Psychodynamic aspects of delayed abortion decisions.

Multiple regression analysis of a wide range of variables for a sample of 58 women obtaining elective abortion identified psychodynamic factors as the only statistically significant explanations for seeking abortion at later gestational ages. Delay among these women was associated with greater disturbance in the basic sense of self as noted in indications of gender/sexual conflict on their drawings of a human figure, and lower achievement orientation ('striving') as expressed by lower levels of striving attributed to parents or other primary (early) caretakers. These findings are discussed as an active taking charge of an unintended pregnancy for women who present early for abortion; for those who delay, attempts to affirm a deficient feminine identification and/or reunite psychologically with the early caretaker are discussed as underlying dynamics.

Munchausen's syndrome: a reconceptualization of the disorder.

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) delineates three categories of factitious disorders: chronic with physical symptoms (Munchausen's syndrome); factitious disorder with psychological symptoms; and other factitious disorders with physical symptoms. Munchausen's syndrome served as the prototype for all factitious disorders at the time DSM-III was drafted, partly due to the disproportionate attention given to this variant of the disorder. Clinical experience suggests that existing categories do not adequately provide for commonly seen forms of factitious illness. It is now recognized that factitious disorder is the result of a complex interaction of personality factors and psychosocial stressors that often present with both medical and psychiatric symptomatology. Proposed changes in the revised edition of the diagnostic manual DSM-III-R include separate categories of factitious disorder with psychological, physical, and both psychological and physical symptoms. A case report of a patient for whom extensive records and thorough psychological assessment were available is exemplary of a more common course of the disorder (both psychological and physical symptoms) that by current classification would be considered "atypical." A reconceptualization of the disorder that gives emphasis to course and clinical features is suggested.