Eating Disorders and the Rorschach
A Research Review From the French School and the Comprehensive System
Abstract
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
2013). Diagnostic and statistical manual of mental disorders (5th ed.).
. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.
(1997). Le Rorschach en Clinique adulte: Interprétation psychanalytique
([Rorschach Test in adults: A psychoanalytical interpretation] (2nd ed.). Dunod.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.022.00912009). Personality disorder cognitions in the eating disorders. Behaviour Research and Therapy, 47, 77–82. https://doi.org/10.1016/j.brat.2008.10.010
(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
(2013). Disturbi dell’alimentazione e obesità. Trattamento multiprofessionale integrato?
([Eating disorders and obesity. Multi-professional integrated treatment?] . Psiche. Rivista Di Cultura Psicoanalitica, 1, 1–13.2006). 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
(2009). Eating disorders and obesity: Two sides of the same coin? Epidemiologia e Psichiatria Sociale, 18, 96–100.
(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.1970). La pratique du Rorschach
([The practice of Rorschach] . Presses universitaires de France.2003). The Rorschach: A comprehensive system: Vol. 1. Basic foundations (4th ed.). John Wiley & Sons.
(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
(2003). Eating disorders. Lancet, 361, 407–416. https://doi.org/10.1016/S0140-6736(03)12378-1
(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
(1969). La vie sexuelle
([The sexual life] (D. Berger , Trans.). PUF (Original work published in 1927).1991). Eating Disorders Inventory-2, professional manual. Psychological Assessment Resources.
(1982). The eating attitudes: Psychometric features and clinical correlates. Psychological Medicine, 112, 871–878.
(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
(2007). Eating disorders in adolescents. Australian Family Physician, 36(8), 614–619.
(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
(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
(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
(Lingiardi, V.McWilliams, N. (Eds.). (2017). Psychodynamic diagnostic manual (2nd ed.): PDM-2. Guilford Press.
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
(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
(2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process. Guilford Press.
(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.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
(1985). On potential space. International Journal of Psychoanalysis, 65, 129–140.
(2001). OPD–operationalized psychodynamic diagnosis: Foundations and manual. Hogrefe and Huber Publishers.
. (2017). Rorschach research through the lens of bibliometric analysis: Mapping investigatory domain. SIS Journal of Projective Psychology & Mental Health, 24(1), 34–38.
(2012). Les perversions narcissiques
([Narcissistic perversions] . Payot.2019). Mental health. https://ourworldindata.org/mental-health
(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
(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
(1965). Anorexia nervosa. Thieme.
(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
(1970). STAI manual for the State-Trait Anxiety Inventory. Consulting Clinical Press.
(2010). Trait-defined eating disorder subtypes and history of childhood abuse. International Journal of Eating Disorders, 43(5), 428–432.
(2007). Risk factors for eating disorders. American Psychologist, 62(3), 181–198. https://doi.org/10.1037/0003-066X.62.3.181
(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.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
(2005). Personality subtypes in eating disorders: Validation of a classification in a naturalistic sample. The British Journal of Psychiatry, 186(6), 516–524.
(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
(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
(2009). Dissociative states in eating disorders: An empirical Rorschach study. Psychoanalytic Psychology, 26(1), 69–82. https://doi.org/10.1037/a0014675
(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
(2014). The dynamics of TAT processes: Psychoanalytical and psychopathological perspectives. Rorschachiana, 35(2), 103–133. https://doi.org/10.1027/1192-5604/a000056
(2020). Psychoanalysis and projective methods in personality assessment: The French School. Hogrefe Publishing.
(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.522.03392011). 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.2010.11.0082012). 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.018.00832003). Refinements in the Rorschach ego impairment index incorporating the human representational variable. Journal of Personality Assessment, 81, 149–156.
(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
(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
(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
(2005). Personality subtyping and bulimia nervosa: Psychopathological and genetic correlates. Psychological Medicine, 35, 649–657. https://doi.org/10.1017/S0033291704004234
(