Rorschach evaluation of adolescent bulimics

It has become apparent that the excessive dieting engaged in by many girls when they reach puberty frequently serves as an impetus for the later development of eating disorders. While the existence of bulimia nervosa has been well documented in late-adolescent girls, only minimal research has been devoted to delineating the personality characteristics that distinguish bulimics from normal adolescents. The present study utilized the Rorschach to contrast 12 DSM-III-R diagnosed adolescent bulimics with 12 female adolescent controls. Exner's (1986) Comprehensive System was used for scoring the protocols. Statistically significant group differences were detected on both the overall Depression and the Schizophrenia Indices, as well as on several subcomponents of each. Additionally, bulimics averaged a greater number of aggression responses. The data suggested that the adolescent bulimics were more depressed, self-punitive, and negativistic than their peers, and that they had more disordered thoughts, inaccurate perceptions, and impaired judgment. The cognitive disturbances were not limited to the areas of food and weight. The results are alarming for this young population, particularly since the severity of symptoms certainly will increase over time if left untreated. Recommendations are made for early symptom identification and intervention.     

MCMI characteristics of DSM-III-R bulimics

The literature on bulimia has suggested that bulimic women exhibit a number of pathological personality characteristics. However, the Millon Clinical Multiaxial Inventory (MCMI), an objective measure of personality functioning, has not previously been utilized to assess the personality characteristics of a bulimic population. The MCMI was administered to 37 female bulimics, 32 female general psychiatric outpatients, and 30 normal female controls in order to assess the relationship between bulimia and pathological personality traits. Bulimic women were found to score higher than the other groups on MCMI Scales 1 (Schizoid), 2 (Avoidant), and 3 (Dependent). They also scored lower than the other two groups on Scale 6 (Antisocial). Results are discussed within the framework of parallels between the MCMI profiles of bulimics and the existing literature on bulimics' personality characteristics.     

Rorschach assessment of purging and nonpurging bulimics

Research in bulimia has flourished in recent years, and yet minimal attention has been devoted to explorations of the bulimic's basic personality organization. We utilized the Rorschach to differentiate between purging and nonpurging bulimics and controls. There were 15 subjects in each group. The Comprehensive System (Exner, 1986) was used for the scoring of the protocols. Statistically significant differences were not found between the two bulimia groups, but interesting trends were detected in the areas of depression, anger, and self-preoccupation. Results appear to be constrained by the low rate of purging behavior. Comparisons between the combined bulimia groups and the controls resulted in solidly characterizing the bulimics as displaying perceptual inaccuracies, disordered thinking, a vulnerability to interpersonal problems, a damaged self-image, and a pessimistic outlook. The strengths of the study were its use of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) nonpatients bulimic subtypes and a control group that was comparable in terms of demographics. Future Rorschach studies with bulimics displaying higher frequencies of binging and purging behaviors are suggested.     

Psychological characteristics of dieters and bulimics.

Two studies examined the continuum and discontinuity models of the relation between dieting and bulimia nervosa. In Study 1, 21 dieters, 19 bulimics, and 33 nondieting controls were compared on 24 measures. Multivariate analyses revealed that each of the groups differed significantly from the other two. Univariate analyses found 18 significant differences between bulimics and dieters and 1 significant difference between dieters and controls. In Study 2, 86 subjects completed measures of psychological functioning, dieting, and bulimia nervosa. On the basis of regression analyses using factor scores from the psychological variables as predictors, high scores on a psychopathology factor and low scores on a defensiveness factor predicted both bulimia and dieting. Low self-concept scores also predicted bulimia. These data indicate that both continuity and discontinuity characterize the relation between dieting and bulimia.     

Prevalence of personality disorders among bulimics,nonbulimic binge eaters,and normal controls

We examined the comorbidity of bulimia and personality pathology among college women. Subjects included women (n=23) meeting DSM-III-R criteria for bulimia nervosa (bulimics), women (n=23) who reported binge eating but did not fulfill the criteria for bulimia nervosa (binge eaters), and women (n=23) who did not binge eat (normals). The subjects completed an assessment battery consisting of the Personality Disorders Examination and the SCID as well as the Beck Depression Inventory, the Rosenberg Self-Esteem Index, and measures of impulsivity and self-defeating tendencies. Fourteen of 23 bulimics (61%) met criterion for a personality disorder using DSM-III-R Axis II criteria. In comparison, 3 of 23 (13%) binge eaters and 1 of 23 (4%) normal subjects received an Axis II diagnosis. Borderline and self-defeating diagnoses were the predominant personality disorders in 96% of the bulimics exhibiting clinically significant personality pathology. Bulimics also exhibited significantly more depression, impulsivity, and self-defeating behavior and lower self-esteem than binge eaters and normals. The findings are discussed within a conceptual framework that posits an interaction between personality pathology and restrained eating.     

Comparison of bulimics, obese binge eaters, social phobics, and individuals with panic disorder on comorbidity across DSM-III-R anxiety disorders.

Eighty-two women, presenting as normal-weight bulimics, obese binge eaters, social phobics, and individuals with panic disorder, were compared on anxiety, depression, and substance abuse. All were administered the Anxiety Disorder Interview Schedule-Revised and completed the Michigan Alcohol Screening Test, Drug Abuse Screening Test, and Self-Consciousness Scale. A striking proportion of eating disorder subjects were comorbid for one or more anxiety disorders, the most frequent diagnoses being generalized anxiety disorder and social phobia. The results suggest that the place of anxiety in bulimia nervosa goes beyond that discussed within the context of the anxiety reduction model. Conflicting comorbidity findings among this and prior investigations are noted, however, and discussed in terms of the issue of differential diagnosis between eating and anxiety disorders.     

Monologs,Dialogues, Bodies,Words, Silence,Photographs, Death

ABSTRACT

An examination of a clinical case in which severe demands on the analyst were made to bear silence and trauma unprocessable by the analysand. This discussion draws on the work of Coltart and Ferenczi to consider the demands of such work on the analyst. Intergenerational transmissions of trauma are also considered in the understanding of this case.     

Narrow-band 1, 2, 3, 4, 8, 16, 24, 32, 48, 64, and 96 cycles/360 degrees angular frequency filters

We measured human frequency response functions for eleven angular frequency filters using a forced-choice procedure in a supra-threshold summation paradigm. Each of the eleven functions of 17 experimental conditions was measured 4-9 times among 12 observers. Results show that, for the arbitrarily selected filter phases, maximum summation effect occurred at test frequency for all filters. These results lead to the conclusion that there are narrow-band angular frequency filters operating in human visual system mostly through summation surrounded by inhibition at the specific test frequency ranges. Our previous suggestion (Simas and Santos, 2002), arguing that summation for the higher angular frequency filters should occur if background angular frequency contrast were set to a maximum of 5 times the test frequency threshold, was supported.     

Contrast, induction, facilitation, suppression, and conservation

Ten rats received all of their water in daily 1-hr sessions. Following a baseline phase in which lever and water spout were freely available throughout each session, subjects were trained to press the lever for water on mixed schedules composed of two alternating components. Each component gave access to water for a fixed cumulation of drinking time every time the rat cumulated a fixed amount of lever-pressing time. Changes in one component produced contrast and induction effects, both positive and negative, with respect to both lever pressing and drinking in the unchanged component. All schedules facilitated lever pressing relative to baseline. All schedules suppressed drinking relative to baseline, even though contingency sessions allowed ample time to perform the baseline amount of drinking. The entire pattern of results was predicted in quantitative detail by assuming that the total amount of a dimension apportioned to lever pressing and drinking is conserved between baseline and contingency sessions. Conservation theory was shown to predict several effects produced by simple fixed-ratio schedules, and was compared favorably with probability-differential (Premack, 1971) and response-deprivation (Timberlake and Allison, 1974) theory.     

A Breast Cancer Experience Re-narrated: The Undying: Pain,Vulnerability, Mortality,Medicine, Art,Time, Dreams,Data, Exhaustion,Cancer, and Care by Anne Boyer,New York: Farrar,Straus and Giroux, 2019

Journal of Medical Humanities -     

Silent Virtues: Patience,Curiosity, Privacy,Intimacy, Humility,and Dignity,by Salman Akhtar,Routledge, Abingdon and New York, 2019, 192 pp.

The American Journal of Psychoanalysis -