Am J Psychiatry 1997; 154:250-255
Copyright © 1997 by American Psychiatric Association
Transitional objects and borderline personality disorder
W Cardasis, JA Hochman and KR Silk
Department of Psychiatry, University of Michigan Medical School, Ann Arbor 48109-0704, USA.
OBJECTIVE: The relationship of possession of transitional objects to the
borderline personality disorder diagnosis was explored in a psychiatric
inpatient setting. It was hypothesized that a greater proportion of
inpatients who bring objects of special meaning with them to the hospital
have borderline personality disorder. METHOD: Psychiatric inpatients (N =
146) were administered a semistructured interview to determine the presence
of special (i.e., transitional) objects in the hospital, at home, or during
childhood. Borderline personality disorder was determined by criteria on a
DSM-III-R borderline personality disorder checklist and by DSM-III-R
discharge diagnosis. RESULTS: Significantly more patients who endorsed
having transitional objects in the hospital or at home had the diagnosis of
borderline personality disorder. Sensitivity, specificity, positive
predictive power, and negative predictive power of the possession of the
transitional object for the borderline personality disorder diagnosis were
calculated. Specificity was higher than sensitivity, and negative
predictive power was higher than positive predictive power in each
instance. While these results suggest that absence of a transitional object
is more likely to be associated with absence of borderline personality
disorder than the presence of a transitional object is with the presence of
borderline personality disorder, the sensitivity of a transitional object
during adulthood to predict a diagnosis of borderline personality disorder
was 63%, and the positive predictive power was 45%. CONCLUSIONS: A
transitional object brought to the hospital may help remind the inpatient
with borderline personality disorder of home or provide soothing during
separation from home. The persistence of transitional objects into
adulthood may inform the therapist of possible transference paradigms that
may develop in treatment.
