THE RELATIONSHIP BETWEEN PERSONALITY ORGANIZATION, REFLECTIVE FUNCTIONING, AND PSYCHIATRIC CLASSIFICATION IN BORDERLINE PERSONALITY DISORDER (original) (raw)
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Psychoanalytic Psychology, 2011
Relationships between personality organization, reflective functioning (RF), and the number of Axis I and Axis II disorders were examined. Ninety-two female patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV-TR) borderline personality disorder (BPD) were administered the Structured Interview of Personality Organization (STIPO), the Adult Attachment Interview for assessment of RF, and the Structured Clinical Interview for DSM Disorders. Significant correlations were found between the level of personality organization and the number of Axis I and Axis II diagnoses. In contrast, no association was found between RF and the severity of Axis I and Axis II pathology. RF and level of personality organization were moderately associated. The results indicate that the concept of personality organization is related to the descriptive approach of the DSM-IV-TR. The STIPO provides a differentiated picture of the severity of personality pathology and allows di-Psychoanalytic Psychology 395 mensional ratings of several domains central to personality functioning. The RF findings confirm previous studies indicating impairments of mentalizing capacity in BPD patients. The association between RF and level of personality organization supports both shared and divergent conceptual considerations underlying mentalization and personality organization. Further investigation of the relationship between these structural constructs would shed light on the complex interplay of an individual's capacity to mentalize and the personality structure shaped by identity integration, defense mechanisms, and reality testing. In addition to the psychiatric classification, measurements of RF and personality organization should be considered in psychotherapeutic treatment planning as well as evaluation of therapy response.
Psychiatry research, 2017
Patients with borderline personality disorder (BPD) show poor psychosocial functioning over the course of their lives. To date, predictors of functionality in BPD patients have remained mostly unexplored. In this study, we aimed to assess the association between personality organization and clinical and functional features in a sample of 50 patients with BPD referred to a specialized outpatient clinic. We used the Structured Interview of Personality Organization (STIPO) to assess personality organization and the Global Assessment of Functioning (GAF) scale to measure functionality. Clinical and demographic associations with personality organization were also explored. STIPO scores were negatively correlated with GAF scores (i.e. higher scores in the STIPO dimensions, which reflected greater personality pathology, were significantly associated with lower psychosocial functioning). After controlling for potential confounders, the STIPO domain "identity" significantly account...
Diagnosis and treatment of borderline personality organization
Clinical Social Work Journal, 1978
This paper describes the diagnostic and therapeutic approach to borderline personality organization proposed by Otto Kernberg. Diagnosis is based primarily on the characteristic ego pathology which includes the mechanism of splitting, defined as the defensive separation of '~good" and ~%ad" self and object representations. The therapeutic strategy emphasizes systematic exploration of the negative transference and the pathological defenses. A case is presented to illustrate the applicability of Kernberg's concepts to the therapy of a borderline client treated by a clinical social worker on a once-a-week outpatient basis.
Journal of Personality Assessment, 2010
Relationships between personality organization, reflective functioning (RF), and the number of Axis I and Axis II disorders were examined. Ninety-two female patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV-TR) borderline personality disorder (BPD) were administered the Structured Interview of Personality Organization (STIPO), the Adult Attachment Interview for assessment of RF, and the Structured Clinical Interview for DSM Disorders. Significant correlations were found between the level of personality organization and the number of Axis I and Axis II diagnoses. In contrast, no association was found between RF and the severity of Axis I and Axis II pathology. RF and level of personality organization were moderately associated. The results indicate that the concept of personality organization is related to the descriptive approach of the DSM-IV-TR. The STIPO provides a differentiated picture of the severity of personality pathology and allows di-Psychoanalytic Psychology 395 mensional ratings of several domains central to personality functioning. The RF findings confirm previous studies indicating impairments of mentalizing capacity in BPD patients. The association between RF and level of personality organization supports both shared and divergent conceptual considerations underlying mentalization and personality organization. Further investigation of the relationship between these structural constructs would shed light on the complex interplay of an individual's capacity to mentalize and the personality structure shaped by identity integration, defense mechanisms, and reality testing. In addition to the psychiatric classification, measurements of RF and personality organization should be considered in psychotherapeutic treatment planning as well as evaluation of therapy response.
Understanding and treating borderline personality organization
Psychotherapy, 1983
For many years clinicians have been ceptualizations of these borderlines states puzzled by those nonpsychotic but severely dis-reflects the sense of urgency that many cliturbedpatients referred to as "borderline." Recent n i c i a n s feei abOut this puzzling, seemingly work in object relations theory has suggested that f o r m l e s S j b u t v i r u i e n t disorder. Unfortuborderhne conditions are the result of a failure ^ {{ ^ r e f l e c t § c o n f u s i o n a n d l a c k o f of integration of the basic personality, leading to J / T. .. *nr<,\ IT a major distortion in the patient's sense of self. consensus (Knight, 1953). However, recent Because most of this investigative work is relatively investigations by object relations theorists, recent, many clinicians are unfamiliar with current most notably Kernberg (1967, 1968, 1972, theory and clinical observations on the subject. 1975a,fr, 1976), have stimulated the emer-Failure to comprehend these patients' dynamics gence of a greater understanding of the nature can lead to treatment catastrophes, whereas un-of borderline conditions. Kernberg redirects derstanding of these phenomena may be helpful Our attention away from patterns of sympin dealing with a wide variety of borderline and tomatology and toward an examination of the other clinical problems. Here we present an overs t r u c t u r e a n d organization of personality.
Journal of Personality Assessment, 2012
We investigated the validity of different subtypes of borderline personality organization (BPO) as assessed by theory-driven profiles of the Minnesota Multiphasic Personality Disorder (MMPI; Hathaway & McKinley, 1943) Dutch Short Form (DSFM; Eurelings-Bontekoe, Onnink, Williams, & Snellen, 2008) in a naturalistic follow-up study among 2,062 psychiatric outpatients who received 6 months of ambulatory treatment. Patients were assessed at intake (T1) and 6 months later (T2). At T2, both patients and therapists rated the level of improvement, using the Global Assessment of Improvement. Patients with the high-level BPO profile showed the largest increase in well-being and the largest decrease in severity of symptomatology, whereas severity of symptomatology and well-being of patients with psychotic BPO profiles did not change over time. Agreement between patients and therapists about improvement was good for the internalizing immature BPO and high-level BPO patients, but poor for the externalizing low-level BPO and narcissistic patients.
Journal of Behavior Therapy and Experimental Psychiatry, 2005
Based on cognitive concepts of personality disorders as well as on the bio-social model of borderline personality disorder (BPD), a 34-item instrument, the questionnaire of thoughts and feelings (QTF) was developed for the assessment of feelings, strategic cognitions, and assumptions characteristic for BPD. In different studies, item-and factor analyses were conducted with a dataset of N ¼ 646 clinical and non-clinical participants. Cross-sectional data as well as longitudinal data are available including several other measures on personality and personality disorders: DSM-IV SCID II dimensional score, a personality inventory (PSSI), the German version of the personality disorder beliefs questionnaire (PBQ), as well as overall severity of symptoms (GSI) of the SCL-90-R.
The regulative function of mentalization and mindfulness in borderline personality organization
Current Issues in Personality Psychology, 2015
The aim of this study was to broaden the understanding of the emotional difficulties of borderline personality organization (BPO) by reference to a meta-ability named 'orientation on the internal world', here conceptualized as mentalization and mindfulness, in the framework of object relation theory. It was assumed that it is not mentalization "in itself", but mainly its regulatory function, that is important for BPO. participants and procedure The clinical and control groups (30 individuals each) were examined using The Mental States Task, The Difficulties of Emotion Regulation Scale and The Mindful Attention Awareness Scale. results Individuals with BPO functioned worse than the control group in terms of mentalization, mindfulness, and emotion regulation. The relationship between BPO and the meta-abilities was mediated by emotional dysregulation: total mediation was revealed for one mentalization dimension, and partial mediation was observed for mindfulness. conclusions Orientation on emotional experience and emotional dysregulation are not independent predictors of BPO, but they can be treated as levels in the hierarchical model. Mentalization determines and influences emotion regulation in BPO.
Journal of behavior therapy and experimental psychiatry, 2015
Borderline personality disorder (BPD) is characterized by an unstable and incongruent self-concept. However, there is a dearth of empirical studies investigating self-concept in BPD. In order to bridge this research gap, the purpose of this study was to apply an in-depth analysis of structural aspects of the self-concept in BPD. We examined the degree of compartmentalization, i.e., a tendency to organize knowledge about the self into discrete, extremely valenced (i.e., either positive or negative) categories (Showers, 1992). We hypothesized and found that BPD patients had the most compartmentalized self-concept structure and a higher proportion of negative self-attributes relative to both a non-clinical and a depressed control group. Moreover, BPD patients rated negative self-aspects as more important than positive ones relative to non-clinical controls. We cannot determine whether causal relationships exist between psychological symptoms and self-concept structure. Moreover, furthe...
Journal of Abnormal Psychology, 2012
The proposal for the diagnosis of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5;American Psychiatric Association, in preparation) involves, in part, the use of elevated scores on dimensional personality traits. For instance, the diagnosis of borderline personality disorder (BPD) in the DSM-5 will require evidence of self-and interpersonal impairment as well as elevated scores on traits of emotional lability, anxiousness, separation insecurity, depressivity, impulsivity, risk taking, and hostility. Using a sample of individuals from the community , half of whom were receiving psychiatric treatment, we tested whether the summation of relevant personality trait scores, using data derived from a measure of the Five-Factor Model of personality (FFM), would result in a construct that corresponds to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV, American Psychiatric Association, 2000) BPD construct as scored by expert consensus ratings. The DSM-IV and FFM BPD scores were significantly correlated (r ϭ .60) and generated highly similar patterns of relations (r icc ϭ .84) with key constructs from BPD's nomological network. These data should serve to allay concerns that the DSM-5's new diagnostic approach will be detrimental to the identification of BPD.