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Borderline Personality Organization and Dissociation
Carsten Spitzer, MD Sven Barnow, PhDJan Armbruster, MD Stefan Kusserow, MD Harald J Freyberger, MD Hans Joergen Grabe, MD
The relationship between Kernbergs psychodynamic model of personality organization (PO) and dissociation has not yet been explored. Seventy-two nonclinical subjects and 222 psychiatric patients completed the Dissociative Experiences Scale and the Inventory of Personality Organization. Its Reality Testing subscale emerged as the most important predictor for all facets of dissociation. Discussing our results in the framework of Fonagy and coworkers model of mentalization, we suggest that dissociation may reflect the preoedipal pretend mode of psychic functioning while impaired reality testing and psychotic experiences might be indicative of the psychic equivalent mode. (Bulletin of the Menninger Clinic, 70[3], 210-221)
Numerous studies have indicated that dissociation is a prominent feature of borderline personality disorder (BPD), and that it distinguishes BPD from other personality disorders (PDs) (Skodol et al., 2002; Wildgoose, Waller, Clarke, & Reid, 2000; Zanarini, Ruser, Frankenburg, & Hennen, 2000). This is also acknowledged by DSMIV, which lists severe dissociative symptoms as one out of nine diagnostic criteria for BPD (American Psychiatric Association, 1994). Dissociative symptoms in BPD have been related to selfinjurious behavior (Brodsky, Cloitre, & Dulit, 1995; Kemperman, Russ, & Shearin, 1997; Spitzer, Effler, & Freyberger, 2000) and traumatic experiences, particularly childhood maltreatment (Brodsky et al., 1995; Heffernan & Cloitre, 2000; Simeon, Nelson, Elias, Greenberg, & Hol-
The authors are from the Department of Psychiatry and Psychotherapy, ErnstMoritzArndtUniversity, Greifswald/ Stralsund, Germany. Correspondence may be sent to Dr. Spitzer at the Department of Psychiatry and Psychotherapy, ErnstMoritzArndtUniversity, Rostocker Chaussee 70, D18437 Stralsund, Germany; email:[email protected]. (Copyright 2006 The Menninger Foundation)
210 Bulletin of the Menninger Clinic
Borderline personality organization and dissociation
lander, 2003; Spitzer et al., 2000; Van Den Bosch, Verheul, Langeland, & Van Den Brink, 2003; Zanarini, Ruser, Frankenburg, Hennen, & Gunderson, 2000). Correspondingly, posttraumatic stress disorder has been found to be a frequent comorbid disorder in patients with BPD (Heffernan & Cloitre, 2000; Skodol et al., 2002; Spitzer et al., 2000; Van Den Bosch et al., 2003; Zimmerman & Mattia, 1999).
Despite the valuable contributions of these studies, they might be limited by adhering to the DSM classification, which has some disadvantages with respect to PDs. First, the DSM represents...