The Incremental Validity of Self-Report and Performance-Based Methods for Assessing Hostility to Predict Cardiovascular Disease in Physicians.

We evaluated the utility of an integrative, multimethod approach for assessing hostility-related constructs to predict premature cardiovascular disease (CVD) and premature coronary heart disease (CHD) using participants from the Johns Hopkins Precursors Study, which was designed to identify risk factors for heart disease. Participants were assessed at baseline while in medical school from 1946 to 1962 (M age = 24.6) and have been followed annually since then. Baseline assessment included individually administered Rorschach protocols (N = 416) scored for aggressive imagery (i.e., Aggressive Content, Aggressive Past) and self-reports of 3 possible anger responses to stress. Cox regression analyses predicting morbidity or mortality by age 55 revealed a significant interaction effect; high levels of Aggressive Content with high self-reported hostility predicted an increased rate of premature CVD and CHD, and incrementally predicted the rate of these events after controlling for the significant covariates of smoking (CVD and CHD) and cholesterol (CHD) that were also assessed at baseline. The hostility and anger measures, as well as other baseline covariates, were not predictors of CVD risk factors assessed at midlife during follow-up. Overall, this integrative model of hostility illustrates the potential value of multimethod assessment to areas of health psychology and preventive medicine.

A principal components analysis of Rorschach aggression and hostility variables.

We examined the structure of 9 Rorschach variables related to hostility and aggression (Aggressive Movement, Morbid, Primary Process Aggression, Secondary Process Aggression, Aggressive Content, Aggressive Past, Strong Hostility, Lesser Hostility) in a sample of medical students (N= 225) from the Johns Hopkins Precursors Study (The Johns Hopkins University, 1999). Principal components analysis revealed 2 dimensions accounting for 58% of the total variance. These dimensions extended previous findings for a 2-component model of Rorschach aggressive imagery that had been identified using just 5 or 6 marker variables (Baity & Hilsenroth, 1999; Liebman, Porcerelli, & Abell, 2005). In light of this evidence, we draw an empirical link between the historical research literature and current studies of Rorschach aggression and hostility that helps organize their findings. We also offer suggestions for condensing the array of aggression-related measures to simplify Rorschach aggression scoring.

The interrater reliability of Elizur's hostility systems and Holt's aggression variables: a meta-analytical review.

We provide a meta-analytic review of interrater reliability for scoring the 2 most commonly studied Rorschach (2003) aggression measures: (a) The Elizur (1949) Hostility Scale and its main derivative scoring systems (Holtzman, Thorpe, Swartz, & Herron, 1961; Murstein, 1956) and (b) Holt's (1977, 2005) aggression variables. Substantial reliability was observed for both Elizur's hostility score (e.g., weighted mean summary score correlation = .91, N = 1,279) and Holt's aggression variables (e.g., weighted mean summary score correlation = .84, N = 226). These meta-analytic data suggest that like the contemporary variables included in Exner's Comprehensive System or Gacono and Meloy's (1994) extended aggression scores, the historically important Elizur scoring systems and Holt aggression variables can be scored reliably. [Supplementary materials are available for this article. Go to the publisher's online edition of the Journal of Personality Assessment for the following free supplemental resources: a document of results examining publication source, scoring system, amount of rater training, and severity of aggressive pathology in the sample as potential moderators of reliability.]