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Success of cathartic therapy as a function of patient variables.

Treated sample of 42 patients with cathartic psychotherapy and evaluated differential effectiveness on types of patients. Patients without mental disorders experienced more emotional catharsis than all others, and those with obsessive compulsive personality disorders improved more than all others as a result of emotive treatment. Contrary to popular notions, neither women nor hysterics experienced more catharsis or improved more in cathartic therapy. Although women and hysterics may cry more easily in daily life, obsessives are apparently more able to maintain focus on unhappy experiences and are therefore able to express more emotion in cathartic therapy. Furthermore, it seems that cathartic treatment is beneficial by disrupting long-standing defenses against emotional experiences, rather than by releasing stored-up affects.

Abreaction↗

[Failure effects and gender differences in perfectionism].

Perfectionism is a dimension which has been studied very little as a separate entity. It is not even considered as a nosological factor. No classification of the medical sciences underlines its importance other than to speak of a personality trait, of an aspect, or of a parameter. Nevertheless, perfectionism is related to multiple disorders such as depression (18, 20, 36), suicide (8, 16, 55), nutritional problems (11, 28), anxiety (3), obsessive-compulsive personality disorder (53), social phobia (2), as well as insomnia (46). Certain authors stress the possible role of perfectionism in the development or the persistence of a substantial number of these disorders (7, 22, 38). Given these facts, it is all the easier to understand the interest shown by clinicians and researchers in the subject. Better detection and evaluation of its impact on behaviour is important in putting therapies in place (6, 53). Relationships between perfectionism and fear of failure have been approached (21, 51, 54). Correlations between perfectionism and high levels of state and trait anxiety have been demonstrated (23). The evaluation of perfectionism has been dealt with very little. Some questionnaires devote a sub-category to it, such as the Eating Disorder Inventory and the Irrational Beliefs Test. However, recently, it has been recognized that perfectionism is a multidimensional construct. Two Multidimensional Perfectionism Scales have been developed and investigated in relative isolation. Frost, Marten, Lahart and Rosenblate defined perfectionism as the setting of excessively high standards for performance associated with critical self-evaluation. Six dimensions are described: concern over making mistakes, high personal standards, parental expectations, parental criticism, doubt about quality of performance and organization. Internal consistency and validity have been established (25, 26). Hewitt and Flett (30, 31, 33, 35) have developed another approach where three dimensions of perfectionism are described: SOP (Self Oriented Perfectionism) related to high standards and self criticism, SPP (Socially Prescribed Perfectionism) related to the need of approval from others and fear of negative evaluation, OOP (Other-Oriented Perfectionism) reflecting a tendency to set high expectations for others and to evaluate them in a demanding way; this component is related, especially for males, to self-esteem, hostility and authoritarianism. Validity and internal consistency have been established too (30, 31, 35). The Frost and al's Multidimensional Perfectionism Scale and the Hewitt and Flett's scales are closely associated, except concerning the OOP. Because this component could provide new information, we have chosen the second scale, referring to the French translation and validation of Labrecque (45). EMP is the French name of MPS; it is a self-report questionnaire of 45 questions, in fact three subscales of 15 items rated on a 7-point Likert-type scale. MPS was administered to 617 first year students at the university of Liège (table II). Differences are considered according to gender and experience of failure i.e. the fact of repeating an academic year. We realized a component analysis with promax rotation. Among the different possibilities offered by the scree-test the choice of a 4 factor solution stresses the original structure: SOP (14 items), SPP (12 items), OOP (9 items) and anti OOP (10 items); the last one is additional but allows for respecting semantics and saturation of the items. The first aim of confirming validity and internal consistency is satisfactory. In other respects the multidimensional structure of the concept leads to consideration of a positive, adaptive perfectionism and a more negative perfectionism, facilitating psychopathology (59, 60, 61). So it seems interesting to compare the different components of MPS in order to find an eventual sex-failure effect. The evaluation of perfectionism is obvious, considering it as a personality trait, but it can be used also in taking into account stress and its impact, for instance that of academic performance (29, 37, 39, 58). Conferring on MPS more pertinence in gender differentiation and failure evaluation is an other goal of this research. Through the particular choice of statistical results, sex and sex-failure effects can be demonstrated: a MANOVA underlines sex effect (lambda de Wilks = 0.96, p = 0.001) and sex-failure effect (lambda de Wilks = 0.98, p = 0.05). Structure of MPS is different in four groups (FE: women with failure, FnE: women without failure, ME: men with failure, MnE: men without failure). ANOVA show differences of MPS3, MPS1 and MPS2. Far more promising is the use of LISREL method allowing for the construction of a coherent model of relationships between some dimensions of MPS and Test-Anxiety, approached here with THEE (test d'habileté aux études et à leur évaluation) French abbreviated version (49) of TASTE (Test for Ability to Study and Evaluation). In fact according to the literature of fear of failure, girls score higher on anxiety and procrastination but less on self-confidence. The structural model shows different pathways, more especially between SPP (socially prescribed perfectionism), T2 (sense of incompetence) and T1 (anxiety). SOP (self oriented perfectionism) and SPP (socially prescribed perfectionism) by girls are very much correlated; it seems that they are more subjected to society and its exigencies of studying but consequently they are more at risk of anxiety and a sense of incompetence. SOP (self oriented perfectionism) by boys functions more indiscriminately of SPP (socially prescribed perfectionism) and is negatively correlated with self-incompetence; boys are more self-confident but they usually procrastinate more probably because failure expectancies would be particularly harmful for their self-esteem; consequently, failure should be related to something else than their own capacity; this may be an explanation of the high rate of male dropouts and failure in the first year at the university of Liège; also a factor explaining the female domination at the university. In the same way the first choice of studies is moving towards shorter and less difficult orientation (46). In case of failure the model is very similar according to gender: SOP (self oriented perfectionism) and T1 (anxiety) are directly connected; SOP and SPP are in this case better correlated by boys but the path between SPP, sense of incompetence and anxiety is less significant than in girls. In conclusion, providing some modifications according to semantics, the choice of a four factor solution allows for confirmation of the original structure of MPS and for internal consistency. The different components of MPS vary according to gender: SOP and more OOP discriminate men and women; SPP allows for differentiating women with failure. A structural model enhances the role of perfectionism in the cognitive and behavioural contexts; for instance it clarifies its action on fear of failure and success rates according to gender.

Adult↗

[Epidemiology of obsessive-compulsive disorder in children and adolescents].

Although obsessive-compulsive disorders are rarely found in young subjects seen in infantile psychiatry, anamnestic studies have shown that more than one third of obsessive patients seen at adult age agree that the onset of their disorder dates back to when they were under 15 years of age. The first direct epidemiological study on the prevalence of obsessive-compulsive disorder during adolescence was recently conducted in a New Jersey county, USA. Over 5,500 high school teenagers were asked to fill in a questionnaire dealing with different aspects of mental pathology and 356 of them were selected, on the basis of their answers, to be included in further clinical examinations. Thus, the current prevalence rate of obsessive-compulsive disorder was found to be 1 (+/- 0.5)% of the general adolescent population, and the lifetime prevalence rate, 1.9 (+/- 0.7)%. These results are close to the rates of prevalence observed in the U.S. general adult population during the same period. The obsessive-compulsive cases detected in this investigation showed the same characteristics as the clinical cases usually described, except for the absence of male predominance generally observed in consulting patients; 75% of obsessive patients also presented other associated psychopathological disorders, most often major depression, overanxious disorder and/or bulimia, but only 20% of them had already consulted mental health professionals. This study shows that obsessive-compulsive disorder during adolescence is more frequent than expected, but often remains undiagnosed and untreated.

Adolescent↗

Are the eating disorders related to obsessive compulsive disorder?

The evidence supporting the idea that the eating disorders of anorexia and bulimia nervosa may be related to obsessive compulsive disorder is reviewed with respect to studies in phenomenology, comorbidity, neurotransmitters, central nervous system functional metabolism, and treatment and outcome. Although no definitive conclusion can be drawn, research generated from the idea has refined our thinking on the eating disorders.

Brain↗

The facade compulsive: a diagnostic formulation derived from projective testing.

A psychological "type" characterized by repetitive and compulsive action tendencies but not by obsessive thoughts was delineated. It was shown how this syndrome could be identified through differential inter-test patterning on projective techniques. The possibility of improving psychodiagnostic accuracy by stipulating expected configurations among tests in a battery was noted.

Adult↗

Eating disorders and personality: a methodological and empirical review.

Methodological approaches utilized to evaluate models of the relationship between personality and eating disorders, as well as empirical support for each model, are reviewed. Limited prospective research suggests that negative emotionality, perfectionism, drive for thinness, poor interoceptive awareness, ineffectiveness, and obsessive-compulsive personality traits are likely predisposing factors. Limited family study research suggests that obsessive-compulsive personality disorder (OCPD) and anorexia nervosa share a common familial liability. Potential pathoplastic personality factors include Cluster B personality disorders and OCPD, which predict a poorer course and/or outcome, and histrionic personality traits and self-directedness, which predict a more favorable course and/or outcome. Future research should focus upon sophisticated prospective and family study research in order to best evaluate competing models of the eating disorder-personality relationship.

Anorexia Nervosa↗

Dimensional representations of DSM-IV personality disorders: relationships to functional impairment.

OBJECTIVE: This study compared three-dimensional representations of DSM-IV personality disorders and standard categories with respect to their associations with psychosocial functioning. METHOD: Six hundred sixty-eight patients with semistructured interview diagnoses of schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders or with major depressive disorder and no personality disorder completed questionnaires assessing three-factor and five-factor dimensional models of personality. Personality disorder categories, dimensional representations of the categories based on criteria counts, and three- and five-factor personality dimensions were compared on their relationships to impairment in seven domains of functioning, as measured by the Longitudinal Interval Follow-up Evaluation-Baseline Version. RESULTS: Both the categorical and dimensional representations of DSM-IV personality disorders had stronger relationships to impairment in functioning in the domains of employment, social relationships with parents and friends, and global social adjustment and to DSM-IV axis V ratings than the three- and five-factor models. DSM-IV dimensions predicted functional impairment best of the four approaches. Although five-factor personality traits captured variance in functional impairment not predicted by DSM-IV personality disorder dimensions, the DSM-IV dimensions accounted for significantly more variance than the measures of personality. CONCLUSIONS: Scores on dimensions of general personality functioning do not appear to be as strongly associated with functional impairment as the psychopathology of DSM personality disorder. A compromise in the ongoing debate over categories versus dimensions of personality disorder might be the dimensional rating of the criteria that comprise traditional categories.

Adaptation, Psychological↗

Incidence of obsessive-compulsive phenomena in the course of acute schizophrenia and schizoaffective disorder.

Studies examining OC phenomena in schizophrenic and schizoaffective disorders have shown a prevalence of such phenomena in 1 to 60% of schizophrenic or schizoaffective patients. In this prospective study, about 10% of 150 male patients suffering from acute psychotic disorders (fulfilling DSM-IV criteria for Schizophrenia or Schizoaffective Disorder) were found to have OC symptoms. These symptoms showed no correlation to the type and severity of psychosis. As only 19% of the patients with obsessions and compulsions during acute psychosis showed an obsessive-compulsive personality disorder prior to their psychotic episodes, it may be concluded that there is no clear linkage between intrapsychotic OC phenomena and premorbid anancastic personality traits.

Acute Disease↗

Serotonin transporter missense mutation associated with a complex neuropsychiatric phenotype.

Two common serotonin transporter (SERT) untranslated region gene variants have been intensively studied, but remain inconclusively linked to depression and other neuropsychiatric disorders. We now report an uncommon coding region SERT mutation, Ile425Val, in two unrelated families with OCD and other serotonin-related disorders. Six of the seven family members with this mutation had OCD (n=5) or obsessive-compulsive personality disorder (n=1) and some also met diagnostic criteria for multiple other disorders (Asperger's syndrome, social phobia, anorexia nervosa, tic disorder and alcohol and other substance abuse/dependence). The four most clinically affected individuals--the two probands and their two slbs--had the I425V SERT gene gain-of-function mutation and were also homozygous for 5'-UTR SERT gene variant with greater transcriptional efficacy.

Amino Acid Sequence↗

Some standardization data for the Sandler-Hazari Obsessionality Inventory.

Although it has been used in a number of small-scale pieces of research in recent years, there exist as yet no adequate standardization data for the Sandler-Hazari Obsessionality Inventory, a device designed to yield scores for both obsessional traits and obsessional symptoms. The present article describes research aimed at contributing towards a partial standardization of the Inventory using 736 subjects spread over six different samples. Results suggest that obsessional traits and symptoms are present in the non-clinical as well as in the clinical population, though the Inventory appears able to discriminate reliably between the two. Results also suggest that there may be a low-level correlation between traits and symptoms in both clinical and non-clinical populations, and that the presence of unscored buffer items in the Inventory may reduce the risk of clinical and non-clinical subjects faking good in their responses to it.

Adult↗

Compulsive hoarding.

Four cases of compulsive hoarding are described, all sharing the following characteristics: (1) onset in the twenties, (2) preoccupation with hoarding to the exclusion of work and family, (3) diminished insight, (4) little interest in receiving treatment, (5) no attempt to curb their compulsion. They do not show clear psychotic features. The implications of these characteristics for the diagnosis of hoarding are discussed.

Adult↗

Review of the relationship between obsession and depersonalization.

Depersonalization is discussed and a brief outline of the primary symptoms is presented. The relationship between obsessionalism and depersonalization is reviewed in the literature, and subsequent similarities are presented. The intellectual obsessive depersonalization syndrome is postulated as a variant, and also as an exposition of what might occur in many other cases of depersonalization. Finally, a picture is presented which takes into account a strong component of obsessionalism in both the etiology and course of depersonalization.

Anxiety↗

Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders.

Despite advances in our understanding of the pathology and genetics of obsessive compulsive disorder (OCD) and in our ability to successfully treat patients with medications and behavioral psychotherapy, the identification of homogeneous subgroups of patients with OCD has remained elusive. Once identified, such subgroups may be found related to treatment response, biological markers, or genetic transmission of OCD. To clarify identification of symptom subtypes, my colleagues and I administered the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist to 107 patients with OCD and applied principal components analysis (e.g., factor analysis) to these data. We then examined the correlations between these factor scores and the presence of comorbid tic and personality disorders, which are thought to be related to OCD. We found that three factors, which we named "symmetry/hoarding," "contamination/cleaning," and "pure obsessions," best explained the symptoms of the Y-BOCS Symptom Checklist. Only the first factor was significantly related to comorbid obsessive compulsive personality disorder or to a lifetime history of Tourette's syndrome or chronic tic disorder. Implications of these findings regarding possible clinical utility are discussed.

Adolescent↗