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This article describes 3 studies evaluating normative reference data for the Rorschach Comprehensive System (CS; Exner, 2003, 2007), with a particular focus on the viability of the Composite International Reference Values (CIRVs) that were compiled from 21 adult studies by Meyer, Erdberg, and Shaffer (2007). Study 1 documented how the CIRV norms are virtually identical when organized into 3 groups differentiated by the quality of their data collection effort, including an optimal group of 4 samples that relied on multiple experienced examiners and provided ongoing quality control over administration and coding. Analyses also showed that relative to the group of more optimal samples, the group of less optimal samples did not produce more variability in summary scores within or across samples or lower interrater reliability for coding. Study 2 used the existing CS reference norms to generate T scores for the CIRV means and documented how the CS norms make other samples of healthy nonpatients look psychologically impaired in multiple domains. Study 3 documented with examples from 4 different countries how 2 sets of within-country local norms produced notably different results on some variables, which compromises the ability of local norms to be used instead of the CIRVs. Taken together, the 3 studies provide support for the use of CIRVs in clinical practice as norms that are generalizable across samples, settings, languages, and cultures and that account for the natural variability that is present when clinicians and researchers contend with the ambiguity contained in the standard CS reference materials concerning the proper ways to administer and code. We conclude by urging CS users to rely on the CIRVs when making clinical inferences and to adopt alternative methods of ensuring they are following cohesively standardized administration and coding guidelines. [ABSTRACT FROM AUTHOR]

Differences in offense history, brain functioning, and psychological functioning of rape (n = 45) and molest offenders (n = 15) who were receiving psychiatric treatment while in prison were evaluated. Significant differences were found in each of these domains. Rape offenders were more likely to have histories of high violence offenses other than sexual offense, including murder, serious juvenile offenses, and both juvenile and adult sexual offenses. Rape offenders were more likely to show lower intellectual functioning and diffuse brain dysfunction associated predominantly with temporal and prefrontal brain cortices. Rape offenders were also more likely to display psychological functioning associated with illogical thinking and disordered attachment but less immature self-focus and fewer feelings of alienation than demonstrated by molest offenders. Implications for treatment and social policy for sexual offenders are suggested. Logistic regression demonstrated that these neuropsychological measures resulted in 71.7% accurate prediction and Rorschach measures resulted in 79.2% accurate prediction in differentiating rape from molest offenders. Implications for theoretical understanding of sexual offending are discussed. [ABSTRACT FROM PUBLISHER]

This study examines the intercoder reliability of Rorschach Comprehensive System (CS; Exner, 2001) protocol-level variables. A large international sample was combined to obtain intercoder agreement for 489 Rorschach protocols coded using the CS. Intercoder agreement was calculated using an Iota coefficient, a statistical coefficient similar to kappa that is corrected for chance. Iota values for the variables analyzed ranged from .31 to 1.00, with 2 in the poor range of agreement, 4 in the fair range, 25 in the good range, and 116 in the excellent range of agreement. Discrepancies between variables are discussed. [ABSTRACT FROM PUBLISHER]

This paper explores the issues and widespread impact surrounding child sex offenders (CSO) who commit suicide after learning they are under criminal investigation. This phenomenon, which has received scant attention in the literature, affects family, friends, and victims of offenders who may experience a range of conflicting emotions including anger, guilt, confusion, betrayal, and loss. Involved law enforcement may, likewise, experience a range of complex reactions. Law enforcement personnel are neither trained nor required to assess offenders' suicidality. However, awareness of how CSOs are impacted by an investigation may mitigate the risk of suicide and enhance operational strategies, including officer safety. [ABSTRACT FROM AUTHOR]

We used before-and-after testing with the Rorschach Inkblot Test (Exner, 1997/2003) and the Minnesota Multiphasic Personality Inventory-2 (Butcher et al., 2001) to assist a psychotherapy client—a survivor of child abuse suffering from depression accompanied by hallucinations—in evaluating a course of electroconvulsive therapy that she underwent. The results of both tests indicated positive changes. During the collaborative discussion of the test results, especially the changes seen on the Rorschach, a deeper understanding of her skeptical response to evidence of improvement came to light and helped to refocus the ongoing psychotherapy work. [ABSTRACT FROM AUTHOR]

This study is composed of 52 older adults, ages 60 to 80, all from the United States. In addition to being administered the Rorschach (Rorschach, 1942), all participants also were administered the Wechsler Adult Intelligence Scale—Revised (WAIS–R; Weschler, 1981), the Minnesota Multiphasic Personality Inventory—2 (MMPI–2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), the Neuro Cognitive Status Examination (NCSE; Kiernan, Mueller, Langston, & Van Dyke, 1987), and the Trail Making Test Part B (Reitan, 1958; Reitan & Wolfson, 1993). Examiners included the principal author as well as three other trained examiners. Inclusion criteria are described. Interrater reliability statistics at the response level are presented along with scores for the Rorschach Comprehensive System (CS; Exner, 1995). [ABSTRACT FROM AUTHOR]

This study is composed of 37 American adolescents, ages 15 to 17 years of age, all from the United States. The principal author was the sole examiner. Inclusion criteria are described. Interrater reliability statistics at the response level are presented along with scores for the Rorschach Comprehensive System (CS; Exner, 2003). The results revealed differences from the published norms on variables that reflect poor form quality, fewer popular responses, more attention to detail, more poor human relationship responses, and a more simplistic, affective-free approach to the environment, among others. [ABSTRACT FROM AUTHOR]

This Introduction provides an overview to the JPA Special Supplement on International Reference Samples for the Rorschach Comprehensive System (CS; Exner, 2001). It contains a history of this project and a table including all of the lead authors, their country and the type and size of their sample. Suggestions for conducting this type of research are offered, including information on normative vs. nonpatient samples, inclusion/exclusion criteria, the use of collateral instruments, and concerns relative to representativeness. Reliability and coding concerns are addressed, and information on the Popular response in Japan are reviewed. Finally, trends within and across the data are highlighted. [ABSTRACT FROM AUTHOR]

We build on the work of all the authors contributing to this Special Supplement by summarizing findings across their samples of data, and we also draw on samples published elsewhere. Using 21 samples of adult data from 17 countries we create a composite set of internationally-based reference means and standard deviations from which we compute T-scores for each sample. Figures illustrate how the scores in each sample are distributed and how the samples compare across variables in eight Rorschach Comprehensive System (CS; Exner, 2003) clusters. The adult samples from around the world are generally quite similar, and thus we encourage clinicians to integrate the composite international reference values into their clinical interpretation of protocols. However, the 31 child and adolescent samples from 5 countries produce unstable and often quite extreme values on many scores. Until the factors contributing to the variability among these samples are more fully understood, we discourage clinicians from using many CS scores to make nomothetic, score-based inferences about psychopathology in children and adolescents. [ABSTRACT FROM AUTHOR]

This article presents an update on adult nonpatients living in central California previously described by Shaffer, Erdberg, and Haroian (1999). In this study an additional 160 nonpatients were administered the Rorschach for a total sample size of 283. Graduate students enrolled in a 2-year Rorschach research seminar administered the Rorschach (Exner, 1995), WAIS–R (Weschler, 1981), and MMPI–2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), and were provided with extensive supervision and ongoing quality control. All protocols were recoded by the first two authors and a psychologist with extensive Rorschach experience. Exclusion criteria are described. Interrater reliability statistics at the response level are presented along with scores for Rorschach Comprehensive System (CS), WAIS–R, and MMPI–2 variables. [ABSTRACT FROM AUTHOR]

This study is composed of 42 Mexican American children, ages 8 to 10 years, all from the United States. In addition to the children being administered the Rorschach, they also were administered the Children's Hispanic Background Scale (CHBS) and the Children's Personality Questionnaire (CPQ). The principal author was the sole examiner. Inclusion criteria are described. Interrater reliability statistics at the response level are presented along with scores for the Rorschach Comprehensive System (CS; Exner, 1995). [ABSTRACT FROM AUTHOR]

This article addresses the role of personality assessment—specifically the Rorschach (Exner, 2002)—]in the context of the health care industry's increased focus on patient satisfaction. When providing psychotherapy, a challenge to providing patient-centered care turns on understanding and acting on the key aspects of the patient's personality that are crucial to forming an effective alliance. This article includes a description and examples of how personality assessment can enhance therapists' understanding of the ideational, affective, and self-control aspects of complicated patients' problem-solving styles. This enhanced understanding in turn can lead to improved therapeutic alliance between therapists and patients and to increased patient satisfaction with their care. How to provide feedback to the therapist also is addressed. [ABSTRACT FROM AUTHOR]

ABSTRACT: In this study, 242 randomly selected male offenders who were receiving psychiatric treatment in prison were administered psychological and neuropsychological evaluations and were followed during their treatment in a prison psychiatric hospital. Offenders who harmed themselves in treatment were compared to those who did not harm themselves. Eighteen percent of offenders harmed themselves, the severity of which required medical intervention. Young age, drug abuse, absence of Axis I mental disorder but presence of Axis II borderline personality disorder identified offenders who harmed themselves. Psychopathy checklist‐revised (PCL‐R) total rating ≥30 and PCL‐R Factor 2 (antisocial lifestyle) rating also identified offenders who harmed themselves. Additionally, offenders who harmed themselves also were 8.36 times more likely than their cohorts to harm treatment staff. Theoretical understanding of offenders who harm themselves, the importance of considering the environmental context in identifying risk factors for self‐harm, and implications for treatment are suggested. [ABSTRACT FROM AUTHOR]

Evaluates prison assault histories and assaults while in prison psychiatric treatment for 222 randomly selected male inmates. Association of Youth Authority placement, inhalant use, antisocial lifestyle, neurological injury, neuropsychological impairment and higher Psychopathy Checklist-Revised Factor II ratings, with assault in prison psychiatric treatment; Factors importance in the identification of risk for violence.

Demonstrates the way in which personality test data can be plotted with a multivariate method known as Partial Least Squares of Latent Structures (PLS). Basic methodology behind PLS modeling; Comparative performance of PLS with other methods; Applicability of the PLS modeling for extracting clinically relevant information from complex personality test data matrixes.

This article evaluates the case of an 11-year-old male with congenital agenesis of the corpus callosum, against Rourke's NLD models. A comprehensive neuropsychological assessment was completed, and impairments with attention, movement, fine motor and sensory perception, visuo-spatial organization, and verbal memory were identified. Additionally, a volumetric analysis of the magnetic resonance image (MRI) was completed. Although no gross structural abnormalities, beyond agenesis, were present, the possibility of unobservable abnormalities was considered. [ABSTRACT FROM PUBLISHER]

There is a paucity of peer-reviewed, nonpatient Rorschach studies in psychological journals, particularly for children. This study examined 100 preteenage children, using the Comprehensive System to code their Rorschach protocols. The participants were also evaluated with the Conners Parent Rating Scale-93 (Conners, 1989) and 5 exclusionary behavior criteria. The 100 participants demonstrated better than average behaviors. The results presented include all the ratios and indexes found in the nonpatient statistics for the Comprehensive System. We discuss interrater reliability issues and offer recommendations for further cross-validating research. [ABSTRACT FROM AUTHOR]

A literature review yields a surprisingly small number of nonpatient studies focusing on three widely used assessment tools: the WAIS-R, Rorschach, and MMPI-2. In this study, 123 nonpatient adults residing in central California were administered these three instruments. We performed intercoder reliability statistics on 52 of the 123 Rorschach records. WAIS-R and MMPI-2 results are similar to current standardization data for these instruments, whereas many of the Rorschach variables are quite different from those published in the manual for the Comprehensive System (Exner, 1995). We discuss these findings and offer recommendations for further normative research. [ABSTRACT FROM AUTHOR]

A multimethod approach that included demographic, criminal offense, drug use, neuropsychological, Rorschach, psychiatric diagnosis, and psychopathy characteristics was used to evaluate 131 incarcerated male psychiatric inpatients. Each criminal offense was ranked from nonviolent to severely violent, and participants were classified as having lifetime histories of either high or low violent behavior. Univariate analyses revealed 12 characteristics which independently discriminated inmates with lifetime histories of high or low violent behavior (married, non-Caucasian race, Axis I psychotic diagnosis, drug other than alcohol or marijuana used most, positive for psychopathy on the Hare Psychopathy Checklist-Revised, scores indicating impairment on the Halstead Impairment Index and Category Test, and five Rorschach measures). Logistic regression revealed that eight of those characteristics (married, non-Caucasian race, Axis I psychotic diagnosis, positive for psychopathy on the Hare Psychopathy Checklist-Revised, scores indicating impairment on the Halstead Impairment Index, and Rorschach Coping Deficit Index, Personal Responses, and Raw Sum Special Scores) significantly contributed to identifying inmates with lifetime histories of highly violent behavior. Data are provided for sensitivity, specificity, positive and negative predictive power, and overall correct classification rate for neuropsychological and Rorschach measures. Because this sample represented only incarcerated male psychiatric inpatients, and not a general prison population, caution as to limits of generalization are discussed. Implications for use of this information in understanding violent behavior are also discussed. [ABSTRACT FROM PUBLISHER]

Background. The extent of involvement of the subcutaneous Tenckhoff catheter tract in CAPD peritonitis and catheter-related infections is of major therapeutic importance. By definition, both peritonitis and exit-site infections do not involve the catheter tract. However, diagnosis of these infections as well as the more sinister tunnel infection is based mainly on clinical signs. Methods. We examined the usefulness of ultrasound examination (US) of the catheter tract in delineating catheter-related (exit-site and tunnel) infections, and their relationship to each other and to peritonitis. CAPD patients with no evidence of peritonitis or catheter-related infections for 6 months prior to examination served as controls. US were performed by one of two experienced radiologists using the Acuson 128XP/10 scanner with a 7-MHz linear transducer. A positive US was defined as an area of hypoechogenicity (indicative of fluid collection) >2 mm in width along any portion of the catheter tract. Findings were localized into segments (S) as follows: S1, limited to external cuff; S2, intercuff segment adjacent to the external cuff; S3, intercuff segment adjacent to the internal cuff; S4, limited to the internal cuff; and S5, involvement extending throughout the catheter tract. Results. Between March 1993 and January 1995, 39 CAPD patients, all with a double-cuff straight Tenckhoff catheter with the exit site situated above the point of entry into the peritoneum were studied. A total of 56 US were performed divided among 26 episodes of peritonitis, four tunnel infections, 13 exit-site infections, and 13 controls. There were 30 positive US distributed among 16 peritonitis, four tunnel, eight exit site infections and two control patients. Conclusions. We conclude that peritonitis and exit-site infections are frequently accompanied by involvement of the catheter tract. The localization of infection to the internal cuff region in cases of exit-site infection probably occurred as a result of downward migration along the catheter tract. This supports the notion that ideally the exit site should be pointing caudally or that the peritoneal catheter have a swan-neck configuration. With regard to peritonitis, infection within the peritoneal cavity appears to extend and involve the internal cuff region. Thus both the internal and external cuffs do not seem to pose an effective barrier against the spread of infection. Based on our data, we recommend that US be performed as a routine investigation in all cases of exit-site infection and in cases of refractory or relapsing peritonitis. [ABSTRACT FROM PUBLISHER]

This study describes the psychological problems of a group of Catholic clergy and religious who were referred for residential treatment. Psychological test data were obtained from 29 men and 13 women ranging in age from 29 to 64. The main tests used were the Weschler Adult Intelligence Scale-Revised, the Minnesota Multiphasic Personality Inventory, and Exner's Comprehensive System approach to the Rorschach Inkblot Test. A consistent constellation of problems was found; an intellectualized orientation along with naive defensiveness and difficulty in the handling of emotions. The men did not respond in a stereotypically masculine way and 30% were found to be confused or distressed about their sexual orientation. The longstanding nature of the problems suggests that the need for help could have been identified with thorough evaluations at the seminary or novitiate level and so prevented some of the disruption that led to the referrals. [ABSTRACT FROM AUTHOR]

Low values of serum creatine phosphokinase (CPK) were found in a group of 27 patients suffering from acute viral hepatitis. The values were significantly lower than CPK values in a group of 25 patients with extra hepatic obstructive jaundice (23.3 ± 32.1 versus 163 ± 43 U/L, p < 0.001). CPK values in the hepatitis group when recovered (6 months after hospitalization) were much higher than the mean CPK levels in the same group during the acute illness (178 ± 28 versus 23.3 ± 32.1 U/L, p < 0.001) and were the same as a control group of 26 healthy volunteers (179 ± 28 versus 179 ± 20.9 U/L). Similar results were found when the groups were divided into separate male and female groups. Serum CPK values, thus, were found to be a useful diagnostic tool to distinguish between patients with intrahepatic jaundice due to acute viral hepatitis and patients with extra hepatic obstructive jaundice. [ABSTRACT FROM AUTHOR]

This article focuses on the application of standard Minnesota Multiphasic Personality Inventory (MMPI) criteria to a rural, isolated African American sample. These racial differences in MMPI performances are associated with a different pattern of interests, values and expectations, and hypothesized that the greater the separation between the races, the greater the differences on MMPI scales. Several psychologists proposed that separate norms be developed for scoring MMPIs obtained from African Americans to help prevent misinterpretation of such profiles and published a large sample as a start in that direction. Since African Americans usually obtain higher clinical scale scores than whites, they would more often be labeled sick unless one took their typically different performance into account.

The existence of diurnal variation in CAPD remains controversial. We therefore attempted to delineate the blood-pressure (BP) pattern in CAPD patients by ambulatory blood-pressure monitoring (ABPM). Initially ABPM was performed in 31 patients (21 M, 10 F), mean age 65.4 years (26–87) using the Spacelabs model 90207. The maximal normal BP preset on the recorder was 140/90 mmHg. Daytime and night-time readings, recorded every 30 min, were defined as those from 0600 to 2100 and 2100 to 0600 hours respectively. Mean duration of dialysis was 15.2 months (3–76). There were 14 hypertensive patients, defined as a basal BP > 140/90 mmHg, or those on antihypertens-ive medications. Taking the group as a whole a significant difference between day and night-time readings was found as regards minimal systolic BP (118 versus 107.6 mmHg), maximal systolic BP (181.6 versus 171.2 mmHg), mean diastolic BP (83.9 versus 79.6 mmHg), and maximal diastolic BP (121.7 versus 104.5 mmHg), <0.05. Diurnal variation, defined in the initial study as a 10% decrease of MAP occurring during any consecutive 4-h period, was present in 21 patients. In three the diurnal variation manifested as a paradoxical reduction of BP during the day. The only significant difference between those with diurnal variation and those without was the duration of dialysis, being 19.2 ±19.9 versus 13.3 ±17.3 months respectively, (<0.05). In a second study 18 hypertensive CAPD patients were subjected to ABPM. Nine of them had participated in the first study. These patients were specifically asked to detail their periods of sleep and arousal. Diurnal variation was here defined as a 10% decrease of MAP occurring 2 h after the onset of sleep. Diurnal variation was found to exist in 10 patients (55%). Comparing the day to night-time readings in this group, no significant differences were found in mean systolic and MAP. When, however, the arousal versus sleep period readings were compared, a significant difference was observed in mean diastolic BP (83±14 versus 77±17mmHg, <0.01), and in the MAP (104 ± 18 versus 98±20.5 mmHg, <0.01). The mean systolic BP just failed to reach statistical significance (141±26 versus 137±30 mmHg) due probably to the small sample size. We conclude that diurnal variation exists in the majority of CAPD patients. Our findings support the concept that the set point model of diurnal variation, in which the major determinant is activity or arousal is the operative one in these patients. Due to disordered sleep patterns in patients on CAPD, diurnal variation might thus be better elicited when taking into account a decrease of MAP occurring during any consecutive 4-h period. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented that reports on a scale for measuring patients' ability to cope.

People that the author would like to thank for their assistance in the publishing of the journal are mentioned.