Anorexia Nervosa: A Referred patient for Rorschach
Anorexia nervosa is starvation brought about by the patient’s refusal to eat. A concomitant symptom is amenorrhea. The disorder occurs more often in girls and young women and is sometimes allied with conversion or schizophrenia. The mortality rate of the condition is high.
Rorschach provides evidence of the unconscious motives underlying a patient’s need to destroy herself by starvation.
A recorded example on Rorschach:
The person has polite behavior and is very guarded, the posture is rigid, sitting on the extreme edge of an armchair.
This is typical of depression, showing the following characteristics:
1. A low number of responses, seventeen.
2. Very slow response time, 118 seconds per response.
3. No human or animal movement, except one M, restrained and given only at a later stage. But for this afterthought, no life is allowed.
4. Reactions to colour are also markedly restrained. In Cards II and III, she ignored colour in the image. She could not do so in the last three, wholly coloured cards, but she did not relate it to any living object, neither animal nor plant.
5. There is an emphasis on the least personal type of determinant, the F being 59. Her only tactile percept- the type which, by hypothesis, might signify the conscious need for a comforting human relationship, is not only linked with a dead object but one described as of poor quality… would rub away (means can be removed easily).
6. Form level. As with other depressives, Patient is carefully logical, but the lowering of reactivity exemplified in slow timing and restraint, as described above, hampers her cognitive freedom. She functions perceptually below her ascertained I.Q. of 125 on the Revised Stanford Binet scale
7. Another significant point is the complete lack of sinister responses Other features, such as the number and nature of erects based on concepts of inanimate force, i.e. that which is beyond human control suggested that she feels threatened but cannot consciously formulate the nature of her fears.
So far, arising from the psychogram only, one may set up the hypothesis that this girl is seriously depressed, and that her condition involves almost a complete rejection of libidinal drives no FM or M an a partial, near complete, rejection of human relationships (see both sides of the graph, low P, and in turning Erlebnistyp).
Psychiatrist diagnostic interview and the Rorschach both show a severe degree of disturbance in this girl, while the case history indicates that some degree of maladjustment has existed since infancy.
The Rorschach test results add to the material previously obtained by revealing the degree and nature of the depression underlying the resenting symptom of anorexia. It also shows the infantile and pubertal conflicts against which self-starvation is a mode of ego defence. Some major factors in these repressed unconscious conflicts are
1. The association of eating and aggression, with death as a punishment.
2. Association of eating and sexuality, which leads to deadening of activity, and thus of sexuality.
3. A childhood disturbance about body contents, messiness, associated with impatience, (a polite term for anger).
Keeping in mind, the extreme difficulty of her feeding from birth, the sequence of eating, anger, and death is comprehensible. With the inability to get food from the breast or satisfaction from the bottle, the infant could gain no comfort from the mother-child relationship, which was her only source of life. Inevitably, she must have felt massive anger of an unsatisfied infant, directed towards the mother who seemed to give her only tummy aches, vomiting and the sense of emptiness. The result is an intolerable situation. Anger is a destructive force, but because of the unity of mother and child, it is felt as mutually destructive. So need and love alike cause the infant to repress to anger which is allied to fear of death. In the Rorschach test, this repressed conflict is unconsciously demonstrated together with its sequel of guilt-laden conflicts around the anal and genital activity. The resultant tensions are shown in limitation of perception, the content of responses, and lowering of form level insight of a careful intellectual defence. In all these ways the restriction on activity is apparent. It is especially so in the failure to respond to internal stimuli by the projection of kinaesthesia. There is only one, much restrained, human movement, FM, animal movement, which by hypothesis represents the libidinal drive, that is wholly absent rate omission in any Rorschach record.