Beyond Posttraumatic Stress Disorder: Object Relations and Reality Testing Disturbances in Physically and Sexually Abused Adolescents

To evaluate posttraumatic stress disorder (PTSD) symptom severity, object (interpersonal) relations disturbances, and reality testing disturbances in a sample of physically and sexually abused adolescents. Subjects were 37 students, 16 boys and 21 girls, enrolled at a private, residential school for children with various conduct problems. Students completed several psychological tests, including the Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI) and the Bell Object Relations and Reality Testing Inventory. Of the 37 students, 22 (59.5%) had CPTSD-RI scores in the severe and the very severe ranges. The most common object relations and reality testing disturbances were insecure attachment and uncertainty of perception, respectively. CPTSD-RI scores were positively correlated with two of the four object relations scores (insecure attachment and egocentricity) and with all three reality testing scores (reality distortion, uncertainty of perception, and hallucinations/delusions). Mean CPTSD-RI scores were higher for students whose abuse had involved sex (sexual and physical abuse, sexual abuse only) than they were for students whose abuse had been physical only. Alienation and social incompetence, the two object relations disturbances not correlated with PTSD symptom severity, were associated with having experienced abuse at an early age and having been abused by a parent or stepparent (versus a nonparent). To address more effectively the long-term difficulties associated with child maltreatment, clinicians and clinician-investigators ought to evaluate interpersonal and reality testing disturbances, as well as PTSD symptom severity. J. Am. Acad. Child Adolesc. Psychiatry, 1995, 34, 8:1054–1059.