Personality Disorder Traits, Rorschach Performance, and Neuropsychological Functioning in the Case of a Serial Killer: The Importance of a Multilevel Approach in the Assessment of Personalities Associated with Extreme and Repetitive Violence.

The present paper utilized the case study of an incarcerated serial killer ("Keith") to demonstrate how combining three assessment techniques (the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, the Rorschach task, and a comprehensive battery of neuropsychological measures) within a multilevel personality assessment framework might elucidate possible personality-based underpinnings of extreme and repetitive violence-representing a "next wave" of serial killer research while also highlighting the empirical and clinical value of an empirically-neglected multilevel assessment approach. Gacono and Meloy's multimethod "levels" model was selected as a multilevel framework, and Leary's recommended examination of inter-level consistency was utilized as an integrative strategy. Results indicated marked divergencies among Keith's data levels in areas of executive abilities, psychotic symptoms, affective/emotional disconnectivity, and sexual disturbance that suggested areas for potential change (perhaps in therapy), while consistencies among levels in social cognition and object relations suggested more stable characteristics that may be resistant to modification. The application of multilevel personality assessment methods to extremely and repetitively violent persons represents an important clinical approach worthy of future study-potentially having implications for research, clinical and forensic assessment, and treatment, and advancing empirical and clinical understandings of the continuum of interpersonal violence.