All told, these research interviews were administered to 362 consecutive inpatients at McLean Hospital as part of a larger study. The methodology of that study has been described elsewhere (Zanarini, Frankenburg, Hennen, & Reich, 2003
). Two hundred and ninety patients met both DIB-R and DSM-III-R criteria for BPD and 72 met DSM-III-R criteria for at least one nonborderline axis II disorder (and neither criteria set for BPD).
Baseline demographic data have been reported before (Zanarini et al., 2003
). Briefly, 77.1% (N=279) of the subjects were female and 87% (N=315) were white. The average age of the subjects was 27 years (SD=6.3), the mean socioeconomic status was 3.3 (SD=1.5) (where 1=highest and 5=lowest), and their mean GAF score was 39.8 (SD=7.8) (indicating major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood).
shows the mean scores and standard deviations of borderline patients and axis II comparison subjects for each of Bond’s four defensive styles, which were derived from factor analyses. As can be seen, borderline patients had significantly higher scores than axis II comparison subjects on each of the styles except that measuring adaptive or higher-level defenses. In addition, the following effect sizes were found: adaptive defense style (0.17), image distorting defense style (0.46), self-sacrificing defense style (0.53), and maladaptive action defense style (1.02). Only one of these was large (0.8 or higher) using Cohen’s guidelines (1988)
and the other three were small (0.2) to medium (0.5).
Mean DSQ Defense Styles Scores among Borderline Patients and Axis II Comparison Subjects
shows the mean scores and standard deviations of borderline patients and axis II comparison subjects for each of 19 specific defenses studied. These defenses are organized partly by Vaillant’s empirically derived hierarchy of defenses: mature, neurotic, and immature defenses. The remaining defenses are organized according to Kernberg’s theoretical model of borderline defenses. As can be seen, borderline patients had significantly higher scores than axis II comparison subjects on one neurotic-level defense (undoing), four immature defenses (acting out, emotional hypochondriasis, passive aggression, and projection), and two image-distorting/borderline defenses (projective identification and splitting). In contrast, axis II comparison subjects had significantly higher scores than borderline patients on one mature defense (suppression). In terms of effect sizes, only three were large using Cohen’s guidelines: undoing (0.82), acting out (0.98), and emotional hypochondriasis (0.88). The remaining effect sizes were small to medium: altruism (0.33), anticipation (0.02), humor (0.04), sublimation (0.02), suppression (0.41), isolation (0.35), reaction formation (0.41), denial (0.26), fantasy (0.12), passive aggression (0.53), projection (0.79), devaluation (0.07), omnipotence (0.02), primitive idealization (0.26), projective identification (0.41), and splitting (0.48).
Mean DSQ Defense Scores among Borderline Patients and Axis II Comparison Subjects
As shows, three defenses were found in multivariate analyses to be significantly associated with a borderline diagnosis: acting out, emotional hypochondriasis, and undoing. In terms of these three defenses, a patient’s risk of meeting DIB-R and DSM-III-R criteria for BPD was about 35–46% greater for each point higher on that defense’s mean score.
Forced Entry Logistic Regression of Significant Associations Between DSQ Defenses and Borderline Diagnosis
Overall, this model was highly significant (χ2=83.73, df=3, p<0.0001) () and correctly classified 83% of the 362 subjects in the study. More specifically, it had high levels of sensitivity (.95) and positive predictive power (.86) but substantially lower levels of specificity (.36) and negative predictive power (.63). Looked at another way, 95% (275/290) of the borderline patients in this study exhibited high levels of this defensive triad and 86% (275/321) of those with this defensive constellation met study criteria for BPD. However, 64% (46/72) of OPD subjects were false positives (i.e., had a high score on this defensive trio).
Receiver Operating Characteristics of Defensive Triad of Acting Out, Undoing, Emotional Hypochondriasis