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PubMed1995

Suicidal children grow up: ego functions associated with suicide attempts.

OBJECTIVE: To evaluate the relations between suicidal behavior in children and ego functions including impulse control, reality testing, and ego mechanisms of defense. METHOD: One hundred thirty-three children were assessed initially and at a 6- to 8-year follow-up for levels of reality testing and impulse control and frequency of use of several ego mechanisms of defense. Associations between suicidal ideation and suicide attempts at the initial assessment and at follow-up were analyzed with regard to ego functions. RESULTS: Specific ego functions, such as impulsivity, poor reality testing, and ego mechanisms of defense such as projection, regression, compensation, and reaction formation were positively associated with suicide attempts. Repression was a protective factor to prevent suicide attempts in the follow-up period. CONCLUSIONS: The results suggest that ego functions are related to behavior of consequence and are useful in the identification of children at risk for suicidal behavior.

Adolescent↗
PubMed1999

Children's understanding of the relation between delayed video representation and current reality: a test for self-awareness?

This study investigated whether children's ability to recognize themselves in delayed video feedback indicates changes in self-awareness (Povinelli, Landau, & Perilloux, 1996, Child Development, 67, 1540-1554). Children were presented with 3-min-old videos of themselves to test whether they would investigate the current state of affairs upon seeing a surprising element in the video. In one condition, a sticker had been covertly placed into the child's hair, and in another an object had been hidden in a box. Both conditions proved equally difficult and performance correlated. Four-year-olds performed better than 3-year-olds, and children who failed the tasks retrieved the "surprise" item when presented with a mirror. There was no evidence to suggest that children's difficulties were due to immature metarepresentational thinking, lack of experience, problems with the questions, or problems appreciating the correspondence between image and referent. Yet, the parallel results in both conditions and the likelihood of false positives and false negatives indicate that the video test in its present form may not be a valid measure of differences in self-awareness.

Age Factors↗
PubMed1985

[Ego function rating by the specialist working alone in neurology and psychiatry].

Bellak and coworkers' "Ego-Function" rating was performed at a neuropsychiatric outpatients department by having an interview that was recorded once on tape analyzed by the same rater at intervals of 16 +/- 6 months using an estimation scale divided into seven main points. The result shows a high degree of uniformity in assessing the following functions: Reality testing, judgement, feeling for reality of oneself and the world, control of drives and affects, relationship to objects, ability to think, use of fantasy for solving problems, protection from stimuli, defence function, autonomic function, synthetic integrative function and feeling of competence. The most important result is that the rating can be used to good effect by neurologists and psychiatrists working alone.

Adaptation, Psychological↗
PubMed2004

Virtual reality combats test anxiety: a case study report.

This pilot study is the first known in-depth case study of the effectiveness of virtual reality therapy (VRT) as a treatment for Test Anxiety (TA). The subject of the study was a 28-year-old male, whose anxiety and avoidance behavior was interfering with his normal academic activities. For treatment, he was placed in a virtual classroom and later in a virtual auditorium. The subject was exposed to six moderately increasing in difficulty level virtual situations. The subject rated each situation for discomfort. As a simple measure of anxiety, a modified version of the Subjective Units of Disturbance (SUD) scale was used every five minutes during exposure. This case study showed VRT to be an effective treatment method for reducing self-reported TA. Symptoms experienced by the subject during VRT sessions were just as real to the subject as actual test taking and general TA situations. They included increased heart rate, mild dizziness, and headaches. This case study of TA indicates that VRT may be used as an effective treatment method for reducing self-reported anxiety and improving the performance of subject(s) who suffer from TA.

Adult↗
PubMed2005

A Rorschach investigation of incarcerated female offenders with antisocial personality disorder.

Although male psychopathy has been linked to histrionic, narcissistic, and antisocial personality disorders (ASPD), less is known about female psychopathy. The Psychopathy Checklist-Revised (PCL-R) and the Rorschach were used to explore the personality functioning of 45 incarcerated female offenders with ASPD delineated by their psychopathy level. Psychopaths (PCL-R > or = 30) and nonpsychopaths (PCL-R < 24) were compared on Rorschach measures of self-perception, interpersonal relatedness, and reality testing. Compared to female offenders with ASPD who were nonpsychopathic, female offenders with ASPD who were psychopathic exhibited marked disturbances in self-perception, interpersonal relatedness, and reality testing. Our findings highlight the heterogeneity of the ASPD diagnosis in women, support the utility of the psychopathy construct with female offenders, and implicate important differences between men and women with ASPD. These gender differences have relevance to the evaluation (PCL-R scoring) and treatment of female offenders. Our findings are discussed within the context of the female psychopath's hypothesized hysterical character style.

Adult↗
PubMed1986

A comparison of psychopathology in child psychiatric inpatients, outpatients, and nonpatients. Implications for treatment planning.

A total of 308 preadolescents who were either psychiatric inpatients, psychiatric outpatients, or nonpatients were studied with semistructured interview research instruments that have been described previously. The three groups of children included 106 children consecutively admitted to a voluntary hospital psychiatric inpatient unit, 101 consecutively admitted children to the same voluntary hospital center psychiatric outpatient clinic, and 101 randomly selected nonpatients. The research instruments included a Spectrum of Suicidal Behavior Scale, a Spectrum of Assaultive Behavior Scale, a Precipitating Events Scale, General Psychopathology (recent and past) Scales, a Family Background Scale, a Child's Concept of Death Scale, an Ego-Functioning Scale, and Ego-Defense Scale, and a Medical-Neurological Assessment Scale. The results of the study indicated that the presence of recent depression and recent and past aggression, the use of such ego defenses as projection, displacement, and regression, and the experience of parental separation were significantly different for the three groups of children. Impulse control and reality testing were best in the nonpatients and poorest in the inpatients. The variables that best predicted the need for psychiatric hospitalization were suicidal behavior, recent depression, recent aggression, poor reality testing, and such ego defenses as projection and regression. Implications of these findings are discussed.

Aggression↗
PubMed1994

Psychological correlates of codependency in women.

This study examined several potential psychological correlates of codependency to determine the parameters and feasibility of the codependency construct. Subjects were 171 adult female volunteers from a university. Results indicated significant relationships between codependency and: object relations and reality testing (p = .01), intensity of depression (p < .01), introjective depression (p < .001), and history of abuse (p < .001). The results are supportive of codependency as a useful construct which involves a cluster of difficulties in interpersonal relationships, reality testing, and introjective depression. An association was demonstrated between codependency and parental alcoholism, or history of childhood abuse, or both.

Adult↗
PubMed1986

Oedipal determinants in differential outcome of bereavement.

According to psychoanalytic theory, a bereaved individual's prior relationship with the lost person affects his vulnerability to bereavement. Freud attributed the vulnerability to the intensity of ambivalence, and Fenichel saw Oedipal rivalry as one example of that ambivalence. It is argued that, after the death of a parent, reality testing, crucial to the resolution of the Oedipus complex, is disrupted differently for children of the same sex, from those of the opposite sex. Based on Freud's and Fenichel's clinical observations, the effects of disrupted reality testing were transformed into a testable hypothesis. The predictions were validated by testing them against the data supplied by patients before they had any professional contact, when two-thirds of bereaved psychotherapy patients exhibited different effects when the deceased parent was of the same sex, from when he/she was of the opposite sex. A majority of the same-sex children develop an unconscious sense of guilt, which blocks their expression of Oedipal attitudes towards both parents and which attacks their capacity to function adequately at work, and in their sex-linked roles; while the opposite-sex children maintain their preference for the dead parent, aversion to the alive one, and have idealized expectations of their lovers or spouses.

Adult↗
PubMed1985

Borderline manifestations in the Rorschachs of male transsexuals.

It was hypothesized that male transsexuals manifest a character structure consistent with Kernberg's criteria for borderline personality organization. Exploring this hypothesis, Kernberg's criteria for borderline personality organization were operationalized using Rorschach measures. The following variables were examined: aggression (Holt System Aggressive Content Section), object relations (Urist's Mutuality of Autonomy Scale), reality testing (Exner System X + %), and self/object differentiation (Exner System Special Scorings). A group of male college students, a group of male borderlines, and a group of male transsexuals were compared on the above variables. Compared to the normals, the transsexuals and borderlines displayed significantly more intense levels of aggression, a lower level of object relations, poorer reality testing, and impaired boundary differentiation. The transsexuals and borderlines did not differ significantly. The results were taken as suggesting that male gender dysphorics may be a sub-group of the wider borderline diagnostic category.

Aggression↗
PubMed2001

The Inventory of Personality Organization: psychometric properties, factorial composition, and criterion relations with affect, aggressive dyscontrol, psychosis proneness, and self-domains in a nonclinical sample.

This report describes 2 studies of the psychometric characteristics of the primary clinical scales of the Inventory of Personality Organization (IPO; O. F. Kernberg & J. F. Clarkin, 1995), which assess reality testing, primitive psychological defenses, and identity diffusion, in a nonclinical sample. The 3 IPO scales display adequate internal consistency and good test-retest reliability. Item-level confirmatory factor analysis supported a two-factor structure of the IPO consistent with O. F. Kernberg's (1984, 1996) model of borderline personality organization. Each of the 3 IPO scales was associated with increased negative affect, aggressive dyscontrol, and dysphoria as well as lower levels of positive affect consistent with Kernberg's model of borderline personality organization. The IPO Reality Testing scale is closely related to various measures of psychotic-like phenomena.

Adolescent↗
PubMed1978

Dying without death: the third wish in suicide.

A hypothesis is proposed that the nonpsychotic patient in the presuicidal state may have impaired reality testing in which the act of suicide is perceived as not leading to injury or death. Impaired reality testing may be enhanced by intense affects, drugs, and sleep deprivation.

Adult↗
PubMed2003

Borderline personality organization in violent offenders: correlations of identity diffusion and primitive defense mechanisms with antisocial features, neuroticism, and interpersonal problems.

Although theoretical assumptions and empirical evidence suggest an association between borderline personality disorder (BPD) and antisocial behavior or even antisocial personality disorder (APD), there is no study relating the psychodynamic aspects of BPD to antisocial behavior. In this study, the authors tested the correlation between the structural criteria of borderline personality organization (BPO)--that is, identity diffusion, primitive defense mechanisms, and reality testing--and antisocial features, neuroticism, and interpersonal problems. A sample of imprisoned violent offenders (N = 91) was studied using the Antisocial Personality Questionnaire (APQ), the Borderline Personality Inventory (BPI), the Neo-Five-Factor-Inventory (Neo-FFI), and the Inventory of Interpersonal Problems (IIP). Significant correlations were predicted and found between the BPI scales of identity diffusion, primitive defense mechanisms, impaired reality testing, and fear of closeness and antisocial features, neuroticism, agreeableness, and interpersonal problems. The results are consistent with both object relations theory and attachment theory.

Adult↗
PubMed1983

Borderline psychopathology as displayed on psychological tests.

Despite the surge of interest in borderline psychopathology in psychiatric quarters, contributions from the perspective of psychological testing have been few. A brief delineation of the range of borderline psychopathology is offered. Broad trends in the test performance of patients within the borderline range are described with regard to: intelligence and cognitive operations, thought and language, reality testing, organization of affect, configuration of defenses, structure of the object world, dynamics and the interpersonal aspects of the test process.

Affect↗
PubMed1989

Identity integration and ego pathology in disturbed adolescents.

Utilizing the Rorschach and the Wechsler, groups of borderline adolescents (n = 26) and adolescents with other personality disorders (n = 26) were compared to determine whether there were differences in magnitude and type of disturbances in ego functioning. The specific aspects of ego functioning that were studied included disturbances in identity integration, reliance on primitive defensive operations, vulnerability to regressive thinking, and lapses in reality appreciation. Results indicated that during adolescence the borderline personality represents a more severe form of character pathology than other personality disorders, as revealed by more disturbances in identity integration, a greater regression to primary-process thinking in unstructured settings, and more frequent lapses in reality testing. This contrast was most striking in the area of identity integration, where identity disturbances tended to be associated with lapses in reality testing in borderline adolescents, while there was essentially no relationship between these two indicators of ego pathology in non-borderline adolescents. This supports the notion that disturbances in identity integration, or the sense of self, form an important part of the borderline diagnosis, even during adolescence.

Adolescent↗
PubMed1999

Differential patterns of responding among three groups of chronic, psychotic, forensic outpatients.

Elements of response style were examined among three groups of chronic, psychotic, forensic patients: paranoid schizophrenics (N = 89); undifferentiated-disorganized schizophrenics (N = 38); and schizoaffective patients (N = 53). Forensic patients with elevated MMPI-2 L Scales produced increased percentages of Pure Form (F%) on the Rorschach. A similar relationship occurred when the Rorschach was used as the independent measure. Schizoaffective patients reported more psychotic symptoms on the MMPI-2 and lower F% (Rorschach) than both schizophrenic groups. Although undifferentiated schizophrenics evidenced the most psychopathology on the Rorschach (impaired reality testing and perceptual accuracy disturbance), all three groups produced lower than expected frequencies for Rorschach variables commonly associated with thought disorder and poor reality testing (Exner, 1995b). The clinical importance of using the MMPI-2 and Rorschach in tandem with forensic psychiatric patients is discussed. Our empirical findings suggest the need for forensic evaluators to consider the important relationship between psychiatric diagnosis and response style (defensiveness, denial, illness chronicity, medications, and concurrent Axis II psychopathology) when interpreting often-constricted psychological testing protocols in chronic forensic patient populations.

Adult↗
PubMed1990

Differentiating ego functions of borderline and narcissistic personalities.

This study investigated differences in ego functions of borderline and narcissistic personality disorders through examining responses to Rorschach structural and content variables. Reality testing, thought process, affective regulation, impulse control, and the defenses of splitting and grandiosity were examined from Rorschach protocols of 50 borderlines and 26 narcissists. The borderlines produced greater distortion in reality testing, p less than .05; the narcissists produced more insidious thought process disturbance, p less than .05; and higher functioning groups demonstrated greater control of impulses, p less than .05. Borderlines in this sample demonstrated more affective constriction than the narcissists and used more splitting, p less than .05; narcissists used more grandiosity, p less than .05. Implications of this study are (a) ego functions mature inconsistently, (b) affective responsivity influences ego disorganization, and (c) level of functioning and IQ are related to the production of Rorschach variables.

Adolescent↗
PubMed2006

[What is a delusion? A phenomenological view].

BACKGROUND: The debate about dimensional or categorised classification ofsymptoms has widened to include the concept of delusions, one of the key notions in psychiatry. Although interrater agreement concerning the delusion concept is considerable, it is extremely doubtful whether approval also extends to the construct validity. Can the delusion concepts till be described according to the DSM-criteria? AIM: To describe the history of the delusion concept and to present current views on the subject. METHOD: The literature was reviewed with the help ofPubMed. RESULTS: A delusion can best be described as an individual and personal view which cannot befalsifted and to which patientsfeel emotionally attached. Most people consider a delusion to be implausible because it is expressed with such unshakeable certainty. With regard to a a dimension such as conviction there seems to be a continuum that extends from normal ideas to impaired reality-testing. CONCLUSION: If delusions are to be considered as dimensional constructs this will give rise to questions concerning discriminant validity. It will become increasingly difficult to discriminate between delusions and other types of belief that are associated with impaired reality-testing.

Delusions↗