Object relation quality, alexithymia, and defense mechanisms of drug abusers with antisocial personality disorder

The purpose was to investigate, in a sample of drug abusers, whether subscales in the KAPP (Karolinska Psychodynamic Profile, Weinryb, 1992) interview and defense mechanisms explored by the DMTm (Defense Mechanism Technique modified) could differentiate between DSM-III-R clusters and personality disorders (PDs). Forty-seven (47) subjects out of the 84 injecting drug abusers (56%) recruited from a detoxification hospital ward in Sweden had a primary antisocial PD (ASPD) with a comorbid second DSM-III-R PD diagnosis. Pathology was significant on the KAPP subscales of “Dependency and separation,” “Alexithymic traits,” “Normopathic traits,” “Coping with aggressive affects,” and “Sexual satisfaction” in relation to cluster B (dramatic). All subscales were predominant in patients with ASPD/narcissistic PD, who showed the defense mechanism marked denial. The two latter subscales were related to patients with ASPD/borderline PD, who showed the defense of introaggression and the DMTm sign of disappearance of threat. Finally, some psychoanalytic constructs in KAPP and DMTm showed congruence.