Método:

Se trata de un estudio cualitativo cuya muestra fue seleccionada intencionalmente. Los casos fueron examinados en los últimos años y han sido directa o indirectamente etiquetados como antisociales, ya sea por especialistas o por la ley. Consideramos relevante para el tema del trastorno de personalidad, específicamente el antisocial, exponer lo que hemos observado y abrir una discusión al respecto. El primer grupo de los sujetos seleccionados cumple con los criterios diagnósticos de la prueba de Rorschach para referirse a la personalidad antisocial y además coincide con lo que la sociedad evalúa como tal. El segundo grupo se refiere a aquellos sujetos que de acuerdo a los criterios de la prueba presentan elementos antisociales, pero sin embargo, no son vistos así por la sociedad. Finalmente, los sujetos del tercer grupo, no corresponderían según los criterios de la prueba de Rorschach a casos de personalidad antisocial, pero social y legalmente, sí se les considera como tales.

Resultados:

Se observaron diferentes tendencias entre los grupos estudiados y los criterios psicodiagnósticos propios de cada uno. En los sujetos en los que se evidenció un funcionamiento antisocial, se buscaron indicadores de psicopatía que ya han sido descritos en la bibliografía: juicio de realidad conservado, respuestas de reflejo, disminución de respuestas H y ausencia de respuestas K. Además, se encontraron signos recurrentes, no descritos con anterioridad, y que nos parece importante destacar: Presencia de fabulación en una línea agresiva y descontrol ante estímulos que evocan fantasías violentas; respuestas de defecto (indicador de disociación y objetos internos mal configurados); respuestas de acción padecida (se asocian a la existencia de elementos sadomasoquistas; relaciones entre agresor-victimario en un contexto de fantasías persecutorias muy destructivas); contenidos que revelan ansiedad persecutoria; respuestas de ocultamiento que revelan falta de autenticidad; rechazo a la figura de autoridad; presencia de contenidos antagónicos o contradictorios (imágenes violentas v.s. imágenes benevolentes o pacíficas); shock o fracaso en la lámina X.

Discusión:

Debido a lo difícil que resulta plantear un diagnóstico de personalidad antisocial, así como a las contradicciones y confusiones que se pueden generar en este terreno, creemos im portante subrayar los beneficios que tiene el psicodiagnóstico por medio del Test de Rorschach. Este permitiría discriminar con mayor exactitud entre algún tipo de conducta antisocial y un trastorno de personalidad antisocial propiamente dicho. La posibilidad de ir aclarando cuáles son los criterios del Test de Rorschach que tienen relación con este trastorno, se convierte en un aporte relevante para la psiquiatría forense.

El análisis de los casos nos confirma la dificultad para realizar un diagnóstico categorial de los trastornos de personalidad. No sólo es necesario considerar la dificultad que presenta el hecho de formular una hipótesis diagnóstica en casos éticamente tan delicados, sino también la responsabilidad que esto implica y la necesidad de mantenerse al margen de la influencia que tienen ciertos fenómenos sociales, tales como la presión ejercida por las opiniones públicas acerca de "lo políticamente correcto".

¿Cuáles serían entonces las medidas a tomar, ya que lo que se está decidiendo con una evaluación de este tipo es la vida futura de los sujetos? Desde el punto de vista de los profesionales del psicodiagnóstico, es necesaria la triangulación, es decir, la revisión sistemática de las pruebas junto con uno o más especialistas en la materia. Este procedimiento tiene las ventajas de disminuir el sesgo propio de una mirada profesional y permite contrarrestar la influencia consciente o inconsciente de orden contextual ejercida por los medios de comunicación ante los casos públicamente notorios.

Method:

A descriptive study was used, whose sample was taken from an experiment involving cases examined over a period of ten years. The first group of subjects selected who confirm the sample meet the diagnostic criteria of the Rorschach Test for antisocial personality and also are in line with what society considers this to be. The second group includes those subjects who according to the test criteria evidence signs of being antisocial but are nonetheless not considered so by society. Finally, the third group is formed by those who do not fulfill any of the Rorschach Test criteria for antisocial personality, but socially and legally are considered to have it.

Results:

Significant differences were found between the three groups being studied. The first group shows signs or indications that are clearly associated with the antisocial personality. The case analysis revealed signs that had not previously been described as peculiar to the antisocial personality in the test but which nonetheless we consider essential to enable us to draw a diagnostic conclusion. In the other two groups, it was more difficult to reach a diagnostic agreement between the clinical and legal criteria. This illustrates the difficulty of making a categorical diagnosis of personality disorders, as other authors have already pointed out (Jaspers, Kernberg y Dórr).

The other phenomena are not found in the literature relating to the Rorschach Test, and agree with the character traits described in classical psychopathological literature, such as the description by Schneider of the ruthless psychopath and the assertions made by Jaspers regarding the existence of an ideal type and numerous personalities between these two extremes.

Moreover, Kernberg draws a distinction between "antisocial behavior" and "antisocial psychic functioning". Antisocial behavior may appear in different personality profiles, especially in Narcissistic personalities, while the psychic functioning of an antisocial personality is closer to that of Schneider"s ruthless psychopath.

Other phenomena not described, but which we observed and consider important to point out in severe cases of psychopathic behavior were

Presence of an aggressive tendency to lie and make up stories: This reveals a marked tendency to fantasize and even to lie, to embellish their surroundings and seek gratification more in fantasy than in reality. Such cases are disturbing because of the violent and excessive nature of the fantasies. Stimulus can cause them to lose control when evoking violent fantasies.

Frequent defect responses: This is a disassociation index. The phrasings of "incompleteness" (broken, split, fragmented) could be linked to the existence of badly configured or conserved internal objects, in the sense that they are damaged, looked at in a warped or incomplete way.

Suffered action responses: These are associated with the existence of sadomasochistic elements, with signs of aggressor to victim and victim to aggressor relationships in a context of very lurid and destructive persecution fantasies.

Presence of thoughts that reveal persecution anxiety: It is possible to appreciate indicators of a paranoid type of anxiety, associated with borderline constructs. It also shows up in the attitude to-ward the exam, marked by a very defensive bearing, distant, cold, controlling and overly critical.

Hiding responses: Many times the subjects perceive "covered" figures, "hidden", avoiding direct and frank contact.

Reaction to plate IV (authority or paternal): Indicators abound in rejection of the authority figure, lack of appreciation of the other's power; avoid to recognize the superiority of the other, attempt to put them down and downplay their power or the threat they pose.

Presence of antagonistic elements: It is worth noting the presence of very contradictory elements, revealing very violent images appearing alongside their opposites, in the sense of benevolent, peaceful, unthreatening images.

Shock or failure inplate X: Another phenomenon not described and that surprise us, was the inability to give responses in Plate X. This fact strikes us as curious given that this plate is called the "forecaster". This plate requires a greater integration of the perceptive process.

Discussion:

As it is difficult to come up with a diagnosis for antisocial personality, let alone the contradictions and confusion that can arise in this field, we believe it is important to point out the benefits of psychodiagnosis through the Rorschach Test. This enables us to discriminate more accurately between some type of antisocial behavior and an antisocial personality per se. The possibility of narrowing down the criteria of the Rorschach Test associated with this disorder becomes a significant contribution to forensic psychiatry. The analysis of the above cases reveals to us the difficulty of carrying out a diagnosis by categories of

Personality Disorders. This conclusion takes us to what Jaspers already proposed with his "Ideal Type", Kernberg with his classi-fication on gradients of the different types of borderline Personality, and O. Dórr, with his phenomenological perspective of the concepts of normality and abnormality. That is, whether a given number of symptoms or traits confirms the existence or nonex-istence of a disorder, without taking into account the transition to other clinical pathologies or the particular case in the context of the subjecfs family and social life.

Although there are cases that do not involve major difficulties in reaching a diagnosis where the clinical impression agrees with the tests and the behavior, it also happens that in many others, the different indicators do not agree. This fact leads us to the following reflections:

I) It is not only necessary to consider the difficulty of forming a diagnostic hypothesis in cases that are ethically so sensitive, but also the responsibility that this brings and the need to remain at the verge of the influence that social phenomena exercise, namely the pressure exerted by public opinion on what is "politically correct". With this we referred to certain cases in our sample, that were quite widely publicized (priest, doctor and agronomist), charged with pedophilia and murder, and for whom our diagnostic hypothesis didn't agree with either the way the media depicted them or the assessment of the judges. We think that in these situations the subjects were already condemned by society before their trials, to the point that not even the justice system remained immune from this influence.

II) What is there to be done, given what is being decided with an assessment of this type is the future life of the subjects? On the one hand, from the point of view of the professionals in psycho-diagnosis, it is necessary to count on the evidence and have tests systematically checked independently by one or more specialists in the area.

III) Another important aspect to consider is related to the diagnosis itself. It is here, as we already stated, where we found the biggest problem. The fact that our conclusions did not always agree with the judgment of other social organizations (judicial power, society and family) leads us to be very careful when stating a definitive conclusion. We already mentioned the problem with categorical diagnoses, such as DSM-IV, since they do not consider transitions and are based only on the presence or absence of symptoms to determine the type of disorder. We think that when dealing with personality disorders it is necessary to make use of dimensional diagnoses. It is also suggested to propose a Tentative Diagnostic Hypothesis, and not state cat-egorically that the subject pertains to such or other type.

Finally, we wish to address the aspect related to the presentation of the report itself to professionals outside of the area of psycho-metrics although in charge of the case, that is, psychiatrists and legal professionals. Lately the Rorschach test has been questioned a lot particularly in the formulation of legal expert opinions. This criticism may be due mainly to three factors: 1) Use of very specialized and esoteric terminology that makes it incomprehensible to those who are not specialized in the Test. 2) Insufficient experience in the Test as it requires a lot of study and experience. 3) Individual marking of the test, that is, without contrasting the results with another specialist, a fact that does not help to reduce the subjective factor, which is impossible to avoid.