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PubMed1981

Partners of distressed transvestites.

The authors studied partners of 18 transvestites who sought consultation because of their disorder. They found that all of these women were moral masochists and that all tolerated the self-centered, obsessive-compulsive behavior of their transvestic spouses. Many of these women had experienced multiple losses and poor parenting, and their transvestic partners fulfilled their dependency needs. The authors recommend supportive and insight-oriented therapy for such women who, in order to stay with a transvestic man, sacrifice their own self-esteem and desire to engage in a mutual relationship.

Adult↗
PubMed1995

Demographic and clinical comparison of obsessional followers and offenders with mental disorders.

OBJECTIVE: The purpose of this study was to compare certain demographic and clinical variables in a group of obsessional followers and in a group of offenders with mental disorders. METHOD: A static group design comprised of a nonrandom group of convenience and a randomly selected comparison group was used. Twenty obsessional followers in custody and 30 offenders with mental disorders in custody were evaluated by psychiatrists and psychologists for court-ordered reasons during their criminal proceedings. Both groups were evaluated during the same period, in the same court diagnostic clinic, and for the same psycholegal reasons. The group of obsessional followers was measured on demographic, clinical, and victim variables. Inferential comparisons that used nonparametric statistics were done between groups on selected demographic and clinical variables. RESULTS: The obsessional followers were significantly older, more intelligent, and better educated than the offenders. There were no significant differences in DSM-III-R axis I diagnoses. Axis II diagnoses showed significant differences, with the obsessional followers more likely to have a personality disorder other than antisocial personality disorder and less likely to have antisocial personality disorder. CONCLUSIONS: The likelihood of obsessional followers having a nonantisocial axis II personality disorder (related to attachment pathology) distinguishes them from offenders with mental disorders in general. They are also likely to be older, smarter, and better educated, consistent with their resourcefulness and manipulativeness. Idiographic aspects of the obsessional followers further illuminate their psychological defenses and object relations.

Adolescent↗
PubMed1995

Correlates of stress reactivity in patients with bipolar disorder.

OBJECTIVE: The authors examined individual differences in stress reactivity as well as whether features of the illness itself or psychological characteristics differentiate between patients with bipolar disorder who are highly stress reactive and those who are not. METHOD: They assessed stressors and bipolar episodes in 58 patients with bipolar disorder followed for at least 1 year. RESULTS: Not only did stress level predict relapse, so did personality variables such as introversion and obsessionality and their interaction with stress. Number of previous episodes of bipolar illness, however, did not affect stress response. CONCLUSIONS: These results are not consistent with the view that episodes of bipolar disorder become increasingly independent of stressors after initial episodes. However, psychological traits may affect reactivity to stressors.

Adolescent↗
PubMed2005

The knight as patient of the squire.

Many types of non-professional, non-credentialed relationships are seen by laypersons as analogous to those occuring in psychotherapy. This paper takes a leap backwards several centuries and describes two examples of one such type of interaction as portrayed in artistic masterpieces. In Miguel de Cervantes' novel, "Don Quixote," an elderly, depressed man pursues a restitutive and grandiose delusion of being a heroic knight errant. In Ingmar Bergman's film, "The Seventh Seal," a disillusioned knight returns from the Crusades to face the lethal bubonic plague, and he uses obsessional means in an attempt to outwit death. Both men are accompanied by squires who try, with varying degrees of success, to help their masters relinquish their infantile needs for omniscience and omnipotence, accept their human limitations, and deal more appropriately with their surrounding realities. The powerful and inspiring insights of both works have much to teach contemporary therapists whose patients wear more metaphorical suits of armor.

Aspirations, Psychological↗
PubMed2005

Level of obsessionality among neurosurgical patients with a primary brain tumor.

Obsessive-compulsive symptoms have been associated with different types of damages or dysfunctions in the brain. However, the accumulated evidence on obsessive-compulsive symptoms among patients with a primary brain tumor is so far based on case reports only. The study population consisted of 59 neurosurgical patients with a primary brain tumor. One preoperative and two postoperative assessments for the level of obsessionality were done with the Crown-Crisp Experiential Index (CCEI)-instrument. Mean obsessionality scores increased significantly among the patients with a tumor in the left anterior region of the brain measured at 3 months after operation, especially in women, compared to the patients with a tumor in other regions of the brain. The level of obsessionality seemed to increase immediately after operation among patients with a primary tumor left anteriorly in the brain. This increase may be linked with the lesion caused by the tumor itself or the neurosurgical operation.

Adult↗
PubMed1985

Superego formation, adolescent transformation, and the adult neurosis.

The superego is heir to the Oedipus complex but has a much larger developmental legacy which includes preoedipal precursors and the influence of latency and adolescence. The superego continues to change in function and content throughout life, and radical transformation in adolescence may result in developmental discontinuity as well as core developmental continuity. A case is discussed in which adolescence was overlooked in previous analysis and in which adolescent superego modification had a major impact on the patient's character and his adult neurosis. The developmental significance of adolescence experienced under conditions of social isolation and rejection with forebodings of the Holocaust was unrecognized in sanctioned silence and shared analytic denial. These repeated earlier experiences of silent submission and stifled protest, and the silent suffering of the patient and his family, were an integral part of his humiliating and emasculating adolescent experiences. The intimidated adolescent, threatened from within and without, identified with the aggressor as well as with the victim. Identification with the aggressor and glorified victor contributed to a final adolescent structuralization of a punitive, sadistic superego and a rigidly perfectionistic ego ideal. As an adult, he tended to passive masochistic compliance with diminished self-esteem and unconscious self-denigration. He was prone to shame and guilt, self-criticism, and hidden hypercritical attitudes toward others. The adolescent internalization of aggression, intense castration anxiety, and pervasive narcissistic mortification led to retreat from resolution of revived oedipal conflict and to concomitant detrimental superego alteration. These issues were of major importance for analytic understanding and therapeutic progress.

Adolescent↗
PubMed1992

The absence of the father.

The author discusses the role of the father in early development through the concept of triangulation. Three male patients are presented who seemed to lack images and memories of their fathers and experienced them as absent, despite their physical presence during childhood. In these men, the oedipal phase appeared skewed and a dyadic relationship with the mother dominated the material. They reported a lack of a sense of masculinity and a phobic concern about the dangers of male violence, along with feelings of specialness and grandiosity. Analytic data suggested that the image of an absent father reflected a process akin to splitting of the ego, in which the significance of the father was disavowed and the patients fantasized a special role with their mothers; via projection, the fathers reappeared as dangerous intruders. It is proposed that this structure derives from a specific developmental situation in which a disturbed parental relationship has impaired the father's position as a "third" in the early triangle. The child's sexual and aggressive tensions cannot be contained in his fantasies of the couple and must be projected outside. The absent father returns in the transference, where the analyst is reexperienced as useless and absent and as a threat to the specialness of the dyad, thereby recapitulating the predicament of the child.

Adult↗
PubMed1978

Study of psychiatric illness in adolescence, psychiatric breakdown in adolescence: diagnosis and prognosis.

A discussion on the pitfalls of studying adolescent psychiatric breakdown emphasises two difficulties, firstly that of delineating the age of adolescence, and secondly the difficulty in applying adult diagnostic criteria. A study of 52 adolescents has been made to establish an initial, and a two year follow-up diagnostic formulation, and to attempt through a detailed survey of the adolescent's early history to identify prognostic indices. The difficulty of formal diagnoses is shown, but prognostic factors of relevance can be identified in the group which have helpful predictive value. Outcome in a group of 50 treated adolescents showed a satisfactory conclusion at two year follow-up, in 70% of cases.

Adjustment Disorders↗
PubMed1978

Separation experiences and other emotional traumata in childhood, and their relationship to subsequent adolescent breakdown.

This paper forms part of an M.D. Thesis presented at the University of Cambridge. One hundred adolescents and their parents were interviewed to ascertain details of their early history. Fifty were obtained from adolescent patients in psychiatric units in Newcastle-upon-Tyne, and were compared with fifty matched individuals who had no psychiatric history, obtained from other departments in the hospital. A comparison of these two groups showed a significantly higher incidence of separation experiences in the childhood of the patient group than in the control group. This was also true of other traumatic events occurring in childhood. These factors also related adversely to prognosis in a two year follow-up of the patient group.

Adjustment Disorders↗
PubMed1978

Empathetic relationships in adolescents and their relevance to prognosis in psychiatric breakdown.

Many authors have shown that adolescent breakdown is often associated with emotional deprivation in childhood. Psychotherapeutic intervention before the personality becomes too fixed and rigid should offer a means of improvement through the creation of substitute empathetic relationships, and prognosis should be improved to the extent to which this is successful. This hypothesis is tested through a follow-up study involving 100 adolescents, and the hypothesis is found proved in the diagnostic category of adolescent personality disorder, but of no apparent relevance in other groups.

Adjustment Disorders↗
PubMed1994

Psychiatric morbidity in adults with hypopituitarism.

Forty-one adults with established hypopituitarism and deficiency of growth hormone (GHD) were compared to an age and sex-matched group with another chronic metabolic disorder (diabetes mellitus) using standardized psychiatric rating and diagnostic measures. Nineteen (46%) of the GHD group were identified as definite psychiatric cases compared with 10 (24%) of the diabetics (odds ratio 1:9:1). The most frequent DSM III-R axis I psychiatric diagnoses were major depression (32% GHD patients and 10% of diabetic patients) and dysthymia. The risk of being a psychiatric case showed an association with duration of illness in the diabetic group, but not in the GHD group. Biochemical indices were not related to the risk of being a case in either group. Hypopituitarism is associated with a higher prevalence of psychiatric disturbance than can be attributed solely to the presence of a chronic disorder.

Adult↗
PubMed2002

Stalking, homicide, and catathymic process: a case study.

Despite the proliferation of research on various aspects of stalking, there has been relatively little study of stalkers who commit homicide. In this article, a man who stalked and killed a casual acquaintance is reported. He developed an idea to kill her that, at first, seemed ego-alien and unreal but eventually became fixed and was accompanied by a mounting inner pressure to act. The concept of catathymic process--a change in thinking whereby the offender comes to believe that he can resolve his inner conflict by committing an act of extreme violence against someone to whom he feels emotionally bonded--is of particular help in understanding this case, as well as similar cases of stalking that culminate in homicide.

Adult↗
PubMed2002

Occupational effects of stalking.

OBJECTIVE: This case report and discussion describe the psychiatric and social consequences of being a stalking victim, with particular focus on its impact on the victim's occupation. METHOD: Data were gathered from the assessment and arbitration hearing of a female employee who lost her job while being stalked. Computerized literature searches were used to identify relevant papers from psychiatric and legal journals. RESULTS: This case illustrates many of the common features of stalking. The female victim was harassed by a male after a failed intimate relationship. The victim suffered from depression, anxiety, guilt, shame, helplessness, humiliation, and posttraumatic stress disorder (PTSD). The stalking affected her psychological, interpersonal, and occupational functioning. Consequently, she was fired for poor work performance and poor attendance. CONCLUSION: Stalking may affect a victim's ability to work in several ways. The criminal behaviours often interfere directly with work attendance or productivity and result in the workplace becoming an unsafe location. Further, stalking may indirectly affect a person's ability to work through the many adverse emotional consequences suffered.

Absenteeism↗