The missionary syndrome

Early sexual explorations of children that are of a traumatic nature are often labeled by the child as bad or wrong and subsequently repressed. The guilt that results from the labeling may be intensified at a later date by some other similar incident, and at this time the person may make a binding commitment or promise to God to serve Him in some dutiful way. If, at a later date, these plans to serve God cannot be realized, depression, phobias, or conversion symptomatology may occur, which we have referred to as the Missionary Syndrome.Ray O. Sexton, M.D., is a psychiatrist in private practice in Memphis, TennesseeWith Dr. Sexton, he maintains a private practice in Memphis, Tennessee.     

The prostitutes' syndrome

When female patients, at critical periods in their lives, receive suggestions regarding promiscuous and unacceptable behavior, they may at a later time in life act upon these suggestions. However, involvement in promiscuous sexual behavior results in guilt, which will often be seen clinically in the form of depressive neuroses or psychosomatic illness. Several case histories are presented, and implications for treatment are discussed.M.D. is a psychiatrist in private practice in Memphis, Tennessee, maintaining an active inpatient and outpatient practice of psychotherapy.With Dr. Sexton, he maintains a private practice in Memphis.     

The pathological left-handedness syndrome

A clinical syndrome of pathological left-handedness (PLH) is proposed to identify the pattern of correlative changes in lateral development associated with early brain injury in some manifest left-handers. This syndrome is believed to be caused by a hemispheric lesion that is predominantly left-sided (or bilateral asymmetric), which onsets before Age 6, and which encroaches upon the critical speech zones of the frontotemporal/frontoparietal cortex. The pattern of changes may include any or all of the following features: shifts in manual dominance, trophic changes in the extremities, transfer of hemispheric speech, and/or intrahemispheric reorganization of visuospatial cognitive functions. Although some of these correlates of PLH have long been known, they have not been recognized as an interrelated pattern of traits that constitute a clinical syndrome. Identification of these individuals, all manifest left-handers, will be shown to have implications for diagnosis/remediation and for models of recovery of function.     

The syndrome of hyperlexia

Recent research on hyperlexic children is reviewed and criticized. A case study of a mute hyperlexic girl is presented, along with comments on the implications of this case for theories of hyperlexia. The hypothesis is put forth that hyperlexia in children suggests the existence of an innate written language capacity. The implications of this hypothesis for linguistic theory are discussed.     

The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome

The hypothalamo-pituitary-adrenal (HPA) axis plays a major role in the regulation of responses to stress. Human stress-related disorders such as chronic fatigue syndrome (CFS), fibromyalgia syndrome (FMS), chronic pelvic pain and post-traumatic stress disorder are characterized by alterations in HPA axis activity. However, the role of the HPA axis alterations in these stress-related disorders is not clear. Most studies have shown that the HPA axis is underactive in the stress-related disorders, but contradictory results have also been reported, which may be due to the patients selected for the study, the methods used for the investigation of the HPA axis, the stage of the syndrome when the tests have been done and the interpretation of the results. There is no structural abnormality in the endocrine organs which comprise the HPA axis, thus it seems that hypocortisolemia found in the patients with stress-related disorder is functional. It may be also an adaptive response of the body to chronic stress. In this review, tests used in the assessment of HPA axis function and the HPA axis alterations found in CFS and FMS are discussed in detail.     

The Adam and Eve syndrome

Conclusion The concept of divine forgiveness is incomprehensible to most, since it involves principles that defy rational interpretation on the level of human cognition. As a result, individuals, and especially those who present themselves for treatment, find themselves caught up in a repetition of self-judgment and selfpunishment, which is a reenactment of the original sin and the disobedience encountered in the Garden of Eden. It can be pointed out to patients that this continuous, repetitious acting out of the functions of self-judgment and selfpunishment represents the worst sin of all—the original sin in which the power and authority of God are usurped and assumed, resulting eventually in a denial of God along with symptoms that are often incapacitating. When these functions are returned to God, punishment can be expected to be much less severe and intense, because of the nature and characteristics of divine forgiveness.Ray O. Sexton, M.D., is a psychiatrist in private practice in Memphis, Tennessee, maintaining an active inpatient and outpatient practice of psychotherapy. He is a graduate of the University of Tennessee Center for Health Sciences and is a clinical instructor in psychiatry at the Center. He was a Duke University fellow in psychiatry and served with the U.S. Navy as a medical officer from 1969 to 1971.Richard C. Maddock, S.T.M., Ph.D., is an Episcopal priest and a licensed psychologist in Arkansas and in Tennessee. He has published a number of scholarly articles in the areas of social and clinical psychology and in the psychology of religion. He is a member of the American Psychological Association and various state and regional associations, at which he has presented scientifie papers. With Dr. Sexton, he maintains a private practice in Memphis, Tennessee.     

The syndrome of traumatic grief

Traumatic grief is a common and debilitating syndrome whose clinical presentation is well recognized but whose diagnostic criteria have only recently been delineated. Though it shares features with major depressive disorder, adjustment disorder, and posttraumatic stress disorder, none of these subsume the criteria set for traumatic grief, and the diagnostic overlap is limited in community samples. Furthermore, diagnosis of traumatic grief appears to have prognostic value for clinical course and treatment response among bereaved individuals. In the absence of empirically supported treatments of pathological grief, a new, manualized treatment for traumatic grief symptoms has been developed and is currently undergoing testing in a randomized controlled trial. The conceptual basis for Traumatic Grief Treatment (TGT) is presented, the structure of the treatment is outlined, and the primary clinical strategies employed are described.     

The Williams syndrome cognitive profile

Williams syndrome is a rare neurodevelopmental disorder caused by a hemizygous deletion of approximately 1.5 megabases on chromosome 7q11.23. In this article, we outline a Williams Syndrome Cognitive Profile (WSCP) that operationalizes the cognitive characteristics of the syndrome using measures of absolute and relative performance on subtests of the Differential Abilities Scales (Elliot, 1990a). Testing confirmed excellent sensitivity and specificity scores for the WSCP. Seventy-four of 84 individuals with Williams syndrome fit the WSCP while only 4 participants in a contrast group met all of the WSCP criteria. It was also found that the WSCP does not vary greatly with chronological age or overall level of cognitive ability for individuals with Williams syndrome. Possible applications for the WSCP include psychoeducational evaluation and empirical research such as the search for genotype/phenotype relations in this genetically based syndrome.     

The borderline syndrome in adolescents

The borderline adolescent is discussed in terms of diagnostic perspectives, characteristic features based on disturbed object relations, and treatment. The disorder is not fully manifest in adolescence but gradually emerges into a definable personality type, the various features of which express the unsatisfactory outcome of a complex psychodynamic struggle related to developmental arrests in psychic structure. Based on clinical observations, the diagnosis of borderline personality, like the schizoid personality, is considered to be compatible with a past, present or future schizophrenic disorder. Finally, therapeutic approaches in a day-treatment program, and individual therapy is considered from a developmental object relations viewpoint.     

The savant syndrome and autistic disorder

Savant syndrome, characterized by remarkable islands of mental ability in otherwise mentally handicapped persons, may occur in autistic as well as nonautistic individuals. Overall, approximately 10% of autistic persons exhibit savant abilities; roughly 50% of those with savant syndrome have autism, and the remaining 50% have other forms of developmental disability. Most commonly, savant syndrome takes the form of extraordinary musical abilities, but may also include calendar-calculation, artistic, mathematical, spatial, mechanical, and memory skills. While savant syndrome was first described more than a century ago, only recently have researchers begun to employ a more uniform nomenclature and more standardized testing in an effort to compare the abilities of savants with those of normal persons. Males show signs of savant syndrome approximately four times more often than females. Along with imaging study findings, this fact suggests the presence of a developmental disorder involving left-brain damage with right-brain compensation.     

The cognitive profile of Sotos syndrome

Sotos syndrome is a congenital overgrowth disorder, associated with intellectual disability. Previous research suggests that Sotos syndrome may be associated with relative strength in verbal ability and relative weakness in non-verbal reasoning ability but this has not been explicitly assessed. To date, the cognitive profile of Sotos syndrome is unknown. Cognitive abilities of a large and representative sample of individuals with Sotos syndrome (N = 52) were assessed using the British Ability Scales (BAS3). The majority of participants had intellectual disability or borderline intellectual functioning. The cluster score profile analysis revealed a consistent verbal ability > non-verbal reasoning ability profile. Four specific criteria were proposed as the Sotos syndrome cognitive profile (SSCP): verbal ability > non-verbal reasoning ability; quantitative reasoning T-score or matrices T-score <20th percentile; quantitative reasoning T-score < mean T-score; recognition of designs T-score or recognition of pictures T-score > mean T-score. Of the 35 participants included in the profile analysis, 28 met all four SSCP criteria, yielding a sensitivity of 0.8. The sensitivity of each of the SSCP criteria was >0.9. Individuals with Sotos syndrome display a clear and consistent cognitive profile, characterized by relative strength in verbal ability and visuospatial memory but relative weakness in non-verbal reasoning ability and quantitative reasoning. This has important implications for the education of individuals with Sotos syndrome.