The psychic life of the young infant: review and critique of the psychoanalytic concepts of symbiosis and infantile omnipotence

The subjective life of the young infant is examined in the light of classical psychoanalytic theory and of recent empirical studies of early infant behavior and development. The concepts of symbiosis and omnipotence are argued to be products of poetic but largely misguided reconstructions from adult experience, providing a questionable developmental foundation for contemporary psychodynamic theories of object relations.     

Psychosocial situations, quality of depression and schizophrenia in adolescents

The relationships between acute life events and type of depression were evaluated among inpatient adolescents with schizophrenia. Forty-two adolescent inpatients were assessed, 25 with schizophrenia and 17 with personality disorder. Acute life events and other psychosocial situations were identified with the ICD-10 Axis V semistructured interviews. The Depression Equivalent Questionnaire for Adolescents (DEQ-A) and the Positive and Negative Symptom Scale (PANSS) were used to measure quality and severity of depression. In the patients with schizophrenia, psychosocial situations were related to the anaclitic type of depression, whereas in the subjects with personality disorder, they were highly correlated with introjective depression. In the schizophrenic group, the psychosocial situations related to depression were of a more intrapersonal nature and, in the personality-disordered group, they were more interpersonal. Environmental factors play an important role in the course of schizophrenia in adolescents and should remain a focus of study. Object relations theory may be of heuristic value in the investigation of these factors.     

Validation study of the Depressive Experience Questionnaire

Sidney Blatt, considering as being insufficient the categorical-symptomatic approach of depression, has worked out a theory of depression and psychopathology that integrates the contributions of psychoanalysis as well as cognitive and developmental psychology. Within a broad psychoanalytic framework, Blatt's formulation focus on the quality of interpersonal relationship, the nature of object representation and early life experiences. Personality development is viewed as the consequence of the interaction of 2 basic developmental tasks: the establishment of the capacity to form stable, enduring, mutually satisfying interpersonal relationships and the achievement of a differentiated, realistic, essentially positive identity. The relationship between these 2 developmental lines involves a complex dialectical process during which progress in each line is essential for progress in the other and which contributes to the development of both a sense of identity and the capacity for interpersonal relatedness. These developmental lines permit not only to define an during individual's primary personality configuration but also enable to identify cognitive structures that are inherent in various forms of psychopathology, including depression. Disruptions at different developmental stages create vulnerability to different subsequent psychological disturbances. Blatt characterised as anaclitic or dependent the axis concerned with interpersonal relationship and as introjective or self-critical the axis concerned with development of the sense of self and identity. Depressive Experience Questionnaire was developed by Blatt et al. to determine the validity of this model of psychopathology which emphazises continuities between normal and pathological forms of depression. The instrument was developed by Blatt et al. by assembling a pool of items describing experiences frequently reported by depressed individual. Sixty-six items were selected and administered to a large nonclinical sample (500 female and 160 male undergraduates). Principal component analysis within sex performed on the answers to DEQ confirmed his assumption in identifying two principal depressive dimensions. The first factor involved items that are primarily externally directed and refer to a disturbance of interpersonal relationships (anaclitism); the second factor consists of items that are more internally directed and reflect concerns about self-identity (self-criticism). A third factor emerged, assessing the good functioning of subject and confidence in his resources and capacities (efficacy). Scales derived from these factors have high internal consistency and substantial test-retest reliability. The solutions for men and women were highly congruent. Factor structure has been replicated in several nonclinical and clinical samples, supporting considerable evidence to the construct validity of the DEQ Dependency and Self-criticism scales. An adolescent form of DEQ (DEQ-A) has successively been developed. Factor analysis revealed three factors that were highly congruent in female and male students and with the three factors of the original DEQ. The reliability, internal consistency and validity of DEQ-A indicate that the DEQ-A closely parallels the DEQ, especially in the articulation of Dependency and Self-criticism as two factors in depression. These formulations and clinical observations about the importance of differentiating a depression focused on issues of self-criticism from issues of dependency are consistent with the formulations of others theorists which, from very different theoretical perspectives, posit 2 types of depression, one in which either perceived loss or rejection in social relationships is central and the other in which perceived failure in achievement, guilt or lack of control serves as the precipitant of depression. These 2 types of experiences have been characterized as dominant other and dominant goal , as anxiously attached and compulsively self-reliant and as sociotropic and autonomous . Our work presents the results of a validation study of both forms of Blatt's questionnaire (for adults--DEQ--and for adolescents--DEQA) translated in French in a large population of normal subjects, aged 15 to 45 years. DEQ and DEQ-A were compared by inspection of items loading strongly on each factor and by correlation of the three factors of adults and adolescents. The exploratory factor analysis of DEQ and DEQA revealed three orthogonal factors, corresponding with Blatt's original dimensions. Consistency and external validity were adequate for all 3 factors of DEQ and DEQ-A. Anaclitism and self-criticism dimensions of DEQ and DEQ-A correlate positively with measures of depression (DSM-IV, Beck Depression Inventory), consistently with the results obtained by Blatt. Differently from this author, anaclitism appears to be less differentiated in males than in females, suggesting that the concept of dependence could assume different relevance for men and women.     

Vulnerability, stress, and resilience in the early development of a high risk child

A young girl at risk for schizophrenia is admitted for inpatient evaluation at age 30 months with growth failure and psychosocial retardation. Her history suggests that adverse environmental experiences, particularly the traumatic loss of primary caregivers around age 15 months, resulted in symptoms consistent with the clinical picture of anaclitic depression and associated psychosocial dwarfism. Intervention in the form of hospitalization and placement by "prescribed" adoption into a favorable caregiving environment produced dramatic recovery in growth and psychological functioning. Follow-up data document sustained positive development 3 1/2 years later. This case illustrates the power of a developmental perspective on psychopathology for conceptualizing and planning treatment for an individual child.     

Personality, shame, and the breakdown of social bonds: the voice of quantitative depression research.

Scheff's argument (2001), whereby shame and the breakdown of social ties are causality implicated in depression, has potential to inform quantitative research on depression, particularly research focused on determinants of personality vulnerability. In the present article, I relate Scheff's argument to more than two and a half decades of theory and research on the interpersonal nature of depression, and on personality vulnerability to depression. The focus of this review is on the personality theories of Blatt (1974) and Beck (1983), in which an introjective/self-critical/autonomous personality dimension and an anaclitic/dependent/sociotropic personality dimension are each conceptualized as a marker of vulnerability. Reviewing empirical research on these two dimensions, I then point out a certain puzzle emerging from previous findings: The introjective personality dimension appears to confer considerably more vulnerability than the anaclitic personality dimension. An attempt is made to reconcile this puzzle by drawing from Scheff's discussion of shame, as well as from psychosocial research on internal representations of self and others (Blatt, Auerbach, and Levy 1997), and from sociological work on the depressogenic conditions of modernity (Giddens 1991; Seligman 1990).     

The depressive character.

The depressive character is characterized by perpetual and unsuccessful efforts to maintain self-esteem and to avoid a sense of helplessness. Such individuals suffer from chronic depression which may or may not be masked, but which permeates their character. Although the condition is among the commonest seen in many of our clinics and practices, it remains without a generally accepted diagnostic form. It is suggested that the essential, clinical, dynamic, and structural features of the depressive character are: (1) consistently low self-esteem and a sense of helplessness, dependent object relations and chronic guilt; (2) self-directed aggression and masochism are frequent but not invariable; (3) extensive use of the mechanism of denial is as common as the previously described obsessional defenses seen in patients subject to psychotic depression; (4) often the depressive character suffers from intense oral envy; (5) depressive character traits may help to ward off any of the basic anxieties, namely, object loss, loss of love, castration anxiety, and superego anxiety (guilt) (6) the depressive character may be similar to a number of related disorders, namely, the obsessional character, hysterical characters with a large oral component, and depressive borderline states; (7) sensitivity to loss, sadness, and fragility of self-esteem makes the depressive character especially vulnerable to regression into overt depression; (8) the persistence of oral incorporative mechanisms, ambivalent, dependent object relations, ego versus superego tension with depressive affect, and sensitivity to loss are characteristic of the ego of the depressive character.     

Anaclitism, the abandonment syndrome and essential depression

Following the recall of certain basic notions such as anaclitic depression, "abandonic syndrome" and "essential depression", the authors concentrate their interest on the clinical case of an adolescent girl both asthmatic and "abandonic"; the deprivation syndrome is discussed as a consequence of abandonment when the substitutive figure is deficient; the relationship between psychosomatic disorder and perturbations of the mother-child relationship is examined. A certain correlation between anaclitic depression in the infant and "essential depression" in adult life is suggested in the light of a re-enactment of the initial psychosomatic unit.     

Depressive Experiences in Inpatients with Borderline Personality Disorder

We investigate the quality of dependent and self-critical depressive experiences in a hospitalized sample of depressed (n = 17), depressed borderline (n = 29), and borderline non-depressed inpatients (n = 10). Subjects were administered structured diagnostic interviews for axis I and axis II along with the Symptom Checklist-90-Revised Depression Scale (SCL-90-R-DS) and the Depressive Experiences Questionnaire (DEQ). As predicted, there were no differences between the three groups in overall level of impairment or severity of depression. Phenomenologically, however, depressive experiences were quite different. Subjects with borderline personality disorder, with and without a diagnosed depressive disorder, scored higher than subjects with depression only on the measure of anaclitic neediness. Further analyses revealed that anaclitic neediness was significantly associated with interpersonal distress, self-destructive behaviors, and impulsivity. Findings suggest the importance of considering phenomenological aspects of depression in borderline pathology.     

Severity of depression and developmental levels of psychological functioning in 8-16-year-old girls

Clinical knowledge of subjective experience is considered essential for formulation of appropriate treatment expectations and goals. This study examined the relationship between self-reported depression and affective and cognitive correlates. Results indicated that girls reporting more depression had significantly earlier developmental levels of object relations and cognition than girls reporting less depression, regardless of chronological ages.     

The superego: a revised developmental model

The superego is not, as psychoanalytic theory asserts, primarily heir to the oedipus complex. Freud proposed two theories of identification and superego formation, only one of which is widely known and accepted. The first, which he abandoned, argues for the genesis of conscience as compensation for lost narcissism. The second explains superego formation as a response to object loss and fear of castration. The latter view faces a number of anomalies, including the occurrence of preoedipal and postoedipal identifications unrelated to the castration complex, and the difficulty in providing a cause for female superego development. An alternative theory is proposed that returns to Freud's first theory of identification, arguing that gender-specific explanations are inappropriate for a phenomenon such as conscience, which occurs in both sexes. Prototypical male and female cases are presented alongside a general model of the development of ego processes and object relations. Case material is briefly examined, and the argument is made for conceptualizing psychosexual development as a developmental line rather than as the core of character formation.     

Failure to produce direct object clitic pronouns as a clinical marker of SLI in school-aged Italian speaking children

We administrated a clitic elicitation task to 16 school-aged Italian speaking children with specific language impairment (SLI) in order to investigated whether the failure to produce third person direct object clitics (DO clitics) is a persistent clinical marker of SLI in Italian; we examined whether this failure also extends to reflexive clitics. Results show that Italian children with SLI aged 6 to 9;11 years fail to produce DO clitics and tend to produce a lexical noun introduced by a determiner (full DP) in the argument postverbal position instead of the pronoun; the production of reflexive clitics is preserved in the same population. Receiver operating characteristic curve analyses and computation of likelihood ratios show that the failure to produce DO clitics is a persistent good clinical marker of SLI in Italian. We argue that DO clitic production requires complex morphosyntactic operations that are hardly achieved by children with SLI; our findings are compatible with theories considering SLI as a deficit of processing complex linguistic relations.     

From some experiences in pharmaco-psychotherapy]

The author had developed the anaclitic pharmaco-psychotherapy as an integrated treatment of levomepromazine (a phenothiazine derivate), psychoanalytic interviewing and intensive nursing care for severe cases. Nevertheless the author had good results by the new therapy, some severe cases were still non-responded. The author found some differences of personality pattern between responder and non-responder. Responders had hyperkinetic pattern with good verbal expression and dependent behavior. Non-responders had hypersensory pattern with holding their tongue and keeping tension. The author had tried psychotherapy under using LSD for hypersensory pattern cases and gotten good results by it. But using LSD was prohibited by legal reason, now. The author could get significant development of three areas of psychiatric treatment through our development of the pharmacopsychotherapy as follows. 1) Significance of some biological factors for personality The author has clarified that two different response types to drug, hyperkinetic-visual dominant type and hypersensory-auditory dominant type. Assessments of such personality pattern or trait are useful for selection of appropriate drug. 2) Some changes in psychoanalytic stance. The author could find some therapeutic significances of object relationship in therapeutic process. These findings have stimulated the author to shift from classic drive oriented psychoanalysis to object relation psychoanalysis. 3) Significance of psychiatric nursing, team approach and therapeutic environment. The author has convinced of importance of role of psychiatric nursing and team approach. And the author has found importance of making and maintaining of appropriate psychiatric milieu and environment.     

Self-other representations mediate the relationship between Five-Factor Model depression and depressive states

While it is well established that trait depression is a risk factor for experiencing increased rates of episodes of depression, it is also the case that the ways in which the self and others are perceived, and nature of the relationship between self and other, predispose individuals to frequent depressive episodes. In this study, 182 psychiatric outpatients at three treatment facilities were evaluated for Five-Factor Model depressive traits, depressive states, and self-other representations (object relations). It was hypothesized that object relations would mediate the relationship between trait and state depression. Results partially confirmed this hypothesis. While trait depression significantly predicted variance in the Beck Depression Inventory-II (BDI-II; Beck et al., 1988), two dimensions of the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995)--Alienation and Insecure Attachment--partially mediated the relationship between trait and state depression. Similarly, trait depression predicted tendencies to experience frequent shifts toward depressive episodes, although the Insecure Attachment and Egocentricity scales of the BORRTI fully mediated the relationship between trait depression and depressive lability. Knowledge of self-other representations, which is being considered for inclusion in the DSM-5, allows for a more refined understanding of those factors that contribute shifts in depressive mood.     

Long term group psychotherapy with (near) psychotic children

Traditionally, psychotherapy groups for children included only relatively intact youngsters. This paper describes a group consisting of four (near) psychotic children and two co-therapists which met for over three years. The developmental changes which occurred in the group over the course of time will be identified and discussed using a neo-psychoanalytic, object relations framework.     

Infantile depression,nonorganic failure to thrive,and DSM-III-R: A different perspective

A controversy exists regarding the classification of nonorganic failure to thrive within the psychiatric nomenclature. There are a number of DSM-III-R diagnoses that may be applied to NOFTT, including Reactive Attachment Disorder of Infancy (RADI) and Major Depressive Disorder (MDD). The behaviors characteristic of NOFTT are symptomatic of depression, and are similar to those exhibited by infants with anaclitic depression as well as those of the adult with depression. The correspondence of the behaviours of NOFTT and the DSM-III-R criteria for Major Depression are reviewed, as are the conceptual and therapeutic reasons to view NOFTT infants as suffering from Depression.     

Some Theoretical and Practical Implications of a Longitudinal Study of College Woment†

Abstract

While it is well established that trait depression is a risk factor for experiencing increased rates of episodes of depression, it is also the case that the ways in which the self and others are perceived, and nature of the relationship between self and other, predispose individuals to frequent depressive episodes. In this study, 182 psychiatric outpatients at three treatment facilities were evaluated for Five-Factor Model depressive traits, depressive states, and self-other representations (object relations). It was hypothesized that object relations would mediate the relationship between trait and state depression. Results partially confirmed this hypothesis. While trait depression significantly predicted variance in the Beck Depression Inventory-II (BDI-II; Beck et al., 1988), two dimensions of the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995)—Alienation and Insecure Attachment—partially mediated the relationship between trait and state depression. Similarly, trait depression predicted tendencies to experience frequent shifts toward depressive episodes, although the Insecure Attachment and Egocentricity scales of the BORRTI fully mediated the relationship between trait depression and depressive lability. Knowledge of self-other representations, which is being considered for inclusion in the DSM-5, allows for a more refined understanding of those factors that contribute shifts in depressive mood.     

Indicators of depression and self-efficacy in the PPAT drawings of normative adults

The present study sought to examine whether individuals with elevated levels of introjective depression, anaclitic depression, and self-efficacy, artistically express themselves differently. Sixty young adults, between the ages of 20 and 30, were asked to draw a person picking an apple from a tree (PPAT) and respond to the Depressive Experiences Questionnaire (DEQ). The drawings were analyzed and rated according to the FEATS. Participants were divided into three groups, based on their higher personality traits on the DEQ. Individuals with elevated levels of self-efficacy showed high levels of problem-solving in their PPAT. Also, individuals with elevated levels of introjective depression received low scores on the FEATS scale that could implicate depression. The study offers that the PPAT, in conjunction with the FEATS manual, can be used to reliably distinguish between individuals with high degree of specific features of depression through using the DEQ.     

Depression viewed as a state of disturbed psychic contact

The nature of disturbed object relations in depression is analyzed. The concept, area of interest, is introduced to describe the disturbed interplay between the depressive subject and the external world. Loss of psychic contact with the environment is considered the central feature in depression. Various psychological symptoms in depression, such as decline in self-esteem, feelings of guilt, self-reproach, hopelessness, and helplessness, are arranged in an understandable sequence beginning with loss of psychic contact. The paper discusses a model of depression, in which the loss of psychic contact with the external world is considered the stimulus for physiological symptoms such as early morning wakening, diurnal variation, and weight loss. The depressive episode may be viewed primarily as a state of disturbed psychic contact rather than as a state of disturbed affect.