Primary Process Thinking, Primitive Defensive Operations and Object Relationships in Borderline and Neurotic Patients

Abstract

In the present paper Kernberg’s hypothesis concerning the connection between primary process thinking on the one hand and primitive defense mechanisms and modes of object relationships on the other hand were tested empirically in a sample of 30 hospitalized borderline and 30 hospitalized neurotic patients. The diagnoses of the patients were given according to the ‘Diagnostic Interview for Borderlines’ of Gunderson and Kolb, the functions mentioned above were assessed on the basis of the Holtzman Inkblot Technique applying scoring systems of Lerner and coworkers for primitive defense mechanisms and of Urist for the scoring of object relationships to the Holtzman Inkblot Technique. According to the results the hypothesis derived from assumptions of Kernberg could be corroborated. Primary process thinking in borderline patients seems to be closely connected with high levels of anxiety and hostility, projective identification/projection, primitive denial and sadomasochistic relationships. A model for the coming about of primary process thinking in borderline patients is proposed.

Borderline Personality Disorder

“…32 Susceptibility to behaving in a manner that is not age-appropriate in unstructured settings has been empirically demonstrated with unstructured psychological tests such as the Rorschach test or the Thematic Apperception Test. [33][34][35][36] In these unstructured conditions, people with BPD show bizarre-idiosyncratic thinking (eg, "This is a man with the face of a snake and the paws of a tiger"). [33][34][35][36] Adverse Childhood Experiences and Development of BPD Genetic factors and adverse childhood experiences may interact to influence brain development through altered hormones and neuropeptides, increasing the risk of BPD.…”

“…[33][34][35][36] In these unstructured conditions, people with BPD show bizarre-idiosyncratic thinking (eg, "This is a man with the face of a snake and the paws of a tiger"). [33][34][35][36] Adverse Childhood Experiences and Development of BPD Genetic factors and adverse childhood experiences may interact to influence brain development through altered hormones and neuropeptides, increasing the risk of BPD. 7,[37][38][39][40] Adverse childhood experiences may modulate gene expression and lead to stable personality traits.…”

“…Although the symptoms are not listed in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) ( DSM-5 ), BPD is characterized by non–age-appropriate emotions or behaviors in unstructured situations, which can complicate treatment of BPD . Susceptibility to behaving in a manner that is not age-appropriate in unstructured settings has been empirically demonstrated with unstructured psychological tests such as the Rorschach test or the Thematic Apperception Test . In these unstructured conditions, people with BPD show bizarre-idiosyncratic thinking (eg, “This is a man with the face of a snake and the paws of a tiger”) …”

“…Susceptibility to behaving in a manner that is not age-appropriate in unstructured settings has been empirically demonstrated with unstructured psychological tests such as the Rorschach test or the Thematic Apperception Test . In these unstructured conditions, people with BPD show bizarre-idiosyncratic thinking (eg, “This is a man with the face of a snake and the paws of a tiger”) …”

“…Several reliable and validated interview methods exist . In addition, self-report questionnaires are helpful in diagnosis, as well as unstructured tests such as the Rorschach test or the Thematic Apperception Test, which facilitate assessment of personality functioning . Sensitivity of these different diagnostic instruments ranges between 83% and 89% and specificity between 78% and 93% …”