[Symptomatology, basic structure and therapy of compulsion neurosis; case report and clinical observations].
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Of 17 adult patients with long-standing trichotillomania, 13 completed an 8- to 12-week open trial of fluoxetine, up to 80 mg per day. No patient had obsessive-compulsive disorder or major depression. We used the compulsions subscale of the Yale-Brown Obsessive-Compulsive Scale (YBOCS) to rate patients' hair-pulling behavior. The 13 completing patients' mean YBOCS score decreased significantly from 10.15 at baseline to 5.92 at the completion visit (Student's paired t = 4.82, df = 12, two-tailed p less than .001). Of these 13 patients, 5 experienced a 50 percent or greater decrease in their pulling behavior as measured by the YBOCS; 4 experienced between a 25 percent and 50 percent decrease. Three of the patients stopped pulling entirely, as did 2 of the 4 noncompleting patients. Three noncompleting patients discontinued treatment because of side effects, and 1 insisted on early use of behavior therapy. Comparative treatment trials elucidating the indications, risks, and expectable benefits of psychotherapeutic and pharmacological treatments are needed.
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The article is a review of the selected theoretical concepts of eating disorder etiological factors and the authors' experience in the field of psychotheraphy of women with anorexia and bulimia nervosa. The authors describe various psychological and psychoanalytical concepts, for instance the theory of object relations by R. Spitz, D. Winnicott and H. Bruch's the theory of development. They indicate the importance of primary mother-child relations in the genesis of eating disorders as well as the process of the child's separation, his becoming independent and the basis of forming the child's attitude towards eating. They also show the difficulties during the course of psychotherapy for women with eating disorders.
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Patients with obsessive-compulsive disorder complain of anxiety-producing intrusive thoughts and/or perform repetitive, anxiety-reducing rituals. A combination of behavior therapy and drug therapy is generally beneficial in this relatively common disorder. Behavior therapy consists of exposing patients to anxiety-provoking situations and helping them avoid ritualistic responses. Drug therapy appears to work by blocking serotonin reuptake in the brain.
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