Rorschach Assessment of Purging and Nonpurging Bulimics

Research in bulimia has flourished in recent years, and yet minimal attention has been devoted to explorations of the bulimic's basic personality organization. We utilized the Rorschach to differentiate between purging and nonpurging bulimics and controls. There were 15 subjects in each group. The Comprehensive System (Exner, 1986) was used for the scoring of the protocols. Statistically significant differences were not found between the two bulimia groups, but interesting trends were detected in the areas of depression, anger, and self-preoccupation. Results appear to be constrained by the low rate of purging behavior. Comparisons between the combined bulimia groups and the controls resulted in solidly characterizing the bulimics as displaying perceptual inaccuracies, disordered thinking, a vulnerability to interpersonal problems, a damaged self-image, and a pessimistic outlook. The strengths of the study were its use of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) nonpatient bulimic subtypes and a control group that was comparable in terms of demographics. Future Rorschach studies with bulimics displaying higher frequencies of binging and purging behaviors are suggested.     

Bulimia,dietary restraint,and concern for dieting

The concept of dietary restraint has recently been used to explain binge-eating in dieters. It has been proposed that the violation of various restraint rules typically leads to hinging in individuals exhibiting high dietary restraint. This study examined the role of dietary restraint in a clinical sample of bulimics. After eating a preload to break dietary restraint, bulimic binge-eaters (those who binge but do not purge) were found to eat significantly more than bulimics who binged and purged (bulimia nervosa) and significantly more than normals. In addition, purging bulimics were found to have more concern about dieting than binge-eaters, while normals were found to have less concern about dieting and less anxiety about eating than both bulimic groups. These data suggest that the psychopathology of bulimia nervosa and bulimia (binge-eating) may be substantially different. It was proposed that the most distinguishing characteristic may be the preoccupation with dieting, weight, and body size, which is more extreme in bulimia nervosa.     

Rorschach evaluation of adolescent bulimics

It has become apparent that the excessive dieting engaged in by many girls when they reach puberty frequently serves as an impetus for the later development of eating disorders. While the existence of bulimia nervosa has been well documented in late-adolescent girls, only minimal research has been devoted to delineating the personality characteristics that distinguish bulimics from normal adolescents. The present study utilized the Rorschach to contrast 12 DSM-III-R diagnosed adolescent bulimics with 12 female adolescent controls. Exner's (1986) Comprehensive System was used for scoring the protocols. Statistically significant group differences were detected on both the overall Depression and the Schizophrenia Indices, as well as on several subcomponents of each. Additionally, bulimics averaged a greater number of aggression responses. The data suggested that the adolescent bulimics were more depressed, self-punitive, and negativistic than their peers, and that they had more disordered thoughts, inaccurate perceptions, and impaired judgment. The cognitive disturbances were not limited to the areas of food and weight. The results are alarming for this young population, particularly since the severity of symptoms certainly will increase over time if left untreated. Recommendations are made for early symptom identification and intervention.     

MCMI characteristics of DSM-III-R bulimics

The literature on bulimia has suggested that bulimic women exhibit a number of pathological personality characteristics. However, the Millon Clinical Multiaxial Inventory (MCMI), an objective measure of personality functioning, has not previously been utilized to assess the personality characteristics of a bulimic population. The MCMI was administered to 37 female bulimics, 32 female general psychiatric outpatients, and 30 normal female controls in order to assess the relationship between bulimia and pathological personality traits. Bulimic women were found to score higher than the other groups on MCMI Scales 1 (Schizoid), 2 (Avoidant), and 3 (Dependent). They also scored lower than the other two groups on Scale 6 (Antisocial). Results are discussed within the framework of parallels between the MCMI profiles of bulimics and the existing literature on bulimics' personality characteristics.     

MCMI Characteristics of DSM-II-R Bulimics

The literature on bulimia has suggested that bulimic women exhibit a number of pathological personality characteristics. However, the Millon Clinical Multiaxial Inventory (MCMI), an objective measure of personality functioning, has not previously been utilized to assess the personality characteristics of a bulimic population. The MCMI was administered to 37 female bulimics, 32 female general psychiatric outpatients, and 30 normal female controls in order to assess the relationship between bulimia and pathological personality traits. Bulimic women were found to score higher than the other groups on MCMI Scales 1 (Schizoid), 2 (Avoidant), and 3 (Dependent). They also scored lower than the other two groups on Scale 6 (Antisocial). Results are discussed within the framework of parallels between the MCMI profiles of bulimics and the existing literature on bulimics' personality characteristics.     

Psychological characteristics of dieters and bulimics.

Two studies examined the continuum and discontinuity models of the relation between dieting and bulimia nervosa. In Study 1, 21 dieters, 19 bulimics, and 33 nondieting controls were compared on 24 measures. Multivariate analyses revealed that each of the groups differed significantly from the other two. Univariate analyses found 18 significant differences between bulimics and dieters and 1 significant difference between dieters and controls. In Study 2, 86 subjects completed measures of psychological functioning, dieting, and bulimia nervosa. On the basis of regression analyses using factor scores from the psychological variables as predictors, high scores on a psychopathology factor and low scores on a defensiveness factor predicted both bulimia and dieting. Low self-concept scores also predicted bulimia. These data indicate that both continuity and discontinuity characterize the relation between dieting and bulimia.     

The neglected bulimic: The nonpurger

For nearly 10 years bulimia has been recognized officially as a distinct eating disorder, and yet in that time only minimal attention has focused on the nonpurging subtype. The present investigation compared 21 DSM-III-R diagnosed nonpurging bulimics with 22 non-eating-disordered controls on three standardized questionnaires and during a unique assessment task. In this procedure subjects imagined that they were the character in a series of slides and audiotaped flooding scenes. The content of the stimuli ranged from food and weight cues to issues hypothesized to play a role in the development or maintenance of bulimia (e.g., rejection or loss of control fears). A MANOVA conducted on the three questionnaires was highly significant, with the Beck Depression Inventory and the Restraint Scale being responsible for the elevated bulimic scores. A repeated-measures ANOVA performed on the self-report ratings during the exposure task also achieved significance, as the bulimics reported higher anxiety reactions than controls to each experimental stimulus. Significant skin conductance reactions were detected when a group of only the most psychophysiologically responsive bulimics and controls were compared. The importance of continued comprehensive evaluations with DSM-III-R nonpurging bulimics was emphasized.This research was supported by grants both from the University of New Mexico's Research Allocation Committee and the Biomedical Research Support Grant committee. Portions of this paper were presented at the Association for the Advancement of Behavior Therapy annual conference, Boston, November 1987.     

Public and private self-consciousness as specific psychopathological features

Public self-consciousness (PUBSC) and private self-consciousness (PRISC) represent aspects of dispositional self-directed attention. The aim of the present study was to investigate whether four clinical groups, namely patients with a diagnosis of social phobia, panic disorder, obsessive–compulsive disorder or bulimia nervosa, and normal controls differentiated on the basis of their PUBSC and PRISC scores. Results indicated that both PUBSC and PRISC are extremely elevated in patients with social phobia. Patients with panic disorder and patients with obsessive–compulsive disorder score somewhere between social phobics and normal controls on PUBSC and PRISC scales. Bulimics had significantly higher PUBSC values than both controls and patients with panic disorder, but had lower values than social phobics. Compared to normal controls, bulimics showed no elevated PRISC scores. In addition, contrary to the other groups, PUBSC and PRISC seem to be unrelated in bulimics. Thus, PUBSC and PRISC appear to be specific psychopathological features for German females when comparing groups with different mental disorders and normal controls.     

The Continuum Versus Categorical Debate on Eating Disorders: Implications for Counselors

The authors summarize a study by D. A. Williamson et al. (2002) in which clinical groups with anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, and binge eating disorder were contrasted with nonclinical groups of participants (i.e., obese and normal weight). The eating disorder groups were qualitatively different. Also, bulimia nervosa, purging and nonpurging types, may fall on a continuum of pathology with the binge‐eating, purging type of anorexia. Anorexia nervosa, restricting type, may be distinct from bulimia nervosa, purging and nonpurging types, and the binge‐eating, purging type of anorexia.     

La boulimie à l'épreuve du Rorschach : étude des représentations de soi et d'objet dans une analyse multivariée

The aim of this study was to examine self and objet representation disorders defined by bulimic women. 113 bulimics and 115 non-bulimics, aged 18 to 58, both outpatient women, where assessed by the Rorschach test according to the french method. 14 topics were selected from ther international psychopathological literature then translated into 14 Rorschach indices from the analysis of each protocol. Ten of the fourteen selected indices distinguish the two groups in a significant way. A multivariate analysis (AFCM) reveals in the bulimic group five dimensions corresponding to 63% of the inertia. If the first dimension appears to be related to general psychopathology, the four others are more specific to bulimic representation disorders.     

Bulimia and taste: possible interactions

Potential abnormalities of taste were examined in bulimic subjects who purged by vomiting and in controls. When spatial testing of the tongue and palate was performed by direct local application of sweet, salty, sour, and bitter solutions, bulimics showed a selective spatial loss on the palate. The palate may be affected by purging because vomit is directed toward the roof of the mouth where the palate receptors are located. The data suggest that the acid in vomit damages these receptors. Bulimics and controls did not differ in their basal ratings of intensity or pleasantness of sweet, salty, sour, and bitter stimuli when these were sipped rather than directly applied to the tongue. However, after ingesting a glucose load, controls found sweet taste significantly less pleasant, whereas bulimics did not. The results suggest that bulimics may also have an abnormal experience of satiety.     

Biased perception of overeating in bulimia nervosa and compulsive binge eaters

This study investigated the relationship between caloric intake and perceived overeating in subjects with and without a history of problematic binge eating. Eighty subjects (20 in four groups: bulimia nervosa, compulsive binge eaters, obese, and normal controls) self-monitored eating for 2 weeks. The regression slopes for self-reported overeating as a function of caloric intake were contrasted across the four groups. At higher caloric levels, bulimics and binge eaters reported overeating at a significantly higher rate compared to obese and normal control groups. These data were interpreted as a type of cognitive bias whereby subjects with a history of binge eating distorted their perception of overeating at progressively higher caloric levels. It was proposed that excessive concern about eating and dieting may cause such cognitive biases. A parallel was drawn with body image distortion, which appears to be associated with overconcem with body size and shape.     

The development of a scale to measure cognitive distortions in bulimia

The Bulimia Cognitive Distortions Scale (BCDS) was developed to measure irrational beliefs and cognitive distortions associated with bulimia. The final 25-item scale was found to have excellent internal consistency with high item to total correlations and a coefficient alpha of .97. Factor analysis revealed two clear factors measuring cognitive distortions related to automatic eating behaviors and to physical appearance. Data attesting to the convergent and divergent validity of the BCDS are also presented. With 110 subjects (55 bulimics, 55 controls), a discriminant analysis revealed the BCDS to be the only significant variable in predicting group membership, correctly classifying 93.6% of all subjects. The BCDS was also predictive of severity of bulimia as measured by the frequency of binge eating episodes. The potential of the BCDS as both a diagnostic and research instrument is discussed.     

The Development of a Scale to Measure Cognitive Distortions in Bulimia

The Bulimia Cognitive Distortions Scale (BCDS) was developed to measure irrational beliefs and cognitive distortions associated with bulimia. The final 25-item scale was found to have excellent internal consistency with high item to total correlations and a coefficient alpha of .97. Factor analysis revealed two clear factors measuring cognitive distortions related to automatic eating behaviors and to physical appearance. Data attesting to the convergent and divergent validity of the BCDS are also presented. With 110 subjects (55 bulimics, 55 controls), a discriminant analysis revealed the BCDS to be the only significant variable in predicting group membership, correctly classifying 93.6% of all subjects. The BCDS was also predictive of severity of bulimia as measured by the frequency of binge eating episodes. The potential of the BCDS as both a diagnostic and research instrument is discussed.     

Depression and bulimia: the link between depression and bulimic cognitions

This study assessed the link between bulimic and depressive cognitions. Twenty-nine bulimics and 16 controls from the general population were first assessed on levels of depression using the Schedule for Affective Disorders and Schizophrenia-Change Version and the Beck Depression Inventory (BDI). Bulimics were significantly more depressed than controls. Bulimics differed significantly from controls on all cognitive measures associated with depression (Automatic Thoughts Questionnaire, Dysfunctional Attitude Scale, and Attributional Style Questionnaire), but differences on these measures were nonsignificant when depression, as measured by the BDI, was controlled. Bulimics differed from controls regardless of level of depression on the three scales of the Restraint Inventory, the Rationalization and All-or-None scales of the Thoughts About Eating Inventory, and most of the eight scales of the Eating Disorders Inventory. Bulimics showed more maladaptive thinking associated with depression, but these differences likely reflect the levels of depression for each group. The differences on the measures of cognitive and behavioral symptoms of bulimia remained when the level of depression was controlled statistically. This suggests that although depression can be frequently diagnosed in a bulimic sample, specific maladaptive cognitions and behaviors reflect a distinct disorder (bulimia) and are not simply the expression of an affective disorder.     

Prevalence of personality disorders among bulimics,nonbulimic binge eaters,and normal controls

We examined the comorbidity of bulimia and personality pathology among college women. Subjects included women (n=23) meeting DSM-III-R criteria for bulimia nervosa (bulimics), women (n=23) who reported binge eating but did not fulfill the criteria for bulimia nervosa (binge eaters), and women (n=23) who did not binge eat (normals). The subjects completed an assessment battery consisting of the Personality Disorders Examination and the SCID as well as the Beck Depression Inventory, the Rosenberg Self-Esteem Index, and measures of impulsivity and self-defeating tendencies. Fourteen of 23 bulimics (61%) met criterion for a personality disorder using DSM-III-R Axis II criteria. In comparison, 3 of 23 (13%) binge eaters and 1 of 23 (4%) normal subjects received an Axis II diagnosis. Borderline and self-defeating diagnoses were the predominant personality disorders in 96% of the bulimics exhibiting clinically significant personality pathology. Bulimics also exhibited significantly more depression, impulsivity, and self-defeating behavior and lower self-esteem than binge eaters and normals. The findings are discussed within a conceptual framework that posits an interaction between personality pathology and restrained eating.     

Bulimia nervosa: a descriptive and therapeutic study

This study examined a sample of 24 Ss who met strict criteria for a diagnosis of bulimia nervosa. Assessments were made on: (1) demographic characteristics, (2) eating attitudes and behaviour and (3) personality measures. The effectiveness of two types of therapeutic intervention (cognitive-behavioural group therapy vs cognitive-behavioural group therapy plus specific behavioural instruction) was examined in a baseline, therapy intervention, follow-up design.The group was characterized prior to therapy by high N, Depression and Anxiety and low Self-esteem scores compared with control group data. Following therapy, Depression and Anxiety scores were significantly lower and Self-esteem scores higher, whereas N scores remained high. Binge-purging frequencies were significantly reduced in some of the Ss but the reduction could not unequivocally be attributed to the therapeutic interventions. The pattern of results suggested that bulimia nervosa (defined by a binge-purging pattern in association with high neuroticism) should be distinguished from bulimia (defined by a binge pattern not related to purging or high neuroticism) and that DSM-III should be revised to reflect this distinction. A theory is advanced to account for the rapid association of binging and purging in Ss high in neuroticism but not in Ss low in neuroticism.     

Indications of depression and distress in divorce and nondivorce children reflected by the Rorschach test

The appearance of depressive features, as reflected by responses to the Rorschach test, were explored in two groups of children from divorced and nondivorced families (referred to here as divorce and nondivorce children). The relationships between the depression scores and the children's hostility, aggression, and anxiety levels were also studied. The Rorschach Inkblot Test was individually administered to a nonclinical sample of 108 Swedish school children between 10 and 12 years old. The subjects constituted two groups, a divorce group (27 girls, 27 boys) and a nondivorce group (27 girls, 27 boys). Divorce children scored significantly higher on Exner's (1986) Depression Index than their nondivorce peers. Furthermore, divorce children with depressive features in their Rorschach responses were found to have a high level of hostility and aggression (as manifested in their Rorschach protocols), whereas no such associations were found among nondivorce children.     

A Rorschach study of oral dependence in alcoholics and depressives

Despite the strong association between alcoholism and orality in psychoanalytic theory, use of the Rorschach Inkblot Test to provide empirical support for such a link has yielded decidedly mixed results. However, Masling's Rorschach Oral-Dependency (ROD) scale has shown twice that people with alcoholism give more oral-dependent responses on the Rorschach than matched comparison groups (Bertrand & Masling, 1969; Weiss & Masling, 1970), which is supportive of classical analytic theory. In this study, we investigated alcohol groups, depression groups, and "normal" undergraduates with the ROD scale and found that the 2 clinical groups produced higher ROD scores than the undergraduates. In addition, recent studies by Duberstein and Talbot (1993) and Fowler, Hilsenroth, and Handler (1996) provide evidence for an object relations model of dependency that suggests that a balance between anaclitic dependence and complete independence, in which dependency needs are acknowledged but are not overwhelming, is most adaptive. This model of dependency was evaluated; it was found that a simple difference in group means provided a better fit with the data, although some evidence of an object relations model also was found. Finally, Rorschach and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) levels of general defensiveness and primary process manifestations in Rorschach content were investigated to assess whether participants were responding defensively to the testing and whether there were any differences in the nature of oral-dependent responses between the clinical groups.     

Directory of Members of the Society for Projective Techniques as of March 1, 1964

The appearance of depressive features, as reflected by responses to the Rorschach test, were explored in two groups of children from divorced and nondivorced families (referred to here as divorce and nondivorce children). The relationships between the depression scores and the children's hostility, aggression, and anxiety levels were also studied. The Rorschach Inkblot Test was individually administered to a nonclinical sample of 108 Swedish school children between 10 and 12 years old. The subjects constituted two groups,, a divorce group (27 girls, 27 boys) and a nondivorce group (27 girls, 27 boys). Divorce children scored significantly higher on Exner's (1986) Depression Index than their nondivorce peers. Furthermore, divorce children with depressive features in their Rorschach responses were found to have a high level of hostility and aggression (as manifested in their Rorschach protocols), whereas no such associations were found among nondivorce children.