Original article The Rorschach test and Gilles de la Tourette’s syndrome: A pilot case–control study Umberto Balottin b , Maura Rossi b , Giorgio Rossi b , Lucia Vigano ` b , Marta Nanti a , Silvia Salini c , Giovanni Lanzi b , Cristiano Termine a, * a Child Neuropsychiatry Unit, Department of Clinical and Biological Sciences, University of Insubria, Varese, Piazza Biroldi 19, 21100 Varese, Italy b Department of Child Neurology and Psychiatry, IRCCS ‘‘C. Mondino Foundation”, University of Pavia, Pavia, Italy c Statistics and Mathematic Unit, DEPA, University of Milan, Milan, Italy Received 25 March 2008; received in revised form 14 September 2008; accepted 19 October 2008 Abstract Background: To date only three studies, all lacking a control group, have investigated the personality style underlying tic disor- ders or Tourette’s syndrome (TS), using the projective Rorschach test. Despite the recent controversy about its proper use in clinical practice and research, the Rorschach test may be useful to explore personality organization in TS. The research hypothesis under investigation in this exploratory study was that young TS patients exhibit a peculiar personality organization, with significantly increased indicators of poor emotional control, aggression, anxiety and depression, on the Rorschach test, compared to healthy con- trols. Methods: We analyed the Rorschach protocols of 17 newly diagnosed paediatric TS patients and 17 age- and sex-matched healthy controls. Results: Compared with the controls young TS patients recorded significantly lower mean percentages of F and F+ responses and a significantly higher number of FM and FC responses, thus showing reduced control of emotions and difficulty in integrating aggressivity. Furthermore, associations emerged between comorbidity with ADHD and increased emotional instabil- ity and between severity of tics and of OCD and a pattern of emotional hyper-control and application of rigid defensive mecha- nisms. Conclusions: These results seem to confirm the existence of a peculiar personality style in young TS patients and may have important implications, both pathogenetic and therapeutic. Ó 2008 Elsevier B.V. All rights reserved. Keywords: Tourette’s syndrome; Psychopathology; Rorschach test 1. Introduction Tourette’s syndrome (TS) is a childhood-onset neuro- psychiatric disorder characterised by the presence of multiple motor tics plus one or more vocal tics [1]. It is often associated with a broad spectrum of psychiatric comorbid conditions, such as obsessive–compulsive dis- order and other anxiety disorders, mood and personality disorders, self-destructive behaviour and attention defi- cit hyperactivity disorder [2–4]. In the last years psycho- pathological, behavioural and personality associated disorders in paediatric patients with TS have been increasingly recognized, using standardized instruments [5–10]. As regards personality pathology it has been noted that children with TS exhibit increased depres- sion, anxiety, tension, and excessive worry [5]. Several authors have described the main features of personality organization underlying tic disorders in children, such as emotional immaturity or ambivalence, underlining, in particular, the marked presence of repressed, aggressive tendencies in emotional, often unstable children [11]. 0387-7604/$ - see front matter Ó 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.braindev.2008.10.003 * Corresponding author. Tel.: +39 0332 299410; fax: +39 0332 299381. E-mail addresses: cristiano.termine@uninsubria.it, romaura@ libero.it (C. Termine). www.elsevier.com/locate/braindev Brain & Development 31 (2009) 657–665