Rorschach Assessment of Two Distinctive Personality States of a Person With Dissociative Identity Disorder

This case study used test data from a patient with Dissociative Identity Disorder (DID; American Psychiatric Association, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.[Crossref] , [Google Scholar]) to illustrate how two main personality states of the patient (“Ann” and “Ben”) seemed to function. The Rorschach Performance Assessment System (R–PAS; Meyer, Viglione, Mihura, Erard, &; Erdberg, 2011 Meyer, G. J., Viglione, D. J., Mihura, J., Erard, R. E., &; Erdberg, P. (2011). Rorschach Performance Assessment System: Administration, coding, interpretation, and technical manual. Toledo, OH: Rorschach Performance Assessment System. [Google Scholar]) and the Inventory of Interpersonal Problems–Circumplex (IIP–64; Horowitz, Alden, Wiggins, &; Pincus, 2000 Horowitz, L. M., Alden, L. E., Wiggins, J. S., &; Pincus, A. L. (2000). IIP–64/IIP–32 professional manual. San Antonio, TX: Psychological Corporation. [Google Scholar]), administered to Ann and Ben in separate settings, exposed two diverse R–PAS and IIP–64 profiles. Ann's R–PAS profile suggested an intellectualized style of information processing with few indications of psychological problems. Ben's profile indicated severe perceptual, cognitive, and interpersonal difficulties combined with suspicion and anxiety. Ann's IIP–64 profile suggested minor interpersonal problems, whereas Ben's indicated serious relational difficulties. The findings were discussed in relation to the theory of trauma-related structural dissociation of the personality (van der Hart, Nijenhuis, &; Steele, 2006 van der Hart, O., Nijenhuis, E. R. S., &; Steele, K. (2006). The haunted self: Chronic traumatization and structural dissociation of the personality. New York, NY: Norton. [Google Scholar]), which implies an enduring split in the organization of the personality with more or less separate entities with their own sense of self, perception of the world, and ways of organizing emotional, cognitive, and social functions. The DID personality structure is seen as a defense strategy and as a pathway in the personality development producing serious psychological pain and symptoms.     

Rorschach indicators of Multiple Personality Disorder.

The increase in reported cases of Multiple Personality Disorder underscores a great need to differentiate clearly this from other psychiatric disorders and from simulation of Multiple Personality Disorder. Two sets of Rorschach signs have been advanced as clinical markers by their developers, namely Barach and also Wagner, Allison, and Wagner. As the Wagner signs are prevalent in much of the research on Rorschach responses in Multiple Personality Disorder, the purpose of the present study was to evaluate these signs using Wagner's administration and the resulting Rorschach protocols of 16 Multiple Personality Disorder patients and 16 psychiatric controls. Analysis indicated that this system was deficient in correctly classifying these 32 protocols. A new marker, the Splitting Response, emerged, however, which was more useful. This response, in combination with at least one Dissociative response, produced an accuracy rate of 94%. These new criteria may be useful aids in the detection of Multiple Personality Disorder from Rorschach protocols. Replication is urged.     

Fuzzy Fault Lines: Selves in Multiple Personality Disorder

Abstract

This paper outlines a multidimensional conception of Multiple Personality Disorder (MPD) that differs from the ‘orthodox’ conception in terms of the content of its commitment to the reality of the self. Unlike the orthodox conception it recognizes that selves are fuzzy entities. By appreciating the possibility that selves are fuzzy entities, it is possible to rebut a form of fictionalism about the self which appeals to clinical data from MPD. Realism about self can be preserved in the face of multiple personalities.     

Interpersonal Assessment of Borderline Personality Disorder: Preliminary Findings

We examined the reliability and validity of scores on an interpersonal measure of borderline personality disorder (BPD). Ratings on the Interpersonal Measure of Borderline Personality Disorder (IM–B) were based on nonverbal behaviors and interpersonal interactions occurring during clinical interviews with 276 adults. Scores on the IM–B exhibited good reliability. IM–B scores also displayed expected patterns of associations with scores on other measures of BPD, as well as with scores on measures of affective dysfunction, interpersonal pathology, and behavioral impairment associated with BPD, including indexes of maladaptive emotion regulation, interpersonal sensitivity, and self-harm. The pattern of associations for IM–B scores was quite similar to what would be expected for a dimensional measure of BPD symptoms. Scores on the IM–B were also associated with symptoms of disorders generally comorbid with BPD. Finally, IM–B scores contributed incrementally to the prediction of interpersonal dysfunction and suicidal ideation and behavior. Discussion focuses on implications for the assessment of BPD.     

Multiple Personality Disorder and One Analyst's Paradigm Shift

Joseph Sandler elegantly integrated clinical experience and psychoanalytic theory in his three-box model. He unites topographical, structural, and object relations theory with the patient's experience of the lack of safety from humiliation and shame in the psychoanalytic relationship. In the three-box model, the danger of humiliation and shame is reduced by an affect of safety that is promoted by the analyst. By adding recent ideas about a developing self, I demonstrate the clinical usefulness of the three-box model.     

Moral and Metaphysical Reflections on Multiple Personality Disorder

Theoretical Medicine and Bioethics -     

Assessment and Treatment of the Schizotypal Personality Disorder

The Schizotypal Personality Disorder, first appearing as a DSM diagnosis in 1980, is not well understood by social workers and mental health rofessionals in general. Because relatively little has been written a out the disorder, it may be underdiagnosed. Social workers need to be alert to its dynamics, however, as it calls , for a treatment approach different from that of other personality disorders and schizophrenic disorders. Schizotypal clients are rigid and difficult to treat, but when properly identified can be helpful to make a better adjustment to their environments. Long-term, relationship oriented treatment is the intervention most effective with these clients.     

Inpatient Therapeutic Assessment With Narcissistic Personality Disorder

Growing evidence supporting the effectiveness of Collaborative/Therapeutic Assessment (C/TA) has led clinicians and researchers to apply C/TA to a variety of clinical populations and treatment settings. This case example presents a C/TA inpatient adaptation illustrated with narcissistic personality disorder. After a brief overview of salient concepts, I provide a detailed account of the clinical interview, test interpretation paired with diagnostic considerations specific to narcissism, planned intervention, and discussion of assessment results. Throughout the case study, I attempt to demonstrate defining features of C/TA, inpatient adaptations, and clinical techniques that encourage meaningful engagement with a “hard to reach” personality.     

Body Integrity Identity Disorder: From A Psychological to A Neurological Syndrome

Body Integrity Identity Disorder (BIID) is a condition in which individuals experience an intense desire for amputation of an healthy limb. Recently, McGeoch and colleagues provided the first direct evidence that this syndrome may be neurological rather than psychological in its origin. However, before including BIID in body ownership disorders, several concerns should be clarified, exploring other components of body representation and not only somatosensory perception.     

Psychological Test Signs of Borderline Personality Disorder: A Review of the Empirical Literature

Recent empirical work aimed at identifying test signs of borderline personality disorder is reviewed. The review focuses on commonly employed clinical tests, including the Wechsler Adult Intelligence Scale (WAIS), the Rorschach, and the Minnesota Multiphasic Personality Inventory (MMPI). Possible test signs reconsidered in relation to their sensitivity to and specificity for the diagnosis and in relation to the criteria of DSM-III, which define the disorder. Although consistent patterns of potentially useful test signs have begun to appear, methodological difficulties have hampered any subsequent development of clinically useful indices. Greater attention to sample size and its composition and definition as well as demonstrations of adequate reliability and predictive utility are required for further development of these signs.     

Validation of the Five-Factor Model Personality Disorder Prototype Counts with the Personality Assessment Inventory

Five-factor model (FFM) personality disorder (PD) prototype scores drawn from the revised NEO-Personality Inventory (NEO-PI-R) have demonstrated strong convergent validity with clinical measures of PD (Miller in Journal of Personality, 80, 1565–1591, 2012). However, an examination of the relations between the Personality Assessment Inventory (PAI; Morey 1991), which is widely used in personality assessment research, and the FFM PD prototype “count” method, has not been conducted. The present study examines the convergent validity of the FFM borderline, antisocial, and psychopathy prototype counts with the Borderline Features (BOR) and Antisocial Features (ANT) full scales and subscales from the PAI. Furthermore, the BOR and ANT scales are correlated with all 30 NEO-PI-3 facets to empirically evaluate the rationally-selected facet scales used in the borderline, antisocial, and psychopathy PD counts. Five hundred thirty-five undergraduate students completed both the NEO-PI-3 and the PAI. The PD counts demonstrated strong convergent and discriminant validity with the PAI clinical scales. Facet-level analyses generally supported the structure of the PD count formulas, and the exceptions align with previous evidence that the Competence, Dutifulness, and Self-Discipline facets (from the Conscientiousness domain of the FFM) associate strongly with the BOR scale.     

躯体变形障碍与美容整形术前心理评估

躯体变形障碍是一种并不罕见的精神障碍,其临床表现的特殊性使大多数患者以普通求术者的身份出现在美容整形科医生面前。然而,关容整形手术非但不能解决患者的心理问题,更可能引发复杂的医疗纠纷。基于躯体变形障碍在美容整形科呈高发生率的特点,文章对美容整形术前心理评估的必要性和现状进行分析,并列举了有效的评估工具以提高心理评估的准确性。     

Use of the Personality Assessment Inventory in Assessment of Posttraumatic Stress Disorder in Women

This study investigated the utility of the Personality Assessment Inventory (PAI) for the assessment of posttraumatic stress disorder (PTSD). Participants were 55 community-residing adult women who were administered a comprehensive battery that included the PAI and the Clinician-Administered PTSD Scale (CAPS). Participants were classified as either PTSD or non-PTSD based on the CAPS, and PAI profiles were compared between the two groups. Significant group differences were found for seven PAI clinical scales (Anxiety, Depression, Anxiety-Related Disorders, Somatic Complaints, Paranoia, Borderline Features, and Schizophrenia), one validity scale (Negative Impression), and two treatment scales (Nonsupport and Treatment Rejection). When all PAI scales and component subscales are considered, the largest group differences were found for the physiological subscale of the Depression scale (DEP-P) and the Traumatic Stress subscale of the Anxiety-Related Disorders scale (ARD-T). ARD-T and DEP-P also demonstrated excellent diagnostic utility. Finally, correlations between PAI scales and four CAPS symptom clusters provided additional validity evidence, in particular supporting a distinction between effortful avoidance and numbing. Taken together, these results support the use of the PAI in the assessment of PTSD.This study was the basis of a Masters thesis for Meghan McDevitt-Murphy. Portions of this study were presented at the annual meeting of the Association for Advancement of Behavior Therapy, November 2000.     

White Racial Identity Statuses and NEO Personality Constructs: An Exploratory Analysis

This study investigated the relationship between White racial identity development as proposed by J. E. Helms (1995) and the personality constructs Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness. Participants were 105 White college students (55 women and 50 men) who were administered the White Racial Identity Attitude Scale (J. E. Helms & R. T. Carter, 1993), the NEO Five‐Factor Inventory (P. T. Costa & R. R. McCrae, 1992) and the New Racism Scale (C. K Jacobson, 1985). Results indicated that White racial identity was differentially related to several personality constructs and aversive racism. Implications for future White racial identity research are discussed.