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Object Relations and Social Cognition in Borderlines, Major Depressives, and

Normals: A Thematic Apperception Test Analysis

Article in Psychological Assessment · December 1990

DOI: 10.1037/1040-3590.2.4.355

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Psychological Assessment: Copyright 1990 by the American Psychological Association, Inc.
A Journal of Consulting and Clinical Psychology 1040-3590/90/$00.75
1990, Vol. 2, No. 4, 355-364

Object Relations and Social Cognition in Borderlines, Major Depressives,

and Normals: A Thematic Apperception Test Analysis
Drew Westen and Naomi Lohr
Departments of Psychology and Psychiatry
University of Michigan
Kenneth R. Silk, Laura Gold, and Kevin Kerber
Department of Psychiatry
University of Michigan

This study compared reliably diagnosed borderline personality disorder patients (n = 35) with
major depressives (n = 25) and normals (n = 30) on 4 dimensions of object relations and social
cognition coded from Thematic Apperception Test (TAT) responses: Complexity of Representa-
tions of People, Affect-Tone of Relationship Paradigms (malevolent to benevolent), Capacity for
Emotional Investment in Relationships, and Understanding of Social Causality. As predicted,
borderlines scored significantly lower on all 4 scales than did normals and lower on Affect-Tone
and Capacity for Emotional Investment than did nonborderline major depressives. Borderlines
also produced more pathological responses than did both groups on every scale, indicating more
poorly differentiated representations, grossly illogical attributions, malevolent expectations, and
need-gratifying relationship paradigms. The results suggest the importance of distinguishing sev-
eral interdependent but distinct cognitive-affective dimensions of object relations and the poten-
tial utility of assessing object relations and social cognition from TAT responses.

The psychological processes underlying the interpersonal pa-
thology of patients with borderline personality disorder (BPD),
that is, their distorted object relations, have been conceptual-
ized in various ways by different theorists. Most argue that a
disturbance in the first 3 years of life leads to the continued use
of developmentally primitive modes of relating in adulthood
(Kernberg, 1975; Masterson, 1976). Although theorists and cli-
nicians (see Greenberg & Mitchell, 1983) often speak of levels of
object relations as unitary phenomena, from developmentally
immature to mature, the term object relations refers to a conger-
ies of cognitive and affective functions and structures, includ-
ing ways of representing people and relationships, rules of infer-
ence for interpreting the causes of people's feelings, behaviors,
interpersonal wishes, conflicts, and so forth. The concept of
general levels of object relations is clinically an indispensable
heuristic, but these levels should be understood as being com-
posed of several interdependent but distinct developmental
lines that differ in their maturity and quality among individ-
uals as well as within a single individual at any given time (Wes-
ten, 1989, 1990, in press-b). The aim of the present study is to
explore the nature of different dimensions of the cognitive-af-
This research was supported by a grant from the Department of
Psychiatry, University of Michigan.
We thank Alfred Kellam, Natasha Lifton, and John Boekamp for
help in coding the data.
Correspondence concerning this article should be addressed to
Drew Westen, University of Michigan, Department of Psychology,580
Union Drive, Ann Arbor, Michigan 48109-1346
355
fective processes underlying interpersonal functioning in pa-
tients with BPD.
Many of these dimensions have been studied empirically by
developmental researchers, particularly those interested in so-
cial cognition (for a review, see Shantz, 1983). Like object rela-
tions theorists, social-cognition researchers have focused on
representational processes underlying interpersonal function-
ing (see Horowitz, 1987; Singer & Kolligian, 1987; Westen, in
press-a). Social-cognition research comes from a different intel-
lectual tradition, studies normative rather than pathological
processes, uses experimental rather than clinical methods, fo-
cuses on molecular rather than molar processes, and relies on
different metaphors of the mind than does psychoanalytic ob-
ject-relations theory. Nevertheless, this literature addresses is-
sues such as the nature and development of causal attributions
(Ruble & Rholes, 1981) and person-schemas (Horowitz, 1987;
Livesley & Bromley, 1973; Markus & Wurf, 1987; Singer & Kol-
ligian, 1987) in ways that are likely to lead to refinements of
object-relations models (Westen, 1989; in press-a, in press-b).
Until recently (see Bell, Billington, Cicchetti, & Gibbons,
1988; Burke, Summers, Selinger, & Polonus, 1986; Westen, Lu-
dolph, Lerner, Ruffins, & Wiss, 1990), empirical studies of ob-
ject relations in borderline patients have relied exclusively on
human-figure responses on the Rorschach test. Nearly all of
those studies have compared borderline patients (often diag-
nosed with unreported or marginal reliability and validity)
with schizophrenics. By and large, borderlines typically score
higher than schizophrenics on overall developmental level as
measured on Blatt's Rorschach measure for object relations
(Blatt, Brenneis, & Shimek, 1976), though findings on particu-
356 WESTEN, LOHR, SILK, GOLD, KERBER
lar subscales have been less consistent (Gartner, Hurt, &
Gartner, 1989; Hymowitz, Hunt, Cart, Hurt, & Spear, 1983;
Lerner & St. Peter, 1984; Spear & Sugarman, 1984). Lerner and
St. Peter (1984) and Stuart et al. (1990) found that borderlines
tend to produce malevolent, idiosyncratic, but cognitive-devel-
opmentally advanced representations of people's intentions on
the Rorschach. This finding is not entirely consistent with devel-
opmental object-relations theory: Malevolence is not likely to
reflect a normal developmental stage, and cognitively advanced
representations, even if perceived in a manner suggestive of
marginal reality testing, are not easily construed as reflecting
preoedipal regression or fixation.
When multiple facets of object relations are clearly differen-
tiated, many hypotheses about their developmental course and
their quality in severe character pathology can be studied em-
pirically. This study focuses on four dimensions of object rela-
tions and social cognition, as measured from Thematic Apper-
ception Test (TAT; Murray, 1938) responses: Complexity of Rep-
resentations of People (tendency to represent people in
complex ways and to distinguish clearly their subjective experi-
ence and points of view), Affect-Tone of Relationship Para-
digms (affective quality of the object world or interpersonal
expectations, from malevolent to benevolent), Capacity for
Emotional Investment in Relationships and Moral Standards
(need-gratifying orientation to the social world versus invest-
ment in values, ideals, and committed relationships), and Un-
derstanding of Social Causality (tendency to attribute causes of
behaviors, thoughts, and emotions in a complex, accurate, and
psychologically minded way). Each dimension is assessed with
a five-level scale (Westen, Lohr, Silk, & Kerber, 1985). With the
exception of Affect-Tone, the scales attempt to measure devel-
opmental dimensions; Level I is relatively primitive, and Level 5
is mature.
The TAT is an excellent test for assessing object relations and
social cognition because, unlike the Rorschach (1942) blots, the
stimulus is unambiguously social, and subjects are likely to pro-
vide enough detail in describing characters and relationships as
to provide considerable access to cognitive-affective patterns
related to interpersonal functioning. The measures used here
were derived from clinical observation, object-relations theory
and research (see Blatt & Lerner, 1983; Greenberg & Mitchell,
1983; Thompson, 1981; Urist, 1980), and research in develop-
mental social cognition (Bogen, 1982; Damon, 1977; Selman,
1980; Shantz, 1983). Recently completed research has begun
validating the measures with both normal and clinical popula-
tions. Research with undergraduates has found significant
correlations between the TAT measures and analogous mea-
sures devised for use with interview data, such as psychother-
apy transcripts and research interviews (e.g., complexity of TAT
characters correlates with complexity of people in descriptions
of actual interpersonal episodes; see Barends, Westen, Leigh,
Silbert, & Byers, 1990; Leigh, Westen, Barends, & Mendel,
1989). This research has also found predicted correlations be-
tween the four TAT scales and validated instruments, such as
Blatt, Wein, Chevron, & Quinlan's (1979) measures of complex-
ity and affective quality of parental representations applied to
descriptions of significant others. For example, as predicted,
Blatt's "conceptual level" measure correlates with Complexity
and Social Causality but not with Affect-Tone or Emotional
Investment. The scales were also able to predict social adjust-
ment as measured by Weissman's Social Adjustment Scale
(Weissman & Bothwell, 1976) in both clinical and nonclinical
samples. Two developmental studies have documented develop-
mental differences using both TAT and interview responses in
all measures except Affect-Tone, with one study comparing
second and fifth graders and the other comparing early and late
adolescents (Westen, Klepser, et al., 1989). Borderline adoles-
cents have been shown to differ from psychiatric and normal
comparison subjects on the four scales (Westen, Ludolph,
Lerner, et al., 1990), and borderline adults and adolescents have
been shown to differ from each other in ways suggestive of
needed refinements in theory (Westen, Ludolph, Silk, et al.,
1990). Schneider (1990) has recently assessed these dimensions
from psychotherapy transcripts using an analogous instrument
for narrative data and found increases in complexity o frepresen-
tations and capacity for emotional investment over the course
of brief psychoanalytic psychotherapy and at follow-up. Inter-
nal consistency (Cronbach's alpha) has varied depending on the
number of TAT responses and between-subject variance, rang-
ing from .59 to .77 in clinical samples using five to seven cards.
In the present study, we compared the TAT responses of a
sample of BPD patients with responses of patients with major
depressive disorder (MDD) and normals. Hypotheses were the
following. Bordedines should have lower mean scores and a
higher percentage of pathological (Level 1) responses on all four
scales than normals. On Affect-Tone of Relationship Para-
digms and Capacity for Emotional Investment, borderlines
should have lower mean scores than major depressives and
should have a higher percentage of Level 1 scores, reflecting
expectations of malevolence and a need-gratifying orientation
to the social world. Although major depressives should not
differ from borderlines in mean Complexity of Representa-
tions of People or Social Causality because of the cognitive
constriction characteristic of depressives, which should apply
to their representations of people as well, borderlines should
have more poorly differentiated characters (scored Level 1 on
Complexity of Representations) and grossly illogical causal se-
quences (scored Level I on Social Causality) than major depres-
sives. This pattern is expected to hold for borderlines who are
concurrently in a major depressive episode as compared with
nonborderline major depressives as well.
Method
Subjects
The patients used as subjects for this study were drawn from two
inpatient units of the University of Michigan Medical Center. To be
considered for inclusion in the study, as an initial screening procedure,
potential subjects had to meet at least two criteria of the third edition
of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II1
or DSM-111-R [revised ]; American Psychiatric Association, 1980,
1987) for BPD or schizotypal personality disorder or three such criteria
for major depressive episode on admission. Exclusion criteria included
chronic psychosis or medical problems that would prohibit a 2-week
drug-free period or would confound biological test results.
Ninety-two percent of eligible subjects consented to be considered
 OBJECT RELATIONS IN BORDERLINES
for inclusion in the research. While consenting subjects were drug-free,
they were administered the Diagnostic Interview for Borderlines (DIB;
Gunderson, Kolb, & Austin, 1981), which has been shown in several
studies to predict clinician diagnosis of BPD using DSM-IIIor DSM-
II1-R criteria with sensitivity and specificity above 80% (Armelius,
Jullgran, & Renberg, 1985). Interrater reliability (K= .78) by our group
has been described elsewhere (Cornell, Silk, Ludolph, & Lohr, 1983),
and reliability has been maintained through periodic retraining and
assessment. Diagnosis of depression was made by Research Diagnos-
tic Criteria (RDC; Spitzer, Endicott, Gibbon, & Robbins, 1975), a pre-
cursor to DSM-III for research purposes, by a member of the research
team, based on interviews with the patient and the patient's primary
therapist. Interrater reliability on the diagnosis of depression was .92
(weighted kappa; Cohen, 1968), with a range of pairwise reliability of
.88 to .94. As in previous research using the DIB, patients were admit-
ted to the BPD cohort by obtaining a DIB score of>~7. Nonbordedine
MDD comparison subjects scored ~<5 on the DIB and met RDC crite-
ria for major depressive disorder. All subjects scoring 6 on the DIB
were eliminated, as decided in advance, to minimize group overlap.
For particular data analyses, two groups of borderline patients were
distinguished: (a) those who met DIB criteria for borderline but failed
to meet RDC criteria for MDD and (b) those who met criteria for both
disorders, who were comorbid for MDD.
Normal comparison subjects were obtained by advertising in news-
papers in two cities, in two university in-house newsletters, and on two
radio stations. The advertisement requested paid volunteers who are
healthy and reasonably satisfied with life. Potential subjects were ad-
ministered a 10-rain semistructured telephone screening interview
that assessed physical health, mood, current drug use, use of leisure
time, consistency and satisfaction at work, establishment of stable rela-
tionships, ability to make future plans, and history of psychotherapy.
The purpose of the interview was to screen out potential subjects with
serious illnesses or severe psychopathology. Subjects who passed the
telephone screening were asked to sign a consent form and to take the
Minnesota Multiphasic Personality Inventory (MMPI, Hathaway &
McKinley, 1940) and the Rosenberg Self-Esteem Inventory (Rosen-
berg, 1957). Inclusion criteria consisted of an MMPI in which K-
corrected scores on all scales (except Masculinity-Femininity) were
less than two standard deviations from the mean, and at least 8 of the
10 items on the self-esteem inventory were in the direction of high
self-esteem. The MMPI criteria, like criteria on the self-esteem inven-
tory, were chosen to rule out serious psychopathology and are mark-
edly different from published reports of depressed and borderline
MMPI profiles. On follow-up 1 to 2 years later, normal subjects were
also administered the DIB; only I subject scored above a 3 (M = 2.02),
and none received any points for depression on the Affects sections of
the DIB, corroborating that the normal sample did not overlap with
either clinical sample. Table I describes subject characteristics.
Procedures
The subjects were administered a variety of biological and psycholog-
ical tests and interviews as part of a larger project on the relation
between BPD and mood disorder. A series of TAT cards was adminis-
tered in standardized sequence by members of the research team or by
clinical psychology interns (graduate students), following specific in-
structions for administration, including order of presentation of cards
and instructions for prompting. For each card, subjects were asked to
tell a story, including what was happening in the picture, what led up to
it, and what was going to happen. Subjects who did not spontaneously
describe what the character or characters were thinking and feeling
were asked to do so. lfa subject provided an incomplete response (omit-
ting or minimally elaborating any of the elements of the story), testers
inquired about missing elements. This was done to minimize biases of
357
verbal productivity or motivation and to elicit adequate material for
scoring (and for clinical use in cases in which the testing was used for
clinical purposes). Testers were unaware of DIB diagnosis.
Measures
Seven TAT cards (Cards 1, 2, 3BM, 4, 13MF, 15, and 18GF) were
coded on the four dimensions outlined above: Complexity of Represen-
tations of People, Affect-Tone of Relationship Paradigms, Capacity for
Emotional Investmem in Relationships, and Understanding of Social
Causality. Each scale has five levels; Level I represents the lowest level
response, and Level 5, the highest level response. Scoring requires
training using an extensive manual. A brief description of the levels of
each scale is provided in Table 2.
Complexity of Representations of People. Although object-relations
theorists vary widely in their particular models of the development of
self- and object-representations, they are largely in agreement about
three developmental phenomena. First, development of representa-
tions is characterized by increasing differentiation among representa-
tions, in which the points of view of self and others are gradually more
clearly distinguished. Second, representations gradually become more
complex, internally differentiated, and integrated as children mature.
Third, whereas young children tend to split their representations of
people by affective valence, having difficulty forming representations
that include both positive and negative attributes, both children and
adults are able to integrate more complex, ambivalent, or multivalent
representations. While challenging some of the developmental timeta-
bles, research in developmental psychology has largely documented
these developmental changes. (Harter, 1986; Shantz, 1983; Westen,
1989, 1990). Research on the development of representations of self
and others (Damon & Hart, 1982; Livesley & Bromley, 1973; Rosen-
berg, 1979) suggests a shift from concrete, transitory, relatively unor-
ganized, and often contradictory representations in the preschool
years to unidimensional traits in late childhood, to a focus on internal
processes, including unconscious personality processes, in adoles-
cence. The measure of complexity of representations of people for use
with the TAT was designed to assess what might be called "working"
representations of self and others (i.e., the momentarily activated repre-
sentations that guide conscious and unconscious information process-
ing and behavior). The notion of working representations is related to
the "internal working models" (Bowlby, 1969) receiving considerable
focus in attachment research (Kobak & Seeery, 1988; Main, Kaplan, &
Cassidy, 1985).
Affect-Tone of Relationship Paradigms. A critical dimension of the
representations underlying interpersonal functioning is the Affect-
Tone of Relationship Paradigms. From a psychoanalytic perspective,
this can be conceptualized as the affective coloring of the object world,
ranging from malevolent to benevolent. The concept of Affect-Tone
has been implicitly used by theoreticians of severe personality dis-
orders (e.g., Klein, 1948), particularly BPD (Gunderson, 1984; Kern-
berg, 1975; Masterson, 1976). From a social-cognitive perspective, this
construct can be conceptualized as the affective quality of interper-
sonal expectancies. Relevant research has focused on hostile or malevo-
lent attributions in aggressive boys (Dodge & Somberg, 1987), dis-
tressed marital couples (Fincham, Beach, & Baucom, 1987), trauma
victims (Janoff-Bulman, 1989), and abusive mothers (Larrance &
Twentyman, 1983). The measure of Affect-Tone of Relationship Para-
digms for use with the TAT was designed to assess the extent to which
the person expects relationships to be destructive and threatening or
safe and enriching.
Capacity for Emotional Investment in Relationships and Moral Stan-
dards. Despite their differences, object-relations theorists posit a de-
velopmental movement from a need-gratifying pattern of emotional
investment in people (often referred to as narcissistic), in which rela-
358 WESTEN, LOHR, SILK, GOLD, KERBER
Table 1
Means and Standard Deviations o f Subject Characteristics
Age
Group n M SD
BPD total 37 28.24 9.03
BPD/non-MDD 19 25.68 7.96
BPD/MDD 18 30.94 9.50
MDD 25 40,20 11.93
Normal 30 32,30 11.35
Note. HDRS = Hamilton Depression Rating Scale (Hamilton, 1960); SES = socioeconomic status (Hol-
lingshead & Redlich, 1958); BPD = borderline personality disorder; MDD = major depressive disorder.
tionships with others are valued primarily for the gratification, secu-
rity, or benefits they afford, to mature object relations based on mutual
love, respect, and concern for others who are valued for their specific
attributes (e.g., Fairbairn, 1954). Research in developmental psychol-
ogy on children's conceptions of friendship, justice, convention, author-
ity, and morality tend to support this view; again, however, these litera-
tures suggest a much longer maturational process than described by
psychoanalytic theory, which proposes that need-gratifying object rela-
tions are transcended by the end of the oedipal period (see Damon,
1977; Rest, 1983; Selman, 1980; Shantz, 1983; Westen, 1989,1990). The
measure for assessing capacity for emotional investment in relation-
ships and moral standards reflects a developmental model aimed at
integrating cognitive-developmental theories and research with ob-
ject-relations theory and clinical observation (Westen, 1985). It at-
tempts to assess investment in relationships and values rather than
simply knowledge of them; many sociopaths, for example, "know" so-
cial rules but lack an affective-motivational investment in them.
Understanding of Social Causality Clinical experience with patients
with BPD suggests that these patients tend to make highly idiosyncra-
tic, illogical, and inaccurate attributions of people's intentions. One
could probably posit a "borderline attributional style" (Westen, in
press-c), characterized by egocentric attributions, expectations of ma-
levolence in interpersonal relations, a tendency to make peculiar and
inaccurate attributions, and a tendency to make affect-centered attri-
butions (i.e., attributions that are congruent with mood or affective
valence of representations, rather than more cognitively based attribu-
tions). Extensive research in the development of understanding of so-
cial causality in children (Chandler, Paget, & Koch, 1978; Piaget, 1951;
Ruble & Rholes, 1981 ; Selman, 1980) suggests a number of developmen-
tal shifts in the way children infer causality in the social realm. These
include increased complexity, abstractness, accuracy, internality (i.e.,
focus on internal psychological processes rather than on surface-level,
observable, behavioral causes), and understanding of unconscious
processes. Bogen (1982) assessed dimensions such as understanding of
reciprocal causal influences of characters in stories children tell. The
measure of understanding of social causality for use with TAT re-
sponses was designed to assess the logic, complexity, and accuracy of
attributions.
Coding and Interrater Reliability All cards were coded indepen-
dently by two raters on each scale. Two advanced graduate students in
clinical psychology and two B.A.-level research assistants, who had
been trained extensively using detailed scoring manuals, coded the
data for the study. Coders met at regular intervals to discuss indepen-
dently scored responses in order to prevent coder drift and to resolve
discrepancies. Because coding extended over several months, and
coders' time commitments varied, each coder was trained to code all
four scales; different pairs of coders thus scored different subsets of the
data on the various scales.
HDRS score SES
Sex
(% female) M SD M SD
73.00 13.65 7.43 4.24 2.57
68.40 10.29 6.08 3.18 2.56
77.80 17.00 7.27 5.07 2.34
72.00 17.24 5.57 6.17 1.98
60.00 1.25 1.35 6.77 1.48
Coders received the stories typed one to a page in random order, so
that rating multiple stories in the same protocol would be entirely
independent. Reliability was computed using Pearson's r, with Spear-
man-Brown correction for double coding. Uncorrected pairwise reli-
abilities ranged from .88 to .95. Corrected average reliabilities for the
four scales were as follows: Complexity of Representations, .94; Af-
fect-Tone, .97; Emotional Investment, .94; Social Causality, .95. lntra-
class correlation coefficients yielded similar reliability estimates.
Results
All groups (BPD/non-MDD, B P D / M D D , M D D , and nor-
mal) were primarily female, with no significant sex differences
a m o n g them. As could be expected from differences in (a) age
o f onset o f the disorders, (b) the disorders' relative effects on
occupational functioning, and (c) diagnostic criteria, the groups
differed significantly in age, F(3, 88) = 7.16, p = .0002, socioeco-
n o m i c status (SES; Hollingshead & Redlich, 1958), F(3, 61) =
8.51, p = .0001, and severity o f depression as assessed by the
H a m i l t o n Rating Scale for Depression ( H R S D ; H a m i l t o n ,
t960), F(3, 63) = 24.43, p = .0001. As will be addressed below,
these group differences did not account for significant find-
ings.
To avoid the possibility o f spurious findings reflecting po-
tentially intercorrelated measures, TAT scores were entered
into a multivariate ANOVA. Mean scores on each scale were
then analyzed by ANOVA, with planned pairwise comparisons
by t test with Bonferroni correction for the number o f tests on
each variable. Presence or absence o f pathological responses
(Level 1) was also coded as a dichotomous variable on each TAT
response for each scale; to aggregate the data and control for
missing data points, percentage o f pathological responses per
subject was calculated for each variable. These data were then
treated as continuous and analyzed by ANOVA.
A multivariate analysis using TAT scores as dependent vari-
ables was significant, F(8, 172) = 2.74, p = .007. Table 3 reports
the results o f univariate ANOVAs for m e a n scores on all four
variables. As can be seen, the three groups differed on all four
variables as predicted. Planned comparisons (one-tailed t tests
with Bonferroni adjustment) demonstrated highly significant
differences between borderlines and normals on all four scales,
and clear differences between the borderlines and major de-
pressives on the two scales on which they were hypothesized to
differ--Affect-Tone and Emotional Investment.
 OBJECT RELATIONS IN BORDERLINES 359

Table 2
Brief Synposis of Measures of Object Relations and Social Cognition
Scale

Complexity of Affect-Tone of Relationship Capacity for Emotional Understanding of Social

Level Representations of People Paradigms Investment Causality

1 People are not clearly Malevolent representations; Need-gratifying orientation; Noncausal or grossly illogical
differentiated; gratuitous violence or gross profound self- depictions of psychological
confusion of points of negligence by significant preoccupation, and interpersonal events.
view. others.
2 Simple, unidimensional Representation of relationships Limited investment in people, Rudimentary understanding
representations; focus as hostile, empty, or relationships, and moral of social causality; minor
on actions; traits are capricious but not standards; conflicting logic errors or unexplained
global and univalent, profoundly malevolent; interests recognized, but transitions; simple
profound loneliness or gratification remains stimulus-response
disappointment in primary aim; moral causality.
relationships. standards minimally
developed or followed to
avoid punishment.
3 Minor elaboration of Mixed representations with Conventional investment in Complex, accurate situational
mental life or mildly negative tone. people and moral causality and rudimentary
personality. standards; stereotypic understandingof the role
compassion, mutuality, or of thoughts and feelings in
helping orientation; guilt mediating action.
at moral transgressions.
Expanded appreciation of Mixed representations with Mature, committed Expanded appreciation o f the
complexity of neutral or balanced tone. investment in relationships role of mental processes
subjective experience and values; mutual empathy in generating thoughts,
and personality and concern; commitment feelings, behaviors, and
dispositions; absence of to abstract values. interpersonal interactions.
representations
integrating life history,
complex subjectivity,
and personality
processes.
Complex representations, Predominantly positive Autonomous self hood in the Complex appreciation of the
indicating representations; benign and context of committed role of mental processes
understanding of enriching interactions. relationships; recognition in generating thoughts,
interaction of enduring of conventional nature of feelings, behaviors, and
and momentary moral rules in the context interpersonal interactions;
psychological of carefully considered understanding of
experience; standards or concern for unconscious motivational
understanding of concrete people or processes.
personality as system relationships.
of processes interacting
with each other and the
environment.

Table 4 reports the percentage of Level I (hypothesized to be
pathological) responses per protocol by diagnosis. As can be
seen in the table, again the groups differed significantly on all
four variables, with significant differences found between the
borderlines and both comparison groups on every variable ex-
cept Complexity, on which the borderlines produced more
poorly differentiated responses than major depressives, but the
differences did not reach a significant level. The significance
values reported here represent relatively conservative estimates,
because the Bonferroni correction was technically not neces-
sary due to the highly significant multivariate analysis.
An even more conservative test of the differences between
the borderlines and the major depressives would control for
depression by comparing only those BPDs who were comorbid
for major depression with MDDs; such a comparison would
contrast patients who share an Axis I diagnosis and differ only
on Axis II (and do not differ significantly in HRSD depression
scores). To test this hypothesis, we first ran a multivariate analy-
sis to determine whether differences on the TAT measure still
emerge when dividing the sample into four groups: borderlines
without major depression, borderlines with major depression,
nonborderline major depressives, and normals. The multivar-
iate analysis was significant, F(12, 225.2) = 1.97, p = .03, and
the general pattern of ANOVA findings was similar to the
three-group analysis. The specific comparison of borderline
patients comorbid for major depression with nonborderline
major depressives (one-tailed t tests) is presented in Table 5. As
can be seen, the basic pattern found with the entire borderline
sample, in which borderlines have lower mean scores on Af-
fect-Tone and Emotional Investment and a higher percentage of
pathological responses on all four scales, was largely con-
firmed. The significance values are, of course, slightly lower
360 WESTEN, LOHR, SILK, GOLD, KERBER

Table 3
Mean Scores by Diagnosis

Planned comparisons
Diagnosis
Borderlines
Major vs. major Borderlines vs.
Borderlines depressives Normals depressives normals

Scale M SD M SD M SD F stat df T stat df T stat df

Complexity of Representations 2.80 .59 2.76 .57 3.16 .57 4.48** 2,89 .01 60 2.58** 65
Affect-Toneof Relationship
Paradigms 2.53 .59 2.83 .53 2.97 .39 6.22*** 2,89 2.20* 60 3.44**** 65
Capacity for Emotional
Investment 2.18 .54 2.42 .40 2.61 .48 6.31"** 2,89 1.88t 60 3.53**** 65
Understanding of Social
Causality 2.49 .60 2.58 .48 2.90 .54 4.79** 2,89 .07 61 3.01"** 65

Note. Data analyzed by analysis of variance. Planned comparisons analyzed by one-tailed T tests with Bonferroni adjustment for number of
comparisons.
* = p < . 0 5 , **=p<.01, ***=p<.005, ****=p<.001, t = t r e n d ( p ~ - 0 6 ) .

than they were with the total borderline sample because of the
smaller sample size.
We similarly analyzed the presence of scores on Levels 4 and
5, although we had not formulated specific hypotheses about
them (and hence they are not summarized in tabular form). We
did not expect to see a total absence of high-level responses in
any group, because of our assumption that people do not always
operate at a single level of object relations and that different
cards are likely to activate different issues, relationship para-
digms, and levels of functioning. Contrary to current theories,
we expected that a substantial percentage of borderlines would
produce complex representations and attributions. In fact,
45.9% of borderlines produced more than one story that scored
Level 4 or 5 on Complexity of Representations, which was com-
parable to those of the normals and higher than those of the
MDDs.
To address potential confounding variables, we ran several
additional analyses. First, because age and SES differed among
the groups, we correlated these variables with all dependent
variables within and between groups. There were no significant
correlations with age. Only Complexity of Representations
correlated with SES (r = .24, p = .03). Although covariation is
probably inappropriate because lower SES in the borderline
group is likely to be a reflection of diagnosis, to be conservative
we covaried for SES in an additional analysis of the complexity
data. The overall ANOVA remained marginally significant,
F(2, 75) = 3.01, p = .055, with BPDs significantly lower than
normals but not significantly different from MDDs.

Table 4
Percentage o f Level 1 (Pathological) Responses per Protocol by Diagnosis
Diagnosis Planned comparisons

Major Borderlines vs.

Border- depres- major Borderlines vs.
lines sives Normals depressives normals

Scale M SD M SD M SD F star df T star df T star df

Complexity of
Representations
(Poorly differentiated) 08 .16 03 .07 0.5 .03 3.46* 2,89 1.61 60 2.57** 65
Affect-Toneof
Relationship
Paradigms (Malevolent) 16 .17 07 .11 05 .09 7.74**** 2,89 3.61 *** 60 3.54**** 65
Capacity for
Emotional Investment
(Need-gratifying) 24 .23 14 .18 10 .11 4.95** 2,89 2.11" 60 3.01"** 65
Social Causality
(Grossly illogical) 13 .20 05 .11 0.3 .07 4.17" 2,89 1.99" 60 2.74** 65

Note. Data analyzed by analysis of variance. Planned comparisons analyzed by one-tailed T tests with Bonferroni adjustment for number of
comparisons. Nonparametric analyses yielded similar results.
*=pA.05, **=p<.01, ***=p<.005, ****=p_<.001.
 OBJECT RELATIONS IN BORDERLINES
Table 5
Mean Scores and Percentage of Level 1 (Pathological) Responses for Major
Depressives With and Without BPD
Mean scores
BPD/ MDD
MDD only
Scale M SD Mean
Affect-Tone of Relationship
Paradigms 2.52 .52 2.87
Complexity of Representations 2.86 .61 2.75
Capacity for Emotional
Investment 2.22 .46 2.42
Understanding of Social
Causality 2.63 .67 2.57
Note. Data (planned comparisons) analyzed by t test (one-tailed), dr= 41. BPD = borderline personality
disorder; MDD = major depressive disorder.
*=p_<.05, **=p<.01, ***=p_<.005, t=trend(p<.07).
To address rival hypotheses that the results reflect degree of
psychopathology rather than borderline pathology per se, or
that the findings reflect characteristics of the normals rather
than of the borderlines, the following analyses were conducted.
Borderlines and depressives were compared on the General
Symptomatology Index of the Revised Symptoms Checklist-
90. (SCL-90-R; Derogatis, 1977; the two groups did not differ
significantly, t[29] = .52, p = .61), suggesting that degree of
psychopathology does not explain the findings. Additionally,
we tested for differences on the dependent variables between
the depressives and the normals. Whereas the borderlines were
significantly more pathological than the normals on all eight
variables tested, depressives differed from normals only on the
two variables expected to distinguish the two groups because of
the cognitive constriction of the MDD group: mean Complex-
ity and mean Social Causality. The two BPD groups (with and
without MDD) did not differ significantly from each other on
any TAT variable.
Another potential confound is that, although the testers were
unaware of diagnosis (as during the administration of the TAT),
they may have been able to intuit the group to which the subject
belonged (particularly the normals) and thus able to influence
responses by additional prompting. To test for prompting ef-
fects, we compared subjects who were tested by administrators
acquainted with the measures with those unacquainted. Both
across and within diagnostic groups, one-tailed t tests revealed
no significant differences on any measure. A second analysis
comparing subjects tested by members of the research team
with those not tested by members of the research team simi-
larly yielded no differences approaching significance.
Discussion
In general, the results of this study suggest that patients with
BPD can be successfully discriminated from major depressives
and normals on the basis of their object relations and social
361
Percentage of Level 1
responses
BPD/ MDD
MDD only
SD T stat M SD M SD T stat
.52 2.20** 18 1.54 06 1.09 2.86***
.58 .62 06 1.62 03 .71 .93
.41 1.51t 23 1.99 14 1.58 1.71"
.49 .35 13 2.09 05 1.17 1.64"
cognition. The overall pattern of findings suggests that BPDs
are distinguished by poorly differentiated, egocentric represen-
tations of people; malevolent expectations of relationships; dif-
ficulty investing in relationships and moral standards; and
idiosyncratic and grossly illogical attributions. It is likely that
these characteristics of the object relations and social cognition
of borderline patients underlie many of the interpersonal diffi-
culties of these patients.
A particularly strong finding is that BPDs have a tendency to
view the world of people as malevolent, which was replicated in
a study comparing borderline adolescents to psychiatric and
normal comparison subjects (Westen, Ludolph, Lerner, et aL
1990). This finding has emerged consistently in studies using
various sources of data, including Rorschach responses (Lerner
& St. Peter, 1984; Spear & Sugarman, 1984; Stuart et al., 1990),
early memories (Nigg, Lohr, Westen, Gold, & Silk, 1989), sto-
ries told in response to the Picture Arrangement subtest of the
WAIS-R (Segal, Westen, Lohr, Silk, & Cohen, 1989), and the
SCL-90-R (notably the Paranoia and Interpersonal Sensitivity
subscales; Benjamin, Silk, Lohr, & Westen, 1989). Together
these findings suggest that malevolent expectations appear to
be characteristic of borderline patients and thus should be con-
sidered for inclusion as a diagnostic criterion for BPD.
Despite a tendency among the BPD subjects in this study to
produce poorly differentiated, extremely egocentric representa-
tions, a substantial percentage of borderline subjects (45.9%)
showed evidence of a capacity to form more complex represen-
tations (Level 4 or 5) on at least two of the seven TAT cards. This
finding points to the importance of focusing on the dynamic
flux and flow of object relations and on the conditions under
which pathological processes are evoked, rather than strictly on
levels of object relations as monolithic structures. This shift in
focus would require a greater integration of more classical psy-
choanalytic thinking about momentary dynamic processes and
compromise formations into object-relations concepts. It would
also suggest the importance for psychoanalytic theory of wres-
tling with contemporary issues in personality psychology re-
362 WESTEN, LOHR, SILK, GOLD, KERBER
garding person-situation interactions and the importance of
specifying conditions under which trait-like phenomena be-
come manifest. Future research should be directed toward un-
derstanding the conditions under which BPDs manifest prob-
lematic object relations. No one is borderline all the time, yet
we know little about the activating conditions for pathological
processes. Future research will also need to explore the possibil-
ity that different dimensions o f object relations may be in-
fluenced by different experiences and that pathogenic experi-
ences may not all occur during the preoedipal period (Westen,
in press-b; Westen, Ludolph, Block, Wixom & Wiss, 1990).
The data also suggest that if BPD is a variant of a mood
disorder, the relationship is not simple. BPDs with major de-
pression did not significantly differ from BPDs without major
depression on any scale; in contrast, the BPD group as a whole
differed from the M D D group, as did the BPD/MDD sub-
group, in nearly every comparison where predicted. In other
words, borderlines with major depression look like borderlines,
not like major depressives. Although there is likely to be a bio-
logical substrate to some subgroups of patients with BPD, this
substrate is not a simple vulnerability to major depression.
Finally, this study supports the utility of projective tests, and
particularly the TAT, in assessing dimensions of object rela-
tions and social cognition. Since Mischel's (1968) sophisticated
critique of trait psychology and projective testing, generations
of psychologists, including personality and clinical psycholo-
gists, have been trained with a deeply ingrained assumption
that projective techniques are inherently invalid and unreliable.
In the present study, however, four complex coding schemes
were applied to TAT data with high interrater reliability, and
these were able to document some relatively subtle predicted
differences.
This study has the following limitations. First, the study in-
volves the use of TAT measures whose validity and psychomet-
ric properties are only beginning to be established, and clearly
results must be interpreted cautiously, Convergent findings us-
ing other methods and samples have, however, been very con-
sistent (Bell et al., 1988; Benjamin et al., 1989; Burke et al., 1986;
Nigg et al., 1989; Westen, Ludolph, Lerner, et al., 1990). Fur-
ther, we made some very specific predictions in this study, all
but one of which were borne out, and it is difficult to conceive
of a rival hypothesis based on problems with the measures that
could account for this set of findings as parsimoniously.
A second limitation is that the groups differed in age and
SES, reflecting group differences inherent in the population.
Neither age nor SES, however, correlated with any dependent
variable except for a low correlation between complexity and
SES, suggesting that the findings are not reducible to group
differences on these variables. A study comparing borderline
adolescents to normal and psychiatric comparison subjects in
which age and SES were matched produced a very similar pat-
tern of results (Westen, Ludolph, Lerner, et al., 1990). The find-
ings were also not reducible to degree of psychopathology as
assessed by the S C L - 9 0 - R ; it would be difficult to argue that
patients hospitalized for MDD, who are typically debilitated by
their illness and receive multiple discharge diagnoses on both
Axis ! and Axis II (e.g., avoidant or dependent personality dis-
order), have less severe psychopathology than patients hospital-
ized for BPD.
Another possible objection is that the findings reflect char-
acteristics of the normal sample, rather than of the borderline
sample. Differences between the BPD and M D D groups, how-
ever, cannot be explained with this rival hypothesis, nor can it
explain why multiple differences between BPDs and normals
were not also present between MDDs and normals. From a
psychoanalytic perspective, a substantial percentage of people
who are typically used as normals in psychological research
have considerable character pathology, so that a sample repre-
sentative of the population of American adults would not be an
appropriate comparison group for a study of patients with per-
sonality disorders. What we had hoped to select with a brief
screening interview, a self-esteem inventory, and the MMPI was
a sample of people who seemed relatively intact clinically, re-
ported the same, and were statistically normal on all scales of a
psychometrically valid and reliable instrument.
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sity, P.O. Box 11A Yale Station, New Haven, CT 06520-
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