[Some reflections on body dysmorphic disorder by proxy]. / Bespiegelingen over body dysmorphic disorder by proxy.

Body dysmorphic disorder by proxy is a body image disorder that causes considerable distress and discomfort to the patient and to his or her close relatives and friends. There have been hardly any publications on this topic and little is know about treatment. In this paper we present the case of a 36-year-old male who exhibited extreme dissatisfaction with his wife's appearance. In particular, cognitive behaviour therapy and several systemic interventions led to a marked reduction in the patient's symptoms.

Assessment of self-statements in agoraphobic situations construction and psychometric evaluation of the Agoraphobic Self-Statements Questionnaire (ASQ).

The study describes the development and psychometric evaluation of a self-report questionnaire for use in both treatment-outcome research and process studies: the Agoraphobic Self-Statements Questionnaire (ASQ). The ASQ comprises two subscales: a positive self-statements subscale and a negative self-statements subscale. Confirmatory factor analysis showed that, with the exception of one item, the proposed bidimensional structure of the ASQ reappeared in a second agoraphobic patient sample. Internal consistency of both subscales was satisfactory. Both subscales appeared to be sensitive to change in treatment and discriminated between agoraphobic patients and normal controls. Construct validity of the negative subscale was satisfactory, whilst additional validation of the positive subscale is required. Findings also revealed that positive thinking may serve as a coping device and that the occurrence of negative self-statements might be considered a sine qua non for the occurrence of positive self-statements. It is concluded that the ASQ can contribute to the understanding of cognitive processes during treatment of agoraphobia.

The treatment of hypochondriasis: exposure plus response prevention vs cognitive therapy.

In this study (1) exposure in vivo plus response prevention, (2) cognitive therapy and (3) a waiting-list control condition were compared on their efficacy on the treatment of hypochondriasis. Seventy-eight patients with a DSM-IV diagnosis of hypochondriasis were randomly assigned to one of these conditions. Patients in both active treatment conditions improved significantly on all the measures, whereas the patients in the waiting-list control condition did not improve. The improvements were clinically significant. Exposure in vivo plus response prevention and cognitive therapy were equally effective. The improvements were maintained at the 7 months follow up.

Attentional correlates of illness anxiety in a non-clinical sample.

BACKGROUND: Attentional processes are assumed to play an important role in the maintenance of illness anxiety, although empirical support is relatively scarce. METHODS: The present study explores the relationship between selective attention (i.e. private body consciousness and symptom reporting), intensive concentration (i.e. attentional control and sustained attention), and illness anxiety in 57 non-clinical subjects. RESULTS: Zero-order and multiple correlations suggest that illness anxiety is significantly related to cognitive failures in everyday life and private body consciousness and to a lesser extent to symptom reporting. CONCLUSION: It is concluded that illness anxiety can be partly predicted from specific attentional variables. However, specific operationalizations of attentional parameters seems to determine the existence and magnitude of these relations.

Cognitive and behavioural treatment of hypochondriasis.

BACKGROUND: This study investigates the feasibility and effectiveness of time-limited treatment protocols based upon cognitive and behavioural interventions. METHOD: Seventeen patients with DSM-IV diagnoses of hypochondriasis were offered 12 1-hour sessions of either 'pure' cognitive or 'pure' behavioural (i.e. exposure in vivo and response prevention) treatment. Patients were used as their own controls by observing a 4-week period without interventions before and after treatment. RESULTS: Patients in both treatment conditions improved on specific measures of hypochondriasis (Kellner's Illness Attitude Scales) and depression. These changes took place during the active treatment period, whereas in the control periods scores remained unchanged. Furthermore, no differential treatment effectiveness could be demonstrated. CONCLUSIONS: Cognitive and behavioural interventions seem to be active ingredients in the treatment of hypochondriasis, although the contribution of nonspecific factors (e.g. patient motivation, therapist attitudes, and the therapeutic relationship) requires further study.

Cognitive-behavioural approaches in the treatment of hypochondriasis: six single case cross-over studies.

This study evaluates a cognitive and a behavioural treatment protocol for hypochondrical complaints. In a cross-over design, six patients with a primary diagnosis of hypochondriasis were treated. Three of them first received a block of behavioural therapy (exposure in vivo and response prevention), followed by a block of cognitive therapy. The other three patients were first treated with cognitive therapy followed by behavioural therapy. The results were promising: four patients made significant improvements. The behavioural therapy sessions appeared to account more often for improvement than did the cognitive sessions. The sequence of behavioural therapy followed by cognitive therapy tended to be more successful than the other way around. The results of these six case studies suggest that exposure in vivo with response prevention and cognitive therapy may both be useful in the treatment of hypochondriasis. A journal controlled study is recommended.

Lithium prophylaxis and interepisode mood. A prospective longitudinal comparison of euthymic bipolars and non-patient controls.

The mood stabilizing effect of lithium prophylaxis was investigated in a longitudinal design. Eighteen euthymic bipolar outpatients using lithium and 20 non-patient controls completed 13 weekly mood ratings. Groups did not differ in biographical characteristics and pre-test manic and depressive symptomatology. Apart from a higher mean happiness rating in the patient group, no statistically significant differences were found on most mood scores between groups, nor was there a group difference in variability over time. It is concluded that lithium prophylaxis does not have an extreme mood normalizing effect in well-controlled bipolars.

Homogeneity of Beck's Depression Inventory (BDI): applying Rasch analysis in conceptual exploration.

Rasch analysis of the BDI resulted in three unidimensional subscales, viz. a "Mood and Inhibition", a "Guilt and Failure" and a "Somatic" subscale. All three subscales were of moderate to good internal consistency, and intercorrelated modestly. No significant correlations with sex, age, or education were found. It can be concluded, that the BDI does not, in terms of Rasch measurement model, constitute a unidimensional scale for the measurement of depression.

Reproducibility of an assessment scale of denture quality.

Assessment of denture quality is important in prosthetic research. The aim of this investigation was to determine the intra- and interexaminer reliability of denture quality assessment. Three groups of patients with full maxillary and mandibular dentures and two dentists participated. The patients in group 1 (n = 195) were examined by the two dentists independently, in group 2 (n = 35) twice by one of the dentists and in group 3 (n = 20) twice by the other dentist. A denture quality scale was constructed containing nine variables. The internal consistency (coefficient alpha) of this scale was 0.60. The intra- and interexaminer reliability was between 0.59 and 0.86. For individual items of this scale these values were between 0.22 and 1.00.

Comparison of tests for dysfunction of the stomatognathic system.

As part of a validating process, tests and indices for dysfunction of the temporomandibular joints and masticatory muscles were compared and correlated in 211 persons with an almost complete or complete natural dentition. Helkimo's Clinical Dysfunction Index (CDI), the Mandibular Dysfunction Symptoms (MDS) scale from the "Erweiterter Giessener Beschwerdebogen", the Modified Half-Minute (MHM) test and the palpation test for the stomatognathic system (PALP-test) were compared. The PALP-test had the highest internal consistency (coefficient alpha = 0.92) and the highest intercorrelation with the CDI. Furthermore, it was found that the PALP-test and the CDI probably yield the most realistic distribution of persons in the three classes no symptoms, mild to moderate and severe, and also show the highest percentage of absolute correspondence. The MDS-scale and MHM-test scores showed little dispersion and probably indicated too much or too little pathology. The correspondence between the last two measures is mainly due to an overrepresentation of the middle scoring class (mild to moderate indication of dysfunction of the temporomandibular joints and masticatory muscles). In screening procedures this can easily result in an overrepresentation of people with supposed pathology.

The effectiveness of lithium prophylaxis in bipolar and unipolar depressions and schizo-affective disorders.

The effectiveness of lithium prophylaxis in bipolar affective disorders is generally supported in the literature. The effects in this group, as well as in unipolar depressions and schizo-affective disorders were studied, using an individual retrospective control method, and the Life Table method. Lithium prophylaxis resulted in a substantial decrease in the number of episodes and hospital admissions in bipolar and schizo-affective disorders. In addition, these two groups showed frequent relapses after termination of the prophylaxis. The number of episodes preceding the prophylaxis and the absence of unipolar depression are found to be predictors of effectiveness. The consequences of patient selection and of inconclusive diagnostic criteria are pointed out.

Reproducibility of a palpation test for the stomatognathic system.

Disadvantages of Helkimo's Clinical Dysfunction Index have led to the introduction of a palpation test of 20 sites for grading the severity of dysfunction of the stomatognathic system. The reproducibility of this palpation test was studied using two experienced dentists and two first grade dental students to examine the subjects. Measurements of maximal mouth opening were carried out for comparison. The intra- and interexaminer reproducibility was found to be satisfactory for both the dentists and the students, showing that for this test good training is as important as clinical experience. The palpation test has the advantage that it is fast (60 s) and is an interval scale, which is especially important for epidemiologic and correlational studies.

Relations between TMJ pain dysfunction syndrome (PDS) and some psychologic and biographic variables.

A total of 211 persons with a complete natural dentition were examined for signs and symptoms of the TMJ pain dysfunction syndrome. They also answered the questions of the Dutch version of the Hopkins Symptoms Check List (HSCL). Schooling, age and sex were also registered. Signs and symptoms of the TMJ pain dysfunction syndrome proved to be highly correlated to the psychologic and somatic scales of the HSCL with one exception: maximal mouth opening. The total palpation score proved to be a reliable, sensitive, easy and fast predictor for the severity of the TMJ pain dysfunction syndrome.