Psychological Signs and Symptoms

The first encounter between psychiatrist or therapist and patient (or client) is multi-phased. The mental health practitioner notes the patient’s history and administers or prescribes a physical examination to rule out certain medical conditions. Armed with the results, the diagnostician now observes the patient carefully and compiles lists of signs and symptoms, grouped into syndromes.

Symptoms are the patient’s complaints. They are highly subjective and amenable to suggestion and to alterations in the patient’s mood and other mental processes. Symptoms are no more than mere indications. Signs, on the other hand, are objective and measurable. Signs are evidence of the existence, stage, and extent of a pathological state. Headache is a symptom – short-sightedness (which may well be the cause of the headache) is a sign.

Here is a partial list of the most important signs and symptoms in alphabetical order:

Affect

We all experience emotions, but each and every one of us expresses them differently. Affect is HOW we express our innermost feelings and how other people observe and interpret our expressions. Affect is characterized by the type of emotion involved (sadness, happiness, anger, etc.) and by the intensity of its expression. Some people have flat affect: they maintain “poker faces”, monotonous, immobile, apparently unmoved. This is typical of the Schizoid Personality Disorder Others have blunted, constricted, or broad (healthy) affect. Patients with the dramatic (Cluster B) personality disorders – especially the Histrionic and the Borderline – have exaggerate and labile (changeable) affect. They are “drama queens”.

In certain mental health disorders, the affect is inappropriate. For instance: such people laugh when they recount a sad or horrifying event or when they find themselves is morbid settings (e.g., in a funeral). Also see: Mood.

Read about inappropriate affect in narcissists

Ambivalence

We have all come across situations and dilemmas which evoked equipotent – but opposing and conflicting – emotions or ideas. Now, imagine someone with a permanent state of inner turmoil: her emotions come in mutually exclusive pairs, her thoughts and conclusions arrayed in contradictory dyads. The result is, of course, extreme indecision, to the point of utter paralysis and inaction. Sufferers of Obsessive-Compulsive Disorders and the Obsessive-Compulsive Personality Disorder are highly ambivalent.

Anhedonia

When we lose the urge to seek pleasure and to prefer it to nothingness or even pain, we become anhedonic. Depression inevitably involves anhedonia. the depressed are unable to conjure sufficient mental energy to get off the couch and do something because they find everything equally boring and unattractive.

Anorexia

Diminished appetite to the point of refraining from eating. Whether it is part of a depressive illness or a body dysmorphic disorder (erroneous perception of one’s body as too fat) is still debated. Anorexia is one of a family of eating disorders which also includes bulimia (compulsive gorging on food and then its forced purging, usually by vomiting).

Learn more about comorbidity of eating disorders and personality disorders

Anxiety

A kind of unpleasant (dysphoric), mild fear, with no apparent external reason. Anxiety is akin to dread, or apprehension, or fearful anticipation of some imminent but diffuse and unspecified danger. The mental state of anxiety (and the concomitant hypervigilance) has physiological complements: tensed muscle tone, elevated blood pressure, tachycardia, and sweating (arousal).

Generalized Anxiety Disorder is sometimes misdiagnosed as a personality disorder

Autism

More precisely: autistic thinking and inter-relating (relating to other people). Fantasy-infused thoughts. The patient’s cognitions derive from an overarching and all-pervasive fantasy life. Moreover, the patient infuses people and events around him or her with fantastic and completely subjective meanings. The patient regards the external world as an extension or projection of the internal one. He, thus, often withdraws completely and retreats into his inner, private realm, unavailable to communicate and interact with others.

Asperger’s Disorder, one of the spectrum of autistic disorders, is sometimes misdiagnosed as Narcissistic Personality Disorder (NPD)

Automatic obeisance or obedience

Automatic, unquestioning, and immediate obeisance of all commands, even the most manifestly absurd and dangerous ones. This suspension of critical judgment is sometimes an indication of incipient catatonia.

Blocking

Halted, frequently interrupted speech to the point of incoherence indicates a parallel disruption of thought processes. The patient appears to try hard to remember what it was that he or she were saying or thinking (as if they “lost the thread” of conversation).

Catalepsy
 
“Human sculptures” are patients who freeze in any posture and position that they are placed, no matter how painful and unusual. Typical of catatonics.
 
Catatonia
 
A syndrome comprised of various signs, amongst which are: catalepsy, mutism, stereotypy, negativism, stupor, automatic obedience, echolalia, and echopraxia. Until recently it was thought to be related to schizophrenia, but this view has been discredited when the biochemical basis for schizophrenia had been discovered. The current thinking is that catatonia is an exaggerated form of mania (in other words: an affective disorder). It is a feature of catatonic schizophrenia, though, and also appears in certain psychotic states and mental disorders that have organic (medical) roots.
 
Cerea Flexibilitas
 
Literally: wax-like flexibility. In the common form of catalepsy, the patient offers no resistance to the re-arrangement of his limbs or to the re-alignment of her posture. In Cerea Flexibilitas, there is some resistance, though it is very mild, much like the resistance a sculpture made of soft wax would offer.
 
Circumstantiality
 
When the train of thought and speech is often derailed by unrelated digressions, based on chaotic associations. The patient finally succeeds to express his or her main idea but only after much effort and wandering. In extreme cases considered to be a communication disorder.
 
Clang Associations
 
Rhyming or punning associations of words with no logical connection or any discernible relationship between them. Typical of manic episodes, psychotic states, and schizophrenia.
 
Clouding
 
(Also: Clouding of Consciousness)
 
The patient is wide awake but his or her awareness of the environment is partial, distorted, or impaired. Clouding also occurs when one gradually loses consciousness (for instance, as a result of intense pain or lack of oxygen).
Compulsion
 
Involuntary repetition of a stereotyped and ritualistic action or movement, usually in connection with a wish or a fear. The patient is aware of the irrationality of the compulsive act (in other words: she knows that there is no real connection between her fears and wishes and what she is repeatedly compelled to do). Most compulsive patients find their compulsions tedious, bothersome, distressing, and unpleasant – but resisting the urge results in mounting anxiety from which only the compulsive act provides much needed relief. Compulsions are common in obsessive-compulsive disorders, the Obsessive-Compulsive Personality Disorder (OCPD), and in certain types of schizophrenia.
 
 
 
Concrete Thinking
 
Inability or diminished capacity to form abstractions or to think using abstract categories. The patient is unable to consider and formulate hypotheses or to grasp and apply metaphors. Only one layer of meaning is attributed to each word or phrase and figures of speech are taken literally. Consequently, nuances are not detected or appreciated. A common feature of schizophrenia, autism spectrum disorders, and certain organic disorders.
 

Confabulation

 
The constant and unnecessary fabrication of information or events to fill in gaps in the patient’s memory, biography or knowledge, or to substitute for unacceptable reality. Common in the Cluster B personality disorders (narcissistic, histrionic, borderline, and antisocial) and in organic memory impairment or the amnestic syndrome (amnesia).
 
 
Confusion
 
Complete (though often momentary) loss of orientation in relation to one’s location, time, and to other people. Usually the result of impaired memory (often occurs in dementia) or attention deficit (for instance, in delirium). Also see: Disorientation.
Delirium
 
Delirium is a syndrome which involves clouding, confusion, restlessness, psychomotor disorders (retardation or, on the opposite pole, agitation), and mood and affective disturbances (lability). Delirium is not a constant state. It waxes and wanes and its onset is sudden, usually the result of some organic affliction of the brain.
 
 
A belief, idea, or conviction firmly held despite abundant information to the contrary. The partial or complete loss of reality test is the first indication of a psychotic state or episode. Beliefs, ideas, or convictions shared by other people, members of the same collective, are not, strictly speaking, delusions, although they may be hallmarks of shared psychosis. There are many types of delusions:
 
I. Paranoid
 
The belief that one is being controlled or persecuted by stealth powers and conspiracies.
 
2. Grandiose-magical 
 
The conviction that one is important, omnipotent, possessed of occult powers, or a historic figure.
 
3. Referential (ideas of reference)
 
The belief that external, objective events carry hidden or coded messages or that one is the subject of discussion, derision, or opprobrium, even by total strangers.
 
 
 
Dementia
 
Simultaneous impairment of various mental faculties, especially the intellect, memory, judgment, abstract thinking, and impulse control due to brain damage, usually as an outcome of organic illness. Dementia ultimately leads to the transformation of the patient’s whole personality. Dementia does not involve clouding and can have acute or slow (insidious) onset. Some dementia states are reversible.
Depersonalization
 
Feeling that one’s body has changed shape or that specific organs have become elastic and are not under one’s control. Usually coupled with “out of body” experiences. Common in a variety of mental health and physiological disorders: depression, anxiety, epilepsy, schizophrenia, and hypnagogic states. Often observed in adolescents. See: Derealization.
 
Derailment

A loosening of associations. A pattern of speech in which unrelated or loosely-related ideas are expressed hurriedly and forcefully, with frequent topical shifts and with no apparent internal logic or reason. See: Incoherence.

 
Feeling that one’s immediate environment is unreal, dream-like, or somehow altered. See: Depersonalization.
 
 
Dereistic Thinking
 
Inability to incorporate reality-based facts and logical inference into one’s thinking. Fantasy-based thoughts.
 
 
Not knowing what year, month, or day it is or not knowing one’s location (country, state, city, street, or building one is in). Also: not knowing who one is, one’s identity. One of the signs of delirium.
 
 
Imitation by way of exactly repeating another person’s speech. Involuntary, semiautomatic, uncontrollable, and repeated imitation of the speech of others. Observed in organic mental disorders, pervasive developmental disorders, psychosis, and catatonia. See: Echopraxia.
 
 

Imitation by way or exactly repeating another person’s movements. Involuntary, semiautomatic, uncontrollable, and repeated imitation of the movements of others. Observed in organic mental disorders, pervasive developmental disorders, psychosis, and catatonia. See: Echolalia.

 

 

Rapidly verbalized train of unrelated thoughts or of thoughts related only via relatively-coherent associations. Still, in its extreme forms, flight of ideas involves cognitive incoherence and disorganization. Appears as a sign of mania, certain organic mental health disorders, schizophrenia, and psychotic states. Also see: Pressure of Speech and Loosening of Associations.
 
 
Folie a Deux (Madness in Twosome, Shared Psychosis)
 
The sharing of delusional (often persecutory) ideas and beliefs by two or more (folie a plusieurs) persons who cohabitate or form a social unit (e.g., a family, a cult, or an organization). One of the members in each of these groups is dominant and is the source of the delusional content and the instigator of the idiosyncratic behaviors that accompany the delusions.
 
Read more about Shared Psychosis and cults – click on these links:
 
 
 
 
 
Fugue
 
Vanishing act. A sudden flight or wandering away and disappearance from home or work, followed by the assumption of a new identity and the commencement of a new life in a new place. The previous life is completely erased from memory (amnesia). When the fugue is over, it is also forgotten as is the new life adopted by the patient.
 
 
False perceptions based on false sensa (sensory input) not triggered by any external event or entity. The patient is usually not psychotic – he is aware that he what he sees, smells, feels, or hears is not there. Still, some psychotic states are accompanied by hallucinations (e.g., formication – the feeling that bugs are crawling over or under one’s skin).
 
There are a few classes of hallucinations:
 
Auditory – The false perception of voices and sounds (such as buzzing, humming, radio transmissions, whispering, motor noises, and so on).
 
Gustatory – The false perception of tastes
 
Olfactory – The false perception of smells and scents (e.g., burning flesh, candles)
 
Somatic – The false perception of processes and events that are happening inside the body or to the body (e.g., piercing objects, electricity running through one’s extremities). Usually supported by an appropriate and relevant delusional content.
 
Tactile – The false sensation of being touched, or crawled upon or that events and processes are taking place under one’s skin. Usually supported by an appropriate and relevant delusional content.
 
Visual – The false perception of objects, people, or events in broad daylight or in an illuminated environment with eyes wide open.
 
Hypnagogic and Hypnopompic – Images and trains of events experienced while falling asleep or when waking up. Not hallucinations in the strict sense of the word.
 
Hallucinations are common in schizophrenia, affective disorders, and mental health disorders with organic origins. Hallucinations are also common in drug and alcohol withdrawal and among substance abusers.
Ideas of Reference 
 
Weak delusions of reference, devoid of inner conviction and with a stronger reality test. See: Delusion.
 
 
Illusion
 
The misperception or misinterpretation of real external – visual or auditory – stimuli, attributing them to non-existent events and actions. Incorrect perception of a material object. See: Hallucination.
 
 
Incomprehensible speech, rife with severely loose associations, distorted grammar, tortured syntax, and idiosyncratic definitions of the words used by the patient (“private language”). A loosening of associations. A pattern of speech in which unrelated or loosely-related ideas are expressed hurriedly and forcefully, using broken, ungrammatical, non-syntactical sentences, an idiosyncratic vocabulary (“private language”), topical shifts, and inane juxtapositions (“word salad”). See: Loosening of Associations; Flight of Ideas; Tangentiality.
 
Insomnia
 
Sleep disorder or disturbance involving difficulties to either fall asleep (“initial insomnia”) or to remain asleep (“middle insomnia”). Waking up early and being unable to resume sleep is also a form of insomnia (“terminal insomnia”).
 
 

Thought and speech disorder which involves the translocation of the focus of attention from one subject to another for no apparent reason. The patient is usually unaware of the fact that his train of thoughts and his speech are incongruous and incoherent. A sign of schizophrenia and some psychotic states. See: Incoherence; Flight of Ideas; Tangentiality.

 

Mood

 
Pervasive and sustained feelings and emotions as subjectively described by the patient. The same phenomena observed by the clinician are called affect. Mood can be either dysphoric (unpleasant) or euphoric (elevated, expansive, “good mood”). Dysphoric moods are characterized by a reduced sense of well-being, depleted energy, and negative self-regard or sense of self-worth. Euphoric moods typically involve an increased sense of well-being, ample energy, and a stable sense of self-worth and self-esteem. Also see: Affect.
 
Mood Congruence and Incongruence
 
The contents of mood-congruent hallucinations and delusions are consistent and compatible with the patient’s mood. During the manic phase of the Bipolar Disorder, for instance, such hallucinations and delusions involve grandiosity, omnipotence, personal identification with great personalities in history or with deities, and magical thinking. In depression, mood-congruent hallucinations and delusions revolve around themes like the patient’s self-misperceived faults, shortcomings, failures, worthlessness, guilt – or the patient’s impending doom, death, and “well-deserved” sadistic punishment.
 
The contents of mood-incongruent hallucinations and delusions are inconsistent and incompatible with the patient’s mood. Most persecutory delusions and delusions and ideas of reference, as well as phenomena such as control “freakery” and Schneiderian First-rank Symptoms are mood-incongruent. Mood incongruence is especially prevalent in schizophrenia, psychosis, mania, and depression.
 
Misdiagnosing the Bipolar Disorder as Narcissistic Personality Disorder
 
Depression and Cluster B Personality Disorders – click on these links:
 
 
 
Mutism
 

Abstention from speech or refusal to speak. Common in catatonia.

 

Negativism

 

In catatonia, complete opposition and resistance to suggestion.
 
Neologism
 
In schizophrenia and other psychotic disorders, the invention of new “words” which are meaningful to the patient but meaningless to everyone else. To form the neologisms, the patient fuses together and combines syllables or other elements from existing words.
 
Obsession
 
Recurring and intrusive images, thoughts, ideas, or wishes that dominate and exclude other cognitions. The patient often finds the contents of his obsessions unacceptable or even repulsive and actively resists them, but to no avail. Common in schizophrenia and obsessive-compulsive disorder.
 

Panic Attack
 

A form of severe anxiety attack accompanied by a sense of losing control and of an impending and imminent life-threatening danger (where there is none). Physiological markers of panic attacks include palpitation, sweating, tachycardia (rapid heart beats), dyspnea or apnoea (chest tightening and difficulties breathing), hyperventilation, light-headedness or dizziness, nausea, and peripheral paresthesias (an abnormal sensation of burning, prickling, tingling, or tickling). In normal people it is a reaction to sustained and extreme stress. Common in many mental health disorders.

 

Sudden, overpowering feelings of imminent threat and apprehension, bordering on fear and terror. There usually is no external cause for alarm (the attacks are uncued or unexpected, with no situational trigger) – though some panic attacks are situationally-bound (reactive) and follow exposure to “cues” (potentially or actually dangerous events or circumstances). Most patients display a mixture of both types of attacks (they are situationally predisposed).

 

Bodily manifestations include shortness of breath, sweating, pounding heart and increased pulse as well as palpitations, chest pain, overall discomfort, and choking. Sufferers often describe their experience as being smothered or suffocated. They are afraid that they may be going crazy or about to lose control.

 

 

Misdiagnosing General Anxiety Disorder (GAD) as Narcissistic Personality Disorder

 
Paranoia
 
Psychotic grandiose and persecutory delusions. Paranoids are characterized by a paranoid style: they are rigid, sullen, suspicious, hypervigilant, hypersensitive, envious, guarded, resentful, humorless, and litigious. Paranoids often suffer from paranoid ideation – they believe (though not firmly) that they are being stalked or followed, plotted against, or maliciously slandered. They constantly gather information to prove their “case” that they are the objects of conspiracies against them. Paranoia is not the same as Paranoid Schizophrenia, which is a subtype of schizophrenia.
 

Perseveration
 
Repeating the same gesture, behavior, concept, idea, phrase, or word in speech. Common in schizophrenia, organic mental disorders, and psychotic disorders.
 
Phobia
 
Dread of a particular object or situation, acknowledged by the patient to be irrational or excessive. Leads to all-pervasive avoidance behavior (attempts to avoid the feared object or situation).  A persistent, unfounded, and irrational fear or dread of one or more classes of objects, activities, situations, or locations (the phobic stimuli) and the resulting overwhelming and compulsive desire to avoid them. See: Anxiety.
 
Posturing
 
Assuming and remaining in abnormal and contorted bodily positions for prolonged periods of time. Typical of catatonic states.
 
Poverty of Content (of Speech)
 
Persistently vague, overly abstract or concrete, repetitive, or stereotyped speech.
 
Poverty of Speech
 
Reactive, non-spontaneous, extremely brief, intermittent, and halting speech. Such patients often remain silent for days on end unless and until spoken to.
 
 

Rapid, condensed, unstoppable and “driven” speech. The patient dominates the conversation, speaks loudly and emphatically, ignores attempted interruptions, and doesn’t care if anyone is listening or responding to him or her. Seen in manic states, psychotic or organic mental disorders, and conditions associated with stress. See: Flight of Ideas.

 

Psychomotor Agitation

 
Mounting internal tension associated with excessive, non-productive (not goal orientated),  and repeated motor activity (hand wringing, fidgeting, and similar gestures). Hyperactivity and motor restlessness which co-occur with anxiety and irritability.Psychomotor Retardation

Visible slowing of speech or movements or both. Usually affects the entire range of performance (entire repertory). Typically involves poverty of speech, delayed response time (subjects answer questions after an inordinately long silence), monotonous and flat voice tone, and constant feelings of overwhelming fatigue.

Psychosis

Chaotic thinking that is the result of a severely impaired reality test ( the patient cannot tell inner fantasy from outside reality). Some psychotic states are short-lived and transient (microepisodes). These last from a few hours to a few days and are sometimes reactions to stress. Persistent psychoses are a fixture of the patient’s mental life and manifest for months or years.

Psychotics are fully aware of events and people “out there”. They cannot, however separate data and experiences originating in the outside world from information generated by internal mental processes. They confuse the external universe with their inner emotions, cognitions, preconceptions, fears, expectations, and representations.

Consequently, psychotics have a distorted view of reality and are not rational. No amount of objective evidence can cause them to doubt or reject their hypotheses and convictions. Full-fledged psychosis involves complex and ever more bizarre delusions and the unwillingness to confront and consider contrary data and information (preoccupation with the subjective rather than the objective). Thought becomes utterly disorganized and fantastic.

There is a thin line separating nonpsychotic from psychotic perception and ideation. On this spectrum we also find the schizotypal personality disorder.

Narcissism, Psychosis, and Delusions

Reality Sense

 
The way one thinks about, perceives, and feels reality.
 
Reality Testing
 
Comparing one’s reality sense and one’s hypotheses about the way things are and how things operate to objective, external cues from the environment.
 
 
A list of symptoms compiled by Kurt Schneider, a German psychiatrist, in 1957 and indicative of the presence of schizophrenia. Includes:
 
Auditory hallucinations
 
Hearing conversations between a few imaginary “interlocutors”, or one’s thoughts spoken out loud, or a running background commentary on one’s actions and thoughts.
 
Somatic hallucinations
 
Experiencing imagined sexual acts couple with delusions attributed to forces, “energy”, or hypnotic suggestion.
 
Thought withdrawal
 
The delusion that one’s thoughts are taken over and controlled by others and then “drained” from one’s brain.
 
Thought insertion
 
The delusion that thoughts are being implanted or inserted into one’s mind involuntarily.
 
Thought broadcasting
 
The delusion that everyone can read one’s mind, as though one’s thoughts were being broadcast.
 
Delusional perception
 
Attaching unusual meanings and significance to genuine perceptions, usually with some kind of (paranoid or narcissistic) self-reference.
 
Delusion of control
 
The delusion that one’s acts, thoughts, feelings, perceptions, and impulses are directed or influenced by other people.
 
Stereotyping or Stereotyped movement (or motion)
 
Repetitive, urgent, compulsive, purposeless, and non-functional movements, such as head banging, waving, rocking, biting, or picking at one’s nose or skin. Common in catatonia, amphetamine poisoning, and schizophrenia.
Stupor
 
Restricted and constricted consciousness akin in some respects to coma. Activity, both mental and physical, is limited. Some patients in stupor are unresponsive and seem to be unaware of the environment. Others sit motionless and frozen but are clearly cognizant of their surroundings. Often the result of an organic impairment. Common in catatonia, schizophrenia, and extreme depressive states.
 
 
Inability or unwillingness to focus on an idea, issue, question, or theme of conversation. The patient “takes off on a tangent” and hops from one topic to another in accordance with his own coherent inner agenda, frequently changing subjects, and ignoring any attempts to restore “discipline” to the communication. Often co-occurs with speech derailment. As distinct from loosening of associations, tangential thinking and speech are coherent and logical but they seek to evade the issue, problem, question, or theme raised by the other interlocutor.
 
Thought Broadcasting, Though Insertion, Thought Withdrawal
 
 
Thought Disorder
 
A consistent disturbance that affects the process or content of thinking, the use of language, and, consequently, the ability to communicate effectively. An all-pervasive failure to observe semantic, logical, or even syntactical rules and forms. A fundamental feature of schizophrenia.
 
Vegetative Signs
 
A set of signs in depression which includes loss of appetite, sleep disorder, loss of sexual drive, loss of weight, and constipation. May also indicate an eating disorder.
 
Read more about eating disorders – click on these links:
 
 

 

Psychological Defense Mechanisms

According to Freud and his followers, our psyche is a battlefield between instinctual urges and drives (the id), the constraints imposed by reality on the gratification of these impulses (the ego), and the norms of society (the superego). This constant infighting generates what Freud called “neurotic anxiety” (fear of losing control) and “moral anxiety” (guilt and shame). But these are not the only types of anxiety. “Reality anxiety” is the fear of genuine threats and it combines with the other two to yield a morbid and surrealistic inner landscape.

These multiple, recurrent, “mini-panics” are potentially intolerable, overwhelming, and destructive. Hence the need to defend against them. There are dozens of defense mechanisms. The most common among them:

Acting Out

When an inner conflict (most often, frustration) translates into aggression. It involves acting with little or no insight or reflection and in order to attract attention and disrupt other people’s cosy lives.

Denial

Perhaps the most primitive and best known defense mechanism. People simply ignore unpleasant facts, they filter out data and content that contravene their self-image, prejudices, and preconceived notions of others and of the world.

Devaluation

Attributing negative or inferior traits or qualifiers to self or others. This is done in order to punish the person devalued and to mitigate his or her impact on and importance to the devaluer. When the self is devalued, it is a self-defeating and self-destructive act.

Displacement

When we cannot confront the real sources of our frustration, pain, and envy, we tend to pick a fight with someone weaker or irrelevant and, thus, less menacing. Children often do it because they perceive conflicts with parents and caregivers as life-threatening. Instead, they go out and torment the cat or bully someone at school or lash out at their siblings.

Dissociation

Our mental existence is continuous. We maintain a seamless flow of memories, consciousness, perception, and representation of both inner and external worlds. When we face horrors and unbearable truths, we sometimes “disengage”. We lose track of space, time, and the continuum of our identity. We become “someone else” with minimal awareness of our surroundings, of incoming information, and of circumstances. In extreme cases, some people develop a permanently rent personality and this is known as “Dissociative Identity Disorder (DID)”.

Fantasy

Everyone fantasizes now and then. It helps to fend off the dreariness and drabness of everyday life and to plan for an uncertain future. But when fantasy becomes a central feature of grappling with conflict, it is pathological. Seeking gratification – the satisfaction of drives or desires – mainly by fantasizing is an unhealthy defense. Narcissists, for instance, often indulge in grandiose fantasies which are incommensurate with their accomplishments and abilities. Such fantasy life retards personal growth and development because it substitutes for true coping.

Idealization

Another defense mechanism in the arsenal of the narcissist (and, to lesser degree, the Borderline and Histrionic) is the attribution of positive, glowing, and superior traits to self and (more commonly) to others. Again, what differentiates the healthy from the pathological is the reality test. Imputing positive characteristics to self or others is good, but only if the attributed qualities are real and grounded in a firm grasp of what’s true and what’s not.

Isolation of Affect

Cognition (thoughts, concepts, ideas) is never divorced from emotion. Conflict can be avoided by separating the cognitive content (for instance, a disturbing or depressing idea) from its emotional correlate. The subject is fully aware of the facts or of the intellectual dimensions of a problematic situation but feels numb. Casting away threatening and discomfiting feelings is a potent way of coping with conflict in the short-term. It is only when it become habitual that it rendered self-defeating.

Omnipotence

When one has a pervading sense and image of oneself as incredibly powerful, superior, irresistible, intelligent, or influential. This is not an adopted affectation but an ingrained, ineradicable inner conviction which borders on magical thinking. It is intended to fend off expected hurt in having to acknowledge one’s shortcomings, inadequacies, or limitations.

Projection We all have an image of how we “should be”. Freud called it the “Ego Ideal”. But sometimes we experience emotions and drives or have personal qualities which don’t sit well with this idealized construct. Projection is when we attribute to others these unacceptable, discomfiting, and ill-fitting feelings and traits that we possess. This way we disown these discordant features and secure the right to criticize and chastise others for having or displaying them. When entire collectives (nations, groups, organizations, firms) project, Freud calls it the Narcissism of Small Differences.

Projective Identification

Projection is unconscious. People are rarely aware that they are projecting onto others their own ego-dystonic and unpleasant characteristics and feelings. But, sometimes, the projected content is retained in the subject’s awareness. This creates a conflict. On the one hand, the patient cannot admit that the emotions, traits, reactions, and behaviors that he so condemns in others are really his. On the other hand, he can’t help but being self-aware. He fails to erase from his consciousness the painful realization that he is merely projecting.

So, instead of denying it, the subject explains unpleasant emotions and unacceptable conduct as reactions to the recipient’s behavior. “She made me do it!” is the battle cry of projective identification.

We all have expectations regarding the world and its denizens. Some people expect to be loved and appreciated – others to be feared and abused. The latter behave obnoxiously and thus force their nearest and dearest to hate, fear, and “abuse” them. Thus vindicated, their expectations fulfilled, they calm down. The world is rendered once more familiar by making other people behave the way they expect them to. “I knew you would cheat on me! It was clear I couldn’t trust you!”.

Rationalization or Intellectualization

To cast one’s behavior after the fact in a favorable light. To justify and explain one’s conduct or, more often, misconduct by resorting to “:rational, logical, socially-acceptable” explications and excuses. Rationalization is also used to re-establish ego-syntony (inner peace and self-acceptance).

Though not strictly a defense mechanism, cognitive dissonance may be considered a variant of rationalization. It involves the devaluation of things and people very much desired but frustratingly out of one’s reach and control. In a famous fable, a fox, unable to snag the luscious grapes he covets, says: “these grapes are probably sour anyhow!”. This is an example of cognitive dissonance in action.

Reaction Formation

Adopting a position and mode of conduct that defy personally unacceptable thoughts or impulses by expressing diametrically opposed sentiments and convictions. Example: a latent (closet) homosexual finds his sexual preference deplorable and acutely shameful (ego-dystonic). He resorts to homophobia. He public berates, taunts, and baits homosexuals. Additionally, he may flaunt his heterosexuality by emphasizing his sexual prowess, or by prowling singles bars for easy pick-ups and conquests. This way he contains and avoids his unwelcome homosexuality.

Repression

The removal from consciousness of forbidden thoughts and wishes. The removed content does not vanish and it remains as potent as ever, fermenting in one’s unconscious. It is liable to create inner conflicts and anxiety and provoke other defense mechanisms to cope with these.

Splitting

This is a “primitive” defense mechanism. In other words, it begins to operate in very early infancy. It involves the inability to integrate contradictory qualities of the same object into a coherent picture. Mother has good qualities and bad, sometimes she is attentive and caring and sometimes distracted and cold. The baby is unable to grasp the complexities of her personality. Instead, the infant invents two constructs (entities), “Bad Mother” and “Good Mother”. It relegates everything likable about mother to the “Good Mother” and contrasts it with “Bad Mother”, the repository of everything it dislikes about her.

This means that whenever mother acts nicely, the baby relates to the idealized “Good Mother” and whenever mother fails the test, the baby devalues her by interacting, in its mind, with “Bad Mother”. These cycles of idealization followed by devaluation are common in some personality disorders, notably the Narcissistic and Borderline.

Splitting can also apply to one’s self. Patients with personality disorders often idealize themselves fantastically and grandiosely, only to harshly devalue, hate, and even harm themselves when they fail or are otherwise frustrated.

Read more about idealization followed by devaluation – click on the links:

http://www.narcissistic-abuse.com/faq43.html

http://www.narcissistic-abuse.com/faq44.html

http://www.narcissistic-abuse.com/devaluediscard.html

Sublimation

The conversion and channelling of unacceptable emotions into socially-condoned behavior. Freud described how sexual desires and urges are transformed into creative pursuits or politics.

Undoing

Trying to rid oneself of gnawing feelings of guilt by compensating the injured party either symbolically or actually.


Many additional Frequently Asked Questions (FAQs) about Personality Disorders – click HERE!

Psychological Signs and Symptoms

Psychological Tests and Interviews

Psychological Tests

I. Introduction

Personality assessment is perhaps more an art form than a science. In an attempt to render it as objective and standardized as possible, generations of clinicians came up with psychological tests and structured interviews. These are administered under similar conditions and use identical stimuli to elicit information from respondents. Thus, any disparity in the responses of the subjects can and is attributed to the idiosyncrasies of their personalities.

 

Moreover, most tests restrict the repertory of permitted of answers. “True” or “false” are the only allowed reactions to the questions in the Minnesota Multiphasic Personality Inventory II (MMPI-2), for instance. Scoring or keying the results is also an automatic process wherein all “true” responses get one or more points on one or more scales and all “false” responses get none.

This limits the involvement of the diagnostician to the interpretation of the test results (the scale scores). Admittedly, interpretation is arguably more important than data gathering. Thus, inevitably biased human input cannot and is not avoided in the process of personality assessment and evaluation. But its pernicious effect is somewhat reined in by the systematic and impartial nature of the underlying instruments (tests).

Still, rather than rely on one questionnaire and its interpretation, most practitioners administer to the same subject a battery of tests and structured interviews. These often vary in important aspects: their response formats, stimuli, procedures of administration, and scoring methodology. Moreover, in order to establish a test’s reliability, many diagnosticians administer it repeatedly over time to the same client. If the interpreted results are more or less the same, the test is said to be reliable.

The outcomes of various tests must fit in with each other. Put together, they must provide a consistent and coherent picture. If one test yields readings that are constantly at odds with the conclusions of other questionnaires or interviews, it may not be valid. In other words, it may not be measuring what it claims to be measuring.

Thus, a test quantifying one’s grandiosity must conform to the scores of tests which measure reluctance to admit failings or propensity to present a socially desirable and inflated facade (“False Self”). If a grandiosity test is positively related to irrelevant, conceptually independent traits, such as intelligence or depression, it does not render it valid.

Most tests are either objective or projective. The psychologist George Kelly offered this tongue-in-cheek definition of both in a 1958 article titled “Man’s construction of his alternatives” (included in the book “The Assessment of Human Motives”, edited by G.Lindzey):

“When the subject is asked to guess what the examiner is thinking, we call it an objective test; when the examiner tries to guess what the subject is thinking, we call it a projective device.”

The scoring of objective tests is computerized (no human input). Examples of such standardized instruments include the MMPI-II, the California Psychological Inventory (CPI), and the Millon Clinical Multiaxial Inventory II. Of course, a human finally gleans the meaning of the data gathered by these questionnaires. Interpretation ultimately depends on the knowledge, training, experience, skills, and natural gifts of the therapist or diagnostician.

Projective tests are far less structured and thus a lot more ambiguous. As L. K.Frank observed in a 1939 article titled “Projective methods for the study of personality”:

“(The patient’s responses to such tests are projections of his) way of seeing life, his meanings, signficances, patterns, and especially his feelings.”

In projective tests, the responses are not constrained and scoring is done exclusively by humans and involves judgment (and, thus, a modicum of bias). Clinicians rarely agree on the same interpretation and often use competing methods of scoring, yielding disparate results. The diagnostician’s personality comes into prominent play. The best known of these “tests” is the Rorschach set of inkblots.

II. MMPI-2 Test

The MMPI (Minnesota Multiphasic Personality Inventory), composed by Hathaway (a psychologist) and McKinley (a physician) is the outcome of decades of research into personality disorders. The revised version, the MMPI-2 was published in 1989 but was received cautiously. MMPI-2 changed the scoring method and some of the normative data. It was, therefore, hard to compare it to its much hallowed (and oft validated) predecessor.

The MMPI-2 is made of 567 binary (true or false) items (questions). Each item requires the subject to respond: “This is true (or false) as applied to me”. There are no “correct” answers. The test booklet allows the diagnostician to provide a rough assessment of the patient (the “basic scales”) based on the first 370 queries (though it is recommended to administer all of 567 of them).Based on numerous studies, the items are arranged in scales. The responses are compared to answers provided by “control subjects”. The scales allow the diagnostician to identify traits and mental health problems based on these comparisons. In other words, there are no answers that are “typical to paranoid or narcissistic or antisocial patients”. There are only responses that deviate from an overall statistical pattern and conform to the reaction patterns of other patients with similar scores. The nature of the deviation determines the patient’s traits and tendencies – but not his or her diagnosis!

The interpreted outcomes of the MMPI-2 are phrased thus: “The test results place subject X in this group of patients who, statistically-speaking, reacted similarly. The test results also set subject X apart from these groups of people who, statistically-speaking, responded differently”. The test results would never say: “Subject X suffers from (this or that) mental health problem”.

There are three validity scales and ten clinical ones in the original MMPI-2, but other scholars derived hundreds of additional scales. For instance: to help in diagnosing personality disorders, most diagnosticians use either the MMPI-I with the Morey-Waugh-Blashfield scales in conjunction with the Wiggins content scales – or (more rarely) the MMPI-2 updated to include the Colligan-Morey-Offord scales.

The validity scales indicate whether the patient responded truthfully and accurately or was trying to manipulate the test. They pick up patterns. Some patients want to appear normal (or abnormal) and consistently choose what they believe are the “correct” answers. This kind of behavior triggers the validity scales. These are so sensitive that they can indicate whether the subject lost his or her place on the answer sheet and was responding randomly! The validity scales also alert the diagnostician to problems in reading comprehension and other inconsistencies in response patterns.

The clinical scales are dimensional (though not multiphasic as the test’s misleading name implies). They measure hypochondriasis, depression, hysteria, psychopathic deviation, masculinity-femininity, paranoia, psychasthenia, schizophrenia, hypomania, and social introversion. There are also scales for alcoholism, post-traumatic stress disorder, and personality disorders.

The interpretation of the MMPI-2 is now fully computerized. The computer is fed with the patients’ age, sex, educational level, and marital status and does the rest. Still, many scholars have criticized the scoring of the MMPI-2.

III. MCMI-III Test

 

The third edition of this popular test, the Millon Clinical Multiaxial Inventory (MCMI-III), has been published in 1996. With 175 items, it is much shorter and simpler to administer and to interpret than the MMPI-II. The MCMI-III diagnoses personality disorders and Axis I disorders but not other mental health problems. The inventory is based on Millon’s suggested multiaxial model in which long-term characteristics and traits interact with clinical symptoms.

The questions in the MCMI-III reflect the diagnostic criteria of the DSM. Millon himself gives this example (Millon and Davis, Personality Disorders in Modern Life, 2000, pp. 83-84):

“… (T)he first criterion from the DSM-IV dependent personality disorder reads ‘Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others,’ and its parallel MCMI-III item reads ‘People can easily change my ideas, even if I thought my mind was made up.'”

The MCMI-III consists of 24 clinical scales and 3 modifier scales. The modifier scales serve to identify Disclosure (a tendency to hide a pathology or to exaggerate it), Desirability (a bias towards socially desirable responses), and Debasement (endorsing only responses that are highly suggestive of pathology). Next, the Clinical Personality Patterns (scales) which represent mild to moderate pathologies of personality, are: Schizoid, Avoidant, Depressive, Dependent, Histrionic, Narcissistic, Antisocial, Aggressive (Sadistic), Compulsive, Negativistic, and Masochistic. Millon considers only the Schizotypal, Borderline, and Paranoid to be severe personality pathologies and dedicates the next three scales to them.

The last ten scales are dedicated to Axis I and other clinical syndromes: Anxiety Disorder, Somatoform Disorder, Bipolar Manic Disorder, Dysthymic Disorder, Alcohol Dependence, Drug Dependence, Posttraumatic Stress, Thought Disorder, Major Depression, and Delusional Disorder.

Scoring is easy and runs from 0 to 115 per each scale, with 85 and above signifying a pathology. The configuration of the results of all 24 scales provides serious and reliable insights into the tested subject.

Critics of the MCMI-III point to its oversimplification of complex cognitive and emotional processes, its over-reliance on a model of human psychology and behavior that is far from proven and not in the mainstream (Millon’s multiaxial model), and its susceptibility to bias in the interpretative phase.

IV. Rorschach Inkblot Test

 

The Swiss psychiatrist Hermann Rorschach developed a set of inkblots to test subjects in his clinical research. In a 1921 monograph (published in English in 1942 and 1951), Rorschach postulated that the blots evoke consistent and similar responses in groups patients. Only ten of the original inkblots are currently in diagnostic use. It was John Exner who systematized the administration and scoring of the test, combining the best of several systems in use at the time (e.g., Beck, Kloper, Rapaport, Singer).The Rorschach inkblots are ambiguous forms, printed on 18X24 cm. cards, in both black and white and color. Their very ambiguity provokes free associations in the test subject. The diagnostician stimulates the formation of these flights of fantasy by asking questions such as “What is this? What might this be?”. S/he then proceed to record, verbatim, the patient’s responses as well as the inkblot’s spatial position and orientation. An example of such record would read: “Card V upside down, child sitting on a porch and crying, waiting for his mother to return.”

Having gone through the entire deck, the examiner than proceeds to read aloud the responses while asking the patient to explain, in each and every case, why s/he chose to interpret the card the way s/he did. “What in card V prompted you to think of an abandoned child?”. At this phase, the patient is allowed to add details and expand upon his or her original answer. Again, everything is noted and the subject is asked to explain what is the card or in his previous response gave birth to the added details.

Scoring the Rorschach test is a demanding task. Inevitably, due to its “literary” nature, there is no uniform, automated scoring system.

Methodologically, the scorer notes four items for each card:

I. Location – Which parts of the inkblot were singled out or emphasized in the subject’s responses. Did the patient refer to the whole blot, a detail (if so, was it a common or an unusual detail), or the white space.

II. Determinant – Does the blot resemble what the patient saw in it? Which parts of the blot correspond to the subject’s visual fantasy and narrative? Is it the blot’s form, movement, color, texture, dimensionality, shading, or symmetrical pairing?

III. Content – Which of Exner’s 27 content categories was selected by the patient (human figure, animal detail, blood, fire, sex, X-ray, and so on)?

IV. Popularity – The patient’s responses are compared to the overall distribution of answers among people tested hitherto. Statistically, certain cards are linked to specific images and plots. For example: card I often provokes associations of bats or butterflies. The sixth most popular response to card IV is “animal skin or human figure dressed in fur” and so on.

V. Organizational Activity – How coherent and organized is the patient’s narrative and how well does s/he link the various images together?

VI. Form Quality – How well does the patient’s “percept” fit with the blot? There are four grades from superior (+) through ordinary (0) and weak (w) to minus (-). Exner defined minus as:

“(T)he distorted, arbitrary, unrealistic use of form as related to the content offered, where an answer is imposed on the blot area with total, or near total, disregard for the structure of the area.”

The interpretation of the test relies on both the scores obtained and on what we know about mental health disorders. The test teaches the skilled diagnostician how the subject processes information and what is the structure and content of his internal world. These provide meaningful insights into the patient’s defenses, reality test, intelligence, fantasy life, and psychosexual make-up.

Still, the Rorschach test is highly subjective and depends inordinately on the skills and training of the diagnostician. It, therefore, cannot be used to reliably diagnose patients. It merely draws attention to the patients’ defenses and personal style.

V. TAT Diagnostic Test

The Thematic Appreciation Test (TAT) is similar to the Rorschach inkblot test. Subjects are shown pictures and asked to tell a story based on what they see. Both these projective assessment tools elicit important information about underlying psychological fears and needs. The TAT was developed in 1935 by Morgan and Murray. Ironically, it was initially used in a study of normal personalities done at Harvard Psychological Clinic.

The test comprises 31 cards. One card is blank and the other thirty include blurred but emotionally powerful (or even disturbing) photographs and drawings. Originally, Murray came up with only 20 cards which he divided to three groups: B (to be shown to Boys Only), G (Girls Only) and M-or-F (both sexes).

The cards expound on universal themes. Card 2, for instance, depicts a country scene. A man is toiling in the background, tilling the field; a woman partly obscures him, carrying books; an old woman stands idly by and watches them both. Card 3BM is dominated by a couch against which is propped a little boy, his head resting on his right arm, a revolver by his side, on the floor.

Card 6GF again features a sofa. A young woman occupies it. Her attention is riveted by a pipe-smoking older man who is talking to her. She is looking back at him over her shoulder, so we don’t have a clear view of her face. Another generic young woman appears in card 12F. But this time, she is juxtaposed against a mildly menacing, grimacing old woman, whose head is covered with a shawl. Men and boys seem to be permanently stressed and dysphoric in the TAT. Card 13MF, for instance, shows a young lad, his lowered head buried in his arm. A woman is bedridden across the room.

With the advent of objective tests, such as the MMPI and the MCMI, projective tests such as the TAT have lost their clout and luster. Today, the TAT is administered infrequently. Modern examiners use 20 cards or less and select them according to their “intuition” as to the patient’s problem areas. In other words, the diagnostician first decides what may be wrong with the patient and only then chooses which cards will be shown in the test! Administered this way, the TAT tends to become a self-fulfilling prophecy and of little diagnostic value.

The patient’s reactions (in the form of brief narratives) are recorded by the tester verbatim. Some examiners prompt the patient to describe the aftermath or outcomes of the stories, but this is a controversial practice.

The TAT is scored and interpreted simultaneously. Murray suggested to identify the hero of each narrative (the figure representing the patient); the inner states and needs of the patient, derived from his or her choices of activities or gratifications; what Murray calls the “press”, the hero’s environment which imposes constraints on the hero’s needs and operations; and the thema, or the motivations developed by the hero in response to all of the above.

Clearly, the TAT is open to almost any interpretative system which emphasizes inner states, motivations, and needs. Indeed, many schools of psychology have their own TAT exegetic schemes. Thus, the TAT may be teaching us more about psychology and psychologists than it does about their patients!

VI. Structured Interviews

The Structured Clinical Interview (SCID-II) was formulated in 1997 by First, Gibbon, Spitzer, Williams, and Benjamin. It closely follows the language of the DSM-IV Axis II Personality Disorders criteria. Consequently, there are 12 groups of questions corresponding to the 12 personality disorders. The scoring is equally simple: either the trait is absent, subthreshold, true, or there is “inadequate information to code”.

The feature that is unique to the SCID-II is that it can be administered to third parties (a spouse, an informant, a colleague) and still yield a strong diagnostic indication. The test incorporates probes (sort of “control” items) that help verify the presence of certain characteristics and behaviors. Another version of the SCID-II (comprising 119 questions) can also be self-administered. Most practitioners administer both the self-questionnaire and the standard test and use the former to screen for true answers in the latter.

The Structured Interview for Disorders of Personality (SIDP-IV) was composed by Pfohl, Blum and Zimmerman in 1997. Unlike the SCID-II, it also covers the self-defeating personality disorder from the DSM-III. The interview is conversational and the questions are divided into 10 topics such as Emotions or Interests and Activities. Succumbing to “industry” pressure, the authors also came up with a version of the SIDP-IV in which the questions are grouped by personality disorder. Subjects are encouraged to observe the “five year rule”:

“What you are like when you are your usual self … Behaviors. cognitions, and feelings that have predominated for most of the last five years are considered to be representative of your long-term personality functioning …”

The scoring is again simple. Items are either present, subthreshold, present, or strongly present.

VII. Disorder-specific Tests

There are dozens of psychological tests that are disorder-specific: they aim to diagnose specific personality disorders or relationship problems. Example: the Narcissistic Personality Inventory (NPI) which is used to diagnose the Narcissistic Personality Disorder (NPD).

The Borderline Personality Organization Scale (BPO), designed in 1985, sorts the subject’s responses into 30 relevant scales. These indicates the existence of identity diffusion, primitive defenses, and deficient reality testing.

Other much-used tests include the Personality Diagnostic Questionnaire-IV, the Coolidge Axis II Inventory, the Personality Assessment Inventory (1992), the excellent, literature-based, Dimensional assessment of Personality Pathology, and the comprehensive Schedule of Nonadaptive and Adaptive Personality and Wisconsin Personality Disorders Inventory.

Having established the existence of a personality disorder, most diagnosticians proceed to administer other tests intended to reveal how the patient functions in relationships, copes with intimacy, and responds to triggers and life stresses.

The Relationship Styles Questionnaire (RSQ) (1994) contains 30 self-reported items and identifies distinct attachment styles (secure, fearful, preoccupied, and dismissing). The Conflict Tactics Scale (CTS) (1979) is a standardized scale of the frequency and intensity of conflict resolution tactics and stratagems (both legitimate and abusive) used by the subject in various settings (usually in a couple).

The Multidimensional Anger Inventory (MAI) (1986) assesses the frequency of angry responses, their duration, magnitude, mode of expression, hostile outlook, and anger-provoking triggers.

Yet, even a complete battery of tests, administered by experienced professionals sometimes fails to identify abusers with personality disorders. Offenders are uncanny in their ability to deceive their evaluators.

APPENDIX: Common Problems with Psychological Laboratory Tests

Psychological laboratory tests suffer from a series of common philosophical, methodological, and design problems.

A. Philosophical and Design Aspects

  1. Ethical – Experiments involve the patient and others. To achieve results, the subjects have to be ignorant of the reasons for the experiments and their aims. Sometimes even the very performance of an experiment has to remain a secret (double blind experiments). Some experiments may involve unpleasant or even traumatic experiences. This is ethically unacceptable.
  1. The Psychological Uncertainty Principle – The initial state of a human subject in an experiment is usually fully established. But both treatment and experimentation influence the subject and render this knowledge irrelevant. The very processes of measurement and observation influence the human subject and transform him or her – as do life’s circumstances and vicissitudes.
  1. Uniqueness – Psychological experiments are, therefore, bound to be unique, unrepeatable, cannot be replicated elsewhere and at other times even when they are conducted with the SAME subjects. This is because the subjects are never the same due to the aforementioned psychological uncertainty principle. Repeating the experiments with other subjects adversely affects the scientific value of the results.
  1. The undergeneration of testable hypotheses – Psychology does not generate a sufficient number of hypotheses, which can be subjected to scientific testing. This has to do with the fabulous (=storytelling) nature of psychology. In a way, psychology has affinity with some private languages. It is a form of art and, as such, is self-sufficient and self-contained. If structural, internal constraints are met – a statement is deemed true even if it does not satisfy external scientific requirements.

B. Methodology

    1. Many psychological lab tests are not blind. The experimenter is fully aware who among his subjects has the traits and behaviors that the test is supposed to identify and predict. This foreknowledge may give rise to experimenter effects and biases. Thus, when testing for the prevalence and intensity of fear conditioning among psychopaths (e.g., Birbaumer, 2005), the subjects were first diagnosed with psychopathy (using the PCL-R questionnaire) and only then underwent the experiment. Thus, we are left in the dark as to whether the test results (deficient fear conditioning) can actually predict or retrodict psychopathy (i.e., high PCL-R scores and typical life histories).

    2. In many cases, the results can be linked to multiple causes. This gives rise to questionable cause fallacies in the interpretation of test outcomes. In the aforementioned example, the vanishingly low pain aversion of psychopaths may have more to do with peer-posturing  than with a high tolerance of pain: psychopaths may simply be too embarrassed to “succumb” to pain; any admission of vulnerability is perceived by them as a threat to an omnipotent and grandiose self-image that is sang-froid and, therefore, impervious to pain. It may also be connected to inappropriate affect.

    3. Most psychological lab tests involve tiny samples (as few as 3 subjects!) and interrupted time series. The fewer the subjects, the more random and less significant are the results. Type III errors and issues pertaining to the processing of data garnered in interrupted time series are common.

    4. The interpretation of test results often verges on metaphysics rather than science. Thus, the Birbaumer test established that subjects who scored high on the PCL-R have different patterns of skin conductance (sweating in anticipation of painful stimuli) and brain activity. It did not substantiate, let alone prove, the existence or absence of specific mental states or psychological constructs.

    5. Most lab tests deal with tokens of certain types of phenomena. Again: the fear conditioning (anticipatory aversion) test pertains only to reactions in anticipation of an instance (token) of a certain type of pain. It does not necessarily apply to other types of pain or to other tokens of this type or any other type of pain.

    6. Many psychological lab tests give rise to the petitio principii (begging the question) logical fallacy. Again, let us revisit Birbaumer’s test. It deals with people whose behavior is designated as “antisocial”. But what constitute antisocial traits and conduct? The answer is culture-bound. Not surprisingly, European psychopaths score far lower on the PCL-R than their American counterparts. The very validity of the construct “psychopath” is, therefore, in question: psychopathy seems to be merely what the PCL-R measures!

    7. Finally, the “Clockwork Orange” objection: psychological lab tests have frequently been abused by reprehensible regimes for purposes of social control  and social engineering.


Many additional Frequently Asked Questions (FAQs) about Personality Disorders – click HERE!

Psychological Defense Mechanisms

Psychological Signs and Symptoms

Your abuser in Therapy

Testing the Abuser

Conning the System