An examination of generalized anxiety disorder and dysthymia utilizing the Rorschach inkblot method

Somatic symptoms of helplessness and hopelessness

Helplessness and hopelessness are transdiagnostic and aggravating factors of mental ill health, but their relation with somatization is not well documented. The main objectives were to identify somatic symptoms that are particularly associated with helplessness, referred to as somatic symptoms of helplessness (SS-He), and hopelessness, referred to as somatic symptoms of hopelessness (SS-Ho), determine increased risk of helplessness and hopelessness if having these symptoms and a certain number of these symptoms, and determine sensitivity and specificity in identifying helplessness and hopelessness based on number of these symptoms in a general Swedish sample. Population-based data from validated questionnaire instruments were used from 3,210 participants who constituted case groups of helplessness and hopelessness, and corresponding reference groups. Among 15 common somatic symptoms, five SS-He (e.g., feeling tired/having low energy) and five SS-Ho (e.g., dizziness) were identified, showing increased risk of helplessness and hopelessness that ranged from the factor 1.73 to 2.58 and from 1.44 to 1.92, respectively, which decreased considerably when controlled for depression and anxiety. The risk of helplessness increased by the factor 1.49 for each additional SS-He, and by 1.38 for each SS-Ho. A cutoff of two/three or more SS-He showed a sensitivity of 81.7/63.7% and a specificity of 40.6/61.4% in identifying helplessness, and 77.4/54.6% and 40.4/66.1%, respectively, in identifying hopelessness based on two/three or more SS-Ho. Primary care clinicians may consider further investigation of helplessness and hopelessness as well as depression and anxiety if presenting with these symptoms.

Clarifying Deeper Psychological Characteristics of Hikikomori Using the Rorschach Comprehensive System: A Pilot Case-Control Study

Hikikomori, a form of severe social withdrawal more than 6 months, has increasingly become a crucial issue especially among adolescents. Loneliness, avoidant personality, Japanese culture-related attachment style ("amae"), and difficulty in expressing emotions are suggested to be related to hikikomori. However, deeper psychological aspects have not been well clarified. The Rorschach test is one of the most popular psychological assessment tools to evaluate deeper personality traits. The Rorschach Comprehensive System (CS) has been established as the most reliable scoring method. Until now, no CS research has been conducted focusing on hikikomori. Therefore, we herein conducted a pilot case-control study using CS in clinical cases with and without hikikomori condition. Participants were recruited from the Mood Disorder/Hikikomori Clinic at Kyushu University Hospital. Twenty-two patients with hikikomori (HK patients) and 18 patients without hikikomori (non-HK patients) participated in the present study. All the 40 participants conducted the self-report Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) personality questionnaire and CS. Regarding the SCID-II personality questionnaire, various personality traits including passive aggressive trait were significantly higher in HK patients. Among CS variables, HK patients showed higher scores on FC (Form Color) and SumT (total number of texture-related responses). In addition, frequency of SumT was higher in HK patients. The present results suggest that persons with hikikomori are more likely to express emotions indirectly and expect others to presume their feelings and thoughts. Persons with hikikomori may also have difficulty in becoming independent emotionally from primitive dependence and attachment on significant others. Further investigations with larger samples are warranted for validation.