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[Ulcerative rectocolitis: autogenous training. On serveral serious cases (author's transl)].
Three patients, suffering from severe ulcerative rectocolitis which could require surgery, were significantly improved by standard exercises of autogenous training with a combination of drug treatment. Somatic morbid signs (clinical as well as rectoscopical) were disappearing through the establishment of a better adaptation to reality. The importance of the therapeutic frame is underlined.
[Sexual failure expectation syndrome and the modification of behavior].
Modifications of behavior were examined in 105 men with sexual failure expectation syndrome. Such modifications were revealed in 77 persons. The determinants and sources of behavioral modifications were defined. It has been shown that phenomenology of behavioral modifications is uncertain, being different as regards the complexity and degree of realization. Different variants of behavioral modifications are described: defense, compensatory, controlling oneself, by the detention type, manipulative, and combined. It is recommended that they be taken into consideration with a purpose of forming in patients of constructive behavioral programs.
Passive-aggressive behavior in patients and staff.
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Helping disturbed children change their passive-aggressive behavior through milieu therapy.
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The sweet saboteur in your office.
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Attachment and educational investment of adolescence.
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The comorbidity of multiple personality disorder and DSM-III-R axis II disorders.
Our ability to differentiate MPD from DSM-III-R Axis I disorders has become increasingly refined. Differentiation of MPD from the Axis II personality disorders is an area of more recent clinical investigation. MPD can be found comorbidity with many other psychiatric conditions. It is found in association with each of the DSM-III-R personality disorders. At the present time, however, we lack research data that define the prevalence of the comorbidity of MPD with the personality disorders. Objective study of this area is complicated by the paucity of instruments available to assess personality dimensions in the presence of a DD. In addition, the currently available personality inventories tend to overdiagnose BPD in patients with a high level of distress and acuity of symptoms. The diagnosis of a personality disorder in a patient with MPD is made on the basis of the assessment of the "whole" human being. It is based on the presence of a pervasive and relatively inflexible pattern of behaviors that reflects the individual predominant mode of being. The diagnosis of a personality disorder is not made on the basis of personality traits contained within any single alternate personality or groups of personalities. The personality disorders defined by DSM-III-R are a heterogeneous group of conditions whose individual etiologies reflect a complex interplay of constitutional, genetic, environmental, interpersonal, and psychodynamic factors. The interplay is variable and diverse between these determinants of the personality disorders and the traumatic forces that result in the development of a DD. For the Cluster A personality disorders (schizoid, schizotypal, paranoid), there is evidence supporting a relationship with specific psychotic illnesses. The combination of dissociative pathology with these personality disorders commonly results in a greater impairment of reality testing than in either condition alone. The Cluster B personality disorders (histrionic, narcissistic, borderline, antisocial) and Cluster C personality disorders (avoidant, compulsive, dependent, passive-aggressive) are believed to be primarily developmental disturbances. Comorbidity of these personality disorders with MPD involves consideration of the interaction of many developmental processes with the psychological impact of severe childhood trauma. Many MPD patients present with an apparent mixed personality profile consisting of an array of avoidant, compulsive, borderline, narcissistic, dependent, and passive-aggressive features. Although this article explores comorbidity of MPD with each of the personality disorders defined in DSM-III-R individually, it seems likely that a number of posttraumatic personality organizations can be defined that commonly coexist with MPD.(ABSTRACT TRUNCATED AT 400 WORDS)
The doctor's wife: mental illness and marital pattern.
It is a clinical impression that physicians' wives present in disproportionately large numbers as psychiatric patients; that in the vast majority severe marital problems are present; and that the marital relationships show a similar pattern. The purpose of this paper is to ascertain whether the latter two impressions have any basis in fact. Accordingly, a random sample of twenty physicians' wives who had been in-patients in the University of British Columbia Health Sciences Centre Hospital during the period March 1, 1969 to May 31, 1973, and whose husbands had been interviewed, was selected. The records were reviewed to obtain personal data, pertinent psychiatric history, diagnosis, the personality of husband and wife and information on the marital relationship. These conclusions emerged: 1. Ninety per cent of the patients had a primary diagnosis of depressive neurosis. 2. Ninety-five per cent of the patients had a secondary diagnosis of personality disorder, hysterical personality and passive-aggressive personality in order of frequency. 3. In 90 per cent of the patients there was a history of suicidal preoccupation or attempt. 4. In 55 per cent of the patients there was a history of significant drug and/or alcohol abuse. 5. The patients were more frequently ward management problems. 6. A common marital pattern was noted: a dependent, histrionic wife and an emotionally detached husband. 7. The cases were characterized by their complexity, severity, long duration and difficulties involving the patient and spouse in an appropriate treatment plan. The authors discuss the implications of this study, particularly its significance in provoking examination of what measures might be utilized for early detection and intervention with those physicians and physician-marriages at risk.
Diagnosis of DSM-III-R personality disorders by two structured interviews: patterns of comorbidity.
OBJECTIVE: The purpose of this study was to examine patterns of co-occurrence of axis II disorders in a group of consecutive patients evaluated with two contrasting structured interviews. METHOD: One hundred of 106 consecutive applicants for long-term, inpatient treatment of severe personality psychopathology were assessed, face-to-face, by psychiatrists using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Personality Disorder Examination (PDE). The percent of co-occurrence of pairs of disorders diagnosed by each structured interview separately was calculated, and significance levels were determined by using chi-square tests of independence. Finally, odds ratios were computed for the odds of each pair of disorders occurring together compared with the odds for the occurrence of each disorder alone. RESULTS: The two interview methods revealed different comorbidity patterns. Significant covariation was found for 29 pairs of disorders diagnosed with the PDE, compared with 12 pairs diagnosed with the SCID-II. Six pairs of disorders covaried significantly and were associated with odds ratios greater than 4: histrionic with borderline, histrionic with narcissistic, narcissistic with antisocial, narcissistic with passive-aggressive, avoidant with schizotypal, and avoidant with dependent. CONCLUSIONS: Substantial overlap occurred among personality disorders. In this group of patients, consistent patterns of comorbidity involving narcissistic, avoidant, and histrionic personality disorders suggest that categorical distinctions between them and certain other DSM-III-R personality disorders may be illusory. The question of which of two overlapping disorders is more valid, however, is left unanswered. For clinical purposes, a two-level diagnostic convention is proposed.
MCMI-II diagnosis of borderline personality disorder: base rates versus prototypic items.
The Millon Clinical Multiaxial Inventory-II (MCMI-II) profiles of 26 psychiatric inpatients diagnosed as having borderline personality disorders were compared with profiles of 42 patients with no personality disorders. The borderline group scored significantly higher on the following scales: Disclosure (X), Debasement (Z), Passive-Aggressive (8A), Self-Defeating (8B), Borderline (C), and Major Depression (CC). Differences approaching significance were also found on substance abuse measures: the Alcohol Dependence (B) scale and Drug Dependence (T) scale. These findings are consistent with criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) and the results of other studies utilizing the MCMI-II. In addition, diagnostic efficiency of Scale C was assessed at various cutoff points defined by either base rate (BR) scores or the number of prototypic items endorsed. The greatest efficiency was found when a cutoff of seven or more prototypic items was utilized, with nearly 80% of the patients correctly classified. Results are discussed in terms of their relevance for further research.
[Relations between mood disorders and personality. Recent data].
In the field of studies of links between mood disorders and personality, the need to study only completely remitted patients has been demonstrated recently. Indeed, the clinically depressed state strongly influences the assessment of some personality traits in a more pathological direction (for instance for emotional stability, extraversion, interpersonal dependency, ego strength). The studies concerning unipolar depression have been mainly made according to two methodological approaches which results are relatively consistent. The first one uses batteries of standard self-report personality inventories such as the Hirschfeld and Klerman battery which includes the Guilford-Zimmerman Temperament Survey, the Interpersonal Dependency Inventory, the shortened version of the Lazare-Klerman-Armor Personality Inventory and two subscales of the MMPI. This approach shows that compared to normal population, recovered depressive, have less emotional strength more interpersonal dependency and a more introverted personality. The second approach uses diagnostic criteria of personality disorders according to DSM III. The clinical evaluation can be performed with the help of the Structured Interview for DSM III Personality Disorders (SIDP) or with of the help the Millon Clinical Multiaxial Inventory (MCMI), a self rated questionnaire. The most frequent personality disorder among recovered unipolar patients is dependent personality, followed by the avoidant and histrionic personalities and lastly the schizoïd, schizotypal, borderline, compulsive and passive-aggressive personalities. But the interpretation of all these results must be cautious given that a recent study dealing with premorbid personality invites one to consider that not only depression influences personality assessment during illness, but also that depression may result in personality change after recovery. Few studies are available concerning bipolar patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Treatment outcomes of Vietnam veterans with Posttraumatic Stress Disorder.
This study examined changes on the Millon Clinical Multiaxial Inventory for 45 Vietnam veterans who completed a specialized inpatient treatment program. The average length of stay for these veterans was 140 days. Patients' scores on the Millon decreased on 12 of the 20 scales and increased on 8, and their Posttraumatic Stress Disorder-related symptoms of anxiety and dysthymia decreased significantly. Posttraumatic Stress Disorder-related character styles, schizoid, avoidant, and passive-aggressive, also showed significant decreases.
The relationship between personality type and style of alcohol use.
Two hundred fifty male, alcoholic VA inpatients were administered the Millon Clinical Multiaxial Inventory (MCMI) and the Alcohol Use Inventory (AUI). A cluster analysis, based on the scales of the MCMI, yielded three clusters: Cluster 1 was the smallest and was described by the least overall psychopathology. Cluster 2 had significant elevations on Antisocial, Narcissistic, Paranoid, Drug and Alcohol Abuse scales. Cluster 3 was the largest and had significant elevations on Avoidant, Schizoid, Dependent, Passive-Aggressive, Anxiety, Dysthymia, and Alcohol Abuse scales.
Accuracy of MCMI classification of angry and psychotic black and white patients.
This study compared the ability of the MCMI personality scales to accurately predict anger and psychosis in White (n = 778) and Black (n = 272) psychiatric inpatients. Race-adjusted norms (Millon, 1984) were used to compute patients' scale scores. The MCMI successfully predicted anger and psychosis for both races (p less than .001). No difference was found in accuracy of prediction between Whites and Blacks (p greater than .40). In addition, the scales important for prediction were similar for Whites and Blacks. The Passive-Aggressive Scale best predicted anger, whereas the Avoidant Scale best predicted psychosis. The results suggest that the MCMI does predict accurately two important characteristics with both Black and White patients, but some racial bias remains.
DSM-III-R narcissistic personality disorder evaluated by patients' and informants' self-report questionnaires: relationships with other personality disorders and a sense of entitlement as an indicator of narcissism.
Modified versions of the revised Personality Diagnostic Questionnaire (PDQ-R) for DSM-III-R personality disorders (PDs) were completed by 60 patients and their informants. Patients' ratings gave a mean number of 4.5 PDs per subject and narcissistic (NAR) PD in 42%. Informants' ratings gave NAR PD in 38%. For patients and informants, NAR PD scores (i.e., the number of positive NAR PD criteria for each subject) were significantly correlated with histrionic (HIS) and borderline (BOR) PD scores and with scores of some PDs outside DSM-III-R's "cluster B." Also, there were significant correlations between patients' and informants' NAR PD scores and between NAR PD scores and total number of positive criteria (i.e., for all 13 PDs) for patients and informants. For patients' ratings, there were significant associations between NAR PD and HIS, BOR, and passive-aggressive (PAG) PDs and, for informants' ratings, between NAR and HIS PDs. There was no significant association between patients' and informants' diagnoses of NAR PD. Grandiosity, the most characteristic feature of narcissism, is related to NAR PD criteria 3 through 6. The patients' evaluation of criterion 6 (i.e., "Has a sense of entitlement ...") shows satisfactory item-total correlation and endorsement frequency, together with "fair to good" reliability when patients' and informants' ratings are compared (kappa = 0.62). The identification of a sense of entitlement by the patient may be a relatively reliable and valid indicator of narcissism.
The use of the MCMI in the personality assessment of head-injured adults.
MCMI (Millon Clinical Multiaxial Inventory) profiles of 79 head-injured patients were compared with self-report of personality change following head injury. Mean MCMI scale scores were highest on Scales D (Dysthymia), A (Anxiety), 6 (Antisocial), H (Somatoform), 5 (Narcissistic) and 7 (Compulsive). Taking only high-point codes above an adjusted base-rate score of 75, the sample showed most frequent elevations on A (Anxiety), D (Dysthymia), H (Somatoform), 5 (Narcissistic), 6 (Antisocial-Aggressive) and 8 (Passive-Aggressive), in order of cumulative frequency. Personality trait scales and clinical scales were compared with self-report of personality changes. Elevated personality trait scales correlated with self-reports of dysfunction and so did clinical scale elevations. There was no relationship between the number of elevated scales and severity of head injury, nor between the number of elevated scales and interval after head injury.
Personality status: changes through adolescence.
1. Forty-two percent of a nonclinical sample of urban 18 year olds displayed some degree of personality dysfunction. This rate of disturbance is similar to a previously reported rate for 13 year olds, but higher than the prevalence rate for 16 year olds. Thus, early and late adolescence seem to represent "at risk periods" for the genesis of character pathology. 2. In late adolescence, the form of this disturbance is as follows: 40% fall into a histrionic, borderline, narcissistic cluster, whereas nearly 30% demonstrate an atypical or mixed picture. This differs markedly from the distribution of dysfunction in earlier subphases. 3. Thirty-eight percent of the disturbed sample showed evidence of dysfunction at all three subphases (early, middle, and late), whereas 62% fluctuated in or out of disturbance at one subphase or another. 4. There was a notable lack of consistency with respect to type of personality dysfunction from both a group and individual perspective, except for paranoid, schizoid, and schizotypal disturbance. This particular cluster retained both group and individual stability from age 13 to 18. 5. Two trends were evident however: teenagers who initially presented as avoidant, dependent, compulsive, or passive-aggressive seemed to grow out of their dysfunction. By age 18, hardly any of the original subjects remained in this cluster, and most had become clear. Secondly, most of the adolescents identified as antisocial in early or middle adolescence migrated into the histrionic, narcissistic, borderline cluster in late adolescence. This latter group showed a steady increase throughout the time span studied, suggesting the importance of developmental factors.