Differences in Self and Other Representations in Inpatients Diagnosed with Depression, Borderline Personality Disorder, and Psychotic Disorders: A Test of Blatt’s Model

Psychoanalytic theorists contend that severe psychopathology involves fundamental disturbances in self- and object representations. Kernberg distinguishes between neurotic, borderline, and psychotic levels of personality organization based on the degree of differentiation and integration of self and object representations. Blatt developed the Object Relations Inventory (ORI) for assessing the structure of mental representations by evaluating open-ended descriptions of self and significant others. In the present study we examine the relationship of mental representations to clinical diagnosis (i.e. neurotic, borderline, and psychotic). Participants were 76 (41 men, 35 women) young adult and adolescent psychiatric inpatients, ages ranging from 13 to 26 (median = 16). Participants were reliably diagnosed with psychotic disorders (n = 12), borderline personality disorder (n = 43), or depression (n = 21) and assessed with the ORI. Consistent with our main hypotheses, results suggest a progression in the developmental level of mental representations, though primarily between patients with psychotic versus neurotic and borderline diagnoses. While limited by the small sample size, the implications of findings for psychodynamic models of psychopathology are discussed.