The Use of the Rorschach to Differentiate Unipolar and Bipolar Disorders

Abstract

We compared the Rorschach performance (using the Comprehensive System; Exner, 1986) of 29 unipolar depressed, 15 bipolar depressed, and 18 bipolar manic inpatient subjects (N = 62) classified on the basis of the Research Diagnostic Criteria (RDC; Spitzer, Endicott, & Robbins, 1985). The three main groups differed from one another on a variety of variables, especially those related to ideation and information processing. One finding of particular importance was that bipolar depressed subjects, like bipolar manic and unlike unipolar depressed subjects, showed a high level of cognitive slippage. These results suggest that the Rorschach possesses utility in the differential diagnosis of affective disorders.

The Psychological Assessment of Depression: Unipolars Versus Bipolars

“…This finding is consistent with the finding that BD patients during a manic episode exhibit relatively high levels of thought disorder (i.e., SUM6, SCZI, and Level 11 special scores, and combinatory thinking as measured by Holaman's Thought Disorder Index; Singer & Brabender, 1993;Solovay, Shenton, & Holzman, 1987). The difference between BD patients as they move from a manic phase to a depressed phase is the increased level of cognitive constriction (Singer & Brabender, 1993;Wagner & Heise, 1981).…”

“…Rorschach studies (Donnelly, Murphy, & Scott, 1975;Singer & Brabender, 1993) suggest that BD patients have more cognitive constriction (i.e., low Zf and DQ+ scores) and have more cognitive slippage (i,e., high SUM6 scores) than do UD patients. This finding is consistent with the finding that BD patients during a manic episode exhibit relatively high levels of thought disorder (i.e., SUM6, SCZI, and Level 11 special scores, and combinatory thinking as measured by Holaman's Thought Disorder Index; Singer & Brabender, 1993;Solovay, Shenton, & Holzman, 1987). The difference between BD patients as they move from a manic phase to a depressed phase is the increased level of cognitive constriction (Singer & Brabender, 1993;Wagner & Heise, 1981).…”

Empirical support for interrater reliability of Rorschach Comprehensive System coding

“…% agreement reported in study ranged from 70-93% for 11 categories with only two categories below 80% Lerner & St. Peter (1984b, p. 346) a % agreement for both human differentiation and content above 90% Meyer (1993, p. 157) % agreement calculated for response categories. Agreement ranged from 74-97%, with a mean of 89.2% Perry & Braff (1994, p. 365) ⌲s ranged between .88 and .97 for EII and subcomponents Perry, McDougall, & Viglione (1995, p. 115 Silberg & Armstrong (1992) % agreement on a sample of 10 protocols ranged from 91-95%; % agreement for special scores was 94% Singer & Brabender (1993) % agreement across response categories ranged from 84-93%, with a mean of 86.9% Sloan, Arsenault, Hilsenroth, Harvill, & Handler (1995) 20 protocols were chosen randomly and scored independently, achieving an overall % agreement of 88%; range 84-93% Sloan, Arsenault, Hilsenroth, Handler & Harvill (1996) 20 protocols were chosen randomly and scored independently, with an overall % agreement of 88% Stuart, Westen, Lohr, Benjamin, Becker, Vorus, & Silk (1990) a ⌲, ranging from .62-.96; above .80 for 9 of 13 scales.…”

Differences between bipolar and unipolar depression on Rorschach testing

“…These special cognitive scores indicate specific verbal expressions, such as deviant verbalization, inappropriate combinations, deviant response, and inappropriate logic. WSum6 expresses the severity of thought disorder and cognitive slippage, as well as primary process thinking 13,16,21. As Table 3 shows, DR2 > 0 (deviant responses, level 2) was significantly more frequent in the bipolar depression group than in the unipolar depression and control groups.…”

“…For example, use of Comprehensive System normative data as a control group as reported by Exner, nonblinded judgments of coding, poor interrater reliability, selective reporting of results, and failure to control alpha level, have been criticized 12. Only two studies using the Rorschach test for comparison of bipolar depression with unipolar depression have been reported in the relevant literature 13,14. The reports describe more responses based on external characteristics of a blot, more color-naming responses, and more cognitive slippage by subjects with bipolar depression than by those with unipolar depression.…”