Object Relation Quality, Alexithymia, and Defense Mechanisms of Drug Abusers with Antisocial Personality Disorder

By Aleman, Kristian | Social Behavior and Personality: an international journal, November 30, 2007 | Go to article overview

Object Relation Quality, Alexithymia, and Defense Mechanisms of Drug Abusers with Antisocial Personality Disorder


Aleman, Kristian, Social Behavior and Personality: an international journal


The purpose was to investigate, in a sample of drug abusers, whether subscales in the KAPP (Karolinska Psychodynamic Profile, Weinryb, 1992) interview and defense mechanisms explored by the DMTm (Defense Mechanism Technique modified) could differentiate between DSM-III-R clusters and personality disorders (PDs). Forty-seven (47) subjects out of the 84 injecting drug abusers (56%) recruited from a detoxification hospital ward in Sweden had a primary antisocial PD (ASPD) with a comorbid second DSM-III-R PD diagnosis. Pathology was significant on the KAPP subscales of "Dependency and separation," "Alexithymic traits," "Normopathic traits," "Coping with aggressive affects," and "Sexual satisfaction" in relation to cluster B (dramatic). All subscales were predominant in patients with ASPD/narcissistic PD, who showed the defense mechanism marked denial. The two latter subscales were related to patients with ASPD/borderline PD, who showed the defense of introaggression and the DMTm sign of disappearance of threat. Finally, some psychoanalytic constructs in KAPP and DMTm showed congruence.

Keywords: KAPP, DMTm, drug abusers, ASPD, Alexithymia, defense mechanisms.

Karolinska Psychodynamic Profile (KAPP; Weinryb, 1992) is a semi-structured interview method for making an assessment of personality traits. KAPP is not limited to diagnosis of personaUty pathology as is, for instance, Kernberg's (1981, 1984) Structural interview for borderline patients or Gunderson and Singer's (1975) Diagnostic interview for narcissism (DIN) or Diagnostic interview for borderlines (DIB). It specifically focuses on phenomena such as (counter) transference as described by Luborsky and Crits-Christoph (1998), and also phenomena such as resistance, wishes, feelings, and so on. KAPP has a theoretical anchorage in object relations theory.

Defense Mechanism Technique modified (DMTm) is a projective personality assessment, especially exploring defense mechanisms in a theoretical construct by Andersson (Andersson & Ryhammar, 1999). DMTm has been developed from the original Defense Mechanism Test (DMT) invented by Kragh (1960). DMTm signs are supposed to reveal defense mechanisms in relation to different kinds of anxiety. Additional DMTm signs are interpreted as signs of neither defense nor anxiety. These are still under empirical validation.

The KAPP was applied when Weinryb (1992) studied DSM-DI personality disorders (PDs) in patients with ulcerative colitis and found that it could discriminate these subjects with and without PD. Wilczek, Barber, Gustavsson, Åsberg, and Weinryb (2001) investigated 55 patients in a naturalistic psychoanalytic psychotherapy study. The aim was to explore whether the longterm psychoanalytic psychotherapy had an effect on the patients' character and symptoms measured according to KAPP. The psychotherapy group improved their capacity to handle important aspects of life and reduced their symptomatic suffering. Four KAPP subscales of specific importance were: Intimacy and reciprocity, Coping with aggressive affects, Sexual satisfaction, and Personality organization. Weinryb (1992) explored the subscale of Alexithymic traits applying KAPP ratings and self-reports. Measuring the phenomenon of alexithymia is one of the main issues in the construction of KAPP. The KAPP assessment instrument has so far not been used to investigate injecting drug abusers.

In a sequence of studies with the DMTm, Aleman (2000, 2004) first investigated how 19 substance abusers with psychosis (DSM-IIl-R) differed in DMTm from 65 nonpsychotic drug abusers (mainly heroin or amphetamine). The psychotics showed: traumatic anxiety, repression, denial 2-3, splitting, reference (lack of symbolic capacity), and denial through reversal I, III, and IV, which revealed difficulties in maintaining three emotional barriers, the first dealing with separating from and being different from the other, the second distinguishing the barrier of gender and the third, oedipal position concerned with the generation gap. …

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