Charles F. Stroebel

Borderline Personality Subcategories

A careful study of 106 patients, diagnosed as borderline using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, is in progress at a private psychiatric facility. Three distinct Subcategories of the borderline personality disorder have been identified: history of no organicity, history of trauma, encephalitis, or epilepsy, and history of attentional deficit disorder/learning disabilities. A discriminant function analysis approach clearly distinguishes the three borderline Subcategories from one another and from a schizophrenic control group. Borderline patients also show significant sex differences. The borderline personality disorder is viewed as either on a continuum with affective disorders and atypical psychoses, or with organic brain dysfunction including the episodic dyscontrol syndrome and/or adult minimal brain dysfunction. Future research should be directed toward further classifying homogeneous subgroups of borderline patients in order to provide more specific and effective treatment.

Biofeedback Treatment in Medicine and Psychiatry: An Ultimate Placebo

Speculation about the potentials of biofeedback in the treatment of psychiatric, psychosomatic, and somatopsychic disorders is widespread. Enthusiasts view biofeedback as an objective scientific means for achieving control of neural and visceral processes that are normally outside the range of conscious awareness, even though they are also associated with attention, perception, emotions, and feelings. A subjective parallel is an apparently comparable degree of control reportedly achieved through inner suggestion by practitioners of various yogic techniques.

Use of clomipramine in treatment of obsessive-compulsive symptomatology.

An open clinical trial was conducted on the use of oral clomipramine in the treatment of obsessive-compulsive symptomatology in patients with various primary psychiatric diagnoses. The overall success rate of the 50 patients was 60%; those with a primary diagnosis of obsessive-compulsive disorder had an 80% success rate. No significant differences in outcome were observed by current age, age of illness onset, duration of illness, or severity of illness. Minnesota Multiphasic Personality Inventories of a subsample of the population revealed a significantly higher T score for depression in the successful patients. Since 83% of the successful patients had adequate prior treatments on other antidepressants without improvement in their obsessive-compulsive symptoms, it would appear that clomipramine is effective in treating obsessive-compulsive symptoms as well as depressive symptoms.

Susceptibility to Motion Sickness and Field Dependence-Independence as Measured with the Rod and Frame Test

This paper reports an experiment investigating the relationship between field dependence-independence and susceptibility to motion sickness in a normal volunteer and in a psychiatric patient population. Both variables have previously been related to psychiatric diagnosis and possible differential interaction between the cerebral hemispheres. Anticipated differences in field dependence according to degrees of motion sickness were not found; however, significant male-female and patient-control differences were observed and these occurred primarily in the non-motion sick and intermediate motion sick groups, suggesting that fundamental differences in field attitude do exist across in apparent spectrum of motion sickness.

Motion sickness: an index of sensory conflict relating to behavior.

Diverse measures of behavior are examined in a student and large patient sample for the purpose of supporting the concept that conflict in sensory mechanisms may contribute to diminished or impaired function. Evidence supports the contention that two patterns of orientation may exist at the extremes of motion sickness susceptibility and that individuals showing transitional patterns of organization may be vulnerable to different kinds of central nervous system disorganization. The authors believe that a consideration of sensory function as it relates to patterns of behavior may contribute to an expansion in the medical model of mental illness.

Psychophysiological Rationale for the Application of Biofeedback in the Alleviation of Pain

By elucidating the apparent psychophysiologic mechanisms affected by biofeedback in the treatment of psychosomatic conditions, considerable qualification must be extended to sweeping claims currently being made for the application of this new treatment modality to the problem of pain. This discussion will conclude that biofeedback is largely ineffective after the onset of the sensation of pain, except in reducing the level of activation of the emergency fight or flight response and in reducing muscular “bracing against” the pain. However, clinical experience does indicate that biofeedback can be highly effective in a preventive sense, altering physiology so that the antecedent mechanisms leading to the production of pain do not occur. The psychophysiologic mechanisms presumed to be operating in muscular contraction and vascular headache pain will be used as illustrative, since experience in treating these conditions with biofeedback is most extensive at the present time.

Susceptibility to motion sickness and ego closeness, ego distance as measured by the autokinetic response tendency.

This paper reports results from one phase in an ongoing study of the relationship between vestibular function and various aspects of personality, cognitive style and symptom formation in mental illness. In the experiment reported here a measure of autokinesis was shown to relate to motion sickness experience as judged by actual stimulation in a rotating chair. Low and intermediate sensitive subjects showed less autokinesis than the most motion sick individuals (two-way analysis of variance F = 5.735, P = 0.006). Males in this sample showed a significantly greater autokinetic tendency than females (two-way analysis of variance F = 6.995, P = 0.011).

Passive Meditation: Subjective, Clinical, and Electrographic Comparison with Biofeedback

Early in this decade, a number of investigators began to study a variety of meditation-relaxation techniques that offered promise as alternatives to the increasingly widespread use, and abuse, of minor tranquilizers for alleviation of the discomfort and disability caused by stress-related disorders. At about this same time the concept of holistic medicine formally emerged, with an emphasis on individual self-responsibility in preventing and recovering from illness. Physicians, too, were developing an awareness of the limitations of scientific-technical medicine, which surgically or pharmacologically alters the body while ignoring the person, his personality, his memory, and important interpersonal issues. Animal studies confirmed this new awareness, correlating environmental stress with increases in mammary cancer, in hypertension, and even in the lymphocytic immune response to antigens. Further, consensus among anecdotal reports suggested that 50–70% of all complaints in general medical practice were stress-related, so that the symptom would not have occurred, or would have been less severe, in the absence of stress.

A user-interactive graphics-based computer system for analysis of the EEG

Computer technology provides a powerful high-resolution tool for the analysis and understanding of the electroencephalogram (EEG). A system of user-interactive graphics-based computer programs analyzing the power spectral density (PSD), coherence, and phase-angle relationships of the EEG is described, along with the mathematical algorithms used. The analytic variables inherent in coherence analysis are reviewed. These variables include choices of sampling parameters, auto- and cross-spectral algorithms, smoothing techniques, and use of the γ2(f) or γ(f) value for coherence. These variables in the analysis itself have a net interactive effect on the calculated results that often makes comparability of data across studies impossible. Thus, it is proposed that studies include a graph showing the authors’ derived coherence values for a set of standard test signals to enhance scientific communication.

Use of a psychiatric patient record system

We began our efforts to computerize all of the functions of the Institute of Living, a 400 bed, private, nonprofit psychiatric hospital, including the full patient record, in 1962. In the intervening years we have gradually developed our concepts of appropriate computer and terminal hardware and the kind of programming capability and file structure necessary for optimum utilization of the system for day-to-day clinical care of our patients, as well as furnishing support for the administrative and business operations of the institution.