Abstract
The Diagnostic and Statistical Manual of Mental Disorders has evolved considerably since it was first published nearly 80 years ago. The diagnostic prototypes that comprised the first two editions of the manual were replaced by a symptom-focused categorical model in DSM-III (American Psychiatric Association [APA], 1980). Over time, limitations of the categorical model became apparent, particularly with respect to the diagnosis of personality pathology (see Herpertz et al., 2017; Waugh et al., 2017). As a result, DSM-5 (APA, 2013) includes two sets of criteria for diagnosing personality disorders: the traditional categorical model that appears in the main portion of the manual, and the alternative model for personality disorders (AMPD) that is included in a separate section titled “Emerging Measures and Models.” This ongoing evolution in the diagnostic criteria, and the controversy accompanying it, was the impetus for my Rorschachiana article (Bornstein, 2022), which forms the basis for this Special Section.
The key issue addressed in my 2022 article was straightforward: How can the Rorschach inkblot method (RIM) enhance the assessment of psychological dysfunction and improve the diagnostic process? Put another way, can the RIM add incremental validity to questionnaires and diagnostic interviews?
Questionnaires are often used as screening tools for various forms of psychological impairment in clinical and research settings, but structured interviews represent the “gold standard” in psychiatric diagnosis (Krishnamurthy & Meyer, 2016; Sommers-Flanagan & Sommers-Flanagan, 2023). As several writers have noted, however, interviews are best suited to gathering information that is accessible via introspection and verbal report (see Bradford et al., 2024; Sun & Vazire, 2019). Interviews are not optimal for obtaining information regarding underlying psychological processes about which the patient may have minimal insight (e.g., implicit motives, conflicts, defenses). To understand these processes the assessor must complement self-report data with information obtained from performance-based tests like the RIM.