Assessing Criterion A of the Alternative Model for Personality Disorders: The Potential of Performance-Based Personality Measures.

The conceptualization of personality disorder has been refined through recent nosological advances introduced in the Alternative Model for Personality Disorders (AMPD). These advances locate self and interpersonal (dys)function at the core of personality pathology. Self-report personality assessment instruments have demonstrated promise in the assessment of Criterion A domains. However, research highlighting the utility of performance-based personality assessment instruments has been largely absent in these advances, despite acknowledgment of their potential. We adhered to PRISMA review guidelines to survey and assess the potential relevance and utility of select performance-based personality instruments in assessing Criterion A domains of the AMPD. We conclude that performance-based personality measures are uniquely positioned to assess maladaptive self- and interpersonal functioning and may address some limitations of self-report measures. Toward this end, we propose a working model that provides ranges of test scores that correspond to the 5-point scale of the Criterion A domains of the AMPD.

Simulating Local Biases in Visual Attention in Neurocognitive Performance.

Typical visual perception includes an attention bias toward right hemisphere mediated global, holistic cortical processing. An atypically local, detail-oriented focus of attention is characteristic of left hemisphere processing and is often observed in patients whose field of attention is restricted by certain types of neurocognitive impairment. We designed the present pair of studies to induce a local attentional focus to observe its consequences on neurocognitive measures of visuospatial processing. In Experiment I, participants wore glasses mimicking simultanagnosia, a disorder of visual attention, to induce a narrowed, atypical attentional style while they completed visual neuropsychological tasks. This simulation impaired participants' capacities to visually synthesize and efficiently reproduce Complex Figure stimuli as measured with the Boston Qualitative Scoring System (BQSS), and it induced an atypical attentional style on Rorschach Performance Assessment System (R-PAS) responses. In Experiment II, participants wore glasses designed to provoke differential hemispheric activation, also hypothesized to influence style of visual attention; but this manipulation did not influence neurocognitive task performance. We discuss implications for the interpretation of BQSS and R-PAS scores and offer directions for future research.

The Effects of Coding the Location of Individual Objects in a Normative Sample of Rorschach Data.

The locations people use when constructing responses to the Rorschach task demonstrate their style of perceiving the environment. Current systems code location use into three mutually exclusive categories: use of the whole inkblot (W), common detail areas (D), and rare detail areas (Dd). The location of objects within multiobject W responses typically are never classified and those within D areas might or might not be, which could lead to a biased understanding of the visual structure embedded in the task. To better understand this structure, we systematically coded the location of all individual response objects in 145 normative protocols, finding some notable differences relative to conventional coding guidelines. Across cards, from 8% to 71% (M = 40.2%) of W responses had multiple subcomponent objects that typically are never tallied, and multiple unnumbered location areas are used more often than many specific numbered areas. To assess generalizability, we documented correspondence with location frequencies in 4,786 protocols gathered using Rorschach Performance Assessment System guidelines. The results contribute to an improved understanding of the visual structure built into the inkblot stimuli and a method for quantifying exhaustiveness, commonness, and atypicalness as independent dimensions. We discuss implications for coding and interpreting inkblot location use.

Contemporary Data on the Location of Response Objects in Rorschach's Inkblots.

Using a diverse sample of 4,786 protocols obtained with the Rorschach Performance Assessment System (Meyer, Viglione, Mihura, Erard, & Erdberg, 2011), we provide a contemporary overview of how people organize Rorschach's inkblots into identifiable regions while formulating responses. After examining how frequently each location was used across all cards in this sample, we examined the consistency of their use by computing parallel information in 17 samples (N = 4,701) obtained using the Comprehensive System (CS; Exner, 2003), including clinical, nonclinical, and adult, child, and adolescent data. Even though the CS data could only record a single location for each response, the average correlation of location use across samples was .96. The results also document continuous dimensionality in use rather than any discontinuities that would demarcate a boundary between common and uncommon locations. Implications of this notable reproducibility and dimensionality are discussed for future conceptualization of location typicality, including location coding considerations and possibilities for improved measures of perceptual fit.

A neurobiological hypothesis of treatment-resistant depression - mechanisms for selective serotonin reuptake inhibitor non-efficacy.

First-line treatment of major depression includes administration of a selective serotonin reuptake inhibitor (SSRI), yet studies suggest that remission rates following two trials of an SSRI are <50%. The authors examine the putative biological substrates underlying "treatment resistant depression (TRD)" with the goal of elucidating novel rationales to treat TRD. We look at relevant articles from the preclinical and clinical literature combined with clinical exposure to TRD patients. A major focus was to outline pathophysiological mechanisms whereby the serotonin system becomes impervious to the desired enhancement of serotonin neurotransmission by SSRIs. A complementary focus was to dissect neurotransmitter systems, which serve to inhibit the dorsal raphe. We propose, based on a body of translational studies, TRD may not represent a simple serotonin deficit state but rather an excess of midbrain peri-raphe serotonin and subsequent deficit at key fronto-limbic projection sites, with ultimate compromise in serotonin-mediated neuroplasticity. Glutamate, serotonin, noradrenaline, and histamine are activated by stress and exert an inhibitory effect on serotonin outflow, in part by "flooding" 5-HT1A autoreceptors by serotonin itself. Certain factors putatively exacerbate this scenario - presence of the short arm of the serotonin transporter gene, early-life adversity and comorbid bipolar disorder - each of which has been associated with SSRI-treatment resistance. By utilizing an incremental approach, we provide a system for treating the TRD patient based on a strategy of rescuing serotonin neurotransmission from a state of SSRI-induced dorsal raphe stasis. This calls for "stacked" interventions, with an SSRI base, targeting, if necessary, the glutamatergic, serotonergic, noradrenergic, and histaminergic systems, thereby successively eliminating the inhibitory effects each are capable of exerting on serotonin neurons. Future studies are recommended to test this biologically based approach for treatment of TRD.