Personality scale, psychological tests and BPD
Rorschach, MMPI, Das, MCMI, SAS, PDQ, IPDE, SIDP...,

There are a lot of tests available to test personnaliy, no one are perfects. Some indicates tendancies and some seems to be totally obsolete. Semi structured interviews seems to be the best choice

• The Rorschach consists of a set of ten card with an inkblot on each card.

It was developed in 1910 The test is considered "projective" because the patient is supposed to project his or her real personality into the inkblot via the interpretation. Update 1942
The reliability and validity of the Rorschach is highly controversial - especially with subjects who are resistant. Most professionals agree that using the Rorschach alone is probably negligent.  The Rorschach can be rendered useless or invalid if a subject provides less than 10 responses or describes only one area per card.  Some professionals consider the Rorschach to be unscientific
 
• The MMPI 1942 (see MMPI-2)  is a true false questionnaire that has 556 questions

 
• The DAS or dysfunctional attitude scale from Weissman (1980) is a questionnaire with 40 items with answers from "I totally agree" to "I totally disagree"

 
• The MCMI / MCMI-II or Millon Clinical Multiaxial Inventory is a true false questionnaire that has 175 questions.

First version was developed in the 1970's and was constructed with scales that represented  personality disorders contained in DSM III.
The original MCMI was highly controversial
The new version was released in 1987 and was based on DSM III-R but does not represent the current DSM-IV personality disorders.  The attitude of the person taking the MCMI or MCMI-2 and circumstance in which the questionnaires are given can have a significant impact on the validity of the results.
 
• The SAS or sociotropy autonomy scale from BECK is a questionnaire with 60 items with answers from "I totally agree" to "I totally disagree" (in %)

 
• The MMPI-2 or Minnesota Multiphasic Personality Inventory. (60-90 minutes)

Specialized and supervised training is recommended before using these questionnaires.  Use of the MMPI or MMPI-2 and interpretation without training or without proper consideration is probably negligent. The attitude of the person taking the MMPI-2 and circumstance in which the questionnaires are given can have a significant impact on the results.  MMPI-2 567 questions 1990

The minimult is a french summarized version of the MMPI with 172 questions
 

• The PDQ / PDQ-R / PDQ IV or personality diagnostic questionnaire from Dr. Steven Hyler is a true false questionnaire that has 163 questions (99 question for pdq4) (1994)

It was constructed with scales that represented  personality disorders. It takes approximately 10-20 minutes to complete
 
• The IPDE - International Personality Disorder Examination from Loranger and the WHO organization (1994)(french adaptation Dr Pull) is a semistructured clinical interview compatible with the ICD-10 and the DMS-IV (semi-strutured means that questions are completed by evaluator)(The IPDE exists in 2 versions, one 94 questions screening "yes / no" allowing to quickly have some idea about personality disorders and the full version with 100 questions allowing to make diagnosis but also to have dimensional score for each disorder). The IPDE is available in computer software

• The SIDP / SIDP IV or Structured Interview for DSM Personality Disorders from Bruce Pfohl, M.D (SIDP IV 1997) (semi-strutured means that questions are completed by evaluator)

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etc ...

data from "oregoncounseling, jean cottraux, daniel nollet,..."

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Data, studies (statistics, prevalence, comorbidity, co-occurency)

* Wood JM, Lilienfeld SO, Garb HN, Nezworski MT. - Dept. of Psychology, University of Texas El Paso, USA
2000  J Clin Psychol. - The Rorschach test in clinical diagnosis: a critical review
"Despite a few positive findings, the Rorschach has demonstrated little validity as a diagnostic tool"

* Blais MA, Hilsenroth MJ, Castlebury F, - Inpatient Psychiatry Service, Harvard Medical School, Boston, USA
2001 J Pers Assess.- Predicting DMS-IV cluster B personality disorder criteria from MMPI-2 and Rorschach data: a test of incremental validity.
"Despite their frequent conjoint clinical use, the incremental validity of Rorschach (Rorschach, 1921/1942) and MMPI (Hathaway & McKinley, 1943) data has not been adequately established, nor has any study to date explored the incremental validity of these tests for predicting DSM IV Diagnostic
In a reanalysis of existing data, we used select Rorschach variables and the MMPI PD scales to predict DSM-IV antisocial, borderline, histrionic, and narcissistic PD criteria in a sample of treatment-seeking outpatients. The correlational findings revealed alimited relation between Rorschach and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) variables, with only 5 of 30 correlations reaching significance
The correlational findings revealed a limited relation between Rorschach and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989)"

* Zalewski C, Archer RP. - Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk.
1991 J Nerv Ment Dis. - "Assessment of borderline personality disorder. A review of MMPI and Rorschach findings."
This review examines the literature on assessing borderline personality disorder (BPD) using the MMPI and the Rorschach test. Despite the extensive use of these instruments in the assessment of BPD, the degree to which they are successful in identifying the disorder remains unclear...
Furthermore, no supportive evidence was found for the commonly held hypothesis that BPD subjects show more impairment on unstructured measures than on objective measures

• "I do not feel the Rorschach is very well suited to diagnose personality disorders in general or specific ones like BPD, plus it is not necessary, since these disorders are fairly easy  to diagnose from information about the person.  The Rorschach is quite controversial regarding its validity.  It can indicate significant patterns about the ways a person develops and integrates his or her perceptions, so it is helpful to a person's therapist, but not so much for diagnosis as for an understanding of the person's perceptual approach." (daniel c claiborn, "about rorschach", 2OO3)

 
• "Le Roschach est moins utilisé et donne lieu à de moins en moins de publication depuis une vingtaine d'années. Je pense qu'il ne répond plus aux attentes des cliniciens et des chercheurs actuels car il repose trop sur des interprétations malgré une tentative de quantification. Il se fonde sur la théorie psychanalytique que nous considérons comme dépassée." (J Cottraux - Directeur de l'unité de traitement de l'anxiété, hopital neurologique CHU Lyon - 2OO3)

 
• "The MMPI is a relatively useless test for legal issues and to diagnose the BPD. I know of one individual with the BPD who did the MMPI while feeling good, and then the next day while experiencing dysphoria. The results were shocking. The first one showed results similar to what you described, the second one showed antisocial pathology. Neither the MMPI nor the Rorschach tests are particularly useful, and they can be particularly misleading for court problems. These tests were designed for research purposes and to assist patients and therapists in the course of psychotherapy. They were not designed to meet the standards necessary for court decisions, and are not reliable in this regard." (Leland M. Heller, MD, “Borderline Personality Disorder Diagnosis -MMPI”, www.biologicalunhappiness.com )

 
• "In more than twenty years of psychiatric work, I have never known a clinical psychologist to report, on the basis of a projective test, that the subject is a "normal, mentally healthy person." " (Thomas Szasz. The Manufacture of Madness. New York: Harper & Row, Publishers, 1970)

 
• "Dr. Scott Lilienfeld and his colleagues say that there is "virtually no evidence" to support the idea that the Rorschach inkblot test reliably diagnoses emotional problems, such as depression and anxiety." (Erica Goode. "The Battle over Rorschach’s Fabled Blots," Santa Barbara New-Press, Feb 2001)

 
• "The accumulation of published studies that have failed to demonstrate any validity for such projective techniques as the Rorschach . . . is truly impressive... The only thing the inkblots do reveal is the secret world of the examiner who interprets them. These doctors are probably saying more about themselves than about the subjects." (Anne Anastasi,"Rorschach Inkblot Test", op. cit., 1982).

 
• "Dr. Margaret Hagen, in describing the fraud of psychiatric testimony in court, criticizes the use of the Rorschach inkblot test" (Margaret Hagen. Whores of the Court: The Fraud of Psychiatric Testimony and the Rape of American Justice. New York: Regan Books/HarperCollins Publishers, 1997)

 
• The american psychiatric association: Nothing found about "Rorschach" in all the web site (june 2OO3)

 

Here is our feeling.

For what ?
We are thinking that the tests are a "plus", not the essential, to help to determine the personality of a person and especially a personality disorder

On the face on it, "Bad" tests
We think that the more "sensitive" tests are automatic tests with answers "yes / no". "Yes or no" is not a valid answer for a lot of questions in life.
But it is false to suppose that it is the test which is "dangerous", it is not itself but the importance that we give to it

"Worst" test
But for us (everyone is free to don't agree), the worst, even if it is possible to find studies saying that "it works" is the "Rorschach projective test". We consider that it is unacceptable to say that a person has paranoïd tendancies or whatever, only because he see or don't see "things" in a inkblot. It is a way to condamn a person only because of their imagination or lack of imagination
We think that it is a total lack of respect of the human being to use this test as a diagnosis tool. This test is totaly unreproductive and too subject to interpretation.
If you want to read more about peoples who "hate" this "test", you can go to this address http://www.deltabravo.net/custody/rorschach.htm (we are not responsible about the content of this site)

"Better" tests
To be more serious now. Semi-structured interview (like IPDE) seems to be much better and objective to test a personality. That mean that the therapist adjust some questions and reach to a non-automatized answer.
In all cases we always have to be suspicious about the result of a test, depending of the person's mood, if he or she is anxious, if he or she is lying whatever the reason why,...

"Half an hour, and we know you !"
Whatever the tests used, we don't believe that it is possible to "know" a person just after a session !
We can have some clues, but it is necessary to see him / her several times to make our firm conviction, especially to detect a borderline disorder with an high functioning people.
In all cases it will be a "believe", never THE "Truth" but the "therapist truth"

"The best test for BPD" ?
If some are saying that we can detect homosexuality in a ink blot, we think to have the right to speak about  our test without a guilty conscience.