The contribution of psychodiagnostic test results toward understanding anorexia nervosa

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.