Ego Impairment Research Articles

Incremental validity of the Ego Impairment Index: It's fine when it's there.

Incremental validity of the Ego Impairment Index: It's fine when it's there.

Two methods for studying the incremental validity of a Rorschach variable.

The MMPI can be scored by a clerk. Also, both the number and form level of Rorschach responses can be easily assessed. Other Rorschach variables should be examined for their incremental validity beyond number of responses and form level, or from these variables plus simple MMPI variables. This study applied multiple regression analyses to 2 data sets with reasonable criteria of pathology that were predicted by W. Perry and D. J. Viglione's (1991) Ego Impairment Index considered alone. The index had only slight incremental validity over and above the number of responses and form quality, and even less when the average MMPI elevation and L. R. Goldberg's (1965) formula for predicting psychosis versus neurosis were entered before these Rorschach variables. Another way of assessing incremental validity is through the use of unit weights, that is, adding standardized variables weighted equally rather than optimally. The unit-weighted incremental validity analysis resulted in the same conclusions.

Normalization of information processing deficits in schizophrenia with clozapine.

The authors tested the hypothesis that the use of an atypical drug, clozapine, for patients with schizophrenia is related to less impairment in information processing deficits (assessed by prepulse inhibition of the startle response) than is the use of typical antipsychotics. Two groups of schizophrenic patients--receiving either clozapine or a range of typical antipsychotics--were tested for prepulse inhibition (a reduction in response to a starting stimulus, if preceded briefly by a weak, nonstartling stimulus; measured at prepulse-to-pulse intervals of 30 msec, 60 msec, and 120 msec) of the acoustic startle response and compared with a group of healthy volunteers. Patients receiving typical antipsychotics showed less prepulse inhibition with 30-msec and 60-msec prepulse trials than did comparison subjects. Clozapine-treated patients showed normal levels of prepulse inhibition. Clozapine is superior to typical antipsychotics in normalizing prepulse inhibition, presumably because of its pharmacological effects on prefrontal regions of the brain or its effects on a broader range of neuroreceptors.

The Rorschach Human Experience Variable, interpersonal relatedness, and object representation in nonpatients.

W. Perry and D. J. Viglione (1991) combined human representational variables from J. E. Exner's (1993) Comprehensive System in their Ego Impairment Index to create the Human Experience Variable (HEV). To validate the HEV 105 nonpatient women completed the Bell Object Relations Inventory (M. Bell, 1991) and the Rorschach. Their spouses also rated the quality of these women's interpersonal relatedness by completing a modified Bell Object Relations Inventory and the Emotional Maturity Rating Form (H. Bessell, 1984). The HEV was significantly related to the quality of interpersonal relatedness, after considering Rorschach measures of psychopathology and nonhuman Rorschach images. Results indicate that representations of self and other accessed through the Rorschach account for unique variance in the prediction of the quality of interpersonal relationships, thus supporting the validity of the Rorschach and the concept of object relations.

Gender differences on thought disturbance measures among schizophrenic patients

This study examined gender differences on three measures of thought disturbance among patients with schizophrenia and the relation between thought disturbance and social competency. Fifty-three male and 34 female patients diagnosed with schizophrenia according to the DSM-III-R criteria were assessed on measures of thought disturbance: subscales of the Scale for the Assessment of Positive Symptoms (SAPS), subscales of the Brief Psychiatric Rating Scale (BPRS), and the Ego Impairment Index. Gender differences on the three measures of thought disturbance and the relation of these measures to demographic variables and other variables, such as social competency, were examined. Male and female schizophrenic patients demonstrated similar degrees of thought disturbance on the pertinent subscales of the SAPS and the BPRS, but the male schizophrenic patients had scores showing greater impairment on the Ego Impairment Index. Furthermore, a relationship between thought disturbance and social competency was confirmed. These findings support other studies in which female patients were found to have a "milder" form of schizophrenia, generally characterized by better social functioning, than their male counterparts. The literature regarding gender-related differences in thought disturbance in schizophrenia has been unclear and complicated by design issues such as obtaining adequate samples of subjects and optimizing measurement selection. The findings of this study suggest that use of a converging-measures strategy allows a better assessment of thought disturbance in severely ill schizophrenic patients and an understanding of the importance of thought disorder with respect to gender-related patterns of clinical characteristics, such as social competency.

A Five-Year Follow-up on the Temporal Stability of the Ego Impairment Index

This study investigated the temporal stability of the Ego Impairment Index (EII) over a 5-year period. The EII is based on the Comprehensive System (Exner, 1993) and has shown promise as a measure of internal disturbance and psychopathology (Perry & Braff, 1994; Perry & Viglione, 1991; Perry, Viglione, & Braff, 1992). This study successfully recalled 17 subjects from an original sample of 46 who initially suffered from Major Depression, Melancholic-Type 5 years earlier and were treated with antidepressant medication. These subjects did not differ significantly from those Subjects who were not successfully recalled. The Rorschach and a variety of other measures were administered to the subjects. The results revealed impressive temporal consistency over 5 years: a rank-order, test-retest correlation of .68. The EII was also correlated with some of the measures of overall adaptation. These results are consistent with the notion that the EII is a stable trait-measure of psychopathology. Limitations because of the small subgroup of subjects, although not unusual in longitudinal research, are noted.

Information-processing deficits and thought disorder in schizophrenia.

The goal of this investigation was to study the relationship between information-processing deficits and thought disorder in schizophrenic patients. Fifty-two subjects diagnosed with schizophrenia were administered tests of information processing and thought disorder. The information-processing tests included visual backward masking and prepulse inhibition of the startle reflex. Thought disorder was measured with the Magical Ideation Scale, the Scale for the Assessment of Positive Symptoms, the alogia subscale of the Scale for the Assessment of Negative Symptoms, and the Ego Impairment Index-human experience variable and its subcomponents derived from the Rorschach. Elevated poor responses on the Ego Impairment Index-human experience variable were significantly correlated with information-processing deficits. In a simultaneous multiple regression, the auditory prepulse inhibition measure was the best predictor of poor responses on the Ego Impairment Index-human experience variable. The results suggest a correlative relationship between information-processing deficits and thought disorder. The relationship is most apparent when highly sensitive measures of both information processing and thought disorder are used. Furthermore, the prediction of poor responses on the Ego Impairment Index-human experience variable by auditory prepulse inhibition is important, since the neural circuitry of prepulse inhibition is known and involves the modulatory influences of the cortical-striatal-pallidal-thalamic circuit. These findings lend support to the hypothesis that information-processing failures are associated with cognitive fragmentation and thought disorder. More speculatively, these results allow us to hypothesize that impairments in part of the cortical-striatal-pallidal-thalamic circuit may lead to thought disorder, as well as prepulse inhibition deficits.

A computer application for calculation of the Ego Impairment Index.

A computerized application of the Ego Impairment Index, a measure developed by Perry and Viglione in 1991 to assess functioning of the ego via Rorschach scoring variables is described.

The Ego Impairment Index and schizophrenia: a validation study.

This study is an extension of our work on a new scale, the Ego Impairment Index (EII; Perry & Viglione, 1991). The index is theoretically based on Beres's (1956) model of ego assessment and was empirically developed on a sample of melancholic, depressed outpatients, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III]; American Psychiatric Association, 1980). The EII is derived from the Rorschach Inkblot Test and offers a single composite score of ego impairment. This study validates the use of the EII with a heterogeneous sample of schizophrenic patients. In support of the trait-like characteristics of the scale, the EII continues to be expressed as a single factor, with a correlation of .98 when comparing the original factor derived from a melancholic population with this sample of schizophrenic patients. Significant correlations were also found between the EII and other clinical indices, including the Magical Ideation Scale, the Schizophrenia Index, and the Minnesota Multiphasic Personality Inventory (MMPI). Finally, the EII was found to differentiate between a paranoid subgroup and a mixed undifferentiated/disorganized subgroup who theoretically have more ego impairment. These results offer support for the use of the EII as an empirical means of quantitatively and qualitatively assessing thought disorder within a theoretical framework. Further research is needed to understand the application of the EII across different diagnostic groups and its relationship to other indices of psychological disturbance.

A COMPUTER APPLICATION FOR CALCULATION OF THE EGO IMPAIRMENT INDEX

A computerized application of the Ego Impairment Index, a measure developed by Perry and Viglione in 1991 to assess functioning of the ego via Rorschach scoring variables is described.

The Ego Impairment Index as a Predictor of Outcome in Melancholic Depressed Patients Treated With Tricyclic Antidepressants

The standard model of assessing ego impairment relies on patients' accurate self-report and description of their behavior. This study offers an alternative approach to assessing ego impairment in a population of major depression, melancholic type outpatients treated with tricyclic antidepressants. A new index called the Ego Impairment Index (EII) was developed. The index is derived from the Rorschach test and offers a single composite score of ego impairment. It was hypothesized that those melancholic, biologically depressed individuals who were lacking in ego resources were less likely to benefit from tricyclic antidepressant treatment. Thus, the EII could predict overall outcome while on antidepressants. The results support that the level of ego impairment, as assessed by the EII, could predict depression outcome averaged over 9 weeks of tricyclic antidepressant treatment.

Incest reported by children and adolescents hospitalized for severe psychiatric problems.

This study of 65 children and adolescents hospitalized for psychiatric problems revealed a history of incest in 37.5% of the nonpsychotic female subjects. Ten percent of the psychotic girls and about 8% of all the boys had such a history. A comparison of the nonpsychotic girls who had a history of incest and those who had no known history of incest or sexual abuse showed no specific effects of incest. It seems that social and psychological pathology serious enough to warrant hospitalization is not a simple effect of incest itself but is a consequence of severe family disorganization and the resulting ego impairment.

A clinical application of subliminal psychodynamic activation. On the stimulation of symbiotic fantasies as an adjunct in the treatment of hospitalized schizophrenics.

This study attempted to utilize the subliminal psychodynamic activation method as an aid in the treatment of hospitalized schizophrenics. More specifically, we inbestigated whether the subliminal activation of a fantasy of symbiotic gratification would produce an increment in the degree of improvement that schizophrenics manifested as a result of hospitalization. Forty male patients were seen individually for three weekly sessions over a 6-week period for a fantasy expression task carried out by a psychology graduate student. Both at the beginning and at the end of each session and whenever during the session anxiety was in evidence, the patient was exposed to subliminal stimulation. The patients were divided into two groups equated for intelligence, pathology level, and other pertinent variables. For one group, the tachistoscopically presented stimulus consisted of MOMMY AND I ARE ONE, a verbal message which, in several prior studies, produced a significant reduction in ego impairment within a laboratory session. The other group served as a control, and their stimulus was PEOPLE ARE WALKING. The subjects in each group were subdivided in order to investigate the effects of two other interventions in addition to the subliminal symbiotic stimulation. One of these was aggressive expression consisting of an attempt to elicit specifically aggressive fantasies in the fantasy expression task. The other was self-focuing, designed to strengthen self-boundaries. All patients were blindly assessed for seven measures of ego impairment before and after the intervention period and for the number of rehospitalizations over a 9-month follow-up period. Of the three types of interventions impairment measures. For on of the variables, the symbiotic group showed significantly more improvement than the control group, while for two others the results approached significance. In addition, on an overall measure of ego impairment, there was significantly mor improvement for the symbiotic group than for the control patients.

Notes on a Non-Weberian Model of Bureaucracy: The Case of Development Bureaucracy

This paper argues that the traditional Weberian concerns about complex organizations require refinement and extension for the understanding of organizations designed for social development. Six ideal type modes of looking at development bureaucracies are proposed: (1) that the organization is theoretically oriented; (2) that the organization is designed to provide latent structures to meet the changing contingencies of the development process; (3) that the organization is client centered and is consequently designed to work with the entire social system(s); (4) that the organization is designed to perform a socialization or resocialization function; (5) that social detvelopment organizations are ideally committed to a norm emphasizing experimental design as the primary consideration in program design; (6) and that the organization for social development is constrained by the limited alternatives for change available at any given time. In addition, brief attention is given to the great importance of community disintegration and ego impairment as critical constraints on attempts to repair and/or modernize a social system. Berton H. Kaplan is associate professor of mental health and epidemiology, School of Public Health, and is a research associate in the Institute for Research in Social Science, University of North Carolina, Chapel Hill, North Carolina.

The response to psychotherapy in chronic ulcerative colitis. I. Pretreatment factors.

The outcome of psychotherapeutic treatment of 30 patients with chronic ulcerative colitis was compared with 6 pretreatment factors: psychiatric diagnosis, precipitating stress, psychologic defenses, nature of object attachments, secondary elaboration of colitis symptoms, and ego strength. Somatic and psychologic states were reevaluated 1–11 years after the end of psychotherapy. Schizophrenia nearly doubled the likelihood of a poor prognosis for the colitis. Precipitating stress was frequently reported but was more common in nonpsychotic patients. There were no defenses characteristic of colitis although every patient showed a significant degree of regression. Chronic hostility coexisted with anxiety about loss of control. Patients with depression mixed with paranoid distrust had a poorer prognosis than did those with reactive depression to loss of an important dependency object. Secondary gain from the illness perpetuated the colitis and worsened the prognosis. Patients with strong symbiotic needs and attitudes of passive helplessness had a poorer prognosis than those who tried to remain active and relatively independent. Severe ego impairment almost always led to a poor prognosis although ego weakness did not necessarily prevent somatic improvement. Patients who began treatment with greater ego strength, however, had complete remissions of their colitis for as long as 11 years.

Ego impairment and ego adaptation in schizophrenia.

Summary Recent clinical theory and evidence from research converge in describing schizophrenia as a pattern of cognitive defect. In this article the defect was described as an impairment in those psychological processes that integrate and organize mental functioning into a holistic pattern at a given moment, give it continuity over time, and inter-relate the unified complex to external phenomena. Psychological test material (the Rorschachs of two people) was examined to elicit cognitive or perceptual patterns in contradistinction to analyses of conflicts, defenses, or interpersonal vectors. This structural emphasis brings into perspective the fluctuation of mental organization in schizophrenics and relates the fluctuation to degree of impairment, degree of strain imposed by the environment, and capacity for adaptive compensation.

Relation of WAIS verbal and performance IQs for four psychiatric conditions.

Of the diagnostic signs developed by Wechsler on his intelligence scale the most widely used probably is the Verbal minus Performance difference. It has been held by Wechsler that in most mental disorders impairment is generally greater in the performance than in the verbal area. As part of a larger study the WAIS was given to neuropsychiatric in-patients. Four of the major categories were among those to which Wechsler's diagnostic measures apply: schizophrenia; manic-depressive reaction, manic type; depressions of psychotic intensity; and psychoneuroses. It was hypothesized that in all of these the impairment would be significantly greater in performance than in verbal scores. The hypothesis was sustained only for the schizophrenics. This observation may represent a reaction formation against the severe ego impairment characteristic of this disorder. Additional support for this was found in the more reliable behavior of paranoid schizophrenics, in whose symptomatology verbalization is prominent. Some confirmatory data are found in other studies.

The effects of subliminally presented drive stimuli on the cognitive functioning of schizophrenics.

Abstract This was an investigation of the effects of subliminally presented drive related stimuli on the cognitive performance of 30 hospitalized schizophrenics. Subjects were seen individually for three sessions in a balanced design. In each session, an assessment was made of the effects of an aggressive, libidinal, or neutral stimulus on performance in tests of arithmetic, similarities, and picture arrangement (patterned after parts of the Wechsler Intelligence Scales). Assessments were made of ego pathology and cognitive deficit and the effects of the drive conditions were compared with those of the neutral condition. The results obtained support the views that: (a) the stimulation of drive derivatives in schizophrenics exacerbates aspects of their ego impairment; (b) the method described allows for the experimental study of the effects of drive activation on ego functioning.

THOUGHT DISORDER AND FAMILY RELATIONS OF SCHIZOPHRENICS. 3. METHODOLOGY USING PROJECTIVE TECHNIQUES.

<h3>A. Introduction</h3> We HAVE FOUND that certain parental forms of focusing attention, communicating, and interpersonal "relating" are intimately linked to the forms of ego impairment found in offspring.^1-4In companion papers, we have indicated that our general research strategy in studying families of young adult schizophrenic persons has been to focus upon formal, stylistic, transactional patterns of families which might relate to the development of thought-communication disorders in individual offspring. We have conceptualized these disorders along a continuum of amorphousness to fragmentation.⁵ In this paper we shall describe the methodology whereby we have applied these principles to the study of families through projective techniques: (1) predicting the form of thinking and degree of disorganization of each patientoffspring from the tests of<i>other</i>members of his family; (2) matching blindly patients and their families. We shall describe a viewpoint about projective tests which

Narcissistic ego impairment in patients with early physical malformations.

Narcissistic ego impairment in patients with early physical malformations.