Abstract
The current study investigated the inter-rater reliability and the construct validity of the Rorschach Lerner Defense Scale (LDS). In particular, it aimed to explore the inter-rater reliability, analyzing the most frequent coding mistakes in an attempt to improve the coding guidelines, and to investigate the ability of the scale to distinguish between individuals with neurotic-level and borderline-level personality organization, according to the Psychodynamic Diagnostic Manual-2 (PDM-2), and non-clinical subjects. Eighty clinical subjects and 80 non-clinical ones participated in the study. Among the clinical subjects, 40 have borderline-level personality organization and 40 have neurotic-level personality organization. Non-clinical subjects were drawn from an archival dataset of non-clinical individuals who previously participated in a Rorschach normative study. The LDS showed substantial inter-rater reliability; however, guidelines could be improved, specifically with regard to the threshold for coding Devaluation and Idealization at level 1. Furthermore, more examples should be included in the manual about the coding of Projective Identification and Denial. The LDS distinguished borderline-level subjects from both the non-clinical and neurotic groups with regard to Devaluation and Projective Identification, with borderline-level personality organization subjects reporting higher scores than either of the two other groups. Only the Denial scale discriminated between the non-clinical and neurotic group, with the latter reporting higher scores of high-level Denial.
Highlights
In psychoanalysis, the conceptualization of the defenses followed a long path which can be described, briefly and in a reductive way, as the transition from being considered pathogenic elements to becoming protective factors against negative affects (Freud, 1926, 1938). Klein (1946) added that defenses protect individuals from painful feelings and significantly contribute to organizing psychic development.More recently, Kernberg (1975) identified the quality of the defense mechanisms as a crucial diagnostic criterion for differentiating among neurotic, borderline, and psychotic levels of personality organization
The massive use of primitive splitting and denial was peculiar to the psychotic level, especially if associated with impaired reality testing, while projective identification, primitive idealization, and devaluation were distinctive defense mechanisms used by individuals with a borderline level of personality organization
According to the Psychodynamic Diagnostic Manual-2 (PDM-2; Lingiardi and McWilliams, 2017), developed on the basis of Kernberg’s theory, defensive functioning is one of the 12 psychological capacities included in the Mental Functioning Axis (M Axis), and its assessment is essential to identify the level of personality organization (P Axis)
Summary
Kernberg (1975) identified the quality of the defense mechanisms as a crucial diagnostic criterion for differentiating among neurotic, borderline, and psychotic levels of personality organization. The massive use of primitive splitting and denial was peculiar to the psychotic level, especially if associated with impaired reality testing, while projective identification, primitive idealization, and devaluation were distinctive defense mechanisms used by individuals with a borderline level of personality organization. Since defenses are unconscious psychic processes, measuring them may be challenging and performance-based tests may be more appropriate for identifying them. In 1980, Lerner and Lerner developed the Lerner Defense Scale (LDS) based on Kernberg’s theoretical framework in order to evaluate the emergence of the primitive defenses of Splitting, Devaluation, Idealization, Projective Identification, and Denial in the Rorschach test
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