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Research Article

Eating Disorders and the Rorschach

A Research Review From the French School and the Comprehensive System

Published Online:https://doi.org/10.1027/1192-5604/a000136

Abstract. In this article we review research on eating disorders with the Rorschach. In this field there are two main lines of research involving two specific methodologies: the Comprehensive System and the French school. We present the main results of the different studies separately and then comment on some similarities and differences in the findings. We find that the results of these studies are complementary on certain aspects of functioning found in anorexia nervosa as compared with other categories of eating disorders. Both sets of studies underline the self-centeredness of anorexic patients with their difficulty in communicating their feelings and thoughts. In both types of study, treatment is understood as relying on an integrative and multidisciplinary model that seeks to modify the eating behaviors and to improve ego functions in order to moderate the patient’s distress. In addition, both types of research show that secure attachment would be the first priority for the therapist in psychological treatment, which should increase the patient’s confidence in others. They also both stress the importance of the restoration of self-esteem and a sense of identity through the support offered by the relationship to the therapist.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). First citation in articleGoogle Scholar

  • Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E., & Erbaugh, J. K. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. First citation in articleCrossrefGoogle Scholar

  • Chabert, C. (1997). Le Rorschach en Clinique adulte: Interprétation psychanalytique [Rorschach Test in adults: A psychoanalytical interpretation] (2nd ed.). Dunod. First citation in articleGoogle Scholar

  • Chabert, C., & Vibert, S. (2016). Place des aménagements pervers chez des jeunes filles anorexiques et boulimiques: Étude clinique et projective [The role of perverse adjustments in young anorexic and bulimic women: A clinical and projective study]. Psychologie clinique et projective, 22, 91–110. https://doi.org/10.3917/pcp.022.0091 First citation in articleCrossrefGoogle Scholar

  • Connan, F., Dhokia, R., Haslam, M., Mordant, N., Morgan, G., Pandya, C., & Waller, G. (2009). Personality disorder cognitions in the eating disorders. Behaviour Research and Therapy, 47, 77–82. https://doi.org/10.1016/j.brat.2008.10.010 First citation in articleCrossrefGoogle Scholar

  • Curiel-Levy, G., Canetti, L., Galili-Weisstub, E., Milun, M., Gur, E., & Bachar, E. (2012). Selflessness in anorexia nervosa as reflected in the Rorschach Comprehensive System. Rorschachiana, 33(1), 78–93. https://doi.org/10.1027/1192-5604/a000028 First citation in articleLinkGoogle Scholar

  • Cuzzolaro, M. (2013). Disturbi dell’alimentazione e obesità. Trattamento multiprofessionale integrato? [Eating disorders and obesity. Multi-professional integrated treatment?]. Psiche. Rivista Di Cultura Psicoanalitica, 1, 1–13. First citation in articleGoogle Scholar

  • Cuzzolaro, M., Vetrone, G., Marano, G., & Garfinkel, R. E. (2006). The Body Uneasiness Test (BUT) development and validation of a new body image assessment scale. Eating and Weight Disorders, 11, 1–13. https://doi.org/10.1007/BF03327738 First citation in articleCrossrefGoogle Scholar

  • Day, J., Ternouth, A., & Collier, D. A. (2009). Eating disorders and obesity: Two sides of the same coin? Epidemiologia e Psichiatria Sociale, 18, 96–100. First citation in articleCrossrefGoogle Scholar

  • Derogatis, L. R., & Lazarus, L. (1994). SCL-90 Brief Symptom Inventory and matching clinical rating scales. In M. E. MarnishEd., The use of psychological testing for treatment planning and outcome assessment (pp. 217–248). Erlbaum. First citation in articleGoogle Scholar

  • de Traubenberg, N. R. (1970). La pratique du Rorschach [The practice of Rorschach]. Presses universitaires de France. First citation in articleGoogle Scholar

  • Exner, J. E. (2003). The Rorschach: A comprehensive system: Vol. 1. Basic foundations (4th ed.). John Wiley & Sons. First citation in articleGoogle Scholar

  • Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528. https://doi.org/10.1016/S0005-7967(02)00088-8 First citation in articleCrossrefGoogle Scholar

  • Fairburn, C. G., & Harrison, P. J. (2003). Eating disorders. Lancet, 361, 407–416. https://doi.org/10.1016/S0140-6736(03)12378-1 First citation in articleCrossrefGoogle Scholar

  • Farstad, S. M., McGeown, L. M., & von Ranson, K. M. (2016). Eating disorders and personality, 2004–2016: A systematic review and meta-analysis. Clinical Psychology Review, 46, 91–105. https://doi.org/10.1016/j.cpr.2016.04.005 First citation in articleCrossrefGoogle Scholar

  • Freud, S. (1969). La vie sexuelle [The sexual life] (D. Berger, Trans.). PUF (Original work published in 1927). First citation in articleGoogle Scholar

  • Garner, D. M. (1991). Eating Disorders Inventory-2, professional manual. Psychological Assessment Resources. First citation in articleGoogle Scholar

  • Garner, D., Olmstead, M. P., Bohr, Y., & Garfinkel, P. (1982). The eating attitudes: Psychometric features and clinical correlates. Psychological Medicine, 112, 871–878. First citation in articleCrossrefGoogle Scholar

  • George, C., & West, M. (2001). The development and preliminary validation of a new measure of adult attachment: The Adult Attachment Projective. Attachment and Human Development, 3(1), 30–61. https://doi.org/10.1080/14616730010024771 First citation in articleCrossrefGoogle Scholar

  • Gonzalez, A., Kohn, M. R., & Clarke, S. D. (2007). Eating disorders in adolescents. Australian Family Physician, 36(8), 614–619. First citation in articleGoogle Scholar

  • Guinzbourg, M. (2011). Eating disorders – a current concern: Similarities and differences among the anorexia, bulimia, and EDNOS categories. Rorschachiana, 32(1), 27–45. https://doi.org/10.1027/1192-5604/a000014 First citation in articleLinkGoogle Scholar

  • Hoek, H. W., & Van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 34(4), 383–396. https://doi.org/10.1002/eat.10222 First citation in articleCrossrefGoogle Scholar

  • Lavender, J. M., Wonderlich, S. A., Crosby, R. D., Engel, S. G., Mitchell, J. E., Crow, S. J., Peterson, C. B., & Le Grange, D. (2013). Personality-based subtypes of anorexia nervosa: Examining validity and utility using baseline clinical variables and ecological momentary assessment. Behaviour Research and Therapy, 51(8), 512–517. https://doi.org/10.1016/j.brat.2013.05.007 First citation in articleCrossrefGoogle Scholar

  • Lingiardi, V.McWilliams, N. (Eds.). (2017). Psychodynamic diagnostic manual (2nd ed.): PDM-2. Guilford Press. First citation in articleGoogle Scholar

  • Lis, A., Mazzeschi, C., Di Riso, D., & Salcuni, S. (2011). Attachment, assessment, and psychological intervention: A case study of anorexia. Journal of Personality Assessment, 93(5), 434–444. https://doi.org/10.1080/00223891.2011.594125 First citation in articleCrossrefGoogle Scholar

  • Martinez, M. A., & Craighead, L. W. (2015). Toward person(ality)-centered treatment: How consideration of personality and individual differences in anorexia nervosa may improve treatment outcome. Clinical Psychology: Science and Practice, 22(3), 296–314. https://doi.org/10.1111/cpsp.12111 First citation in articleGoogle Scholar

  • McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process. Guilford Press. First citation in articleGoogle Scholar

  • Meyer, G. J. (2004). The reliability and validity of the Rorschach and Thematic Apperception Test (TAT) compared to other psychological and medical procedures: An analysis of systematically gathered evidence. In M. J. HilsenrothD. L. SegalEds., Comprehensive handbook of psychological assessment, Vol. 2. Personality assessment (pp. 315–342). John Wiley & Sons. First citation in articleGoogle Scholar

  • Mihura, J. L., Bombel, G., Dumitrascu, N., Roy, M., & Meadows, E. A. (2019). Why we need a formal systematic approach to validating psychological tests: The case of the Rorschach Comprehensive System. Journal of Personality Assessment, 101(4), 374–392. https://doi.org/10.1080/00223891.2018.1458315 First citation in articleCrossrefGoogle Scholar

  • Ogden, T. H. (1985). On potential space. International Journal of Psychoanalysis, 65, 129–140. First citation in articleGoogle Scholar

  • OPD Task Force. (2001). OPD–operationalized psychodynamic diagnosis: Foundations and manual. Hogrefe and Huber Publishers. First citation in articleGoogle Scholar

  • Piotrowski, C. (2017). Rorschach research through the lens of bibliometric analysis: Mapping investigatory domain. SIS Journal of Projective Psychology & Mental Health, 24(1), 34–38. First citation in articleGoogle Scholar

  • Racamier, P. (2012). Les perversions narcissiques [Narcissistic perversions]. Payot. First citation in articleGoogle Scholar

  • Ritchie, H., & Roser, M. (2019). Mental health. https://ourworldindata.org/mental-health First citation in articleGoogle Scholar

  • Rothschild, L., Lacoua, L., Eshel, Y., & Stein, D. (2008). Changes in defensiveness and in affective distress following inpatient treatment of eating disorders: Rorschach Comprehensive System and self-report measures. Journal of Personality Assessment, 90(4), 356–367. https://doi.org/10.1080/00223890802107982 First citation in articleCrossrefGoogle Scholar

  • Rothschild, L., Lacoua, L., & Stein, D. (2009). Changes in implicit and explicit measures of ego functions and distress among two eating disorder subgroups: Outcomes of integrative treatment. Eating Disorders, 17(3), 242–259. https://doi.org/10.1080/10640260902848592 First citation in articleCrossrefGoogle Scholar

  • Selvini-Palazzoli, M. (1965). Anorexia nervosa. Thieme. First citation in articleGoogle Scholar

  • Smith, B. (1990). Potential space and the Rorschach application of object scale relations theory. Journal of Personality Assessment, 55, 756–767. https://doi.org/10.1080/00223891.1990.9674110 First citation in articleCrossrefGoogle Scholar

  • Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). STAI manual for the State-Trait Anxiety Inventory. Consulting Clinical Press. First citation in articleGoogle Scholar

  • Steiger, H., Richardson, J., Schmitz, N., Israel, M., Bruce, K. R., & Gauvin, L. (2010). Trait-defined eating disorder subtypes and history of childhood abuse. International Journal of Eating Disorders, 43(5), 428–432. First citation in articleGoogle Scholar

  • Striegel-Moore, R. H., & Bulik, C. M. (2007). Risk factors for eating disorders. American Psychologist, 62(3), 181–198. https://doi.org/10.1037/0003-066X.62.3.181 First citation in articleCrossrefGoogle Scholar

  • Strober, M. (1983). An empirically derived typology of anorexia nervosa. In P. DarbyP. GarfinkelD. M. GarnerD. CoscinaEds., Anorexia nervosa: Recent developments in research (pp. 185–195). Alan R. Liss. First citation in articleGoogle Scholar

  • Tasca, G. A., Demidenko, N., Krysanski, V., Bissada, H., Illing, V., Gick, M., Weekes, K., & Balfour, L. (2009). Personality dimensions among women with an eating disorder: Towards reconceptualizing DSM. European Eating Disorders Review, 17, 281–289. https://doi.org/10.1002/erv.938 First citation in articleCrossrefGoogle Scholar

  • Thompson-Brenner, H., & Westen, D. (2005). Personality subtypes in eating disorders: Validation of a classification in a naturalistic sample. The British Journal of Psychiatry, 186(6), 516–524. First citation in articleCrossrefGoogle Scholar

  • Thompson-Brenner, H., Eddy, K. T., Franko, D. L., Dorer, D. J., Vashchenko, M., Kass, A. E., & Herzog, D. B. (2008). A personality classification system for eating disorders: A longitudinal study. Comprehensive Psychiatry, 49, 551–560. https://doi.org/10.1016/j.comppsych.2008.04.002 First citation in articleCrossrefGoogle Scholar

  • Tibon, S., Handerzalts, J., & Weinberger, Y. (2006). Using the Rorschach for exploring the concept of Transitional space within the context of the Middle East. International Journal of Applied Psychoanalytic Studies, 2(1), 40–57. https://doi.org/10.1002/aps.30 First citation in articleCrossrefGoogle Scholar

  • Tibon, S., & Rothschild, L. (2009). Dissociative states in eating disorders: An empirical Rorschach study. Psychoanalytic Psychology, 26(1), 69–82. https://doi.org/10.1037/a0014675 First citation in articleCrossrefGoogle Scholar

  • Turner, B. J., Claes, L., Wilderjans, T. F., Pauwels, E., Dierckx, E., Chapman, A. L., & Schoevaerts, K. (2014). Personality profiles in eating disorders: Further evidence of the clinical utility of examining subtypes based on temperament. Psychiatry Research, 219, 157–165. https://doi.org/10.1016/j.psychres.2014.04.036 First citation in articleCrossrefGoogle Scholar

  • Verdon, B., Chabert, C., Azoulay, C., Emmanuelli, M., Neau, F., Louët, E., & Vibert, S. (2014). The dynamics of TAT processes: Psychoanalytical and psychopathological perspectives. Rorschachiana, 35(2), 103–133. https://doi.org/10.1027/1192-5604/a000056 First citation in articleLinkGoogle Scholar

  • Verdon, B., & Azoulay, C. (2020). Psychoanalysis and projective methods in personality assessment: The French School. Hogrefe Publishing. First citation in articleGoogle Scholar

  • Vibert, S., & Chabert, C. (2009). Anorexie mentale: Une traversée mélancolique de l’adolescence? Etude clinique et projective des processus identificatoires dans les troubles des conduites alimentaires [Anorexia nervosa: A melancholic voyage through adolescence? A clinical and projective study of identificatory processes in eating disorders]. La Psychiatrie de l’Enfant, 2(2), 339–372. https://doi.org/10.3917/psye.522.0339 First citation in articleCrossrefGoogle Scholar

  • Vibert, S., & Cohen de Lara, A. (2011). Anorexie mentale et fonctionnements limites à l’adolescence: Diversité des modalités d’expression des problématiques oedipiennes et de perte d’objet aux épreuves projectives [Anorexia nervosa and borderline functioning: Diversity of the psychic treatment of object loss and oedipal conflict at adolescence]. L’Evolution psychiatrique, 76(1), 55–74. https://doi.org/10.1016/j.evopsy.2010.11.008 First citation in articleCrossrefGoogle Scholar

  • Vibert, S. (2012). Inhibition défensive et fantasmes oedipiens: Approche psychanalytique et projective de deux cas d’anorexie mentale [Oedipal fantasies and defensive inhibition in anorexia in adolescence]. Psychologie clinique et projective, 18, 83–125. https://doi.org/10.3917/pcp.018.0083 First citation in articleCrossrefGoogle Scholar

  • Viglione, D. J., Perry, W., & Meyer, G. (2003). Refinements in the Rorschach ego impairment index incorporating the human representational variable. Journal of Personality Assessment, 81, 149–156. First citation in articleCrossrefGoogle Scholar

  • Weiner, I. B. (1996). Some observations on the validity of the Rorschach inkblot method. Psychological Assessment, 8(2), 206–213. https://doi.org/10.1037/1040-3590.8.2.206 First citation in articleCrossrefGoogle Scholar

  • Westen, D., & Harnden-Fischer, J. (2001). Personality profiles in eating disorders: Rethinking the distinction between axis I and axis II. American Journal of Psychiatry, 158, 547–562. https://doi.org/10.1176/appi.ajp.158.4.547 First citation in articleCrossrefGoogle Scholar

  • Wildes, J. E., Marcus, M. D., Crosby, R. D., Ringham, R. M., Dapelo, M. M., Gaskill, J. A., & Forbush, K. T. (2011). The clinical utility of personality subtypes in patients with anorexia nervosa. Journal of Consulting and Clinical Psychology, 79, 665–674. https://doi.org/10.1037/a0024597 First citation in articleCrossrefGoogle Scholar

  • Wonderlich, S. A., Crosby, R. D., Joiner, T., Peterson, C. B., Bardone-Cone, A., Klein, M., Crow, S., Mitchell, J. E., Le Grange, D., Steiger, H., Kolden, G., Johnson, F., & Vrshek, S. (2005). Personality subtyping and bulimia nervosa: Psychopathological and genetic correlates. Psychological Medicine, 35, 649–657. https://doi.org/10.1017/S0033291704004234 First citation in articleCrossrefGoogle Scholar