Doctoral Dissertations

Date of Award

5-1994

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Psychology

Major Professor

Leonard Handler

Committee Members

Kathleen Lawler. Robert Levey, Sandra Thomas

Abstract

The purposes of this study were to explore object relationships and personality features of patients with ulcerative colitis (UC), to examine the construct of alexithymia in object relational terms, and to demonstrate the validity of analytic concepts for psychosomatic medicine. The literature review traces psychoanalytic developments in psychosomatic medicine from conversion hysteria models to modern object relations theory and alexithymia. Psychological literature pertaining to ulcerative colitis is also presented. Hypotheses addressed clinical observations from the literature contending that UC patients would, (1) exhibit more impaired object relations as measured by Westen's four scales on the Thematic Apperception Test (TAT), (2) evidence a dependent character structure, (3) describe their mothers as domineering, (4) be more closely identified with a key other, (5) evidence less maternal assimilation, (6) show less differentiation between a key other and their maternal representation, and (7) be more alexithymic than a healthy control (HC) group. An eighth hypothesis predicted that alexithymia would be positively correlated with degree of maternal assimilation. Subjects consisted of 20 UC patients, matched by age, race, and gender with 20 HC subjects and 20 patients with rheumatoid arthritis (RA). All subjects were administered the TAT, Leary Interpersonal Checklist (ICL), Toronto Alexithymia Scale (TAB), and Minnesota Multiphasic Personality Inventory (MMPI). The TAT was scored using Westen's system, yielding four variables; Affect Tone (AT), Social Causality (SC), Emotional Investment (El), and Complexity of Representations (CR). The ICL yielded descriptions of self (level IIs), mother (Ilm), father (Ilf), and key other (IIso). Levels Is (Public Communication) and IIImm (Basic Intentionality) were derived from the MMPI. From these measures, the variability indices; Conscious Identification, Maternal Assimilation, and Mother-Significant Other Equation, were derived. Several post-hoc, exploratory analyses were also performed, including between-group comparisons on the MMPI validity and clinical scales. The design of this descriptive, exploratory study was a three group comparison, controlling for the effects of chronic illness with the inclusion of a psychosomatic (RA) control group. Hypothesis 1 was partially confirmed with the UC group scoring lower on three of Westen's scales (CR, El, and SC) than the HC group, suggesting that these patients are characterized by lower level capacities for emotional investment in people, are less accurate in understanding human interactions, and have less sense of people's subjective states and motives. The ICL variables largely failed to differentiate the groups. On the level of Public Communication (Is), UC subjects appeared significantly more conventional and "hypernormal" than HC subjects. Both psychosomatic groups evidenced greater degrees of Conscious Identification and Mother-Significant Other Equation than the HC group, although these differences were not statistically significant for the UC group. There was also a nonsignificant trend toward higher alexithymia scores among the UC subjects. Contrary to prediction, no correlation was found between Maternal Assimilation and alexithymia as measured by the TAS. On the MMPI scales, the UC group scored higher (p<.05) than the HC group on scales L, K, and D, and significantly lower on the Ma scale. Theoretical consistencies and inconsistencies in the data are discussed as are the limitations of the study and implications for research and practice.

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