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A PCL-R, Rorschach, and PAI Investigation of Females with Sex Offenses Against Minors and a Rorschach Comparison with Male Pedophiles

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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.
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Archives of Assessment Psychology, Vol. 9, No. 1, (113-137) © 2019 American Board of Assessment
Printed in U.S.A. All rights reserved Psychology
A PCL-R, Rorschach, and PAI Investigation of Females with
Sex Offenses Against Minors and a Rorschach Comparison
with Male Pedophiles
Jason M. Smith, Psy.D., ABPP, Carl B. Gacono, Ph.D., ABAP, Aaron J. Kivisto, Ph.D.,
and Ted B. Cunliffe, Ph.D.
Abstract 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.
While more males in the United States are incarcerated for sexual assaults/rapes than
females (13.3% males vs. 2.4% females; Carson, 2018), female sexual offending is more
prevalent than previously thought (Cortoni, 2010; Goldhill, 2013; Sandler & Freeman, 2009;
Tewksbury, 2004; Vandiver & Kercher, 2004). Women exhibit sexual re-offense rates at seven
percent while it is 14 percent in males1 (Vandiver, Braithwaite, & Stafford, 2018).
Female sexual offenders tend to be in their late 20’s or early 30’s, with victims less than
12 years old (most likely an acquaintance or family member), and are predominately white
(Faller, 1995; Pflugradt & Allen, 2015; Miller & Marshall, 2018; Vandiver & Kercher, 2004;
Vandiver & Walker, 2002). These offenders tend to have been sexually assaulted as a child, have
substance abuse problems, and have been diagnosed with a psychiatric or personality disorder
(Goldhill, 2013; Green & Kaplan, 1994; Johansson-Love & Fremouw, 2009; Marshall & Miller,
2018; Mathews, Mathews, & Speltz, 1991; McCarty, 1986). Female offenders tend to commit
their sexual offenses with another, often a male accomplice, and there may be gender-specific
cognitions (Beech, Parrett, Ward, & Fisher, 2009; Burkey & ten Bensel, 2015; Cortoni, Hanson,
1 Female sexual offending may result from situational variables (DeCou, Cole, Rowland, Kaplan, & Lynch, 2015)
rather than the ingrained sexual conditioning and preference associated with male sexual offending (Gacono &
Meloy, 1994).
Smith, Gacono, Kivisto, and Cunliffe
_____________________________________________________________________________ 114
& Coache, 2009; Gannon, Hoare, Rose, & Parrett, 2012; Gannon, Rose, & Ward, 2008; Gannon
et al., 2014; Goldhill, 2013; Williams & Bierie, 2015; Wijkman, Bijleveld, & Hendriks, 2011).
Personality Measures with Sexual Offenders
Psychological measures provide unique information about personality characteristics that
contribute to sexual offending (Beauregard & DeLisi, 2018; Gacono & Meloy, 1994; Seto,
Harris, & Lalumière, 2016). For example, a correlation between internet sexual offenses and
depression have has been found utilizing the PAI, suggesting both the compensatory nature of
the behavior and its addictive quality (Laulik, Allam, & Sheridan, 2007; Magaletta, Faust,
Bickart, & McLearen, 2014). The PAI Antisocial features (ANT), Borderline features (BOR),
and Treatment Rejection (RXR) scales were also found to be elevated within male sexual
offenders with institutional misconduct and treatment non-compliance (Boccaccini, Rufino,
Jackson, & Murrie, 2013; Caperton, Edens, & Johnson, 2004).
Studies with the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway &
McKinley, 1940) have found that female sexual offenders, like their male counterparts, elevate
the Psychopathic Deviate (Pd) and Schizophrenia (Sc) scales (Davin, 1993; Hudson; 1995),
suggesting both antisocial attitudes and a high degree of cognitive distortion (both aspects of a
cognitive orientation that allows for offenders to distort interpersonal situations, rationalize,
justify, and externalize blame for their behaviors). Elevations on the Paranoid (Pa) scale also
suggest suspiciousness, sensitivity to criticism, and a tendency to personalize situations
(narcissism; Kohut, 1971). It was found that those sex offenders who offend with another scored
higher on PAI anxiety (ANX) and anxiety-related disorders (ARD) scales than solo female
offenders. Solo offenders also had higher scores on PAI aggression (AGG) and dominance
(DOM) scales (Miller & Marshall, 2018), consistent with greater psychopathic traits.
Studies with the Rorschach (RIM; 1921/1942) have found male and female psychopaths
(PCL-R 30) differ on interpersonal, affective, and self-perception variables. Males have been
found to have less desire for attachment, greater grandiosity, less (shallow) affect, and an
identification with aggression. Females tend to display dependency, have difficulty regulating
emotions, exhibit an increased sense of self with more self-criticism and a damaged view of the
self as well as identifying more with victims of aggression (Gacono, 1988, 1990; Gacono &
Meloy, 1994; Cunliffe & Gacono, 2005, 2008; Cunliffe et al., 2016; Smith, 2013; Smith,
Gacono, Cunliffe, Kivisto, & Taylor, 2014; Smith, Gacono, & Cunliffe, 2018; Smith, Gacono, &
Cunliffe, in press). Males with sexual offenses against minors (MSOAM) produced more popular
(P) responses than non-sexual offenders, consistent with their capacity for appearing normal
(Cohan, 1998).
Gacono, Bridges, and Meloy have produced the most comprehensive Rorschach research
on male sexual offenders (Bridges, Wilson, & Gacono, 1998; Gacono & Meloy, 1994; Gacono,
Meloy, & Bridges, 2000, 2008; Huprich, Gacono, Schneider, & Bridges, 2004). They found that
male pedophiles were rather banal, had a rigid cognitive style with tendencies to abuse fantasy,
avoided emotionally toned stimuli, had dependency, and had chronic oppositionality and
hostility (Bridges et al., 1998; Gacono et al., 2000, 2008; Huprich et al., 2004). Sexual homicide
perpetrators (two were female) were highly disorganized and displayed high levels of aggressive
identifications, abnormal attachment, difficulties disengaging from the environment, and higher
levels of both obsessional thoughts and reality testing impairment. Both groups were highly self-
focused.
A PCL-R, Rorschach, and PAI Investigation of Females with Sex Offenses Against Minors
_____________________________________________________________________________ 115
Rorschach Hypotheses:
1. When compared to an archival sample of males with sexual
offenses against minors (MSOAM; N = 36; Gacono, Meloy, & Bridges, 2000 [the
“nonviolent pedophile” group]), the females (FSOAM; N = 31) will display more
emotional difficulty and a poor sense of self (Females will produce more PureC,
SumC’, and MOR than the males).
2. The females will also have more difficulty related to Rorschach
Aggression Scores examining victimization compared to the males (AgC,
AgPast).
PAI descriptive data were available for 25 of the women and are displayed as a
complement to the Rorschach data. A case study is also provided to highlight the Rorschachs
usefulness in understanding personality functioning contributing to sex offending behaviors.
Method
Participants. Archival data were used for this study. Cases (years 1998-2014) were
reviewed looking for males and females with a history of sex offenses. They were excluded if
they had sex offenses against adults. The female and male groups were part of separate research
projects conducted by Doctoral Level Psychologists at various prisons and forensic hospitals in
the United States (Gacono, Meloy, & Bridges, 2008; Smith, Gacono, & Cunliffe, 2018). All
participants provided informed consent to be included in research; they did not receive any
monetary incentives and participation did not affect their sentence. The research studies were
reviewed/approved by the various institutional review/ethical boards.
All males (MSOAM; N = 36; see Table 1) were white (100%). The average age was 40.4
(range = 24-70) and the average education level was 13.7 years2. PCL-R scores were not
available for this sample; however, none of the individuals met the criteria for ASPD or had a
history of violence, consequently none were psychopathic. The mean number of Rorschach
responses was 27.22 (SD = 8.42) and for Lambda, the mean was 1.06 (SD = 0.65; F%; M = 0.47;
SD = 0.16). See Gacono, Meloy, and Bridges (2000; 2008) for more information about these
males. They were responsible for multiple victims (237 total victims; 68% male, 33% were
acquaintances).
Females with histories of sexual offenses against minors (FSOAM) were on average 35
years old with average intelligence (M = 94.65; range = 80-116). Unlike the males, PCL-R scores
were highly elevated (see Table 1). Eighteen (58.1%) had a PCL-R total score 30, seven
produced a score of 24-29, and five scored 24. The ethnicities of the sample were White
(80.6%) and Black (19.4%). Twenty-five (80.6%) reported being sexually abused as children, 19
(61.3%) were diagnosed with Posttraumatic Stress Disorder (PTSD), 22 (71.0%) were diagnosed
with at least one Personality Disorder (16 [51.6%] with Borderline Personality Disorder [BPD]
and 22 [71.0%] with Antisocial Personality Disorder).
The average victim age was 10.4 (SD = 4.92; range = 2-16). More than four in five
victims were female (26; 83.9%) and just over half were a family member (16; 51.6%). Most had
only one victim (18; 58.1%) and they tended to co-offend with a male (22; 71%).
2 Due to the nature of the archival records, not all demographic data was available (see Table 1).
Smith, Gacono, Kivisto, and Cunliffe
_____________________________________________________________________________ 116
Table 1
Demographic Data
Males
(N = 36)
Females
(N=31)
M
SD
Range
M
SD
Age
40.4
10.43
24-70
35.10
11.47
IQ
N/A
N/A
-
94.65
11.33
Education
Level
13.7
-
-
-
-
PCL-R TS
N/A
N/A
-
29.76
4.86
Responses
27.22
8.42
14-46
22.77
7.22
Lambda
1.06
0.65
0.11-
2.67
0.80
0.47
Victim Characteristics
Age
-
-
-
10.4
4.92
*Note. Some male data are not present due to it not being available. TS = total score.
Measures. The Shipley Institute of Living Scale (SILS; Shipley & Zachary, 1986) or the
Shipley-2 (Shipley, Gruber, Martin, & Klein, 2009), Psychopathy Checklist-Revised (PCL-R;
Hare, 2003), Personality Assessment Inventory (PAI; Morey, 1991), and Rorschach Inkblot Test
(CS; Exner, 2003; Rorschach, 1921/1942) were administered in accordance with procedures
outlined in the test manuals. The administration and scoring of each measure were completed by
a Doctoral Level Psychologist (Ph.D. or Psy.D.) with extensive training in the scoring,
administration, and interpretation of the measures.
The SILS/Shipley-2 was used to provide an estimate of intelligence. The Shipley
measures crystallized intelligence with the Vocabulary scale and fluid intelligence with either the
Abstraction or Block Pattern scale. The Shipley has been shown to correlate with the WAIS-R
Full Scale IQ between .85 and .87 (Shipley & Zachary, 1986). It is important to utilize a
cognitive measure when using the Rorschach as low IQ can contribute to a constricted Rorschach
protocol (Gacono, 2019; Gacono et al., 2008; Smith et al., 2018).
The Personality Assessment Inventory (PAI; Morey, 1991) is a 344-item self-report
measure of personality and psychopathology. It contains 22 non-overlapping full scales,
including 4 validity, 11 clinical, 5 treatment consideration, and 2 interpersonal scales, as well as
30 subscales. The PAI was standardized on adult samples from the community (N = 1,000) and
in mental health treatment (N = 1,265). When examining the validity of a protocol, participants
were retained for analyses only if they obtained an Infrequency (INF) score below 75T and an
Inconsistency (ICN) score below 73T (as outlined in Morey, 1991). Of the 31 participants, 26
completed the PAI and one participant was excluded based on profile invalidity, resulting in a
final sample of 25 female sexual offenders with valid PAI protocols.
The Psychopathy Checklist-Revised (Hare, 1991, 2003) was used to measure
psychopathy. This measure contains 20 items and is administered via a file review and a semi-
A PCL-R, Rorschach, and PAI Investigation of Females with Sex Offenses Against Minors
_____________________________________________________________________________ 117
structured interview (e.g., Gacono, 2005). Prior to the interview, an in-depth file review was
conducted in which medical, legal, psychiatric, and pertinent institutional files were reviewed.
During the interview the personality characteristics and antisocial behaviors were evaluated on a
three-point (0-2) ordinal scale with a total score range of 0 to 40. The inter-rater reliability
estimate (Spearman Rho) was .98 for the PCL-R total score (PCL-R TS).
All the Rorschach protocols were administered and scored per the Exner Comprehensive
System Guidelines (Exner, 2003). In addition, the Extended Aggression Scores (Aggressive
Content (AgC), Aggression Past (AgPast), Aggressive Potential (AgPot), and Sadomasochism
(SM); Gacono & Meloy, 1994), the Rorschach Oral Dependency (ROD) scale (Bornstein &
Masling, 2005), and the Trauma Content Index (TCI; Armstrong & Loewenstein, 1990) were
also scored. Twenty protocols were scored by two raters and inter-rater reliability was calculated
from these protocols. Inter-rater reliability Kappa coefficients for all Rorschach scores were in
the excellent range from .75 to 1.00 (Meyer, 1999).
Descriptive statistics were examined for the females’ Rorschach and PAI data. Then the
male and female groups were compared on the following Rorschach indices: AgC, AgPast,
WSum6, M, MOR, SumC’, Pure C, SumT, and spoiled SumT (a texture response with poor FQ,
a Cognitive Score, or MOR).
Procedure
After obtaining and excluding files, the male and female groups were compared on the
Rorschach variables mentioned above. The Statistical Package for Social Sciences (SPSS)
version 22, was used for all calculations. The data were analyzed for means, standard deviations,
median, mode, skewness, kurtosis, and ranges. Gender comparisons utilized parametric tests (t-
tests) where appropriate. Where unequal distributions and J-shaped curves rendered parametric
tests inappropriate, non-parametric statistics were employed (Chi-square, Mann-Whitney U
statistics; Viglione, 1995).
For the case study, one female was randomly selected from the 25 protocols available
that had both the PAI and the Rorschach. The Rorschach was scored with the Exner
Comprehensive System as well as for the ROD, TCI, and Extended Aggression scores. Further,
psychodynamic scoring for Kwawer (1980) Primitive Modes of Relating and the Cooper, Perry,
and Arnow (1988) Rorschach Defense Scales were completed to add to the Structural Summary.
Results
PAI3 & PCL-R Data The females tended to present themselves in a negative light
(Negative Impression Management [NIM]; M = 75.16; SD = 18.90). They endorsed significant
levels of anxiety (ANX; M = 71.56; SD = 13.20), traumatic stress (ARD-T; M = 84.04; SD =
11.92), and depressive symptoms (DEP; M = 74.28; SD = 12.97). Possibly related to the
significant symptoms of traumatic stress, the FSOAM group reported hypervigilance and
persecutory thoughts (PAR; M = 69.96; SD = 10.54). The data also suggested that they view
things in an idiosyncratic manner and were socially detached (SCZ; M = 70.76; SD = 12.52).
The highest scores among the full scales were on the Borderline features scale (BOR; M
= 77.00; SD = 13.19). All four Borderline features subscales were elevated, including affective
3 For complete PAI Data for the FSOAM group see the online supplement:
https://mfr.osf.io/render?url=https%3A%2F%2Fosf.io%2Fbzerv%2Fdownload
Smith, Gacono, Kivisto, and Cunliffe
_____________________________________________________________________________ 118
instability (BOR-A; M = 68.28), identity problems (BOR-I; M = 72.24), self-harm (BOR-S; M =
70.08), and negative relationships (BOR-N; M = 74.96). They also engaged in antisocial and
stimulus-seeking behavior and they do not take responsibility for these behaviors (ANT; M =
69.60; SD = 14.13; PCL-R item 16 Failure to Accept Responsibility for Own Actions; M = 1.73).
Alcohol and drug issues were also prominent (ALC; M = 71.88; SD = 23.51; DRG; M = 85.20;
SD = 21.53). Physical aggression appeared to be a concern (AGG-P; M = 67.32; SD = 16.86;
PCL-R item 10 Poor Behavioral Controls; M = 1.42) as did the potential for overt violence (VPI;
M = 86.00; SD = 19.14). They also viewed their environment as unsupportive (NON; M = 70.32;
SD = 11.66). Additionally, they appeared to express low levels of dominance and warmth in
relationships (DOM; M = 47.88; SD = 16.37; WRM; M = 41.88; SD = 11.88), consistent with a
disengaged, aloof interpersonal style.
Rorschach.4 The females produced an average amount of Rorschach responses (M =
22.77; SD = 7.22) and normative Lambda (M = 0.80; SD = 0.47; F%; M = 0.41; SD = 0.14).
They either lacked a consistent problem-solving style (35.5% ambitent) or tended toward
environmental engagement (38.7% extratensive), consistent with the high levels of psychopathy
in this sample, and quite different from the male pedophiles who tended to be introversive with
elevated Lambdas. They had significantly fewer human movement responses than the males (see
Table 2). The females had less resources (EA; M = 6.87) compared to their stress (es; M =
10.74). This was evident in their D scores (M = -1.19) and Adj D scores (M = - 0.71) which
would suggest their issues are long-term and characterological.
Affect. The females had difficulty modulating their affect (FC: CF+C = 0.68: 3.16
[1:4.6]) and they tended to discharge emotions impulsively (Pure C; M = 1.19; SD = 0.98).
Consequently, they utilized avoidance to deal with emotionally toned situations (Afr; M = 0.56).
Anger or oppositionality were present (S responses; M = 3.68). They produced a low number of
Blends/R (M = 0.20); however, 45% produced at least one color-shading blend (M = 0.87).
Additionally, their internal world was particularly painful and dysphoric (SumC’; M = 2.32),
characterized by rumination (SumV; M = 1.16; SumV > 0 = 61%), and feelings of anxiety and
helplessness (SumY; M = 1.06; SumY > 0 = 48%; m; M = 1.81). The female sample had
significantly more SumC’ and PureC than the male sample (see Table 2).
Interpersonal & Attachment. The Rorschach data indicated problematic interpersonal
relationships. The females tended to demonstrate a poor understanding of others (GHR: PHR: M
= 2.42: 3.42) and viewed others in an incomplete manner (H:Hd+(H)+(Hd) = M = 1.55:3.61
[1:2.3]). Consistent with their high rates of ASPD and psychopathy, they viewed themselves as
victims and externalized blame for their behaviors (AgPast; M = 1.55; AgPast > 0 = 68%; AgPot;
M = 0.52; AgPot > 0; 35%). The females produced significantly more AgC and AgPast than the
males (see Table 2). Consequently, there was little expectation that relationships will be
cooperative (COP; M = 0.77; COP > 0; 42%). They did not produce a high average of
sadomasochistic responses, but many produced at least one SM response (SM; M = 0.35; SM > 0
= 29%). Though they did not produce many Food responses (M = 0.42; Fd > 0 = 29%),
dependency was present (ROD; M = 0.25). Data also point to a desire to engage with others
(SumT; M = 1.19; T > 0 = 61%). However, most of their T responses were spoiled (e.g., poor
form quality, Cognitive Special score, morbid response, etc.; 52%), suggesting that attachment
4 For complete Rorschach data for the FSOAM group, see the online supplemental:
https://mfr.osf.io/render?url=https%3A%2F%2Fosf.io%2Fbzerv%2Fdownload
A PCL-R, Rorschach, and PAI Investigation of Females with Sex Offenses Against Minors
_____________________________________________________________________________ 119
relationships tended to disrupt their cognitive processes. Though there was no significant
difference in SumT responses between the MSOAM and FSOAM groups, the females produced
significantly more spoiled T responses than the males (see Table 2).
Table 2
Statistics for Select Comprehensive System Rorschach Variables
MSOAM
(N = 36)
FSOAM
(N = 31)
M
SD
Freq
(%)
M
SD
Freq
(%)
Statistic
p
es
Variable
AgC
2.78
1.74
33
(92%)
4.29
2.18
31
(100%)
329.00*
0.003
0.36
AgPast
0.53
0.84
12
(33%)
1.61
1.61
21
(67%)
319.00*
0.001
0.40
MOR
1.03
1.23
20
(56%)
2.39
1.87
25
(81%)
314.50*
0.002
0.38
WSum6
14.94
14.25
33
(92%)
28.55
19.36
31
(100%)
3.305***
0.002
0.80
M
4.11
2.89
36
(100%)
2.77
1.98
28
(90%)
2.099***
0.040
0.54
PureC
0.39
0.77
11
(31%)
1.19
0.98
22
(71%)
238.50*
<0.001
0.46
SumC’
0.89
0.89
22
(61%)
2.32
2.02
26
(84%)
309.00*
0.001
0.40
SumT
0.97
1.40
18
(50%)
1.19
1.38
19
(61%)
485.50*
0.332
0.12
Spoiled
T
9
(28%)
17
(56%)
5.79**
0.020
0.31
Note. * = Mann-Whitney U test; ** = χ2 test; *** = t-test; M = mean; SD = standard deviation; Freq = frequency; es
= effect size.
Self-perception. The women’s EGOI (M = 0.36) were average; however, given their
plethora of affective issues and interpersonal vulnerabilities, one would not say that their self-
worth was adequate. Lack of reflections (M = 0.35; Fr + rF = 0 = 74%), elevations of pairs (2)
(M = 6.97; SD = 4.30; pairs > 0 = 100%), and high levels of Morbid responses spoke to the
tenuous nature of their self-esteem (MOR; M = 2.39; they had significantly more than the males;
see Table 2). Defensiveness (PER; M = 2.74), somatic concerns (An + Xy; M = 1.81), traumatic
stress/dissociation (TCI; M = 0.24), and unrealistic aspirations characterized them (W: M;
8.77:2.77 [3:1]). While FD was present (FD; M = 1.16; FD > 0 = 52%), 51% of these responses
were spoiled and the presence of FD did not suggest that this group was particularly
psychologically minded. Therefore, these women tended to look inward, and this introspection
tended to be unproductive, ruminative, and ultimately disruptive.
Smith, Gacono, Kivisto, and Cunliffe
_____________________________________________________________________________ 120
Cognitive Ideation, Mediation, and Processing. The thinking problems that were
evident were comprised mainly of idiosyncratic ideation and peculiar thoughts (WSum6; M =
28.55; significantly more than the males). This cognitive slippage was symptomatic of
characterological impairment rather that psychosis (Lvl 2 > 0 = 16%). While they did not
produce many M- responses (M = 0.45), their low mean score was consistent with an
extratensive style, impaired empathy, and impulsivity. Their thinking was influenced by self-
reference, defensiveness, and derailment (DR + PER; M = 8.35). Anger appeared to distort their
perceptions (S-; M = 1.48). There was less evidence of fantasy abuse in these women, speaking
to the lack of rehearsal in their sexual offending behavior (Ma: Mp; M = 1.65:1.13). The females
appeared to have significant problems with reality testing (X-%; M = 0.23; X+%; M = 0.51;
WDA%; M = 0.77; XA%; M = 0.74). Their views were less conventional than females from non-
clinical samples (P responses; M = 5.26) and they appeared to view things inefficiently (Zd; M =
-2.02) and focused excessively on the details (W:D: Dd; 8.77:10.32: 3.68).
The following case study highlighted our group data in understanding the relationship
between the personality functioning of these women and their sexually offending behavior.
Case Study. Summer5 is a late 20’s, divorced, college-educated female born in North
America. She was diagnosed with Posttraumatic Stress Disorder (PTSD) and BPD. Consistent
with BPD, her personal and relationship histories were particularly chaotic. She has a history of
being physically abused by her ex-husband, sexually abused as a child, self-directed violence
(cutting), and significant alcohol abuse. She had multiple marriages (PCL-R Item 17 = 2; ex-
husband involved in the sexual offense) and she has no contact with her daughter (less than age
12). This sex offense which she engaged in (rape of her daughter) was her only criminal arrest.
Summer had been employed in local government. Behavioral observations and mental status
were within normal limits and her intelligence was average (Shipley-2; IQ = 99). Her
psychopathy level was moderate (PCL-R = 25.6).
Summer’s PAI protocol suggested health concerns and the presence of traumatic events
consistent with her trauma history (SOM-H; T = 70; ARD; T = 78). Hypervigilance, resentment,
and social detachment were evident (PAR; T = 70; SCZ-S; T = 71). Consistent with her
diagnosis of BPD, she elevated the Borderline features subscales related to identity problems,
affective instability, and negative relationships (BOR; T = 71). Further, due to the impulsivity of
her crime, she elevated the Antisocial and Aggression scales (ANT; T = 74; AGG; T = 69). She
had low levels of dominance and warmth which appeared to be related to her co-offending
behavior with her ex-husband (DOM; T = 47; WRM; T = 38).
5 Pseudonym
A PCL-R, Rorschach, and PAI Investigation of Females with Sex Offenses Against Minors
_____________________________________________________________________________ 121
Table 3
Rorschach Responses for Summer
Card I
1. S: A bug
CS Scoring: Wo 1 Fo A,An ZW INC
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Reaction Formation, Intellectualization
S: I guess because of this right here and the wings
E: Bug? S: because of the spine, antennas, wings, does
that make sense?
2. S: More than one thing, this may sound weird
but it looks like an award, a military award,
that’s it
CS Scoring: Ddo 99 C’Fo Art PER
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Primitive Idealization, Isolation
S: I haven’t seen many awards, they look similar,
greyish in color, metal, symmetrical on both sides
Card II
3. S: Oh hmm, I don’t know why, a pelvis bone
like a part of a skeleton, I have no idea other
than that
CS Scoring: DSo 6 C’F.VFo Xy MOR
Aggression Scoring: None
Primitive modes of relating: Boundary Disturbance
Defenses coded: Isolation
S: The whole thing other than the red kind of
E: Pelvis? S: x-ray of a pelvis
E: X-ray? S: dark and its grayish, color of gray, bone
density, diff colors of gray
Card III
4. S: More bones
CS Scoring: DSo 1 C’Fo Xy MOR
Aggression Scoring: None
Primitive modes of relating: Boundary Disturbance
Defenses coded: Isolation
S: I don’t know, arm bones, pelvis, somebody’s
ultrasound, how it is all gray
5. S: I don’t know an x-ray of something
CS Scoring: DSv 1 Y Xy
Aggression Scoring: None
Primitive modes of relating: Boundary Disturbance
Defenses coded: Isolation
S: X-ray, turns out the same way, light or dark
depending on what they are x-raying
6. S: I don’t know, the red looks like blood
splatter that you would see on a TV program,
that’s it
CS Scoring: Dv 2 m’a.Co 2 Bl PER MOR
Aggression Scoring: AgPast
Primitive modes of relating: Violent symbiosis,
separation, and reunion
Defenses coded: Projection, Isolation, Devaluation
S: I don’t know on a movie
E: Blood? Starts and runs, just runs and maybe this way
E: Splatter? Just what I have seen on TV
Smith, Gacono, Kivisto, and Cunliffe
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Card IV
7. S: A shadow umm, a bush or tree comes to
mind
CS Scoring: Wv 1 Fo Bt PER DR
Aggression Scoring: None
Primitive modes of relating: Engulfment
Defenses coded: None
S: I don’t know, the whole thing in general into the
woods
E: Shadow? Bottom tree, stump branches, shadow of a
tree some bushes
S: Stump? Looks like a stump, tree top, the top of a tree,
bushes grow weirder, need to prune or they get crazy on
you
8. S: A scary monster
CS Scoring: Wo 1 Fo (H) P ZW GHR
Aggression Scoring: AgC
Primitive modes of relating: None
Defenses coded: Projective Identification, Higher-Level
Denial
S: I don’t know, a scary monster in a closet, these look
like feet and arms
E: Scary? S: because it is big
9. S: This part up here looks like a lizard or
dragon by their head
CS Scoring: Ddo 99 FMpu (A) DV
Aggression Scoring: AgC
Primitive modes of relating: None
Defenses coded: Repression
S: This looks like a communal (sp) dragon, puffs up
E: Dragon? These are, see it’s a dragon, back puffs up a
lot, scales and kinda what it looks like scales
10. S: These look like feet
CS Scoring: Do 6 Fo Hd PHR
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: None
S: feet or boots
E: Feet? Toes, heel
Card V
11. S: A moth
CS Scoring: Wo 1 Fo A ZW DV
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: None
S: because of the whole symmetrical on both sides, moth
looks like wings
12. S: A bat
CS Scoring: Wo 1 Fo A P ZW PSV
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: None
S: Something bigger like the size, big bat or moth, same
shape
A PCL-R, Rorschach, and PAI Investigation of Females with Sex Offenses Against Minors
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13. S: Some other type of bug I don’t know about
CS Scoring: Wo 1 Fo A ZW DV
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Repression, Isolation
S: Multiple bugs with wings I don’t know about, kinda
looks like a bug
Card VI
14. S: Something that got split, looks like a crack
down the middle like something that got split,
the whole thing is symmetrical, it is the same
on both sides, someone took a piece of paper
and folded it in half
CS Scoring: Wv 1 VFo Id MOR DV
Aggression Scoring: AgPast
Primitive modes of relating: Boundary Disturbance,
Violent symbiosis, separation, and reunion
Defenses coded: Devaluation
S: Like down the middle, there is a crack, um and
something split, flows out darker and lighter, dispenses
Card VII
15. S: Bushes
CS Scoring: Wo 1 F- 2 Bt ZW PER
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Repression
S: I see two bushes, this part, each one is individual
trees, I have seen them around, a spiral
E: Bushes? S: Spirals
16. S: Looks like an aerial view of some land
CS Scoring: Wv 1 VFu Ls
Aggression Scoring: None
Primitive modes of relating: Boundary Disturbance
Defenses coded: Isolation
S: Lay it flat just took a picture of land or an island or
something, different colors, dark and light, a lot of
density
Card VIII
17. S: Kinda like, try to think of a lizard or it is
some other type of animal
CS Scoring: Do 1 Fo 2 A P DR
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Higher-level Denial
S: These here, I thought of a lizard, doesn’t look like
some type of animal, tail and body of a lizard, makes me
think of a racoon, not sure of a lizard or other type of
animal
18. S: This kinda looks like treetops
CS Scoring: Do 4 CF.YFu Bt
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: None
S: This kinda looks like treetops
E: Tree tops? S: the green, just the colors, the dark and
the light and how it comes to a point at the top
Smith, Gacono, Kivisto, and Cunliffe
_____________________________________________________________________________ 124
19. S: Someone took a sponge and sponged it with
paint
CS Scoring: Wv 1 T.C Hh,Id ALOG
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Isolation, Intellectualization,
Hypomanic Denial
S: The texture, multiple colors therefore I would say
paint and the texture looks like a sponge, makes sense
20. S: This kinda looks like a valley
CS Scoring: DSv 3 F- Ls DR
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Isolation
S: Right here, a map, land drops off a cliff
E: Valley? S: Valley came to mind first
Card IX
21. S: This kinda looks like deer horns
CS Scoring: Ddo 99 Fu 2 Ad ALOG
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Repression
S: this right here and right here because of the points, the
whole thing looks like deer horns because that is how
deer horns look like
22. S: There is a shadow in the background
CS Scoring: DSv 8 V Id
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Isolation
S: First, where it is lighter in the background
23. S: Looks like something got split in the middle
because it is darker on the inside and lighter on
the outside
CS Scoring: Dv 2 VF.TF.m’p- Id MOR
Aggression Scoring: AgPast
Primitive modes of relating: Boundary disturbance,
Violent symbiosis, separation, and reunion
Defenses coded: Devaluation, Isolation
S: Something got split, darker, lighter out here, smeared
E: Smeared? S: lighter in color, texture like a paint
brush, wet
24. S: Kinda looks like a spine down the back of it
CS Scoring: Do 5 Fo An
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Repression
S: this right here
E: Spine? S: Because it looks like vertebrae, lines in the
middle, long, I don’t know, just looks like a spine
25. S: A heart comes to mind at the bottom of it but
I don’t know why
CS Scoring: Ddo 35 CF- An
Aggression Scoring: None
Primitive modes of relating: Boundary Disturbance
Defenses coded: Isolation
S: right here
E: Heart? S: multiple chambers, its red, um I guess that’s
about it
A PCL-R, Rorschach, and PAI Investigation of Females with Sex Offenses Against Minors
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Card X
26. S: Oh my hmmm, I don’t know but I know
wishbone isn’t green but this reminds me of a
wishbone
CS Scoring: Do 10 Fo Sc MOR PER
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Rorschach Oral Dependency, Higher-
level denial, Pollyannish Denial
S: this one right here looks like a wishbone other than it
is green
E: Wishbone? S: the wishbone point in the center, bones
of it on a turkey, we don’t pull it off a turkey for
Thanksgiving
27. S: Reminds me of looking under a microscope
because these look like walnuts
CS Scoring: Do 2 FT- 2 Fd ALOG
Aggression Scoring: None
Primitive modes of relating: None
Defenses coded: Rorschach Oral Dependency,
Projection, Isolation
S: This looks like on both sides potentially like a walnut
of some sort
E: Walnut? S: This looks like, shaped like a walnuts,
kinda like a shape and looks fuzzy
E: Fuzzy? S: The strokes hard and prickly [touch]
28. S: Or a type of egg
CS Scoring: Do 2 Fo 2 An,Art DR
Aggression Scoring: None
Primitive modes of relating: Boundary Disturbance
Defenses coded: Projection, Isolation
S: It’s going to sound weird but eggs for worms
E: Eggs? S: Egg under a microscope, nuclear and cell
membranes in a cell
29. A smear on a slide
CS Scoring: Wv/+ 1 CF.YF- A,Sc,Art ZW
Aggression Scoring: None
Primitive modes of relating: Boundary Disturbance
Defenses coded: Isolation
S: Smear, some of the colors, something on a slide,
stained because bacteria, different bacteria
Smith, Gacono, Kivisto, and Cunliffe
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Figure 1
Rorschach Coding and Summary for Summer
I 1 Wo 1 F o A,An ZW INC 1
2Ddo 99 C'F oArt PER
II 3DSo 6C'F.VF oXy MO R
III 4DSo 1C'F oXy MOR
5DSv 1 Y no Xy
6Dv 2m'a.C o 2 Bl PER MO R AgPast
IV 7Wv 1 F o Bt PER DR
8Wo 1 F o (H) PZW GHR 2AgC
9Ddo 99 FMp u(A) DV AgC
10 Do 6 F o 2 Hd PHR
V11 Wo 1 F o A ZW DV 1
12 Wo 1 F o A P ZW PSV 1
13 Wo 1 F o A ZW DV 1
VI 14 Wv 1VF oId MOR DV AgPa s t
VII 15 Wo 1 F - 2 Bt ZW PER 2.5
16 Wv 1VF uLs
VIII 17 Do 1 F o 2 A P DR
18 Do 4CF.YF
uBt
19 Wv
1T.C
no Hh,Id ALOG
20 DSv 3 F
-Ls DR
IX 21 Ddo 99 F u 2 Ad ALOG
22 DSv 8V
no Id
23 Dv 2VF.TF.m'p -Id MOR AgPa s t
24 Do 5 F
oAn 1
25 Ddo 35 CF
-An
X26 Do 10 F
oSc MOR PER
27 Do 2FT - 2 Fd ALOG 1
28 Do 2 F o
2An,Art DR
29 Wv/+ 1CF.YF -A,Sc,Art ZW 5.5
A PCL-R, Rorschach, and PAI Investigation of Females with Sex Offenses Against Minors
_____________________________________________________________________________ 127
R =
29 L = 0.93 F% = 0.48 S-CON =Affect
EB: N A,
DEPI CD I
36 eb =3 : 14 Dis comf ort
Styles S tate Patho. P. Cons
EB =0 : 6 EA = 6
EBp er =
NA Very Vulnerable Afr =0.81 Afr : EB : Age
eb =3 : 14 es = 17 D = -4 Vali d AdjD PTI= 2 PC% = 0.45
EB: NA,
Adj e s =
14 Adj D = -3 D<Daj DEPI=6* ΣC':WΣC =3:6
EB: NA, CDI>3 DEPI&CDI CDI =4* in tel 30
FM = 1
Su mC' =
3SumT= 3D aj<0 DEPI >5 HVI : ns . CP =0
m =2SumV= 5SumY= 3O BS: ns . F C:CF+ C =0:5 E.im pulsive ness (1 /5)
EBt ( XP) EBt = 1 Pure C = 2 freque nt discharg e
S = 5 lateS = 2
Blends/R =6:29 Bl d% 0.21
StressBld = 3
Adj Blend =4:29
AdjBl d%
0.14
3xBl d =1
Process ing Mediati on Coding Validity >3xBl d =0
PSV =1Attention difficulty ( 1/2) a tten tio n XA% = 0.69 AGE Ca rd s Col-Shd Bld = 3
DQv 1 st = 2 C. Impul s. OR Atte ntion diff. WDA% = 0.68 L oc&D Q Shd Bld = 2
Zd =-6.5 underinc orporati ve scanni ng X-% = 0.21 DET Bl en d : EB : L
Adj Blend : EB : L
Dd =4atypi cal proces sing S- = 1FQ medi um low
Zf =7low efforts P = 3CONT
W/D =11:14 ecomoni cal e a s y:9:11 X+% = 0.55 Z s core 3xBl d % & >3xB ld
DQ+ = 0 low quality Xu% = 0.14 SpSc
DQv, v/+ =10 failures .Stp3 a FQ- H omogenei ty (6)
W/M =11:0 NA objectives 3.1stC- 0Relati ons (Perception) Col-Shd Bld : EB Shd Bld
Step3: Loc Sequence (XP), Incoherent Loc Index, ILI = 3 BC- 1/6 COP = 0 confus ion ***
CC- 5/6 AG = 0
Ideation
EB: N A,
RC- 0GHR:PHR =1 : 1 Self
EBpe r =NA PC- 5/6 a :p =1 : 2 EGO =0.24 EGO : Age : low
a/p =1 : 2 S um6= 12 S- 1/6 Food = 1 F r+rF = 0
HVI Lvl 2 = 0Dd- 1/ 6 SumT = 3 SumV = 5
OBS Wsu m6 33 M- 0H Co nt. = 2 FD = 0
MOR=6 pessimism FMm- 1/ 6 Pure H = 0 An+ Xy = 7
m=2 periphe ral ideat ion (stres s) Color- 1/3 PER = 5 MOR = 6
Shd- 1/2 Isol ° Indx =0.17
H:(H)+Hd+(Hd)
=0:2 Se lf R° NA
F- 1/3 Step 7b :Human content responses qua lity (XP)
Ma/ Mp =0 : 0 M- = 0An XySxB l - 1/6
H Con t:R:EB (I ntere st)
low
Generally Positive Features, GPF
Sum =12
µ=6
In tel° =3Mnone 0Hcont- 0Hpur:R:EB (comp°)
mis underst
Generally Negative Features,GN
Sum=0 µ =0
Self Criticism
Step 4) Adj es
distur bed thinking
3/3
Irritation Helplessness Loneliness S.Criticism
medi um
disc omfor
t
FM=1
WSu m6 : Age
NA
0
NA
Inval id AdjD
(Ws umC=0 )
Compute f or
Scori ng
Positive
10
Abandon
DEPI & CDI : RE LATIONS -> S ELF -> CONTR OLS -> AFF ECT -> PROCES SING -> MED IATION -> IDEATION
Controls
Age:
Step 1) Adj D
Ste p 2) EA
Ste p 3) EB &L
Agressive Contents
AgC 2
AgPot 0
AgPas t 3
AgV 0
IMP 0
SM 0
ROD/TCI
SumROD
2.00
ROD/R
0.07
TCI
0.38
Note. Rorschach scoring and summary for Summer using CHESSSS (Fontan et al., 2013). For the Rorschach
scoring, the ‘1’ in the second column from the right denotes a ROD response.
Smith, Gacono, Kivisto, and Cunliffe
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Rorschach Analysis. Summer’s Structural Summary supported the borderline
personality organization characterized by borderline/psychotic reality testing and idiosyncratic
thinking, damaged sense of self, entitlement, victim stance, abnormal bonding and dependency,
affective instability, impulsivity, and chronic anger of the FSOAM (see Table 3 & Figure 1). As
Summer’s protocol was administered with the CS procedures, her sequence of scores can be used
as a blueprint for understanding how she responds to novel situations, the vulnerabilities that
contribute to her sex offending behavior, and the types of dynamic issues that contribute to her
thinking problems and how she reacts to those issues (Meloy, Acklin, Gacono, Murray, &
Peterson, 1997; Schafer, 1954).
She began the task with response 1, a bug (devaluation). The introduction of this
ambiguous stimulus caused some disruption to her cognitive functioning as indicated by the
inappropriate combination. It is also a mildly devalued content when considered as reflective of
her self-worth. Response 2 can be interpreted as her reaction to Card 1 and the way she copes.
She attempted to narrow the stimulus field. However, she resorted to primitive defenses which
were not as effective (suggesting hysteria and the potential for dissociation). The result was a
biting of the tongue (C’F, an anatomy response [spine], and a defensive posture [PER]).
Although the devaluation is not technically scorable we see a glimpse of splitting in the
juxtaposition of the undesirable bug and the military award (idealization).
Card II highlighted Summer’s problems with affect. She was overwhelmed by the
introduction of color; it taps into her dysphoric internal world (MOR). While she attempts to
control her affective experience (C’F) through isolation (potential dissociation), it does not
protect her from disorganization (boundary disturbance). The response highlighted the cycle
between poor affect regulation, disorganization, and a damaged sense of self (MOR). Emotional
mastery is a basic developmental task. When it is unsuccessful, self-worth and identity suffer,
and interpersonal relationships are impaired. Further, the response has another anatomy percept
(pelvis) highlighting her anger that stems from her emotional vulnerability.
Card III began with more hard anatomy indicating her frustration in struggling with
boundary issues and difficulty with affect, and she used isolation to manage affect (potential
dissociation). What began on Response 3 continues to 4 and 5. The cumulation of the first four
responses finally contributed to severe disruptions as suggested by the formal scoring as well as
the vague form quality. Finally, on response 5, we see the complete breakdown of Summer’s
attempts to “keep it together.Formal scoring m’a.C, reveals her feeling of helplessness and
explosive affect, while the special scores highlighted her aggression and the reliance on primitive
defenses (projection, isolation, devaluation---dissociation). The impact of her inability to manage
affect is highlighted on this card; that is, her damaged sense of self (MOR; AgPast). If one feels
damaged, has poor boundaries, and cannot manage affect in a mature way (use of primitive
defenses), at the cost of cognitive distortion, certainly they will have difficulties interpersonally.
What is of note through the first five responses is the absence of Popular responses indicating
that Summer is unable to tap into social conventionality in order to pull herself together or
“appear normal.
Card IV began with a rather bland response. The card stimulates a defensive reaction
with some disorganization (PER, DR, Wv). Response 8 used a Popular to stay organized, despite
the aggressive imagery and the use of projective identification and denial. On 9, Summer gave
up her attempt to take in the entire blot by narrowing the stimulus field (Dd) to make it
manageable. Perhaps the presence of aggressive imagery is disorganizing. While using a higher-
level defense, she still evidenced cognitive disruptions (FQu, DV). She recovered on response
A PCL-R, Rorschach, and PAI Investigation of Females with Sex Offenses Against Minors
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10 by producing an ordinary detail, a simple construct, devoid of affect. What caused the
disruption on Card IV? Typically, it is viewed as a card with masculine features. We will leave
it to the reader to make inferences concerning her relationship to men, past, present and future.
Card V was relatively easy for Summer. For the most part the simplicity of the percept
allows her to avoid affect and maintain some higher-level defenses. This was midway through
the Rorschach task, and perhaps offered some relief from the experience of the first four cards
which highlighted how her energy is used to cope with affect and how affect disorganized her.
However, her relief was short-lived. On Card VI her struggles continued as highlighted by her
poor boundaries, damaged sense of self (AgPast, MOR) and her problematic relationships
(violent symbiosis). Responses 15 and 16 on Card VII continue the patterns noted prior to Card
V. We see the failure of repression (#15, FQ-) and the reversion to isolation (potential
dissociation as a means of coping).
Card VIII began with relatively healthy response due to her using a common detail, the
avoidance of color, the use of conventionality to structure her response (P), and a reliance on
higher level denial. But note this is only her second P response in the record and she does
produce a DR. Her respite was short lived as, perhaps, the impact of color (affect) impacted the
following three responses with the usual display of disruptive affect and cognitive slippage. She
did not recover on her final response (#20) as DQv, FQ-, and cognitive slippage highlighted her
difficulty with affect (Card VIII is a color card) and, perhaps, the cumulative impact of the test.
Card IX can be the most difficult for individuals who have difficulty managing dysphoric
affect. The colors tend to be less harmonious. Summer’s first response attempted to make the
stimulus more manageable, but she failed (ALOG). Response 22 was completely overwhelming
(Dqv, FQnone) and strongly suggested dissociation. Response 23 highlighted her dysphoric
internal world, her neediness, her feelings of helplessness, and her damaged sense of self. While
not the healthiest response, she did recover on #24 with the use of a common detail and higher-
level defenses. There was still a strained quality (An) to this temporary adjustment. As noted on
the final response to this card, her attempt to make things manageable (Dd) and the use of
isolation were not successful (FQ-). Card X offered more of the same. It highlighted the impact
of affect on her thinking, further supported her neediness (and its impact on reality testing, FT-
with ALOG), her damaged sense of self, and the use of primitive defenses. She ended the task on
response 29 with FQ-, boundary disturbance, and dissociation.
Overall, Summers Rorschach Sequence Analysis portrayed the way her lack of
emotional mastery and her struggles with affect sap her psychic energy, disrupt her ability to
function interpersonally, and impact her self-esteem. Summer has little left for healthy
relationships which only further contributed to her poor judgment.
Discussion
In reading Kernberg’s (1975) description of the antisocial personality, clearly, he was
describing the most severe antisocial individual or the psychopath. He posited that these
individuals, specifically the males, had severe narcissistic personality disorders organized at a
borderline level of functioning. In our study of the female sex offenders, we have found support
for at least part of Kernberg’s (1975) formulation as applied to women. Indeed, these antisocial,
mostly psychopathic women (58% scored 30 on the PCL-R), are organized at a borderline
level of functioning.
Borderline personality organization is characterized by reality testing deficits (difficulty
objectively differentiating from the internal and external world) and a reliance on primitive
Smith, Gacono, Kivisto, and Cunliffe
_____________________________________________________________________________ 130
defenses, poor impulse control, and poor anxiety tolerance (Acklin, 1997). Psychotic reality
testing and idiosyncratic thinking were quite evident in these women. Primitive defenses
(splitting, devaluation, and primitive idealization) were present in the case study of Summer.
While Summer produced higher-level defenses (i.e., neurotic; Acklin, 1997), they failed to
function in warding off threats or stabilizing primitive defenses (Gacono & Meloy, 1994; Smith
et al., 2014).
Though the males can be described as having a rigid cognitive style with tendencies to
abuse fantasy, avoiding emotionally toned stimuli, having dependency, and having chronic
oppositionality and hostility, this would not be the case for the females. The females had a less
rigid style and fantasies, displayed differences in aggression, and had difficulty regulating
emotions. Though the females had dependency like the males, the quality and presentation were
different.
Further, abundant dysphoric affect distinguished the females from the males as did the
potential for explosive emotions. The females presented with depressive symptoms and
anxiousness perhaps related to past trauma. Poor emotional regulation with explosive
emotionality may cause the female sexual offender to act impulsively on their sexual desires.
Emotional dysregulation problems likely contribute to their impulsivity, including impulsively
engaging in sexually deviant behavior. The females experienced problems with delay that further
impact their problem-solving style (unlike male pedophiles, the majority are ambitent or
extratensive). Their poor boundaries, affectivity impaired judgment, and lack of self-worth make
them easy vehicles for going along with whatever they find themselves involved with.
The females had sexual crimes that were impulsive with another co-offender, which
would be different from males whose sex crimes tend to be pre-meditated and fantasy based (p >
a; the females were also not preoccupied with sex). Further, unlike the males, the females tended
to have more idiosyncratic and peculiar thoughts related to the borderline personality
organization with them. The females’ impulsivity can be seen with their high use of alcohol and
drugs. The use of these substances to ineffectively cope with her affect, abusive relationships,
and past trauma makes her more susceptible to engage in antisocial behaviors. Related to
impulsive behaviors, she tended to have chronic anger which also caused difficulty with her
affective instability and perceptual distortions.
However, unlike the narcissism in the males, our women manifested a malignant
hysterical personality style (also see Cunliffe & Gacono, 2005, 2008; Gacono & Meloy, 1994;
Smith et al., 2014, 2018). 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 self-
criticism (Cunliffe & Gacono, 2005, 2008; Wiener, 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). There was significantly more damaged
sense of self in the females than the males suggesting lower self-worth. This makes it difficult to
have trust in the decisions they make, which may make it less likely to leave a relationship that
includes sexual offending.
Their perceptions of appropriate sexually behaviors may be inaccurate given their own
sexual abuse. The sense of self would also be present in body concerns. She is very likely to take
on a victim stance that allows her to blame others for mistakes or in this case her sexual offenses
A PCL-R, Rorschach, and PAI Investigation of Females with Sex Offenses Against Minors
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against children. The males studied were unlikely to view themselves as victims. Additionally,
the females in this sample also evidenced a sense of entitlement regarding their ego-syntonic
aggression. They tend to display the cognition that “you hurt me, I hurt you” which can help
justify sexual behavior toward children. The males had more of an ego-dystonic view of
aggression which suggests their aggressive behavior would cause stress and anxiousness when it
was displayed.
Dependency, a part of the hysterical personality, is apparent in the females’ co-offending
behavior. The attachment in the relationship, however, appears to be primitive and more related
to neediness, dissimilar to the male sexual offenders (spoiled SumT). Even when coming to
prison, the dependency/bonding problems becomes apparent, as they still state they are in love
with their co-offender even if abuse was present or they engage in unhealthy relationships with
other female inmates which mimics their other abnormal bonding patterns. This abnormal
bonding and dependency, coupled with a poor understanding of others and low levels of
dominance, allows the female sexual offender to be submissive to a co-offender.
Figure 2
Female Sexual Offender Personality Conceptualization
The females appeared to have difficulties in six areas: 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.
Additionally, they meet the behavioral criteria related to antisocial personality disorder of
irresponsibility, failing to conform to social norms, and lack of remorse. This antisocial
Smith, Gacono, Kivisto, and Cunliffe
_____________________________________________________________________________ 132
orientation (lack of empathy) coupled with their borderline organization (instability) provides
fertile ground for sex offending behavior.
The data supported the authorsclinical impressions of interacting with female sexual
offenders. Their sexually deviant behavior may be more related to poor cognitions, interpersonal
deficits, and affective instability which leads to impulsive behaviors more than an entrenched
attraction to minors. Clinically, these females tend to state affective lability as a driving force
behind many of their ineffective/illegal behaviors in and out of prison. It was common for them
to state when emotions reach a certain level there was no way to lower/regulate it and then the
behavior happened. They tended to misperceive the severity of their crime, believe that they will
win an appeal, be granted clemency, and frequently failed to understand how society regards
their crimes. Such offenders were often not cognizant of the consequences of engaging in
sexually deviant behavior or becoming involved with someone who suggested this behavior (co-
offender). They also tended to blame their co-offender, their parents, their lawyer, and past
abusers rather than themselves (failure to accept responsibility). One woman even blamed her
minor victim, saying he raped her and stated he “should burn in hell.” Therefore, the data/clinical
impressions shed light on these females which can help in assessment, treatment, and
management. Clinicians/researchers need to be aware of the subtle differences in relation male
sexual offenders.
About the Authors
Jason M. Smith, Pierpont Community and Technology College, Fairmont, WV
Correspondence concerning this article should be sent via email to Dr. Jason M. Smith, ABPP,
jmsmithpsyd(at)gmail.com
Carl B. Gacono, Private Practice, Asheville, NC
Aaron J. Kivisto, University of Indianapolis, Indianapolis, IN
Ted B. Cunliffe, Private Practice, Miami, FL
Acknowledgment: Part of this article was presented at the 2018 Society of Personality
Assessment Convention in Washington, D.C.
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The histories of incarcerated women exhibit a multitude of personality issues including psychopathy, trauma, and interpersonal dependency. Two studies were undertaken to better understand these issues with psychopathic (PCL-R ≥ 30; N = 115) and non-psychopathic (PCL-R ≤ 24; N = 53) women incarcerated for drug, theft, fraud, violence, and sex offenses. In the first study, trauma symptoms were compared on Rorschach variables, TSI-2, and PAI scales. The female psychopathic group experienced more problems related to intrusive experiences and dissociation (TSI-2, Rorschach). In the second study, interpersonal dependency was also examined with the PAI, TSI-2, and Rorschach. The psychopathic females had higher rates of interpersonal dependency (PAI, Rorschach). Based on our findings we discuss the relationship between trauma and interpersonal dependency and the meaning of these testing variables and concepts within the personality functioning of these antisocial women.
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Long before psychology, bias has existed in science. From the beginning, concerns have been raised about the reliability, validity, and accuracy of social science research (Meehl, 1954). In this chapter, we define and discuss the origins of bias and how it can erode the scientific method. We focus specifically on bias in psychological research, theory, assessment, and treatment. We discuss the range of common misconceptions and misinformation that permeates the female offender literature. Finally, we conclude with ten myths about female offenders and offer guidelines for identifying bias and how to avoid it.
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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.
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Historically, the cornerstone of the psychologist’s identity rested on providing competent in-depth psychological assessment (Rapaport, Gill, & Schafer, 1946). The ability to utilize a battery of assessment methods to elucidate complex issues makes the psychologist unique among other mental health professionals. Recent trends, however, have tarnished that cornerstone. Not surprisingly, the movement away from proficiency in psychological assessment has led to a decline in the need for psychologists. In this chapter, we discuss these harmful trends, define psychological assessment, offer a model for assessing female offenders, and provide examples of how record review, clinical interview, the Hare Psychopathy Checklist-Revised (PCL-R), Personality Assessment Inventory (PAI), and Rorschach Inkblot test can be useful with female offenders. We discuss the interpersonal aspects of the assessment process, evaluate gender specific patterns for several PCL-R criteria (also see Appendices A & B), and provide caveats for assessing female offenders. We conclude with a case study.
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In this chapter, we provide a theoretical and empirically based understanding of antisocial and psychopathic women. We begin by clarifying the differences between psychopathy, sociopathy, and ASPD, and then provide a historical perspective of hysteria. While the underlying personality of the female psychopath is paranoid, malignant hysteria is their predominant personality style (Gacono & Meloy, 1994). Overviews of the Hare Psychopathy Checklist-Revised (PCL-R), Personality Assessment Inventory (PAI), and Rorschach are offered as a refresher for those experienced clinicians and as a resource for those that are not. Finally, we present group PAI and Rorschach data (also Trauma Symptom Inventory-2 [TSI-2]) for 337 female offenders including subsets of psychopathic (N = 124) and non-psychopathic (N = 57) females. We make note of the differences between female and male psychopaths.
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In this study, PCL-R scores were used in correlational analyses with PAI scales in a sample of incarcerated women (N = 133). The total PCL-R score was significantly correlated with many PAI scales including ANT, DRG, and AGG. Categorical analyses were also used where the psychopathic women (N = 71; PCL-R ≥ 30) were significantly higher on the PAI scales of MAN, VPI, PAR, BOR, ANT, AGG, DOM; the non-psychopathic women (N = 28; PCL-R total score ≤ 24) scored higher on the RXR scale. These results further elucidate the conceptualization of female psychopathy (borderline and histrionic personality traits) and were consistent both with clinical observations, theoretical conceptualizations, and previous Rorschach research. Clinical implications were provided for working with incarcerated psychopathic women.
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In several articles, my colleagues and I have addressed concerns regarding methodological issues with the recent RIM research (see Cunliffe et al., 2012; Gacono, Loving, &Bodholdt, 2001; Smith et. al., 2018). In many studies, the impact of these issues is frequently hidden, masked in a description of statistical procedures and shrouded by the umbrella of a meta-analysis. Findings from these flawed studies influence conclusions that may appear "controversial" but are in actuality an artifact of the individual studies' inadequate design. Alarmingly, such method-related practices negatively impact the scholarly perception of the Rorschach and are frequently cited by editors for rejecting submitted Rorschach studies for publication, based largely on the presence of "controversy" which does not exist. In this brief commentary, the importance of Lambda to the generalizability of Rorschach findings is discussed.
Thesis
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Psychopathy is one of the oldest personality disorders and causes the most concern within society. The majority of the research has focused on males and little is known about female psychopathy. Fourteen female psychopaths (PCL-R ≥ 30) were studied using the Psychopathy-Checklist Revised and the Rorschach Inkblot Method with different scoring scales (Exner Comprehensive System, Rorschach Oral Dependency Scale, Gacono & Meloy Extended Aggression Scales, Cooper, Perry, & Arnow Rorschach Defense Scales, and Kwawer Primitive Modes of Relating) to examine personality structure. PCL-R scores were used to identify the psychopaths (PCL-R ≥ 30) and a data analysis was performed to provide descriptive statistics for the different Rorschach variables related to different domains: interpersonal (object relations), self-perception, affect, cognitive processing and mediation. The results were that the female psychopath has disturbances in perceptual accuracy, masochistic aggression/hostility, poor emotional control, avoidance of emotionally toned situations, dysphoric affect, an impressionistic and suggestible cognitive style, dependency, used primitive defenses and interpersonal modes of relating, somatic complaints, and a pathological self-focus accompanied with a damaged self view. Support was found for conceptualizing the female psychopath at the borderline level of personality organization with a hysterical style. These characteristics are presented as a model of the female psychopath. These results allow for a more comprehensive view of the female psychopath as well as an understanding of the importance to the construct of psychopathy, the administration of the PCL-R, treatment, and the proper administration of the Rorschach in research studies.
Article
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Exner’s (1995a) Issues and Methods in Rorschach Research provided a standard of care for conducting Rorschach research; however, the extent to which studies have followed these guidelines has not been examined. Similarly, meta-analytic approaches have been used to comment on the validity of Exner’s Comprehensive System (CS) variables without an evaluation as to the extent that individual studies have conformed to the proposed methodological criteria (Exner, 1995a; Gacono, Loving, & Bodholdt, 2001). In this article, 210 studies cited in recent meta-analyses by Mihura, Meyer, Dumitrascu, and Bombel (2013) were examined. The studies were analyzed in terms of being research on the Rorschach versus research with the Rorschach and whether they met the threshold of validity/generalizability related to specific Rorschach criteria. Only 104 of the 210 (49.5%) studies were research on the Rorschach and none met all five Rorschach criteria assessed. Trends and the need for more stringent methods when conducting Rorschach research were presented.
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The Personality Assessment Inventory (PAI; Morey, 1991) and Rorschach Inkblot Method (RIM; Rorschach, 1921) are two of the most commonly used and well-validated instruments used in forensic settings (see Gacono & Evans, 2008, Morey & Meyer, 2013). Both instruments have been found to meet standards necessary for use in court (PAI: Mullen & Edens, 2008; Rorschach: McCann & Evans, 2008, Meloy, 2008, Erard, 2012). Furthermore, several aspects of these tests make them highly complementary for clinical and forensic assessment. However, thus far there are currently few resources in the literature on how to combine these instruments for clinical practice (Charnas, Hilsenroth, Zodan, & Blais, 2010; Klonsky, 2004), let alone forensic practice. In this chapter, we first review the PAI in terms of its development, validity, and interpretation in forensic settings. We will then discuss a case example highlighting the value of synthesizing PAI and Rorschach data in forensic practice. We will conclude with the integration of the PAI with the Rorschach for forensic personality assessment.
Chapter
In this chapter, we provide a theoretical and empirically based understanding of antisocial and psychopathic women. We begin by clarifying the differences between psychopathy, sociopathy, and ASPD, and then provide a historical perspective of hysteria. While the underlying personality of the female psychopath is paranoid, malignant hysteria is their predominant personality style (Gacono & Meloy, 1994). Overviews of the Hare Psychopathy Checklist-Revised (PCL-R), Personality Assessment Inventory (PAI), and Rorschach are offered as a refresher for those experienced clinicians and as a resource for those that are not. Finally, we present group PAI and Rorschach data (also Trauma Symptom Inventory-2 [TSI-2]) for 337 female offenders including subsets of psychopathic (N = 124) and non-psychopathic (N = 57) females. We make note of the differences between female and male psychopaths.
Book
Featuring a collection of essays by leading experts, Female Sexual Offenders: Theory, Assessment and Treatment is the first book to bring together current research, clinical assessment, and treatment techniques of female sexual offenders into one accessible volume. Describes the most recent research data regarding female sexual offenders, covering such issues as female-perpetrated sexual abuse prevalence and juvenile offenders. Includes an assessment of the risk of recidivism, international treatment initiatives, and a discussion on the use of the polygraph with female sexual offenders. Features practitioner-focused essays which evaluate current assessment strategies, treatment needs, effectiveness, and processes for female sexual offenders.
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Research on justice-involved women has provided evidence for the importance of using gender-specific information in the assessment, treatment, and understanding of criminal pathways and risk of recidivism in women who have committed offenses. Although research on women who have sexually offended suggests there are differences between men and women who sexually offend, no studies have compared gender-specific and gender-neutral factors to predict recidivism with this group. The current study provided an examination of gender-specific and gender-neutral recidivism risk factors in a sample of 225 women who had sexually offended and were subsequently released from custody with an average follow-up time of about 5 years. Results of the study indicate gender-specific factors, such as mental illness symptoms and victimization history, are demonstrative of risk of reoffense in women who sexually offend. These findings provide implications for future research regarding risk assessment and more effective application of treatment for this understudied population.
Article
In this study, we examine recidivism in a cohort of 471 registered, adult female sexual offenders for an average follow-up of 18.83 years. About half (52%) of the female sexual offenders were re-arrested for a subsequent offense during the follow-up period. Nine percent were re-arrested for a violent offense, and 7 % were re-arrested for a sexual offense. Recidivists for any offense, compared to non-recidivists, were younger, had more extensive criminal histories, and were more likely to have a sexual assault as an index offense. Recidivists for violent (non-sexual) offenses, compared to non-recidivists, were younger, had more extensive criminal histories, and were more likely to have a male victim for an index offense. Recidivists for sexual offenses, compared to non-recidivists, had more prior arrests for any offense, more prior arrests for alcohol/drug offenses, and were more likely to have an acquaintance victim for an index offense. These results are compared to prior studies.
Article
Due to the smaller proportion of female sex offenders (2%-12% of all sexual offenses) compared with male sex offenders, we know much less about these women to aid in the assessment, treatment, and prevention of their offending behavior compared with men. One promising distinction in female sex offender typology is solo-offending females versus females who offend with a male co-offender. The current study uses a sample of 225 incarcerated female sex offenders to compare solo and co-offending women on variables of psychopathology, criminal history, victim and offender information, and recidivism rates. Results indicate that solo offenders are more likely to have male, unrelated victims, score higher on dominance and aggression, and are more likely to generally recidivate. Solo versus co-offending status was not a significant predictor for sexual recidivism. Implications for assessment and treatment are discussed.