How to Cite:

Chand, B. K. S., & Pangajam, A. (2022). Comparison of Rorschach indices among normal,
Schizophrenic and substance induced psychotic males. International Journal of Health
Sciences, 6(S3), 2547²2554. https://doi.org/10.53730/ijhs.v6nS3.6083

Comparison of Rorschach indices among

normal, Schizophrenic and substance induced
psychotic males

Bibin Chand K. S.
(Rtd) Indian Air Force Psychologist, Clinical Psychologist & Assistant Professor,
Department of Clinical Psychology, SRM Medical College Hospital & Research
Centre, Chennai

Pangajam A.
Assistant Professor, Department of Clinical Psychology, SRM Medical College
Hospital & Research Centre, Chennai

Abstract---The complex and inter correlated nature of symptoms often

construct hurdles in the diagnostic and therapeutic management of
primary psychotic and substance induced psychotic individuals for
mental health professionals. The significant role of psychological
projective assessments comes at this juncture, where the subject is
unaware of the purposes of the test due to the ambiguous nature of
stimulus and also, unable to judge how particular responses are
interpreted. Among projective assessments Rorschach Ink Blot Test
(RIT) by Herman Rorschach occupies a nobel position that
demonstrates detailed protocols to identify Psychopathological
construct. The Exner Scoring system provides most comprehensive
process with focus on interpretation based on Hypothesis formulation.
In the method, various indices are used to elicit significant findings
pertaining the psychopathology of individuals which is explored in the
current study viz: Perceptual Thinking Index (PTI), Depression Index
(DEPI), Coping Deficit Index (CDI), Suicide Potential Constellation (S-
CON), Hyper Vigilant Index (HVI), Obsessive Style Index (OBS),
Intellectualization Index, Isolation Index and Egocentricity Index. The
objective of the current study was to understand the difference in
Rorschach Ink Blot Test indices among normal, schizophrenic and
substance induced psychotic males using Exner comprehensive
system and to verify the possibilities of add in research findings
towards the implementation of various Psychotherapies. Null
hypothesis framed to fulfil the aim of study is there is no significant
difference between normal, schizophrenic and substance induced
psychotic males based on Rorschach Indices. Based on Purposive
sampling method data collected from total 90 males between 30 ² 50

International Journal of Health Sciences ISSN 2550-6978 E-ISSN 2550-696X © 2022.

Corresponding author: Chand, B. K. S.; Email: [email protected]
Manuscript submitted: 18 Dec 2021, Manuscript revised: 27 March 2022, Accepted for publication: 09 April 2022
2547
2548

years of age, consisting of 30 males in normal, Schizophrenic and

Substance induced psychotic groups. Inclusion criteria for normal
male group was a below score of 4 in General Health Questionnaire
and for Clinical groups were males diagnosed with Schizophrenia and
Substance-induced psychosis as per ICD-10. The statistical
evaluation is done reflecting descriptive statistics and chi square test
using SPSS version 16.0. Hypothesis testing conducted in two-tailed
DW D VLJQLILFDQW OHYHO Â 7KHUH LV VLJQLILFDQW GLIIHUence between
normal, schizophrenic and substance induced psychotic males based
on Rorschach Indices. The verdicts of present study can be used
retrospectively for the clarity as well as the confirmatory of psychotic
disorders, differential diagnosis and its efficient management using
psychotherapy by mental health professionals. Moreover, these
findings can be adopted for the precise therapeutic formulations for
primary and substance induced psychotic disorders.

Keywords---rorschach ink blot test, exner comprehensive scoring,

schizophrenia, substance induced psychosis.

Introduction

The symptoms and criteria for behavioural disorders vary significantly, still it
often amalgamates with each other and makes it a difficult task for mental health
professionals for diagnosing and management (Holt, 1958; Singer & Brabender,
1993). Personality dynamics, physiological factors and environmental factors
often make this task more intricate. The common neuro pathways, role of neuro
transmitters and the psychotogenic properties of specific substances viz cannabis,
amphetamines, cocaine, opioids, hallucinogens play a vital role in differentiating
between schizophrenia like psychotic disorder and substance induced psychosis
disorder (Shariff & Tandon, 2019). Substance-induced psychosis is confirmed
when the diagnosis criteria meet psychotic symptoms which occurs during or
within two weeks of substance use and persists for more than 48 hours and not
exceeds a duration of six months (ICD-10). Whereas schizophrenia is diagnosed
with the criteria meeting first rank symptoms, its intensity, duration along with
the exclusion criteria of organicity and psychotic substance usage. Intensity of
symptoms pertaining to thought, coping, affect and behaviour, varies with
individual to individual. At this complex juncture, projective techniques play a
notable role in abetting mental health professionals to confirm diagnose and
formulate therapeutic interventions effectively as these techniques relies on the
unconscious process of responding to a stimulus by an individual (Bellak &
Abrams, 1997). Among the various projective techniques, Rorschach Ink Blot Test
(RIT) developed by Herman Rorschach is perhaps the most widely used and
controversial projective technique among Psychiatrists and Clinical Psychologists
(Exner, 2003). Among the various RIT interpretation methods viz: Klopfer,
Rapaport, Beck, Piotrowski and Hertz, the most comprehensive system is the
Exner comprehensive method. In Exner comprehension interpretation system
various indices are used to elicit significant findings pertaining the
psychopathology of individuals. Indices often gives a cumulative value which will
overpower the discrete scores in any tests. The core indices focused in RIT for
 2549

psychodiagnostics as well as the therapeutic formulation are Perceptual Thinking

Index (PTI), Depression Index (DEPI), Coping Deficit Index (CDI), Suicide Potential
Constellation (S-CON), Hyper Vigilant Index (HVI), Obsessive Style Index (OBS),
Egocentricity Index, Isolation Index and Intellectualization Index. Even though
numerous researches have targeted the more snarled psychosis disorders and its
relationship by administrating projective techniques, there exists a significant
research gap pertaining projective techniques like Rorschach Ink Blot test and
SV\FKRWLF GLVRUGHUV $LNHQ ,Q ,QGLDQ FRQWH[W %HFN·V LQWHUSUHWDWLRQ V\VWHP
is most widely followed than Exner Comprehensive System. The purpose of the
current study was to compare the Rorschach Ink Blot indices among normal,
schizophrenic and substance induced psychotic males using Exner
comprehensive system.

Method

Objectives

To study the difference in Rorschach Indices viz: Perceptual Thinking Index (PTI),
Depression Index (DEPI), Coping Deficit Index (CDI), Suicide Potential
Constellation (S-CON), Hyper Vigilant Index (HVI), Obsessive Style Index (OBS),
Egocentricity Index, Isolation Index and Intellectualization Index among normal,
schizophrenic and substance induced psychotic males.

Hypothesis

Following null hypothesis was framed to study the objective.

H0 : There is no significant difference between normal, schizophrenic and
substance induced psychotic males based on Rorschach Indices.

Variables studied

Independent Variables studied were normal male population and males with
schizophrenia and substance-induced Psychosis as per ICD-10 criteria.
Dependent Variables were Rorschach Indices (Exner, 2003) viz;

x Perceptual Thinking Index (PTI): Difficulties in perceptual accuracy and

thinking consists of cognitive triad disturbances including information
process, cognitive mediation and ideation of concepts that can have a
pervasive impact througKRXW DQ LQGLYLGXDO·V SHUVRQDOLW\ VWUXFWXUH FXW RII
score 4 & above).
x Depression Index (DEPI): Measure of sadness or depression clinical
features, identify individuals who may be emotionally distraught, cognitively
pessimistic, lethargic, or self-defeating (cut off score 5 & above).
x Coping Deficit Index (CDI): Compute the capacity for control and tolerance
for stress as well as predisposed to functional disorganization, especially in
unusual stress situations or those in which there are expectations for social
/interpersonal effectiveness (cut off score 4 & above)
x Suicide Potential Constellation (S-CON): Reckon vulnerability of an
individual towards Deliberately Self-Harm (DSH) (cut off score 8 & above).
2550

x Hyper Vigilant Index (HVI): Estimate the mistrusting attitude towards

environment / safe guarding the individXDO·V SHUVRQDO LQWHJULW\ FXW RII VFRUH
4 & above).
x Obsessive Style Index (OBS): Signifies a preoccupation with perfectionism,
which if carried to excess can become a pathological abnormality.
x Egocentricity Index: Estimate self-concern of an individual. It can be
considered as a rough measure of self-attending behaviour. The normal
range of the Index for adults is .33 to .45, a below score indicates self-
esteem is lower than the other same aged groups & a above score indicates
an excessive involvement with the self by an individual.
x Isolation Index: This index is used to elicit the interpersonal perception of
an individual by gauging the social involvement. When this index falls
between .26 & .32 it indicates the individual is less active in social
interactions than might be expected and an above score of .32 indicates
social cut off.
x Intellectualization Index: Conceptual thinking can be sometimes used by an
individual for defensive purpose which can be termed as Intellectualization,
which is a form of denial. If the value of this index falls between 4 and 6,
then the person is adapting a distorted form of conceptual thinking that
assists to deny the true impact of a situation, if the value exceeds 6 then
this adaptation might have become a major defensive tactic for that
individual.

Sample

In this cross-sectional study, males diagnosed with Schizophrenia and

Substance-induced psychosis as per ICD-10 were targeted, non-probability
purposive sampling method was used to collect data from an outpatient
department of Psychiatric Hospital. Total sample size (N=90) consisting of 30
normal males, 30 Schizophrenic males and 30 substance-induced psychotic
males between 30 and 50 years with secondary education at least up to 10th
standard were included. Inclusion criteria for normal male group was a below
score of 4 in General Health Questionnaire (GHQ-28). All individuals who
possessed knowledge about the Rorschach Inkblot Test (RIT) or other types of
Inkblot Tests were excluded.

Tools

x General Health Questionnaire (GHQ-28) Goldberg and Hiller (1979):

Administrated to screen out normal group having the potential mental
illness morbidity. GHQ-28 consists of total 28 items with four responses,
which can be scored using binary scoring (0,0,1,1). The cut off score for
GHQ-28 is a score higher than 4, which is highly sensitive for the person to
have potential psychiatric / mental illness morbidity. Validity in Indian
context is .94 (Goldberg, et al.; 1997).
x Rorschach Inkblot Test: (Rorschach,1942): The test was developed by
Hermann Rorschach in 1921 as a Psychodiagnostic. Rorschach test
consists of 10 cards, on each of which is one bisymmetrical inkblot. Five are
achromatic cards, three cards are chromatic and two cards are semi-
 2551

chromatic with various shades. The cards were presented to the subject one
at a time and in prescribed sequence, responses and enquiry part were
noted in verbatim for further analysis.
x The Rorschach - A Comprehensive System: (Exner, 2003): was utilized for
interpretation and scoring. Reliability of Exner Scoring System is reported
between 0.85 to 0.94 (Mattlar, 2004) along with a high validity (Weiner,
1966).

Statistical analysis

Descriptive statistics, Chi-Square test have been used for analysing data and
hypothesis testing. Hypothesis testing conducted in two-tailed at a significant
OHYHO Â The statistical package for social sciences (SPSS), version 17.0 was
used for the analysis of the data.

Results

Table 1 reveals the chi-square values of frequencies of various Rorschach Indices

among the three groups. Significant difference in frequency and percentage was
elicited among the groups based on (PTI) Perceptual Thinking Index (Ø2(2) =30.39,
p<.01), (CDI) Coping Deficit Index (Ø2(2) =4.608, p<.05), Egocentricity Index (Ø2(2)
=19.289, p<.01) and Isolation Index (Ø2(2) =9.145, p<.05). Hence, the null
hypothesis H0 is rejected. There is significant difference between normal,
schizophrenic and substance induced psychotic males based on Rorschach
Indices.

Table 1
Rorschach Indices among normal, schizophrenic and substance induced
psychotic male groups

Groups
Normal males Substance induced Schizophrenic males Chi-
Indices Sig
N=30 psychotic males (N=30) N=30 square
Frequency Percentage Frequency Percentage Frequency Percentage
Present 0 0 0 0 13 43.33
PTI 30.39 .000*
Absent 30 100 30 100 17 56.67
Present 05 16.67 08 26.67 10 33.33
DEPI 2.21
Absent 25 83.33 22 73.33 20 66.67 .33
Present 07 23.33 15 50 18 60
CDI 4.60 .04**
Absent 23 76.67 15 50 12 40
Present 0 0 0 0 0 0
S-CON -- --
Absent 30 100 30 100 30 100
Present 2 6.67 2 6.67 4 13.33
HVI 1.09 .578
Absent 28 93.33 28 93.33 26 86.67
Present 0 0 0 0 0 0
OBS -- --
Absent 30 100 30 100 30 100
Egocentricity Low 06 20 18 60 21 70
Index Normal 12 40 08 26.67 07 23.33 19.28 .000*
High 12 40 04 13.33 02 6.67
Isolation Normal 27 90 17 56.67 20 66.67
Index Less
02 6.67 06 20 01 3.33
Active 9.14 .035**
Socially
01 3.33 07 23.33 09 30
cut off
 2552

Intellectual Normal 20 66.67 19 63.33 21 70

Index Distorted
06 20 05 16.67 03 10
Denial 3.21 .503
Defensive
04 13.33 06 20 06 20
denial
p < .01*, p < .05**

Discussion

The findings of present study were consistent with previous research conclusions
pertaining to Rorschach Ink Blot Test (RIT). The disparity in brain physiology and
neuro transmitters can predominantly justify the significant difference in
cognitive, functional as well as coping strategy domains among primary psychotic
and substance induced psychotic patients (Stahl, 2013). Even though behavioural
indications including hallucinatory behaviour shares certain similarities between
both groups, the nature of critical and enduring transformations found in brain
anatomy differs from each group (Kalivas & Volkow, 2005). Perceptual thinking,
encompassing cognitive triads of information processing, cognitive mediation and
ideation often gets pathologically distraught among patients with thought
disorders (Casey & Kelly 2007). As in the case of primary psychotic patients like
schizophrenic, a serious deficit in perceptual thought process is not warned in
substance induced psychotic patients (Hall, 1980). The dysfunctional intensity of
neurotransmitters like dopamine and serotonin on Dorsolateral prefrontal cortex
which accounts for cognitive dysfunctions differs from schizophrenic and
substance induced psychotic patients (Stahl, 2013). Egocentric Enormous studies
concluded lower self-esteem and self-worth in psychotic as well as substance
abusers (Mary, 2010) which in turns promote dysfunctional interpersonal
relationships. This can be addressed by the poor reality checking by an individual
(Exner, 2003). These loosened reality checking can be a precursor for delusional
like symptoms and poor modulation of emotions among these individuals. The
lower self-esteem as well as self-worth can contribute an individual to react
inappropriately and in a disorganised manner in complex situations (Exner, 2003
& Mary, 2010). The negative self-worth aroused due to the consideration of self as
less favourable than others and the unrealistic interpersonal perceptions, often
nurture coping deficits among these groups (Donald & Muriel, 1974). Several
researches concluded that substance abusers have poor coping skills and is
significantly correlated with low self- concept (Verma & Misra 2002). Impulsivity
and reward seeking have a significant biological basis in the medial prefrontal
cortex (mPFC) and lateral prefrontal cortex (lPFC). The former plays the key role in
reward processing, attention and drug reinstatement; while the later in decision-
making and behavioural inhibition (Jennifer et., 2011). Whereas the key
dopamine pathways responsible for positive and negative symptoms in
schizophrenia are mesolimbic and mesocortical respectively. It can be concluded
that the difference in brain circuit anatomy and role of neurotransmitters as well
as unique personalities of individual can be accounted for these dissimilarities
among groups.

The study was envisioned to elicit the variance in the Rorschach indices among
normal, schizophrenic and substance induced psychotic males and the results
revealed significant disparity in perceptual thought, coping strategies, self-esteem
and interpersonal perception among the groups. The verdicts of present study can
 2553

be used retrospectively for the clarity as well as the confirmatory of psychotic

disorders, differential diagnosis and its efficient management using
psychotherapy by mental health professionals. Moreover, these findings can be
adopted for the precise therapeutic formulations for primary and substance
induced psychotic disorders.

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