Diagnosis of Schizophrenia by Rorschach Patterns

In the belief that the diagnostic validity of Rorschach methods would gain from formalizing the judgmental processes of clinicians, 14 score patterns were constructed from eight Rorschach variables, each pattern designed to characterize patients in one of three broad diagnostic categories, Schizophrenic, Borderline Psychotic, or “Other.” A random sample of 196 patients of a VA mental hygiene clinic was drawn from clinic files. The “pattern diagnoses” obtained by applying the pattern system to their Rorschach scores were found significantly related to diagnoses formulated by the examining psychologists and by the clinic intake staff. More patients diagnosed schizophrenic by the pattern method engaged in autistic behavior than patients with other pattern diagnoses. The diagnostic efficiency of the pattern method, measured in terms of ability to reach a definite diagnosis, proportion of correct diagnoses, and proportion of false positive errors, did not differ significantly from the diagnostic efficiency of the psychological examiners, and differed significantly from the psychiatrists' diagnostic efficiency only in producing more “indeterminate” diagnoses. The diagnostic validity of the patterns was considered to be established, but their usefulness as a clinical tool depends heavily on population base rates and the relative costs of false positive and false negative diagnostic errors.     

The relationship of the Rorschach Schizophrenia Index to psychotic features in a child psychiatric sample

In this study we investigated the reliability and validity of the Rorschach Schizophrenia Index (SCZI) from Exner's (1978, 1993) Comprehensive System for a sample of 413 child psychiatric inpatients by examining relationships with the Personality Inventory for Children-Revised (PIC-R) and chart diagnoses. Interscorer reliability and internal consistency were acceptable. Multivariate analyses of variance results revealed significantly different PIC-R profiles for those with and without elevated SCZI scores, with significant differences emerging on the PIC-R Psychosis (PSY) scale and 2 cognitive triad scales (Intellectual Screening and Development), which have been reported to be more frequently elevated in PIC-R profiles of children with psychotic disorders. Significant differences were found across SCZI groups for the PSY scale, Reality Distortion scale, reality testing critical items and chart diagnoses of psychotic disorder. Implications for clinical interpretation of the SCZI with children and issues for further research with this population are discussed.     

Application of the consensus Rorschach to couples

The consensus method of administering the Rorschach is described and the literature reviewed. The consensus method is viewed as an adaptation of the Rorschach as a form of behavioral assessment, especially as regards couple interaction. Materials on two couples are presented as illustrations.     

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.     

Rorschach Scores and Schizophrenia: An Evaluation of Weiner's Signs in Clinical Practice

An article by Fried in this Journal has raised some questions, not only of substance in regard to sex differences in fantasy, but also of procedure and of professional standards for “replication” of research.     

Current status of the Rorschach Inkblot Method

The current scientific, clinical, and professional status of the Rorschach Inkblot Method (RIM) is reviewed with respect to its psychometric properties, the applied purposes it can be expected to serve, the extent of its use, and the nature of prevailing attitudes toward it. Available evidence indicates that the RIM is a psychometrically sound measuring instrument that provides valid assessments of personality characteristics and can facilitate differential diagnosis and treatment planning and evaluation. The RIM continues as in the past to be widely used by both clinicians and researchers. However, the esteem in which it is held by practitioners, who are generally agreed that clinical psychologists should be competent in Rorschach assessment, is not universally shared by academicians, many of whom presently question the future place of Rorschach training in graduate education.     

An Evaluation of the Validity of Rorschach Popular Responses as Differentiae of Ambulatory Schizophrenia

We compared MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, &; Kaemmer, 1989) profiles of 2 groups of adult biological men requesting sex reassignment surgery; 1 group was diagnosed with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) transsexualism and the other with gender identity disorder of adolescence and adulthood, nontranssexual type (GIDAANT). Although the mean profiles for the transsexual group did not demonstrate any psychopathology, the GIDAANT group showed moderate psychopathology. A cluster analysis indicated that 85% of the transsexual group showed low psychopathology and 47% of the GIDAANT group showed severe psychopathology. Neither the MMPI-2 results nor the DSM-III-R clinical evaluation support the conclusion of many authors that transsexualism is associated with severe personality disorder; rather, the data indicate that transsexualism and other gender identity disorders without persistent wish for sex reassignment differ significantly in degree of psychopathology.     

The diagnostic efficiency of the Rorschach Depression Index and the Schizophrenia Index: a review

This review focuses on the diagnostic efficiency of the new versions of the Rorschach Comprehensive System Depression Index (DEPI) and the Schizophrenia Index (SCZI). Clinical diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders was chosen as the external validation criteria. The sensitivity, specificity, and overall classification rates for the indices were presented from the studies or computed from the data when possible. The positive and negative predictive validity was estimated at three different base rates. As regards the DEPI the results showed a large variation in diagnostic performance as the index seemed to have relatively more success in identifying nonpsychotic and unipolar depression than psychotic and bipolar depression. The DEPI did not successfully identify depression among adolescent patients. As regards the SCZI the results more consistently indicated that the index effectively discriminates between psychotic and nonpsychotic patients and the predictive validity of both a positive and negative SCZI was found to be high.     

Construct Validation of Scales Derived From the Rorschach Method: A Review of issues and Introduction to the Rorschach Rating Scale

I suggest the main goal of Rorschach validation should be a refined understanding of what each score means. Toward this end, I review general issues in construct validity, hurdles unique to the Rorschach, and general limitations with validation criteria. I then recommend two approaches for improving criteria so they can begin approximating the gold standards that are necessary for a refined understanding of what scores actually measure. The first is a method for improving expert clinical judgment, and the second is a method for aggregating data across diverse judges. Finally, the Rorschach Rating Scale (RRS) is presented as a criterion tool to be used with either of these approaches to validation. The RRS is a fairly comprehensive summary of the constructs thought to be measured by various Rorschach scoring systems. The utility of the RRS for research and training are discussed, as are other practical, theoretical, and psychometric issues in its application.