Evaluación Personalidad (Butcher)

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Annu. Rev. Clin. Psychol. 2010.6:1-20. Downloaded from arjournals.annualreviews.org by Universidad Adolfo Ibanez on 04/15/10. For personal use only.
Personality Assessment from the Nineteenth to the Early Twenty-First Century: Past Achievements and Contemporary Challenges
James N. Butcher
Department of Psychology, University of Minnesota, Minneapolis, Minnesota 55455; email: butch001@umn.edu
Annu. Rev. Clin. Psychol. 2010. 6:120 First published online as a Review in Advance on January 19, 2010 The Annual Review of Clinical Psychology is online at clinpsy.annualreviews.org This articles doi: 10.1146/annurev.clinpsy.121208.131420 Copyright c 2010 by Annual Reviews. All rights reserved 1548-5943/10/0427-0001$20.00
Key Words
assessment history, phrenology, Rorschach, Exner Comprehensive System, TAT, MMPI, MMPI-2, MMPI-2-RF, RC Scales, Restructured Clinical Scales
Abstract
The historical basis of personality assessment that led to the development of todays approaches and applications is described. The modern era of personality assessment began in late nineteenth-century Europe. Early twentieth-century highlights included the development of projective techniques like the Rorschach and several early self-report inventories, culminating in the development of the most widely used measure, the Minnesota Multiphasic Personality Inventory (MMPI). The most recent 30-year period showed expansions into personnel screening; clinical assessment, including wide use in forensic settings; and therapeutic assessment. However, contemporary controversies are apparent with two of the most widely used measures, the Rorschach and the MMPI instruments. These controversies are described, including concerns about the Exner Comprehensive System for the Rorschach and the last ve years of changes to the MMPI-2, including the introduction of the Restructured Clinical (RC) Scales, the adoption of the Fake Bad Scale (FBS) into the instrument, and the release of the MMPI-2 Restructured Form (MMPI-2-RF). Current challenges facing psychologists in personality assessment are highlighted.
Contents
INTRODUCTION . . . . . . . . . . . . . . . . . . NINETEENTH-CENTURY PRECURSORS TO PERSONALITY ASSESSMENT . . EARLY-TWENTIETH CENTURY DEVELOPMENTS IN PERSONALITY ASSESSMENT . . . . . . . . . . . . . . . . . . . USE OF PERSONALITY INVENTORIES IN PERSONNEL SETTINGS . . . . . . . USE OF PERSONALITY MEASURES IN MENTAL HEALTH AND MEDICAL SETTINGS . . . . . . . . . . . . . . . . . . . . . . . LATTER HALF OF THE TWENTIETH CENTURY . . . . . . . CONTEMPORARY CONCERNS ABOUT TWO ASSESSMENT STANDARDS . . . . . . . . . . . . . . . . . . . . . Criticisms of the Rorschach . . . . . . . . Recent Public Exposure of the Rorschach Blots . . . . . . . . . . . . . . . . Controversial Changes to the MMPI-2 . . . . . . . . . . . . . . . . . . . . . . . CONCLUDING COMMENTS . . . . . . 2
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INTRODUCTION
People have been interested in appraising the personality of others for as long as our available records show. The earliest documented attempts at understanding personality characteristics can be found in ancient civilizations. Both Hathaway (1965) and Sundberg (1977) pointed out that one of the initial descriptions of behavioral observation techniques in assessing personality can be found in the Old Testament when Gideon used observations of his men trembling with fear as well as observations of how they chose to drink water from a stream as a means of selecting soldiers for battle. In ancient Greece and Rome, Tacitus provided a number of examples in which the appraisal of a persons personality entered into judgments
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about him, often life-or-death decisions (Grant 1956). Tacitus pointed out that in one situation, Tiberius had pretended to be hesitant for another reason too, in order to detect what leading men were thinking (Grant 1956, p. 36). Physicians such as Galen and Soranus used medical techniques of the day, particularly observation, to understand the thinking and behavior of people with mental health problems (Gerdz 1994). Galen (AD 130200) believed that a persons temperament was related to the predominance of various body uids. Soranus (AD 96138) provided descriptions of different personality factors involved in several mental disorders, based on observations and medical examinations of the day, that are recognizable even today in clinical diagnoses. During the middle ages, in the fteenth and into the seventeenth centuries, the assessment of mental health problems took a morbid direction that led to the accumulation of information that contributed to the execution of thousands of people. Beliefs at the time of the Spanish and Roman Inquisitions maintained that some people were witches who worked on behalf of the devil and needed to be identied in order that they could be stopped. Spanos (1978) pointed out that many of the best-educated and most intelligent men in Western Europe during this period believed in the existence of witches, mostly women, who belonged to an international satanic conspiracy dedicated to the defamation of God. Thousands of people confessed to being witches and to carrying out various incredible activities against God during this period. The evidence that was most commonly used by the ofcials of the day to expose a person as a witch and mentally unbalanced was the persons own acknowledgment, usually under intense external pressure and torture (Kieckhefer 1976). In determining whether a person was a witch, a representative of the church evaluated individuals to establish whether they had qualities of demonic possession. Church ofcials, who were referred to as witch prickers, would stick sharp objects deep in the suspects body, as far as the bone, to determine whether the
suspect had locations that had been marked by the Devil (known as Devils marks) (Ostermann 1629); such areas on the body were considered to be insensitive to the pain of torture (Guazzo 1608/1929). In many cases, the evaluations were carried out publicly, in situations that resulted in extreme fear and embarrassment for the suspects. A person who became terried and confused was considered mentally disordered and a likely witch. According to writings of authorities of the time (Boguet 1603/1929), most suspects readily confessed to their sins. However, some suspects failed to confess when tortured, and it was thought that the Devil had provided them with protection, such as drugs or spells that made them insensitive to pain. This review addresses the historical roots of contemporary personality assessment, highlighting prominent developments from its origins in the nineteenth century to current times. Any view of the history of a eld is necessarily selective given the constancy of change and broad development of thinking and instruments. The present review and perspective highlights major contributions, describes the more lasting trends, and highlights some current challenges facing personality assessment. The scope of this article does not allow for a comprehensive review of all techniques that have been published to measure various aspects of personality. One needs to examine critically and recognize the limitations of a particular historical perspective. Those interested in further exploration of the historical overviews of personality assessment can nd more information in several resources (e.g., Benjamin 2005, Boring 1950, Goldberg 1971, Gibby & Zickar 2008, Paterson et al. 1938, Sundberg 1977). Personality research methods are reviewed by Craik (1986).
NINETEENTH-CENTURY PRECURSORS TO PERSONALITY ASSESSMENT

Historical trends or precursors may not directly contribute to development in a eld, but they can reect social motivation for change or
methodological ideas that can indirectly inuence the transformation. In the nineteenth century, there were several notable attempts, based on scientic thinking of the day, to develop formal methods for studying personality and character. Two separate and quite different historic trends emerged in this period. One such intellectual movement was phrenology, the view that there was a means of deriving information about the character of individuals by examining their head size and shape. The second approach during the nineteenth century, begun by Francis Galton, involved careful scientic observation and mental testing. Galtons ideas were highly inuential to later personality assessment developments. The science of phrenology was explored and widely taught by several prominent physicians in Europe. Phrenology appealed to intellectuals who accepted the view that biological determinism enabled individuals to be able to read and understand the character of other people by examining their physical appearance. This movement was initiated by the Viennese physician Franz Joseph Gall (1758 1828) and his student Johan Spurzheim (1776 1832). Gall, was a prominent lecturer who explored and taught, for example, that having a powerful memory was a characteristic resulting from having very prominent eyes; he thought that other bodily characteristics such as head size and shape were related to character or special talents for painting or music. Gall and Spurzheim became very popular speakers among upper-class intellectuals and scientists in Europe in the 1820s. They wrote and lectured widely on phrenology throughout Europe. Gall and Spurzheim had a disagreement that prompted Spurzheim to start his own career in phrenology. Spurzheim later expanded his theory and established a new and more complete topography of the skull, lling in blanks for areas that had not been established. He expanded the terminology of phrenology and continued to lecture on this theory around Europe and the United States. His lectures and writings inuenced some physicians in other countries, such as the British physician George
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www.annualreviews.org Personality Assessment from the Nineteenth to the Early Twenty-First Century
Combe (17881858), who became well known as a phrenologist. Spurzheim also inuenced the work of John C. Warren (17781856), a professor of medicine at Harvard who performed the rst surgery under ether in the United States. When Warren returned to Boston, he developed a series of lectures on phrenology at Harvard and later incorporated these ideas into presentations for a broader audience at the Massachusetts Medical Society. One of the most widely traveled promoters of phrenology in the United States during the 1820s was Charles Caldwell (1772 1853), who had attended Spurzheims lectures in Paris. He lectured on phrenology throughout the United States and founded organizations that promoted phrenology. In 1832, after a series of lectures in the United States, Spurzheim became ill and died. The most visible phrenologists in the United States were two brothers, Orson Squire Fowler (18091889) and Lorenzo Fowler (18111896). The Fowlers lectured and wrote extensively about phrenology during the 1840s. They established and operated a publishing house, a mail-order business, and a museum of human and animal skulls to promote phrenology as a method for understanding other people. Although the phrenology movement was popular for a time, even among some physicians, it was not widely accepted in the broader medical scientic community. The high interest in phrenology occurring in both Europe and the United States is important in the history of assessment in that it reects the idea that there was both a general and professional interest in the process of evaluating personality characteristics and character through use of external information. In contrast to the pseudoscientic phrenology fad in the early-nineteenth century, there were major contributions to the development of a science of personality assessment toward the end of the century. In England, Francis Galton (18221911), a relative and contemporary of Charles Darwin, conducted a number of experiments on mental processes and postulated procedures for measuring psychological
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attributes. Galton (1879, 1884) thought that human character could be studied by observation and experimentation and suggested strategies for making personality-based observations that could be standardized and compared by the use of normative procedures. For example, he used Galens typology in his studies of temperament (Galton 1874). Galton proposed that questionnaires could be developed for measuring mental traits, although he did not develop a specic questionnaire for this purpose. In 1890, James McKeen Cattell, following ideas of Galton, initiated a study of measurements to appraise mental processes that incorporated rigorous standards to evaluate human qualities, for example, procedures that would be valuable in the diagnosis of nervous diseases and in studying abnormal states of consciousness (Cattell 1890, p. 349). Although his work primarily focused upon physical measures, his attention to accurate observation and quantication and his coining of the term mental tests provided a scientic basis and direction for the objective study of human characteristics.
EARLY-TWENTIETH CENTURY DEVELOPMENTS IN PERSONALITY ASSESSMENT

Benjamin (2005) pointed out that psychological assessment was the beginning of clinical psychology and that between the two world wars, clinical psychology was essentially about assessment. Most work on mental testing at the turn of the century included the use of physical tests in the tradition of Cattell. For example, a manual on testing published by Whipple (1910) addressed primarily physical, motor, sensory, and perceptual tests. However, at about the same time, three early publications signaled an interest in using procedures other than physical qualities for understanding psychological processes. The rst formal use of a questionnaire to study personal qualities involved the use of a structured rating scale for studying human character that was published by Heymans & Wiersma (1906). They developed a 90-item rating procedure and obtained
the collaboration of 3000 physicians to rate people with whom they were well acquainted. Other early efforts to evaluate personality can be found in the work of Carl Jung (1907), who studied associations to words in order to evaluate a persons thought processes and personality, and Kent & Rosanoff (1910), who developed a measure to study free association among psychiatric patients. The rst personality inventory for use in obtaining information through self-report was developed by Robert Woodworth (1919, 1920) as part of a U.S. Army program to develop an instrument to detect psychiatric problems among draftees. The scale, the Woodworth Personal Data Sheet (PDS), included 116 items related to physical problems, social behavior, and mental health symptoms that were thought to address the persons psychological adjustment. Items included:
Have you ever seen a vision? Do you have a great fear of re? Do you feel tired most of the time? Is it easy to get you angry?
Personality assessment expanded and developed substantially after the end of World War I, following Woodworths groundbreaking publication. Two separate but overlapping tracks of development in personality inventories began during the 1920s and 1930s and can be traced to the present: (a) personality assessment in personnel settings and (b) assessments in mental health and medical settings. Both of these trends are examined below.
USE OF PERSONALITY INVENTORIES IN PERSONNEL SETTINGS

The early personality assessment instruments for personnel applications focused, as did the Woodworth Personal Data Sheet, on evaluating maladjustment. Gibby & Zickar (2008) summarize the extensive history of personality assessment in personnel selection as an obsession with adjustment, although more recently measures have attempted to assess other personality dimensions (described below). Initially, personality inventories were devoted to assessing a single personality dimension, such as adjustment; however, other more complex assessment strategies evolved. For example, the Bernreuter Personality Inventory, published by Robert Bernreuter (1931), provided scores for several personality characteristics, including an appraisal of neurotic tendencies, ascendancesubmission, and introversion-extraversion. The Bernreuter Inventory came to be widely used in counseling and clinical settings as well as for personnel applications. This scale was also inuential in the development of other inventories. The Humm-Wadsworth Temperament Scale (Humm & Wadsworth 1934) was a 318item inventory (based upon Rosanoffs theory of personality) designed to analyze temperamental mechanisms. It provided several scores on personality attributes such as emotionality, self-interest, and harmony or disharmony with the environment. The use of personality assessment in screening for personnel applications reached a high point during World War II with the
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The scoring on the scale was the total number of problem items that the individual acknowledged were an indication of adjustment problems. In addition, Woodworth thought that some of the item responses reected behavior problems so severe that the person needed to be carefully evaluated further. These items were referred to as starred items (similar to critical items used in assessment today). (See Table 1 for a discussion of personality scale research strategy development.) Woodworth conducted a study on a sample of draftees and returning soldiers with shell shock and compared the results with responses of college students (Woodworth 1919). The PDS was published after the war and thus was not used as a means of selecting out maladjusted draftees. Interestingly, many of the actual item contents devised by Woodworth for the PDS found their way into the inventories in use today, although items are now typically formulated as TrueFalse rather than Yes-No questions.
Table 1 Different methods of scale construction used in the development of personality questionnaires Theoretically Derived Unidimensional Personality Inventories. Early personality inventories, such as Woodworths Personal Data Sheet, employed a rational composition of items to address characteristics such as adjustment (Woodworth 1920). This type of scale relies upon face validity of the items for measuring the construct of interest. The rational approach assumes a direct correspondence between the item content and the personality attribute evaluated. Theoretically Derived Multidimensional Personality Inventories. Some developers of early personality inventories (e.g., Bernreuter 1931, Humm & Wadsworth 1934) followed a rational-theory based scale-construction approach to develop item contents and combine items into scales to address personality characteristic such as traits or behavior patterns. Multiple personality characteristics were included in a single inventory. This procedure relies upon the scale developers insight into the item-construct relationship. No empirical validation was included. Empirically Derived Personality Measures. In contrast to the selection of items based on the test developers theory, Paterson et al. (1938) recommended that a scale should be validated by a rigorous item analysis and that only items that were highly correlated with the total score should be included. The empirical scale developers for the MMPI, Hathaway & McKinley (1940), followed this strategy and required that in order for an item to be included on a scale it had to actually discriminate statistically between a criterion group of patients with similar problems, such as depressed patients, and a sample of normal individuals. Because items are selected based on prediction of criterion variables, the scale may be composed of heterogeneous content. Moreover, empirically derived scales for multiple clinical or personality constructs can contain items that overlap other scales because, in part, the constructs themselves are composed of complex content, not simple dimensions. Factor-Analytic Developed Personality Measures. This approach, often referred to as exploratory factor analysis (Cattell 1946, Gorsuch 1963), uses internal statistical methods such as item correlation to develop dimensions or scales. In this approach, homogeneous item sets are obtained when a pool of items is administered and factored, with the resulting dimensions then named as scales. Since items for a scale are selected on the basis of item intercorrelation, the scales tend to be homogeneous in content and narrowly dened. Sequential System of Construct-Oriented Scale Development. A somewhat modied factorial approach was developed by Jackson (1970) as a means of constructing construct-oriented measures. Others such as Tellegen et al. (2003), in constructing their Restructured Clinical Scales, modeled their scale development on this strategy. First, personality constructs are theoretically dened; next, a relevant item pool to potentially measure these constructs is formed; then factor analysis is used to assure homogeneity of constructs. This factor-dimensional strategy results in homogeneous content scales that can be recognizable to test takers and somewhat open to response manipulation. Content-Based Personality Measures. An effective means of constructing personality scales involves grouping items according to similar contents as done by Wiggins (1973) following, in part, from Cronbach & Meehls construct validity approach or using a combination of content grouping and statistical renement. Constructs such as traits serve as the basis for developing an item pool to measure the personality domains. Some researchers use Alpha coefcients to assure high scale homogeneity once item-scale membership has been postulated and external validation against behavioral or clinical criteria. (Butcher et al. 1990). This strategy, as in the sequential system, results in scales that are homogeneous in content, recognizable to test takers, and consequently somewhat open to response manipulation.
government project for the selection of Special Forces for military duty. The U.S. Ofce of Strategic Services (OSS), a predecessor to the present Central Intelligence Agency, performed extensive psychological evaluations on persons who were to be assigned to secret overseas missions. The program, supervised by Henry Murray, evaluated more than 5000 candidates for special duty assignment. The assessment team used more than one hundred different psychological tests and specially designed procedures to perform the evaluations. The
operations of this extensive assessment program were described after the war, when the project was declassied (Off. Strat. Serv. Assess. Staff 1948) [see also a review by Handler (2001) for a discussion of the OSS]. The military services implemented several programs in which tests such as the Minnesota Multiphasic Personality Inventory (MMPI) were used in personnel selection for positions such as pilots and special services personnel (Altus 1945, Blair 1950, Fulkerson et al. 1958, Jennings 1949, Melton 1955; see discussion by Butcher et al. 2006).
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Personnel selection using personality adjustment questionnaires in industry diminished in the 1970s as a result of criticisms that the available measures lacked predictive validity for job-related criteria and also discriminated against people or were unfair to persons seeking employment because they addressed qualities that were not job related (Butcher et al. 2009). However, the use of personality assessment instruments in personnel selection has made a comeback in contemporary psychology, particularly with respect to evaluating persons for high-risk occupations.
USE OF PERSONALITY MEASURES IN MENTAL HEALTH AND MEDICAL SETTINGS

A few years after the end of World War I, Woodworth & Matthews (1924) adapted the Personal Data Sheet approach for children and adolescents. They published a 75-item version of the inventory that included some of the original items as well as some additional items they thought would address the problems of young people, such as Are you troubled with dreams about your play? and Do you nd school a hard place to get along in? and Did you ever feel that you were very wicked? The inventories developed by Woodworth and his colleagues inuenced the development of a number of clinical personality scales to assess psychological adjustment problems during the 1920s and 1930s. Multidimensional personality inventories following the rational scaledevelopment strategy, such as the Bernreuter and the Humm-Wadsworth, became available during this period as well. For example, the Bell Adjustment Inventory (Bell 1934) was a 140item scale that included questions dealing with areas of home, health, and social and emotional adjustments. Hathaway & McKinley (1940) developed one of the most effective measures in personality assessment, the MMPI, in the late 1930s. Hathaway and McKinley, who were critical of the rational strategy of developing personality inventories, followed an empirical method for
item selection that had been used effectively with other measures (Paterson et al. 1938). They developed a large set of items without determining in advance which items measured a particular characteristic. They next dened several clinical problem areas, such as somatization of problems, depression, and schizophrenia, by grouping homogeneous sets of patients with similar problems and symptoms. They then constructed their scales by selecting only items that actually discriminated the clinical group from a sample of nonpatients or normals, i.e., individuals not receiving patient care. The test was widely adapted for both clinical assessment and research during the 1940s and 1950s and became the most widely used personality instrument in psychology. The MMPI was not without criticism (see Ellis 1946, Goldberg 1974). Ellis (1946) criticized all group-administered paper-and-pencil questionnaires as being of dubious value in distinguishing between groups of adjusted and maladjusted individuals. Goldberg (1974) questioned the utility of the empirical scale-development strategy used in the MMPI compared with other methods of scale development. Parallel to the development of paper-andpencil inventories in personality assessment, other psychologists were exploring very different methods of personality appraisal that used more indirect stimuli to obtain responses through which personality inferences could be drawn, for example, ink blots, ambiguous pictures, and drawings. This approach, referred to as projective assessment, uses ambiguous stimuli to which a person responds, thereby providing information about himself or herself through projecting his or her own feelings, thoughts, attitudes, etc. Although some recent theorists (Meyer & Kurtz 2006) have explored moving away from the distinction between objective and projective personality assessment strategies, this conceptualization has a clear historical basis as well as (in my view) pertinent contemporary value. A key direction for clinical assessment emerged in the 1920s and 1930s with the development of projective techniques. Herman
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Rorschach (1921) published his monograph, Psychodiagnostik, which detailed the development of the Rorschach inkblot technique in 1921. This method of assessment was adapted in the United States by Levy in 1924 (Beck 1973). Subsequent developments and renements of the Rorschach inkblot technique occurred in the United States when Beck (1938), Klopfer & Tallman (1938), and Hertz (1938) developed Rorschach interpretation strategies to understand personality and emotional characteristics of patients in a movement that was to see the publication of thousands of articles and recruitment of countless advocates. Beck, Klopfer, and Hertz also developed separate interpretation systems for the inkblots in the 1940s. The most widely used contemporary Rorschach interpretive system was developed by John Exner (1974). Henry Murray and Christiana Morgan developed the Thematic Apperception Test (TAT; Murray 1938, 1943). The TAT is a projective measure made up of a series of pictures that portray human gures in a variety of activities and situations, to which a client is asked to make up a story describing the events going on in the picture. The clients responses allow the clinician to develop a picture of the clients thought patterns, attitudes, beliefs, observational capacity, and emotional responses. The TAT has been administered to individuals in a variety of settings, such as clinical assessment, personnel screening, and research in personality, to gain a picture of what a client thinks and feels. It has been shown to be an effective means of eliciting information about a persons view of others as well as his or her attitudes toward the self and expectations of relationships with peers, parents, or other authority gures. Lilienfeld et al. (2001) criticized the TAT as being unreliable and invalid in describing personality attributes and noted a lack of an effective scoring system for use in assessment. Although the TAT is still used extensively in clinical evaluations, its use in research has diminished signicantly compared with the Rorschach and MMPI instruments.
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Contemporary criticisms of the Rorschach are discussed below.
LATTER HALF OF THE TWENTIETH CENTURY

A plethora of clinical personality assessment procedures were explored and developed during the latter half of the twentieth century, ranging from structured interviews to behavioral assessment instruments to projective tests such as sentence completion, sensory appraisal tasks, and drawing of objects such as gures or the hand (see handbooks surveying various personality assessment measures by Butcher 2009, Graham & Naglieri 2003, Weiner & Greene 2008). The sheer number of research articles and journals devoted to personality assessment methods makes it difcult to keep current in more than a few techniques. A number of reasons can be found for the increased rates of research publication and clinical application of personality assessment methods. For example, personality assessment devices are often used as criterion measures for psychological research into abnormal behavior and psychological processes. Psychological tests have become a respected and engaging task for clinical practitioners today, with diverse applications such as psychological screening in health care settings as well as traditional mental health assessment. In addition, there is an increased acceptance of personality assessment in forensic settings. Psychological tests are more frequently requested and admitted as evidence in court today than they were even a decade ago (see Pope et al. 2006). Moreover, psychological assessment is widely accepted in industrial applications, both for conducting tness-for-duty evaluations and for personnel screening (Butcher et al. 2006). In personnel or industrial settings today, two distinct types of personality assessments are conducted that differ in terms of goals, demands of government rules, and the measures used. The rst is selection for management positions, and the second is evaluation of individuals in high-risk occupations, such as police, reghters, and airline pilots. In management
selection, the use of personality scales to assess positive personal qualities involves the appraisal of more general personality factors such as the Big Five personality dimensions that are used in management appraisal. Some research has indicated that personality assessment in personnel and industrial applications is making a comeback (Hough 2001). One of the most widely used instruments in personnel selection was developed shortly after the end of World War II by using factor analysis as the primary mode of scale construction. Cattell & Stice (1957) published the Sixteen Personality Factors Questionnaire (16-PF) based upon a number of factor analyses conducted on a large pool of adjectives they used to construct trait names. The 16-PF included a set of fteen personality trait scales and one scale to assess intelligence, which were designed to assess the full range of normal personality functioning (Cattell & Stice 1957). Another personality inventory that attained broad acceptance, but was based on a different scale-construction methodology, was the California Psychological Inventory (CPI) by Harrison Gough (1956). Gough, who had studied with Starke Hathaway at the University of Minnesota, began work on a set of personality trait scales that would assess general personality characteristics or traits in nonclinical populations. The CPI contained 489 items (over 200 of which were from the original MMPI). He included an additional group of items to address personality traits that were not dealt with by MMPI items. The CPI scales were grouped into four categories that addressed different personality constructs: (a) poise; (b) socialization; (c) achievement potential; and (d ) intelligence and interest modes. The CPI scales used both a rational and an empirical scale-development strategy to assess personality attributes found in normal populations. The CPI became a standard measure for assessing personality in personnel selection and in conducting psychological research (see discussion by Megargee 2009). The NEO-Personality Inventory (NEOPI) was developed by Paul Costa & Robert McCrae (1985) as a means of assessing what
they consider to be the major personality trait dimension often referred to as the Big Five or Five-Factor Model of personality. The NEO was published in 1985 to measure these major dimensions in normal personality, referred to as openness, agreeableness, neuroticism, extraversion, and conscientiousness (Costa & McCrae 1985). This instrument has been widely used as a measure of general personality characteristics (Costa & McCrae 2009). Evaluating potentially detrimental personality characteristics for high-risk occupations is an important activity today. Such assessments are now conducted posthire, as are preemployment medical examinations to assure tness for duty. A more extensive evaluation that involves the assessment of personality or emotional stability is required for personnel evaluations of applicants for positions of high risk or public safety, such as police and re department workers, airline pilots, and nuclear power plant employees. In such settings, there is a need to closely assess personality using clinical instruments such as the MMPI for positions of high public responsibility. The MMPI became the most widely used adjustment-oriented personality scale, in part as a result of its wide use in military screening during and after World War II. However, during the 1960s and 1970s, the MMPI was increasingly criticized because of some awkward item wording and content given changes in language usage over time; an item pool that did not address relevant contemporary problems; and limited and out-of-date norms (Butcher 1972, Butcher & Owen 1978). In 1982, the MMPI revision and data collection began. The MMPI-2 Revision Committee was composed of James Butcher and W. Grant Dahlstrom. Within the rst year, they invited John Graham to participate in the revision. Auke Tellegen joined the Committee in the data analysis stage, after the research protocol had been developed and the data collected. The MMPI-2 was published in 1989 and the MMPI-A (for adolescents) in 1992 (Butcher et al. 1992). Research on the MMPI-2 and MMPI-A continues to this day. More than 19,000 articles
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and books have been published on the MMPI, the MMPI-2, and MMPI-A. The MMPI-2 manual was revised in 2001 (Butcher et al. 2001). This revision added new validity and supplementary scales to the instrument. In addition to the developments on the MMPI-2 and MMPI-A, several personality questionnaires were developed in the 1970s and 1980s to address clinical problems. The two most widely used of these newer measures for clinical settings, the Millon Clinical Multiaxial Inventory (MCMI) and the Personality Assessment Inventory (PAI), illustrate these developments. In 1977, Theodore Millon developed the MCMI (see Millon 1977) to assess personality problems among clients in psychotherapy. Millon based his test development strategy upon his theory of psychopathology. Item development followed a rational strategy, and his comparison samples were patients in psychotherapy rather than a normal population. The MCMI largely addresses the Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis II dimensions of personality rather than symptom disorders on AXIS I of DSM that are addressed by other more general measures. However, the most recent version, MCMI-III, does have a number of scales that are specic to DSM-IV-TR Axis I disorders (e.g., alcohol dependence, bipolar manic, major depression, dysthymia, somatoform disorder, and drug dependence). Leslie Morey developed the PAI in 1991. Very similar to the MMPI, the PAI was designed to address the major clinical syndromes, such as depression (Morey 1991) and the personality disorders. Other personality measures addressing personality disorders are also available (see Widiger & Boyd 2009). In addition, many personality scales have been devised to address more focal problems such as anxiety (Spielberger et al. 1972), depression (Beck 1973, Hamilton 1960), and psychopathic behavior (Hare 2003), to mention a few. The Rorschach technique has been widely used in clinical and forensic assessment for almost 90 years, and the Exner Comprehensive
System has been used for scoring and interpretation for almost 35 years. The Rorschach and the Exner Comprehensive System are considered by many assessment psychologists as effective means of identifying personality characteristics, assessing progress in treatment, appraising cognitive and behavioral dysfunction, and evaluating posttraumatic stress disorder and many other behavioral features or problems (Weiner & Greene 2008, Weiner & Meyer 2009). The Rorschach is also widely used in forensic evaluations, particularly family custody cases, as well as in clinical settings (Archer et al. 2006). One of the more innovative and recent applications of personality assessment in clinical settings is the use of test feedback to clients as a means of bringing about behavioral change. Several researchers have demonstrated that providing sensitive test feedback to clients based upon the MMPI-2 or the Rorschach can have powerful effects. Finn & Tonsager (1992), in what has been called therapeutic assessment, have shown that patients in psychological treatment can gain substantial selfesteem, understanding of their problems, and reduced adjustment difculties if they have a clear picture of their MMPI-2-measured personality factors. For a more extensive discussion of psychological assessment and client feedback, see Finn & Kamphuis (2006) and Fischer (1994).
CONTEMPORARY CONCERNS ABOUT TWO ASSESSMENT STANDARDS

Progress in the personality assessment eld over the past century has been accompanied by controversies surrounding two of the most widely used instruments, the Rorschach and the MMPI-2. In the case of the Rorschach, the controversies center around the Exner Comprehensive System for interpreting the Rorschach, introduced 35 years ago. The MMPI-2 controversies involve changes to the instrument made in the past ve years.
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Criticisms of the Rorschach

The norms underlying the Exner Comprehensive System have been described as problematic in that they are from small and unrepresentative samples, suffer redundancy of subjects, and are considered an inaccurate reference population (Garb et al. 2005, Wood et al. 2001). In response to this criticism, the generality of Rorschach norms has been more broadly supported in a cross-cultural normative study of 21 samples in 17 different countries. An international normative study showed that the responses of the normative population across cultures was similar regardless of the language the subjects spoke. These results show congruence with scoring relationships across international samples (Shaffer et al. 2007). The Rorschach has also been criticized as an instrument that overpathologizes people (Wood et al. 2001). The norms have been criticized as characterizing test takers, even normal individuals, as having emotional problems (Shaffer et al. 1999). This situation is considered to result in excessive false positives. This criticism has been countered by others (see Ganellen 2001, Weiner 2009, Weiner & Meyer 2009), including two meta-analyses that reported the Rorschach predictive power is comparable to other personality assessment measures (Grnnerd 2004, Hiller et al. 1999). The use of the Rorschach in forensic evaluations has been questioned by Wood et al. (2001) and Grove et al. (2002). They suggest that common knowledge about the test is either incorrect or in dispute and that psychologists who use the test in forensic cases can be successfully challenged. Rorschach proponents have countered this argument. Meloy (2008) reported that in the years 1996 to 2005, 150 cases involved the Rorschach, with only 2% being challenged by opposing attorneys. An earlier review reported that the Rorschach had been used in 247 cases between 1945 and 1995 and accepted into evidence without challenge in 90% of the cases (Meloy et al. 1997). The Rorschach is still widely used in both clinical assessment and research (Weiner &
Meyer 2009) despite the limitations on its use, in particular the amount of time required for administration, scoring, and interpretation which makes it difcult for contemporary managed-care programs to support (Piotrowski et al. 1998)as well as the fact that a reduced number of graduate training programs offer Rorschach training (Viglione & Hilsenroth 2001). The current controversy over the adequacy of Rorschach score norms and predictive validity continues in the literature.
Recent Public Exposure of the Rorschach Blots

A recent controversy has emerged with the Rorschach that could, over time, have a signicant impact on clinical use of the test. The entire set of 10 inkblots was recently placed on the Wikipedia Web site along with a listing of possible responses to the test, which some have referred to as a cheat sheet (Cohen 2009). Although efforts have been made to have the picture of the blots removed from the site, they have not been successful because the copyright for the test has expired and the pictures are considered to be in the public domain. The openness and pervasiveness of the Internet make the general distribution of the cards on other sites likely, for example, on YouTube, Facebook, comedy shows, and so forth. The familiarity that people can gain about the Rorschach cards could have an impact on their assessment if they are scheduled for an evaluation. The widespread availability of the card stimuli can have a signicant inuence on the utility of the test in clinical applications. One of the basic assumptions of the test is that clients are presented with a vague stimulus upon which they project their own interpretation, including attitudes, beliefs, perceptions, motivations, and feelings. Although some psychologists who responded on the Web site have considered the Wikipedia exposure to be of minimal importance, it is unclear as to what the actual impact of this availability will have on patients perceptions over time. Further consideration and
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empirical research are needed to evaluate the impact of this potential problem on the test norms and interpretations.
Controversial Changes to the MMPI-2

Since 2003, several controversial changes have been made to the MMPI-2, including the release of a new set of scales, the addition of a controversial validity measure to the standard scoring of the MMPI-2 and its recommended use in all settings, and the release of a new version of the instrument. The MMPI-2 community of researchers and practitioners is sharply divided about these changes. Each of these changes is described below. Perhaps the most signicant change is the release of a shortened MMPI-2, called the MMPI-2 Restructured Form (MMPI-2-RF; released in August 2008) (Ben-Porath & Tellegen 2008, Tellegen & Ben-Porath 2008). This instrument uses a portion of the MMPI-2 item pool (338 items, a reduction of 40% of the item content of the MMPI-2), eliminates the Clinical Scales and their code-type data derived over the past 70 years, and uses the normative data collected during the MMPI Restandardization Project (Butcher et al. 1989) to develop nongendered norms, all signicant departures from the historical research foundation of this instrument. The MMPI-2-RF replaces the MMPI-2 Clinical Scales with the Restructured Clinical (RC) Scales, a set of measures that was introduced in the previous four years for use as supplementary scales (Tellegen et al. 2003). Although the developers of the RC Scales published a series of articles about their scales subsequent to their release in 2003 (see Pearson Assessments 2009 for a bibliography of research on the RC Scales), critics of the RC Scales, including the current author, have been resolute in descriptions of their limitations and the underlying theory and methodology that led to their creation (see Butcher & Williams 2009). The MMPI-2 Restructured Clinical Scales. The MMPI-2 RC Scales and MMPI-2-RF were developed following the model described
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by Jackson (1970) using rational-factor-analytic procedures rather than the empirical tradition used to establish the MMPI and MMPI-2. The RC scales are not the rst attempt to remake the MMPI clinical scales through factor analysis. Welsh (1956), using scale-level factor analysis, recommended a system of interpretation based on combining results from the factor scales Anxiety (A) and Repression (R). This interpretive approach was not widely accepted. The Tellegen et al. (2003) factor approach used essentially the same main Welsh factor (A), renaming it Demoralization (RCd),1 to determine which items to delete from the Clinical Scales. Many of the RC Scale constructs, such as RCd, RC1, and RC3, were also reported in an earlier item factor analysis by Johnson et al. (1984). The MMPI-2 RC Scales (Tellegen et al. 2003, p. 2) were introduced in a 2003 monograph with the following statement: At this point, the RC Scales can be used as aids in the interpretation of the Clinical Scale prole. It will be necessary to conduct additional studies to determine what other roles these new scales may ultimately play. In the nal chapter we return to these possible future developments. The nal chapter of the RC monograph concluded, The RC Scales hold promise both as research tools and as clinical instruments (Tellegen et al. 2003, p. 85). The RC developers identied the following areas for future research: Exploration of the utility of the RC Scales in a wider variety of settings than those included in the 2003 manual (i.e., substance abuse, general medical, correctional, forensic, and personnel screening). Comparisons of the predictions from the RC Scales with code-type descriptors including psychopathology, personality characteristics, and behavioral propensities associated with the code types. Additional investigations and analyses of the construct validity of the RC Scales.
Welsh A and RCd are correlated at 0.90 (see Rouse et al. 2008).
Additional MMPI-2 scale development following the theoretical and methodological strategies of Tellegen et al. (2003) to eliminate demoralization as a confounder in other important MMPI2 scales in addition to the Clinical Scales. Tellegen et al. (2003, p. 86) indicated, Through such efforts it may be possible to eventually capture the full range of core attributes represented by the large body of MMPI-2 constructs with a set of new scales more transparent and effective than those currently available. However, before the above program of research was undertaken, a project was initiated to develop a shortened version of the MMPI-2, based on the RC Scales (and funded by the test publisher), in 2002, a year prior to the publication of the RC Scales monograph. Not surprisingly, given its methodological departure from the empirical tradition of Hathaway and McKinley, the developmental approach in this restructuring effort resulted in measures that were highly different from those of the Clinical Scales (Rogers et al. 2006). Making drastic changes to a standard in personality assessment like the MMPI-2 with over 70 years of research support is a risky venture, as detailed by Ranson et al. (2009), especially when those changes are based on a substantially altered test-development strategy with a limited research base. There can be no coattails effect in establishing the validity and utility of personality assessment instruments. A new instrument should be thoroughly vetted by the eld before widespread adoption for clinical assessment. Development of this alternate form of the MMPI-2, with the RC Scales as its core, continued even with growing criticism in the research literature about the utility and validity of these new scales (e.g., Binford & Liljequist 2008, Butcher et al. 2006, Gordon 2006, Nichols 2006, Ranson et al. 2009, Rogers & Sewell 2006, Rouse et al. 2008, Simms et al. 2005, Wallace & Liljequist 2005). Critics
argued that the RC Scales are new measures distinct from the Clinical Scales, and their validity needs to be established independent of the past 70 years of research on the Clinical Scales and their code-type descriptors. For example, Simms et al. (2005, p. 357) pointed out that, Also, despite the temptation to do so, it also is apparent that the RC scales cannot be interpreted on the basis of previous empirical studies of the original scales; the RC scales represent new measures whose meanings now must be determined empirically. Several problems have been reported with the RC Scales. The theoretical model to develop the scales has been questioned (Butcher & Williams 2009, Gordon 2006, Nichols 2006, Ranson et al. 2009). In addition, the majority of the RC scales do not address the personality constructs from the original MMPI clinical scales but are simply redundant measures of several other MMPI-2 Content and Supplemental Scales (Caldwell 2006, Greene et al. 2009, Nichols 2006, Rogers et al. 2006, Rouse et al. 2008). The RC Scales show a low sensitivity to mental health problems (Binford & Liljequist 2008, Butcher et al. 2006, Cumella et al. 2009, Gucker et al. 2009, Megargee 2006, Rogers & Sewell 2006, Wallace & Liljequist 2005). For example, Binford & Liljequist (2008, p. 613), in a study of outpatient mental health clients concluded, RC2 appears to predict fewer behaviors conceptually related to depression than its Clinical Scale counterpart or Content Scale DEP reecting the more narrow focus of RC2. Removal of the general distress component changes the strength of the empirical correlates of two Clinical Scales measured in this study and may do so for the other scales not assessed in this study, possibly to the benet of some and the detriment of others.
The MMPI-2 Fake Bad Scale. Another recent and controversial decision by the MMPI2 publisher and distributor was the addition of the Fake Bad Scale (FBS) to the Extended Score Report for the MMPI-2 in January 2007 and the inclusion of a shortened version of the
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scale (FBS-r) in the MMPI-2-RF.2 The FBS was developed originally by Lees-Haley et al. (1991) to assess malingering of symptoms in personal injury cases. It has been shown to result in high false-positive rates among persons in mental health treatment (Butcher et al. 2003, 2008). For example, 62% of inpatient women with eating disorders would be considered malingering based upon Lees-Haley et al.s (1991) original recommended cutoff scores, and 11% would be considered to be malingering based on the currently used cutoff scores on the FBS (Butcher et al. 2008). This inherent bias in the FBS results, in part, from the fact that the developers of the scale include a large portion (one-third) of items on the scale that were used by Hathaway and McKinley to identify somatic problems that occur frequently in psychiatric patients and another large portion (again, one-third) of items that were used to assess a defensive response style. The FBS scale has been excluded from use as part of psychologists expert witness testimony in court cases through six recent Frye hearings (Davidson v. Strawberry Petroleum et al. 2007, Stith v. State Farm Insurance 2008, Vandergracht v. Progressive Express et al. 2007, Williams v. CSX Transportation, Inc., 2007, LimbaughKirker & Kirker v. Dicosta 2009, Anderson v. E & S Enterprises 2009). Butcher et al. (2008) provide descriptions about the limitations of use of the FBS. Ben-Porath et al. (2009) provided a response to these concerns, and Williams et al. (2009) answered their response. The MMPI-2-RF. A number of inherent weaknesses have emerged with the MMPI-2RF in addition to the above concerns about the RC Scales and the Fake Bad Scale. Scales must have solid validity and reliability before they are depended upon in making decisions about individuals. The majority of the scales in MMPI-2-RF are new, with limitedif
anypsychometric studies conducted by independent researchers. A number of these measures, as acknowledged by Tellegen & Ben-Porath (2008), show very low reliability coefcients for personality measures perhaps, in part, because of their scale length (e.g., four to six items). For example, the reliability coefcient for the Helplessness or HLP scale (ve items) was only 0.39 for men and 0.50 for women in the normative sample; the BehaviorRestricting Fears or BRF scale (nine items) had reliability coefcients of only 0.44 for men and 0.49 for women; and scale Suicidal/Death Ideation or SUI (ve items) had correlations of only 0.41 for men and 0.34 for women (Tellegen & Ben-Porath 2008). The well-established gender response differences in personality item responding (e.g., Cattell 1948, Hathaway & McKinley 1940, Nichols et al. 2009) were not sufciently addressed in the development of MMPI-2-RF (see discussion by Butcher & Williams 2009). Unlike the original MMPI and MMPI-2, in which separate gender norms were provided, the MMPI-2-RF authors combined genders into one comparison sample. This situation may result in different standards being applied for men and women in assessment and prediction. Further study of this potential bias needs to be conducted. However, the MMPI-2-RF manuals do not provide the information necessary for exploring this question because raw score data by gender are not reported.
CONCLUDING COMMENTS
In contrast to its emerging status at the beginning of the twentieth century, the eld of personality assessment holds a generally respected and dynamic position as we go forward in the twenty-rst century. Much has transpired over the past century to make this advancement possible. The use of personality tests to assist in making decisions and conclusions about people has gained a strong acceptance. At present, psychological assessment has strong public support from clinical administrators, personnel managers, and the courts. An impressive
The name Fake Bad Scale was changed to Symptom Validity Scale by the publisher at the end of 2007, although the abbreviation remains the same. See Williams et al. (2009) for a discussion of the name change.
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array of personality assessment instruments is available todayoften creating a challenge for assessment psychologists attempting to choose appropriate instruments. The next generation of assessment psychologists has a great many resources that can lead to positive growth and development. In addition to support in the United States, there exists a growing worldwide network of psychologists who are interested in and qualied to conduct research in assessment. For example, Butcher & Williams (2009) highlight the international use of the MMPI-2. There are numerous opportunities for developing and conducting cross-cultural assessment research today, given the expansion of the profession of psychology in other countries and the generally broad understanding of psychological assessment methodology and instruments. Research communication and project decisions can be immediately conveyed to distant sites in most countries through the Internet. In this era of globalization of intellectual interests and technology assessment, psychology has the opportunity to contribute substantially to broadened understanding of cross-cultural personality patterns. One imperative in this globalization of personality assessment is that instruments must be carefully evaluated and tested for utility and validity in other cultures (Cheung 2009, Zapata et al. 2009). The future advance of personality assessment will likely have some uneven steps and misdirections given the controversial issues facing the eld, some of which are described above. Assessment psychology faces a number of challenges requiring careful attention if the tradition is to continue to develop and maintain
the condence of the public. It is imperative that new psychological measures that are introduced for professional use are developed according to the highest standards and that they actually perform as promised (Geisinger & Carlson 2009, Ranson et al. 2009). Test users must fully understand the instruments and demand that tests actually measure what they are supposed to measure (that is, have demonstrated validity) and perform in a reliable manner. Newly introduced measures, such as MMPI-2-RF, that appear to rely extensively upon the reputation of the traditional MMPI instruments, need to be independently evaluated by psychologists, including careful consideration and understanding of the criticisms in the published literature. Assessment psychologists need to be aware that many of the available personality assessment measures are owned and managed by commercial rather than scientic organizations and need to be alert that commercial interests can sometimes prevail over scientic needs (Adams 2000). Campbell (1972) and Ranson et al. (2009) describe important steps that need to be taken in test development and revisions. Both called for transparency in test development if consumer condence is to be assured. Personality assessment researchers and practitioners have, in the past, shown a strong capacity to deal with methodological challenges and missteps. A resilience for developing instruments that work is evident in our history. I hope that the present and next generations of assessment psychologists will pursue objective and effective assessment methods and rigorously validate traditional, redeveloped, and new instruments to assure condent application.
DISCLOSURE STATEMENT
The author is one of the developers of the MMPI-2 and MMPI-A. He, like the other authors of the MMPI-2 and MMPI-A, declined royalties on the sales of those instruments and their scales. He authored a computer interpretation system for the original MMPI in the 1980s, the Minnesota Reports, and continues to keep it updated for the MMPI-2 and MMPI-A. He receives royalties from the University of Minnesota for the Minnesota Reports. The authors comprehensive disclosure statement appears at http://www1.umn.edu/mmpi/disclosure.php.
www.annualreviews.org Personality Assessment from the Nineteenth to the Early Twenty-First Century 15
ACKNOWLEDGMENT
The author acknowledges the valuable comments on a draft of this article by Carolyn L. Williams and David S. Nichols. LITERATURE CITED
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Butcher
Annual Review of Clinical Psychology Volume 6, 2010
Contents
Personality Assessment from the Nineteenth to Early Twenty-First Century: Past Achievements and Contemporary Challenges James N. Butcher p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 1 Prescriptive Authority for Psychologists Robert E. McGrath p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p21 The Admissibility of Behavioral Science Evidence in the Courtroom: The Translation of Legal to Scientic Concepts and Back David Faust, Paul W. Grimm, David C. Ahern, and Mark Sokolik p p p p p p p p p p p p p p p p p p p p p p49 Advances in Analysis of Longitudinal Data Robert D. Gibbons, Donald Hedeker, and Stephen DuToit p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p79 Group-Based Trajectory Modeling in Clinical Research Daniel S. Nagin and Candice L. Odgers p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 109 Measurement of Functional Capacity: A New Approach to Understanding Functional Differences and Real-World Behavioral Adaptation in Those with Mental Illness Thomas L. Patterson and Brent T. Mausbach p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 139 The Diagnosis of Mental Disorders: The Problem of Reication Steven E. Hyman p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 155 Prevention of Major Depression Ricardo F. Munoz, Pim Cuijpers, Filip Smit, Alinne Z. Barrera, and Yan Leykin p p p p p p 181 Issues and Challenges in the Design of Culturally Adapted Evidence-Based Interventions Felipe Gonz lez Castro, Manuel Barrera Jr., and Lori K. Holleran Steiker p p p p p p p p p p p p 213 a Treatment of Panic Norman B. Schmidt and Meghan E. Keough p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 241 Psychological Approaches to Origins and Treatments of Somatoform Disorders Michael Witth ft and Wolfgang Hiller p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 257 o
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Cognition and Depression: Current Status and Future Directions Ian H. Gotlib and Jutta Joorman p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 285 The Genetics of Mood Disorders Jennifer Y.F. Lau and Thalia C. Eley p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 313 Self-Injury Matthew K. Nock p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 339 Substance Use in Adolescence and Psychosis: Clarifying the Relationship Emma Barkus and Robin M. Murray p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 365
Systematic Reviews of Categorical Versus Continuum Models in Psychosis: Evidence for Discontinuous Subpopulations Underlying a Psychometric Continuum. Implications for DSM-V, DSM-VI, and DSM-VII Richard J. Linscott and Jim van Os p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 391 Pathological Narcissism and Narcissistic Personality Disorder Aaron L. Pincus and Mark R. Lukowitsky p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 421 Behavioral Treatments in Autism Spectrum Disorder: What Do We Know? Laurie A. Vismara and Sally J. Rogers p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 447 Clinical Implications of Traumatic Stress from Birth to Age Five Ann T. Chu and Alicia F. Lieberman p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 469 Emotion-Related Self-Regulation and Its Relation to Childrens Maladjustment Nancy Eisenberg, Tracy L. Spinrad, and Natalie D. Eggum p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 495 Successful Aging: Focus on Cognitive and Emotional Health Colin Depp, Ipsit V. Vahia, and Dilip Jeste p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 527 Implicit Cognition and Addiction: A Tool for Explaining Paradoxical Behavior Alan W. Stacy and Rineout W. Wiers p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 551 Substance Use Disorders: Realizing the Promise of Pharmacogenomics and Personalized Medicine Kent E. Hutchison p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 577 Update on Harm-Reduction Policy and Intervention Research G. Alan Marlatt and Katie Witkiewitz p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 591 Violence and Womens Mental Health: The Impact of Physical, Sexual, and Psychological Aggression Carol E. Jordan, Rebecca Campbell, and Diane Follingstad p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 607
Contents
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ANNUAL REVIEWS

NINETEENTH-CENTURY PRECURSORS TO PERSONALITY ASSESSMENT

EARLY-TWENTIETH CENTURY DEVELOPMENTS IN PERSONALITY ASSESSMENT

USE OF PERSONALITY INVENTORIES IN PERSONNEL SETTINGS

USE OF PERSONALITY MEASURES IN MENTAL HEALTH AND MEDICAL SETTINGS

Contemporary criticisms of the Rorschach are discussed below.

LATTER HALF OF THE TWENTIETH CENTURY

CONTEMPORARY CONCERNS ABOUT TWO ASSESSMENT STANDARDS

Criticisms of the Rorschach

Recent Public Exposure of the Rorschach Blots

Controversial Changes to the MMPI-2

Annual Review of Clinical Psychology Volume 6, 2010

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