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Functional deficits in the self and depression in widows

Published online by Cambridge University Press:  31 October 2008

Jill Gentile ,
Dante Cicchetti ,
Ruth A. O'Brien  and
Fred A. Rogosch
Jill Gentile
Affiliation:
University of Medicine and Dentistry of New Jersey, Community Mental Health Center at Piscataway
Dante Cicchetti
Affiliation:
University of Rochester, Mt. Hope Family Center
Ruth A. O'Brien
Affiliation:
University of Colorado Health Sciences Center, School of Nursing
Fred A. Rogosch
Affiliation:
University of Rochester, Mt. Hope Family Center
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Abstract

This study addressed the role of deficits in the organization of the self, or narcissistic pathology, among widows who evidenced depressive outcomes following the loss of their husbands. The significance of object representations and self-regulatory capacities (introjects) within the self-representation in predicting psychiatric status in a sample of 77 widows 1 year after spousal loss was examined. In addition, the link between functional deficits within the self and observable state markers of such deficits as they related to depression was investigated. A combination of projective and self-report measures were used to assess self and object representation. The General Health Questionnaire (Goldberg & Hillier, 1979) and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.) (Spitzer & Williams, 1985) were employed as measures of psychiatric disorder. Analyses revealed that functional aspects of self representations, or introjects, differentiated clinically depressed widows from those experiencing “normal” mourning. However, object representations were relatively weak predictors of depression following bereavement and evidenced little association with self representation. Observable markers of self-pathology were strongly related to functional impairments in the self but did not operate causally to predict depressive outcome. Theoretical and clinical implications of the linkage between functional deficits in the self and depression are discussed.

Type
Research Article
Information
Development and Psychopathology , Volume 4 , Issue 2 , April 1992 , pp. 323 - 339
Copyright
Copyright © Cambridge University Press 1992

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References

Akhtar, S. (1989). Narcissistic personality disorders: Descriptive features and differential diagnosis. Psychiatric Clinics of North America, 12, 505–530.CrossRefGoogle ScholarPubMed
Akhtar, S., & Thomson, J. A. Jr (1982). Overview: Narcissistic personality disorder. American Journal of Psychiatry, 139, 12–20.Google ScholarPubMed
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
Aneshensel, C. S. (1985). The natural history of depressive symptoms: Implications for psychiatric epidemiology. In Greenley, J. R. (Ed.), Research in community and mental health (Vol. 5, pp. 45–75). Greenwich, CT: JAI Press.Google Scholar
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.CrossRefGoogle ScholarPubMed
Benjamin, L. (1974). Structural analysis of social behavior. Psychological Review, 81, 392–425.CrossRefGoogle Scholar
Benjamin, L. (1977). Structural analysis of a family in therapy. Journal of Consulting and Clinical Psychology, 45, 391–406.CrossRefGoogle ScholarPubMed
Benjamin, L. (1980). Validation of the structural analysis of social behavior. Unpublished manuscript, University of Wisconsin, Madison.Google Scholar
Blatt, S., Chevron, E. S., Quinlan, D. M., & Weir, S. (1981). The assessment of qualitative and structural dimensions of object representations. Unpublished manuscript, Yale University, New Haven, CT.Google Scholar
Blazer, D., Hughes, D. C., & George, L. K. (1987). The epidemiology of depression in an elderly population. Gerontologist, 27, 281–287.CrossRefGoogle Scholar
Bornstein, P. E., Clayton, P. H., Halikas, J. A., Maurice, W. L., & Robins, E. (1973). The depression of widowhood after thirteen months. British Journal of Psychiatry, 122, 561–566.CrossRefGoogle ScholarPubMed
Bowlby, J. (1969/1982). Attachment and loss: Vol. 1, Attachment (2nd ed.). New York: Basic Books.Google Scholar
Bowlby, J. (1980). Attachment and loss: Vol. 3, Loss, sadness, and depression. New York: Basic Books.Google Scholar
Breslau, N. (1985). Depressive symptoms, major depression and generalized anxiety: A comparison of self-reports on CES-D and results from diagnosis with interviews. Psychiatry Research, 15, 219–229.CrossRefGoogle ScholarPubMed
Bretherton, I. (1985). Attachment theory: Retrospect and prospect. In Bretherton, I. & Waters, E. (Eds.), Crowing points in attachment theory and research. Monographs of the Society for Research in Child Development, 50 (pp. 3–35). Chicago: University of Chicago Press.Google Scholar
Bretherton, I. (1987). New perspectives on attachment relations. In Osofsky, J. (Ed.), Handbook of infancy (2nd ed., pp. 1061–1100). New York: Wiley.Google Scholar
Bruce, M. L., Kim, K., Leaf, P. J., & Jacobs, S. (1990). Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample. American Journal of Psychiatry, 147, 608–611.Google Scholar
Cassidy, J. (1988). Child-mother attachment and the self in six-year-olds. Child Development, 59, 121–134.CrossRefGoogle ScholarPubMed
Cicchetti, D., & Aber, J. L. (1986). Early precursors of later depression: An organizational perspective. In Lipsitt, L. & Rovee-Collier, C. (Eds.), Advances in infancy (Vol. 4, pp. 87–137). Norwood, NJ: Ablex Press.Google Scholar
Clayton, P. J. (1974). Mortality and morbidity in the first year of widowhood. Archives of General Psychiatry, 30, 747–750.CrossRefGoogle ScholarPubMed
Clayton, P. J. (1979). The sequelae and nonsequelae of conjugal bereavement. American Journal of Psychiatry, 136, 1530–1534.Google ScholarPubMed
Clayton, P. J. (1986). Bereavement and its relation to clinical depression. In Hippius, H., Klerman, G. L., & Matussek, N. (Eds.), New results in depression research (pp. 59–69). New York: Springer-Verlag.CrossRefGoogle Scholar
Crittenden, P., & Ainsworth, M. (1989). Attachment and child abuse. In Cicchetti, D. & Carlson, V. (Eds.), Child maltreatment: Theory and research on the consequences of child abuse and neglect (pp. 432–463). New York: Cambridge University Press.CrossRefGoogle Scholar
Dorpat, T. L. (1977). Depressive affect. Psychoanalytic Study of the Child, 32, 3–27.CrossRefGoogle ScholarPubMed
Epstein, S. (1983). The Mother–Father–Peer scale. Unpublished manuscript, University of Massachusetts, Amherst.Google Scholar
Fairbairn, W. R. D. (1952). An object relations theory of the personality. New York: Basic Books.Google Scholar
Freud, S. (1957). Mourning and melancholia. In Strachey, J. (Ed. and Trans.). Standard edition of the complete psychological works of Sigmund Freud (Vol. 14). London: Hogarth Press.Google Scholar
Gallagher, D. E., Breckenridge, J. N., Thompson, L. W., & Peterson, J. A. (1983). Effects of bereavement on indicators of mental health in elderly widows and widowers. Journal of Gerontology, 38, 565–571.CrossRefGoogle ScholarPubMed
Giovacchini, P. (1975). Psychoanalysis of character disorders. New York: Jason Aronson.Google Scholar
Click, I., Weiss, R., & Parkes, C. M. (1974). The first year of bereavement. New York: Wiley.Google Scholar
Goldberg, D. P., & Hillier, V. F. (1979). Scaled version of the General Health Questionnaire. Psychological Medicine, 9, 139–145.CrossRefGoogle ScholarPubMed
Goldberg, D. P., Rickels, K., Downing, R., & Hesbacher, P. (1976). A comparison of two psychiatric screening tests. British Journal of Psychiatry, 129, 61–67.CrossRefGoogle ScholarPubMed
Gunderson, J. G., Morris, H., & Zanarini, M. (1985). Transitional objects and borderline patients. In McGlashan, T. (Ed.), The borderline: Current empirical research (pp. 43–60). Washington, DC: American Psychiatric Press.Google Scholar
Gunderson, J. G., Ronningstam, E., & Bodkin, A. (1990). The diagnostic interview for narcissistic patients. Archives of General Psychiatry, 47, 676–680.CrossRefGoogle ScholarPubMed
Guntrip, H. (1961). Personality structure and human interaction: The development synthesis of psychodynamic theory. New York: International Universities Press.Google Scholar
Harris, T., Brown, G., & Bifulco, A. (1986). Loss of parent in childhood and adult psychiatric disorder: The role of lack of adequate parental care. Psychological Medicine, 16, 641–659.CrossRefGoogle ScholarPubMed
Hirschfeld, R. M., Klerman, G. L., Clayton, P. J., Keller, M. B., McDonald-Scott, P., & Larkin, B. (1983). Assessing personality: Effects of the depressive state on trait measurement. American Journal of Psychiatry, 140, 695–699.Google ScholarPubMed
Hirschfeld, R. M., Klerman, G. L., Gough, H. A., Barrett, J., Korchin, S. J., & Chodoff, P. (1977). A measure of interpersonal dependency. Journal of Personality Assessment, 41, 610–614.CrossRefGoogle ScholarPubMed
Hirschfeld, R. M., Klerman, G. L., Keller, M. B., Andreasen, N. C., & Clayton, P. J. (1986). Personality of recovered patients with bipolar affective disorder. Journal of Affective Disorders, 11, 81–89.CrossRefGoogle ScholarPubMed
Hollingshead, A. B. (1975). Four-factor index of social status. Working paper. Department of Sociology, Yale University, New Haven, CT.Google Scholar
Horowitz, M., Wilmer, N., & Alvarez, W. (1979). Impact of event scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–218.CrossRefGoogle Scholar
Humphrey, L. L., & Benjamin, L. S. (1986). Using structural analysis of social behavior to assess elusive family processes. American Psychologist, 41, 979–989.CrossRefGoogle ScholarPubMed
Joffe, W. G., & Sandier, J. (1965). Notes on pain, depression, and individuation. Psychoanalytic Study of the Child, 20, 394–424.CrossRefGoogle ScholarPubMed
Kobak, R. R., & Sceery, A. (1988). Attachment in late adolescence: Working models, affect regulation, and representations of self and other. Child Development, 59, 135–146.CrossRefGoogle Scholar
Kohut, H. (1971). The analysis of the self. New York: International Universities Press.Google Scholar
Kohut, H. (1977). The restoration of the self. New York: International Universities Press.Google Scholar
Kohut, H. (1984). How does analysis cure? Chicago: University of Chicago Press.CrossRefGoogle Scholar
Kohut, H., & Wolf, E. (1978). The disorders of the self and their treatment: An outline. International Journal of Psychoanalysis, 59, 413–425.Google Scholar
Lewinsohn, P. M., Hoberman, H. M., & Rosenbaum, M. (1988). A prospective study of risk factors for unipolar and bipolar depression. Journal of Abnormal Psychology, 97, 251–264.CrossRefGoogle Scholar
Maddison, D., & Viola, A. (1968). The health of widows in the first year following bereavement. Journal of Psychosomatic Research, 12, 297–306.CrossRefGoogle Scholar
Main, M., & Goldwyn, R. (1984). Predicting rejection of her infant from mother's representation of her own experiences: A preliminary report. International Journal of Child Abuse and Neglect, 8, 203–207.CrossRefGoogle Scholar
Main, M., Kaplan, N., & Cassidy, J. (1985). Security in infancy, childhood, and adulthood: A move to the level of representation. In Bretherton, I. & Waters, E. (Eds.), Growing points in attachment theory and research. Monographs of the Society for Research in Child Development, 50 (pp. 66–104). Chicago: University of Chicago Press.Google Scholar
McLemore, C., & Benjamin, L. S. (1979). Whatever happened to interpersonal diagnosis?: A psychosocial alternative to DSM-III. American Psychologist, 34, 17–34.CrossRefGoogle ScholarPubMed
Meissner, W. W. (1981). Internalization in psychoanalysis. New York: International Universities Press.Google ScholarPubMed
Miller, A. (1979). Depression and grandiosity as related forms of narcissistic disturbances. International Journal of Psychoanalysis, 60, 47–58.Google Scholar
Mullins, L. S., & Kopelman, R. E. (1988). Toward an assessment of the construct validity of four measures of narcissism. Journal of Personality Assessment, 52, 610–625.CrossRefGoogle ScholarPubMed
O'Brien, R. A. (1990). Risk factors and processes in older widows' mental health. Final report of grant #RO1MH41758, National Institute of Mental Health, DHHS.Google Scholar
Osterweis, M., Solomon, F., & Green, M. (1984). Bereavement: Reactions, consequences and care. Washington, DC: National Academy Press.Google Scholar
Parkes, C. M. (1970). “Seeking” and “finding” a lost object: Evidence from recent studies of the reaction to bereavement. Social Science and Medicine, 4, 187–201.CrossRefGoogle ScholarPubMed
Parkes, C. M., & Brown, R. J. (1972). Health after bereavement: A controlled study of Boston widows and widowers. Psychosomatic Medicine, 34, 449–461.CrossRefGoogle ScholarPubMed
Parkes, C. M., & Weiss, R. S. (1983). Recovery from bereavement. New York: Basic Books.Google Scholar
Radloff, L. (1975). Sex differences in depression: The effects of occupation and marital status. Sex Roles, 1, 249–265.CrossRefGoogle Scholar
Ricks, M. H. (1985). The social transmission of parental behavior: Attachment across generations. In Bretherton, I. & Waters, E. (Eds.), Growing points in attachment theory and research. Monographs of the Society for Research in Child Development, 50 (pp. 211–227). Chicago: University of Chicago Press.Google Scholar
Riskind, J. H., Beck, A. T., Berchick, R. J., Brown, G., & Steer, R. A. (1987). Reliability of DSM-III diagnoses for major depression and generalized anxiety disorder using the Structured Clinical Inter-view for DSM-III. Archives of General Psychiatry, 44, 817–820.CrossRefGoogle Scholar
Ronningstam, E. (1989). Comparing three diagnostic systems for narcissistic personality disorder. Psychiatry, 51, 300–311.CrossRefGoogle Scholar
Ronningstam, E., & Gunderson, J. (1989). Descriptive studies on narcissistic personality disorder. Psychiatric Clinics of North America, 12, 585–601.Google ScholarPubMed
Ronningstam, E., & Gunderson, J. (1990). Identifying criteria for narcissistic personality disorder. American Journal of Psychiatry, 147, 918–922.Google ScholarPubMed
Schafer, R. (1968). Aspects of intemalization. New York: International Universities Press.Google Scholar
Skolnick, A. (1986). Early attachment and personal relationships across the lifecourse. In Baltes, P. B., Featherman, D., & Lerner, R. (Eds.), Lifespan development and behavior (Vol. 7). Hillsdale, NJ: Erlbaum.Google Scholar
Spitzer, R. L., Forman, J. B. W., & Nee, J. (1979). DSM-III field trials: I. Initial interrater diagnostic reliability. American Journal of Psychiatry, 136, 815–817.Google ScholarPubMed
Spitzer, R. L., & Williams, R. B. J. (1985). Structured Clinical Interview Jor DSM-III (SCID). New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
Sroufe, L. A. (1983). Infant–caregiver attachment and patterns of adaptation in preschool: The roots of maladaptation and competence. In Perlmutter, M. (Ed.), Minnesota symposium in child psychology (Vol. 16, pp. 41–81). Hillsdale, NJ: Erlbaum.Google Scholar
Sroufe, L. A., & Fleeson, J. (1986). Attachment and the construction of relationships. In Hartup, W. & Rubin, Z. (Eds.), Relationships and development (pp. 51–71). Hillsdale, NJ: Erlbaum.Google Scholar
Stolorow, R. D. (1975). Toward a functional definition of narcissism. International Journal of Psychoanalysis, 56, 179–185.Google Scholar
Tolpin, M. (1971). On the beginnings of a cohesive self: An application of the concept of transmuting and internalization to the study of the transitional object and signal anxiety. Psychoanalytic Study of the Child, 26, 316–352.CrossRefGoogle Scholar
Vachon, M. L. S., Rogers, J., Lyall, W. A. L., Lancee, W. J., Sheldon, A. R., & Freeman, S. J. J. (1982). Predictors and correlates of adaptation to conjugal bereavement. American Journal of Psychiatry, 139, 998–1002.Google ScholarPubMed
Volkan, V. D. (1972). The linking objects of pathological mourners. Archives of General Psychiatry, 27, 215–227.CrossRefGoogle ScholarPubMed
Winnicott, D. W. (1953/1971). Transitional objects and transitional phenomena. In Winnicott, D. W., Playing and reality. Middlesex, England: Penguin.Google Scholar
Zisook, S., & Shuchter, S. R. (1991). Depression through the first year after the death of a spouse. American Journal of Psychiatry, 148, 1346–1352.Google ScholarPubMed
Zubin, J., & Spring, B. (1977). Vulnerability: A new view of schizophrenia. Journal of Abnormal Psychology, 56, 103–126.CrossRefGoogle Scholar