The Rorschach Ego Impairment Index in Heterogeneous Psychiatric Patients

There is a need for test measures of ego functioning that identify treatment needs and predict treatment response. Perry and Viglione's Rorschach Ego Impairment Index (EII; Perry & Viglione, 1991) is a composite measure assessing reality testing, thought process, defensive regulation, and object relations. It has been shown to correlate with Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) scales and subscales and other measures of psychosis in a schizophrenic sample and to predict antidepressant treatment outcome in a depressed sample. This investigation examined the EII as a measure of ego impairment in a sample of 85 heterogeneous psychiatric inpatients and outpatients. In this sample, the EII did discriminate between inpatients and outpatients; it did not discriminate between psychotic and nonpsychotic patients, though there was a trend in this direction and one of the EII's object relations variables (Good H) did so. The EII did not generally show significant relations with MMPI indices of ego impairment (Es or Scale 8), though there were some significant patterns of relation with Scale 8 subscales. The study provides some, though not unequivocal, support for the EII as measure of ego impairment and for its utility compared to other measures and adds credence to earlier suggestions of the importance of object relations measures to ego functioning assessment.     

A Comparison of New and Revised Rorschach Measures of Schizophrenic Functioning in a Serbian Clinical Sample

We empirically evaluated indexes derived from the Rorschach Comprehensive System (CS) and the Rorschach Performance Assessment System (R–PAS) that are used for the assessment of psychotic functioning in schizophrenia. We compared the Perceptual Thinking Index (PTI) and the Ego Impairment Index (EII–2) with their revised versions: Thought and Perception Composite (TP–Comp) and EII–3. We evaluated their predictive validity for differentiating schizophrenic from nonschizophrenic patients in a Serbian sample. The sample consisted of 211 (109 men and 102 women, 18–50 years old) inpatients in Serbia who were divided into 2 groups: schizophrenic (100) and nonschizophrenic (111). Test administration, coding, and form quality classification followed CS guidelines. Logistic regression analysis indicated that the new indexes TP–Comp and EII–3 have slightly better predictive power than their counterparts, PTI and EII–2, in identification of schizophrenia, and that TP–Comp performed better than other indexes, although all 4 indexes were successful in differentiating these groups. The results supported the use of TP–Comp in diagnosis of schizophrenia and generally provided evidence for the utility of the Rorschach in evaluating psychosis and for its use in a cross-national context.     

Refinements in the Rorschach Ego Impairment Index incorporating the human representational variable

The Ego Impairment Index (EII; Perry & Viglione, 1991) is a composite measure of psychological impairment and thought disturbance developed from the empirical and theoretical literature on the Rorschach. In this article, we summarize reliability and validity data regarding the EII. Our major goal was to present the rationale and empirical basis for recent refinements in the EII. Among the subcomponents of the original EII was the Human Experience variable (HEV), which has recently been revised and replaced with the Human Representational variable (HRV; Viglione, Perry, Jansak, Meyer, & Exner, 2003). In this study, we replaced the HEV with the HRV to create the EII-2. This was accomplished by recalculating the factor coefficients with a sample of 363 Rorschach protocols. We present additional validity data for the new EII-2. Research recommendations and interpretive guidelines are also presented.     

A five-year follow-up on the temporal stability of the Ego Impairment Index

This study investigated the temporal stability of the Ego Impairment Index (EII) over a 5-year period. The EII is based on the Comprehensive System (Exner, 1993) and has shown promise as a measure of internal disturbance and psychopathology (Perry & Braff, 1994; Perry & Viglione, 1991; Perry, Viglione, & Braff, 1992). This study successfully recalled 17 subjects from an original sample of 46 who initially suffered from Major Depression, Melancholic-Type 5 years earlier and were treated with antidepressant medication. These subjects did not differ significantly from those Subjects who were not successfully recalled. The Rorschach and a variety of other measures were administered to the subjects. The results revealed impressive temporal consistency over 5 years: a rank-order, test-retest correlation of .68. The EII was also correlated with some of the measures of overall adaptation. These results are consistent with the notion that the EII is a stable trait-measure of psychopathology. Limitations because of the small subgroup of subjects, although not unusual in longitudinal research, are noted.     

Incremental validity of the Ego Impairment Index: a re-examination of Dawes (1999)

This article examined the incremental validity of the Ego Impairment Index (EII), a Rorschach measure of cognition, perception, and reasoning. R. M. Dawes (1999) borrowed 2 previously published data sets to assess the incremental validity of the EII. Dawes determined that in order for the EII to be considered a valid measure, the overall EII score should "outperform" 2 of the variables that compose the index. Using this approach, Dawes reported that the EII had "deficient" (p = .059) incremental validity. In this study, the incremental validity of the EII was re-examined using 1 of the data sets used by R. M. Dawes (1999). Applying the same strategy as Dawes, the author tested the incremental validity of the EII in predicting positive symptoms of schizophrenia, a more appropriate and clinically relevant criterion measure of impairment. The EII significantly predicted positive symptoms (p < .005) even after the 2 EII variables selected by Dawes and the measure of social competence were 1st entered into the equation. The results suggest that the EII adds meaningful information in the assessment of thought disturbance.     

Let's call the whole thing off: a response to Dawes (2001)

There has been a recent controversy regarding the validity of the Rorschach test. This comment is in response to criticism levied by R. M. Dawes (2001) on the incremental validity of the Ego Impairment Index (EII), a Rorschach-derived measure of cognition, perception, and reasoning. The Dawes articles (1999 and 2001) serve as an example of the recent practice of placing extraordinary challenges on the Rorschach test. Dawes's arguments are examined and parallel examples are provided that demonstrate the bias used to judge the validity of the EII, the Rorschach, and psychological assessment. Still, in the face of criticism, the results (see Dawes, 2001) support the incremental validity of the EII. Thus, the conclusion presented in this Comment is that it is time for us to "call the whole thing off" and end the Rorschach controversy that has occupied so much recent attention and generated so few new ideas.     

Factor-derived categories of chronic aphasia

A large sample of patients with aphasia (N = 118), unselected for etiology, were administered the Porch Index of Communicative Ability more than 6 months after the onset of aphasia. Factor analysis of PICA subtest scores identified five factors which accounted for 83.9% of the total variance. The factors were labeled speaking, writing, comprehension, gesturing, and copying. Cluster analyses of the factor scores yielded five patient categories which differed in the pattern of impairment on the language factors as well as in overall severity of aphasia. A subgroup of the parent sample consisting of 52 patients with localized left-hemisphere CVA had cluster analyses repeated after having first been studied as part of the larger sample. The factor-derived categories for the subgroup were similar to those of the entire group. Discriminant functions of the PICA raw scores of the 52-patient subsample correctly classified all of the patients. When discriminant functions were based upon the factor scores of the 118-patient parent sample, 80.7% of the 52 patients were correctly classified into the five categories.     

Does the social concerns component of the anxiety sensitivity index belong to the domain of anxiety sensitivity or the domain of negative evaluation sensitivity?

The present study utilized an exploratory factor-analytic approach (i.e. principal-components analysis; PCA) to investigate whether the Social Concerns component of the Anxiety Sensitivity Index (ASI [Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index manual (2nd ed.). Worthington, OH: International Diagnostic Systems.]) is best conceptualized as belonging to the domain of anxiety sensitivity (AS) and/or the domain of negative evaluation sensitivity (NES). A sample of university students (N = 216) was administered measures of both NES (i.e. Brief Fear of Negative Evaluation scale; Leary, 1983) and AS (i.e. ASI). Participants' responses to the items comprising these measures were subjected to a PCA with oblique rotation. Factors representing the NES construct and the three lower-order AS constructs (i.e. AS Physical, Psychological and Social Concerns) were obtained. Subscales derived from these four factors were positively and significantly correlated with one another and loaded on a single higher-order factor labeled Threat Sensitivity. Thus, the present findings suggest that the AS Social Concerns factor is distinct from NES and the other lower-order components of AS. However, correlational analyses and higher-order PCA indicated that the AS Social Concerns factor taps a blend of AS and NES as well as something unique and distinct from both global AS and NES.     

The use of the Ego Impairment Index across the schizophrenia spectrum

The goal of this study was to assess perceptual and thought disturbance, as indexed by the Ego Impairment Index (EII; Perry & Viglione, 1991), a Rorschach-derived measure, across the schizophrenia spectrum. We hypothesized that there would be an increase in EII scores (indicating increased disturbance) across the spectrum from nonpatients to severely disturbed, hospitalized schizophrenia patients. Normal comparison participants (n = 66), students with elevated scores on either the Perceptual Aberration/Magical Ideation or the Physical Anhedonia Scales (n = 24), first-degree relatives of schizophrenia patients (n = 36), participants diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) schizotypal personality disorder (n = 36), outpatient schizophrenia participants (n = 33), and hospitalized schizophrenia patients (n = 56) were studied. As hypothesized, we found increased EII scores in all of the schizophrenia spectrum groups when compared against normal comparison participants. Furthermore, the EII was significantly different between the schizophrenia patients and the other schizophrenia spectrum groups. These findings support the use of the EII as a sensitive measure of perceptual and thought disturbance across the schizophrenia spectrum that yields specific information regarding the type of thinking problems that occur within schizophrenia spectrum subgroups.     

Differentiation of personality types among opiate addicts

A wide range of studies indicate that although sociopathic characteristics are predominant in opiate addiction, depressive and psychotic features are also frequently observed. To test the hypothesis that there are really three types of individuals who become addicted to opiates (rather than a single, predominant personality style), fifty-three opiate addicts were given the Loevinger Sentence Completion Test, the Bellak Ego Functions Interview, and the Rorschach. Variables derived from these three procedures were submitted to cluster and discriminant function analyses. Three groups of addicts were identified--those primarily with impaired interpersonal relationships and affective lability (42%), those primarily characterized by thought disorder and impaired ego functioning (30%), and a group with diminished ideational and verbal activity (28%). Comparison of the assessment of these three groups with independently defined normal, neurotic, and schizophrenic samples provided support for three opiate-addicted personality types, each respectively characterized as character disordered, borderline psychotic, and depressed. Although there seems to be a predominance of character-disordered individuals who become addicted to opiates, the data indicate several additional types of opiate addicts with different types of psychopathology who may require different approaches to management and treatment.     

Differentiation of Personality Types Among Opiate Addicts

A wide range of studies indicate that although sociopathic characteristics are predominant in opiate addiction, depressive and psychotic features are also frequently observed. To test the hypothesis that there are really three types of individuals who become addicted to opiates (rather than a single, predominant personality style), fifty-three opiate addicts were given the Loevinger Sentence Completion Test, the Bellak Ego Functions interview, and the Rorschach. Variables derived from these three procedures were submitted to cluster and discriminant function analyses. Three groups of addicts were identified-those primarily with impaired interpersonal relationships and affective lability (42%), those primarily characterized by thought disorder and impaired ego functioning (30%), and a group with diminished ideational and verbal activity (28%). Comparison of the assessment of these three groups with independently defined normal, neurotic, and schizophrenic samples provided support for three opiate-addicted personality types, each respectively characterized as character disordered, borderline psychotic, arid depressed. Although there seems to be a predominance of character-disordered individuals who become addicted to opiates, the data indicate several additional types of opiate addicts with different types of psychopathology who may require different approaches to management and treatment.     

Components of the High School Environment

A principal components analysis was conducted on the scale scores of Stern's High School Characteristics Index (HSCI). Nine factors accounted for slightly more than two-thirds of the variability of the instrument. The lack of similarity of the HSCI factors and those reported for the College Characteristics Index was noted. The most significant factor was labeled Intellectual Self-Expression and resembled a factor derived from earlier analyses of the scale.     

HLA-B27 as a possible genetic marker of psychoticism

In an earlier study HLA-B27 was found to correlate with some subgroups of schizophrenia, having an increased incidence specially in the subgroup of patients with poor prognostic features.In order to study a possible association between the P-score from the Eysenck Personality Questionnaire and HLA-B27, two subgroups of chronic paranoid schizophrenic patients selected according to the same diagnostic criteria were compared. P-scores were significantly higher in the subgroup of patients showing HLA-B27, when compared with patients without HLA-B27 (p < 0.02).This finding gives support to the hypothesis of a genetic factor underlying P, and indicates the possibility of using P-scores in the selection of more homogeneous patients groups for other researches, as well as a factor in prognostic prediction.     

Reliability and factor structure of the Finnish version of the Sport Imagery Questionnaire

The aim of this study was to examine the reliability and factor structure of the Finnish version of the Sport Imagery Questionnaire, a measure which examines cognitive and motivational functions of imagery. The final sample comprised 231 participants drawn from 34 sports and ranging in age from 14 to 49 years (M = 20.9, SD = 5.8). Internal consistency and confirmatory factor analyses were undertaken to evaluate the reliability and factorial validity of the scale. Fit indices and modification data generated from examining the 30-item five-factor model were equivocal, suggesting minor amendment and recategorization of several items rather than major adjustment to the proposed latent factor structure. Cronbach coefficients alpha indicated the scale is reliable. Overall, these results provide positive additional support for the claim that the Sport Imagery Questionnaire has a reproducible factor structure and is a reliable test for measuring imagery use in Finnish athletes.     

An Investigation of the Structural Validity of Loevinger's Model and Measure of Ego Development

This study demonstrates the use of structural equation modeling for investigating a hierarchical model of personality based on Loevinger's (1976) conceptualization. This model was constructed to have a multifactorial and hierarchical structure in which the ego development construct served as the source of covariation for specific personality constructs of impulse control, interpersonal style, conscious preoccupations, and cognitive style. This model and three other conceivable models were investigated to determine which structure best represented the relations among specific personality constructs and ego development. The specific personality constructs were identified by measures chosen from the available pool of measures that were compatible with Loevinger's conceptualization. The four conceivable models were fitted to sample data from 267 adult subjects using confirmatory factor analysis and were compared with indices of model fit and methods for comparison of nested models. Results suggested that the four specific personality constructs and ego development are part of the same process. Although a hierarchical structure appeared tenable for this process, the role of ego development perhaps is not as dominant as envisioned by Loevinger. These results must be considered tentative due to measurement limitations.     

Adaptation to divorce and ego development in adult women

The purpose of this study was to assess how the experience of stressful life changes might provide an opportunity for ego development in adulthood. The sample included 104 women in the early stage of the separation and divorce process; 91% of the sample was recontacted after 1 year had elapsed. Longitudinal analyses of the adaptation process supported the hypothesis that marital separation and divorce might be a disequilibrating life change, but one that might foster ego development. Those women who experienced this life change as disequilibrating but who made a successful adaptation by Time 2 showed a significant increase in ego level. Furthermore, those women who were high in adjustment at Time 1 but low in adjustment at Time 2 showed a theoretically consistent regression in ego level. Patterns of adaptation to life changes, their relationship to ego development, and the theoretical implications for Loevinger's model are discussed.     

A Validation of the Inventory of Callous-Unemotional Traits in a Community Sample of Young Adult Males

Callous-unemotional (CU) traits have been shown to delineate a subgroup of individuals at high risk for exhibiting severe and persistent criminal behavior. The Inventory of Callous-Unemotional Traits (ICU; Frick 2004) was recently developed as a comprehensive rating scale designed to measure multiple facets of CU traits. However, validation of this measure has been limited to youth in adolescence and emerging adulthood (age range?=12–20), leaving questions about the utility of this measure in early adulthood unanswered. The current study evaluated the factor structure of the ICU within a racially diverse and well characterized community sample of adult males (n?=?425) using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). While results found the best fitting model to be the three-bifactor structure that has been previously reported in adolescent samples, the fit indices were only marginally acceptable and suggest the need for scale refinement. Total and subscales scores demonstrated significant and distinct associations with relevant external criteria (e.g., delinquency, psychopathy, psychopathology, psychosocial functioning). Implications and directions for future research are discussed.     

Italian version of the task and ego orientation in sport questionnaire

The 1992 Task and Ego Orientation in Sport Questionnaire developed by Duda and Nicholls was translated into Italian and administered to 802 young athletes, 248 girls and 554 boys aged 8 to 14 years, drawn from a range of individual and team sports, to examine its factor structure. Data sets of a calibration sample (boys 12-14 years) and of four cross-validation samples (boys 8-11 years, girls 8-11 years, boys 12-14 years, and girls 12-14 years) were subjected to confirmatory factor analysis specifying, as in the original questionnaire, an Ego Orientation scale (6 items) and a Task Orientation scale (7 items). Results across sex and age yielded chi2/df ratios ranging from 1.95 to 3.57, GFI indices above .90, AGFI indices ranging from .90 to .92, and RMSEA values not above .10. Findings provided acceptable support for the two-dimension structure of the test. In the whole sample, the Ego factor accounted for the 27.2% of variance and the Task factor accounted for the 33.5% of variance. Acceptable internal consistency of the two scales was also shown, with Cronbach alpha values ranging from .73 to .85.