Bell Object Relations and Reality Testing Inventory

Submitted by mholliday on Tue, 07/10/2012 - 13:44

Overview

Acronym: 
BORRTI
Author(s): 
Bell, Morris, D., Ph.D.
Citation: 

Bell, M.D. (1995) Bell Object Relations and Reality Testing Inventory (BORRTI) Manual. Los Angeles: Western Psychological Services.

Obtain(Email/Website): 
Cost: 
Cost Involved
Copyrighted: 
Yes
Measure Description: 

The BORRTI is a widely used measure designed to evaluate individuals for personality and thought disorders. It provides
information regarding the “respondent’s ability to sustain essential relationships and accurately identify internal and
external reality.”

It yields scores on four object relations scales: 1) Alienation, 2) Insecure Attachment, 3) Egocentricity, and 4) Social Incompetence. The 45 Object Relations items can be administered separately (Form O). The measure also yields scores on three Reality Testing subscales: 1) Reality Distortion,
2) Uncertainty of Perception, and 3) Hallucinations and Delusions.

The measure includes several validity checks, including an inconsistent responding scale. Interpretation of scores is done by looking at the profile of scores. The manual provides interpretive guidelines for specific profiles. The computerized scoring report profiles scores, makes diagnostic suggestions and treatment recommendations, and lists specific clinical themes including: 1) Doubts About Perceptual Accuracy, 2) Substance Abuse and Disorientation, 3) Irrational Beliefs, 4) Hostility and Self-Centeredness, 5) Mistrust and Humiliation, And 6) Appeasement and Dependency.

The measure has been used with different clinical populations including schizophrenics, eating disorder populations, substance abusers, criminal psychopaths, individuals with PTSD, and individuals with borderline personality disorder. BORRTI scores have also been found to be associated with the quality of the therapeutic relationship.

Representative content from the BORRTI copyright (c) 1995 by Western Psychological Services. Reprinted for reference within the NCTSN Measure Review Database by permission of the publisher, WPS, 12031 Wilshire Boulevard, Los Angeles, CA 90025, www.wpspublish.com. All rights reserved.

Domain(s) Assessed : 
Externalizing Symptoms
Relationships & Attachment
Cognition & Development
Language(s) : 
English
Dutch
French
German
Italian
Japanese
Korean
Portuguese
Slovene (ian)
Swedish
Age Range: 
11-99
Measure Type: 
In-depth Assessment
# of Items: 
90
Measure Format: 
Questionnaire
Average Time to Complete (min): 
15
Reporter Type: 
Self
Average Time to Score (min): 
5
Periodicity: 
Not reported.
Response Format: 

True/False

Materials Needed: 
Paper/Pencil
Other Materials Needed: 
Computer (Opyional)
Sample Item(s): 
DomainsScalesSample Items
Object RelationsAlienationIt's hard for me to get close to anyone. (T)
 Insecure AttachmentI feel that I have to please everyone or else they may reject me. (T)
 EgocentricityPeople are never honest with each other. (T)
 Social IncompetenceMaking friends is not a problem for me. (F)
Reality TestingReality DistortionPeople are often angry with me whether they admit it or not. (T)
 Uncertainty of PerceptionI experience anxious feelings which I cannot explain. (T)
 Hallucinations and DelusionsI can hear voices that other people cannot seem to
hear. (T)
Information Provided: 
Areas of Concern/Risks
Clinician Friendly Output
Continuous Assessment
Graphs (e.g. of elevated scale)
Percentiles
Raw Scores
Standard Scores
Strengths
Written Feedback From a Computer Program

Training

Administration Training: 
Manual/Video
Training to Interpret: 
Manual/Video
Prior Experience Psych Testing/Interpretation

Parallel/Alternate Forms

Parallel Form: 
No
Alternate Form: 
No
Different Age Forms: 
Yes
Altered Version Forms: 
Yes
Describe Alternative Forms: 

A shortened version of the BORRTI (called Form O) that contains only the 45 object relations items can be obtained. There is also a version of Form O, specifically designed for adolescents, titled the Bell Relationship Inventory for Adolescents (BRIA), also reviewed in this database). While the BORRTI has and can be used with adolescents, the BRIA may be more appropriate.

Psychometrics

Notes on Psychometric Norms: 

Norms developed with 934 individuals recruited from nonclinical settings including universities and community organizations. No specific details
regarding this population's ethnic composition or socioeconomic status are provided, but, given the population, it would appear the majority were college educated.

Clinical Cutoffs: 
Yes
If Yes, Specify Cutoffs: 
Inconsistent Responding: contradictory responses on > 3 item pairs. FREQ score should be > 8 if any subscale is 70T or greater. On all other scales, scores > 60T.
Reliability: 
Type:RatingStatisticsMinMaxAvg
Test-Retest- # of days: 28 Acceptabler0.580.90.76
Internal ConsistencyAcceptablealpha0.790.90.83
Inter-rater
Parallel/Alternate Forms
References for Reliability: 

From the manual, Bell (1995)
TEST-RETEST RELIABILITY
Reported in the manual for 4-week, 13-week, and 26-week periods. The 4-week reliability data were gathered from a mixed diagnosis psychiatric sample who were undergoing treatment. Reliability scores were as follows: Alienation=.88, Insecure Attachment=.73, Egocentricity=.90, Social Incompetence=.58, Reality Distortion=.63, Uncertainty of Perception=.74, Hallucinations and Delusions=.89.

INTERNAL CONSISTENCY (alpha)
Alienation=.90, Insecure Attachment=.82, Egocentricity=.78, Social Incompetence=.79,Reality Distortion=.87, Uncertainty of Perception=.82, Hallucinations and Delusions=.85.

Internal consistency was also assessed using Spearman split-half reliability and yielded similar reliability scores as Cronbach's alpha (range .77-.90).

Construct Validity: 
Validity TypeNot knownNot foundNonclincal SamplesClinical SamplesDiverse Samples
Convergent/ConcurrentYesYes
DiscriminantYesYes
Sensitive to ChangeYes
Intervention EffectsYes
Longitudinal/Maturation EffectsYes
Sensitive to Theoretically Distant GroupsYesYesYes
Factorial ValidityYesYesYes
References for Construct Validity: 

The measure discriminates among patients with borderline personality disorder, other personality disorders, psychosis, and affective disorders. Nonclinical students also scored lower than all clinical populations. In a study of criminal psychopaths, BORRTI subscale scores were related to scores on the Psychopathy Checklist Screening Version and to a history of child abuse (Brody
& Rosenfeld, 2002).

In a study of undergraduate women, BORRTI scores, specifically on Alienation and Egocentricity, were related to physiological reactivity during active coping (Kelsey, Ornduff, Reiff, & Arthur, 2002). Scales have been found to be associated with clients’ ability to develop a therapeutic alliance and with the quality of the therapeutic relationship (Mallinckrodt, Porter, & Kivlighan, 2005). The BORRTI has been used with individuals with PTSD symptoms. PTSD symptomatology among emergency workers, assessed using the Impact of Events Scale, was positively correlated with scores on the alienation, insecurity, and egocentricity subscales of the BORRTI (Regehr, Goldberg, Glancy, & Knott, 2002). A history of childhood physical and childhood sexual abuse has been associated with elevations on BORRTI subscales (Ornduff, Kelsey, O’Leary, 2001). Among males who experienced child sexual abuse BORRTI scores were related to aspects of the abuse, including perpetrator’s gender and perpetrator’s relationship to the victim (Morrell, Mendel, & Fischer, 2001).

The measure was developed using factor analysis (see “Content Validity”).

Haviland, Sonne, & Woods (1995) used the BORRTI with adolescents aged 11-19 at a residential school and found that BORRTI scores were associated with scores on the Child Post-Traumatic Stress Disorder Reaction Index, the Children’s Depression Inventory, and the Revised Children’s Manifest Anxiety Scale. Alienation, Egocentricity, and Social Incompetence scores were negatively correlated with age of onset of last abusive episode they had experienced.

Regehr & Marziali (1999) administered the BORRTI to a sample of women aged 17-47 who had been raped and found that BORRTI scores were related to scores on the Posttraumatic Symptom Scale, the Beck Depression Inventory, and the Inventory of Interpersonal Problems.

A Brazilian version of the BORRTI, developed through forward and backtranslation, was factor analyzed, resulting in a 4-factor solution similar to that
found in the English sample. The measure also showed good internal consistency and test-retest reliability, and was able to distinguish between a
Brazilian normal sample and a Brazilian schizophrenic sample (Bell & Bruscato, 2002; Bruscato & Iacoponi, 2000).

Criterion Validity: 
Not KnownNot FoundNonclinical SamplesClinical SamplesDiverse Samples
Predictive Validity:Yes
Postdictive Validity: Yes
References for Criterion Validity: 

Bell, Billington, Cicchetti, & Gibbons (1988) examined the sensitivity and specificity of the Object Relations subscales looking at how individuals with a
diagnosis of borderline personality disorder scored compared to other groups of psychiatric patients. Rates are given using alienation cut scores (>60T) and comparing patients with a borderline personality disorder diagnosis to those with affective disorder diagnosis. Good rates were also found looking at Insecure Attachment and comparing diagnosis of BPD with diagnosis of schizophrenia and mixed affective and psychotic features.

Overall Psychometric Limitations: 

While multiple aspects of the psychometric properties of the measure have been examined and established, the measure has not been widely used with measures of diverse ethnic groups including African-Americans and Latinos in the U.S. More research is needed including these and other groups.

Translation Quality

Language(s) Other Than English: 
Language:TranslatedBack TranslatedReliableGood PsychometricsSimilar Factor StructureNorms AvailableMeasure Developed for this Group
1. PortugueseYesYesYesYesYes
2. SloveneYes
3. DutchYes
4. FrenchYes
5. JapaneseYes
6. KoreanYes
7. SwedishYes
8. GermanYes
9. ItalianYes

Population Information

Population Used For Measure Development: 

See Notes under "Norms." No data regarding ethnicity or socioeconomic status of the development sample was reported.

Measure has demonstrated evidence of reliability and validity in which populations?: 
Physical Abuse
Sexual Abuse
Use with Diverse Populations: 
Population Type: Measure Used with Members of this GroupMembers of this Group Studied in Peer-Reviewed JournalsReliableGood PsychometricsNorms AvailableMeasure Developed for this Group
1. Methadone maintenance patientsYesYes
2. Inpatient and outpatients with borderline personality disorderYesYes

Pros & Cons/References

Pros: 

1. Widely used among diverse clinical populations.
2. Used, with interesting findings, in populations with PTSD.
3. Taps interesting and important dimensions relevant to the study of traumatized individuals.

Author Comments : 

1. The manual cautions that respondents should be fluent in English because it contains idiomatic expressions that are not well understood by foreign-born English speakers. While it is admirable that the author notes this limitation, this limits the measure's usability.
2. The measure is face valid, and as the author mentions, should not be used by those who are not cooperative and willing to respond honestly.
3. While the measure can be used with those 11 and older, the measure was not normed for adolescents, and the BRIA may be a more appropriate measure for that age group.
4. The measure is long and does not tap domains that are traditionally assessed in trauma populations, so adding this measure (while potentially important) would constitute additional burden to participants and clinicians. However, Form O is half the length and may be useful in situations where object relations issues are of concern.

References: 

The manual is:
Bell, M.D. (1995). Bell Object Relations and Reality Testing Inventory (BORRTI). Los Angeles: Western Psychological Services.

A PsychInfo literature search (6/05) for “Bell Object Relations and Reality Testing Inventory” or “BORTTI” anywhere revealed that the measure has been referenced in 46 peer-reviewed journals. Below is a sampling of these references:

1. Bell, M.D., Billington, R., & Becker, B. (1986). A scale for the assessment of reality testing: Reliability, validity, and factorial invariance. Journal of Consulting and Clinical Psychology, 53, 506-511.

2. Bell, M.D., Billington, R., & Becker, B. (1985). A scale for the assessment of object relations: Reliability, validity, and factorial invariance. Journal of Clinical Psychology, 42, 733-741.

3. Bell, M.D., Billington, R., Cicchetti, D., & Gibbons, J. (1988). Do object relations deficits distinguish BPD from other diagnostic groups? Journal of Clinical Psychology, 44, 511-516.

4. Bell, M.D. & Bruscato, W. (2002). Object relations deficits in schizophrenia: A crosscultural comparison between Brazil and the United States. The Journal of Nervous and Mental Disease, 190(2), 73-79.

5. Brody, Y. & Rosenfeld, B. (2002). Object relations in criminal psychopaths. International Journal of Offender Therapy and Comparative Criminology, 46(4), 400-411.

6. Bruscato, W.L., & Iacoponi, E. (2000). Validity and reliability of the Brazilian version of an inventory for the evaluation of object relations. Revista Brazileira de Psiquiatria, 22(4), 172-177.

7. Haviland, M.F., Sonne, J.L., & Woods, L.R. (1995). Beyond posttraumatic stress disorder: Object relations and reality testing disturbances in physically and sexually abused adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 34(8), 1054-1059.

8. Kelsey, R.M., Ornduff, S.R., Reiff, S., & Arthur, C.M. (2002). Psychophysiological correlates of narcissistic traits in women during active coping. Psychophysiology, 39, 322-332.

9. Mallinckrodt, B., Porter, M., & Kivlighan, D.M. (2005). Client attachment to therapist, depth of in-session exploration, and object relations in brief psychotherapy. Psychotherapy, Theory, Research, Practice, Training, 42(1), 85-100.

10. Morrell, B., Mendel, M.P., & Fischer, L. (2001). Object relations in sexually abused males. Journal of Interpersonal Violence, 16(9), 851-864.

11. Ornduff, S.R., Kelsey, R.M., & O’Leary, D. (2001). Childhood physical abuse, personality, and adult relationship violence: A model of vulnerability to victimization. American Journal of Orthopsychiatry, 71(3), 322-330.

12. Regehr, C., Goldberg, G., Glancy, G.D., & Knott, T. (2002). Posttraumatic symptoms and disability in paramedics. Canadian Journal of Psychiatry, 47(10), 953-958.

13. Regehr, C., & Marziali, E. (1999). Response to sexual assault: A relational perspective. Journal of Nervous and Mental Disease, 187(10), 618-623.

Other Related References
1. Bellak, L., Chassan, J.B., Gediman, H.K., Marvin, H. (1973). Ego function assessment of analytic psychotherapy combined with drug therapy. Journal of Nervous and Mental Disease, 157(6), 465-469.

Developer of Review: 
Chandra Ghosh Ippen, Ph.D.
Editor of Review: 
Chandra Ghosh Ippen, Ph.D.
Last Updated: 
Mon, 03/17/2014
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