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1, Objeotives of the Work Proposed

A,6

The purpose of the proposed studles is to test certain-aspects of aredaa personality theory by compering the subtest perforasnce on the Wechslor Intelligence Sceles of patient groups differing primarily in overt symptoos. Two suoh studies are anticipated. The first will be an investigation of the Wechsler soores of a dample of coaversion hysterics, and will inoluda comparisons of comparablo suberoups charactarized by different syoptoms. The second will donsist of a comperison of the subtest performance of comparable groups of migreine and uloer patients. It is proposed that the three wajor personality dimensions and their intarrelationships, (as foroulated by rsyand as described belov) be analyzed sithin and across the groupe.

Por purposes of research, r personality theory offers two major advantages:

l. Sowe'aspects or the theory are immediately and objoctively verifiable.

2. From'a long-range point of vies, the method by ahich the theory orders the data permits of relatively specific prediotions concerning the individual's behavlor.

In order to olarify sone of the major theoretical considerations to ba investigated, à brief summary of the theory is includad here. The summary is based on direot information froa , and on Saunder's research memorande, (see'bibliography). The theory is given more erplicit ststenent in a seporato memorondum by Saunders (1).

Aocording: to the theory, the personality struoture and function of the individusl can be expressed in terms of three basio porsonality dimensions. These dimenaions consist of the Erternalizer-Internalizer, the Plezible-Rigid. and the Aoceptable-Unaoceptable qontinua. These ill hereafteri bo referred to ss the E-I, F-R, and A-U dimensions, respeotively.

As the individual develope, he is confronted with the task of rocouciling his basic personality pattern with various environmental and sooial demands, which require him to modify his position on each of the three basio continus. His modifications represent the eztont to which the individuel is able to compensate for the limitations on adjustment imposed by his basio personality struoture.

The theorv further postulates that the individusl's\_modifications of his besio personsllty pattern, as well as the basio dimensions thenselvea, are refleoted by his performance on various subtests of the Wechsler Scales. Thus, his score on the Digit Spon subtest shows his position with regard to tha E-I dimension, his ultirate lccatioo on this continuua teing deterwined by wodifyinz faotors which are indicated by his Arithmetio and Information scores; His Blook Design score determines his placement on the F-R continuun, modified by his performance on the Similarities and Comprehensioà subtests. His position on the A-U oontimuun is shon by his score on the Pioture Arradgement subtest,\_modifiod by his Picture Coopletion and Object Assembly performance.

A,G has developed a method of expressing the dynamid struoture of the individual, in terms of three formulee which are basad on Wechsler subtest porrormance. These foraulao, taken together, reprosent the development of the individual's porsonality strugture scross time.

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2.Method

Since the studles ill test\_difterent hypotheses, certain procedures for oollecting and treating the data will be dirrerent for\_tho two invesiigations. Procedures which will te speoifio to each study-are described first. Those hioh will be coaon to both studies are disoussed later, under the section dovoted to the trestment of the data.

A. The Conversloa Hysterio Study A6

Conversion hysterics sre thought to constitute an ercellent group for an investigation of tuedee personality theory, in that their particular symptoms presumably refleot essential aapects of the individual's dynaoio struoture.: A.6

à pilot study. based on 46 conversion subjeots, häs slready been completed, and has providad results vhich are gonsistent ith Crs theorotical formulations. Though the number of subjeots was rolatively sooll, portioularly in the comparisons based cn subgroups, the obtained statistically significont findinga and a number of trends vhioh were found, ore thought to bo woll worth a more ertensive analyçis with a largor sample. The pilot studý is sumparized in the Appendir of this proposal. Its results suggost th following hypotheses:

l. Pronounced sensory and motor symptoms vill be more cheraoteristio of predominantly "2" individuals.

2. Severe and frequently generalized headachay will oocur more often in predooinantly "I" subjects. (This does not include pigraines, whioh theoretioally constitute à difforent type of symptoa).

3. Predominantly "I" individuals vill comploin of fower and less speoifio syoptoms than ill the predominantly "E" groups.

4. Both the F-R ond the A-U coutinuo ill be rolated to symptom choioe.

5. Fredooinantly "I" and predominsntly "E" subjeots with low soores on the:Pioture Corapletion subtest of the Wechsler Soales will differ in their ezpressed symptoas, in accordance with theoretical expectetions of their respeotive tendencies toward withdrewal and identification.

6. Bohávioral difforonces apert fron symptoms will characterize the predoninantly "E" and the predominantiy ."I", groups, these differences depending to soms extont on the location of the iodividusl on the\_7-R\_and\_A-U continus.

Somple

The sample sill consist of cpproricatsly l00 subjeots, whose medical records do not indicate naurological pathology. and who have baen diegnosed as conversion hysterios by exasining neurologists. It is anticipated that the age range will not go below 15 or above 49 ysars, and that mentally rstarded subjects alll be ezoluded.

Speoific Procedures

1. The oocurronce of tho varlous u forbulae vlll bo dotorminod first for the group as a whole.

2. Weohsler subtest persorcance of comparable subgroups charaotorized by differont syaptons will be compared.

3. Specifio hypotheses pertaining to tho rolationships botween syoptom choice, porsonallty structure. and behaviar, aa dafinad hv tha theors, will ba tested. 7

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4. The. influence on Weohslor\_subtest performance of population variables suoh as age, sex, educational and sooio-economio background, and intelligence (as measured by the individual's normal level, in aocordance with the theory) will be analyzed,

B. The Comporisons of Ulcer snd Migraino ratlonts

TV⁻ Ulcer and wigraine patients have been selected becauss their use\_pormits the teating of a number of hypotheses whichtheory implies. These hypotheses are as follows:

1. Theorotically, the predominantly "I" individual looks inward. is. ideationelly doainant, and tonds toward withdrawal. ak er ha s predloted that suoh subjects will te qore characteristio of the uloor groups. 6

2. In\_contrast, the predominantly "E" individual looks\_outwerd, is porceptually dominent, and environmentally sensitive. It is predioted by  that the migrcine potionts will consist of subjects predominantly in the "E" category.

3. It is further antioipated that the strength of the "i" or "g" coaponent of the individual's personality, as deteruined by the thrãe foruulse,\_will be\_a significantiy differontiating factor.

4. With respuot to the P-R contimuum, it is pradioted that ulcer pstients will be predominantly "p" individuals. The "F coopensated" subjeots. in\_perticular should tend toward ulcers, because of the\_continusl physiologicel and psyohologicsl stress vith\_which their equilibrium is mointained. Theoretically. low Block Design scores plus lov Similaritiss performonce.should be more typical of ulcer sufferera, since a low Similarities sooro indicates e tendanoy. toward represslon. On the other hánd, a high Similariti soore in a low Block Design record points to greater control of emotionality and therefore to less nead for'repressioo, which would represent a contra-indicetion of the formation of ulcers.

5. It ia hypothosized that the migraine patients will consist ohierly of predominaatly "R" subjeots. Compensatory faotors, corresponding to those stated above in connection with predomie nately "g" groups, will be studied for the predominantly "R" subjaots.

6. It is further hypothesized that the strength of the "F" or "R" components of the individual's porsonality structure, as represented by the three formulae, vill be a significantly difterentiating factor.

7. It is also sntioipated that the quality of the individual's social relationships eill be related to his psychological equilibrium, and possibly to his syuptoe choice as well.Therefore, his developuent along the A-U contiruua willlalso be studied.

Sample

Approximately 50 ulcer and 50 migraine patients are-snticipated. Insofar as possible, the groups will be limited tolthose without evidence of further medical complications. The diagnoses'will be medically determined.i Groups comparable with respeot to age; ser, educationsl and socio-economio levels, and intelligence (as meestured by normal levels) will be used. It is anticipeted that subjects will-be restricted to those boteeen the ages of 15 and 49, and will not inolude the mentally retarded.

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Specifle Procedurea

1. Tho ocourrence of the vsrious  formulae will be studied within eaoh of the groups. AS

2. The ooourronce of the vorious  rormulae in the groups will\_be compered.

3.Spooifio hypotheses related to the symptoas of ulcera and migraines intorms of the theory will be tested.

Treatment of the Date

The oxperigontal data vill oonsist of the three formulae, computed for eaoh subjeot, and bosed on welghted scores from the Wechsler subtests. Purther, soores will be derived fron a theory-deterwined weighting of various degrees of compensation of the individual's basio tendenciss, to produce three single soores for caoh subjeot on eaoh continuun. These will be interpreted as repressnting the strength of the bosio dimonsions within the individual's pere conality configurstiou.

The\_ data will be treated in accordance with theoretiçal prediotions, Contingenoy tests, (Chi-square and Fisher's ezaot tests), will be applied, to deterwine the differentisl incidence of the various porsonality configurations within and between the groups.

In analyzirg the results for the strength of the basio tendencies, tests of the differencus in location of these score distributions within and between groups will be porformed by means of the t distribution, or its nonparametrio analogue, depending on the nature of the datá obtained. The influence of pertinent population variables on test performance vill probably be analyzed by appropriate analysis of variance techniques.

Although tho studies will be undertaken to test a theory, (for ehich onetailed tests of significance are sometimes used), only two-tailed testa sill be smployed, in order to permit the intorpretation of contratheoroticai resulta.

3. Poriod of tine

A one-year projoot is antioipeted.

4. Estimoted Budget

Psychometrist and Researoh Assistant,... \$6,000
Co-Prinoipal' Investigator (part time) 3,000
Clericsl Aesistance (part tims)..... 1,800
Miscellaneoua.... 1,000
(Payohological Test Equipuent, Ofrice Supplies, Telephone & Travel)
Total of Direot Costs.......... 11,800
Indireot Cost Allovence. 1,770

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6. Provious Work in this Area A pilot study, based on 46 converslon hysterics, has been coopleted. It is described in the Appendiz, which follows.

7. Other Souroes of Support

Support hae not been nor is boing roquested of other foundations.

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Sapie A,6

The sample consistad\_of 46 subjoots medically eramined and psychologiçally evalunted atemea
The subjects were diagnosed as conversion hysterics by the examining neurologiste and their rocords lacked indications of neurological pathology. The group raaged in age fron 15 to 49, with a meon of 34,4l. Norwal levels rsnged fron 6 to 14, mean l0.44. There vere 14 malos and 32 femsles. They vere tosted on the Weohsler Bellevue Intelligence Scale, Form I..

Mothod

AS

The experimentel data consisted of the three fcrmulae, datermined for each subject on the basis of his weighted scores on the Wechsler subtests, The data were studied both for the group as a whole, and in comparisons of subgroups ithin it. Since difforent procedures were follovwed in the two types of analyses. and different results vere obtained, they sre separately prosented below.

I. The Pilot Study with the Whole Group, (N = 46).

In the attempt to study symptom-choice, the folloaing groupings were used for the varloua syuptoms which the subjects manifasted:

1. Fsinting spells, dizziness, drowsiness, and generalized states of geokness. shaking, and nausea.

2. Pain in areus other tlan the hoad reglon.

3. Headaches.

4 Paralysis of oxtremities, and spasms, jerks, and numdnes in those areas.

5. Pronounced sensory syoptoms.

6. Numbness and jorking movements in the bead and faco reglon.

B. Trestdent of tho Data and Resultal

1. Pronouncad gennory syuptoms (#s) wore found in 7 of the 46 subjeots and were signiticantly more characteristic, of Prodominantly E individuals (as. deterpined by the first foraula).2 Age and normal

1 One-tailod tests of signiticance were used when direction was predicted in advance. Othorwise, two-tailed tests were used. Reported "trends" fell within the ,10to .20 levels..

2 2<.02 by Fishor's oxoct tost.

Appondix

AG A Pilot.Study in ePersonality Theory with Conversion Hysterics

-0.

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level did not significantly inrluence the occurrenos of these symptons, nor were-any significant differences obtained botvoon the compensated and uncoopensated groups. However, a trend in the direotion of inoressed nuobera of subjeots in the componsated groups, (IC ond EC) ves obeorved,

2.\_In studying the formulae of subjeots with proncunced sensory symptoas, it was noted that the 3 cases in the roup sho suffered from hyaterica: blindness wore F-uncompencated-compensated individuols in their location on\_the F-R continuum. This suggested a further study of such subjeots, of whom there were 9, These 9 zere aimost equally divided bettaen "i" and "E" subjeots aocording to their first forwulae, 7 becoming "g" individuels acoording to the second. All of thea conoluded as "I" individusls in tho third formula. departing significsntly trom tho hypothesis of an equal E-I split.\*P

The abovo-mentioned rosults sre thought to be in line vith o thooreticol forwulations in the following respects.Disturbances in the sensors areas vould be woro typical of "E" subjeots, who are theoreticalls peroeptually dominont and vho, if moladjusted, would tend tovard defensive. ness in this rsspect. A6 -

Furtber, in conncotion vitheplacement of the individual on the P-R continuum, it would bo antioipated that subjopts in whom the "R" component was comperetively recent (i.o., appearing in the third foroula only) would repain affeotod by their "p" charactoristics, snd be therefore subieot to confusional states.

3. Numbness and jorking movements in the head and face cegions (#6) wore significantiy more prevalent among the "E" subjects.5 The Jerking povomenta were sspeoially comon in these individuals. Since the lattor were primarily motor dicturbances, sll of the subjeots who auffored froa motor disturbances were selected out, end à morked trend:in the diraction of increased numbers in the "E" Lndividuals was obsorved.

These findings, too, sre thought to be consistent, ith the theory. in that motor disturbances would be expeoted in "E" groups, who are both perceptuslly dominsnt and environmentally sonsitive.

4. Fainting spells, dizziness, drowsinoes, and genorelized states of weakness, shaking, and nausea (#1), which oocurred in 15 of the 46 subjegts, vere significantly more charaotoristio of tho dull group than of the brighter subjects.t A trend was also found in the

3 For anolyses bésed on ago, the group was split at the median (37.69), oreatins a young and old group saoh sith 23 subjeots, Nonsignificant differénces in their mean normal levels and ser distributions wore obtained.  In studying the influence of normel level, a bright group of 3l subjects with normel levels of 10 and over, and a dull group of 15 individuals with dormal levels below 10 vere used. No'signiflcant differences vero found betieen their moon ages and their sex distributions.

4 R≤ .004 by tho binomia1 test.

5P .Ols by Fisher's exact tost.

6 2< .008 by Fisher's exaot test.

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diraotioa of wore subjects in the unoompenssted vorsus the compensated groups, with the grestest numter of individusls falling in the unoompensated E cetegory. Age was a-nonsigoificant faotor.

These resulte are supportivo of the theory, in that a less differentiated level of percaptual disturbance, refleoted in sensory symptoms, would be antioipated in predominantly-"E" subjects sho are oharaoterized by a lover level of intelleotual funotioning.

5. The following tronds were slso noted.

a. In dividing the group into four quadrants acoording to groupings, subjeots were distributed as follows:

A 6

Uncompensated I 10

Uncompenssted 8

Compensated I 16

Compensatād E T2

It can be seen that thore is a trend toward the greatest numbers of:subjeots falling in the two compensated groups.  while more subjects are neoded for a more definitive breakdosn in terms of quadrant placements, the predominance of 'compensated subjects is consistent with theoretical expectations.

b. A trend tovard fever sywptoms, ususlly somewhat generalized in their nature, waes found to be moreicharaoteristio of the "z" group, the "E" subjects having a greater nupber of relativoly speoifio complaints. Whilé the teo compensated groups shoved no marked differonce inthese respoots, all of the l0 uncompensated I subjeots compläined of 2 or less syoptoms, while only 4 of the 8 uncomponsated "E" individusls did so, the remainder compléining of 3 or more. Neither age nor norwsl level influenced these results to any marked eztent.

The inoreased number of reported symptoms in the"e" subjeots, as well ss their relatively greater speoifioity. may agein refloot their perceptusl dominance and assooiated specificity, as conpared to the idestionally dominant, more abstract "f" group.

6. No significant rosults or marked trends were obtained with regerd to the romaining syoptom groupings.  Hovever, s more theory-oriented clsssification of these symptons is thought to be-worth attempting.

II. The P1lot Study with Subgroups. (N  14).

A. Procedures

A\_subgroup vas seleoted out of the whole sample, ,consisting of all subjects with low scores on the Picture Completion subtest of the Wechsler Scale. A low PC score was defined as -3 or morelin relation to the individual's norwal level. Fourteen of the 46 subjeots met this oriterion. This subgroup was chosen because of the theoretical distinotion made in the meaning of s low PC score in a predominantly, "I" end a predominently "E" individuel. Theoreticslly. such a score in the former suggests withdrazal in the diraction or autism. On the other, hand, in the latter, it indicates withdraval chiofly through identification. It wss therofore thought that this distinotion might be rerlected in syuptom choice.

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B. Treatment of the Data and Results

Seven of the l4 "low PC" subjeots were found to be in tho "I» category and 7 in the "E" group, as deterainod bg the first formula.-Six in aach group wera compensatsd, end l was-uncompensated.The groups were closelr aatched in terus of sex dis tribution, chronological age, and noroal level, as well as on verbal, performance, and full-scale IQ, and rsnge end mean PC scores.7

The folloving results vere obtained:

1. None of the 7 "E" subjects suffered from headaches, and all of the 7 "f" subjeots suffered from severe hoadachos. (Notet None of these zere migraines, the lattor being ebsent in the conversion group. This is in line with theoreticel erpeotations, since migraines constitute a different symptom in terns of the individual's dynemic struoture).

It is thought that these results are strongly supportive of theoretical views, in that headaches would be more apt to occur in ths ideationally-dooinant I individuals. Further in most cases the "I" subjects reported headaches of á more or less generalized nature, suggesting the charaotoristio lsok of specifioity in sych individuols.

2.: Of the headaohe sufferers, 3 reportod no-additional symptoms. Thesa were "iru" individuels according-to the third formuls, and were also Ioi aoross the three forwulae. The remaining "I" subjects inoluded 2 "iru"individuals, 1 "eru," and 1 "iru." Thus, all of them conoluded as "unaoceptable" on the A-U continuum.9"vhile 6 were originslly "soceptable."

It'goy well be that the efforts at adjustment made by these subjoots was furthor coaplicated by their unacceptability, whloh would theoretically roflect increaséd difticulties in the individual's social relationships,thus inireasing the need for compensotion.

3.: In viev of the apparent distinotion in conneotion with headaches, the romsinder of the conversion subjoots (not characterized by low PC soores) wos surveyod for the ooourrence of this symptom. Nine such=subjoots wore found, 4 in the "I" group and 5 in the "E", a olosrly nonsignificant

7 Eaoh group inoluded 6 females and 1 male. The age range for the I group was from 17 to 44 years, mean 33.86, while that of the E group was 20 to 49, mean 35.l6. No significant differences were found between the age ranges. Normal levels for the I subjeots ranged from 8 to 12, mean 10,14, and for the 5 group from 9 to 13, mean l0.83, with nonsignificant differences obtalned between them Nonsignificant differences wera also obtained between thoir full-scale, verbal and performance IQs. In both, PC scores were -3 to -7, means -5.00 & -4,63 (NS)

8 P .001 by Fisher's exaot test.

9 2< .016 by the binomial test.

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difference.

This finding tends to support the ratlonale for conduoting further study of "low PC" individuels with\_additionel subjectsrrather than considering the divislon in terms\_of "I" and "E" components alone.

4. In- the "E" group, a trend tovard symptoms contering primarily in the area of the legs and feet was noted. This was observed in 6 of the 7 "E" subjeots, as opposedito 2 of the 7 "I" individuals. There was also a predominance of walking difficulties among the "E" subjeots.

Since 6 of the 7 in the "E" category were cowponsated, it may be that\_their motor difficulties reflact the later development of an "I", component, mitigeting against a primarily environmentally dominated\_orientation.

5.:On the A-U continuum, in contrast to the"I"group, sll of the "E" subjests hegen as "acceptable" acccrding to the first formula,10 shifted to the "unaeceptabls" according to the second,ll and were about equally divided in this respeot on the third.

Those findings suggost that the A-U continuum may by relavant to symptoa-choice, perhaps operating differentially with basically difrerent types of personality configurations.

6. On the F-R continuum, both groups were approximately equslly divided batween "p" and "R" components aocording to the first and second forwulae. However, according to the third, 6 of the 7 "I" subjeots conoluded as "R" individuals, while the "E" group roasined about evenly divided botween "R" and."B."

This trend toword inoreased rigidity on the' part of "I" subjeots with low PC scores would have considerable theoretical importance. if substantiated by further investigation, i It\_also constitutes a further indication that the three basio coutinus and their interrelationships must all be taken into consideration in evaluating personality functioning, a point of view which the theory stresses.

7. when the subgroups were combinod into a single "lo PC" group. (N  14), a signiricantly greater number of "compensated" as opposed to "uncompenseted" subjeots wers fqund (when coapared to the possibility of an equal division).12 The relevance of this finding to the theory has already been coomented on under rosults obtained for the whole sample.!

8.Significant behavioral dirforencos aport from syaptoms were also obtained in comparing the two "lowiPo" groups. Among the "I" subjeots, 5 of the 7 were oharaoterized by perlods of abrupt disruption of control with outbrdaks of irrational smotional displey, while none of the "Ei subjects demonatrated this behavior.13

These results, whioh were bssed\_on the psychological and psychiatric records of the subjects. strongly suggsst that further investigation with'a larger sample wight sarve to support the theory in terms of difforontial emotic ol reactions. It would be anticipeted that the interrolations among the continus would be bighly pertinent in this conneotion.

P≤.0l6 by the binomial test.

11 2<.016 by the binoaial tost.

12 2<.01 bythe\_binomial test.

13 p<.025 by Fisher'a\_exaot\_test.

=10

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Bibliogrephy

Some statistically signiticant results as well as a nuber of trends, in sccord eith theoretical expeotations, were found in a pilot study besed on 46 conversion subjeots. The findings were relatod to the three major personality dimensions of theory, (i.e., the I-E, P-R.and A-U continus). S1gnificant differences in behavior, as well as in syoptod-choice, were also noted. The conversion group appears to be wali suited to s more extensive investigation of the theory, since syoptom-choice presumably reflects bosio aspeots of the individual's dynamio struoture. The preliminary work hap suggested a number of hypotheses vhich warrent further tosting with a larger, saople.

2. Saunders, D. R. On the dimensionality of the WAIS, batterg for too groups of normal males. Psychol. Rep., 1959. 5, 529-541.

3. Saunders, D. R. A Faotor analysis of the Pioture Completion items of the WAIS. J. 0lin, Psycho1., 1960, 16, 146-149.

4 Saunders, D. R. A Computer progrem to find the best-fitting orthogonal faotors for e given bypothesis. Psyohocetrika, l960, 25, 199-205.

5 Saunders, D. R. Further implications of Mundy-Castle's correlations betveon t EEG and Weohsler-Bellavue variables. ETS Res. Bull, 59-16, 1959.

6. Saunders, D. R. The Contribution of communality estimation to the achievement of faotorial invariance, with speoial roference to the MupI. ETS Res. Bul1.. 60-65, 1960.

7.. Saunders, D. R. Digit Span and alphs frequency: a cross-vslidation. Eis Res. Bul1., 60-3, 1960.

8.. Saunders, D. R. Evidenoe bearing on the existence of a rstionel correspondence beteeen the personelity typclogies of Spranger and Jung. ETS Res. Bull., 60-6, 1960.

Sumwary of the Pilot Study

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