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Biomedical subjects

C B Gacono

Publications and source records attributed to C B Gacono.

At least 19 recordsLinked to original sources
PubMed2001

The Rorschach and psychopathy: toward a more accurate understanding of the research findings.

In this article we present the reader with an understandable essay on the relation between the Rorschach and psychopathy. Some degree of sophistication and applied knowledge of the Hare Psychopathy Checklist-Revised (Hare, 1991) and the Rorschach (Rorschach, 1921/1942) are necessary to wade through the literature, weigh the relative merits of arguments made by proponents and detractors of Rorschach assessment, and meaningfully interpret the findings of relevant studies. Often studies reviewing the Rorschach's utility in assessing Antisocial Personality Disorder (American Psychiatric Association, 1994) and psychopathy exhibit a flawed or superficial understanding of essential theoretical and methodological issues. Argument derived from a suspect or specious premise, such as the notion that the Rorschach was designed or aspires to correspond with formal diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1952, 1994), vitiates conclusions based on such a premise. In this article, we discuss theoretical and methodological issues that can aid the reader or reviewer in achieving a more accurate understanding of this body of research.

Antisocial Personality Disorder↗
PubMed2000

A Rorschach comparison of psychopaths, sexual homicide perpetrators, and nonviolent pedophiles: where angels fear to tread.

Nonsexually offending psychopaths (N = 32) were compared to sexual homicide perpetrators (N = 38) and nonviolent pedophiles (N = 39) on select Comprehensive System Rorschach variables (Exner et al., 1993). Results indicate similarities among the groups in pathological narcissism, formal thought disorder, and borderline level reality testing. Nonsexually offending psychopaths are distinguished by their lack of interest in and attachment to others and their seemingly conflict-free internal world. While both sexually deviant groups evidenced interest in others and appear to experience a very dysphoric internal world, the sexual homicide perpetrators are distinguished by high levels of obsessional thought and an inability to disengage from environmental stimuli. Pedophiles show significantly more characterological anger, which may stem from their general inadequacy, cognitive rigidness, less alloplastic (acting out) style, and their introversive inability to gratify their needs. Rorschach differences add to our understanding of sexual deviation and violence among these three groups.

Adolescent↗
PubMed1999

Differential patterns of responding among three groups of chronic, psychotic, forensic outpatients.

Elements of response style were examined among three groups of chronic, psychotic, forensic patients: paranoid schizophrenics (N = 89); undifferentiated-disorganized schizophrenics (N = 38); and schizoaffective patients (N = 53). Forensic patients with elevated MMPI-2 L Scales produced increased percentages of Pure Form (F%) on the Rorschach. A similar relationship occurred when the Rorschach was used as the independent measure. Schizoaffective patients reported more psychotic symptoms on the MMPI-2 and lower F% (Rorschach) than both schizophrenic groups. Although undifferentiated schizophrenics evidenced the most psychopathology on the Rorschach (impaired reality testing and perceptual accuracy disturbance), all three groups produced lower than expected frequencies for Rorschach variables commonly associated with thought disorder and poor reality testing (Exner, 1995b). The clinical importance of using the MMPI-2 and Rorschach in tandem with forensic psychiatric patients is discussed. Our empirical findings suggest the need for forensic evaluators to consider the important relationship between psychiatric diagnosis and response style (defensiveness, denial, illness chronicity, medications, and concurrent Axis II psychopathology) when interpreting often-constricted psychological testing protocols in chronic forensic patient populations.

Adult↗
PubMed1998

A Rorschach investigation of defensiveness, self-perception, interpersonal relations, and affective states in incarcerated pedophiles.

Rorschach protocols of 60 incarcerated men who met the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria for Pedophilia were compared to those of 60 incarcerated men with no history of sex offenses (matched for age, education, and race). Comprehensive System Rorschach variables (Exner, 1991) were selected based on both psychodynamic and cognitive-behavioral models of pedophilia. Pedophiles' Rorschachs (a) contained significantly more responses and were more likely to reveal signs of (b) anxiety and helplessness, (c) painful introspection, (d) distorted views of others, and (e) primitive dependency needs than the comparison group's Rorschachs. Like other incarcerated men, the pedophiles exhibited disturbances in self-worth (either poor self-esteem or excessive self-focus), tendencies to abuse fantasy and avoid emotionally tinged stimuli, and chronic oppositionality and hostility. Pedophiles possess many core personality features associated with Narcissistic Personality Disorders, but are less well defended against feelings of vulnerability and painful introspection than other incarcerated men. Like Antisocial Personality Disorder patients (Gacono & Meloy, 1994), our pedophiles and nonpedophile offenders showed signs of impaired attachment and, in the context of incarceration, failed narcissism.

Adult↗
PubMed1997

A Rorschach comparison of psychopathic and nonpsychopathic conduct disordered adolescents.

Forty-eight male subjects who met the DSM-IV (APA, 1994) criteria for conduct disorder (CD) were assessed for psychopathy level using a modified version of the Psychopathy Checklist-Revised (PCL-R, Forth, Hart, & Hare, 1990). Rorschach variables associated with self-perception, affects, and object relations, early behavioral problems and history of violence were compared between psychopathic and nonpsychopathic CD adolescents. Psychopathic CD subjects were significantly more self-centered and violent than nonpsychopathic CD subjects. Decreased attachment and anxiety were found in both CD groups. Our study adds empirical support to the heterogeneity noted among CD adolescents (PCL-R), supports the utility of the Rorschach for detecting individual differences among CD subjects, and extends the empirical work of Gacono and Meloy (1994) to adolescent psychopathy.

Adolescent↗
PubMed1995

A clinical investigation of malingering and psychopathy in hospitalized insanity acquittees.

This study compares Psychopathy Checklist-Revised (PCL-R) scores, DSM-III-R diagnoses, and select behavioral indices between hospitalized insanity acquittees (N = 18) and hospitalized insanity acquittees who successfully malingered (N = 18). The malingerers were significantly more likely to have a history of murder or rape, carry a diagnosis of antisocial personality disorder or sexual sadism, and produce greater PCL-R factor 1, factor 2, and total scores than insanity acquittees who did not malinger. The malingerers were also significantly more likely to be verbally or physically assaultive, require specialized treatment plans to control their aggression, have sexual relations with female staff, deal drugs, and be considered an escape risk within the forensic hospital. These findings are discussed within the context of insanity statutes and the relevance of malingering, psychopathy, and treatability to future policy concerning the disposition of insanity acquittees.

Adult↗
PubMed1993

A borderline psychopath: "I was basically maladjusted...".

The case of a 21-year-old White man who committed a robbery and homicide is presented. His Rorschach is analyzed and interpreted using both psychostructural (Exner, 1986a) and psychodynamic (Cooper, Perry, & Arnow, 1988; Gacono & Meloy, 1992; Kwawer, 1980) methodologies. Findings are used to understand the presence and interaction of both psychopathic character and borderline personality organization in this explosive and sadistic young man.

Adult↗
PubMed1992

The aggression response and the Rorschach.

We propose the addition of four aggressive indices for Rorschach scoring: aggressive content, aggressive potential, aggressive past, and sado-masochism scores. Interrater agreement is presented and ranges from 92-100%. Nomothetic comparisons are made between groups with higher base rates for violence with mixed results, although the sado-masochism frequency was significantly higher in severe psychopaths than in moderate psychopaths. Idiographic use of the aggression indices is emphasized, with a particular focus upon inferring the quality, intensity, and directionality of intrapsychic aggression in relation to self and object representations.

Adult↗
PubMed1992

The Rorschach and the DSM-III-R antisocial personality: a tribute to Robert Lindner.

This study utilized the Rorschach as a psychometric measure for understanding Antisocial Personality Disorder (American Psychiatric Association, 1987). Comprehensive System (Exner, 1986) Rorschach data for a sample of 60 ADP subjects and Rorschach object relations and defensive operations for 22 psychopathic APD (P-APD) and 21 nonpsychopathic APD (NP-APD) subjects are presented and discussed. The data support the absence of anxiety and attachment and the presence of pathological narcissism and borderline personality organization in P-APDs. The Rorschach's ability to differentiate antisocial groups based on level of psychopathy (Hare, 1980, 1985) strongly supports the need to use psychopathy as an independent measure when one is studying APD.

Adolescent↗
PubMed1992

A Rorschach study of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents.

We investigated the constructs of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents. Texture, diffuse shading, and pure human content (Exner, 1986) Rorschach indices were compared between 48 subjects who met the criteria for conduct disorder and 30 subjects who met the criteria for dysthymia, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987). We also compared mild, moderate, and severe conduct-disorder groups on the three selected Rorschach variables and investigated certain family characteristics for the two groups. We found a lower frequency of texture and pure human content responses in conduct-disordered subjects and a greater frequency of diffuse shading responses in the dysthymic subjects. The conduct-disordered subjects also came from homes in which the mother figure was significantly less present. Our psychometric findings of lessened attachment and diminished anxiety in the conduct-disordered adolescents are similar to adult psychopaths. We urge that an attachment or socialization disturbance criterion be reintroduced into the forthcoming DSM-IV conduct-disorder diagnosis.

Adolescent↗
PubMed1992

A psychotic (sexual) psychopath: "I just had a violent thought ...".

The case of a 33-year-old White male with a history of sexual assault is presented. His Rorschach is analyzed and interpreted using both psychostructural (Exner, 1986) and psychodynamic (Cooper & Arnow, 1986; Kwawer, 1980; Meloy & Gacono, in press-b) methodologies. Findings are used to understand the presence and interaction of both psychopathic character and psychotic personality organization in this mentally ill, sadistic, and sexually predatory young man.

Adult↗
PubMed1992

Object relations, defensive operations, and affective states in narcissistic, borderline, and antisocial personality disorder.

Rorschach data were used to psychometrically "map" the internal psychological operations of three Cluster B personality disorders, listed in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987), all of which may be organized at a borderline level. Psychopathic antisocial subjects (P-APDs) and narcissistic subjects (NPDs) were highly narcissistic. NPD subjects, however, produced more indices of anxiety and attachment capacity and fewer scores related to borderline object relations and damaged identity. P-APDs and borderline subjects (BPDs) produced similar mean numbers of borderline object relations; however, the BPDs were more anxious, produced more unsublimated aggressive and libidinal drive material, and evidenced greater potential for attachment. BPDs were also less narcissistic than both P-APDs and NPDs. Nonpsychopathic antisocial subjects (NP-APDs) were less borderline than P-APDs and BPDs, less narcissistic in terms of a stable grandiose self-structure than NPD and P-APDs, produced less evidence of attachment capacity than NPDs and BPDs but more than P-APDs, and were similar to BPDs in their proneness to anxiety. The outpatient NPDs and BPDs produced more idealization responses than the incarcerated antisocial personality disorder (APD) groups. We conclude that the behavioral descriptions offered for these three Cluster B personality disorders, when used in conjunction with information such as level of personality organization (Kernberg, 1984), level of psychopathy (Hare, 1980, 1985), and outpatient versus inpatient research settings, may have greater intrapsychic specificity than previously thought.

Adult↗
PubMed1991

A Rorschach investigation of attachment and anxiety in antisocial personality disorder.

We investigated the constructs of anxiety and attachment in a group of 42 offenders who met the DSM-III-R criteria for antisocial personality disorder. Each antisocial subject's level of psychopathy was assessed with the Hare Psychopathy Checklist (PCL). Three Rorschach variables related to attachment, anxiety, and coping were compared between subjects scoring greater than or equal to 30 (N = 21) on the PCL and subjects scoring less than 30 (N = 21). Comparison Rorschach variables are also presented from a sample of 60 antisocial personality-disordered offenders. Moderate psychopaths (PCL score, less than 30) produced texture and diffuse shading responses at a significantly greater frequency than severe, or primary, psychopaths (PCL score, greater than or equal to 30). There was no significant difference in the two groups' propensity for producing vista responses. Although there were no significant differences between the coping index scores, the trend suggests less conflictual functioning in the severe psychopaths. A virtual absence of texture responses in the severe psychopaths, and a significantly greater frequency of diffuse shading responses in the moderate psychopaths, add construct validity to the lack of attachment in psychopaths and the role of anxiety in differentiating secondary from primary psychopathy. We view the presence of vista responses in this population as a measure of a failed grandiose self-structure, and note that it often occurs in the records of moderate psychopaths who also present achromatic color responses.

Adult↗
PubMed1990

An empirical study of object relations and defensive operations in antisocial personality disorder.

This study assessed the object relations, defensive operations, and level of psychopathy and narcissism in a group of antisocial personality disordered offenders. The Rorschach protocols of 33 subjects who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R], American Psychiatric Association, 1987) criteria for antisocial personality disorder were analyzed utilizing Kwawer's (1980) criteria for borderline object relations categories (borderline phenomena), the Lerner and Lerner (1980) Defense Scale, and a number of experimental criteria including Cooper and Arnow's (1986) defense criteria. Level of narcissism was assessed utilizing Exner's (1973) Self-Focus Sentence Completion Test. Hare's Psychopathy Checklist was used as an independent variable to determine a subject's level of psychopathy. Those subjects scoring 30 or more on the psychopathy checklist were compared to subjects scoring less than 30. The level of narcissism or proportion of defenses did not differ significantly between the severe psychopaths (greater than or equal to 30) and the moderate psychopaths (less than 30). The severe psychopaths produced a significantly greater number of borderline object relations. I conclude that antisocial individuals tend to be highly egocentric, and that narcissism is one component of psychopathy. Severe psychopaths, as a group, tend to be more borderline in their functioning than those exhibiting moderate levels of psychopathic disturbance. I also conclude that individuals who are incarcerated for felony offenses and also meet the DSM-III-R criteria for antisocial personality disorder exhibit degrees of borderline personality organization.

Adult↗
PubMed1990

A Rorschach investigation of narcissism and hysteria in antisocial personality.

We investigated Rorschach responses associated with narcissism and hysteria in a group of antisocial personality disordered offenders. The Rorschach protocols of 42 subjects who met the criteria from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) for antisocial personality disorder were analyzed using Exner's (1986) criteria for pairs, reflections, and personal responses, and Gacono's (1988) criteria for the impressionistic response. Severe, or primary psychopaths (n = 21), scoring greater than or equal to 30 on the Hare (1980) Psychopathy Checklist (PCL), were compared to moderate, or secondary pscyhopaths (n = 21), scoring less than 30 on the PCL. The mean number of pair and impressionistic responses did not significantly differ for the two antisocial groups. The highly psychopathic group, however, did exhibit a significantly greater mean number of reflection and personal responses. We discuss pair and reflection responses and their relationship to narcissism in psychopathic disturbance. We recommend interpreting the personal response within the context of the psychopathic character and view personal responses as expressions of narcissism and omnipotence in highly psychopathic subjects. We also hypothesize that the impressionistic responses are indicative of primitive dissociative processes and hysteria in psychopathic subjects, and that their presence provides construct validity for the work of Guze (1976) and others who suggested an underlying histrionic dimension to psychopathy.

Adolescent↗