Interpersonal Dependency and Personality Pathology. Variations in Rorschach Oral Dependency Scores Across Achses II Diagnoses | Borderline Personality Disorder | Diagnostic And Statistical Manual Of Mental Disorders

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Although several investigations have examined the relationship of Rorschach Oral Dependency (ROD; Masling, Rabie, & Blondheim, 1967) scores to Axis I diagnosis, there has been very little research assessing variations in ROD scores across Axis II personality disorders (PDs). In this study,RODscores were compared in 5 PDgroups (borderline PD inpatients, borderline PD outpatients, avoidant–dependent PD outpatients, narcissistic PD outpatients, and antisocial PD outpatients), and 2 non-PD comparison groups (psychotic disorder inpatients and college students). Borderline PD inpatients had significantly higher ROD scores than borderline PD outpatients, antisocial PD outpatients, and college students; no other between-group differences were found. We discuss implications of these results for research on dependency and Axis II psychopathology and offer suggestions for future studies.
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  See discussions, stats, and author profiles for this publication at:https://www.researchgate.net/publication/12211576 Interpersonal Dependency andPersonality Pathology: Variations in Rorschach OralDependency Scores Across AxisII Diagnoses  Article   in  Journal of Personality Assessment · January 2001 Impact Factor: 1.84 · DOI: 10.1207/S15327752JPA7503_08 · Source: PubMed CITATIONS 15 READS 51 4 authors , including:James Christopher FowlerBaylor College of Medicine 96   PUBLICATIONS   1,194 CITATIONS   SEE PROFILE Available from: James Christopher FowlerRetrieved on: 21 June 2016  Interpersonal Dependency andPersonality Pathology: Variations inRorschach Oral Dependency ScoresAcross Axis II Diagnoses Robert F. Bornstein  Department of PsychologyGettysburg College Mark J. Hilsenroth  Department of PsychologyUniversity of Arkansas Justin R. Padawer  Department of PsychologyUniversity of Tennessee J. Christopher Fowler  Erik H. Erikson Institute for Training and Research Austen Riggs Center Stockbridge, Massachusetts Although several investigations have examined the relationship of Rorschach OralDependency(ROD;Masling,Rabie,&Blondheim,1967)scorestoAxisIdiagnosis,there has been very little research assessing variations in ROD scores across Axis IIpersonalitydisorders(PDs).Inthisstudy,RODscoreswerecomparedin5PDgroups(borderlinePDinpatients,borderlinePDoutpatients,avoidant–dependentPDoutpa-tients,narcissisticPDoutpatients,andantisocialPDoutpatients),and2non-PDcom-parison groups (psychotic disorder inpatients and college students). Borderline PDinpatients had significantly higher ROD scores than borderline PD outpatients, anti-socialPDoutpatients,andcollegestudents;nootherbetween-groupdifferenceswerefound. We discuss implications of these results for research on dependency and AxisII psychopathology and offer suggestions for future studies. JOURNAL OF PERSONALITY ASSESSMENT, 75 (3), 478–491Copyright © 2000, Lawrence Erlbaum Associates, Inc.  DEPENDENCY AND PERSONALITY PATHOLOGY 479 Masling et al.’s (1967) Rorschach Oral Dependency (ROD) scale has beenthe most widely used projective measure of interpersonal dependency duringthe last 30 years (Bornstein, 1996, 1999). ROD scores predict conformity,compliance, help seeking, and interpersonal yielding in a variety of situationsand settings (Bornstein, Riggs, Hill, & Calabrese, 1996; Masling, Weiss, &Rothschild, 1968; Shilkret & Masling, 1981). High scores on the ROD scaleare also associated with increased sensitivity to interpersonal cues (Masling,Johnson, & Saturansky, 1974), an insecure attachment style (Duberstein &Talbot, 1993), and difficulty terminating psychotherapy (Greenberg & Born-stein, 1989).These results support the convergent validity of the ROD scale as a measure of interpersonaldependency(seealsoViglione,1999,forareviewofresearchonthisissue). Other findings confirm that the ROD scale meets established psychometriccriteria for discriminant validity (Gordon & Tegtemeyer, 1983; Kertzman, 1980),retest reliability (Bornstein, Rossner, & Hill, 1994), and interrater reliability (Juni& Semel, 1982; Weiss & Masling, 1970). As expected, ROD scores show strongpositive correlations with scores on other projective measures of dependency(Fowler, Hilsenroth, & Handler, 1996; Masling et al., 1967) and more modest cor-relations with scores on self-report dependency measures (Bornstein, Rossner,Hill, & Stepanian, 1994).GiventhewidespreaduseoftheRODscaleinclinicalandresearchsettings,therehas been surprisingly little exploration of the relationship between ROD score andpsychiatricdiagnosis.Intwoearlystudiesofthisissue,BertrandandMasling(1969)andWeissandMasling(1970)foundthatalcoholicpsychiatricoutpatientsproducedhigherRODscoresthannonalcoholicoutpatientsmatchedonsalientdemographicand diagnostic variables. More recently, ROD scores have been found to distin-guisheating-disorderedfromnon-eating-disorderedfemalepsychiatricinpatients(Bornstein & Greenberg, 1991), with eating-disordered patients showing higherratesofbothoral(i.e.,foodandmouth-related)anddependentimagery.HighRODscores are also associated with elevated levels of depression in psychiatric inpa-tients,outpatients,andnonclinicalparticipants(O’Neill&Bornstein,1990,1991);in each of these samples, depressed participants had significantly higher RODscores than nondepressed participants matched on salient demographic and (in thecase of clinical participants) diagnostic variables.Although the aforementioned studies assessed links between ROD scores andseveral Axis I disorders, there has been only one investigation of the relationshipbetween ROD scores and Axis II personality disorder (PD) diagnoses. Blais,Hilsenroth, Fowler, and Conboy (1999) assessed the correlations between RODscores and dimensional symptom ratings for each of the  DiagnosticandStatisti-calManualofMentalDisorders  (4th ed. [  DSM–IV  ]; American Psychiatric As-sociation, 1994) Cluster B PDs (i.e., antisocial, borderline, histrionic, andnarcissistic) in a mixed-sex outpatient sample. They found a significant negative  correlation between ROD scores and borderline PD symptom ratings ( r   = –.43)but obtained only small (and statistically nonsignificant) correlations betweenROD scores and symptom ratings for the other three Cluster B PDs.Further research on this topic is important for two reasons. First, variations independency levels have long been assumed to distinguish different forms of per-sonality pathology (Bornstein, 1997; Millon, 1996), yet data documenting thesehypothesizedintercategorydifferencesarelackingformostAxisIIPDcategories.Second, high levels of patient dependency have been shown to influence thecourse of inpatient and outpatient psychological treatment (Bornstein, 1993;Masling,1986);elucidatingthelinksbetweenRODscoresanddifferentAxisIIdi-agnoses may, therefore, aid in treatment planning.The purpose of this study was to assess the ROD–PD link by examining differ-ences in ROD scores across diagnostically defined criterion groups. Five PDgroups were included: borderline PD inpatients (BPD–Is), borderline PD outpa-tients (BPD–Os), narcissistic PD outpatients (NPD–Os), antisocial PD outpatients(APD–Os), and a combined group of dependent and avoidant PD outpatients (D/ APD–Os). Two non-PD comparison groups were also included: psychiatric inpa-tients diagnosed with various psychotic disorders (PSD–Is), and nonclinical col-lege student control (CSC) participants.On the basis of recent analyses of the dependency–PD relation (Beck & Free-man,1990;Bornstein,1997;Millon,1996;Widiger&Bornstein,inpress),wehy-pothesized that D/APD–O and BPD–I participants should show the highest RODscores.NPD–O,PSD–I,andCSCparticipantsshouldshowlowerRODscoresandthat the ROD scores in these groups would not differ from each other. We also hy-pothesized that BPD–O and APD–O participants would show the lowest RODscores (Blais et al., 1999; Bornstein, 1997).In addition to assessing differences in ROD scores across these seven criteriongroups, a secondary purpose of this investigation was to examine the frequenciesof different ROD subcategory scores. Although numerous studies have assessedthefrequencyofRODwhole-scalescoresindifferentclinicalandnonclinicalpop-ulations, there are no published studies that have examined the frequencies of the16 ROD subscale scores. Thus, these data represent preliminary norms for theROD subscales that may be useful for future studies of ROD scores in clinical andresearch settings. METHODParticipants Inpatient groups: BPD–I and PSD–I.  These groups consisted of (a) 27adult inpatients with a  DSM–IV   diagnosis of BPD and (b) 33 adult inpatients 480  BORNSTEIN, HILSENROTH, PADAWER, FOWLER
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