The concealment of obsessions

Patients' deliberate concealment from others of the content and frequency of their obsessions is a common and important aspect of obsessive-compulsive disorder (OCD). It is an overlooked manifestation of the safety behaviour that is believed to sustain OCD (e.g., neutralizing, thought suppression, avoidance behaviour, concealment). The phenomenon of concealment is understandable in terms of the cognitive theory of obsessions which states that obsessions are caused when the person attaches catastrophic personal significance to their unwanted intrusive thoughts. It is suggested that the selected, planned, suitable disclosure of obsessions can be therapeutic--presumably because it exposes the patient to alternative interpretations of the significance of the unwanted thoughts.     

“The Terrorism of Suffering”—The Clinical Diary of Sandor Ferenczi Revisited

The American Journal of Psychoanalysis -     

Health anxiety disorders: a cognitive construal

The features of severe health anxiety, intense and persistent anxiety about one's present and future health, are described. In common with other anxiety disorders such as GAD, PTSD and OCD, the core of HAD is distressing, uncontrollable anxiety, and is classifiable as an Anxiety Disorder, Health Anxiety Disorder (HAD). The cognitive construal of HAD proposes that health anxiety is caused by catastrophic misinterpretations of the significance of sensations and/or changes in bodily functions and appearance (such as swellings, pain, loss of energy, dizzy spells). The nature, causes, triggers, persistence, assessment and treatment of HAD are reviewed, and the present status of the cognitive model is appraised. Suggestions are made for future research and clinical applications, and the need for incisive evaluations of the main premises of the model is emphasized.     

Betrayal: A psychological analysis

Betrayal is the sense of being harmed by the intentional actions or omissions of a trusted person. The most common forms of betrayal are harmful disclosures of confidential information, disloyalty, infidelity, dishonesty. They can be traumatic and cause considerable distress. The effects of betrayal include shock, loss and grief, morbid pre-occupation, damaged self-esteem, self-doubting, anger. Not infrequently they produce life-altering changes. The effects of a catastrophic betrayal are most relevant for anxiety disorders, and OC D and PTSD in particular.Betrayal can cause mental contamination, and the betrayer commonly becomes a source of contamination. In a series of experiments it was demonstrated that feelings of mental contamination can be aroused by imagining unacceptable non-consensual acts. The magnitude of the mental contamination was boosted by the introduction of betrayal themes. Feelings of mental contamination can also be aroused in some ‘perpetrators’ of non-consensual acts involving betrayal. The psychological significance of acts of betrayal is discussed.     

Separating hoarding from OCD

There is confusion about the status of excessive hoarding. In particular, there is an unresolved question about whether or not it is a manifestation of obsessive-compulsive disorder (OCD). There are some definite similarities between ‘compulsive’ hoarding and OCD, but they are outweighed by the differences between them. It is proposed that the matter can be clarified by separating hoarding from OCD, and that this would advance clinical work and research.     

Non-accidental injury to children--III. Methodological problems of evaluative treatment research

The practical difficulties of traditional evaluative treatment research with child-abusing families are discussed in the light of a controlled treatment trial conducted with an unselected sample of families in a service setting. Problems encountered included the heterogeneity of the sample, the high rate of non-cooperation, and the consequent sample attrition. Methodological issues of experimental design, data collection, sample attrition and outcome measures at follow-up are discussed, and guidelines suggested for more innovative research.     

Agoraphobia--a safety-signal perspective

The addition of a ‘safety perspective’ to the construal of agoraphobia as avoidance behaviour is proposed as a means of addressing several theoretical problems. Regarding agoraphobia as a balance between danger and safety signals enables one to re-examine the problem of the undue persistence of the avoidance behaviour component. It also opens for consideration the ‘non-exposure’ onset of agoraphobia (e.g. after loss or bereavements), the age of onset, the sex ratio, the role of trusted companions and talismen. A method for studying safety signals and safety factors is adumbrated, and some predictions are made. The advantages and limitations of the ‘safety perspective’ are considered.