Changes in the self-image of severely disturbed psychiatric patients diagnosed with Kernberg's (1981) structural interview as having neurotic, borderline and psychotic personality organization (NPO, BPO and PPO) were studied in a naturalistic 5-year follow-up programme of milieu treatment. Self-image was measured with Structural Analysis of Social Behavior (Benjamin, 1974) introject ratings. After treatment all patients had changed in the affiliation dimension of the self-image, while there was almost no change in the interdependence dimension. A more detailed analysis showed that for the NPO and PPO patients the higher overall affiliation was due to a less attacking self-image, while for the BPO patients it was due to more self-love. Both at intake and follow-up the PPO patients' ratings showed a positive self-image and those of the BPO patients showed high self-control. These ratings contrast with the diagnostic descriptions of such patients. It is suggested that these differences in perspective might lead to interpersonal problems.
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