Howard D. Lerner

Object Relations in Borderline Adolescents

Although pathological object relations is a core aspect of borderline psychopathology, few studies have examined borderline object relations empirically, and none has focused on borderline adolescents. The present study examined four dimensions of object relations, as measured by the Thematic Apperception Test, in a sample of adolescent borderlines, psychiatric comparison subjects, and normals. These dimensions are complexity of object representations, affect-tone of relationship paradigms, capacity for emotional investment in relationships and moral standards, and understanding of social causality. Borderlines differed significantly from both comparison groups in several distinct ways, supporting some aspects of psychoanalytic theories of borderline object relations, while challenging others. Borderline adolescents have a malevolent object world, a relative incapacity to invest in others in a non-need-gratifying way, and a tendency to attribute motivation to others in simple, illogical, and idiosyncratic ways. Their object representations, however, can be quite complex, suggesting something other than a preoedipal arrest.

Assessment of Borderline Symptomatology in Hospitalized Adolescents

This study was designed to determine if 1) the diagnostic interview for borderlines (DIB) could be reliably administered to hospitalized adolescents and 2) to examine convergence of independently derived diagnoses of borderline personality disorder (BPD). Adolescents evaluated using the DIB were independently evaluated using the SADS and DSM-III criteria. It was found that the DIB could be reliably administered to hospitalized adolescents and that convergence between DIB defined BPD and DSM-III defined BPD was 75%. Major affective disorder frequently coexisted with BPD and the implications of this finding are discussed.

Contemporary psychoanalytic perspectives on gorge‐vomiting. A case illustration

The purpose of this paper is to bring recent formulations derived from different lines of conceptual development within psychoanalytic theory to bear on the anorectic and bulimic/gorge-vomiting syndromes. A brief review of major trends and conceptual advances in psychoanalytic theory is followed by a clinical case presentation of a hospitalized anorectic and gorge-vomiting adolescent girl. Her chaotic history, vexing clinical picture, and turbulent course of treatment are reviewed. Finally, a comprehensive formulation derived from self-psychology, psychodynamic developmental theory, and object relations theory is advanced with a view toward titrating clinical manifestations to their developmental origin, providing a more comprehensive understanding of symptomatology, and securing the formation of a more accurate treatment program.

A psychoanalytic clinician looks at diagnostic labels and diagnostic classification systems.

As psychoanalytic clinicians, we do not believe that assessment should be diagnosis based. However, we are supportive of attempts to create a diagnostic classification system that reflects something essential about human nature and also serves clinical purposes. In this article, we present a psychoanalytic diagnostic scheme that combines a more descriptive characterological diagnosis with a more structural level of personality organization diagnosis. The scheme is applied to a clinical case and then we discuss it in terms of the functions such a scheme provides for assessment.