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"Split Personality" by rustymermaid.

The prior review highlights the more influential attributes of Object Relations Theory in context with contemporary relational theory. The evolution of which, today, includes absorption of many past criticisms. Contributing to the branching out into a plethora of related but specialized research and practices.

CRITICISMS

In noting the more significant criticisms I am, likewise, referring to discourse that began a few decades ago. For this reason it is important to recognize a particular rift in theoretical methodology that existed. In keeping with my location (North America) and language of study (English) I am referring to the American and (Hungarian-)British schools of psychoanalytic thought.

The development of Ego Psychology in the U.S. continued to adhere to the structural tenants inherited and furthered by Anna Freud. With notable shifts in both use of terms and interpretation of the triad structure (Id-Ego-SuperEgo), the libidinal development phases remained intact. While this work relied upon relational influences, and a theory of maturation, the analytic approach itself was criticized for distancing inter-personal themes. This movement in theory and research followed suit into the Cognitive Sciences, while the criticisms lent to development of practices in the field of Behavioural Psychology.

The British School more readily shifted away from treating the ‘isolated mind’, thus was more attentive to patterns of behaviour. A hybrid theory of individuation was thereby further particularized, in tandem with similarities and differences in pathology, even while Freud’s observations of melancholia were revisited. Research pertaining to empathy, attachments, social belonging were absorbed into general theory. Though slower to incorporate into methodology, eventually leading to new approaches to clinical practice as well. The resultant discourse made way for Social Psychology, meanwhile representing departures in Attachment Theory.

While Ego Psychology was seen as too rigid and concerned with self/ego regulation, Self Psychology was criticized for ignoring cultural biases inherent to normative standards. In both cases, the question of societal influence was to transform discourse surrounding Self-representation, resulting in development of identity theory as a dimensional complexe. The relevance of Self Psychology to patients with developmental disabilities came under thorough scrutiny, but have lent to both neurological and genetic studies. Categories further distinguishing types of autism and schizophrenia, for example, were created as a result.

Object Relations Theory evolved in alignment with the British School, which benefited from inclusion of divergent research and theory from throughout Europe. Nonetheless, adoption of theory into popular therapies in North America garnered especial interest, generating a plethora of critical theory surrounding the analyst-analysand relationship itself.

Of course, in time, these schools borrow and lend and build upon each others findings and, combined, moved Object Relations Theory into the new territories explored today. In particular, I think of Malher’s observation that infants respond, developmentally, to being held and engaged. That which has since been confirmed by way of medical technologies. Kohut’s work surrounding the function of narcissism and Winnicott’s ‘third space’, where the engagement and interaction is described taking place, have reverberated throughout several theoretical disciplines.

Finally, the rarer critique (but that I have particular interest in) pertains to the more distant reference to embodied states. While physiology and physicality is deemed important to early childhood development, analytic theory is generally more concerned with the body as an image (the Self-object and it’s progeny, for e.g. ‘body-image’). Theory correlating latent affective states with prior experience of physical trauma, for example, has benefited from clinician treatment innovations. Inclusion of both self-reporting and biometrics, to empirical methodologies, also offer potential of re-bridging the conceptual mind-body divide. Summary of these interests, likewise, mark my transitive forays into cross-disciplinary fields of research.

THE DSM (See Development of #5)

There is much debate. around the usefulness of the Diagnostic and Statistical Manual of Mental Disorders (DSM). This handbook describes criteria for diagnosis that are frequently deemed too simplistic and / or outdated. Some categorical descriptions, attributed to personality dysfunctions, could as well describe traits among patients with biological impairments or moderate neurosis for example. It has even been argued that each cluster lists mainly variations, with differing trait emphasis or degrees of severity, but of the same syndrome.

Some therapists and psychologists refer to Jung’s outline of Psychological Types (P-Types), while assessing an approach to treatment, and advocate broader recognition of neurotic ‘personality styles’. Theorists meanwhile point to issues of gender relevancy, in tandem with family culture, and the statistical predominance of men with some traits and the predominance of women with others.

Criteria for Cluster A, B, and C disorders are seen to overlap and inter-correlate particularly, among clinical patients, whereas the manual promotes a concept of pure types. It is not unusual for researchers and practitioners alike to group traits on tests while weighting the significance of aggression, narcissism, anxiety, and paranoia instead. The latter is thought also to assist in distinguishing between transient conditions, and severe pathology, lending to more appropriately supportive therapy expectations.

Hierarchical Structure Of Personality Disorders

This graph represents another possible, more empirically founded, approach to personality dysfunction recognition. Taxonomy begins instead with an Internalizing Spectrum, Externalizing Spectrum, Borderline-Dysregulated Spectrum, and Neurotic Styles. Click on the image above to read the related study: Westen, Drew (Ph.D); Shedler, Jonathan (Ph.D); Bradley, Bekh (Ph.D); DeFife, Jared A. (Ph.D). An Empirically Derived Taxonomy for Personality Diagnosis: Bridging Science and Practice in Conceptualizing Personality, The American Journal of Psychiatry, Vol 169(3), March 2012.

“Our expanded descriptions of personality syndromes solve a problem inherent in DSM-IV: it is psychometrically impossible for criterion sets of only eight or nine items to delineate distinct disorders and also retain fidelity to the clinical syndromes they are intended to describe (1). Certain personality characteristics are central to more than one personality disorder (e.g., lack of empathy is characteristic of narcissistic and antisocial personality disorder; hostility is characteristic of paranoid, antisocial, and narcissistic personality disorders). As DSM is currently configured, including the same item in more than one criterion set gives rise to unacceptably high comorbidity, but arbitrarily excluding items from criterion sets results in clinically inaccurate descriptions.

Prototype matching resolves this problem because items can be included in multiple diagnostic prototypes without giving rise to artifactual comorbidity. For example, narcissistic, antisocial-psychopathic, and borderline-dysregulated patients may all be characterized by deficits in empathy, but not in the same way. Narcissistic patients are often oblivious to others’ needs, antisocial-psychopathic patients may recognize others’ needs and exploit them, and borderline-dysregulated patients may have trouble recognizing others’ internal states when they are overwhelmed by their own emotions or because they are prone to seeing others in black-or-white terms. Clinical practitioners generally do not confuse these configurations. The problem of “comorbidity” is not inherent in personality diagnosis but is an artifact of abbreviated criterion sets that do not capture the complexity of real-life personality syndromes.”

 

An introduction to the trajectory of British Psychoanalysis:

If you can forgive the script / acting, this sequence of videos demonstrate major evolutions in analytic practice. From the Ontario Psychotherapy and Counselling Program site: Sigmund Freud, Heinz Hartmann, Harry Guntrip, Heinz Kohut, Robert Stolorow. [Or go to YouTube]

In order to most clearly demonstrate relevance of the theory. The more infamous personality disorders are, unfortunately, well known due to vengeful and / or self-harming behavioural patterns that, eventually, prompt treatment intervention:

Borderline Personality Disorder [on YouTube] a compassionate appeal / from the viewpoint of the patients.

Narcissistic Personality Disorder [on YouTube].  Very sensationalized, but two patients are present to speak on their own behalf. This video series presents a talk that addresses defining developmental deficits.

Dissociative Personality Disorder [on YouTube], follows treatment of three patients.

4 thoughts on “ORT Notes & The DSM

  1. food for thought, there is something in that, like also I awakened with a thought, an incongruent sentence though congruent- cognitive can solve the emotions which made me think that we are involved in a trinty the mind, the body and our emotions.

    • Have totally had that thought too; of the trinity. I’d be wary of – wait and rephrase – I am wary of any remedies that aren’t integrative. Treating the whole. Not that bits and parts can’t be helpful, but that sometimes we veer off into engineering… As opposed to healing or nurturing or encouraging I mean.

  2. Pingback: ORT Notes & Vids. | Supervision Today

  3. Pingback: Schizo Perception [I] | scrapaduq

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