罗夏测验在西方近10年的最新发展

近10年来, 罗夏综合系统不断发展, 新增了XA%与WDA%、知觉−思维指数PTI、GHR:PHR等多个指标, 修改了8个群变量, 删除了精神分裂SCZI指标。这些新调整虽然不是本质性的, 但使得罗夏综合系统内容更加完善, 信度和效度不断提高, 更加精确化和标准化, 成为西方不可或缺的心理测验工具。尽管罗夏综合系统不断发展, 但仍然存在着操作过于复杂、功能还需要进一步完善等问题。罗夏综合系统作为一个代表性的投射测验, 与其它客观测验组成了一个完整的心理测量体系, 会发挥越来越大的作用。     

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.     

Differentiating psychotic patients from nonpsychotic patients with the MMPI-2 and Rorschach

The goal of this study was to examine the incremental validity and the clinical utility of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and Rorschach (Rorschach, 1942) with regard to differential diagnosis in a sample of adult inpatients with a primary psychotic disorder or a primary mood disorder without psychotic features. Diagnostic efficiency statistics have suggested that the Rorschach Perceptual Thinking Index (PTI; Exner, 2000a, 2000b) was better than MMPI-2 scales in discriminating psychotic patients from nonpsychotic patients. We compared the 84% overall correct classification rate (OCC) for the PTI to an OCC of 70% for the MMPI-2 scales. Adding the MMPI-2 scales to the PTI resulted in a decrease in OCC of 1%, whereas adding the PTI to the MMPI-2 resulted in an increase in OCC of 14%. Sensitivity, specificity, positive predictive power, negative predictive power, and kappa were equal or higher with only the PTI in the model.     

Follow-up Validation of Rorschach Tempo and Color Use Indicators of Schizophrenia

Two to five year psychiatric follow-ups through a case register of original cross-validating samples for some Rorschach tempo and color use indicators of schizophrenia found subsequent diagnosis of schizophrenia associated (a) beyond the .001 level with certain deviations from normative tempo and (b) beyond the .01 level with presence of pure C or two or more of the following: 1–2 CF, Sum C 1.5–3.0, CF without C. Combined classification by the tempo and color variables was accurate in 90% of schizophrenic and 80% of nonschizophrenic cases manifesting neither or both variables. These findings, occurring within a population of psychiatric patients referred for testing, recommend the clinical utility of the variables.     

The Ego Impairment Index and schizophrenia: a validation study.

This study is an extension of our work on a new scale, the Ego Impairment Index (EII; Perry & Viglione, 1991). The index is theoretically based on Beres's (1956) model of ego assessment and was empirically developed on a sample of melancholic, depressed outpatients, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III]; American Psychiatric Association, 1980). The EII is derived from the Rorschach Inkblot Test and offers a single composite score of ego impairment. This study validates the use of the EII with a heterogeneous sample of schizophrenic patients. In support of the trait-like characteristics of the scale, the EII continues to be expressed as a single factor, with a correlation of .98 when comparing the original factor derived from a melancholic population with this sample of schizophrenic patients. Significant correlations were also found between the EII and other clinical indices, including the Magical Ideation Scale, the Schizophrenia Index, and the Minnesota Multiphasic Personality Inventory (MMPI). Finally, the EII was found to differentiate between a paranoid subgroup and a mixed undifferentiated/disorganized subgroup who theoretically have more ego impairment. These results offer support for the use of the EII as an empirical means of quantitatively and qualitatively assessing thought disorder within a theoretical framework. Further research is needed to understand the application of the EII across different diagnostic groups and its relationship to other indices of psychological disturbance.     

A comparison of Rorschach developmental level and form-level systems as indicators of psychosis.

Psychotic and nonpsychotic psychiatric inpatients were tested on the Rorschach. "Reality-testing" was measured by four form-level scoring systems designed by Beck, Mayman, Becker, and Wilensky. The psychotic subjects were dichotomized on three diagnostic dimensions: schizophrenia, paranoia, and premorbid social adjustment. No significant differences were found for the Beck system. With the other systems, psychotics showed significantly poorer reality testing than nonpsychotics. No differences were found for the schizophrenic and paranoid dimensions. The Phillips premorbid adjustment score was negatively correlated with all four measures of "reality-testing." The conclusion drawn was that Rorschach measures of "reality testing" are associated with psychotic and poor premorbid functioning, but do not differentiate schizophrenic from nonschizophrenic psychotics or paranoid schizophrenics from nonparanoid schizophrenics.     

Symposium: Research In Projective Techniques

Psychotic and nonpsychotic psychiatric inpatients were tested on the Rorschach. "Reality-testing" was measured by four form-level scoring systems designed by Beck, Mayman, Becket, and Wilensky, The psychotic subjects were dichotomized on three diagnostic dimensions: schizophrenia, paranoia, and premorbid social adjustment. No significant differences were found for the Beck system. With the other systems, psychotics showed significantly poorer reality testing than nonpsychotics. No differenced were found for the schizophrenic and paranoid dimensions. The Phillips premorbid adjustment score was negatively correlated with all four measures of "reality-testing." The conclusion drawn was that Rorschach measures of "reality-testing" are associated with psychotic and poor premorbid functioning, but do not differentiate schizophrenic from nonschizophrenic psychotics or paranoid schizophrenics from nonparanoid schizophrenics.     

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.     

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.     

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.     

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.     

Coming to grips with negative evidence for the Comprehensive System for the Rorschach: a comment on Gacono, Loving, and Bodholdt; Ganellen; and Bornstein

The Comprehensive System (CS; Exner, 1991, 1993) for the Rorschach is currently engulfed in controversy. This comment article responds to 3 articles by Rorschach proponents in this issue of the Journal of Personality Assessment. Contrary to the claims of Gacono, Loving, and Bodholdt (this issue), CS scores do not bear a well-demonstrated relationship to psychopathy, antisocial personality disorder, or conduct disorder. Contrary to the claims of Ganellen (this issue), both the original and the revised CS Depression Index (Exner, 1993) bear little or no relationship to depression diagnoses. Furthermore, the scoring reliability of some CS scores is problematic. Although we agree with Bornstein (this issue) that Rorschach scores generally bear little or no relation to psychiatric diagnoses or self-report questionnaires, we believe this lack of relationship tends to disconfirm hypotheses concerning the validity of the Rorschach. In the spirit of the philosopher Sir Karl Popper, the Rorschach community should not minimize negative evidence or engage in post hoc arguments to immunize the CS against falsification.     

The Family Rorschach with families of schizophrenics: replication and extension

Using a modified version of procedures outlined by Shapiro and Wild (9), this study evaluates the use of a Family Rorschach technique as a means of distinguishing families of schizophrenic patients from those of psychiatrically hospitalized, nonschizophrenic individuals. The patients were diagnosed using Research Diagnostic Criteria, and families were matched for age, intelligence, and socioeconomic characteristics. Results showed that the families with schizophrenic offspring scored significantly lower (that is, they had more communication and attentional difficulties) than those with nonschizophrenic offspring; offspring gender and family constellation had little effect on scores. Subsequent analyses indicated that lower scores were not simply a reflection of the psychoticism of the patient. These findings suggest that families of schizophrenics have interpersonal communication difficulties that compromise their ability to maintain a shared focus of attention. The findings are consistent with the suggestion that deviant patterns of family communication in interaction with genetic vulnerability in an offspring may result in the development of a schizophrenic disorder.     

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.     

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.     

Loss of Discriminative “Power” of the MMPI with Older Psychiatric Patients

MMPIs were obtained from four groups of 20 hospitalized male patients which differed in age (18–28 years vs 45–59 years) and psychiatric diagnosis (schizophrenic vs nonschizophrenic). The MMPI discriminated between young schizophrenic and nonschizophrenic patients but did not discriminate between older schizophrenic and nonschizophrenic patients. The apparent loss of discriminative “power” of the MMPI with older patients was interpreted as supporting the importance of the often overlooked nonpathological characteristics of the psychological test subject.     

Relations Between Minnesota Multiphasic Personality Inventory–A Scales and Rorschach Variables With the Scope and Severity of Maltreatment Among Adolescents

This study examined preexisting Rorschach (Exner, 2001) and Minnesota Multiphasic Personality Inventory–A (MMPI–A; Butcher et al., 1992) profiles to determine if selected MMPI–A scales and Rorschach variables would jointly associate with the number and severity of maltreatment subtypes (physical abuse, sexual abuse, neglect, and emotional maltreatment) of 157 adolescents (ages 14–17) with documented maltreatment histories. The Maltreatment Classification System was used to systematically code the maltreatment attributes. Six Rorschach variables (MOR, PER, Afr, SumY, SumC’, Human Content) were significantly correlated with the number of maltreatment subtypes, but none of the anticipated MMPI–A scales were related. MMPI–A Scale 7 and Rorschach variables Ego, MOR, and PER were jointly associated with physical abuse severity. MMPI–A Scale 0 and Rorschach variables MOR, PER, SumY, SumC’, PTI, Human Content, and Texture jointly associated with sexual abuse severity. This study supports the potential for certain MMPI–A scales and Rorschach variables to reflect the impact of adolescents’ maltreatment experiences in terms of the number and severity of types of maltreatment experienced. Because both instruments captured different aspects of adolescents’ maltreatment experiences, clinicians should consider using both when evaluating the impact of maltreatment on adolescents.     

Differentiation of Psychotic From Nonpsychotic Psychiatric Inpatients: The Rorschach Perceptual Thinking Index

The aim of the study was to investigate the validity of the Rorschach Perceptual Thinking Index (PTI) to detect psychotic perceptual and thought disturbance in a sample of Slovene psychiatric inpatients. Using a sample of 275 adult psychiatric inpatients of both sexes, we examined the differences between patients with psychosis (PP) and patients with no psychotic features (NP) from various diagnostic groups on the global PTI and its subcomponent variables. PPs obtained significantly higher PTI scores, indicating more disturbed perception and more thinking disturbance, than NPs. No differences were found for diagnostic differences within the PP and NP groups. Results are in accordance with previous studies of the PTI as a valid cross-cultural index of perceptual and thinking disturbance.     

Psychopathic and nonpsychopathic violent offenders on the rorschach: discriminative features and comparisons with schizophrenic inpatient and university student samples

We examined discriminant and convergent validity of theoretically relevant Rorschach Comprehensive System (CS) variables (Exner, 2003) and Meloy and Gacono's (1992) aggression variables in distinguishing between imprisoned violent offenders (VO) who were psychopathic (P-VO) and nonpsychopathic (NP-VO) under psychiatric treatment, schizophrenic inpatients (ISs), and university students (USs). A total of 7 of 12 variables discriminated significantly between P-VO and NP-VO, which suggests more aggressive, cognitive, and interpersonal disturbances among P-VO. We also found significant differences between VOs, ISs, and USs. Logistic regression analyses revealed that AgPast accumulated incrementally in the classification of P-VO versus NP-VO, and AgC accumulated incrementally in the classification of VO versus IS when entered after CS variables. The findings support the view that psychopathy is a distinctive form of antisocial personality disorder (Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Association, 1994) organized at a more severe pathological level.