Biomedical subjects
Publications and source records attributed to R F Bornstein.
Although dependence in adults has typically been viewed as a flow or deficit in functioning, a review of the literature reveals that high levels of dependency are associated with both positive and negative qualities on the part of the dependent person. Studies confirming this association are discussed, along with the theoretical and practical implications of their findings.
A meta-analysis was conducted on all the double-blind, placebo-controlled efficacy trials of the antidepressant fluoxetine (Prozac). This drug has become the antidepressant most frequently prescribed by psychiatrists and has been hailed by the media as a "wonder drug." Results produced a relatively modest overall effect size that was no greater than effect sizes obtained by previous meta-analyses of tricyclic antidepressants. This study also examined the possibility that bias may have contaminated study outcome ratings. Because past studies suggest that the greater frequency of side effects in active drug groups unblinds study participants, we examined the relationship between study effect sizes and the percentage of patients reporting side effects. As predicted, both clinician and patient outcome ratings correlated significantly with the percentage of patients experiencing side effects. Questions are raised about the role of side effects in mediating drug outcome results.
The retest reliabilities of widely used objective and projective measures of dependency were assessed in a mixed-sex sample of undergraduates (54 women and 34 men). Subjects completed Hirschfeld and colleagues' (1977) Interpersonal Dependency Inventory (IDI) and Masling, Rabie, and Blondheim's (1967) Rorschach Oral Dependency (ROD) scale on two occasions separated by 16, 28, or 60 weeks. The IDI and ROD scale showed good retest reliability over 16 weeks in both men and women. However, the ROD scale did not show adequate retest reliability over longer periods in subjects of either sex. IDI scores showed excellent long-term retest reliability in women, but poor long-term retest reliability in men. Subjects' self-reports and impact ratings of life events experienced during the intertest period were unrelated to changes in subjects' IDI and ROD scale scores from Time 1 to Time 2, regardless of the intertest interval used.
A review of laboratory and clinical studies of dependency reveals that a dependent personality orientation is associated with several traits that are likely to influence psychotherapy process and outcome (i.e., compliance with rules and authorities, sensitivity to interpersonal cues, and desire for help and support from others). Because empirical studies of dependency have produced highly consistent findings, strong conclusions may be drawn from the converging results of these investigations. After a review of the clinical and experimental literature on dependency, the implications of patient dependency for several areas of patient-related behaviors (i.e., willingness to seek treatment, behavior during psychotherapy, and the dynamics of treatment termination) are discussed.
This study examined the construct validity of a widely used self-report measure of alexithymia in a mixed-sex sample of 101 psychiatric inpatients (62 women and 39 men). Contrary to expectations, scores on Shipko and Noviello's (1984) alexithymia scale (SNALEX) were: (1) correlated positively with a Rorschach index of verbal productivity; (2) unrelated to a Rorschach index of adaptive use of fantasy; (3) correlated negatively with scores on the MMPI L and K scales and correlated positively with scores on the MMPI F scale; and (4) correlated negatively with subject age. In addition, SNALEX scores were correlated negatively with scores on Klieger and Kinsman's (1980) alexithymia scale (KKALEX) in subjects of both sexes. These results do not support the construct validity of the SNALEX as a measure of alexithymia is psychiatric inpatients.
A review of the empirical literature on implicit perception and implicit memory reveals that Freud's hypotheses regarding free association, transference, and the recovery of unconscious material in therapy were correct in some areas and incorrect in others. Empirical evidence confirms that--as Freud hypothesized--when implicit (i.e., unconscious) perceptions and memories are made explicit (i.e., conscious), individuals are able to make more logical, realistic judgments and inferences regarding those perceptions and memories. However, empirical evidence does not support Freud's contention that free association is a particularly powerful tool for accessing unconscious material. The implications of these findings for psychoanalytic theory and therapy are discussed, and alternative approaches to accessing unconscious material in psychotherapy are described.
The relationship between scores on two widely used measures of dependency--one objective and one projective--was examined in a sample of 102 undergraduate subjects (60 women and 42 men). Consistent with previous studies in this area, significant sex differences were found on the objective measure of dependency, with women obtaining higher dependency scores than men. However, as predicted, men and women obtained comparable scores on the projective measure of dependency. Additional analyses confirmed that scores on the objective and projective measures of dependency were significantly intercorrelated in both men and women, although the magnitudes of these correlations were somewhat larger in women than in men. Implications of these results for the assessment of dependent personality traits in research and clinical settings are discussed.
A meta-analysis of 22 studies of antidepressant outcome assessed the level of medication effects under conditions thought to be less subject to clinician bias than those in the typical double-blind drug trial. Studies were included only if, in addition to a newer antidepressant group, they also contained both standard antidepressant and placebo control groups. Effect sizes were quite modest and approximately one half to one quarter the size of those previously reported under more transparent conditions. Effect sizes that were based on clinician outcome ratings were significantly larger than those that were based on patient ratings. Patient ratings revealed no advantage for antidepressants beyond the placebo effect. Effect sizes were unrelated to sample sex ratios, patient age, inpatient or outpatient status, dosage level, and treatment duration. Findings highlight the fragility of the antidepressant effect.
A meta-analysis of research on Zajonc's (1968) mere exposure effect indicated that stimuli perceived without awareness produce substantially larger exposure effects than do stimuli that are consciously perceived (Bornstein, 1989a). However, this finding has not been tested directly in the laboratory. Two experiments were conducted comparing the magnitude of the exposure effect produced by 5-ms (i.e., subliminal) stimuli and stimuli presented for longer durations (i.e., 500 ms). In both experiments, 5-ms stimuli produced significantly larger mere exposure effects than did 500-ms stimuli. These results were obtained for polygon (Experiment 1), Welsh figure (Experiment 2), and photograph stimuli (Experiments 1 and 2). Implications of these findings for theoretical models of the mere exposure effect are discussed.
Developmental, social, and clinical studies of dependency have produced remarkably consistent results. A review and integration of these findings allow strong conclusions to be drawn regarding the etiology and dynamics of dependency. The etiology of dependency appears to lie in overprotective, authoritarian parenting. In social settings, dependency is associated with suggestibility, conformity, compliance, interpersonal yielding, affiliative behavior, and sensitivity to interpersonal cues. Dependency predicts the onset of certain psychological disorders and follows the onset of others. It seems that the fundamental motivation of the dependent person, from which the behaviors that are exhibited in different situations are derived, is a strong desire to obtain and maintain nurturant, supportive relationships. Implications of these findings for different theoretical models of dependency are discussed.
This paper describes a new theoretical model of subliminal psychodynamic activation (SPA) effects. The model conceptualizes subliminal-supraliminal differences in SPA effects as being due to differences in subjects' attributions for the changes in anxiety level that are produced by subliminal versus supraliminal SPA stimuli. Changes in anxiety level produced by supraliminal SPA stimuli can be attributed by subjects to the experimental procedures, diminishing the impact of these messages on subjects' responses. In contrast, subjects cannot attribute changes in anxiety level produced by subliminal SPA stimuli to the experimental procedures. Therefore, no "discounting" (i.e., situational) attributions for subliminally induced changes in anxiety levels are available to subjects, and subliminal SPA messages produce significantly stronger effects on responding than do supraliminal SPA messages. The attributional model of SPA effects is discussed in the context of other long-term research programs investigating subliminal phenomena. The implications of this model for clinical treatment and empirical research utilizing the SPA paradigm are discussed.
Various theories of personality and psychopathology hypothesize that there should be a relationship between parental perceptions and level of psychopathology. However, there has been relatively little research investigating the parental perceptions-psychopathology relationship, and much of the research in this area has been methodologically flawed. The present study tested four hypotheses regarding the parental perceptions-psychopathology relationship, using a parental representations measure that circumvents many of the problems that have characterized previous research on this topic. Results indicated that psychiatric patients (N = 66): a) viewed both parents more negatively than did members of a matched sample of 66 normal subjects; b) expressed significantly greater ambivalence regarding both parents than did normal subjects; and c) described both parents at a more primitive conceptual level than did normal subjects. As predicted, there was a parallel relationship between perceptions of the parents and overall level of psychopathology within the inpatient sample. The findings are discussed in the context of traditional trait-oriented personality theories as well as more recent social learning theories of personality.
Research indicates that oral dependent and eating-disordered individuals have similar personality traits, attitudes, and behaviors, suggesting that dependency may be a factor in the dynamics of anorexia and bulimia. To investigate this issue, we compared the proportions of dependent and food-related percepts in the Rorschach protocols of matched samples of eating-disordered (N = 16), obese (N = 18), and non-eating-disordered, normal-weight female psychiatric inpatients (N = 17). Eating-disordered patients reported significantly more dependent Rorschach imagery than did obese or normal-weight control patients, but no difference in the proportion of food-related imagery was found among the three groups. These results support the hypothesis that unresolved dependency issues underlie anorexia and bulimia.
Meta-analysis that assessed the magnitude of behavior change produced by subliminal vs. supraliminal drive-related stimuli was performed on all subliminal psychodynamic activation (SPA) studies that employed both types of stimuli (N of studies = 11, N of subliminal-supraliminal comparisons = 43). The analysis revealed that subliminal presentation of drive-related stimuli produced significantly stronger effects on behavior than supraliminal presentation of the same stimuli. Stimulus content, type of outcome measure, and subject characteristics all influenced the magnitude of subliminal-supraliminal response differences. These results support Silverman's (1983) hypothesis that drive-related stimuli must be presented subliminally in order to produce SPA effects. Furthermore, given the pattern of subliminal-supraliminal effect sizes obtained, a partial cue hypothesis of SPA effects is not tenable. Implications of these findings for research that examines the restricting effects of awareness on responding to drive- and affect-related stimuli are discussed.
Psychoanalytic theory suggests that orality and being female are positively related to adopting a help-seeking stance in the world. This may result in inflated scores on self-report psychological tests. These hypotheses were investigated using Rorschach-based, oral-dependence scores (Masling, 1986), the Minnesota Multiphasic Personality Inventory (MMPI) help-seeking F minus K index (Gough, 1950; Meehl, 1951), and the MMPI clinical and supplementary scales. High orals are found to be more likely than low orals to adopt a help-seeking response set which in turn results in inflated scores on a number of MMPI clinical scales. Contrary to stereotypes, women are no more likely than men to be help seeking or oral dependent. Several other significant findings, including that orality is positively related to MMPI Scale 2 (Depression) scores for women, not men, are also discussed.
Although there has been a great deal of research assessing behavioral correlates of oral dependency, the defensive style of the oral dependent person remains unexplored. This paper describes two studies investigating the orality--defense mechanism relationship. In the first study, 154 undergraduate subjects (74 males and 80 females) completed the Defense Mechanisms Inventory (DMI; Gleser and Ihilevich, 1969), and were administered the Group Rorschach test which was scored for oral dependent content in the standard manner (Masling, 1986). In the second study, 64 undergraduate subjects (30 males and 34 females) completed the DMI and the Lazare-Klerman Trait Scale (Lazare, Klerman & Armor, 1966, 1970). Results of both studies indicated that orality is positively related to the use of turning-against-self (TAS) defenses, and negatively related to the use of turning-against-object (TAO) defenses in male subjects. In both studies, orality scores were negatively related to scores on a DMI-derived index of outward-directed aggression (AGG) in males. In Study 2, neither obsessiveness nor hysteria scores were related to TAS, TAO or AGG scores in subjects of either sex. Findings are discussed in the context of previous research on oral dependence.
The incidence and clinical characteristics of DSM-III Schizotypal Personality Disorder (SPD) were explored in a series of 76 consecutive outpatients. Ten patients (13.2%) met DSM-III criteria for SPD. Patients with SPD were significantly more likely to receive a diagnosis of drug abuse or dependence and tended to exhibit a higher rate of major affective disorders than did the non-SPD group. Patients with SPD were rated as significantly more severely disturbed than non-SPD patients on the Global Assessment Scale for the current episode and the worst lifetime episode of disorder. In addition, SPD patients were significantly more likely to have histories of psychiatric hospitalization and attempted suicide and first received treatment at a significantly younger age than did non-SPD patients. These results indicate that SPD is relatively common in outpatient settings and is associated with particularly severe psychopathology.
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