Object Relations Deficits in Schizophrenia: A Cross-Cultural Comparison Between Brazil and the United States

Abstract

Object relations deficits are commonly found in schizophrenia samples from the United States, but it is unknown whether these deficits are a reliable finding in other cultures. The Bell Object Relations Inventory was translated into Brazilian Portuguese and administered to 61 stable outpatients with schizophrenia from Sao Paolo, Brazil. Their scores were compared with a Brazilian normal sample and with a matched U.S. schizophrenia sample. The Brazilian normal sample showed a pattern of scores within the normal range when compared with U.S. norms. The Brazilian schizophrenia sample had significantly greater pathology than the Brazilian normal sample on Alienation, Egocentricity, and Social Incompetence. Their mean scores on Alienation were similar to the matched U.S. schizophrenia sample, and they had significantly greater pathology on Insecure Attachment, Egocentricity, and Social Incompetence with 85.6% showing some type of object relations deficit. Findings support the cross-cultural validity of the Bell Object Relations Inventory and the ubiquity of object relations deficits in schizophrenia. The most common profiles for both schizophrenia samples were the Psychotically Egocentric and the Socially Withdrawn object relations types.

Passive/Apathetic Social Withdrawal and Active Social Avoidance in Schizophrenia

“…Studies using the BORRTI have found significantly higher levels of impairment in reality testing and object relations among people with schizophrenia compared to healthy controls (Bell, Lysaker, & Milstein, 1992). Patients with schizophrenia appear to have significant deficits in object relations compared to healthy controls (Bell et al, 2001;Bellak et al, 1973) and more disturbances in reality testing compared to other clinical groups (Bell et al, 1992;Bell & Bruscato, 2002;Bell & Zito, 2005). Studies have also found that object relation deficits, as measured by the BORRTI, discriminate better between patients with adolescent-and adult onset of schizophrenia than clinical symptoms and cognitive functioning (Greig, Bell, Kaplan, & Bryson, 2000b).…”

“…In addition, possible cultural differences between the American and Norwegian sample are not indicated to cause the different findings, even for differences in the design. The translation of the BORRTI has shown good cross-cultural reliability and validity in a Brazilian population (Bell & Bruscato, 2002), and thus preclude the differences in culture to cause the different findings. Again, we argue that the cause may be differences in sample characteristics.…”

“…Thus, it is important for later social interaction and function in daily life. Dysfunctions in object relations have been found in patients with schizophrenia (Bell & Bruscato, 2002;Bell, 2004;Greig, Bell, Kaplan, & Bryson, 2000a;Westen, 1991b), in addition to impairments in reality testing. Reality testing comprises the ability to accurately perceive and interpret external and internal reality.…”

The relationship between post‐traumatic symptom severity and object relations deficits in persons with schizophrenia

“…The link between schizophrenia and object relations deficits is strong and associated with the course of the disease as well as recovery. Indeed, most people with schizophrenia have significant object relations deficits (Bell & Bruscato, ; Bell et al ., ) and their deficits appear to be more profound than those with other, less severe psychiatric disorders (Hansen et al ., ). Furthermore, within a group of people with schizophrenia, those with an earlier onset of schizophrenia have worse object relations deficits than do those with a later onset (Greig, Bell, Kaplan, & Bryson, ).…”

Perceived Social Support, Malevolent Maternal Representations, and Older Adults' Depressed Mood

“…Representation of early relationships with significant others is a basic construct in both psychoanalytic (Blatt, 1974;Kernberg, 1976;Lichtenberg, 1983;Mitchell, 1988;Stern, 1989) and attachment theories (Ainsworth, 1969;Bowlby, 1969). Moreover, there is accumulating empirical support for a link between attachment theory and psychoanalytic paradigms (see Bell & Bruscato, 2002;Beulow, McClain, & McIntosh, 1996;Calabrese, Farber, & Westen, 2005;Levy, Blatt, & Shaver, 1998;Priel & Besser, 2001). Within these two theoretical frameworks, parental representations are assumed to structure responses to and expectations from others throughout life.…”