Bell Object Relations and Reality Testing Inventory

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):

help@wpspublish.com / http://www.wpspublish.com/Inetpub4/index.htm

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

Measure Format:

Questionnaire

Average Time to Complete (min):

Reporter Type:

Self

Average Time to Score (min):

Periodicity:

Not reported.

Response Format:

True/False

Materials Needed:

Paper/Pencil

Other Materials Needed:

Computer (Opyional)

Sample Item(s):

Domains	Scales	Sample Items
Object Relations	Alienation	It's hard for me to get close to anyone. (T)
	Insecure Attachment	I feel that I have to please everyone or else they may reject me. (T)
	Egocentricity	People are never honest with each other. (T)
	Social Incompetence	Making friends is not a problem for me. (F)
Reality Testing	Reality Distortion	People are often angry with me whether they admit it or not. (T)
	Uncertainty of Perception	I experience anxious feelings which I cannot explain. (T)
	Hallucinations and Delusions	I 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:

Alternate Form:

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:	Rating	Statistics	Min	Max	Avg
Test-Retest- # of days: 28	Acceptable	r	0.58	0.9	0.76
Internal Consistency	Acceptable	alpha	0.79	0.9	0.83
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 Type	Not known	Not found	Nonclincal Samples	Clinical Samples	Diverse Samples
Convergent/Concurrent				Yes	Yes
Discriminant			Yes	Yes
Sensitive to Change		Yes
Intervention Effects				Yes
Longitudinal/Maturation Effects	Yes
Sensitive to Theoretically Distant Groups			Yes	Yes	Yes
Factorial Validity			Yes	Yes	Yes

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 Known	Not Found	Nonclinical Samples	Clinical Samples	Diverse 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:	Translated	Back Translated	Reliable	Good Psychometrics	Similar Factor Structure
1. Portuguese	Yes	Yes	Yes	Yes	Yes
2. Slovene	Yes
3. Dutch	Yes
4. French	Yes
5. Japanese	Yes
6. Korean	Yes
7. Swedish	Yes
8. German	Yes
9. Italian	Yes

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 Group	Members of this Group Studied in Peer-Reviewed Journals	Reliable	Good Psychometrics	Norms Available	Measure Developed for this Group
1. Methadone maintenance patients	Yes	Yes
2. Inpatient and outpatients with borderline personality disorder	Yes	Yes

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.

Editor of Review:

Chandra Ghosh Ippen, Ph.D.

Last Updated:

Thu, 06/02/2005