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Homogamous and heterogamous marriages.

This paper explores two marital constructs set forth by Peter Giovacchini. The first is based on a symbiotic reenactment in which the investment of both partners is tenacious and reciprocal, an attachment which Giovacchini refers to as a "character object" relationship. It represents intrapsychic homogramy. In the second construct, this deep form of attraction is absent and the dyadic bond is superficial, frequently transitory. The latter couples do not require an elementary, intrapsychic bond but do share particular defensive traits or symptoms. Thus these unions are termed "symptom object" relationships and are characterologically heterogamous. By means of a group case study approach, this distinction was statistically supported. Furthermore, it was found that homogamous marriages stay in treatment longer, maintain a lower divorce rate, and respond best to individual psychoanalytic psychotherapy. Heterogamous marriages, by contrast, show a higher divorce rate and tend to leave therapy prior to termination. The research also suggests that the initial treatment of choice for this type of marriage may well be conjoint or group psychotherapy.

Compulsive Personality Disorder↗

Somatoform disorders: comorbidity with other DSM-III-R psychiatric diagnoses in Greece.

From a total sample of 1,448 psychiatric outpatients, 175 (12.1%) received a diagnosis of a somatoform disorder according to DSM-III-R criteria. One hundred twenty-two (70%) of these patients had another current axis I diagnosis, and this rate increased to 79% (139 of 175) when lifetime psychiatric diagnoses were recorded. The most frequent comorbid diagnoses were depressive disorders, i.e., dysthymia and major depression, and then anxiety disorders, mainly panic disorder. One hundred ten (63%) of the somatoform patients met the criteria for a personality disorder, significantly higher than the rate (52%) for the rest of the total sample (n = 1,273), who were used as a control group. The most frequent comorbid personality disorders were histrionic, dependent, and personalities of cluster B in general. Hypochondriasis was the only somatoform disorder that was additionally significantly related to obsessive-compulsive personality disorder. Somatoform patients with a concomitant personality disorder manifested more severe overall psychopathology as measured by the Minnesota Multiphasic Personality Inventory (MMPI) and a worse level of functioning than those without. The results of the present study show that (1) patients with somatoform disorders have a high rate of comorbidity with other clinical syndromes and personality disorders, and (2) the presence of a personality disorder is related to more severe overall psychopathology and a worse level of functioning. All of the above indicate that special attention must be paid to the interaction between somatoform disorders, other clinical syndromes, and personality structure at the level of both clinical and research practice.

Adult↗

A Rorschach investigation of incarcerated female offenders with antisocial personality disorder.

Although male psychopathy has been linked to histrionic, narcissistic, and antisocial personality disorders (ASPD), less is known about female psychopathy. The Psychopathy Checklist-Revised (PCL-R) and the Rorschach were used to explore the personality functioning of 45 incarcerated female offenders with ASPD delineated by their psychopathy level. Psychopaths (PCL-R > or = 30) and nonpsychopaths (PCL-R < 24) were compared on Rorschach measures of self-perception, interpersonal relatedness, and reality testing. Compared to female offenders with ASPD who were nonpsychopathic, female offenders with ASPD who were psychopathic exhibited marked disturbances in self-perception, interpersonal relatedness, and reality testing. Our findings highlight the heterogeneity of the ASPD diagnosis in women, support the utility of the psychopathy construct with female offenders, and implicate important differences between men and women with ASPD. These gender differences have relevance to the evaluation (PCL-R scoring) and treatment of female offenders. Our findings are discussed within the context of the female psychopath's hypothesized hysterical character style.

Adult↗

The differential diagnosis of multiple personality. A comprehensive review.

This review offers guidelines for the diagnosis of multiple personality disorder and other dissociative disorders and presents diagnostic criteria for psychotic disorders, factitious disorders, affective disorders, anxiety disorders, psychosexual disorders, and others that may or may not coexist with multiple personalities.

Adult↗

DSM-III-R axis II comorbidity in dysthymia and major depression.

OBJECTIVE: Dysthymia is generally believed to be associated with a high rate of DSM-III-R axis II comorbidity. However, it is unclear whether this rate is higher than that for other axis I disorders, how many dysthymic patients have personality disorders, and what the most common co-occurring axis II conditions are. METHOD: Ninety-seven outpatients with early-on-set dysthymia and 45 with episodic major depression were administered structured diagnostic interviews for axis I and II disorders. In addition, knowledgeable informants were independently interviewed about axis II conditions in the patients. RESULTS: A significantly greater proportion of dysthymic patients (60%) than patients with episodic major depression (18%) met criteria for a personality disorder. The most common axis II conditions among dysthymic patients were borderline, histrionic, and avoidant personality disorder. Informants' reports yielded similar results. CONCLUSIONS: These data indicate that early-onset dysthymia is associated with significantly greater axis II comorbidity than episodic major depression. Further work is necessary to elucidate the processes underlying this association.

Adult↗

[Clinical features and psychopathology of factitious disorders].

Factitious disorders are characterized by self-produced symptoms and a chronic course, sometimes with severe complications. Pathomimia occurs more often in women, even though the Munchausen syndrome is found especially in men. Among the various clinical features of pathomimia, the most frequent are factitious fevers and cutaneous pathomimia. Factitious psychiatric disorders are not rare, such as factitious psychotic symptoms, mournings or post-traumatic stress disorders. The main elements of diagnostic orientation are the odd expression of the reported symptoms, a capricious and disconcerting course, as well as the multiplicity of the previous history, with many imprecise diagnoses. Concerning the psychopathology, and contrary to the simple simulation, immediate utility of the alleged symptoms is not the expected goal, one of the essential psychological motivations being to challenge the physician. Among comorbid pathological personalities, there seems to be some close relations between pathomimia and hysterical personality, whereas the Munchausen syndrome shares common features with antisocial personality.

Adult↗

[Characteristics of the forming personality in children suffering from anorexia nervosa].

AIM: The evaluation of forming personality in 30 children (27 girls and 3 boys) suffering from anorexia nervosa (average age--13.5). METHOD: Anamnesis from patients and their parents, clinical observation, psychiatric investigation, psychological investigation with use of following methods: The Thematic Apperception Test, Colorful Pyramids Test, The House-The Tree-The Man Test. RESULTS: After the conducted investigation and observation, the characteristics of the forming incorrect personality were observed in 80% of examined children. According to DSM IV classification, in 50%--from the cluster C, and in 30% cases--the cluster B. According to ICD-10 classification: 26.6% attributes of dependent personality, 16.6%--histrionic personality, 13.3% avoiding personality, 10%--anancastic personality, 6.7% borderline personality and 6.7% antisocial personality. CONCLUSIONS: There is predominating opinion in literature, connecting restrictive type of psychical anorexia, with disorders of personality of anxiety type--the cluster C, and the figure bulimic--with personality the cluster B. Those results were confirmed with statistical significance in the conducted examinations.

Adolescent↗

Hysteroid dysphoria in depressed inpatients.

Hysteroid dysphoria has been described in outpatient populations and is thought to be a subtype of atypical depression involving rejection sensitivity and therapeutic response to monoamine oxidase inhibitors. The presence of hysteroid dysphoria was assessed, using a semistructured interview, in 18 depressed inpatients. The 6 patients who met the criteria for hysteroid dysphoria did not differ from other depressed patients in severity, premorbid adjustment, number of atypical features, or presence of melancholia. Implications for treatment are discussed.

Adolescent↗

[Therapeutic approach to a case of simulated disorder with psychiatric symptoms].

The case of a 38-year-old female inpatient with the diagnosis of factitious disorder with psychological symptoms--a presentation rarely reported in the psychiatric literature--is presented with special respect to her personality traits. On the basis of her biographical history a therapeutic approach was possible which tried to understand the symbolic value of the histrionic patient's symptoms. We regarded the manifestation of psychological symptoms as an attempt to express conflicts verbally and as an offer of a more mature form of communication in comparison to the former, autodestructive physical syndromes.

Adult↗

[The phenomenology of hysterical personality disorder].

Phenomena that are observable in the "classic" hysterical personality disorder are named, described and classified according to the basic functions of human experience and behavior. In this way, a psychopathological picture of the hysterical personality arises, which can facilitate the sometimes difficult task of diagnosis and differential diagnosis. It is shown that the phenomenon of dissociation is one essential characteristic of this disorder. The dissociation of the mental processes is demonstrated for the various basic functions. It implies a dissociation of contents and of parts of personality on the axis conscious-preconscious/unconscious. The dissociation ultimately becomes a prerequisite for living these not permitted and not integrated parts of personality in a partial and compromising way.

Affective Symptoms↗

Sexual development and life of psychiatric female patients.

Using a structured interview and four questionnaires we examined the sexual development and life in the following groups of psychiatric female patients: 51 with schizophrenia, 50 with manic-depressive psychoses, 50 with neuroses, 30 with hysterical psychopathic personality, and 20 with anorexia nervosa. The results were compared with a control group of 101 gynecological spa patients. The sexual development of the schizophrenic patients was found to be retarded, whereas that of the patients with anorexia nervosa accelerated in the initial stages. The sexual development of patients with hysterical personality was found to be disharmonious. No differences were found between patients with manic-depressive psychoses and the control group as far as the sex life in adulthood is concerned. However, all the other groups of psychiatric patients showed decreased sexual activity and/or reactivity. Sexual dysfunctions in the female psychiatric population are frequent, especially with schizophrenic patients, females with anorexia nervosa, and with hysterical personality. The etiological factors responsible for these sex disturbances are different in the individual groups of psychiatric patients.

Adult↗

Psychosomatic study of 60 patients with vertigo.

The authors examined 60 consecutive patients hospitalized in Modena University Otorhinolaryngological Clinic for vertigo by means of an interview and of three self-rating scales (Zung's SDS, SAS and the Middlesex Hospital Questionnaire). The control group was composed of an equal number of patients hospitalized in the same ward and period for different nonsurgical otiatric diseases; the two groups were matched for age, sex, residential area, sociocultural conditions, duration of hospitalization and disease. According to the clinical diagnosis carried out when discharged from hospital, the patients where divided into five groups (Ménière's disease, neuronitis, vertebrobasilar insufficiency, neurosensorial deafness, nucleoreticular syndrome of Ararslan). The data regarding depression (MHQ and SDS), anxiety (MHQ and SAS), neuroticism, somatization (MHQ) and the prevailing of hysterical personality traits in women (MHQ) resulted particularly relevant from a statistical viewpoint (p less than 0.01).

Adult↗