Differentiating ego functions of borderline and narcissistic personalities

This study investigated differences in ego functions of borderline and narcissistic personality disorders through examining responses to Rorschach structural and content variables. Reality testing, thought process, affective regulation, impulse control, and the defenses of splitting and grandiosity were examined from Rorschach protocols of 50 borderlines and 26 narcissists. The borderlines produced greater distortion in reality testing, p less than .05; the narcissists produced more insidious thought process disturbance, p less than .05; and higher functioning groups demonstrated greater control of impulses, p less than .05. Borderlines in this sample demonstrated more affective constriction than the narcissists and used more splitting, p less than .05; narcissists used more grandiosity, p less than .05. Implications of this study are (a) ego functions mature inconsistently, (b) affective responsivity influences ego disorganization, and (c) level of functioning and IQ are related to the production of Rorschach variables.     

A Rorschach analysis: parallel disturbance in thought and in self/object representation

The relationship between thought process disturbance and the structure of internal object relations was investigated by comparing Rorschach Special Scorings and content variables that reflected developmental levels of object relations. Selected Special Scorings from the Comprehensive System (Exner, 1990) and composite (WSum6) scores were correlated with Urist's (1977) Mutuality of Autonomy Scale (MOA) on the Rorschach protocols of 35 borderlines, 15 schizophrenics, and 19 narcissists. Correlations between composite scores of severe thought process disturbance and severe imbalance in internalized object representations were highly significant, p < .0001. The hypothesis that there is a significant relationship between disturbance in internalized self/object differentiation and thought process disturbance was supported. Implications of this study are discussed as they relate to empirical validation of theoretical constructs concerning ego function deficit and self/object disturbance.     

A Rorschach Study of Narcissism Defense,and Aggression in Borderline,Narcissistic, and Cluster C Personality Disorders

We examined the differences between narcissism, mode of defense, and level of aggression on the Rorschach. We also investigated differences in borderline, narcissistic, and Cluster C personality disorders by examining responses to Rorschach content variables. The Lerner Defense Scale (P. Lerner & H. Lerner, 1980), the aggressive content section of the Holt (1977) method for assessing primary process manifestations, a modified version of Exner's (1986a) Egocentricity Index, Wagner's (1965) exhibitionistic M score, and grandiosity were scored on the Rorschach protocols of 17 borderline, I7 narcissistic, and 17 Cluster C personality disorders. Borderlines were found to employ primitive defensive structures to a greater degree and severity, show more intense and overall aggression as welt as more responses on the three forms of aggression in the Holt method, and have higher levels of grandiosity. Narcissists evinced significantly higher levels of egocentricity than borderlines and higher levels of idealization than the Cluster C group. Convergent validity was found on the measures of defense and aggression, which showed a strong relationship between primitive aggression and primitive defense.     

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.     

Alcoholism and the Rorschach

This study attempts to cross validate 20 hypotheses reported over the past three decades professing to differentiate alcoholics from non-alcoholics using the Rorschach. Comparison groups (N = 25 each) were matched for age, sex, race, income and education, and diagnosis. Each S received the Rorschach and a test to rule out “organicity”. Rorschach scoring was consensually validated and Chi squares were performed for all twenty hypotheses. Through the careful selection and matching of control and experimental groups, only two significant differences were found, both in the direction opposite to that predicted. Non-alcoholics gave 4 or more water responses significantly more often than alcoholics (p < .05) and significantly more “high CF with C” scores (p < .05).     

Borderline manifestations in the Rorschachs of male transsexuals

It was hypothesized that male transsexuals manifest a character structure consistent with Kernberg's criteria for borderline personality organization. Exploring this hypothesis, Kernberg's criteria for borderline personality organization were operationalized using Rorschach measures. The following variables were examined: aggression (Holt System Aggressive Content Section), object relations (Urist's Mutuality of Autonomy Scale), reality testing (Exner System X + %), and self/object differentiation (Exner System Special Scorings). A group of male college students, a group of male borderlines, and a group of male transsexuals were compared on the above variables. Compared to the normals, the transsexuals and borderlines displayed significantly more intense levels of aggression, a lower level of object relations, poorer reality testing, and impaired boundary differentiation. The transsexuals and borderlines did not differ significantly. The results were taken as suggesting that male gender dysphorics may be a sub-group of the wider borderline diagnostic category.     

An external construct validity study of Rorschach personality variables

This study examined (a) hypothesized relationships between Rorschach variables and self-report test measures relating to nominally similar aspects of personality functioning and (b) interrelationships among Rorschach variables. Sixty-two undergraduates were administered the Rorschach, Barron Ego Strength Scale, Kaplan Self-Derogation Scale, Eagly Self-Esteem Scale, Multiple Affective Adjective Checklist (MAACL), Marlowe-Crowne Social Desirability Scale, and the Rotter Locus of Control Scale. Only a few of the predictions received confirmation: inanimate movement (m) correlated, as expected, with MAACL anxiety and hostility, the egocentricity index (3r + 2)/R (R = total responses) correlated significantly with self-esteem, and human movement with minus form level (M-) correlated (inversely) with ego strength. Among the unpredicted findings were some that appear inconsistent with standard Rorschach interpretation. Rorschach variables human movement (M), and experience actual (EA), generally interpreted as reflecting coping resources, related significantly with self-report measures of poor coping and of dysphoric affect. In general, the Rorschach appears better at identifying weaknesses in the ego rather than strengths.     

An External Construct Validity Study of Rorschach Personality Variables

This study examined (a) hypothesized relationships between Rorschach variables and self-report test measures relating to nominally similar aspects of personality functioning and (b) interrelationships among Rorschach variables. Sixty-two undergraduates were administered the Rorschach, Barron Ego Strength Scale, Kaplan Self-Derogation Scale, Eagly Self-Esteem Scale, Multiple Affective Adjective Checklist (MAACL), Marlowe-Crowne Social Desirability Scale, and the Rotter Locus of Control Scale. Only a few of the predictions received confirmation: inanimate movement (m) correlated, as expected, with MAACL anxiety and hostility, the egocentricity index (3r + 2)/R (R = total responses) correlated significantly with self-esteem, and human movement with minus form level (M -) correlated (inversely) with ego strength. Among the unpredicted findings were some that appear inconsistent with standard Rorschach interpretation. Rorschach variables human movement (M), and experience actual (EA), generally interpreted as reflecting coping resources, related significantly with self-report measures of poor coping and of dysphoric affect. In general, the Rorschach appears better at identifying weaknesses in the ego rather than strengths.     

Primary Process Thinking,Divergent Thinking,and Coping in Children

The relationships among primary process thinking, divergent thinking, and coping were investigated in fifth-grade children. Specifically, it was hypothesized from psychodynamic theory that access to and integration of primary process thinking would be positively related to divergent thinking and that both integration of primary process and divergent thinking would be predictive of coping ability. The Rorschach (Holt's scoring system) and Alternate Uses Test (spontaneous flexibility score) were administered to 53 fifth-grade children. Zeitlin's Coping Inventory, a teacher's rating scale, was the coping measure. Results confirmed the hypotheses for boys in that the percentage of primary process and the Adaptive Regression score on the Rorschach were significantly related to divergent thinking, r(27) = .33, p < .05 and r(27) = .34, p < .05, respectively. Divergent thinking was significantly related to teachers' ratings of coping ability for boys, r(27) = .58, p < .01. There were no significant relationships among the variables for girls. These sex differences in the pattern of correlations are consistent with previous findings.     

Neuropathologies of the self: clinical and anatomical features

The neuropathologies of the self (NPS) are disorders of the self and identity that occur in association with neuropathology and include perturbations of the bodily, relational, and narrative self. Right, especially medial-frontal and orbitofrontal lesions, are associated with these conditions. The ego disequilibrium theory proposes this brain pathology causes a disturbance of ego boundaries and functions and the emergence of developmentally immature styles of thought, ego functioning, and psychological defenses including denial, projection, splitting, and fantasy that the NPS patient has in common with the child. I hypothesize that during brain development between approximately ages 3 and 7 immature defensive functions and fantasies tend to be replaced by mature defenses and the inhibition of fantasy a process that depends upon maturational processes within the right hemisphere. I propose a four-tiered model of the NPS that emphasizes a multifactorial approach and includes both negative and positive, bottom up and top down, and neuropsychological and psychological factors.     

Predicting DSM-IV Cluster B Personality Disorder Criteria From MMPI-2 and Rorschach Data: A Test of Incremental Validity

Despite their frequent conjoint clinical use, the incremental validity of Rorschach (Rorschach, 1921/1942) and MMPI (Hathaway & McKinley, 1943) data has not been adequately established, nor has any study to date explored the incremental validity of these tests for predicting Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) personality disorders (PDs). In a reanalysis of existing data, we used select Rorschach variables and the MMPI PD scales to predict DSM-IV antisocial, borderline, histrionic, and narcissistic PD criteria in a sample of treatment-seeking outpatients. The correlational findings revealed a limited relation between Rorschach and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) variables, with only 5 of 30 correlations reaching significance (p < .05). Hierarchical regression analyses showed that both the MMPI and Rorschach data add incrementally in the prediction of DSM-IV borderline and narcissistic PD total criteria scores. The findings were less clear for the incremental value of Rorschach and MMPI-2 data in predicting the total number of DSM-IV histrionic PD criteria, which were best predicted by Rorschach data, and antisocial PD criteria, which were best predicted by MMPI-2 data. In addition to providing evidence of the incremental validity of Rorschach data, these findings also shed light on the psychological characteristics of the DSM-IV Cluster B PDs.     

Analysis of Group Rorschachs of Psychologists and Anthropologists

Wechsler Adult Intelligence Scale-Revised (WAIS-R) IQs and clinical ratings of 10 ego functions in a diagnostically heterogeneous sample of 60 adult psychiatric inpatients were correlated. With severity of pathology statistically controlled, higher intelligence was associated with more adequate ego functioning in several spheres: primary autonomous functions, thought processes, object relations, and masterycompetence. There were also some clinically meaningful differences between the Verbal and Performance IQs in the pattern of correlations. Extending Hartmann's original views, the authors employ an ethological framework to conceptualize intelligence in relation to the ego's role in adaptation, emphasizing that intelligence is an important — albeit neglected — aspect of ego functioning.     

Selected Rorschach variables of psychopathic juvenile offenders

Despite the widely accepted utility of assessing psychopathic personality features in forensic and clinical settings, the Hare Psychopathy Checklist-Revised (PCL-R; Hare, 1991) stands virtually alone in its ability to do so with adequate reliability and validity. Recent studies have demonstrated the effectiveness of the Rorschach Inkblot Method in assessing psychopathy in adult samples, but almost no studies are currently available investigating the Rorschach's ability to assess the condition in younger samples of precisely defined psychopathic groups. In this study, 66 male juvenile offenders, ages 14 to 17, were placed into 3 groups according to level of psychopathy as measured by the youth version of the PCL-R (PCL:YV; Forth, 1995). Nine Rorschach variables conceptually related to various psychopathic features were investigated. Two of the variables (Reflections and Texture Responses) demonstrated statistically significant differences across groups (p < .05). Two additional variables (Vista and White Space) were produced in patterns consistent with existing research, although only to a weak degree. The remaining variables (Egocentricity Index, Form Dimension, Pure Human Content, Inanimate Movement, and Diffuse Shading) did not differ across groups in the predicted directions. Overall, these results offer some support for the validity of the Rorschach as a method of detecting certain psychopathic personality features, including pathological narcissism and interpersonal detachment, in adolescent male offenders.     

Assessment of disordered thinking in children and adolescents: the rorschach perceptual-thinking index.

The new Rorschach Perceptual-Thinking Index (PTI; Exner, 2000a, 2000b) was designed to assess thought disorders more accurately than the Schizophrenia Index (SCZI; Exner, 1993). Using a sample of child and adolescent inpatients, we examined the relation of Rorschach variables (PTI, SCZI, M-, and X- %) to thought disorder indexes on a behavior rating scale (Behavior Assessment System for Children; Reynolds & Kamphaus, 1992) and a self-report measure (Personality Inventory for Youth; Lachar & Gruber, 1995). Results indicate that, when used in a categorical manner, the PTI differentiated between those patients with and without elevated thought disorder scores on the other measures. Of all Rorschach variables, M- was most related to the other measures, indicating that this variable may be a particularly robust indicator of thought disorder among children and adolescents.     

Relation of intelligence to ego functioning in an adult psychiatric population

Wechsler Adult Intelligence Scale-Revised (WAIS-R) IQs and clinical ratings of 10 ego functions in a diagnostically heterogeneous sample of 60 adult psychiatric inpatients were correlated. With severity of pathology statistically controlled, higher intelligence was associated with more adequate ego functioning in several spheres: primary autonomous functions, thought processes, object relations, and mastery-competence. There were also some clinically meaningful differences between the Verbal and Performance IQs in the pattern of correlations. Extending Hartmann's original views, the authors employ an ethological framework to conceptualize intelligence in relation to the ego's role in adaptation, emphasizing that intelligence is an important-albeit neglected-aspect of ego functioning.     

Personality Assessment With Children of Superior Intelligence: Divergence Versus Psychopathology

The perceptual and cognitive functioning of children with intelligence quotients > 135 was examined with the Rorschach Inkblot Test. A criterion measure, the Child Behavior Checklist, was also administered so as to determine whether deviations for Rorschach variables from age-appropriate norms indicated the presence of psychopathology or were evidence of nonentrenched, novel, or creative styles of encoding and processing information. Rorschach variables indicative of intellectual sophistication, nonentrenched thinking or inaccurate testily perception, and cognitive slippage were reliably elevated for this sample versus norms. Results for the Child Behavior Checklist demonstrated that the incidence of psychopathology in the intellectually superior and average samples were comparable. There was a lack of covariance between Rorschach markers of inaccurate reality perception, cognitive slippages, and schizophrenia, and the sum of behavior problems on the Child Behavior Checklist. Results for the Rorschach and Child Behavior Checklist variables were comparable for children with intelligence quotients > 150 versus between 136 and 140. It was concluded that the intellectually superior children did process the Rorschach stimuli in a manner that was nonentrenched and reliably different from norms, but that these differences should not routinely be considered as indications of psychopathology.     

Personality assessment with children of superior intelligence: divergence versus psychopathology

The perceptual and cognitive functioning of children with intelligence quotients greater than 135 was examined with the Rorschach Inkblot Test. A criterion measure, the Child Behavior Checklist, was also administered so as to determine whether deviations for Rorschach variables from age-appropriate norms indicated the presence of psychopathology or were evidence of nonentrenched, novel, or creative styles of encoding and processing information. Rorschach variables indicative of intellectual sophistication, nonentrenched thinking or inaccurate reality perception, and cognitive slippage were reliably elevated for this sample versus norms. Results for the Child Behavior Checklist demonstrated that the incidence of psychopathology in the intellectually superior and average samples were comparable. There was a lack of covariance between Rorschach makers of inaccurate reality perception, cognitive slippages, and schizophrenia, and the sum of behavior problems on the Child Behavior Checklist. Results for the Rorschach and Child Behavior Checklist variables were comparable for children with intelligence quotients greater than 150 versus between 136 and 140. It was concluded that the intellectually superior children did process the Rorschach stimuli in a manner that was nonentrenched and reliably different from norms, but that these differences should not routinely be considered as indications of psychopathology.