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.     

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.     

The Rorschach Ego Impairment Index: prediction of treatment outcome in a child psychiatric population

In this study, we investigated the treatment utility of the revision of Perry and Viglione's (1991) Rorschach Ego Impairment Index (EII-2) in a sample of 53 child psychiatric inpatients. Parent ratings of symptomatic functioning on the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) were obtained at admission, 30 days postdischarge, and 120 days postdischarge. EII-2 scores correlated with initial symptom elevations on the Critical Pathology at admission. EII-2 scores did not predict short-term response to treatment. However, EII-2 scores demonstrated moderate correlations with long-term outcome and relapse. EII-2 was related to prediction of worsening of symptoms between 30-day and 120-day follow-up as measured by Reliable Change Index scores that were computed for the Externalizing, Internalizing, Critical Pathology, and Total DSMD scales.     

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.     

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.     

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.     

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.     

Cross-Cultural Validation of the Rorschach Developmental Index

The Developmental Index (DI) has recently been introduced as a composite Rorschach measure of psychological development and maturation, which can be used both with the Comprehensive System (Exner, 2003), and with the recently developed Rorschach Performance Assessment System (Meyer, Viglione, Mihura, Erard, & Erdberg, 2011). As the DI is new, and its validity has not yet been investigated with independent non-U.S. samples, we tested the correlation between DI and age using 3 relatively large samples, 2 of which were from outside the United States (total N = 902). Other Rorschach variables presumably associated with maturation, such as complexity and productivity, were also investigated. As expected, the DI significantly correlated with age, with small variations across the 3 samples. Importantly, the correlation between DI and age remained statistically significant also after controlling for productivity (i.e., the number of responses) and complexity.     

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     

A Comparison of New and Revised Rorschach Measures of Schizophrenic Functioning in a Serbian Clinical Sample

We empirically evaluated indexes derived from the Rorschach Comprehensive System (CS) and the Rorschach Performance Assessment System (R–PAS) that are used for the assessment of psychotic functioning in schizophrenia. We compared the Perceptual Thinking Index (PTI) and the Ego Impairment Index (EII–2) with their revised versions: Thought and Perception Composite (TP–Comp) and EII–3. We evaluated their predictive validity for differentiating schizophrenic from nonschizophrenic patients in a Serbian sample. The sample consisted of 211 (109 men and 102 women, 18–50 years old) inpatients in Serbia who were divided into 2 groups: schizophrenic (100) and nonschizophrenic (111). Test administration, coding, and form quality classification followed CS guidelines. Logistic regression analysis indicated that the new indexes TP–Comp and EII–3 have slightly better predictive power than their counterparts, PTI and EII–2, in identification of schizophrenia, and that TP–Comp performed better than other indexes, although all 4 indexes were successful in differentiating these groups. The results supported the use of TP–Comp in diagnosis of schizophrenia and generally provided evidence for the utility of the Rorschach in evaluating psychosis and for its use in a cross-national context.     

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.     

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.     

Weighing evidence for the Rorschach's validity: a response to Wood et al. (1999)

Wood, Nezworski, Stejskal, Garven, and West (1999) challenged Ganellen's (1996) characterization of the revised Rorschach Depression Index (DEPI; Exner, 1991) as a promising psychometric marker of depression that deserves serious attention by researchers and clinicians. To the contrary, however, a careful examination of existing studies indicates that no compelling empirical evidence exists indicating that Ganellen's conclusions should be modified at the present time, although no firm conclusions about the DEPI can be reached until further evidence accumulates. Furthermore, although Wood et al. (1999) suggested that evidence supporting the reliability and validity of the Rorschach in general is weak, ample evidence exists demonstrating that the Rorschach can be scored reliably (Meyer, 1997), that Rorschach variables in general have respectable levels of criterion-related validity (Bornstein, 1996; Hiller, Rosenthal, Bornstein, Berry, & Brunnel-Neuleib, 1999), and that the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) and Rorschach have comparable levels of criterion-related validity, with the MMPI outperforming the Rorschach in certain respects and the Rorschach outperforming the MMPI in others (Bornstein, 1999; Hiller et al, 1999).     

An evaluation of the effects of Rorschach EB style on the diagnostic utility of the Depression Index

Several empirical studies have found the Rorschach Depression Index (DEPI) to have questionable diagnostic utility. Studies using adolescent samples suggest that the DEPI has limited sensitivity and fails to differentiate effectively between adolescents with and without depression diagnoses. The present study was conducted to evaluate Viglione, Brager, and Haller's suggestion that the DEPI may have better discriminative ability for individuals with extratensive problem-solving styles, measured by the Rorschach EB (Erlebnistypus) variable, compared to those with introversive and ambitent styles. Comparisons were conducted between adolescents with depression-related diagnoses and adolescents with other diagnoses for each of the three EB groups. The results failed to support the hypothesized greater discriminative power of DEPI for depressed extratensives, and suggest caution in using the DEPI to evaluate adolescent depression.     

Mirroring Activity in the Brain and Movement Determinant in the Rorschach Test

Human movement (M) responses to the Rorschach are related to cognitive sophistication, creativity, and empathy. Recent studies also link Ms to EEG-mu suppression, an index of mirroring activity in the brain. In this article, we further investigate the link between Ms and mu suppression by testing some clinical interpretative distinctions. Previously collected EEG data recorded during the administration of the Rorschach were reanalyzed. We hypothesized that (a) among several responses investigated, only M would be associated with mu suppression, and (b) Ms with active movement, ordinary form quality, or whole human figures would be most strongly associated with mu suppression. Hypothesis 1 was fully confirmed, thus supporting that the traditional interpretation of M has a neurobiological foundation. Hypothesis 2 was partially confirmed; that is, active Ms were associated with mu suppression more strongly than passive Ms (p < .05), but no other significant differences emerged. Clinical implications are discussed.     

The Validity of the Rorschach and the Minnesota Multiphasic Personality Inventory: Results from Meta-Analyses

Results from meta-analyses have been widely cited to defend the validity of the Rorschach. However, the meta-analyses have been flawed. For example, one meta-analysis included results that were obtained by calculating correlations but not results that were obtained by conducting t tests or analyses of variance. When we reanalyzed the data from the most widely cited meta-analysis (Parker, Hanson, & Hunsley, 1988), we found that for confirmatory studies (also called convergent-validity studies), the Minnesota Multiphasic Personality Inventory (MMPI) explained 23% to 30% of the variance, whereas the Rorschach explained only 8% to 13% of the variance. These results indicate that the Rorschach is not as valid as the MMPI.     

A Rorschach study of oral dependence in alcoholics and depressives

Despite the strong association between alcoholism and orality in psychoanalytic theory, use of the Rorschach Inkblot Test to provide empirical support for such a link has yielded decidedly mixed results. However, Masling's Rorschach Oral-Dependency (ROD) scale has shown twice that people with alcoholism give more oral-dependent responses on the Rorschach than matched comparison groups (Bertrand & Masling, 1969; Weiss & Masling, 1970), which is supportive of classical analytic theory. In this study, we investigated alcohol groups, depression groups, and "normal" undergraduates with the ROD scale and found that the 2 clinical groups produced higher ROD scores than the undergraduates. In addition, recent studies by Duberstein and Talbot (1993) and Fowler, Hilsenroth, and Handler (1996) provide evidence for an object relations model of dependency that suggests that a balance between anaclitic dependence and complete independence, in which dependency needs are acknowledged but are not overwhelming, is most adaptive. This model of dependency was evaluated; it was found that a simple difference in group means provided a better fit with the data, although some evidence of an object relations model also was found. Finally, Rorschach and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) levels of general defensiveness and primary process manifestations in Rorschach content were investigated to assess whether participants were responding defensively to the testing and whether there were any differences in the nature of oral-dependent responses between the clinical groups.     

Beyond “Objective” and “Projective”: A Logical System for Classifying Psychological Tests: Comment on Meyer and Kurtz (2006)

Using a diverse sample of 4,786 protocols obtained with the Rorschach Performance Assessment System (Meyer, Viglione, Mihura, Erard, &; Erdberg, 2011), we provide a contemporary overview of how people organize Rorschach's inkblots into identifiable regions while formulating responses. After examining how frequently each location was used across all cards in this sample, we examined the consistency of their use by computing parallel information in 17 samples (N = 4,701) obtained using the Comprehensive System (CS; Exner, 2003), including clinical, nonclinical, and adult, child, and adolescent data. Even though the CS data could only record a single location for each response, the average correlation of location use across samples was .96. The results also document continuous dimensionality in use rather than any discontinuities that would demarcate a boundary between common and uncommon locations. Implications of this notable reproducibility and dimensionality are discussed for future conceptualization of location typicality, including location coding considerations and possibilities for improved measures of perceptual fit.