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Results for “Compulsive Personality Disorder”

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PubMed2002

Obsessive-compulsive hoarding: symptom severity and response to multimodal treatment.

BACKGROUND: Compulsive hoarding and saving symptoms, found in many patients with obsessive-compulsive disorder (OCD), are part of a clinical syndrome that has been associated with poor response to medications and cognitive-behavioral therapy (CBT). We sought to determine whether patients with the compulsive hoarding syndrome had more severe symptoms and functional impairment than nonhoarding OCD patients and whether they would respond to intensive, multimodal treatment previously found to be effective for treatment-refractory OCD. METHOD: We studied 190 consecutive patients with DSM-IV OCD treated openly for approximately 6 weeks with intensive CBT, medication, and psychosocial rehabilitation in a partial hospitalization program for severely ill OCD patients. Twenty of the 190 patients (11%) were identified as having the compulsive hoarding syndrome. All patients were assessed before and after treatment with the Yale-Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D). Hamilton Rating Scale for Anxiety (HAM-A). and Global Assessment Scale (GAS). We compared the symptom severity and response to treatment of compulsive hoarders versus nonhoarding OCD patients. RESULTS: Compulsive hoarders were significantly older than nonhoarders (p < .001). Hoarders had significantly lower GAS scores and higher HAM-A scores than nonhoarders both before (p = .04) and after (p = .002) treatment, but had similar pretreatment YBOCS scores. Both groups improved significantly with treatment as assessed by YBOCS score (p < .001), but nonhoarders had significantly greater decreases in YBOCS scores than hoarders (p = .02). CONCLUSION: While the compulsive hoarding syndrome appears to be a distinct, more disabling, variant of OCD that does not respond as robustly to treatment, it may still improve significantly with intensive, multimodal treatment tailored to its specific features and associated deficits.

Adolescent↗
PubMedDate not supplied

[Inferiority in normal and anxious populations].

BACKGROUND: The construct of inferiority can be defined as an intimate, unrealistic and persistent conviction to be always low-ranking in merit, value, intellectual and/or physical capacities (Weiner et Mohl, 1996; Yao et al., 1996). This can be considered as an important cognitive factor in anxiety disorders. But, does a feeling of inferiority also exist in normal subjects? We hypothesized that the feeling of inferiority might be a normal phenomenon if it is a transient experience, in relation to external events, and represents an aspect of self esteem. The Inferiority Scale (Yao et al., 1998), aimed at measuring the feeling of inferiority in anxiety, is a self-report instrument including 17 items assessing self-appraisal of inferiority and 17 items assessing inferiority linked to others' judgements. It showed good psychometric properties of reliability and validity in previous studies. The aim of our study was to confirm the existence of inferiority feeling in non-clinical subjects, and its continuity between normal and anxious populations. Method - We included 264 non-clinical subjects in the study. The mean age of the sample was 30.38 years old (SD=10.25) and 36% (94 Ss) were men. The anxious population was composed with 57 subjects suffering from obsessive compulsive disorder (OCD) and 43 patients with social phobia according to DSM IV. The mean age of this population was 34.0 years old (SD=10.6) and 51% of them were men. The Inferiority Scale was used in our study for evaluating the feeling of inferiority. RESULTS: Most of non-clinical subjects reported low inferiority feelings and a part of the non-clinical subjects (15%) presented a moderate or strong feeling of inferiority, on the Inferiority Scale. The non-clinical subjects group was divided into two sub-groups (Low and High Inferiority) with the median of the Inferiority Scale total score. The total score and the sub-scores of the Inferiority Scale were all significantly higher in the two anxiety groups than in the two non-clinical sub-groups (p<0.0001) and higher in non-clinical subjects with high inferiority, compared to those with low inferiority (p<0.0001). Noting that the social phobic group presented higher scores of the Inferiority Scale than the OCD group (p=0.0058). There was a significant and negative correlation between age and the Inferiority Scale in non-clinical subjects, but there was no between-sex difference on the scale. CONCLUSION: Our results confirm the existence of inferiority feeling in non-clinical subjects and suggest the existence of continuity of inferiority feeling as a psychological trait between normal and pathological populations.

Adult↗
PubMedDate not supplied

[Psychological aspects of ulcerative rectocolitis (author's transl)].

Ulcerative rectocolitis has been known for quite some time as a psychosomatic disease, it is an organic disease occurring in people with a particular personality rendering them susceptible to certain conflicts or stress which would be able to play a causing role in the appearance or exacerbations of the disease. Insofar as the psychological study is concerned, there are two important points to keep in mind: the role of psychological trauma as a stimulating factor and the basic personality. In 90% of the cases observed, psychological factors are found as provoking the hemorrage, as found by Groen and confirmed by the author. The basic personality is generally the obsessional type with a hypersensibility to rejection and hostility, sometimes of a paranoid dimension. The aggressivity is almost always repressed. The doctor-patient relationship indicates an important dependency as well as a passivity on the part of the patient. Furthermore, these patients rarely express their feelings, even if their behavior is indicative of experiencing intense emotion. By further experimentation, it has been established that these patients have a greater neuro-vegetative fragility than controls, thus demonstrating a greater vulnerability to stress. A pathological relationship between mother and child has almost always been proven. Finally, the principal causal psychological factor in this disease seems to be a relational conflict unresolved between specific figures. The role of psychotherapy influences greatly the disease evolution. the author recounts an interesting research of 900 ulcerative colitis patients, undertaken by O'Connor. In order to insure favorable therapeutic results in ulcerative rectocolitis, one must carefully coordinate a psychological and somatic treatment.

Colectomy↗
PubMedDate not supplied

[Anorexia nervosa in adult women].

AIM AND METHOD: The author presents the clinical picture of anorexia nervosa and comorbidity in women with serious symptoms of anorexia nervosa (diagnosed acc. to DSM-IV), which appeared in adulthood, after the age of 25 years. RESULTS: Most of these patients (25-40 years old) had mild symptoms of eating disorders (restricted anorexia nervosa), from adolescence, never diagnosed and treated, had a nondisturbed somatic state and social functioning. The worsening of psychic state and full development of anorexia nervosa symptoms occurred during stressful life event (e.g. avoidance by sexual partner). The majority of those patients had present and past (from adolescence) various anxiety and depressive disorders and personality disorders (obsessive--compulsive, borderline). In most of the women older than 40 years, anorexia nervosa comorbid with depressive disorders, less often with mixed, anxiety--depressive, disorders. The symptoms occurred during menopause, after loss of life-partner (separation or death). It was not established, which of these disorders appeared as the first one. The prognosis was better for the second group of those patients.

Adult↗
PubMed2003

[Eating disorders: anorexia nervosa, bulimia, binge eating].

We present an overview of three different eating disorders which seem to have an increasing prevalence, especially among young women between 12 and 20 years of age. Anorexia and bulimia nervosa are "threshold disorders" which usually become manifest for the first time during the transition from childhood to early adult life. Eating disorders are chronic disorders and often take a course of 6 or more years. Remission, improvements and symptom change can be expected even after many years of the disorder. Psychiatric comorbidity which occurs in more than 50% of eating disordered patients is of prime importance for prognosis. Depression, anxiety disorders, obsessive-compulsive disorders, and personality disorders are most common. There is a variety of complex in- and outpatient treatments with different components which have to be chosen according to the individual case.

Adolescent↗
PubMed1992

[Obsessive behavior and thoughts in patients with myasthenia gravis].

230 patients with myasthenia gravis were investigated by a german questionnaire, the HAMBURGER-ZWANGS-INVENTAR, in order to quantify their obsessive and compulsive behaviour. Compared to normals, myasthenic patients show higher scores on the compulsion-subscales of the inventory. The most significant differences appeared on the orderliness-subscale. On the other hand ratings of obsessive behaviour are significantly lower than in the normal population. Especially (auto)aggressive ruminations do hardly occur in myasthenia, which is a remarkable fact in this autoaggressive immunological disease. Compulsive behaviour cannot be interpretated as clinical compulsive disorder, caused by myasthenia. Questionnaire replies rather indicate one aspect of the way of coping with the disease and its treatment.

Activities of Daily Living↗
PubMed1992

The epidemiology and clinical features of obsessive compulsive disorder.

During the past decade, there has been rapid growth in understanding the clinical features, pathophysiology, and treatment of obsessive compulsive disorder (OCD). This article reviews the current state of knowledge of the epidemiology and clinical features of OCD with a focus on the disorder's phenomenologic heterogeneity and its comorbidity with other Axis I and Axis II syndromes.

Adult↗
PubMed1992

Trichotillomania. An obsessive compulsive spectrum disorder?

Trichotillomania is a neglected neuropsychiatric disorder that only recently has received research attention. Based on clinical data, it appears far more common than previously believed. Like OCD, the behavior is recognized as senseless and undesirable, but is chronic and difficult to treat. The comorbidity, drug response data, familiality, and phenomenology of the disorder extend the concept of OCD to a spectrum of inappropriately released, excessive grooming behaviors. Although the discovery of clomipramine's effectiveness has provided relief to some trichotillomanics, further work is indicated to find regimens that provide long-term suppression of symptoms. Ongoing investigations of early-onset trichotillomania may reveal etiologic triggers, whereas studies that examine the similarities and differences between trichotillomania and OCD may help define the neurobiology of OCD, and possibly of other atypical impulse control disorders.

Adolescent↗
PubMed1992

Assessment of severity and change in obsessive compulsive disorder.

Useful clinician-rated measures of OCD are now available. The Y-BOCS and NIMH Global OC both seem suitable for monitoring outcome in drug trials of OCD. These two scales seem relatively specific for symptoms of OCD and are sensitive to drug-induced changes in symptoms. Neither the Y-BOCS nor the NIMH Global OC confuse trait with state. There are ample data suggesting that the Y-BOCS is reliable and valid scale. Unlike some of the symptom inventories, such as the LOI and MOCI, final scores on the NIMH Global OC and Y-BOCS are not influenced directly by the type or number of obsessions and compulsions present. A computer-administered version of the Y-BOCS has been developed. Currently available patient-rated instruments suffer from serious shortcomings, including insensitivity to change and poor representation of patients with mono-symptomatic clinical pictures (e.g., hoarding alone). Some rating scales have been adapted for use in children with OCD. Several groups, including our own, have elected to use change scores on the 10-item Y-BOCS and a global measure of OCD, such as the NIMH Global OC or modified OGI, as the principal outcome variables in drug trials in patients with OCD. Several studies have selected a 35% decrease in Y-BOCS scores from baseline as indicative of clinically significant improvement. A limitation of all single-item global measures is that they cannot be resolved into smaller components. The more fine-grained analysis that is possible with the multi-item Y-BOCS makes it more desirable as a primary outcome measure, with a global scale as a secondary outcome measure.

Adult↗
PubMed1992

Behavior therapy for obsessive compulsive disorder.

Behavior therapy for OCD with exposure and response prevention is effective in reducing obsessions and rituals in at least half of those suffering this disabling disorder. Office-based sessions in which patients participate actively in designing exposure and response prevention homework are usually sufficient. Therapist assistance is sometimes needed for those who fail to perform these assignments on their own. Poor compliance, severe comorbid conditions, and CNS-depressing drugs can interfere with behavior therapy. Techniques to manage these difficulties, including modifications of behavior treatment and the use of serotonin reuptake inhibiting drugs, can increase substantially the number of patients responsive to behavior therapy.

Adaptation, Psychological↗
PubMed1992

[Successful treatment of seasonal compulsive syndrome with phototherapy].

We report the case of a 40-year-old woman with a seasonal form of obsessive compulsive disorder (OCD) which was usually accompanied by obsessions and occurred only in autumn or winter. Frequently, the OCD symptomatology was accompanied by depression. After a 12-day treatment with full spectrum bright light (3000 lux; 2 hours a day between 9 and 11 am) without changing the long-term antidepressive medication (125 mg amitriptyline/day) there was a complete remission of OCD symptomatology, with no relapse during the next months.

Adult↗