Treatment of oral character neurosis in group psychotherapy

Summary In summary, orally regressed neurotic characters are generally regarded as extremely resistive and discouraging patients because of their excessive narcissism, weak, unadaptable ego, clinging passive dependency, intense infantile rage, strong psychic masochism, and intense need to provoke aggression. This author has found, however, that patients in this category are more likely to respond to treatment when it is provided in a group setting.This hard core of oral character neurotics who frequently resemble borderline psychotics because of their tenacious masochistic defenses often find it easier to recognize the rigid and inappropriate defenses they habitually employ after they have seen similar defenses enacted by their group peers. Watching others play out their various senseless and stubborn delaying tactics stimulates such patients to question their own inflexible behavior when it is challenged or interpreted. Moreover, in the group setting, they are made aware of the fact that the acknowledgment of anxiety by their peers does not demean them; nor do they become passive and vulnerable objects for annihilation as a result. They find instead that the uncovering of conflicts evokes sympathy, and produces tangible help by all the members of the group, including the unconsciously feared therapist who is perceived as the bad mother.Reprinted with permission from Sager, C. J. and Kaplan, H. S. (Eds.)Progress in Group and Family Therapy. New York: Brunner/Mazel, 1972.     

The core elements of neurosis: mixed anxiety-depression (cothymia) and personality disorder

Although there has been great diagnostic activity within the conditions formally included under the general rubric of neurosis in the last 20 years, there is little evidence that the many new diagnoses (i.e., generalized anxiety disorder, panic disorder, social anxiety disorder, and dysthymic disorder) have helped clinicians and improved the health of those diagnosed. This is largely because of the extensive comorbidity between these disorders negates much of their attempted separation and it is argued that the core of neurosis is a mixed anxiety-depressive disorder, or cothymia, combined with significant personality disorder of any type. The specific association of the anxious-fearful personality cluster (cluster C) and neurosis, called the general neurotic syndrome, is also relevant but appears to have lesser significance as the personality elements are not stable. Data are presented that justify these conclusions from a long-term follow-up study of anxiety and depressive disorders.     

Temperament, character, and attachment patterns in borderline personality disorder.

The aim of this study was to assess the specificity of the association between temperamental vulnerability, character deficits, and Borderline personality disorder (BPD), controlling for the effects of attachment patterns. A total of 44 BPD patients were compared with 98 non-BPD patients with other cluster B Personality Disorder (PD) diagnoses, 39 patients with any cluster A or cluster C PD diagnoses, 70 patients with no PD diagnosis, and 206 nonclinical patients. All patients were administered the Temperament and Character Inventory, the Parental Bonding Instrument, and the Attachment Style Questionnaire. Multivariate and univariate tests showed that BPD patients differed significantly from all control groups on Novelty Seeking and Cooperativeness. These differences remained significant when controlling for the effect of attachment.     

Actual neurosis as the underlying psychic structure of panic disorder, somatization, and somatoform disorder: an integration of Freudian and attachment perspectives

Starting from a contemporary critique of the DSM-IV, this paper argues that the diagnostic categories of panic disorder somatization, and undifferentiated somatoform disorders can be understood as belonging to a common type of psychopathology--i.e., the Freudian actual neuroses. In addition to their strong clinical similarity, these disorders share an etiological similarity; and the authors propose a combination of Freud's focus on this type of patient's inability to represent an endogenous drive arousal with the post-Freudian focus on separation anxiety. An etiological hypothesis is put forward based on contemporary psychoanalytic attachment theory, highlighting mentalization. Concrete implications for a psychoanalytically based treatment are proposed.     

Diagnostic issues in posttraumatic stress disorder: considerations for the DSM-IV

Four issues of key interest with regard to posttraumatic stress disorder in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are discussed. These include: (a) how to define the stressor criterion, especially, whether or not the victim's response ought to be included and whether low-magnitude traumas qualify etiologically; (b) the cohesiveness of the syndrome and the validity of items across stressor groups; (c) the position of posttraumatic stress disorder within DSM-IV; and (d) comorbidity with other illnesses.