The Relationship of the Reality-Fantasy Scale to Psychotic Symptoms in Children

Dana Marie Suozzi, Pace University


Research has shown us that psychological assessments are a valuable tool to be utilized in the process of diagnosis and treatment planning for psychotic disorders. Performance-based measures have been found to contribute valuable information to aid in the diagnostic process, and to clarify and distinguish the nature of psychotic thinking. The purpose of this research has been to determine the utility of a new scale which draws upon variables from the Rorscach Inkblot Test, the Reality-Fantasy Scale. This scale relies upon the concept of potential space as described by Winnicott to understand how an individual's ability to maintain tension between reality and fantasy will contribute to their experience of or vulnerability to psychotic symptoms. The present study aimed to explore the differential diagnostic utility of the RFS in measuring the presence of psychotic thinking in children. This study was conducted with an archival sample of children in an inpatient psychiatric hospital. Children ranging in age from 6 to 12 were identified as demonstrating psychotic symptoms through a combination of procedures that include parent ratings, therapist ratings, chart diagnosis, and diagnostic interviews, as well as measures of cognitive and attentional functioning. The RFS yields two scores: a Mean score, which measures an individual's overall tendency towards reality- or fantasy-bound thinking, and a Standard Deviation score, which measures the variability in an individual's responses. The relationship between the Mean and Standard Deviation scores of the RFS and these other commonly used assessment methods were examined, in order to confirm its utility in identifying the presence of psychotic symptoms associated with a variety of diagnostic classifications. This study aimed to validate this new index of Rorschach variables for the purpose of more accurately and reliably distinguishing children with psychotic symptoms from other children. As expected, findings indicated that the RFS Mean was highly correlated with indices on the Rorschach which are typically relied upon to assess problems with thinking. These data indicate that the RFS Mean is an effective tool for assessing the presence of persistent features of psychotic thinking as demonstrated through Rorschach responses. Findings also indicated that a larger degree of variability on the RFS scale, as measured by the RFS SD, is correlated with a higher likelihood that psychotic features are present, when examined in a child population. The RFS SD was also significantly correlated with other variables within the Rorschach which are typically considered markers of vulnerability to psychotic thinking, as well as other reliable indicants of psychosis such as specific scales on the PIC-2 and DSMD, as well as chart diagnosis and structured interview results. However, the data do not indicate that either score, the RFS mean or variability, are independently as strong as other existing indicators of psychosis. While the findings of this study do not support the use of RFS Mean or SD on their own as diagnostic tools for determining the presence of a psychotic disorder, the data do support the use of this scale as one piece of evidence that can be used in a more comprehensive battery in order to conduct a thorough differential diagnosis, as well as detect the presence of vulnerabilities to these psychotic experiences.

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Recommended Citation

Suozzi, Dana Marie, "The Relationship of the Reality-Fantasy Scale to Psychotic Symptoms in Children" (2014). ETD Collection for Pace University. AAI3580215.



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