Psychoanalytic conceptualizations of borderline personality disorder: A Rorschach study of borderline adolescents.

This study was designed to test several psychoanalytic hypotheses concerning the intrapsychic features which are thought to distinguish borderlines from other psychopathological conditions. Subjects were inpatient and non-patient female adolescents ranging in age from 13 to 18. Adolescent inpatients were diagnosed on the basis of their scored responses to Gunderson's Diagnostic Interview for Borderlines; forty-five were so classified as borderline, and 30 as non-borderline. These groups were compared with a group of 31 normal adolescents. Several Rorschach measures were used to tap intrapsychic dimensions thought to be particularly relevant to assessing borderline functioning (e.g., the quality of internalized object relations, the quality of ego defensive and ego adaptive functioning, aspects of affect regulation, and the quality of separation-individuation conflict). Borderlines were distinguished from both normals and non-borderline inpatients by virtue of ego disturbances suggestive of considerable thought disorder, perceptual distortions and weakened reality testing. Defensively, borderlines appeared to rely excessively and non-specifically on a number of "primitive" defenses, including splitting, denial, projective identification, idealization and devaluation. There was little support, however, for the idea that borderline adolescents utilize splitting more than other adolescents, or that a specific and discernibly unique constellation of "borderline" or "narcissistic" defenses can be thought to characterize them. Borderline adolescents were significantly more preoccupied with aggressive fantasies than were non-borderlines, and appeared more likely to express their aggressive fantasies in a more blatant, "primitive" form. Most typical of borderline adolescents was an inner object world characterized by primitive narcissistic concerns, symbiotic dependency needs, megalomaniacal, omnipotent trends and intensely conflictual, separation-individuation strivings experienced in regressive, oral terms. Overall, these results appear to provide considerable support for several psychoanalytic hypotheses concerning the intrapsychic features which are thought to distinguish borderlines from other patient groups. Furthermore, they lend support to the idea that borderline personality disorder as a personality disorder diagnosis can be meaningfully applied to adolescents who symptomatically resemble adult borderlines.PhDPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/103650/1/9034444.pdfDescription of 9034444.pdf : Restricted to UM users only