Examining an Assumption in Object-Relational Personality Diagnosis: Does Style Imply Severity?

Influenced in part by object relations theory, contemporary models of personality pathology are converging in their emphasis on the central role of the self and interpersonal functioning. However, they have largely not adopted object relations theory's assumption that personality disorder style and personality disorder severity are linked. The present study was designed to investigate the relationship between personality disorder style and severity in an inpatient adolescent sample. Categorical personality disorder diagnoses were converted into (a) personality style groups, permitting group comparisons, and (b) a dimensional personality style score, permitting correlation analyses with measures of personality organization and clinical severity. Group differences and correlation analyses both demonstrated that personality disorder style is associated with clinical severity in our sample. Mediation analyses further demonstrated that, for three of four clinical severity constructs, the relationships between personality style and clinical severity were mediated by differences in personality organization impairment. Results were broadly supportive of hypotheses, providing support for the object-relational model of personality diagnosis.