Dominick Gamache

The Personality Organization Diagnostic Form: Development of a Revised Version

The purpose of this study is to examine the interrater reliability, validity, and internal consistency of a revised version of the Personality Organization Diagnostic Form (PODF; Diguer et al., 2001), a measure that evaluates the major dimensions of Kernbergs model of Personality Organizations (PO). Results show that the revised PODF can be scored with an interrater reliability ranging from good to excellent for the personality dimensions and the global PO (GPO) score. Factor analysis shows that items tend to regroup according to Kernbergs model. The optimal solution includes 2 factors: a borderline-neurotic continuum and a psychotic factor. Internal consistency and convergence with clinical evaluations also indicate moderate to good validity. Convergent validity with mental health and psychiatric severity is good, and in accordance with Kernbergs model. The revised PODF therefore appears to possess sound psychometric properties, with numerous advantages over its predecessor. Its utility for clinical and research work is also discussed.

Personality organization, five-factor model, and mental health.

Otto Kernberg has developed a model of personality and psychological functioning centered on the concept of personality organization. The purpose of this study is to empirically examine the relationships between this model, the five-factor model, and mental health. The Personality Organization Diagnostic Form (Diguer et al., The Personality Organization Diagnostic Form-II (PODF-II), 2001), the NEO Five-Factor Inventory (Costa and McCrae, Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) Professional Manual. 1992a), and the Health-Sickness Rating Scale (Luborsky, Arch Gen Psychiatry. 1962;7:407–417) were used to assess these constructs. Results show that personality organization and personality factors are distinct but interrelated constructs and that both contribute in similar proportion to mental health. Results also suggest that the integration of personality organization and factors can provide clinicians and researchers with an enriched understanding of psychological functioning.

Development of an object relation-based typology of adolescent sex offenders

The aim of this study was to develop a typology of adolescent sex offenders based on object relations theory and Otto F. Kernbergs model of personality organizations (PO). A secondary objective was to compare the identified subtypes on offense characteristics as well as some psychological variables of adolescent sex offenders. Clinical files from 40 male adolescent sex offenders in treatment were examined. Cluster analysis based on PO and object relations variables identified six subtypes of offenders, in line with Kernbergs PO model. These subtypes differed from one another on various variables pertaining to characteristics of sex offenses, general delinquency, relational/sexual history, and trauma history.

Development and Validation of the Treatment Attrition-Retention Scale for Personality Disorders

This study is an investigation of the psychometric properties of the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD), an instrument developed to identify patients with personality disorder (PD) at risk of early dropout from psychotherapy. In a first study, assessment files from 320 patients referred for PD evaluation at an outpatient clinic were examined to assess the instruments inter-rater reliability, construct validity, and discriminant validity. Results showed that the global scale could be scored with excellent reliability. Exploratory factor analysis identified five factors: Narcissism, Psychopathy, Secondary gains, Low motivation, and Cluster A features. A second study focused on the scales predictive validity. The TARS-PD showed high specificity (94%) in identifying dropouts, using a cut-off of ≥ 10. Both global and factor scores from the TARS-PD were significant predictors of treatment status (dropout vs. continuation) at 6 months. The scale should be considered promising for PD evaluation and treatment planning.

Development and initial validity of the Object Relations Rating Scale

Abstract The aim of this study was to report on the development and the initial validation of the Object Relations Rating Scale (ORRS), which is a measure of in-session enactments of object relations that draws on a psychodynamic conceptualization of personality organization. Forty participants were included in the study, distributed among neurotic, borderline and psychotic personality organizations (PO). Results showed that the interrater reliability of this new measure is good. Two tests of criterion validity support the validity of the measure: the ORRS discriminates well between the three PO groups and it correlates in expected ways with five PO dimensions. Finally, ORRS scales that pertain to the degree of in-session object relation enactments correlated with a measure of transference intensity (convergent validity), and correlations with therapists experience were low as expected (discriminant validity).

Premature psychotherapy termination in an outpatient treatment program for personality disorders: a survival analysis

OBJECTIVE Psychological treatment for patients with personality disorders (PD) is plagued with a high proportion of early dropouts, and attempts to identify risk factors for attrition have generated very few conclusive results. The purpose of the present study is to identify significant predictors of early treatment termination in a long-term psychotherapy program for PD. METHODS Data was retrospectively retrieved from 174 files of patients who began long-term psychotherapy in an outpatient treatment program in Quebec City, Canada. Socio-demographic, initial disturbance, and diagnostic variables were considered for prediction, along with a measure specifically designed to identify PD patients at risk of dropping out early from psychotherapy, the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD). Survival analysis using Cox proportional hazard regression was performed to identify significant predictors. RESULTS Results using univariate Cox proportional hazards regressions revealed that unemployment, Global Assessment of Functioning scores, and recent hetero-aggressive behavior were significant predictors of early dropout in the first six months of therapy. Adjusting for these three confounders, four of the factor scores from the TARS-PD (Narcissism, Secondary gains, Low distress, and Cluster A features) were significantly associated with dropout in univariate Cox proportional hazards regressions. Secondary gains and Narcissism remained significant predictors after entering all five TARS-PD factors in a multivariate Cox proportional hazards regression adjusting for confounders. CONCLUSIONS Taking into consideration specific treatment prognosis variables, such as those measured by the TARS-PD, might be more useful for dropout prediction in PD patients in comparison with more general demographic and diagnostic variables.

« Le cinéphile : réflexions sur le traitement d'un trouble de personnalité schizoïde »

While treatment of personality disorders in general is often described as difficult and filled with many obstacles, knowledge is still limited regarding the specific treatment challenges for DSMs Cluster A individuals. The purpose of this paper is to explore these challenges, as illustrated by the case study of a schizoid patient who underwent psychodynamic therapy for over a year. Deep and unconscious interpersonal fears that complicated treatment, and how these fears had to be taken into account in therapeutic interventions, will be explored. Strong countertransference reactions, especially those evoked by long silences and constant management of optimal therapeutic distance, will also be discussed. This paper also proposes some reflections on the limitations of DSMs conceptualization of the schizoid personality disorder, and how a dynamic understanding of relational fears and ambivalence in these patients may be crucial to treatment.