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'Personality' and anorexia nervosa - the phobic avoidance stance. Its origins and its symptomatology.

Experience and behaviour in anorexia nervosa is subordinate to the need to achieve and maintain a low body weight in the presence of the impulse, generated by starvation, to forage and ingest, and moreover in the presence of abundant food supplies. The stance is a phobic avoidance one. Normal adult body weight and attendant post-pubertal 'fatness' is feared and avoided through the process of pubertal regression, facilitated primarily by dietary carbohydrate (and fat) avoidance, but otherwise and less effectively by the vomiting/purging syndrome. The maintenance of this stance requires a total commitment of self-control and control of the environment - which are experienced by others as a primary narcissism within the 'patient' and as a tyrannical manipulative attitude to those others.

Adolescent↗

Taxonomic aspects of clinical character typology.

Whereas clinical character typology is based upon one typological idealized personality description of the same illness model, empirical character typology is concerned with the identification of the different personality structures for the same illness model. We have been able to prove that in a taxonomical analysis (Q-factor analysis) of patients and healthy persons subgroups can be identified whose mean-value profiles justify designation as depressive, compulsive, and hysterical personality. This classification was replicated from a second sample. Through this personality classification it becomes possible to determine the distribution of the three personality structures from a clinical group. The distribution of the personality structure in neurotic depression was 59% for the depressive, 19% for the compulsive, and 22% for the hysterical personality. We were able to prove that they can be characterized by various coping strategies which presumably require different psychotherapeutic interventions.

Adult↗

Should treatment distinguish anxiogenic from anxiolytic obsessive-compulsive ruminations? Results of a pilot controlled study and of a clinical audit.

In a small pilot controlled study over 8 weeks, 12 obsessive-compulsive ruminators listened for 2 h daily to their own audiotaped voice either (1) describing their anxiogenic thoughts (exposure) but omitting anxiolytic thoughts (mental/cognitive rituals), or (2) reading neutral prose or poetry. Taking all patients, both groups improved similarly. However, exposure patients who became anxious early in exposure slightly more improved. Consistent with this, in a clinical audit of 57 ruminators treated by trainee clinicians over 12 years, outcome improved significantly once practice changed so that exposure only involved anxiogenic thoughts, not anxiolytic thoughts, the latter being stopped.

Adult↗

Obsessive-compulsive disorder limited to pregnancy.

The relationship between obsessive-compulsive disorder and pregnancy is reviewed in the light of recent reports concerning the frequent onset and exacerbation of obsessive-compulsive disorder during pregnancy. We present the case of a young woman who developed obsessive-compulsive disorder during a pregnancy and recovered completely after delivery. Five years afterwards she is still symptom-free. Several possible explanations for this unusual occurrence are discussed.

Adult↗

The relationship of menstrual cycle and pregnancy to compulsive hairpulling.

BACKGROUND: Trichotillomania (TTM) or compulsive hairpulling is a cyclical disorder that presents predominantly in females. Anecdotal reports of symptom worsening in the premenstruum and during pregnancy led us to retrospectively study the role of these events in hairpulling behavior. METHODS: Questionnaires assessing demographics, current hairpulling behavior, and the reported effects of menstruation and pregnancy on urges, actual hairpulling and behavioral control were administered to clinic patients and volunteers at a hairpulling conference. The MGH Hairpulling Scale, Beck Depression Inventory and Beck Anxiety Inventory were also completed. Data from 59 hairpullers were analyzed. RESULTS: Premenstrual symptom exacerbation was reported for actual hairpulling urge intensity and frequency, and ability to control pulling and was alleviated during menstruation and shortly thereafter. The impact of pregnancy was less unidirectional, with both symptom exacerbation and lessening reported. CONCLUSIONS: The menstrual cycle appears to affect compulsive hairpulling and deserves recognition in both the assessment and treatment of this disorder. The impact of pregnancy on TTM is less clear.

Adult↗

Premature interruption of psychotherapy: continuation of contact by telephone and correspondence.

The author collected data on 15 patients for whom therapy was interrupted because of a move to a distant city by the analyst or the patient. He found that 14 of these patients refused to accept transfer to another analyst as urged by their analyst; instead, they continued contact by phone and/or correspondence with the analyst for long periods of time. Continuation of contact was not related to diagnosis but perhaps to a basic inability of these patients to face and work through separation or to some type of special patient-therapist relationship.

Adult↗

Dysmorphophobia: symptom or disease?

Although dysmorphophobia, a subjective feeling of ugliness in a person of normal appearance, constitutes a distinctive symptom cluster occasionally seen in patients requesting cosmetic surgery, it is not included in current major psychiatric diagnostic systems. Patients with dysmorphophobia are usually young and perfectionistic and have both schizoid and narcissistic traits. The authors present two representative case histories and suggest that study of more patients with dysmorphophobia is needed to determine whether it is a symptom of an underlying disease or is itself a separate disease entity.

Adolescent↗

Severe depersonalization treated by behavior therapy.

The author reports the use of behavior therapy in the treatment of two cases of severe intractable depersonalization. Outcome criteria included full psychiatric assessment, patients' self-ratings, and psychometric test scores. Treatment by flooding was highly effective in one case, and associated obsessive symptoms and anticipatory anxiety were substantially decreased in the other. Behavioral techniques may prove especially helpful in cases in which anticipatory anxiety, phobic avoidance, and obsessive perseveration are exacerbating features.

Adult↗