Psychodiagnosis of personality structure: psychotic personality organization.

Recent developments in Rorschach psychology, including nomothetic approaches focused on scores, ratios, and indices and idiographic approaches focused on content emerging from psychoanalytic theory, offer the Rorschach clinician a rich and potent interpretive methodology. This article examines the structural diagnosis of personality organization with a focus on psychotic personality structure. Rorschach approaches to the differential diagnosis of psychotic personality organization are presented. The Rorschach is viewed as indispensible in the differential diagnosis of personality organization, especially in the so-called "borderline" cases.     

Illness representations: a prototype approach

Two experiments tested the hypothesis that laypeople cognitively organize and recall information about physical symptoms according to prototyped conceptions they have of physical diseases. Based on pilot studies that identified the extent to which subjects associated specified symptoms with specific diseases, symptom sets were assembled to vary in the extent to which the symptoms were perceived to be associated with (to be prototypical of) a given disease. Experiment 1 asked subjects to indicate whether a given set of symptoms indicated a disease and, if so, which one. Experiment 2 tested subjects' recall for symptom sets varying in prototypicality for given diseases and also tested the effects on recall of giving subjects a diagnosis. Results of both experiments support the prototype hypothesis that information about physical symptoms is organized and processed according to people's preexisting beliefs about the association between particular symptoms and diseases. Implications for illness behavior and help seeking are discussed.     

Longitudinal studies of personality disorders: four lessons from personality psychology

The three longitudinal projects described in this special section of the Journal of Personality Disorders raise a number of intriguing questions concerning the natural history of personality disorders and offer more than their share of surprises. In addition, they underscore several valuable lessons derived from the literature on normal-range personality traits. Drawing in part from the writings of the American trait psychologist Gordon Allport, I describe four such lessons: (1) change and continuity of personality traits and disorders can and do coexist, (2) the covariation among personality traits helps to account for the "comorbidity" among personality disorders, (3) personality traits and disorders influence how individuals interpret life events, and (4) personality traits must be distinguished from behavioral adaptations to these traits. These lessons remind us that the science of personality disorders must be informed by the basic science of personality.     

Illness Identity in Adults with a Chronic Illness

The present study examines the concept of illness identity, the degree to which a chronic illness is integrated into one’s identity, in adults with a chronic illness by validating a new self-report questionnaire, the Illness Identity Questionnaire (IIQ). Self-report questionnaires on illness identity, psychological, and physical functioning were assessed in two samples: adults with congenital heart disease (22–78 year old; n?=?276) and with multisystem connective tissue disorders (systemic lupus erythematosus or systemic sclerosis; 17–81 year old; n?=?241). The IIQ could differentiate four illness identity states (i.e., engulfment, rejection, acceptance, and enrichment) in both samples, based on exploratory and confirmatory factor analysis. All four subscales proved to be reliable. Rejection and engulfment were related to maladaptive psychological and physical functioning, whereas acceptance and enrichment were related to adaptive psychological and physical functioning. The present findings underscore the importance of the concept of illness identity. The IIQ, a self-report questionnaire, is introduced to measure four different illness identity states in adults with a chronic illness.     

Measuring Stigma Toward Mental Illness: Development and Application of the Mental Illness Stigma Scale1

Guided by theory on stigma, a Likert‐type scale was developed to measure 7 factors of attitudes toward people with mental illness: interpersonal anxiety, relationship disruption, poor hygiene, visibility, treatability, professional efficacy, and recovery. The scale was validated among college students and community members, measuring attitudes toward people with mental illness, depression, bipolar disorder, and schizophrenia. In a second application, college students completed the scale from their own perspective, then from an imagined perspective of someone with mental illness, while psychiatric patients completed the scale from their own perspective, then from an imagined viewpoint of someone without mental illness. Psychiatric patients assumed that they were stigmatized to a greater extent than was admitted by the student sample.     

Depressive personality disorder: rates of comorbidity with personality disorders and relations to the five-factor model of personality

Depressive personality disorder (DPD) is listed in the DSM-IV as one of the "Disorders for Further Study." In this investigation we examined (1) the rates of comorbidity of DPD with the 10 personality disorders (PDs) in the main text of DSM-IV, and (2) the convergent and discriminant validity of DPD in its relation to the 30 facet traits of the Five-Factor Model of personality (FFM). One hundred and sixty-nine participants with psychiatric diagnoses were interviewed with the Structured Clinical Interview for DSM-IV Personality Disorders Questionnaire (SCID-II) and completed the Revised NEO Personality Inventory (NEO PI-R). A total of 26 (15%) of the participants met diagnostic criteria for at least one of the 10 main text PDs, and 15 (9%) met criteria for DPD. Of those who met criteria for DPD, 10 (59%) of the participants also met criteria for one or more of the 10 main text PDs. Regression analyses indicated a four-facet trait set derived from the NEO PI-R thought to be uniquely associated with DPD accounted for a significant amount of variance in DPD SCID-II PD scores and was significantly larger for DPD than it was for the 9 of the 10 main text PDs; the sole exception was for avoidant PD. Diagnostically, DPD overlaps significantly with other PDs but is distinguishable in its unique relation with traits from the FFM.     

Coming Out: Considering the Closet of Illness

This essay explores key concerns surrounding coming out as a person with illness and addresses important professional and social considerations for those who are closeted in various kinds of illness. Using central tenets of Queer Theory and Disability and Cultural Studies as a theoretical base, I examine the politics of coming out in the specific context of my lived experience during the 2002 NEH Summer Institute, Medicine, Literature, and Culture While such an environment might foster unusual candor about personal illness experience, I discovered that the choice to come out as a person with chronic, non-infectious disease (Inflammatory Bowel Disease) was nevertheless complicated in interesting ways.     

Environmental Illness/Multiple Chemical Sensitivities:

Recent attention has focused on a hidden disability usually referred to as Multiple Chemical Sensitivities (MCS), Environmental Illness (EI), or Ecologic Illness, and involving detrimental effects on multiple bodily systems in response to exposures to chemicals in levels that have been "generally regarded as safe" (GRAS). This article will briefly describe MCS/EI as a disability, with emphasis on the impediments to a productive life for persons who experience this syndrome. Economic and psychological issues which are likely to be present as a result of being forced to face life with this hidden and unacknowledged problem are discussed. Political and disability issues are discussed, and examples are provided of women coping with the various aspects of this illness. Therapists who wish to be supportive to this population are offered suggestions for caregiving.     

Out of Season: Illness in Adolescent Fiction

The young adult novel is aimed at a carefully defined target market, often focused on a predictable range of issues. Where illness and death are the theme, the process of growing up is more dramatically defined. Young people who suffer or watch a family member suffer a serious illness find their stages of moral development disrupted, their values reorganized, and emerging sexual interests submerged under more insistent demands. The books discussed in this article are not formula novels, but complex tales with interesting subplots and characters. Notable features common to them are as follows: 1) strategies of normalization, 2) abandonment and alienation, 3) unexpected emotions, 4) extra-familial support, 5) other people's problems, and 6) God, meaning, and hope.     

Lay conceptions of personality: Eliciting tiers of a scientific conception of personality

Two studies are reported which examine the availability of scientific propositions of personality in lay conceptions of personality. It is argued from a social constructivist perspective that models of personality must derive from and refer to lay conceptions of persons. Eysenck's trait-type model of introversion-extraversion, containing specific propositions about phenotypic and genotypic differences between extraverts and introverts, was utilized as the scientific model of personality and its availability in lay conceptions of personality was examined in two studies. In the first study, subjects were presented with a genotypic characterization of either an introvert or an extravert target person and asked to infer corresponding phenotypic differences. In the second study, the inference process was reversed with subjects being asked to infer genotypic characteristics of introverts versus extraverts on the basis of phenotypic target person desecrations of the two types. Results from both studies show a high degree of accuracy in subjects' inferences, suggesting that laypersons have well-formed conceptions about personality containing ‘higher-order’ psychogenetic propositions corresponding to Eysenck's trait-type model. The implications of the findings for theory construction are discussed.     

Relative weight and personality: analyses with the personality research form

A sample of 311 West German women and 254 men aged from 16 to 84 yr was investigated in order to examine the relationship between relative body weight (as an indicator of adequate/inadequate nutrition habits) and personality traits as measured by the Personality Research Form (PRF). To control for sex all analyses were done separately for men and women. A larger number of significant (linear and non-linear) relationships was found when sociodemographic factors (age and education) were not controlled. The univariate and multivariate relationships between relative weight and personality became practically insignificant, however, after statistical control of both factors. Personality types formed by cluster analysis also did no longer differ in mean relative weight when the values were adjusted for the effects of age and education. The conclusion is drawn that the individual degree of deviation from a medical or aesthetic body-weight norm is practically independent of the personality traits measured by the PRF (as long as the degree of obesity is not a severe one).     

Prototypicality and personality: Effects on free recall and personality impressions

An experiment was performed to test the hypothesis that it is easier to process information about characters who fit well with and are, therefore, “prototypical” of shared beliefs about various personality types. Character prototypicality was manipulated in a free recall and personality impression paradigm through variations in the consistency of a character's identification with preexisting beliefs about two personality-type categories—extraversion and introversion. Subjects also were given information about each character that varied in degree of abstraction from traits to concrete behavior. As predicted, both the amount and nature of the information correctly recalled were significantly affected by the consistency of the character's identification with extraversion or with introversion. Character consistency also significantly affected the amount of material written in the personality impressions and the tendency to qualify the generality of the impressions. The results support a model in which incoming data about personality are coded, structured, elaborated, and remembered according to the quality of their match with preexisting beliefs about various personality types.