William E. Minichiello

Schizotypal personality disorder:: A poor prognostic indicator for behavior therapy in the treatment of obsessive-compulsive disorder

Abstract Twenty nine obsessive-compulsive patients were evaluated for behavior therapy by the staff of our Obsessive-Compulsive Disorders (OCD) Clinic. Ten (35%) had Axis II diagnoses of Schizotypal Personality Disorder. Of those patients without an Axis II diagnosis of Schizotypal Personality Disorder, 16 (84%) improved at least moderately with either behavior therapy alone (exposure plus response prevention) or a combination of behavior therapy and pharmacotherapy. Among the schizotypal group, only one (10%) improved with the same treatments. This difference was highly significant. Implications for behavior therapy are discussed as well as suggestions for management of these patients and for future research.

Age of onset of phobic disorders: A reevaluation

Abstract The age of onset of agoraphobia with spontaneous panic attacks (DSM III) was studied in 100 consecutive patients. A uniform unimodal age of onset distribution was found. Mean age of onset was 24 years. Sixty-five percent of cases began in the 15–29 age group. Ninety-six percent first started before age 40 years. The finding in two other studies of a bimodal age of onset distribution may result from artifacts inherent in their small sample sizes. The age of onset of simple single phobias without spontaneous panic attacks or other psychopathology was studied in 62 consecutive monophobic patients. The age of onset in this variety of phobic disorder was evenly distributed over all age groups. No evidence was found for a facilitatory period in the development of phobias for the first decade as compared to the second or third life—although age may determine which environmental stimuli become phobic stimuli at different ages. There was a statistically significant difference between the age of onset distribution and the sex ratio in both groups of phobic disorder. The findings are consistent with the authors classification of phobic disorders, into endogenous and exogenous varieties based on the presence or absence of concurrent spontaneous panic attacks with the phobias. It is also consistent with the model that biological factors are preeminent in the genesis of endogenous phobias, while conditioning by environmental stress is preeminent in exogenous phobias.

Age of onset of major subtypes of obsessive—compulsive disorder

Abstract In 138 patients with Obsessive Compulsive Disorder, significant differences in mean age of onset were found among subtypes. Patients with obsessions only or cleaning rituals only had comparable ages of onset (age 27), while patients with checking rituals only or mixed rituals had earlier onset (age 18–19). Implications of these findings are discussed.

Use of a portable computer program to assist behavioral treatment in a case of obsessive compulsive disorder

This case study describes the development and use of a portable computer program to assist in behavioral treatment of obsessive compulsive disorder. A 58-year-old female with a 37-year history of compulsive checking rituals, who had mild improvement following 36 months of standard behavioral techniques and pharmacotherapy, showed improved compliance with behavioral treatments of exposure and response prevention following use of the portable computer program. Computer records indicated marked reductions in frequency of checking rituals and a 91-week follow-up indicated that treatment effects were maintained at home where the patient had resumed using the laptop computer. She had stopped using the pocket computer outside the home, and there her checking rituals had returned to baseline levels.

Obsessive-compulsive disorder with predominantly scrupulous symptoms: clinical and religious characteristics.

OBJECTIVES Scrupulosity is a relatively common but understudied subtype of obsessive-compulsive disorder (OCD) characterized by religious or moral fears. It is difficult to treat and frequently disabling. We examined scrupulosity as it relates to (a) treatment-seeking behavior and perceived treatment gains, (b) the perceived effect of symptoms on religious experience, and (c) conceptions of God. METHOD Seventy-two individuals with scrupulous OCD (mean age = 36; 70% women) and 75 individuals with nonscrupulous OCD (mean age = 38; 81% women) completed an internet-based survey. RESULTS The groups did not differ on demographic variables or overall OCD severity. Compared with the nonscrupulous group, the scrupulous group was (a) more religious, (b) more likely to seek pastoral counseling, (c) less likely to seek medication treatment, and (d) more likely to report that symptoms interfered with their religious experience. Indeed, most scrupulous individuals endorsed that their symptoms interfered with their religious experience. Scrupulous individuals with a more negative concept of God experienced more severe symptoms, whereas a positive description of God was unrelated to severity of scrupulosity in this group. Nearly one in five scrupulous participants reported no religious affiliation. CONCLUSIONS Scrupulous individuals have unique treatment-seeking preferences. Moreover, most scrupulous individuals perceive their symptoms as interfering with their religious experience. Focusing on the religious costs and benefits of scrupulous rituals might have clinical utility. Finally, scrupulous individuals with a more negative concept of God experienced more severe symptoms. Future research is necessary to evaluate whether addressing such concepts can improve treatment outcome.

Trichotillomania: clinical aspects and treatment strategies.

&NA; Trichotillomania is a disorder of compulsive hair pulling that often results in alopecia. The clinical features include the pulling of hair from the scalp, eyebrows, and eyelashes, sometimes symmetrically; pubic and other bodily hair may also be plucked. The disorder is present in 0.6% of college students. The majority of sufferers who seek treatment are female, with usual age of onset between 11 and 16 years. Trichotillomania can occur in a wide variety of psychiatric disorders, and patients with the condition may be more likely to have a lifetime diagnosis of depression or an anxiety, eating, or substance abuse disorder. Although empirically derived treatment guidelines are still lacking, the current literature suggests that behavior therapy and pharmacotherapy are the most efficacious treatments for adult trichotillomania. Controlled trials with pharmacotherapy (clomipramine) have shown significant reductions in hair pulling over the short term. Controlled investigations of behavior therapy have not been conducted, but several treatment series suggest efficacy. At least three reports also suggest that behavior therapy and pharmacotherapy bring some improvement in childhood trichotillomania, although this has not been empirically studied. A case illustrating the combination of behavior therapy techniques and pharmacotherapy in the treatment of trichotillomania is presented.

Behavior therapy for the treatment of Obsessive-Compulsive Disorder: Theory and practice

Abstract Behavior therapy techniques for Obsessive Compulsive Disorder (OCD) have been effective in treating this difficult anxiety disorder. This review explores the theory and underlying behavioral strategies, rebuts common misconceptions about behavior therapy, and outlines the clinical management of obsessions, cleaning rituals, checking rituals, and obsessional slowness. Predictors of treatment failure and outcome research for OCD are reviewed.

Obsessive-compulsive Disorder, Depression, and the Dexamethasone Suppression Test

Five of 29 obsessive-compulsive disorder patients were dexamethasone suppression test (DST) nonsuppressors, all of whom met standard Hamilton Depression Rating scale criteria for at least mild depression. None of 24 nondepressed obsessive-compulsive disorder patients had an abnormal DST. The relationship of the DST to specificity of psychiatric diagnoses is discussed.

Somatic treatments for obsessive-compulsive disorders.

Abstract Patients with obsessive-compulsive disorder (OCD) and related syndromes often present to physicians other than psychiatrists. These patients are difficult to recognize and even more difficult to treat and the abundance of therapeutic approaches available indicates that none is clearly effective in all cases. Patients frequently present with symptoms seemingly laden with unconscious symbolism and dynamic meaning; yet psychodynamic treatments, particularly if they are loosely structured and nondirective, rarely reduce the symptoms. Behavior therapy fares much better, particularly with compulsive rituals. Likewise, electroconvulsive therapy is not regarded as useful in the treatment of OCD. There are, however, a number of modalities that may be extremely helpful in the treatment of these patients. We review somatic treatments of OCD including medications, electroconvulsive therapy, and psychosurgery.