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A Rorschach Investigation of Narcissism and Hysteria in Antisocial Personality
Journal of Personality Assessment
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We investigated Rorschach responses associated with narcissism and hysteria in a group of antisocial personality disordered offenders. The Rorschach protocols of 42 subjects who met the criteria from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) for antisocial personality disorder were analyzed using Exner's (1986) criteria for pairs, reflections, and personal responses, and Gacono's (1988) criteria for the impressionistic response. Severe, or primary psychopaths (n = 21), scoring greater than or equal to 30 on the Hare (1980) Psychopathy Checklist (PCL), were compared to moderate, or secondary pscyhopaths (n = 21), scoring less than 30 on the PCL. The mean number of pair and impressionistic responses did not significantly differ for the two antisocial groups. The highly psychopathic group, however, did exhibit a significantly greater mean number of reflection and personal responses. We discuss pair and reflection responses and their relationship to narcissism in psychopathic disturbance. We recommend interpreting the personal response within the context of the psychopathic character and view personal responses as expressions of narcissism and omnipotence in highly psychopathic subjects. We also hypothesize that the impressionistic responses are indicative of primitive dissociative processes and hysteria in psychopathic subjects, and that their presence provides construct validity for the work of Guze (1976) and others who suggested an underlying histrionic dimension to psychopathy.
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... Though his work was cut short by his untimely death (Gacono & Meloy, 1994), Gacono and Meloy extended Lindner's work with antisocial and psychopathic individuals. They have thoroughly explored the relationship of various Rorschach variables related to narcissism and its vicissitudes with offenders (see Gacono & Meloy, 1994;Gacono, Heaven, & Meloy, 1990;Gacono, Meloy & Bridges, 2008). Cunliffe and Gacono (2005; have extended this study to women offenders. ...
... He concluded that self-centeredness manifests differently on the Rorschach and was influenced by many factors, including characterological presentation. Gacono, Meloy, and Heaven (1990) found that severe male psychopaths (PCL-R total score ≥ 30) had a significantly higher EGOI (M = 0.46) and reflections (M = 0.86) than moderate non-psychopathic scorers (PCL-R total score < 30; EGOI M = 0.30; Fr + rF M = 0.14). There was no difference related to pairs (severe; M = 5.52; moderate; M = 5.19). ...
... There was no difference related to pairs (severe; M = 5.52; moderate; M = 5.19). Gacono et al. (1990) were conservative of their interpretations of the EGOI for male psychopaths. The low EGOI within the moderate psychopaths suggested an ineffective way of regulating their self-worth. ...
The Rorschach Comprehensive System Egocentricity Index (EGOI) and its component variables have been useful in understanding antisocial and psychopathic individuals (Gacono & Meloy, 1994; Gacono, Meloy, & Heaven, 1990). In this study, the EGOI, Personality Assessment Inventory (PAI) scales and the Psychopathy Checklist-Revised (PCL-R) were used with a sample of incarcerated women. The EGOI, Fr + rF, and pairs were examined in relation to PCL-R Items 1 (Glibness/Superficial Charm) and 2 (Grandiose Sense of Self-Worth), PCL-R Factor 1, PCL-R facet 1, and the PAI MAN-G and ANT-E scales. The EGOI and reflections were significantly correlated with PCL-R Item 1 and a combination of PCL-R Items 1 and 2. Unlike highly narcissistic male offenders where grandiosity elevates reflections and EGOI, female psychopaths (PCL-R total score ≥ 30; N = 85) and non-psychopathic females (PCL-R total score ≤ 24; N = 40), did not demonstrate a significant difference for their mean EGOI; however, female psychopaths were more likely to produce protocols with a high EGOI (≥ 0.44) with and without reflections and they had more pairs (a finding consistent with conceptual differences between male and female psychopaths). The utility of the EGOI with incarcerated women is discussed.
... This selfreferential position is further supported by the high levels of PER (MP M = 2.37; FP M = 3.28) when compared to Exner's (2007) non-patients (NP M = 0.99). This cluster B type pathology separates itself from the more heterogeneous character-disordered (CD M = 0.93) participants (Exner, 1995; also see Gacono et al., 1990). The best comparison for the PER response, however, is between psychopathic and non-psychopathic antisocial personality disordered (ASPD) individuals, where interesting differences emerge with psychopaths of both genders exhibiting the more disturbing patterns, including greater degrees of self-focus (Cunliffe & Gacono, 2005;Gacono & Meloy, 1994;Gacono et al., 1990;Smith et al., 2019Smith et al., , 2020aSmith et al., , 2021a. ...
... This cluster B type pathology separates itself from the more heterogeneous character-disordered (CD M = 0.93) participants (Exner, 1995; also see Gacono et al., 1990). The best comparison for the PER response, however, is between psychopathic and non-psychopathic antisocial personality disordered (ASPD) individuals, where interesting differences emerge with psychopaths of both genders exhibiting the more disturbing patterns, including greater degrees of self-focus (Cunliffe & Gacono, 2005;Gacono & Meloy, 1994;Gacono et al., 1990;Smith et al., 2019Smith et al., , 2020aSmith et al., , 2021a. ...
The psychopathic personality is organized at a borderline level of personality. Additionally, while male psychopaths are considered to manifest pathological narcissism, female psychopaths are best understood in terms of malignant hysteria. Using Kernberg's three components of borderline personality functioning (identity diffusion, reliance on primitive defenses, and transient lapses in reality testing),
... With the aim of advancing the multimethod assessment of grandiosity and narcissism, we took a systematic approach to the Rorschach literature to identify relevant research and theoretical efforts that we could build on (Berg, 1990;Berg, Packer, & Nunno, 1993;Blais et al., 2001;Cooper & Arnow, 1986;Cooper, Perry, & Arnow, 1988;Cooper, Perry, & O'Connell, 1991;Exner, 2003;Farris, 1988;Gacono, Meloy, & Berg, 1992;Gacono, Meloy, & Heaven, 1990;Handler & Hilsenroth, 2006;Harder, 1979;Hilsenroth, Fowler, Padawer, & Handler, 1997;Homann, 2013;H. Lerner, 1988;P. ...
... The selected scales derived from previous research have in their original form all shown reasonable interrater reliability and at least some evidence for validity (Blais et al., 2001;Cooper et al., 1988Cooper et al., , 1991Gacono et al., 1990;Gacono et al., 1992;Hilsenroth et al., 1997;Homann, 2013;P. M. Lerner & Van-Der Keshet, 1995;Wagner, 1974;Wagner & Hoover, 1971, 1972. ...
We evaluate 11 Rorschach variables with potential for assessing grandiosity and narcissism. Seven of these variables were drawn from previous literature: Omnipotence, Idealization, Reflection, Personal Knowledge Justification, Exhibitionism, Magic, and Elevated Mood States; four were developed for this research: Expanded Personal Reference, Narcissistic Devaluation, Narcissistic Deflation, and Narcissistic Denial. Using Rorschach protocols from American normative adults and Italian adult outpatients, the dimensional structure of these variables was evaluated by principal components analysis, and validity was tested by correlations with clinician ratings of narcissism on two scales from the Shedler–Westen Assessment Procedure–200 that were made after at least five sessions with the primary clinician. A cohesive dimension was found in both data sets defined by Expanded Personal Reference, Personal Knowledge Justification, Omnipotence, and Idealization, and it was meaningfully correlated with the clinician ratings of narcissism (M r = .41). Implications of the findings include the applicability of these variables in clinical practice and research for assessing narcissistic personality dynamics.
... Through a series of studies (Gacono, 1990;Gacono, Meloy, & Heaven, 1990;Gacono & Meloy, 1991, 1994, the Rorschach has proven to be a sensitive instrument to discriminate between psychopathic and nonpsychopathic subjects. Psychodynamic differences include more pathological narcissism and sadism (Gacono, Meloy & Heaven, 1990), less anxiety, and less capacity for attachment (Gacono & Meloy, 1991). ...
... Through a series of studies (Gacono, 1990;Gacono, Meloy, & Heaven, 1990;Gacono & Meloy, 1991, 1994, the Rorschach has proven to be a sensitive instrument to discriminate between psychopathic and nonpsychopathic subjects. Psychodynamic differences include more pathological narcissism and sadism (Gacono, Meloy & Heaven, 1990), less anxiety, and less capacity for attachment (Gacono & Meloy, 1991). Personality organization (Kernberg, 1984) is predominately at the borderline level (Gacono, 1990). ...
In the present chapter, we discuss the role of the Hare Psychopathy Checklist-Revised (PCL-R) and Rorschach in forensic psychological assessment. We stress the importance of using a multi-method over a mono-method assessment approach and advocate for the incremental validity of psychological testing over interviews alone as an essential aspect of assessment practice. The ability to integrate the nomothetic strengths of the PCL-R with the idiographic potential of the Rorschach allows for conclusions to be refined into nuanced person-context interactions most useful in areas such as risk assessment, forming diagnostic impressions, and determining treatability. A case example involving an incarcerated antisocial male with a history of exclusively affective violence is presented.
... As a group, and unlike male pedophiles and psychopaths where narcissism and a grandiose self-structure organize their personality, these women also elevated the EGOI without producing reflections but rather by elevating pairs, suggesting more selfcriticism (Cunliffe & Gacono, 2005, 2008Wiener, 2003). The pair response may be related to twinship, a form of narcissism that refers to an innate need to be accepted by others (Gacono, Meloy, & Heaven, 1990;Kohut, 1971); contrasted with the arrogant narcissistic functioning exhibited in males (Kernberg, 1975). Their damaged view may be related to their past abuse and traumatic events (81% had sexual abuse as children). ...
In this study, the Psychopathy Checklist-Revised (PCL-R), the Rorschach, and the Personality Assessment Inventory (PAI) were used to elucidate the personality functioning of incarcerated females with sex offenses against minors (FSOAM; N = 31). There was significant convergence among the PCL-R, PAI, and Rorschach data. Both the PAI and Rorschach suggested: 1) borderline/psychotic reality testing and idiosyncratic thinking; 2) damaged sense of self, entitlement, and victim stance; 3) abnormal bonding and dependency; 4) affective instability; 5) impulsivity; and 6) chronic anger. Our comparison with a sample of male pedophiles (N = 36) highlighted gender specific issues with the women. Specifically, the women had more emotional deficits, ego-syntonic aggression, idiosyncratic thinking, and inappropriate attachments. A case study and our findings suggest a conceptual model for understanding the dynamics that result in female sexual offending behavior.
Murder is antithetical to any traditional conceptualization of femininity or the nurturer role. Women do, however, commit murder, as well as a plethora of other heinous offenses. Understanding the personality of women who murder is of both clinical and scientific interest. In this study, we present the PCL-R, PAI, and Rorschach data of 24 incarcerated women who have murdered. We explored the interpersonal, affective, cognitive, and self-concept vulnerabilities that contributed to this behavior within the female offender model. The results were placed within societal contexts (i.e., media) as well as providing recommendations for assessment and treatment of this population.
Despite the perception that women do not commit sexual offenses, female offenders engage in sexual homicide, sexually assault their students or their own children, and, at times, work with co-perpetrators to sexually aggress against their victims. Few studies have used psychological tests to psychometrically map the personality of female sexual offenders. In this chapter, we use the PCL-R, PAI, and Rorschach in studying a sample of female sexual offenders with offenses against minors (N = 39). These women evidenced (1) borderline reality testing, defenses, & thinking; (2) a damaged sense of self (entitlement & victim stance); (3) abnormal bonding and pseudo-dependency (maladaptive neediness); (4) affective instability; (5) impulsivity; and (6) chronic anger couched within a malignant hysterical style that masks an underlying paranoid position. Descriptive personality measure data and two case examples are presented to highlight the dynamics of their offending behavior.
Millon Adolescent Personality Inventory differential diagnosis of disruptive behavior disorder vs no behavior disorder was investigated. Results were twice cross-validated. Millon adolescent Scales 4, 5, 6, G, SS, and TT were closely related to diagnosis of behavior disorder. Two psychometric rules averaged 70% hits and 35% false positives over three samples, Rule 1 of >2 elevations (baserate score >63) among Scales 6-G-SS-TT and Rule 2 of Scale 4 elevated with Scale 5 or with one of 6-G-SS-TT. An ancillary rule was highly specific to behavior disorder (90%). Two broad dimensions or factors appeared to be represented in the key scales; Scales 4 and 5 exemplified a histrionic-narcissistic factor, while the 6-G-SS-TT combination typified behavioral conflict and instability.
La psicopatía ha sido un tema que ha atraído la atención de los profesionales en el ámbito de la salud mental desde la antigüedad. El comportamiento agresivo e impulsivo, las dificultades para relacionarse con otros y la transgresión de normas suelen ser unos de los principales indicadores de la presencia de este trastorno en los individuos. La Psychopathy Checklist-Revision (PCL-R) se había conocido como el instrumento comúnmente empleado para el diagnóstico de esta grave alteración de la personalidad; sin embargo, en los últimos años se ha sugerido el uso de técnicas proyectivas debido a la distorsión que los propios evaluados pueden hacer de los test psicométricos. El objetivo de la presente investigación será explorar en la literatura científica reciente los estudios publicados en población psicopática en la cual se haya empleado el test de Rorschach, para sintetizar los resultados y conclusiones alcanzadas.
O presente estudo investigou a dinâmica do funcionamento psíquico de indivíduos com traços narcisistas que apresentaram respostas de reflexo no método de Rorschach, mas com diferentes níveis de adaptação. Foram considerados dois homens com idades de 28 e 44 anos, com características sociodemográficas semelhantes, mas com adaptação social diferenciada. Os dados foram extraídos do material do arquivo de uma instituição do Poder Judiciário, cujas avaliações foram realizadas com fins periciais distintos. Os resultados evidenciaram diferenças nas variáveis relacionadas ao controle e tolerância ao estresse, ao ajustamento perceptivo, à autopercepção e à percepção interpessoal. Conclui-se a importância de se considerar a integração das variáveis que compõem esses agrupamentos, as limitações para a descrição e previsibilidade de comportamentos e a necessidade de indicadores externos ao teste para confirmar a validade clínica dos achados em avaliações realizadas no contexto judiciário
This is a brief report on the first stage of a longitudinal study of criminal psychopathy. The data to be presented are the criminal records of several hundred predominantly white, male criminals who took part in at least one of our psychophysiological studies from 1964 to 1974. The records were obtained from the RCMP Fingerprint Service (FPS) files, which contained a listing of charges, convictions, and dispositions from the time of first appearance in adult court until December 31, 1975. A later report will describe the criminal histories of around 500 male criminals from their first appearance in adult court until 1982.
THE WIDESPREAD concern over the apparently increasing crime rate needs no documentation. The extent of criminal behavior may be suggested by the following quotation from the 1967 report entitled The Challenge of Crime in a Free Society of the President's Commission on Law Enforcement and Administration of Justice. "In the United States today, one boy in six is referred to the juvenile court. A Commission survey shows that in 1965 more than two million Americans were received in prisons or juvenile training schools, or placed on probation." The report estimates that the annual cost of crime in the United States is about 21 billion dollars, of which about 4.2 billion dollars are for public expenditures such as police, courts, and prisons.
The role of psychiatry in understanding and modifying this extensive and costly criminal behavior is not clear and is a subject of controversy. Since 1959, the senior author
The authors review Yochelson and Samenow's (1977) model of the criminal mind. They propose a levels hypothesis for understanding the relationship among object relations, defensive operations, and the conscious cognitive-behavioral style of the psychopath. They advocate the addition of an explicit psychodynamic dimension to Yochelson and Samenow's model. A hypothetical case is presented to illustrate the relationship between unconscious defense process and conscious cognitive-behavioral style of the psychopathic personality.
This paper describes an early phase in the development of new research scale for the assessment of psychopathy in criminal populations. The scale is meant to be a sort of operational definition of the procedures that go into making global ratings of psychopathy. While the interrater reliability of these ratings is very high ( > 0.85) they are difficult to make, require a considerable amount of experience, and the procedures involved are not easily communicated to other investigators. Following a series of analyses, 22 items were chosen as representative of the type of information used in making global ratings. Two investigators then used interview and case-history data to complete the 22-item checklist for 143 male prison inmates. The correlation between the two sets of total checklist scores was 0.93 and coefficient alpha was 0.88, indicating a very high degree of scale reliability. The correlation between the total checklist scores and global ratings of psychopathy was 0.83. A series of multivariate analyses explored the factorial structure of the scale and demonstrated its ability to discriminate very accurately between inmates with high and low ratings of psychopathy. Preliminary indications are that the checklist will hold up well to crossvalidation.