unpleasant emotions, social
       problems at work, or when experiencing urges to use. No between-group differences
       were found on affect intensity or object relations scores. For the cocaine group only,
       higher egocentricity was associated with lower situational confidence in negative
       situations. An examination of Pearson correlations revealed that situational confidence
       was not associated with duration of heavy substance use, amount of money spent in the
       past month on substances, nor total number of months abstinent since onset of heavy use.

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.
                                                                                           29


This study investigated the prevalence and reciprocal influence of alexithymic
characteristics on individuals who abuse substances as well as on substance abuse relapse
rates. Of particular interest were the concomitant interrelationships among alexithymic
and object relations pathology as well as the influence of reactivity to situational stress on
levels of alexithymia.

Specifically, this study addressed three main questions: (1) What is the relationship
between alexithymia and relapse in substance abusers? (2) Is alexithymia in substance
abusers who have a history of relapse a stable trait or is it a reactive state related to
temporary dysphoric affects (anxiety)? (3) What is the relationship between alexithymia
and personality organization in substance abusers?

This research collected data from a sample of 97 individuals divided into two groups
based on their prior relapse history. Subjects who denied a history of relapse (Group 1)
were compared with subjects who admitted to a history of relapse (Group 2) on measures
of alexithymia, object relations, and anxiety. To measure alexithymia, the 20-item
Toronto Alexithymia Scale (TAS-20) was used. To measure object relations, the Bell
Object Relations and Reality Testing Inventory (BORRTI) was used. To measure
anxiety, the State-Trait Anxiety Inventory (STAI) was used. After initial measurements
with the TAS-20, the BORRTI, and the STAI, subjects repeated measurements with the
TAS-20, STAI-S, and STAI-T.

Twenty-four of the 97 subjects (25.5%) scored in the alexithymic range. No significant
difference in estimates of the rate of alexithymia was found between Group 1 and Group
2. In order to examine the state/trait nature of alexithymia within and between the two
groups, a split-plot analysis of variance was used. No significant difference in the level of
alexithymia as a function of group membership or time tested was obtained. An
examination of correlational data, however, reveals that initial measures (TAS-20-1) and
subsequent measures (TAS-20-2) of alexithymia were more strongly correlated in Group
2 than in Group 1 and more influenced by anxiety in Group 1 than in Group 2. Findings,
therefore, must be categorized as inconclusive.

To clarify the interrelationship among alexithymia (TAS-20), object relations (BORRTI),
and anxiety (STAI) and situational/demographic variables, a stepwise multiple regression
analysis was performed and four significant predictor variables were found: trait anxiety
(STAI-T), alienation (BORRTI-ALN), hallucination/delusions (BORRTI-HD), and
gender. Significant correlations were observed between the BORRTI and the TAS-20 on
all of the BORRTI subscales. A 3 x 2 Manova was run on eight dependent object
relations variables (ALN, IA, EGC, SI, RD, UP, HD, and PR) using alexithymia (POS,
BORDER, and NEG) and group membership as independent variables and resulted in a
significant main effect for alexithymia. No significant main effect for group or group-
alexithymia interaction was found. These finding supported the expectation that
alexithymia is associated with object relations disturbances. They are also compatible
with the view that a state of alexithymia can result from severe anxiety. In conclusion, it
appears that there is a subgroup of substance abusing individuals whose alexithymic
                                                                                                 30


       characteristics interfere with or preclude them from effectively benefitting from
       traditional treatment strategies and relapse prevention programs.

Knott, V., McIntosh, J., Millar, A., Fisher, D., Villeneuve, C., Ilivitsky, V., et al. (2006).
       Nicotine and smoker status moderate brain electric and mood activation induced by
       ketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist. Pharmacology
       Biochemistry and Behavior, 85(1), 228-242.3

Parks, B. S. (1999). Systemic-relational factors associated with addiction severity and frequency
       of formal treatment of alcoholics. University Missouri, Saint Louis.

       This is an exploratory study of the association of the interpersonal factors of (a)
       relationship quality and (b) relationship quantity, and (a) the severity of addiction and (b)
       the frequency of formal treatment of alcoholics. The study also explored differences
       among alcoholics, poly-drug users, and those with a dual diagnosis (alcoholism plus
       another mental disorder) in association with relationship quality and quantity, the
       frequency of formal treatment, and the severity of addiction. Eighty volunteer subjects
       were used for this study while they were receiving treatment for substance abuse at a
       Veterans' Administration Medical Center (VAMC) in St. Louis. The Addiction Severity
       Index (ASI), developed by McLellan, Luborsky, Woody, and O'Brien (1980), was used to
       determine the severity of the addiction. Relationship quality was determined by using the
       Bell Object Relations Inventory (BORI), developed by Bell (1985). Relationship quantity
       was determined by identifying the number of "heavy drinkers" in one's social network
       using the Modified Social Network Inventory (MSNI), based upon the Social Network
       Inventory (SNI) developed by Wesolowski (1985). Subjects were placed in an alcoholic
       subgroup based upon their treatment diagnoses at the VAMC. A multivariate multiple
       regression was performed to determine whether relationship quality and relationship
       quantity were statistically significantly related to the frequency of formal treatment and
       the severity of addiction. The hypothesis was supported, as the BORI subscale of
       egocentricity was significantly associated with the severity of addiction. All of the BORI
       subscales for this sample were elevated above the cutoff for impairment. A multiple
       analysis of variance (MANOVA) was conducted to determine whether there were
       statistically significant differences among alcoholics, poly-drug users, and those with a
       dual diagnosis in relation to the frequency of formal treatment, the severity of addiction,
       relationship quality, and relationship quantity. Significant differences among the
       subgroups were found with regard to the rate of formal treatment, the severity of drug
       addiction, and the BORI subscale of "alienation."

Pennewaert, C. E. M. (1995). Degree of substance use/abuse and level of object relations. St.
      John's University, New York.

       The present study investigated the relationship of the degree of substance use/abuse and
       the object relations functions in 97 adult non-psychotic psychotherapy outpatients from a
       major metropolitan area. Differences in eight object relations outcome variables were
       expected to appear as progressively more impaired based on group membership of a
       3
           For abstract see citation listing in Azis I: Ketamine Studies
                                                                                                31


       nonsubstance-abusing psychiatric control (n = 35), experimental use (n = 33), or heavy
       substance abuse (n = 29).

       All subjects were administered the Comprehensive Object Relations Profile (CORP), the
       Bell Object Relations Reality Testing Inventory (BORRTI), A Drug Involvement Scale
       for Classification of Drug Abusers, and a Demographic Questionnaire that included sex,
       time in psychotherapy, race, socioeconomic status (SES), and marital status. Subjects
       were divided into groups of control, experimental use, or heavy substance abuse based on
       the total score derived from the drug involvement scale.

       Using Multivariate Analyses of Variance (MANOVA), five demographic variables were
       assessed for differences between the three levels of the independent variable of degree of
       substance involvement: sex, race, marital status, socioeconomic status (SES), and time in
       psychotherapy. ANOVAs were then performed separately for the four BORRTI and the
       four CORP dependent variables, respectively: Alienation, Insecure Attachment,
       Egocentricity, Social Incompetence, Object Constancy, Integration, Subjectivity, and
       Appreciation.

       The only significant difference that emerged between level of substance abuse and
       impaired object relations was between the three higher and two lower SES groups and the
       heavy substance abuse condition, such that the lower SES, heavy substance-abusing
       subjects showed more egocentricity than higher SES subjects.

       These results suggested the possibility of two types of substance abusers, one where
       relational impairments are a function of abuse, and another in which the two symptom
       patterns are relatively independent, with object relations pathology as primary. In the
       latter case where drug use is secondary, the level of drug involvement is not predictive,
       varying instead with other, unspecified factors. The relationship between these two types
       of substance abusers bears further investigation, as does the possible connection with
       SES.

Santina, M. R. (1999). Object relations, ego development, and affect regulation in severely
       addicted substance abusers. Columbia University , New York.

       Fifty severely addicted substance abusers were compared to 50 nonaddicted controls on
       measures of object relations, alexythymia, ego development, psychopathology, and
       experienced level of childhood trauma. Substance abusers were selected from residents at
       a therapeutic community program, and were all diagnosed with severe chemical
       dependency. Controls were selected from volunteers who responded to ads placed in
       supermarkets, and were screened to eliminate subjects who reported substance abuse
       problems. Subjects were administered the Bell Object Relations and Reality Testing
       Inventory (BORRTI), the Sentence Completion Test for ego development, the Toronto
       Alexythymia Scale, the Symptom Checklist-90, and the Childhood Trauma
       Questionnaire. Data were analyzed using univariate ANOVAs and discriminant analysis
       to evaluate differences between groups on each variable, and Pearson's r was used to
       determine correlations between constructs. Substance abusers displayed significant
                                                                                                     32


       difficulties in several areas: ability to recognize, differentiate and ameliorate emotions;
       difficulties in forming secure, gratifying, and supportive relationships; chronic feelings of
       alienation and isolation; and egocentricity. Addicts reported significantly greater levels of
       experienced childhood trauma and psychopathology than did controls. Alexythymia and
       experienced level of childhood trauma were highly correlated with object relational
       deficits across the whole sample. Ego development was weakly correlated with some
       measures and not correlated with others. It was concluded that object relations theories of
       addiction received empirical support, and that object relational deficits should be
       addressed in the treatment of addicts. The high level of experienced childhood trauma
       reported by addicts raised the issue of prevalence of PTSD symptoms among addicts. It
       was suggested than PTSD and dissociative symptoms may cause clients to discontinue
       treatment if it is too confrontive.

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.
       ***

       The Bell Object Relations and Reality Testing Inventory (BORRTI) was used to evaluate
       differences in object relations and reality testing in a sample of 151 male alcohol-
       dependent patients based on the diagnosis of psychopathy, measured by the Psychopathy
       Checklist-Revised, and on the diagnosis of antisocial personality disorder, measured by
       the Personality Disorder Examination. A substantial proportion of the study group had
       elevated scores on the BORRTI subscales, indicating generally disturbed object relations
       and reality testing among male alcoholics in this sample. This finding confirmed a
       hypothesis that alcoholics in substance abuse treatment would differ significantly from a
       normative sample. Results did not support the hypothesis that psychopaths in the
       alcoholic sample would exhibit significantly more impairment in object relations and
       reality testing than alcoholic patients in the sample without psychopathy. Men diagnosed
       with antisocial personality disorder demonstrated the greatest impairment on the
       BORRTI's object relations and reality testing dimensions. Reasons for these findings are
       discussed, including the possibility that men with antisocial personality disorder
       demonstrated more borderline-type pathology than men with psychopathy. Alternately,
       object relations and reality testing problems in psychopathic individuals may not be
       evident in their self-reports.

Vieten, C. (1999). Revisiting the alcoholic personality: Object relations, affect regulation, and
       defense styles in alcoholic sibling pairs. California Inst Integral Studies, San Francisco.

       Psychodynamic theories suggest that impaired object relations, poor affect regulation,
       and immature defense styles might contribute to the development of alcoholism and other
       addictions. Adoption and twin studies show that there is a heritable component to
       alcoholism as well. By studying families with alcoholic members, this study looked at
       how object relations, affect regulation, and defense styles might be related to alcoholism
       and influenced by genetics or family environment. Sibling pairs concordant and
       discordant for alcoholism responded to the Bell Object Relations and Reality Testing
       Inventory, the 40-item version of the Defense Styles Questionnaire, and the Affect
                                                                                                33


       Regulation Scale. Difference scores were constructed by subtracting the scores of one
       member of a pair from the other member. Using these difference scores, sibling pairs
       concordant for alcoholism with sibling pairs discordant for alcoholism were compared. If
       these variables were related to alcoholism, the discordant sibling pairs should have had
       higher difference scores than the concordant sibling pairs. The only significant difference
       observed between pairs was on the individual defense style of Displacement. However,
       when alcoholics were compared with non-alcoholics across the whole sample, alcoholics
       had significantly higher scores on the Reality Distortion scale of the Bell Inventory and
       were more likely to exceed the clinical cutoff score (>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 well-
       being 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 post-
       hospitalization 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 self-
       deficits 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
           For abstract, see citation listing in Axis I: Methadone Studies
       6
           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 quasi-
       experimental, 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), State-
       Trait 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 (YSQ-
       SF). 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 24-
       item 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 Separation-
       Individuation 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
           For abstract, see citation listing in Axis I: Methadone Studies
       8
           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
           For abstract see citation listing in Axis I: Depression Studies
       10
            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 avoidant-
       dismissive 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
          For abstract, see citation listing in Axis I: Methadone Studies
       12
          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 non-
       DID 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), 102-
       115. ***

       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
          For abstract, see citation listing in Axis II: Personality Disorders
       17
          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 demographic-
       based 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
            For abstract, see citation listing in Non-Psychiatric: Attachment Studies
       21
            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-90-
       Revised (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 non-
       divorced 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
          For abstract, see citation listing in Axis II: Personality Disorder
       24
          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 separation-
      individuation 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, self-
       esteem 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 separation-
       individuation 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
            For abstract, see citation listing in Axis I: Substance Abuse
       28
            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 separation-
      individuation, 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 self-
       report 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), 449-
      474.

       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
            For abstract, see citation listing in Axis I: Depression Studies
       32
            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 cross-
       sectional 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
            For abstract, see citation listing in Axis I: Eating Disorders
       34
            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 MMPI-
       2 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), 449-
      474.37

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 self-
       esteem 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. Thirty-
       five 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 Self-
       Transformational 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 cross-
       cultural 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. Two-
       step 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, self-
       esteem 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 self-
       directing 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 self-
       reported 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 self-
       reported 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 self-
       object 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 Buss-
       Durke 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
          For abstract, see citation listing in Non-Psychiatric: Psychoanalysis Studies
       42
          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
          For abstract, see citation listing in Axis II: Personality Disorders
       45
          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
          For abstract, see citation listing in Non-Psychiatric: Attachment Studies
       52
          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 1990-11352-
       001) 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 follow-
       up.

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?

				
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