Object relations deficits in subtypes of schizophrenia

Abstract

Forty‐eight subjects with diagnoses of schizophrenia were assessed with the Bell Object Relations Inventory (BORI), the Positive and Negative Syndrome Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), and the Premorbid Adjustment Scale (PAS) to determine the distribution of object relations deficits in the whole sample and four subtypes: paranoid, schizoaffective, poor premorbid, and prominent negative symptoms. Results indicate that 92% of the sample had object relations deficits; 85% showed elevations on the BORI Alienation scale. Subjects with prominent negative symptoms produced lower values on Insecure Attachment and higher values on Egocentricity. This suggests that negative symptoms are associated with a reduction in perceived painfulness of attachment and increased egocentric investment. Other subtyping schemes showed no reliable pattern of object relations deficits.

Parental object representations, attachment to God, and recovery among individuals with psychosis

“…Severe psychopathology such as psychosis is often characterised by chaotic and primitive object representations of the self and other, boundary disturbances in these mental representations, and failure to achieve more integrated levels of object-relations development (Blatt, Wild, & Ritzler, 1975). Problematic object representations, characterised by feelings of alienation, insecure attachment, egocentricity, or social incompetence, are frequently reported by individuals with schizophrenia (Bell, Lysaker, & Milstein, 1992). Qualitative studies from the field of psychiatric rehabilitation have shown that seeking personal space, meaningful social connections, and fulfilling roles are important mechanisms for recovering the self (Sells, Stayner, & Davidson, 2004).…”

“…First, as a result of the difficulty of accessing and assessing this clinical population, the sample size was small relative to the number of variables and the nature of the data analysis. Despite the small sample size in this study, other studies of object representation within this population have generally been a similar size (Bell et al, 1992;Diguer et al, 2004). Only one other previous study (Rizzuto, 1979) has incorporated the assessment of God representation with this population and 20 subjects participated.…”

Object Relations, Reality Testing, and Social Withdrawal in Schizophrenia and Bipolar Disorder

“…Deficits in these functions are extensively found in both these patient groups (Hansen et al, 2012), and in particular, lack of basic trust (alienation) is suggested to be the most common dysfunction among patients with schizophrenia (Bell et al, 1992). Our results suggest that disturbances in this capacity may be a significant contributor to social withdrawal.…”

“…A profound lack of interest in relationships and increased egocentric investments are indicated to be specific patterns in patients with more negative symptoms (Bell et al, 1992). A cluster analysis has found two groups: socially withdrawn (characterized by lack of basic trust in relationships and experiences of being social inept) and socially withdrawn autistic (with additional deficits in reality testing, such as more hallucinations and distortion in the interpretation of one's own feelings or the feelings of others) (Bell et al, 2001).…”

Object relations and reality testing in early- and late-onset schizophrenia

“…Bellak, Hurvich, and Gediman's (1973) method of object-relations measurement provided the framework for the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995), which has facilitated empirical investigations of ego functioning in a number of diagnostic categories (Alpher, 1991;Becker, Bell, & Billington, 1987;Bell, Billington, Cicchetti, & Gibbons, 1988;Heesacker & Neimeyer, 1990;Rutherford, Cacciola, Alterman, & McKay, 1996) including schizophrenia. Bell, Lysaker, and Milstein (1992) found that 92% of a VA schizophrenia sample demonstrated object-relations deficits; 85% had elevated Alienation subscales indicating deficits in the ability to achieve trust and form stable relationships. Such findings demonstrate the relevance of ego deficits in schizophrenia and illustrate the sensitivity of the BORRTI in discriminating within a schizophrenia sample.…”