Variations of the Bender-Gestalt Test: implications for training and practice

Although the Bender-Gestalt Visual Motor Test has been a popular and influential clinical assessment instrument for the last half century, authoritative opinion and a substantial research literature are often inconsistent or contradictory. This paper documents variations in designs, administration procedures, forms, and applications to particular populations. A careful review of scoring systems indicates the current status of objective approaches as contrasted with interpretation that is global, intuitive, and subjective. Some implications of these variations and interpretive procedures for training and assessment practice are discussed. The major conclusions of the review are summarized in seven points.     

Koppitz errors on the Bender-Gestalt for adult retardates: normative data.

Normative data on the Koppitz developmental scoring system for the Bender-Gestalt test were derived from a sample which included 510 protocols of adult resident retardates. Percentile norms are presented on Koppitz error scores for three AAMD ranges of retardation based on WAIS IQs and two AAMD ranges of retardation based on Stanford-Binet IQs.     

A test of the tripartite model of depression and anxiety in older adult psychiatric outpatients

This study examined the tripartite model of depression and anxiety in 131 psychiatric outpatients, ages 55-87. Confirmatory factor analyses revealed that a 3-factor model provided an adequate fit to the observed data, that the 3-factor model was empirically superior to 1- or 2-factor models, and that the 3-factor structure obtained in the current sample of older adult outpatients converged with that obtained on a separate, younger 'sample. Negative affect was significantly related to depression and anxiety symptoms and syndromes, and positive affect was more highly related to depression than anxiety symptoms and syndromes. Ways for taking into account possible age-associated differences in emotion in older adults and thus improving the conceptual model of anxiety and depression are briefly noted.     

Relationship of M.S. Belief Scale scores to depression and anxiety in hospitalized psychiatric patients

The M.S. Belief Scale (MSB) was administered to 61 psychiatric hospital patients on admission and just prior to discharge. Measures of depression and anxiety were also taken before and after hospital treatment. MSB prescores were positively correlated with presenting levels of depression and anxiety. Furthermore, declines in irrational thinking after a treatment program of cognitive-behavioral therapy were associated with declines in levels of depression. Initial levels of irrational thinking did not accurately predict length of hospital stay. The MSB scores for these patients at admission were considerably higher than for other populations previously reported. However, their discharge levels were comparable to normal levels reported by others. The results suggest a relationship between irrational thinking and depression for hospitalized psychiatric patients.Dr. Templeman is a licensed psychologist in private practice in Pendleton, Oregon.     

Neuropsychological performance and suicidal behavior in adult psychiatric inpatients.

Although various studies have shown that suicidal persons exhibit greater cognitive deficiencies than both normals and other psychiatric patients, researchers as yet have been unable to account for the source(s) of the differences. Some of these differences (e.g., cognitive rigidity and impaired problem solving) hint of possible organic involvement. This study explored the relationship of neuropsychological functioning to suicidal behavior by comparing 20 suicidal and 27 nonsuicidal psychiatric inpatients on several tests of neuropsychological functioning. Although results showed no significant differences between the two groups on most measures, both groups showed evidence of notably high levels of cortical dysfunction relative to test norms. Thirty-five percent of suicidal patients and 44% of nonsuicidal patients scored in the impaired range. Implications of this high frequency of impairment for the treatment of suicidal and nonsuicidal psychiatric patients are discussed.     

Directionality in four Bender-Gestalt figures: III.

Two predictions, viz., that for Austrian non-clinical school children whose left-right reading-writing habits parallel an assumed innate left-right drawing tendency, a clear preference for left-right execution of 4 Bender-Gestalt figures (Nos. 1, 2, 3, 6) would be attained at an earlier age and no plateau would be observed in contrast to Israeli non-clinical school children whose right-left reading-writing habits are in a direction opposite to the assumed innate drawing tendency, were confirmed at significant levels of confidence. In a sub-sample of the Austrian population investigated fathers' educational/occupational level as well as the child's position in his sibship as measures of attention and stimulation in the home do not appear to have any significant influence on preference for direction of drawing.     

Bender-Gestalt emotional indicators and acting-out behavior in young children.

This study was designed to investigate the relationship between 15 emotional indicators on the Bender-Gestalt Test and acting-out behavior in young children. The subjects were 93 children ranging in age from five to 12 years. Each was administered the Bender. A measure of each subject's overt acting-out behavior was then obtained by having teachers rate each student on a Behavioral Rating Scale. Subjects' records were then divided into groups on the basis of both sex and age. Results indicated that neither the total number of Bender indicators nor any of the individual Bender indicators were correlated significantly with total scores on the rating scale. Use of the Bender as a projective device to measure acting-out behavior was seriously questioned.     

Neuropsychological characteristics of young adult chronic psychiatric patients: preliminary observations

Psychological evaluation included tests of brain-behavior functioning and academic level for 110 young adults (16 to 39 yr. of age), each a moderate to heavy user of mental health services. The composite patient manifested borderline, diffuse brain dysfunction with deficiencies in language, visuospatial, motor, concentration, and higher-order problem-solving skills, together with below normal performance on tests of intelligence, reading comprehension, arithmetic calculation, and spelling. Standard mental health services appear inadequate for habilitation or rehabilitation of many such people. The findings suggest that one reason for these patients' lack of response to conventional mental health treatments is that clinicians fail to identify patients' fundamental deficiencies and to incorporate this knowledge in planning treatments and evaluating progress. Suggestions for further studies are offered.     

Relation of fatigue with alexithymia and depression in psychiatric outpatients

The complaint of fatigue is common in community, primary care, and psychiatric settings. Fatigue is often associated with depression and psychosocial stress. This report investigated the role of alexithymia and depression in fatigue as reported in a sample of 151 psychiatric outpatients (75 men and 76 women) who completed all scales. The mean age of the sample was 45.5 yr. (SD= 12.5), and mean education was 16.2 yr. (SD=2.4). Fatigue was inversely correlated with education (-.16) and positively correlated with depression (.44), anxiety (.30), and alexithymia (.35). However, in a multivariate regression analysis, only depression and alexithymia remained significant (p < or = .01).     

Comparison and combination of recall and Background Interference Procedures for the Bender-Gestalt Test with brain-damaged and schizophrenic patients.

The Bender-Gestalt Test was administered under standard, recall, Background Interference Procedure (BIP), and BIP-recall conditions to 20 brain-damaged and 20 schizophrenic male inpatients. Individual recall, BIP, and BIP-recall scores differentiated between the groups prior to controlling for IQ, but only recall and BIP-recall continued to discriminate once IQ was held constant. The use of difference scores corrected for standard copy performance (base level) resulted in improved diagnostic discrimination compared to difference scores alone. However, this procedure also produced a substantial multiple correlation with IQ and a consequent loss of group differentiation for the BIP difference score, while failing to yield an appreciable increase in predictive accuracy over individual scores for recall and BIP-recall. Nonetheless, a significant effect emerged independently of both recall and IQ for the BIP-recall score, suggesting that the BIP hypothesis may have merit within the context of memory functioning.     

Narrow and broad definition of mixed-handedness in male psychiatric patients.

Differences in assessment and classification procedures of many mixed-handedness studies have made comparison of findings difficult. In the present study, "narrow" and "broad" definitions of mixed-handedness were investigated using the Annett Handedness Questionnaire in patients with schizophrenia (n=68), panic disorder (n=62), borderline personality disorder (n=35), heroin addiction (n=54), and mental retardation (n=33) in comparison with 944 controls. According to the "narrow" definition of mixed-handedness, an excess of mixed-handedness was observed in patients with borderline personality disorder and mental retardation. An excess of nonmixed-handedness was found in patients with panic disorder. According to the "broad" definition of mixed-handedness, an excess of mixed-handedness was observed in patients with mental retardation, in the total sample of psychiatric patients (n=252), and in the schizophrenic patients. Thus, we can conclude that different mixed-handedness definitions can be associated with different results. Furthermore, we suggest that the neurotic part of the present psychopathology spectrum tends to be related to an excess of normal or nonmixed-handedness, and the psychotic as well as the organic portion is associated with an excess of mixed-handedness, regardless of the definition of mixed-handedness used.