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Psychometric properties of the Borderline Symptom List (BSL).

BACKGROUND: The Borderline Symptom List (BSL) was developed as a self-rating instrument to specifically quantify borderline-typical symptomatology. The items are based on the criteria of the DSM-IV, the Diagnostic Interview for Borderline Personality Disorder - revised version, the opinions of clinical experts and borderline patients. The psychometric properties and validity of the BSL have been investigated in several studies. SAMPLING AND METHODS: A total of 380 borderline patients and 204 healthy controls scored the items. A factor analysis of the BSL items suggests the following subscales: 'self-perception', 'affect regulation', 'self-destruction', 'dysphoria', 'loneliness', 'intrusions' and 'hostility'. RESULTS: The internal reliability as well as the test-retest reliability within 1 week are high. Different aspects of validity (e.g. comparison between groups) provide favorable results. Pre-post comparisons after 3 months of dialectical behavioral treatment reveal a significant reduction of the total score and of 5 of the 7 subscales. CONCLUSIONS: This indicates that the BSL is sensitive to therapeutically induced change of borderline-typical impairment.

Adolescent↗

Comparison of clinical characteristics in good and poor insight obsessive-compulsive disorder.

Beginning with DSM-III-R, the condition of an intact insight towards obsessive-compulsive symptoms, which was essential for the classical definition of obsessivecompulsive neurosis, has been removed, permitting inclusion of cases with poor insight. A total of 94 cases who met DSM-III-R criteria for obsessive-compulsive disorder were included in this study. The Structured Clinical Interview for DSM-III-R (SCID-P), YaleBrown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression (HRSD), Hamilton Rating Scale for Anxiety (HRSA), and State-Trait Anxiety Inventory (STAI) were administered to each patient. Two subgroups determined by DSM-IV item "poor insight" were compared for demographic variables and the scores obtained on the scales. Scores on the Y-BOCS, HRSA, HRSD and STAI-state were significantly higher in the poor insight group. Current and past major depression were also more frequent. Among personality disorders (PDs), avoidant PD was more common in the good insight group and borderline and narcissistic PDs were more common in the poor insight group. HRSA, HRSD, and STAI-state scores had weak to moderate but significant correlations with insight as defined by the item 11 of Y-BOCS. Findings are discussed in view of previous reports.

Adult↗

Obsessive compulsive disorder: comorbid conditions.

According to DSM-IV criteria, obsessive compulsive disorder (OCD) is an anxiety disorder that is characterized by recurrent, intrusive images or thoughts and/or stereotyped, repetitive behaviors that are associated with marked distress, anxiety, or psychosocial impairment. The differential diagnosis of OCD can be quite difficult since OCD symptomatology can occur as either primary or secondary phenomena. Comorbid depression or personality disorder is not uncommon in patients with primary OCD. Other comorbid conditions that occur with OCD can be divided into three major groups based on core features: (1) disorders of altered risk assessment; (2) incompleteness/habit-spectrum disorders; and (3) psychotic spectrum disorders. Such a categorization of core dimensions and comorbid conditions may prove useful in identifying distinct OCD subtypes that share underlying neurobiological or treatment response characteristics.

Adult↗

Comparison of clinical characteristics in trichotillomania and obsessive-compulsive disorder.

Fifteen patients with trichotillomania (TM) and 25 patients with obsessive-compulsive disorder (OCD) were studied. All patients were evaluated using the structured clinical interview for DSM-III-R (SCID-P). TM and OCD patients were compared with respect to demographic variables and the scores obtained from the various scales. The TM group had a greater percentage of women and showed an earlier age at onset. There was no significant difference for depression and anxiety assessed with the STAI, HRSA, and HRSD between the groups. Compared to OCD patients, TM patients had significantly lower scores on the Y-BOCS. The two groups were similar on the measures of resistance to and control of the hair pulling/compulsive symptoms. We found significantly higher incidence of anxiety and depressive disorders, and Axis II personality disorders for OCD patients. These findings are discussed in the view of results from earlier reports.

Adolescent↗

Reliability and validity of a scale to measure change in persons with compulsive buying.

A new scale to measure severity and change in persons with compulsive buying is described. Data were gathered during an open-label study in which compulsive buyers were treated with fluvoxamine, a serotonin reuptake inhibitor. The instrument showed good-to-excellent interrater reliability and high internal consistency. Its 10 separate items showed at least moderate correlations with the total score. The instrument was also sensitive to clinical change and correlated highly with other measures of illness severity. We conclude that this new instrument is both reliable and valid in measuring severity and change in persons with compulsive buying.

Adult↗

Seasonal differences in psychopathology of male suicide completers.

Suicide is known to vary according to season, with peaks in the spring and troughs in the winter. The presence of psychopathology is a significant predictor of suicidality, and it is possible that the seasonal variation of suicide completion may be related to seasonality in the manifestation of psychiatric disorders common to suicide completers. In the current study, we evaluated 115 French-Canadian male suicide completers from the Greater Montreal Area for DSM-IV psychiatric disorders using proxy-based diagnostic interviews. Subjects were assessed for seasonal differences in the prevalence of DSM-IV psychiatric diagnoses just before their deaths. Diagnoses of major depressive disorder (MDD) without comorbid cluster B personality disorders, and schizophrenia were differently distributed between seasons. Most (63.4%) subjects with MDD committed suicide in the spring/summer (P =.038). However, closer examination revealed that depressed suicides with comorbid cluster B personality disorders did not show seasonality, while 83.3% of depressed suicides without comorbid cluster B personality disorders committed suicide in the spring/summer (P =.019). 87.5% of those suicides with schizophrenia committed suicide in the fall/winter (P =.026), and the only suicide with schizophrenia who died in the spring/summer was also the only one without positive symptomology. Our study is limited to male suicide completers, and results should not be generalized to women. We conclude that seasonal variation in suicide manifests itself differently in patients with different psychopathology. These findings indicate that assessment of suicide risk may need to include consideration of possible seasonal effects, depending on psychopathology.

Adult↗

A symptom profile of patients with multiple personalities, including MMPI results.

Patients with multiple personalities are excellent hypnotic subjects, a capability demonstrated both clinically and on a standard hypnotizability test. They tend to experience a plethora of symptoms associated with anxiety states, hysteria, obsessional neuroses, phobic states, depression and mania, schizophrenia, alcoholism, sociopathy, and hyperactivity--although there are exceptions to this profile. Both males and females suffer from this disability, and an MMPI profile for female multiples is described.

Adult↗

Temperament profiles in physicians, lawyers, managers, industrialists, architects, journalists, and artists: a study in psychiatric outpatients.

BACKGROUND: With the possible exception of cyclothymia in artists, there is a paucity of data in the literature on the temperament in different professions. METHODS: For this exploratory study, we sought to generate preliminary data on temperaments among psychiatric outpatients, including physicians (n=41), lawyers (n=30), managers and executives (n=35), industrialists (n=48), architects (n=27), journalists (n=34), and a mixed group of artists (n=48). They were compared with age, sex, social class, and affective disorder matched outpatients outside of these professions, drawn from the same clinical settings to serve as our Comparison Group (CG, n=120). We used an interview version of the Akiskal-Mallya criteria for temperaments. We finally used the DSM-III-R obsessive compulsive personality (OC traits). RESULTS: Compared with the CG, lawyers and physicians had high rates of dysthymic temperament and OC traits. Managers, like lawyers and doctors, had high rates on OC traits but were different in being very low on cyclothymic and twice as hyperthymic than the CG was. Industrialists, who, by definition, were self-made, had even higher rates of hyperthymic traits. Both architects and artists seemed to have benefited from being cyclothymic (3-4 times higher than CG's); interestingly, architects had higher levels of OC traits, and artists were less obsessional than the CG was. Overall, among managers/executives and lawyers, 41% met criteria for affective temperaments, whereas the equivalent rate among the remainder was 77%. LIMITATION: Given that this is a chart review of existing clinical records, it was not possible to be blind to the profession of the patients. A mixed group of artists may have obscured differences among artists from different domains of art (e.g., poets vs. performing artists), and the same can be said of physicians (e.g., internists vs. surgeons). A disclaimer would be appropriate: Ours is not a study on eminence in the different professions but on the temperament and personality profiles that distinguish among them. CONCLUSIONS: Despite the foregoing limitations and overlapping attributes in the different professions, they nonetheless emerged as having distinct temperamental and personality profiles. Dysthymic and obsessional attributes are notable in lawyers and physicians. We confirm the role of cyclothymia in artists and architects. The role of the hyperthymic temperament in managers, self-made industrialists, and journalists, to the best of our knowledge, is being reported for the first time. The role of cyclothymic and hyperthymic temperaments appears to be moderated by obsessional traits across the entire professional realm examined. In particular, artists' creative imagination appears "liberated" by low levels of OC traits, whereas among architects, relatively high levels of OC traits seem to contribute to the execution of their work. More tentatively, judging from the overall levels of affective temperaments in the remaining professions, on average, more of the managers/executives than self-made industrialists could be described as "colder" in temperament, and more of the physicians "warmer" than lawyers are. Journalists, as a group, appeared to possess the broadest representation of affective temperaments. The foregoing conclusions must be regarded as tentative, even hypothetical, in need of verification among professionals without major psychiatric disorders. Nonetheless, temperament profiles among psychiatrically ill professionals in the seven professional realms studies can help predict how they relate to their doctors, family members, colleagues, coworkers, and clients/patients. Such knowledge, in turn, can help the therapeutic process.

Administrative Personnel↗

Depressive disorders and religious conversions.

The sparse psychiatric literature concerning religious conversions is reviewed. Four case histories of diagnosed depressive illness followed by religious conversion are presented. In two obsessive-compulsive patients, the religious experience failed to resolve the depression, and both ended in suicide. Two hysterical personalities had a resolution of depressive symptoms following the religious experience. The authors suggest that religious conversion dynamically strengthens repression in hysterical persons, but in some cases fails to resolve obsessive isolation of affect and ambivalence.

Adult↗

Personality, sexual adjustment, and brain lesions in patients with conversion symptoms.

To clarify the interrelationships of conversion symptoms, hysterical personality, sexual adjustment, and cerebral organic disorders the authors studied 89 patients with classic motor conversion symptoms (group L) and compared a subgroup of 24 of these patients (group H) with 24 matched control patients (group C). They found hysterical personality in 19% of group L, 21% of group H, and none of group C and passive-immature-dependent personality in 19% of group L, 21% of group H, and none of group C. Forty-eight percent of group L, 50% of group H, and 58% of group C had some cerebral disorder. Patients with conversion symptoms who also had hysterical and passive-immature-dependent personalities were especially likely to have sexual abnormalities.

Adult↗

Gender differences in obsessive compulsive disorder.

We investigated gender differences in 219 patients with obsessive compulsive disorder consecutively referred to a centre specialising in the behavioural treatment of anxiety disorders. Females had a later mean onset-age, and were more likely to be married and to have children; they were also marginally more likely to have a past history of an eating disorder or depression, while males were more likely to have a history of anxious or meticulous personality traits. Family loading for psychiatric disorders did not differ significantly between the sexes. The results are discussed in the context of the epidemiological literature on gender differences in OCD.

Adolescent↗

Neuroticism and ABO blood types.

In an attempt to interpret previous findings of a higher incidence of blood phenotype A and a lower incidence of blood phenotype O in patients with either obsessive-compulsive neurosis or hysteria, it was hypothesized that phenotype O might be associated with personality traits that render the individual less prone to developing neurotic symptoms. To test the validity of this hypothesis Form A of the Eysenck Personality Inventory was administered to 600 normal individuals and their ABO phenotype was determined. Our results failed to support the above hypothesis, because the blood phenotype of the participants did not differentiate them with respect to their mean neuroticism score. The possibility of an association between ABO blood phenotypes and other, more specific, personality traits, such as hysteroid or obsessional is presently under investigation.

ABO Blood-Group System↗

Obsessive-compulsive symptoms and the family.

A questionnaire study of 98 family members of individuals with obsessive-compulsive symptoms revealed that 60% of the family members were involved to some extent in rituals with the affected family member. Nearly all family members reported at least some degree of interference in their lives. Information was also gathered about the sort of rituals in which members were involved, how they responded to the demands of the affected relative to engage in the rituals, their beliefs and knowledge about compliance, and the degree to which the rituals interfered in their lives. The study highlights the possible need for support, advice, and education for family members of persons with obsessive-compulsive symptoms.

Adolescent↗