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.     

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 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.     

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.     

Modifying the Rorschach Human Experience Variable to create the Human Representational Variable

The Human Experience Variable (HEV; Perry & Viglione, 1991) provided information about interpersonal perceptions not previously available within the Comprehensive System (CS; Exner, 1993). Research data suggests that it was related to interpersonal functioning and as a result, psychological impairment and health. In this article, we present the rationale and empirical basis for recent psychometric refinements to the HEV, consequently renamed the Human Representational Variable (HRV). Research addressing the reliability and validity for the HRV is summarized. Based on data and experience with the HEV, this study summarized some small modifications to the original algorithm. The refined variable, the HRV, has been added to the CS (Exner, 2000). Data presented here suggest that the HRV has improved psychometric properties compared to the HEV and that it is simpler to understand. Research recommendations and interpretive suggestions are also presented.     

Lateralized impairment of the emotional enhancement of verbal memory in patients with amygdala-hippocampus lesion

This study investigated amygdala-hippocampus's functional asymmetry in the emotional modulation of memory for stories. Thirty-nine, right-handed, drug-resistant epilepsy patients who had been submitted to unilateral temporal lobectomy (19 left and 20 right) watched either an arousing or neutral version of a story presented audio-visually. The slide sequence was the same in the neutral and arousing version, the narratives were matched for structure and comprehensibility. The set and order of the 11 slide sequence were identical in both conditions. Free recall and recognition measures were taken 2h after story presentation. Subjects in the TLE group who watched the arousing version recalled more details than the subjects who watched the neutral version (t(37)=3.4,p<.001). The group who watched the arousing version recalled more details of the phase 2 of the story (t(37)=6.76,p<.001). Scores in both conditions did not differ between control subjects and temporal lobectomy patients. When the right and left lesioned groups' results were analyzed separately, it was observed that the two groups did not differ in their recall of the neutral version. The right lesioned group recalled more items of the arousal than the neutral version (Z=-3.55,p<.001). However the left lesioned group did not show the memory enhancement for the emotional version, in this group it was only found an enhanced recall of the more pictorial emotional segment of the narrative (Z=-3.11,p<.001). This illustrates that the right amygdala can influence retention of complex emotional stimuli with verbal and pictorial arousing properties. We concluded that an intact left amygdala-hippocampus is important for enhancement of memory related to emotionally arousing verbal material.     

The effects of late-life spousal bereavement over a 30-month interval

Self-report measures of grief, depression, and general psychopathology were studied in widows and widowers over a 2.5-year period following death of their partner. A comparison sample of men and women was also followed for the same period. Differences in severity of depression and psychopathology previously reported at 2 months postloss (Gallagher, Breckenridge, Thompson, & Peterson, 1983) diminished to nonsignificant levels at 12 and 30 months. However, significant differences between bereaved and comparison subjects on measures of grief were still apparent 30 months after spousal loss. A main effect of gender for depression and psychopathology (but not for grief) was found at 2 and 12 months: Women reported more distress than men regardless of bereavement status. Results indicate that the experience of grief persists for at least 30 months in both older men and women who have lost their spouse.     

Psychosis,symbol, affectivity 1: etiopathogenesis and treatment through analytical psychology

This is the first of two papers concerning our study into an integrated approach to psychotic disorders, conducted at the University of Palermo’s Psychiatry Unit Polyclinic over approximately 15 years. Here we will explore and reflect upon the acute psychotic condition mainly from a theoretical and conceptual perspective, while in the second paper we will explore the clinical perspective. From the point of view of psychopathology, and in the light of C.G. Jung’s conceptualization of analytical psychology, as well as calling on contributions from other authors from the systemic-relational and post-psychoanalytic field, we will clarify the ideas developed over these last few years by our team. From a more speculative perspective we will advance new interpretive hypotheses in an attempt to thoroughly understand the nature of the psychotic condition, both on a psychodynamic relational and a neuroscientific level. The paper describes how we revised our understanding of psychosis from a brain disease to a process aimed at the rearrangement of psychic functioning, as anticipated by John Weir Perry nearly 40 years ago.     

A Report on a Four-Year Longitudinal Study of Intellectual Development of Engineering Undergraduates

As part of an investigation into the effects of curricular reforms in the undergraduate program in the College of Engineering, a series of Perry-style interviews were conducted over a 4-year period. The study was undertaken in an attempt to assess the impact of collaborative design-based engineering courses that were being implemented. Students who completed the collaborative design course in their first year were higher on the Perry scale than their peers who did not. However, this effect was not sustained through the rest of the curriculum, as more traditional courses dominated. No statistically significant change in Perry position was observed for students in their 1st and 3rd years; however, a growth of approximately one Perry position was observed between the 3rd and 4th years. The relationship of current curricula to this pattern of intellectual development is discussed, and arguments for altering the curriculum to support intellectual development are made.     

A longitudinal investigation of the relationship between maternal mind‐mindedness and theory of mind

Data are presented from a longitudinal investigation examining the relationship between maternal mind‐mindedness (MM) in infancy and socio‐cognitive development in childhood. We revisited children (n = 18) who had taken part in a longitudinal study as infants. MM had been assessed at 10, 12, 16, and 20 months of age. We followed up these children at 5–6 years of age to test their higher order theory of mind (ToM) (using the strange stories task). The convergent validity, temporal stability, and predictive validity of the construct of MM were examined in a longitudinal data set. The five measures of MM were not significantly correlated. Mother's production of appropriate mind‐related comments (but no other measures) showed evidence of temporal stability throughout infancy. Thus, MM (as measured by appropriate mind‐related comments) was confirmed as a stable construct. Children's ToM at 5–6 years of age was significantly predicted by their mother's MM up to 4 years earlier, with MM accounting for 40% of the variance of the strange stories task scores. These findings identify a relationship between MM across a protracted period of infancy and socio‐cognitive development at 5–6 years of age.     

Cognitive-behavior therapy in the management of chronic, occupational pain of the upper limbs

Forty five subjects who experienced chronic, occupational pain of the upper limbs were randomly assigned to one of three conditions; individual cognitive-behaviour therapy (ICBT), group cognitive-behaviour therapy (GCBT) and WLC. Significant benefits were found for both ICBT and GCBT on measures of anxiety, depression, coping strategies, impact on daily living, pain and distress caused by pain. These gains were not evident in the WLC and were maintained at the 6 month follow-up Minimal difference was found between ICBT and GCBT on measures of pain and psychopathology, although client evaluation ratings at the end of treatment favoured ICBT.     

On the science of Rorschach research

Wood et al.'s (1999b) article contained several general points that are quite sound. Conducting research with an extreme groups design does produce effect sizes that are larger than those observed in an unselected population. Appropriate control groups are important for any study that wishes to shed light on the characteristics of a targeted experimental group and experimental validity is enhanced when researchers collect data from both groups simultaneously. Diagnostic efficiency statistics--or any summary measures of test validity--should be trusted more when they are drawn from multiple studies conducted by different investigators across numerous settings rather than from a single investigator's work. There should be no question that these points are correct. However, I have pointed out numerous problems with specific aspects of Wood et al.'s (1999b) article. Wood et al. gave improper citations that claimed researchers found or said things that they did not. Wood et al. indicated my data set did not support the incremental validity of the Rorschach over the MMPI-2 when, in fact, my study never reported such an analysis and my data actually reveal that the opposite conclusion is warranted. Wood et al. asserted there was only one proper way to conduct incremental validity analyses even though experts have described how their recommended procedure can lead to significant complications. Wood et al. cited a section of Cohen and Cohen (1983) to bolster their claim that hierarchical and step-wise regression procedures were incompatible and to criticize Burns and Viglione's (1996) regression analysis. However, that section of Cohen and Cohen's text actually contradicted Wood et al.'s argument. Wood et al. tried to convince readers that Burns and Viglione used improper alpha levels and drew improper conclusions from their regression data although Burns and Viglione had followed the research evidence on this topic and the expert recommendations provided in Hosmer and Lemeshow's (1989) classic text. Wood et al. oversimplified issues associated with extreme group research designs and erroneously suggested that diagnostic studies were immune from interpretive confounds that can be associated with this type of design. Wood et al. ignored or dismissed the valid reasons why Burns and Viglione used an extreme groups design, and they never mentioned how Burns and Viglione used a homogeneous sample that actually was likely to find smaller than normal effect sizes. Wood et al. also overlooked the fact that Burns and Viglione identified their results as applying to female nonpatients; they never suggested their findings would characterize those obtained from a clinical sample. Wood et al. criticized composite measures although some of the most important and classic findings in the history of research on personality recommend composite measures as a way to minimize error and maximize validity. Wood et al. also were mistaken about the elements that constitute an optimal composite measure. Wood et al. apparently ignored the factor-analytic evidence that demonstrated how Burns and Viglione created a reasonable composite scale, and Wood et al. similarly ignored the clear evidence that supported the content and criterion related validity of the EMRF. With respect to the HEV, Wood et al. created a z-score formula that used the wrong means and standard deviations. They continued to use this formula despite being informed that it was incorrect. Subsequently, Wood et al. told readers that their faulty z-score formula was "incompatible" with the proper weighted formula and asserted that the two formulas "do not yield identical results" and "do not yield HEV scores that are identical or even very close." These published claims were made even though Wood et al. had seen the results from eight large samples, all of which demonstrated that their wrong formula had correlations greater than .998 with the correct formula. At worst, it seems that Wood et al. (199     

Testing the accuracy of the retrospective recall method used in expertise research

Expertise typically develops slowly over years, and controlled experiments to study its development may be impractical. Researchers often use a correlational, retrospective recall method in which participants recall career data, sometimes over many years before. However, recall accuracy is uncertain. The present study investigated the accuracy of recalled career data for up to 38 years, in over 600 international chess players. Participants’ estimates of their entry year into international chess, total career games played, and number of games in a typical year were compared with the known true values. Entry year typically was recalled fairly accurately, and accuracy did not diminish systematically with time since list entry from 10 years earlier to 25 or more years earlier. On average, games-count estimates were reasonably accurate. However, some participants were very inaccurate, and some were more inaccurate in their total-games counts and entry-year estimates. The retrospective recall method yields usable data but may have some accuracy problems. Possible remedies are outlined.     

Impulsivity: core aspect of borderline personality disorder

This prospective follow-up study addresses whether impulsivity versus other aspects of borderline personality disorder (BPD) are (1) stable over a 7-year follow-up period; (2) able to predict the persistence versus remittance of BPD over 7 years of follow-up, and (3) more predictive of the level of borderline psychopathology on follow-up than other aspects of the disorder. When the cohort was assembled, 88 of 130 subjects scored seven or higher on the Diagnostic Interview for Borderlines (DIB), indicating a definite diagnosis of BPD. The cohort was reassessed at 2 and 7 years after the index admission. At the 7-year follow up, 81(62.3%) of the original cohort were re-examined, two (1.6%) were deceased, six (4.6%) suicided, 36 (27.7%) refused to participate and five (3.8%) could not be located. The results indicated that the initial impulse action subscale score was highly correlated with the 7-year follow-up score (r = 0.53). Using a stepwise multiple regression technique, the impulse action subscale score from the DIB best predicted borderline psychopathology at the 7-year follow up, with an r2 of 0.24, F = 24.84, p < 0.001. This prospective study of subjects with BPD indicates that impulsivity is stable over time and highly predictive of borderline psychopathology over 7 years follow up. These results suggest the treatment of impulsivity may impact the course of BPD.     

Effects of level of retrieval success on recall-related frontal and medial temporal lobe activations

Brain dedicated single photon emission computed tomography (SPECT) was used to compare the neuroactivation produced by the cued recall of response words in a set of studied word pairs with that produced by the cued retrieval of words semantically related to unstudied stimulus words. Six of the 12 subjects scanned were extensively trained so as to have good memory of the studied pairs and the remaining six were minimally trained so as to have poor memory. When comparing episodic with semantic retrieval, the well-trained subjects showed significant left medial temporal lobe activation, which was also significantly greater than that shown by the poorly trained subjects, who failed to show significant medial temporal lobe activation. In contrast, the poorly trained subjects showed significant bilateral frontal lobe activation, which was significantly greater than that shown by the well-trained subjects who failed to show significant frontal lobe activation. The frontal activations occurred mainly in the dorsolateral region, but extended into the ventrolateral and, to a lesser extent, the frontal polar regions. It is argued that whereas the medial temporal lobe activation increased as the proportion of response words successfully recalled increased, the bilateral frontal lobe activation increased in proportion to retrieval effort, which was greater when learning had been less good.     

All our troubles seem so far away: temporal pattern to accessible alternatives and retrospective team appraisals

Three studies tested the hypothesis that thoughts about alternatives become increasingly accessible over time, leading poor outcomes to feel subjectively farther away and less inevitable. This subjective temporal distance bias was obtained even though actual time since poor and good outcomes was identical. In Study 1, participants who recalled distant poor team outcomes thought of alternatives easily and outcomes felt farther away and less inevitable. Thoughts about outcomes were most easily accessible after good outcomes, which felt closer and more inevitable. In Study 2, with measures obtained immediately or at a later time on a negotiation task, changes over time occurred primarily for poor team outcomes. In Study 3, team performance on an investment task indicated it is whether alternatives are thought of easily, not thought content, that produces this effect. Discussion centers on temporal appraisals, other temporal biases, and teams.     

Incremental validity of the Ego Impairment Index: it's fine when it's there

The results published by W. Perry (2001) demonstrate that with a different criterion more incremental validity can be achieved with the Ego Impairment Index than R. M. Dawes (1999) found using the criterion available to him. Attempting to find statistical rationale for various Rorschach characteristics is, indeed, desirable, especially as a basis for the statistical use of the test. The degree of predictability indicated by most of these statistics, however, still presents a sizable gap between well established validity and much practice, particularly in legal settings. Further, both W. Perry (2001) and D. J. Viglione and M. J. Hilsonroth (2001) raise the issue of evaluating incremental validity in a context where there is some degree of multicolinearity and nesting. The logical equivalence of a nested with a non-nested analysis is established algebraically, and it is noted that the standard concerns about multicolinearity involve the estimations of the coefficients of predictive models--not the degree of predictability per se.     

Rehearsal dynamics in elementary school children

Several studies on free recall suggest that processes responsible for recall are analogous to processes responsible for rehearsal. In children, the relationship between cumulative rehearsal and recall performance has been proven to be critical; however, the locus of the effect of rehearsal is not yet fully understood. To unfold the mechanisms that come into play in an overt rehearsal free recall task, we assessed rehearsal and recall sequences in children between 8 and 10 years of age. These sequences give information about the context in which items are repeated and rearranged throughout the list and subsequently recalled. Rehearsal sequences consisted mainly of items from neighboring list positions in their original temporal order. The same characteristics were true for recall sequences. Qualitatively, order effects during study and recall did not differ over age groups. However, in older children who were using cumulative rehearsal more intensively, successive rehearsal and recall of items in their original order was more pronounced. Therefore, we suggest that a main feature of item rehearsal with regard to facilitating recall is the strengthening of interitem associations based on the temporal order within a list and that this characteristic develops with age.     

Child Anxiety Sensitivity and Family Environment as Mediators of the Relationship between Parent Psychopathology, Parent Anxiety Sensitivity, and Child Anxiety

This study examined child anxiety sensitivity and family environment as mediators of the relationship between (1) parent psychopathology and anxiety sensitivity and (2) child anxiety in a community sample of 157 youths aged 7–18 years. Parents completed measures of anxiety sensitivity, psychopathology, and family environment. Youths completed measures of anxiety sensitivity and anxiety. One structural equation model was tested with child anxiety sensitivity as a mediator of (1) parent psychopathology and parent anxiety sensitivity and (2) child anxiety. Mediation was found with respect to parent psychopathology but not anxiety sensitivity. A second structural equation model was tested with family environment (conflict and control) as a mediator of (1) parent psychopathology and parent anxiety sensitivity and (2) child anxiety. Mediation was found with respect to parent psychopathology and anxiety sensitivity. Possible explanations for these pathways are discussed, including information transmission from parents to children, modeling anxiety-based reactions, temperament, and isolation of children from anxiety-provoking situations.