Obsessive Traits Research Articles

Fantasy or Structural Defect? The Borderline Dilemma as Viewed From Analysis of an Experience of Nonhumanness

The experience of nonhumanness, a crucial aspect of the phenomenal self of borderline states, is studied in two cases to test assumptions concerning the application of the classic ego-psychological or object-relations and self-psychological models. Are these experiences to be seen as fantasy and treated as manifest content, with dynamically active unconscious conflict and meaning, requiring interpretation, or as a developmental arrest in which structural disturbances are ameliorated through clarifying and empathic interventions? The first case is of a patient with a neurotic depression and hysterical and obsessional character traits, treated in a classic psychoanalysis. Even though dyadic oral and anal fantasies were strongly in evidence, the ego was well integrated. The second case is of a severe borderline patient who showed depressive panic and agoraphobia. Her major ego disturbances, poorly integrated and differentiated self- and object representations, and primitive defenses prevented effective psychoanalytically oriented treatment. Interventions were used to consolidate self-representations, internalize tension-regulating structures, promote adaptive ego functions and reality testing. These clarifications were necessary to move the patient to where she could tolerate facing unconscious dynamic conflicts. Only at that point could repression be lifted, memory emerge, and interpretation be utilized.

Obsessiveness and adjustment

The relationship between obsessive symptomatology and traits on the one hand, and adjustment on the other is examined in 94 patients with obsessive-compulsive disorder. Symptomatology, as measured by the Leyton Obsessional Inventory (LOI), was found to be significantly and positively correlated with maladjustment (occupational, leisure, sexual, intrafamillial, extrafamilial, social, and expressed self-satisfaction). Obsessional traits, as measured by the LOI, were found to be uncorrelated with maladjustment. The implication of the results for the theory that traits and symptoms represent a continuum and the generalizability of the findings to normals are discussed.

Clinical characteristics and family history in DSM-III obsessive-compulsive disorder.

The authors present the clinical characteristics, demographic features, and family history of a clinical sample of 44 patients who met DSM-III criteria for obsessive-compulsive disorder. Their findings are consistent with those of previous epidemiologic studies completed before the introduction of DSM-III with regard to phenomenology, course, and demographic characteristics. Most of the 44 patients had concomitant or lifetime histories of a major depressive disorder or another anxiety disorder. A number of first-degree relatives of these patients had probable obsessive-compulsive disorder or obsessive traits. The findings of this study should prove useful in further epidemiologic, biologic, and behavioral studies.

Personality and psychosis: use of the Standardized Assessment of Personality.

The Standardized Assessment of Personality, a semistructured interview for use with an informant, was used with a relative or a close friend to determine the premorbid personality of 100 consecutive patients admitted with major psychiatric disorders - major affective disorders (18 manics, 35 depressives), schizophrenia (28) and other functional psychoses (19). Forty-four per cent of the entire sample had an abnormal personality as defined by the presence of one of 10 prominent traits to a marked degree. A further 6% had the same traits to a lesser degree. The proportion of patients with an abnormal personality (all types) was comparable across the four diagnostic groups (manics 39%, depressives 54%, schizophrenics 39%, other functional psychotics 37%). However, if one included all traits (marked and mild), patients with an affective disorder had more between them than did the non-affective groups. This difference was largely accounted for by cyclothymic, anxious and obsessional traits. The schizophrenics and other functional psychotics had surprisingly few prominent traits and, in particular, a schizoid personality rarely preceded a schizophrenic illness.

Obsessional personality traits and risk for bipolar affective disorder: An offspring study.

Obsessional personality traits and risk for bipolar affective disorder: An offspring study.

Obsessional personality traits and risk for bipolar affective disorder: an offspring study.

Obsessional personality traits and risk for bipolar affective disorder: an offspring study.

Genetic and environmental influences on obsessional traits and symptoms.

A biometrical genetic analysis was carried out on the response of 419 pairs of twins to the 42-item version of Leyton Obsessional Inventory. Just under half the variation in both the Obsessional Trait and Symptom Scales was due to heredity. Multivariate analysis revealed a genetic effect on the development of obsessional personality and also the transmission of a general tendency predisposing to neurotic breakdown. Although the influence of heredity was outweighed by that of the environment, the latter effect showed an absence of general factors and, in particular, of any noticeable effect from the common home environment.

The comparative psychopathology of anorexia nervosa: Obsessive-compulsive disorder or phobia?

The current study investigates the similarities and differences between anorexic restricters, anorexic bulimics, female obsessives, agoraphobics, social phobics, and specific phobics. Measures of psychopathology were self-ratings of adjustment, the IPAT, FSS, MPI, and LOI. Results indicated that persons suffering from anorexia nervosa and bulimia nervosa were more similar to obsessives than to phobics with respect to obsessional personality traits and neuroticism. Additional research is needed in the examination of the central preoccupation in order to understand the differentiation of the various disorders and to what extent anorexia nervosa is a nosological entity.

A description of the psychological effects of chronic painful lesions

The social adjustment and psychological characteristics of a group of patients with lesions presumed to be representative of an ‘ordinary’ pain clinic population have been examined. As expected there was a significant degree of disturbance of work, sleep, sport, exercise, leisure and social activities and sexual relationships. Patients with back pain found sitting to be particularly troublesome ( P < 0.0001) which suggests that they would have physical reasons for responding to programmes emphasizing ‘activity.’ They used more affective words proportionately to describe it than those with pain elsewhere, but both groups used far more sensory words overall than affective ones. Formal depression of the type measured by the Levine-Pilowsky Depression Questionnaire which corresponds to the psychiatric interview was not prominent. On the SCL-90, a more widely ranging type of psychological test, there were marked elevations on the somatization scale which are partly artifact, and also significant elevations for obsessive traits, depression, anxiety and general symptoms. Questions in the tests concerning irritability and frustration were frequently answered affirmatively. Low-back pain patients and compensation patients did not differ significantly from the remainder on the SCL-90 or on the Levine-Pilowsky Questionnaire. The findings are taken to indicate an understandable pattern of emotional response to chronic pain whether in the low back or elsewhere, as well as a specific difference in descriptions in patients with low-back pain. They are held to support the view that many patients receiving compensation have the same pattern of emotional response as those who do not obtain financial payment because of their illness.

Personality traits and disorder in depression.

The authors examined the relationship of personality traits and personality disorder to depressive subtype, descriptive characteristics, and outcome in 160 depressed inpatients. Personality disorder was significantly more common in unipolar nonmelancholic depressed patients (61%) than in unipolar melancholic (14%) or bipolar depressed patients (23%). Personality disorder did not affect symptom manifestation but was related to earlier onset of depressive illness and worse outcome within the unipolar nonmelancholic group. Obsessive traits were most common in the unipolar melancholic patients, while histrionic, hostile, and borderline traits predominated in the nonmelancholic patients. The authors discuss the usefulness of a multiaxial diagnostic system and the importance of separating trait and disorder in personality assessment.

Obsessionality and reversal theory.

The study investigates the hypothesis that obsessional traits may be related to telic dominance (a state in which the individual pursues goals seen by him as essential) while obsessional symptoms may be related to extreme vacillation between telic dominance and its opposite state of paratelic dominance (in which the individual concentrates upon the purely diversionary nature of an activity). Using questionnaire methods and normal subjects, the hypothesis received cautious support.

Relationship between obsessional personality traits, neuroticism and extraversion in normal subjects

On the basis of the available literature, the relationships between obsessional personality traits, neuroticism, and extraversion are unclear. Two studies on recovered depressed patients yielded conflicting results. 1,2 In our present study we attempted to investigate this issue by using a large group of normal individuals.

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.

Non-organic gastrointestinal illness: a medical and psychiatric study.

One hundred consecutive referrals to a general medical out-patient clinic were evaluated psychiatrically under blind conditions in order to investigate the nature and occurrence of non-organic disease presenting as gastrointestinal illness. Twenty-eight patients had marked psychiatric illness with or without physical illness, and there was an association between psychiatric illness and the absence of organic disease, as determined by outcome at follow-up of 4-11 months. Patients with obsessional traits were more at risk of non-organic illness. Historical items indicating a likelihood of non-organic gastrointestinal illness included "nerves", "depression", unhappy childhood, early parental loss and early separations from parents during childhood. Psychiatric illness often persisted after treatment for physical symptoms. Some of the techniques used in this study to identify psychiatric illness could be usefully employed in everyday practice.

Obsessional personality traits and ABO blood types.

The relation of ABO blood types to obsessional personality traits, as measured by the Leyton Obsessional Inventory (LOI), was studied in a sample of 600 normal individuals. High scorers of the LOI trait portion demonstrated a significantly lower incidence of phenotype O and a significantly higher incidence of phenotypes AB, A and B, taken together, compared to those of a general population sample and the entire study group. Findings of the present study, in conjunction with previous findings concerning a lower incidence of phenotype O and a higher incidence of phenotype A in obsessive compulsive patients, could be interpreted as indicating that phenotype O may be associated with personality traits hindering the development of obsessive-compulsive symptomatology.

Relations of obsessional traits to anxiety in patients with ulcerative colitis.

The obsessional personality traits and the "state" and "trait" anxiety, measured by means of self-rating inventories, were correlated in a group of patients with ulcerative colitis and a group of anxiety neurotics. The results suggest that patients with ulcerative colitis demonstrate strong positive trends, contrary to neurotics who show negative or very weak correlations, during the active period of their illness. These findings are discussed and some hypotheses concerning the different association of anxiety to obsessionality between the two groups are presented.

Psychiatric Aspects of Deafness

Paranoia has long been associated with deafness, but the most significant psychiatric questions in the field of deafness concern the effects of prelingual deafness on intelligence, personality, and control of aggressive drives. With intensive language training, an emotionally favorable family situation, and adequate education, prelingual deafness has little or no deleterious effect on intelligence or personality. It does not predispose to major psychotic illnesses, but probably affects character structure in such a way as to accentuate impulsivity, and weaken depressive and obsessional traits. In order to prevent psychiatric morbidity in the deaf, the primary care physician needs not only to be able to diagnose and treat deafness and its causes, but also to grasp the importance of family counseling, adequate communication and education, and vocational rehabilitation for the deaf.

The Leyton Obsessional Inventory: an analysis of the responses of 73 obsessional patients.

The Leyton Obsessional Inventory was administered to 73 obsessive-compulsive neurotics, and their responses compared with those of 100 normal subjects. The ratio of the mean patient to normal scores ranged from 2.4:1 for obsessional traits and 3.2:1 for symptoms to 6.2:1 for resistance and 12.5:1 for interference with other activities. A principal components analysis on the patients' replies produced 3 unitary components (household order, personal contamination, and doubting) plus 2 bipolar components (checking/parsimony and desire for closure/unpleasant ruminations). These appeared to be more definitive representations of components identified from a similar analysis on normal subjects, suggesting that obsessional neurotics differ from normal subjects quantitatively rather than qualitatively. A cluster analysis on the patients' responses produced 3 subgroups. Thirty-two patients were predominantly hesitant and indecisive ('doubters'), 30 were concerned with bodily and clothing contamination ('contaminators'), and 7 were preoccupied with checking ('checkers').

Pre-morbid personality traits and responsiveness to flooding in obsessive-compulsive patients

Clinical and psychophysiological assessments were carried out before and after completion of flooding treatment in two groups of obsessive-compulsive patients, matched for age and duration of the illness but differing in pre-morbid obsessional personality traits. Patients with such traits appear to demonstrate a specific autonomic sensitivity to flooding, probably related to either the reduction of anxiety after treatment or to certain qualities of the treatment itself. Significant changes after treatment regarding neutral stimuli and attitude ratings of untreated obsessional manifestations suggest a more global response to flooding in such patients. Some suggestions for further research are presented.

Anorexia Nervosa in Boys

The literature on primary anorexia nervosa in the male is reviewed and the case histories of 3 new patients are reported. Most surveys comment on the rarity of the syndrome in the male, with the sex ratio in the range of 1 in 10 to 1 in 20. The patients reported here had certain features in common. All the mothers and fathers were overweight, but obesity was marked only in the fathers, who also showed moderate to severe degrees of alcoholism. The mothers were oversensitive, insecure individuals, and the marriages suffered in proportion to the severity of the husband's alcoholism. Preoccupation with food was observed on home visits. There was overt mutual hostility between each father and anorexic son; the boys showed pronounced obsessional traits in their personalities. Dieting in order to ameliorate real or feared obesity was a first step in the development of the syndrome in each boy. In the past 3 years an equal number of boys and girls (new patients) have been referred for treatment in the psychiatric unit. Speculative reasons for this are discussed.