Psychotic, borderline and neurotic personality organization

Report
Psychotic, borderline and neurotic
personality organization – fact or
artifact?
Monika Marszał
Adam Mickiewicz University
Poznań, Poland
Over the past few decades, object relation theories have
become a central topic in conceptualization of personality
disorders. One of them, Otto Kernberg’s theory is
considered to be the most interesting, but also the most
controversial one. When we are analyzing the psychodynamic
literature it is hard not to claim that many of its assumptions
should have been verified and described in an empirical way,
based on well planned research.
aim
to recognize the etiology and describe the essence
of intrapsychic structure, what is believed to be
the source of a specific patterns of thinking,
behaving and experiencing
personality development
… is based on an intrapsychic transformations of positive and
negative self- object- affect representations. It can be inhibited as
a consequence of a biological factor (ex. disharmonized
temperament) and/or psychological factor connected with the
lack of possibility to relate to the object (mother).
 If the fixation takes place in a symbiotic phase, we observe the
psychotic PO
 when in a self/ object differentiation phase there’s borderline
PO
 and when in a consolidation phase- neurotic PO
structural model
The differences between three levels of POs concerning 3 basic
dimensions:
1. level of defense mechanisms maturity
2. level of identity integration
3. capacity to reality testing
BPO is similar to PPO in case of domination of primitive
defense mechanisms and identity disturbances but is
different in case of reality testing, what makes it more
similar to NPO.
defense mechanisms
BPO and PPO are constructed by the primitive
defense mechanisms like: splitting, projection and
projective identification. The maintenance of those
mechanisms results in the lack of integration between
libidinal and aggressive aspects of self and object. This
integration is achieved in NPO, where splitting is
replaced by the more mature mechanisms:
repression, denial, reversal.
identity
In NPO we can observe high level of stability and
continuity of self/object representations, what results in
identity integration. In PPO and BPO identity is
diffused, unstable, or connected with foreclosure
identity (Kernberg, 2004, 2004, 1970, 1967).
Reality testing
A broad deficit in PPO, but individuals with BPO may
present some disturbances as well. In general, we can
assume that reality testing is seriously impaired only
in PPO, when patients suffer from hallucinations,
delusions, and confusion about their own existence
(Kernberg, 2004b, 1970, 1967; McWilliams, 2009).
Reality testing is not disturbed in NPO.
Aim of the study
Concerning this brief theoretical description, in our
research we decided to empirically verify the
assumptions about the differences in capacity to
reality testing, level of identity integration and
predominance of certain defense mechanisms in
neurotic, borderline and psychotic PO.
Participants
 90 individuals: 30 individuals with the BPO, 30 individuals with
the PPO and 30 individuals with the NPO. The criteria of
selection to the groups were psychiatric and/or psychological
evaluation.
 18 -64 years old (M=32.9), 46 women and 44 men. 70% of the
participants had high school degree, 24.5% of the participants
had college/university degree and 5.5% had elementary school
degree. Among the participants with the BPO and NPO there
were more women than men, but in the case of the participants
with the PPO there were considerably more men.
Methods
 Defense Mechanisms Inventory (1969) by C. Gleser and D.
Ihilevich.
 Objective Measure of Ego-Identity Status Bennion i Adams
(1986).
 Ego Strength (Es) F. Barron from MMPI (Barron, 1953).
Results
Ego strength
post hoc T3 Dunnet
NPO
Ego strength
F(2,85)= 16,057; P<
.001
48,1
BPO
41,4
PPO
36,4
 Only patients with NPO are characterized by undisturbed
reality testing, what means that there are no situations
when they have problems with self/ other, inner/ outer
differentiation.
 PPO is the most disturbed, in BPO problems probably
can appear in times of regression (ex. due to severe stress)
Defence mechanisms
Turning against
object
Pojection
Turning against self
P
Reversal
Test Kruskala- Wallisa
Test U Manna- Whitneya
61,22
χ2 (2)= 25,974; P< .001
BPO
PPO
NPO
BPO
PPO
NPO
NPO
BPO
PPO
57,6
46,68
NPO
PPO
BPO
PPO
NPO
BPO
60,57
χ2 (2)= 20,322; P< .001
χ2
(2)= 10,590; P< .05
χ2 (2)= 21,902; P< .001
χ2 (2)= 27,191; P< .001
36,08
30,55
28,35
55,12
39,74
34,63
40,25
30,48
58,16
51,98
25,30
in accordance with the previous
assumptions
 Mature principalization used by neurotic individuals to a
greater degree than by borderline and psychotic individuals
(there has been no differences between those two groups)
 Primitive projection was used less frequently by neurotic
individuals. The differences were statistically significant.
In the case of this two subscales the assumption that mature
defenses are more often used by the NPO individuals has
been confirmed, with the simultaneous lack of differences
between the PPO and the BPO groups.
 Mature reversal- borderline individuals obtained significantly
lower scores than the PPO and NPO groups between which
there were no differences (possible impact of social approval
variable) (Dudley, 1978)
 Primitive turning against the object- borderline
individuals obtained statistically significant higher scores in this
scale than the two other groups
 Primitive turning against self- the most surprising results,
significant differences were observed between the high NPO
scores and the two other groups
Identity
Kruskala- Wallis test
Achieved
Moratorium
Difussed
Foreclosured
χ2 (2)= 16,139; P<
.001
χ2 (2)= 18,398; P<
.001
χ2 (2)= 13,810; P<
.001
χ2 (2)= 20,723; P<
.001
U Mann- Whitney test
PPO
NPO
BPO
PPO
BPO
NPO
PPO
BPO
NPO
PPO
NPO
BPO
55,18
47,21
29,33
56,6
50,75
19,15
58,62
42,93
33,90
61,27
42,23
31,03
 Diffused identity was used more frequently by individuals
with PPO than any other organization
 Moratorium (currently experiencing an identity crisis) is
observed significantly more frequent in PPO and BPO than
NPO
 Foreclosured identity status is more frequently observed
in PPO (seems to be consistent with the
clinical characteristics of psychotic disorders, this identity
status is described as a rather stable structure,
but determined entirely by other people (parents) and
not confirmed in an individual way)
 Achieved identity- higher performance of psychotic and
neurotic patients in achieved identity status. As expected,
the psychotic person should present lower results on the
scale relating to an integrated identity, while a high score of
the neurotic is consistent with the previous assumptions.
To what extent does the organization of
personality pathology can be
explained by the variables in the
model indicated by O. Kernberg?
Logisic regression
NEUROTIC
BORDERLINE
PSYCHOTIC
Variable
B
SE
Exp
(B)
Variable
B
SE
Exp
(B)
Variable
B
SE
Exp
(B)
TAO
-0,70* ,03
,93
Achieved
Identity
-,07*
,03
,94
TAS
-,15*
,06
,87
TAS
,10*
,05
1,10
F Identity
,07**
,03
,93
REV
,12**
,04
1,12
Ego
Strength
,13**
,04
1,14
TAO
,14**
,04
1,16
Ego
Strength
-,12*
,05
,89
Moratori
um
Identity
,09**
,03
,91
Diffused
Identity
,08*
,04
1,08
** p < .01. * p < .05.
Logistic regression
 neurotic personality organization is explained by
the high score on reality testing (ego strength) and turning
against self mechanism, and low scores on the
moratorium identity status and aggression against the object.
 borderline personality organization is explained by
the low scores on the achieved (A) and foreclosed (F)
identity and high scores on agression against object scale.
 psychotic personality organization is explained by
the high scores on reversal (REV) and identity diffusion (D)
scale and low scores on reality testing and a turning against
self.
Conclusion
On the basis of the study we can not clearly answer the
question of whether proposed
by Otto Kernberg personality characteristics of different PO is
in line with reality.The results seem to be interesting, especially
when we consider the qualitative differences between
compared groups in the analyzed variables. It appears
that testing on a larger group of subjects, using a more diverse
and accurate methods could result in a more
unambiguous results. Certainly, this study may serve as
a good starting point for further research in this
very interesting area.
Sources

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4rt ed. rev.).
Washington, DC: Author.

Chabrol, H., & Leichsenring, F. (2006). Borderline personality organization and psychopathic traits in
nonclinical adolescents: Relationships of identity diffusion, primitive defense mechanisms and reality
testing with callousness and impulsivity traits. Bulletin of the Menninger Clinic, 70(2), 160–170.

Gleser, G. C., Ihilevich, D. (1969). An objective instrument for measuring defense mechanisms. Journal of
Consulting & Clinical Psychology, 33, 51-60.

Kernberg, O.F. (1996). A psychoanalytic theory of personality disorders. W: J.F. Clarkin, M.F.
Lenzenweger (red.), Major theories of personality disorders (s. 106-140). New York London: The Guilford
Press

Kernberg, O.F. (2004). Borderline personality disorder and borderline personality organization:
Psychopathology and psychotherapy. W: J. J. Magnavita (red.). Handbook of personality disorders.Theory and
practice. (s. 92-119). New Jersey: John Wiley & Sons, Inc.

Kernberg, O.(1967). Bordeline personality organisation.
Journal of the American Psychoanalytic Assosiation, 15, 641- 685

Leichsenring F, Kunst H, Hoyer J. (2003). Borderline personality organization in violent offenders:
Correlations of identity diffusion and primitive defense mechanisms with antisocial features, neuroticism,
and interpersonal problems. Bulletin of the Menninger Clinic 67(4):314-327

Leichsenring, F. (1999). Development and First Results of the Borderline Personality Inventory: a selfreport instrument for assessing Borderline Personality Organisation. Journal of Personality Assesstment, 73(1),
45- 63
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Leichsenring, F. (1999). Splitting: an empirical study. Bulletin of the Menninger Clinic, vol. 63, No. 4 (Fall

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