Rorschach aggression variables: a study of reliability and validity

This study investigated the extent to which 6 Rorschach variables of aggression (A1, A2, AG, MOR, AgC, AgPast) are related to one another, to the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) Cluster B personality disorder criteria, and to self-report measures of anger, aggression, and antisocial behavior. Seventy-eight patients were found to meet DSM-IV criteria for an Axis II disorder, Cluster A personality disorder (paranoid, schizoid, schizotypal) = 9, Cluster B (antisocial personality disorder [ANPD] = 16, borderline personality disorder [BPD] = 23, histrionic personality disorder = 5, narcissistic personality disorder = 12) = 56, and Cluster C personality disorder (avoidant, dependent, obsessive-compulsive) = 13. The results of this study indicated that (a) these 6 Rorschach aggression variables can be scored reliably; (b) 2 factors, revealed by factor analysis, accounted for 77% of the total variance; (c) selected variables were found to be empirically related to DSM-IV diagnostic criteria for ANPD and BPD; and (d) selected variables were found to be empirically related to a self-report measure of anger and antisocial practices. The conceptual nature and clinical utility of these Rorschach aggression variables as well as implications for future research are discussed.     

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 < .05; the narcissists produced more insidious thought process disturbance, p < .05; and higher functioning groups demonstrated greater control of impulses, p < .05. Borderlines in this sample demonstrated more affective constriction than the narcissists and used more splitting, p < .05; narcissists used more grandiosity, p < .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.     

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.     

The rorschach assessment of borderline defenses: a concurrent validity study

This study assesses the concurrent validity of two Rorschach defense scales designed to identify borderline defensive structure. A Rorschach scale designed by Cooper and his colleagues was systematically compared to a defense scale constructed by Lerner and Lerner. Despite considerable overlap on a conceptual and operational level, the scales are based on divergent theoretical models (developmental arrest and fixation) and Rorschach units of analysis (all responses and human responses). Our results are based on the capacity of each scale to discriminate between independently diagnosed samples (neurotic, outpatient borderline, inpatient borderline, schizophrenic) and the relative discriminatory power of particular defenses within each scale to differentiate between groups.     

Eleventh Annual Meeting of the Society for Projective Techniques

This study assesses the concurrent validity of two Rorschach defense scales designed to identify borderline defensive structure. A Rorschach scale designed by Cooper and his colleagues was systematically compared to a defense scale constructed by Lerner and Lerner. Despite considerable overlap on a conceptual and operational level, the scales are based on divergent theoretical models (developmental arrest and fixation) and Rorschach units of analysis (all responses and human responses). Our results are based on the capacity of each scale to discriminate between independently diagnosed samples (neurotic, outpatient borderline, inpatient borderline, schizophrenic) and the relative discriminatory power of particular defenses within each scale to differentiate between groups.     

Rorschach Assessment of Primitive Defenses: A Review

The Lerner & Lerner Scale for assessing primitive defenses is reviewed, According to its conceptual roots, initial studies assessed the scale's efficacy in distinguishing groups of borderline patients from groups of other diagnostic entities. Later studies extended the use of the scale to assess various clinical groups assumed to have a borderline personality structure. Results from several studies indicate a high level of reliability as judged by degree of interrater agreement. In a host of studies, the scale was found to be valid in distinguishing borderline patients from other types of patients, eating disordered patients from normal controls, and gender disturbed children from normal controls. Another Rorschach scale for assessing primitive defenses was also reviewed and compared.     

An Empirical Study of Object Relations and Defensive Operations in Antisocial Personality Disorder

This study assessed the object relations, defensive operations, and level of psychopathy and narcissism in a group of antisocial personality disordered offenders. The Rorschach protocols of 33 subjects who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-111-R], American Psychiatric Association, 1987) criteria for antisocial personality disorder were analyzed utilizing Kwawer's (1980) criteria for borderline object relations categories (borderline phenomena), the Lerner and Lerner (1980) Defense Scale, and a number of experimental criteria including Cooper and Arnow's (1986) defense criteria. Level of narcissism was assessed utilizing Exner's (1973) Self-Focus Sentence Completion Test. Hare's Psychopathy Checklist was used as an independent variable to determine a subject's level of psychopathy. Those subjects scoring 30 or more on the psychopathy checklist were compared to subjects scoring less than 30. The level of narcissism or proportion of defenses did not differ significantly between the severe psychopaths (230) and the moderate psychopaths (< 30). The severe psychopaths produced a significantly greater number of borderline object relations. I conclude that antisocial individuals tend to be highly egocentric, and that narcissism is one component of psychopathy. Severe psychopaths, as a group, tend to be more borderline in their functioning than those exhibiting moderate levels of psychopathic disturbance. I also conclude that individuals who are incarcerated for felony offenses and also meet the DSM-111-R criteria for antisocial personality disorder exhibit degrees of borderline personality organization.     

Predicting DMS-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 alimited 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.     

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.     

Adolescent personality disorders and conflict with romantic partners during the transition to adulthood

Longitudinal data were used to investigate the association of adolescent personality disorders with conflict between romantic partners during the transition to adulthood (i.e., age 17 to 27). Findings indicated that adolescent personality disorders (PDs) assessed at mean age 16 were associated with subsequent elevated partner conflict. Cluster B PD was associated with sustained elevations in partner conflict throughout the transition to adulthood. Cluster A and C PDs were associated with elevated partner conflict before age 23. Paranoid, schizoid, schizotypal, borderline, narcissistic, and obsessive-compulsive PD symptoms were independently associated with sustained elevations in partner conflict.     

Rorschach assessment of primitive defenses: a review

The Lerner & Lerner Scale for assessing primitive defenses is reviewed. According to its conceptual roots, initial studies assessed the scale's efficacy in distinguishing groups of borderline patients from groups of other diagnostic entities. Later studies extended the use of the scale to assess various clinical groups assumed to have a borderline personality structure. Results from several studies indicate a high level of reliability as judged by degree of interrater agreement. In a host of studies, the scale was found to be valid in distinguishing borderline patients from other types of patients, eating disordered patients from normal controls, and gender disturbed children from normal controls. Another Rorschach scale for assessing primitive defenses was also reviewed and compared.     

Omnipotence in the transference and in the countertransference

The concept of omnipotence refers to a primitive fantasy, a mechanism of defense, and a pathological psychic structure. Omnipotence and its derivative defensive operation, omnipotent control, are highly prevalent in borderline personality organization. Three clinical vignettes illustrate these mechanisms in the treatment of patients with borderline, narcissistic, and obsessive personality disorders, respectively. These vignettes illustrate the transference developments when omnipotence and omnipotence control are dominant, and the therapeutic approach to these conditions.     

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 empirical study of object relations and defensive operations in antisocial personality disorder

This study assessed the object relations, defensive operations, and level of psychopathy and narcissism in a group of antisocial personality disordered offenders. The Rorschach protocols of 33 subjects who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R], American Psychiatric Association, 1987) criteria for antisocial personality disorder were analyzed utilizing Kwawer's (1980) criteria for borderline object relations categories (borderline phenomena), the Lerner and Lerner (1980) Defense Scale, and a number of experimental criteria including Cooper and Arnow's (1986) defense criteria. Level of narcissism was assessed utilizing Exner's (1973) Self-Focus Sentence Completion Test. Hare's Psychopathy Checklist was used as an independent variable to determine a subject's level of psychopathy. Those subjects scoring 30 or more on the psychopathy checklist were compared to subjects scoring less than 30. The level of narcissism or proportion of defenses did not differ significantly between the severe psychopaths (greater than or equal to 30) and the moderate psychopaths (less than 30). The severe psychopaths produced a significantly greater number of borderline object relations. I conclude that antisocial individuals tend to be highly egocentric, and that narcissism is one component of psychopathy. Severe psychopaths, as a group, tend to be more borderline in their functioning than those exhibiting moderate levels of psychopathic disturbance. I also conclude that individuals who are incarcerated for felony offenses and also meet the DSM-III-R criteria for antisocial personality disorder exhibit degrees of borderline personality organization.     

A note on the assessment of idealization

In a series of studies using the Lerner Defense Scale (H. Lerner & P. Lerner, 1980) for assessing primitive defenses, inconsistent and at times perplexing findings have been reported regarding the defense of idealization. A major study examining personality variables, including defense, in a nonclinical population-ballet students-and comparing them to those of patients suffering eating disorders, yielded findings related to the defense of idealization and its assessment. Herein, the results of that study are reviewed and then discussed in light of recent psychoanalytic formulations regarding idealization.     

Self-reported attachment, interpersonal aggression, and personality disorder in a prospective community sample of adolescents and adults

Anxious and avoidant attachment were assessed in the Children in the Community (CIC) Study during adolescence and adulthood using self-report scales developed for this prospective study. The convergent and discriminant validity of the new CIC attachment scales were evaluated and their stability was assessed across a 17-year interval. Attachment scales predicted DSM-IV personality disorders in theoretically coherent and clinically meaningful ways, especially when supplemented with a separate measure of interpersonal aggression. Cluster B and C personality disorder symptoms were associated with elevated anxious attachment. Avoidant attachment was positively associated with Cluster A symptoms and inversely associated with Cluster B and C symptoms. Interpersonal aggression was higher in Cluster B symptoms and lower in Cluster C symptoms, thus differentiating between these symptom clusters.     

Treating the “Mischances of Character,” Simply and Effectively

Cluster B personality disorders, particularly borderline personality disorder (BPD) and narcissistic personality disorder (NPD), are simultaneously among the most disruptive and impairing and among the least well studied, especially regarding treatment. In this paper we present an approach to treating these disorders that emphasizes motivation for treatment, self-control, and a highly structured way to reduce personality disorder symptomatology. Initial testing of the approach on nine patients with BPD and six patients with NPD indicates promise. Case reports are used to illustrate the approach.     

The basic trait of Antagonism: An unfortunately underappreciated construct

Antagonism, the low pole of Agreeableness, references traits related to immorality, combativeness, grandiosity, callousness, and distrustfulness. It is a robust correlate of externalizing behaviors such as antisocial behavior, aggression, and substance use; in fact, in many cases, it is the strongest trait correlate. It represents the core of many important and impactful psychopathological constructs (e.g., psychopathy, antisocial and narcissistic personality disorders). It is also central to models of general and disordered personality, psychopathology, and interpersonal behavior. As Neuroticism is core to understanding the intense distress and suffering that comes with internalizing disorders, Antagonism is core to understanding the impairment and suffering (to the individual and society at large) that comes with externalizing disorders.     

Interpersonal dependency and personality pathology: variations in Rorschach Oral Dependency scores across Axis II diagnoses

Although several investigations have examined the relationship of Rorschach Oral Dependency (ROD; Masling, Rabie, & Blondheim, 1967) scores to Axis I diagnosis, there has been very little research assessing variations in ROD scores across Axis II personality disorders (PDs). In this study, ROD scores were compared in 5 PD groups (borderline PD inpatients, borderline PD outpatients, avoidant-dependent PD outpatients, narcissistic PD outpatients, and antisocial PD outpatients), and 2 non-PD comparison groups (psychotic disorder inpatients and college students). Borderline PD inpatients had significantly higher ROD scores than borderline PD outpatients, antisocial PD outpatients, and college students; no other between-group differences were found. We discuss implications of these results for research on dependency and Axis II psychopathology and offer suggestions for future studies.