Rorschach patterns in Vietnam veterans with post-traumatic stress disorder: A study of cognition, psychophysiology, and psychological defense.

To evaluate Rorschach indicators of post-traumatic stress disorder (PTSD), the Rorschach was administered to 16 combat veterans with PTSD, 9 combat controls, and 12 noncombat controls while heart rate (HR) and skin conductance (SC) were continuously recorded. It was found that PTSD subjects replicated the Rorschach abnormalities previously associated with the disorder, including signs of low stress tolerance, poor coping, affect dysregulation, perceptual distortion, and interpersonal disengagement. However, only two indicators, EB (Erlebnistypus) and CC (combat content), differentiated PTSD subjects from controls. An examination of negative findings revealed that all three groups similarly deviated from Exner (1993) nonpatient norms on many PTSD-associated Rorschach variables. These findings underscore the need for control subjects in Rorschach investigations. Psychophysiologic indices revealed that Rorschach responses containing traumatic content, given only by PTSD subjects, were associated with elevated arousal. No physiologic differences between affect-toned and affect-neutral Rorschach variables were found in the areas of emotional control, experienced stress, perceptual distortion, or combat-related content when data from all three groups were included. When group differences in arousal patterns were explored, it was found that PTSD patients were more easily hyperaroused than their counterparts, especially under conditions of experienced stress and helplessness. Conversely, combat control subjects exhibited lower baseline physiologic values than their counterparts, as well as decelerated HR during combat- and stress-related Rorschach responses, suggesting a physiologic resilience to PTSD in this group. Despite popular claims that PTSD sufferers cannot symbolize or modulate their traumatic experiences, a multilevel Rorschach analysis of defenses revealed that at least some PTSD subjects were able to deploy adaptive, integrative defenses following traumatic percepts. In exploring precipitants of intrusive imagery, I found that traumatic responses appeared most frequently on color cards immediately following black ones (II and VIII), a result which is discussed in light of Rorschach's (1942) color shock hypothesis. Together, the results of this study indicate that the Rorschach is a useful assessment tool for PTSD when the test's entire data yield is considered, and when response sequences are interpreted to reflect the patient's dynamic modes of processing experience.PhDClinical psychologyPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/131215/2/9840546.pd