Anxiety sensitivity: relations to psychopathy, DSM-IV personality disorder features, and personality traits.

Relatively few data are available concerning the relations between anxiety sensitivity (AS) and both abnormal and normal personality traits. In particular, little is known about the associations between AS and personality disorders, although Shostak and Peterson [Behav. Res. Ther. 28 (1990) 513.] hypothesized that AS would be negatively correlated with antisocial personality disorder (ASPD) and perhaps related conditions (e.g., psychopathy). We examined the relations between AS, as assessed by the AS Index (ASI), and measures of psychopathy/ASPD, personality disorder features. and personality traits in a sample of 104 undergraduates. The ASI was not significantly associated with global measures of psychopathy or ASPD, although it was negatively correlated in some cases with the core affective deficits of psychopathy. In addition, the ASI was positively correlated with features of several Clusters B (e.g., borderline) and C (e.g., dependent) personality disorders and with features of passive-aggressive personality disorder. In addition, the ASI was positively associated with measures of several normal-range personality traits, including trait anxiety, alienation, well being, Negative Emotionality, and Constraint. Some, although not all, of the abnormal and normal personality correlates of the ASI were attributable to the variance shared by the ASI with trait anxiety measures. Implications and limitations of the present findings for the correlates and etiology of AS are outlined.

Coming to grips with negative evidence for the Comprehensive System for the Rorschach: a comment on Gacono, Loving, and Bodholdt; Ganellen; and Bornstein.

The Comprehensive System (CS; Exner, 1991, 1993) for the Rorschach is currently engulfed in controversy. This comment article responds to 3 articles by Rorschach proponents in this issue of the Journal of Personality Assessment. Contrary to the claims of Gacono, Loving, and Bodholdt (this issue), CS scores do not bear a well-demonstrated relationship to psychopathy, antisocial personality disorder, or conduct disorder. Contrary to the claims of Ganellen (this issue), both the original and the revised CS Depression Index (Exner, 1993) bear little or no relationship to depression diagnoses. Furthermore, the scoring reliability of some CS scores is problematic. Although we agree with Bornstein (this issue) that Rorschach scores generally bear little or no relation to psychiatric diagnoses or self-report questionnaires, we believe this lack of relationship tends to disconfirm hypotheses concerning the validity of the Rorschach. In the spirit of the philosopher Sir Karl Popper, the Rorschach community should not minimize negative evidence or engage in post hoc arguments to immunize the CS against falsification.

Science and pseudoscience in the development of eye movement desensitization and reprocessing: implications for clinical psychology.

The enormous popularity recently achieved by Eye Movement Desensitization and Reprocessing (EMDR) as a treatment for anxiety disorders appears to have greatly outstripped the evidence for its efficacy from controlled research studies. The disparity raises disturbing questions concerning EMDR's aggressive commercial promotion and its rapid acceptance among practitioners. In this article, we: (1) summarize the evidence concerning EMDR's efficacy; (2) describe the dissemination and promotion of EMDR; (3) delineate the features of pseudoscience and explicate their relevance to EMDR; (4) describe the pseudoscientific marketing practices used to promote EMDR; (5) analyze factors contributing to the acceptance of EMDR by professional psychologists; and (6) discuss practical considerations for professional psychologists regarding the adoption of EMDR into professional practice. We argue that EMDR provides an excellent vehicle for illustrating the differences between scientific and pseudoscientific therapeutic techniques. Such distinctions are of critical importance for clinical psychologists who intend to base their practice on the best available research.

The Rorschach test in clinical diagnosis: a critical review, with a backward look at Garfield (1947).

The present article comments on a classic study by Garfield (1947) then reviews research on the Rorschach and psychiatric diagnoses. Despite a few positive findings, the Rorschach has demonstrated little validity as a diagnostic tool. Deviant verbalizations and bad form on the Rorschach, and indices based on these variables, are related to Schizophrenia and perhaps to Bipolar Disorder and Schizotypal Personality Disorder. Patients with Borderline Personality Disorder also seem to give an above-average number of deviant verbalizations. Otherwise the Rorschach has not shown a well-demonstrated relationship to these disorders or to Major Depressive Disorder, Posttraumatic Stress Disorder (PTSD), anxiety disorders other than PTSD, Dissociative Identity Disorder, Dependent, Narcissistic, or Antisocial Personality Disorders, Conduct Disorder, or psychopathy.

A meta-analytic review of the relation between antisocial behavior and neuropsychological measures of executive function.

Previous narrative reviews of the relation between antisocial behavior (ASB) and neuropsychological tests of executive functioning (EF) have raised numerous methodological concerns and produced equivocal conclusions. By using meta-analytic procedures, this study attempts to remedy many of these concerns and quantifies the relation between ASB and performance on six reasonably well validated measures of EF. Thirty-nine studies yielding a total of 4,589 participants were included in the analysis. Overall, antisocial groups performed .62 standard deviations worse on EF tests than comparison groups; this effect size is in the medium to large range. Significant variation within this effect size estimate was found, some of which was accounted for by differences in the operationalizations of ASB (e.g., psychopathy vs. criminality) and measures of EF. Evidence for the specificity of EF deficits relative to deficits on other neuropsychological tasks was inconsistent. Unresolved conceptual problems regarding the association between ASB and EF tests, including the problem of localizing EF tests to specific brain regions, are discussed.

The Scientific Status of Projective Techniques.

Although projective techniques continue to be widely used in clinical and forensic settings, their scientific status remains highly controversial. In this monograph, we review the current state of the literature concerning the psychometric properties (norms, reliability, validity, incremental validity, treatment utility) of three major projective instruments: Rorschach Inkblot Test, Thematic Apperception Test (TAT), and human figure drawings. We conclude that there is empirical support for the validity of a small number of indexes derived from the Rorschach and TAT. However, the substantial majority of Rorschach and TAT indexes are not empirically supported. The validity evidence for human figure drawings is even more limited. With a few exceptions, projective indexes have not consistently demonstrated incremental validity above and beyond other psychometric data. In addition, we summarize the results of a new meta-analysis intended to examine the capacity of these three instruments to detect child sexual abuse. Although some projective instruments were better than chance at detecting child sexual abuse, there were virtually no replicated findings across independent investigative teams. This meta-analysis also provides the first clear evidence of substantial file drawer effects in the projectives literature, as the effect sizes from published studies markedly exceeded those from unpublished studies. We conclude with recommendations regarding the (a) construction of projective techniques with adequate validity, (b) forensic and clinical use of projective techniques, and (c) education and training of future psychologists regarding projective techniques.

The Rorschach Inkblot Test: a case of overstatement?

In the 1940s, inflated claims were often made regarding the Rorschach Inkblot Test. Over half a century later, overstatements regarding the test are still common. The present article identifies problems with the Rorschach regarding norms, cultural sensitivity, interrater reliability, test-retest reliability, validity, factor structure, and accessibility of supporting studies. Contrary to overstated claims made on behalf of the Rorschach, the test continues to be a highly problematic instrument from a psychometric standpoint.

A preliminary investigation of the construct of psychopathic personality (psychopathy) in chimpanzees (Pan troglodytes).

Although the construct of psychopathy has received considerable attention in humans, its relevance to other animals is largely unknown. We developed a measure of psychopathy for use in chimpanzees (Pan troglodytes), the Chimpanzee Psychopathy Measure (CPM), and asked 6 raters to complete this index on 34 chimpanzees. The CPM (a) demonstrated satisfactory interrater reliability and internal consistency; (b) exhibited marginally significant sex differences (males > females); (c) correlated positively with measures of extraversion, agreeableness, and observational ratings of agonism, sexual activity, daring behaviors, teasing, silent bluff displays, and temper tantrums, and negatively with observational ratings of generosity; and (d) demonstrated incremental validity above and beyond a measure of dominance. Although further validation of the CPM is needed, these findings suggest that the psychopathy construct may be relevant to chimpanzees.

The association between anxiety and psychopathy dimensions in children.

Although several theoretical models posit that low levels of anxiety are a risk factor for psychopathy and antisocial behavior, a number of studies have reported elevated levels of anxiety among antisocial individuals. Nevertheless, most investigators in this literature have not distinguished between fearfulness and trait anxiety or attempted to separate the antisocial lifestyle dimension from the callous and unemotional dimension of psychopathy. In a study of clinically referred children (N = 143), we found that (a) measures of trait anxiety and fearlessness (low fearfulness) exhibited low correlations; (b) conduct problems tended to be positively correlated with trait anxiety, whereas callous and unemotional traits tended to be negatively correlated with trait anxiety; and (c) controlling statistically for the effects of one dimension increased the divergent correlations of the other dimension with both trait anxiety and fearful inhibition. These findings bear potentially important implications for the diagnosis and etiology of psychopathy and antisocial behavior and suggest that distinctions between trait anxiety and fearful inhibition, as well as between the two dimensions of psychopathy, may help to clarify longstanding confusion in this literature.

Dissociative identity disorder and the sociocognitive model: recalling the lessons of the past.

In a recent article in this journal, D. H. Gleaves (1996) criticized the sociocognitive model (SCM; N. P. Spanos, 1994) of dissociative identity disorder (DID) and argued in favor of a posttraumatic model (PTM) in which DID is conceptualized as a consequence of childhood abuse and other traumatic events. The present authors demonstrate that (a) many of Gleaves's arguments were predicated on misunderstandings of the SCM, (b) scrutiny of the evidence regarding the psychopathology and assessment of DID raises questions concerning the PTM's conceptual and empirical underpinnings, (c) the treatment literature suggests that iatrogenic factors play an important role in the etiology of DID, and (d) the evidence linking child abuse to DID is more problematic than implied by Gleaves. The present authors conclude that Gleaves's analysis underemphasized the cultural manifestations of multiple role enactments and that the history of DID imparts a valuable lesson to contemporary psychotherapists.

Essentialism revisited: evolutionary theory and the concept of mental disorder.

J. C. Wakefield's (1999) elaboration of his harmful dysfunction analysis (HDA) of mental disorder does little to address previous criticisms (S. O. Lilienfeld & L. Marino, 1995) and instead reveals further conceptual weaknesses in his position. The authors demonstrate that (a) a Roschian analysis can account for the results of all of Wakefield's conceptual experiments and predicts a number of judgments of disorder not predicted by the HDA, (b) the HDA is incapable in many cases of providing a scientifically nonarbitrary distinction between disorder and nondisorder, and (c) the HDA cannot account for failures of cultural ex adaptations, mismatches between evolutionary design and novel environments, or defenses against threat. The authors argue that the HDA has been convincingly falsified and discuss the failure of essentialistic concepts to resolve controversies in other domains of biological science.

Eye Movement Desensitization and Reprocessing: an analysis of specific versus nonspecific treatment factors.

Incremental validity and incremental efficacy have become important issues in the evaluation of psychological assessment and intervention procedures. Incremental validity in assessment is that shown by novel measures over and above established ones. Incremental efficacy is that shown by novel treatments over and above nonspecific and established treatment effects. In this paper, we critically examine the question of whether Eye Movement Desensitization and Reprocessing (EMDR) possesses efficacy above and beyond nonspecific treatment effects and components that are shared with well-established interventions. A review of recently published efficacy studies reveals that (a) the effects of EMDR are largely limited to verbal report indices, (b) eye movements and other movements appear to be unnecessary, and (c) reported effects are consistent with nonspecific treatment features. Examination of individual studies shows that control procedures for nonspecific features have been minimal. We analyze EMDR for nonspecific treatment features and suggest experimental controls to examine the incremental efficacy of EMDR.

The relation of the MMPI-2 Pd Harris-Lingoes subscales to psychopathy, psychopathy facets, and antisocial behavior: implications for clinical practice.

Little is known concerning the correlates of the MMPI-2 Psychopathic deviate (Pd) Harris-Lingoes subscales. In four studies with undergraduates, Pd2 (Authority Problems) emerged as the most consistent marker of psychopathy and antisocial behavior and was the only Pd subscale to assess the callousness traditionally associated with psychopathy. Pd3 (Social Imperturbability) correlated highly with social potency and was the only Pd subscale to consistently assess low anxiety proneness. Pd1, Pd4, and Pd5 (Familial Discord, Social Alienation, and Self-Alienation, respectively) correlated highly with externalization of blame but exhibited few differential correlates. Pd2 exhibited statistically significant levels of incremental validity above and beyond all other Pd subscales in the prediction of global psychopathy and antisocial behavior. These findings indicate that several Pd subscales assess markedly different facets of psychopathy and suggest that consideration of different Pd subscale elevations may hold important implications for clinical practice and assessment.

Identifying inmates at risk for disciplinary infractions: a comparison of two measures of psychopathy.

Poythress, Edens, and Lilienfeld (1998) recently reported a moderately strong correlation between Hare's (1991) Psychopathy Checklist-Revised (PCL-R) and a newly developed self-report measure of psychopathy, the Psychopathic Personality Inventory (PPI) of Lilienfeld and Andrews (1996), in an ethnically diverse sample of 50 inmates from a youthful offender prison. The present study reports follow-up data regarding disciplinary infractions in this sample and examines the utility of the PCL-R and PPI for identifying those at risk for institutional misbehavior. Generally modest, but statistically significant, correlations were obtained between both measures and indices of aggressive institutional behavior. Multiple regression analyses revealed that both measures accounted for common variance in the criterion but that neither accounted for significant unique variance. Results are discussed in terms of the clinical utility of these measures in populations of young offenders.

Methodological advances and developments in the assessment of psychopathy.

The last decade has witnessed a number of significant methodological advances and developments in the assessment of psychopathy. The Psychopathy Checklist-Revised and the two-factor model of psychopathy have facilitated the assessment of psychopathy and clarified the differential correlates of the personality- and behavior-based operationalizations of this syndrome. Although preliminary evidence suggests that certain features of psychopathy may be underpinned by a latent taxon, the categorical versus dimensional status of psychopathy requires clarification. Researchers have accorded increasing attention to the assessment of psychopathy in non-criminal samples, although the construct of subclinical psychopathy remains controversial. Other recent methodological developments include: (a) the extension of the Five-Factor Model and other higher-order personality taxonomies to psychopathy; (b) development of a Q-sort methodology to permit the assessment of psychopathy by observers; (c) standardized assessment of psychopaths' interpersonal behaviors; (d) assessment of psychopathy in children; and (e) examination of gender, ethnic, and cross-cultural differences in psychopathy.

Déjà vu all over again: critical misunderstandings concerning anxiety sensitivity and constructive suggestions for future research.

The debate concerning the relation between anxiety sensitivity (AS) and trait anxiety has been constructive for the field and has suggested a number of important directions for future research. Reiss' (1997) commentary on AS and trait anxiety in this journal, however, contains several serious factual mis-statements and logical errors that confuse, rather than clarify, many of the central issues in this debate. These misunderstandings are corrected and the implications of the issues raised by Reiss are addressed here. The authors suggest that future research on AS (a) embed this construct within the context of broader temperamental and personality variables and (b) explicitly recognize the biodirectionality of emotional and cognitive influences.