Attachment security and parental bonding in adults with obsessive-compulsive disorder: a comparison with depressed out-patients and healthy controls.

OBJECTIVE: This study examines concurrent associations of attachment security, psychopathology and recollections of early parental interactions, in adults with obsessive-compulsive disorder (OCD), depression, and in healthy controls. METHOD: Thirty-six out-patients with OCD, 16 depressed out-patients and 26 controls were asked to fill out the Revised Adult Attachment Scale and the Parental Bonding Instrument (PBI). RESULTS: OCD and depressed groups were more insecure than controls. The depressed group recalled less caring mothers than the OCD group, while the OCD group was indistinguishable from controls on PBI measures. Married status was associated with greater security, but also with recollections of greater parental control, and lower maternal care. CONCLUSION: OCD and depressed groups demonstrated greater attachment insecurity than controls. No clear relationship emerged between security and PBI recollections. The PBI may not measure aspects of early interactions essential for later attachment security, or recollections may be biased according to diagnosis or attachment style.

Is there an obsessive psychosis? Aetiological and prognostic factors of an atypical form of obsessive-compulsive neurosis.

The study explores whether an atypical form of obsessional illness can be delineated and separated from the conventional form of obsessive-compulsive neurosis (OCN). From a group of 45 obsessive patients, 8 were selected on the basis of 3 criteria: presence of a severely debilitating main obsessive symptom; bordering on the delusional; no schizophrenic symptoms. Assessment and outcome measures included the Psychiatric Questionnaire, the Leyton Obsessional Inventory, Fear Survey Schedule, and IPAT Self-Analysis Form. Self-assessment forms allowed patients to make social adjustment and neurotic symptom ratings. In a multimodal approach, patients were assigned to behavioural and pharmacological treatments on the basis of severity. Reassessment took place after 50 sessions of therapy. Results of analysis of variance statistics indicated that the atypical group had a more malignant form of illness, with more varied and severe obsessions. A poorer prognosis for the atypical group was indicated by: greater social maladjustment, poor employment records, illness of longer duration showing no remissions despite more courses of treatment, and poor response to treatment throughout. The atypical group manifested fewer characteristic features of OCN (example: fewer precipitating events). On the other hand, schizophrenia was not imputed, although delusion-like experiences in the atypical group suggest a psychotic form of illness. The term "obsessive psychosis" suggested by Strauss and recently investigated by Weiss et al and Robinson et al is proposed for our atypical group. Results are compared with those of other investigators. It is concluded that the delineation of a subgroup of obsessional illness is desirable for research and therapy since a form of atypical obsessional illness or obsessive psychosis can be differentiated on aetiological, phenomenological and prognostic factors.

Severe depersonalization treated by behavior therapy.

The author reports the use of behavior therapy in the treatment of two cases of severe intractable depersonalization. Outcome criteria included full psychiatric assessment, patients' self-ratings, and psychometric test scores. Treatment by flooding was highly effective in one case, and associated obsessive symptoms and anticipatory anxiety were substantially decreased in the other. Behavioral techniques may prove especially helpful in cases in which anticipatory anxiety, phobic avoidance, and obsessive perseveration are exacerbating features.

A comparison of clomipramine hydrochloride (Anafranil) and behaviour therapy in the treatment of obsessive neurosis.

A six-week trial of 300 mg clomipramine hydrochloride (Anafranil, Geigy Pharmaceuticals) was compared to a six-month twice weekly therapeutic programme with two widely used behavioural techniques, flooding and thought-stopping. Clomipramine had a substantial ameliorating effect on the number and severity of obsessional symptoms, reducing the total obsessive symptomatology by half. The trends suggested that the drug was as effective as flooding and more effective than thought-stopping in reducing the ruminative symptoms, and was especially effective in reducing pervading doubt. It was considerably less effective than behaviour therapy in reducing the compulsive symptoms. This suggests, and confirms the authors' clinical impression, that a combination of pharmacotherapy and behaviour therapy is the optimal treatment of choice for ritualistic patients who are almost always very ruinative, doubtful and highly anxious. Clomipramine had the most substantial anxiolytic effect of three groups and seemed to be as effective as behaviour therapy in reducing phobias.