The contribution of psychodiagnostic test results toward understanding anorexia nervosa

Abstract

This article contends that recent theoretical formulations of anorexia nervosa from an ego psychological and/or object relations perspective and the results of projective (and sometimes objective) psychological tests are convergent. Furthermore, greater understanding of anorexia nervosa has not been possible because of the lack of use of psychodiagnostic test data. The contribution of psychological test results has been overlooked for a number of reasons. The results of studies using objective tests have added little to our knowledge of anorexia nervosa in terms of either etiology or prognosis. Instead, they have been primarily descriptive studies of personality traits found in anorexics. There is a dearth of studies using projective tests and these are limited by methodological problems, including small sample size and differing evaluative emphases, such as conceptual‐perceptual dimensions, personality structures, defenses, and content. However, despite these limitations, the studies are strikingly consistent in that they point to ego weakness and/or defects. The former is presumed to be a hallmark feature of anorexia nervosa, at least as emphasized by ego psychological theorists. Further impeding progress in the development of a comprehensive theory is the lack of integration of experimental investigations of body image with the clinical and research literature; instead, they are often seen in isolation. Recent advances in developmental theory, the results of projective (and occasionally objective) tests and body image investigations are reviewed and found to be complementary and have the potential to offer a comprehensive theory of anorexia nervosa.

Psychotherapy for anorexia nervosa and bulimia nervosa

“…These observations have shaped the priorities of many recent approaches to psychotherapy which explicitly acknowledge that the correction of the starvation state is a primary goal of the early phase of treatment (Bruch, 1982;Casper, 1982;Crisp, 1980;Goodsitt, 1985). Nevertheless, there have been a number of psychodynamic theorists who have apparently ignored the biological basis for many of the food-and weight-related symptoms in anorexia nervosa by assuming that they will normalize with the resolution of underlying psychological conflicts (Orbach, 1985;Small, 1984;Sours, 1980;Sugarman & Kurash, 1982;Sugarman, Quinlan, & DeVenis, 1982). The failure to differentiate primary psychopathology from the secondary elaboration of starvation symptoms not only leads to a faulty conceptualization of dynamic issues but also disregards the observation that psychological themes at presentation may share little with those which emerge with weight restoration (Crisp, 1980).…”

Ego functioning in eating disorders: Description and relation to diagnostic classification

“…To contribute to an empirical basis from which to investigate these issues, the present study explored ego functioning-a hitherto neglected dimension of likely importance for treatment planning and prognosis (Small, 1984)-in a group of anorexics/ bulimics.…”

“…Despite the explosion of research in eating disorders during the last decade, very little is still known about how to make prognostic forecasts and how to match patient and treatment approach in an optimal way. To contribute to an empirical basis from which to investigate these issues, the present study explored ego functioning-a hitherto neglected dimension of likely importance for treatment planning and prognosis (Small, 1984)-in a group of anorexics/ bulimics.…”

Cognitive dysfunction in eating disorders

“…However, other types of cognitive slippage-independent of body image misperception-have been researched less rigorously. Small (1984) reviewed the psychodiagnostic literature and found evidence for both conceptual laxity and poor reality testing in anorexics' Rorschach protocols. However, Small also noted serious methodological flaws in the surveyed research.…”