Yonago Acta medica 2010;53:53–58

Verification of Rorschach Indicators of Sexual Abuse
Kiyomi Kikuchi*†, Yoshito Kikuchi*, Yuriko Horikawa† and Kohei Horikawa†*Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences,
Yonago 683-8503 and †Communauté Vent et Arc Nozoe Hospital, Kurume 830-0053, Japan

We attempted to find Rorschach indicators of sexual abuse. In the present study, we investigated the propriety of 4 indicators that we reported in 2001 and more precise indicatorsof sexual abuse through statistical analysis of Rorschach records of 108 female psychiatricpatients with a history of sexual abuse and 48 female psychiatric patients without it. We
defined the sex locations on the Rorschach cards and took notice of the particular responses for them. Eighty-two of the 108 (76%) sexually abused patients and 1 of the 48 (2%) nonabused patients gave the sex response, inanimate movement response (m) or m tendency forthe sex locations. Aggression and hostile responses were scored by Mürstein’s Rorschachhostility scale; the scores for the abused was 19.99 ± 15.96 and for the non-abused, 12.37 ±8.57. Number of form-color (FC) response equal to or lower than the total of color-form(CF) response and pure color (C) response (FC ≤ CF + C) was shown in 95 of the 108 (88%)
abused and 30 of the 48 (63%) non-abused. Among these 3 items, the differences between
the 2 groups were remarkably significant (P < 0.001). It becomes obvious that the 3 indicators as shown below are valid for finding sexual abuse histories for differential diagnosis:i) a host of aggression and hostile content; ii) loss of control in color responses, for example
FC ≤ CF + C; and iii) the sex responses, m or m tendency for sex locations.
Key words: psychiatry; Rorschach test; sexual abuse; statistical study

In Japan as well as in other countries, the reporting of child abuse and sexual violence has been
increasing. As Maruta pointed out, many women
who have experienced sexual abuse visit psychiatric hospitals with various symptoms (Maruta,
1995). However, the trauma of sexual abuse isrooted deeply in their personalities and significantly involved in their symptoms, and they can hardly
relate their pain to their doctors or therapists not
only in the first interview but also during the treatment process. It is a matter of everyday occurrence
that they have entirely forgotten the sexual abuse
itself. For clinical psychologists, one of the mostimportant responsibilities is to help patients understand their buried emotions or behavior tendencies
using projective psychological testing. We have
tried to find Rorschach indicators of sexual abuseso that these indicators may help sexually abused
patients speak freely and express the harm that has
been done to them in order to cope therapeutically.
Among preceding studies using projective psychological testing such as the Rorschach test, there
were some excellent case studies (Hurt, 1991;
Ornduff, 1997), research that attempted to understand the pattern of behavior and/or personal
relationship of sexually abused patients (Cerny,Abbreviations: C, pure color response; CF, color-form response; dr, rare detail response; FC, form-color response; FC ≤CF + C, number of FC equal to or lower than the total of CF and C; Fc, form-texture response; ICD-10, The International
Statistical Classification of Diseases and Related Health Problems 10th Revision; m, inanimate movement response;
shading %, percentage of the shading responses in all response

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K. Kikuchi et al.

Least serious [8]1990; Leifer et al., 1991; Briere and Ellott, 1993;
Clinton and Jenkins-Moore, 1994; Ornduff et al.,
1994, 1996, 1997, 1999) and research for finding
Rorschach indicators of sexual abuse for differential diagnosis (Sanders, 1991; Kamphuis et al.,
2000; Leavitt, 2000). Though Leavitt derived 8
indicators of sexual abuse only from the content ofRorschach responses (Leavitt, 2000), Kikuchi et al.
derived 4 indicators from the content, determinant
and location of Rorschach responses comparing
14 sexually abused females with 14 non-abused females and 14 non-abused males as in the following:i) a host of aggression and hostile content, for example, a person who has been stabbed with a knife,a person who has been crushed to death, a person
whose body has been pulled apart with blood being
scattered and dripping from the internal organs,and so on; ii) a loss of control in color responses,
for example number of form-color response (FC)equal to or lower than the total of color-form response (CF) and pure color response (C) (FC ≤CF + C); iii) particular responses on certain locations where one could see the female sexual organ;
and iv) fewer shading responses, especially formtexture response (Fc) (Kikuchi et al., 2001, 2002).
In the present study, we examined larger numbersof Rorschach records of sexually abused femalesby the statistical method. Comparing Rorschachrecords of abused females with those of non-abusedfemales we investigated not only the propriety of
our four indicators but also more precise Rorschachindicators of sexual abuse.

Serious [22]Very serious [78]Sexually abused group [108]Fig. 1. Seriousness of sexual abuse for the 108 patientsof the sexually abused group we categorized into the very
serious, serious and least serious subgroups according to
Russell’s classification (1984). [ ], number of patients.

ousness of sexual abuse into the following 3 groups(Russell, 1984): i) Very Serious Sexual Abuse,including experiences ranging from forced penilevaginal penetration to nonforceful attempted fellatio, cunnilingus, analingus and anal intercourse; ii)
Serious Sexual Abuse, including experiences ranging from forced digital penetration of the vagina to
non-forceful attempted breast contact (unclothed)or simulated intercourse; and iii) Least Serious
Sexual Abuse, including experiences ranging fromforced kissing, intentional sexual touching of the
respondent’s buttocks, thigh, leg or other body part,
including contact with clothed breasts or genitals,
to attempts at any of the same acts without the useof force. In the analysis with Russell’s classification, the abused group consisted of 78 very serious,
22 serious and 8 least serious patients (Fig. 1). The
International Statistical Classification of Diseases
and Related Health Problems 10th Revision (ICD10) (World Heath Organization, 2007) given by
the psychiatrists in charge for the abused grouprevealed 6.5% as schizophrenia, schizotypal anddelusional disorders (F2), 15.7% as mood (affective)
disorder (F3), 49.1% as neurotic, stress-related andsomatoform disorder (F4), 8.3% as behavioral syndromes associated with physiological disturbancesand physical factors (F5), 15.7% as disorders ofadult personality and behaviour (F6) and 4.9% asbehavioral and emotional disorders with onset usually occurring in childhood and adolescence (F9).

Subjects and Methods
Patients
The subjects were 156 Japanese female psychiatric outpatients and inpatients at Nozoe Hospital,
Kurume City, Japan. One hundred and eight had ahistory of sexual abuse (abused group) and 48 had
no history (non-abused control group), and who
had been administered the Rorschach test as a partof a standard psychological test battery ordered forevaluative purposes. Russell categorized the seri54

Rorschach indicators of sexual abuse

RorschachI mage Card

I–III

IV–VI

VII–X

Fig. 2. Sex locations ( ). We identified the sex locations as the areas where one could see the female sexual organ.

The classification for the control group proved 6.3%
as F2, 31.3% as F3, 35.4% as F4, 4.2% as F5 and22.9% as F6. ICD-based scatter analysis proved nosignificant differences between the 2 groups. Subject age ranged from 14 to 56 years with a meanof 27.9 ± 9.4 for the abused group, and from 15 to51 years with a mean of 29.1 ± 8.1 for the control
group. Age-based Student’s t-test showed no significant differences between the 2 groups.

Table 1. Samples of m and m tendency responses for sex locations*
Card
II

IV
VI

Scoring system
All Rorschach images in the present study wereadministrated and scored by the first author using
Klopfer’s system. The degree of aggression andhostile content was scored by Mürstein’s Rorschachhostility scale (Mürstein, 1956). We identified thesex locations (Fig. 2) as the areas where one could
see the female sexual organ: the lower middle redof Card II; the upper middle rare detail response(dr) on Card IV; the lower middle dr on Card VII(Rapaport et al., 1968); the lower middle dr on
Card VI (Klopfer and Kelley, 1942) and the lower

VII

VIII

Response
Someone who has been crushed to death.
Water flowing into a lake.
Copulation.
A heart is beating fast.
Something is torn and blood has been scatteredaround.
Rape is being attempted.
A talisman is glued to a door so that it can’t be
opened.
A pinwheel is turning round and round.
A door seems to be open.
Menstrual blood is flowing.
An intense fire is blazing up.
Both feet are bound.
A rabbit’s is twitching its nose convulsively.
The center point of a revolving pinwheel.
The water in the lake is flowing out.
A tornado bounds up from here.
Lips are mumbling something.
It is crowded here.

m, inanimate movement response.
* We identified sex locations as areas where one could see
the female sexual organ (Fig. 2).

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K. Kikuchi et al.

Table 2. Rorschach scores†
Control group [48]RHS‡
Response
Percentage of form response out of all responses
Human movement response
Animal movement response
Inanimate movement response
Form-texture response
Percentage of shading response in all response
Form-color response (FC)Color-form response (CF)Pure color response (C)C§
Achromatic response
Percentage of animal response in all response
Percentage of human response in all response

12.38
23.92
47.67
3.66
2.43
1.02
0.64
4.48
1.66
2.04
0.15
2.62
1.20
42.58
34.24

± 8.57± 11.32± 17.12± 2.26± 1.69± 1.12± 0.87± 5.65± 1.68± 1.96± 0.46± 2.17± 1.00± 11.99± 55.38

Sexually abused group [108]
19.90
23.31
50.18
3.82
2.14
1.44
0.44
3.91
0.9
2.74
0.19
3.13
1.47
38.09
28.28

± 15.96***± 12.36± 49.70± 3.05± 2.10± 1.69± 0.71± 4.71± 1.32**± 2.06*± 0.58± 2.30± 1.26± 14.85± 14.11

Shown are mean ± SD.
[ ], number of patients.
* P < 0.05; **P < 0.005; ***P < 0.001.
† Rorschach protocols were scored using Klopfer’s system.
‡ Mürstein’s Rorschach hostility scale (RHS) was used to score the degree of aggression and hostile content.
FC + (2 × CF) + (3 × C)
§ C=
		
2

group. FC ≤ CF + C was shown in 95 of the 108(88%) abused and 30 of the 48 (63%) non-abused.
Eighty-two of the 108 (76%) abused and 1 of the48 (2%) non-abused gave the sex responses, m or mtendency for the sex locations. The differences inthese 3 items were considered remarkably significant (P < 0.001).
For FC and CF in the FC ≤ CF + C equation,
there were very significant (P < 0.005) or significant differences (P < 0.05). However, other items
including the percentage of shading responses in all
response (shading %) and FC showed no significant
differences.

middle dr on Card VIII (Kikuchi et al., 2001). We
also took notice of inanimate movement response(m) or m tendency, which is interpreted as evidenceof fear and tension, for the sex locations (Table 1)
and the sex responses for the sex locations given by
flashbacks from patients’ past trauma.
Statistical analysis
All values were expressed as mean ± SD. Statistic
probabilities were calculated with Student’s t-test between the Rorschach responses of the 2 groups. Also
the statistical method was used to compare the differences in the ratio of patients who showed a tendency
toward FC ≤ CF + C and the ratio of patients who
gave m, m tendency or a sex responses for any sex
location. A P value of less than 0.05 was consideredsignificant.

Discussion
In the present study, it becomes obvious that thefollowing 3 indicators are valid for finding sexual
abuse histories for differential diagnosis: i) a hostof aggression and hostile content; ii) loss of control in color responses, for example FC ≤ CF + C;iii) the sex responses, m or m tendency for the sex
locations (Note: In our previous study in 2001, we
expressed this as particular responses on locations

Results
As shown in Tables 2 and 3, the mean for theRorschach hostility scale for the abused groupwas 19.99 ± 15.96 and 12.37 ± 8.57 for the control
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Rorschach indicators of sexual abuse

Table 3. Number of patients who gave FC ≤ CF + C and m, m tendency† or a sex response for sex
locationsControl group [48]Responses on the sex locations
FC ≤ CF + C

Sexually abused group [108]1 ( 2%)
30 (63%)

82
95

(76%)
(88%)

P
0.001
0.001

C, pure color response; CF, color-form response; FC, form-color response; FC ≤ CF + C, number of FC equal to or
lower than the total of CF and C; m, inanimate movement response.
[ ], number of patients.
† We identified sex locations as areas where one could see the female sexual organ (Fig. 2). We took notice of m or mtendency for the sex locations and sex responses for sex locations given by the flashback of their past trauma.

combat veterans with Post Traumatic Stress Disorder had higher frequencies of blood and anatomy
responses (van der Kolk and Ducey, 1989). Ames
et al. also reported that aged people with dementia
gave many sex and anatomy responses (Ames et al.,1954). Likewise concerning FC ≤ CF + C, people
with bipolar affective disorder (Okabe, 1972) andborderline personality disorder (Athey et al., 1980)
showed this tendency.
The Rorschach sex location is an original concept of ours and, as a result, we were able to findthe 3rd indicator. Though Saunders examined thesex response of sexually abused and non-abused
patients, she could find no statistically significant
differences (Saunders, 1991). For sex responses,
the indicator, m or m tendency for the sex locations, is definitely useful because it was shown by
only 2% of the non-abused group. We can say that
almost all patients who give this indicator have history of sexual abuse; however, all sexually abused
patients do not show this indicator. Twenty-fourpercent of the abused did not give this indicator
at all in the present study. This may suggest that
there are some subgroups in the abused group. The

where one could see the female sexual organ).
Though the simple means of shading % and FC
for the abused group were lower than those for thecontrol group, there were no statistically significant
differences. To exhibit more precise Rorschach indicators of sexual abuse, we omitted the 4th indicator, fewer shading responses, especially FC.
Since subjects of both groups were female
psychiatric patients, these indicators become mostuseful in discriminating sexual abuse from otherproblems in psychiatric settings. As Takahashi and
Kitamura reported, psychiatric patients showed
higher levels of FC ≤ CF + C than normal persons(Takahashi and Kitamura, 1981), so our indicatorsof sexual abuse may be useful also in other counseling or consultation centers.
The above 3 are useful indicators provided
they are fortified with statistical analysis. However,aggression and hostile contents were given not only
by sexually abused patients. Frieswyk and Colson
reported that borderline personality disorder patients frequently gave aggressive responses on theRorschach test (Frieswyk and Colson, 1980), whilevan der Kolk and Ducey reported that Vietnam
Rorschach indicator

Russell’s classification
Very serious

Indicator of sex location present [82][54]

Indicator of sex location absent [26]Serious Least serious
[20]

[24]

[8]
[2]

Fig.3. Seriousness of sexual abuse analyzed with Russell’s classification (Russell, 1984) for 82 patients who gave an indicator of the sex location and 26 who gave no indicator. [ ], number of patients.

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K. Kikuchi et al.

ICD-10 for patients who gave this indicator showed
6.1% as F2, 15.9% as F3, 46.4% as F4, 9.8% as
F5, 18.3% as F6 and 3.7% as F9. The ICD-10 for
those who did not give it showed 7.7% as F2, 15.4%
as F3, 57.7% as F4, 3.8% as F5, 7.7% as F6 and7.7% as F9. ICD-10-based scatter analysis proved
no significant differences between the 2 groups.
However, we observed that the patients who did
not show this indicator had more serious history ofabuse (Fig. 3). Further investigation is needed tofind factors of sexually abused females who do notgive this indicator. Combining the 3 indicators is amore useful tool than using only one indicator, because every indicator is not perfect and should be
supported by as many parameters as possible.

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Received March 29, 2010; accepted May 10, 2010
Corresponding author: Kiyomi Kikuchi, MA, CP

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