An analysis of physician resistance to psychiatric consultations.

Although it has been estimated that between 30% and 60% of hospital patients have an emotional problem related to and sometimes affecting the course of their hospitalization, psychiatric consultations for such patients are rarely requested. We conducted chart rounds with house and nursing staffs to identify those patients with prominent psychiatric problems relating to hospitalization. It was found that physician resistance to consultation was involved in more than 50% of cases not referred, usually because the physicians believed that there was no psychiatric problem or that psychiatry could not help, and less often because the physician thought that the patient might become upset or the patient-doctor relationship would be destroyed. The basis of the physicians' resistance was found not justified in 26 of 29 patients seen, and 23 of these patients were judged to have been helped by the psychiatrist.

Behavioral science teaching in U.S. medical schools: a 1980 national survey.

The teaching of behavioral science in medical school has become increasingly complex in the attempt to integrate biological, social, and psychological knowledge. The authors sent a survey questionnaire to determine actual and preferred organizational structures to 130 medical schools; 90 responded. The most frequent structure--46 schools (51%)--was unidepartmental. Thirty-four schools (38%) were multidepartmental, and 10 (11%) had a matrix organization. Schools with a unidepartmental structure reported a higher degree of satisfaction and more organizational advantages. Multidepartmental and matrix models offered some educational advantages at the cost of administrative efficiency. During the 1980s, funding for unidepartmental schools may prove more cost effective than funding for schools with different organizational structures.

Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: a multicenter study.

OBJECTIVE: The Dissociative Experiences Scale has proved a reliable and valid instrument to measure dissociation in many groups, but its capacity to distinguish patients with multiple personality disorder from patients with other psychiatric disorders has not yet been conclusively tested. METHOD: A discriminant analysis was performed to classify 1,051 subjects as having or not having multiple personality disorder. Another discriminant analysis was performed on a subgroup of 883 subjects more closely representing patients in a typical psychiatric facility in terms of base rates of dissociative disorders. A cutoff score of 30 was also used to classify subjects, and Bayes's theorem, which allows for the calculation of the positive predictive value and the negative predictive value of a screening test, was applied. RESULTS: According to discriminant analysis of the total study group, the scale's sensitivity was 76% and its specificity was also 76%; according to discriminant analysis of the more representative subgroup, the scale's sensitivity was 76% and its specificity was 85%. Use of the cutoff score of 30 produced similar results. Results of the application of Bayes's theorem showed that 17% of the subjects scoring 30 or higher would actually have multiple personality disorder and 99% of those scoring less than 30 would not have multiple personality disorder. CONCLUSIONS: These results indicate that the Dissociative Experiences Scale performs quite well as a screening instrument to identify subjects with multiple personality disorder. In addition, the consistency of responses to scale items across centers indicates that the symptoms reported by patients with multiple personality disorder are highly similar across diverse geographic centers. This consistency supports the reliability and validity of the diagnosis of multiple personality disorder across centers.

Burns in the Lebanon War 1982: "the blow and the cure".

There were 70% more burns in the October 1973 war than in the Six Day War of 1967. This increase caused great concern and emphasized the need for better personal and crew protection against burns. Some of these measures were already implemented by the outbreak of the 1982 war in Lebanon. Analysis of the burn injuries of this war is the subject of this short report.

"Back from the future": a powerful age-progression technique.

This paper briefly reviews the benefits of using age-progression techniques in hypnotherapy, followed by a detailed explanation and illustration of the "back-from-the-future" technique with two case examples, including their outcome. The patients presented with feelings of helplessness, hopelessness, and a sense of futurelessness. Following the hypnotherapeutic intervention, patients were instructed to take time to reflect on the session and to write down the specific experiences they had on their voyage into the future focusing on their visual images, auditory sensations, experiences with other senses (touch, smell, and taste), as well as thoughts, emotions, and self-perceptions. Follow-up validated that the patients maintained their therapeutic accomplishments several months after the initial interventions.

Hypnotherapeutic techniques in the treatment of hyperemesis gravidarum.

Hyperemesis gravidarum is not an uncommon condition in the first trimester of pregnancy. In some of these patients, the condition is so severe that it causes the development of dehydration and electrolyte imbalances. When that happens, the patient usually requires hospital treatment, which includes intravenous fluids and antiemetic medications. Obstetricians are very careful before prescribing any medications in the first trimester of pregnancy, making it necessary to consider methods of treatment that minimize the risk of medication side effects to both mother and baby. One such method is the use of hypnotherapy. In this paper, I describe five cases where hypnotherapy was successfully used with a variety of techniques to resolve the problem of hyperemesis. This is followed by a discussion regarding the most efficacious techniques and the type of patient that best responds to hypnotherapeutic interventions.

Therapeutic writing as a form of ego-state therapy.

In this paper I describe a special form of ego-state therapy that integrates writing letters to one's self as an internal therapeutic communication among various ego states previously not fully aware of each other or engaged in destructive power struggles. Expressing one's thoughts, feelings, and urges in writing transforms primary process activities of the self into secondary processes that are more mature and adaptive to healthy functioning in day-to-day living. This method also reinforces the idea of patient empowerment in the form of self-healing and utilizing internal resources in the process of recovery.

Ego-state therapy for self-injurious behavior.

The authors describe the use of ego-state therapy for the treatment of self-injurious behavior (SIB). We propose that for some patients, SIB results from conflict among dissociated ego states. We review the historical and theoretical basis for this position and delineate a specific treatment technique. Our strategy consists of identifying an ego state in which SIB occurs, activating the patient's ego strengths using inner-adviser techniques and facilitating the integration of these resources within the ego state responsible for the behavior. We have used this strategy with favorable results for patients with dissociative symptoms, primarily those suffering from borderline personality disorder, posttraumatic stress disorder, or dissociative disorders.

The eye-roll sign and the PAS dissociation scale.

In the past decade we have seen many new articles devoted to the study of dissociation and its implications in health and illness. The area of dissociative disorders received special attention with many authors pointing out the probability that dissociative disorders may, in fact, be much more pervasive than used to be thought. The need for a reliable measurement of dissociation has become more acute. This paper reports the results of a study comparing the Perceptual Alteration Scale (PAS), a behavioral scale measuring dissociation capacity, with Spiegel's Eye-Roll Sign (ERS) a postulated biological marker for the capacity to dissociate. 107 subjects' PAS scales and eye-roll sign measurements were analyzed. The results showed a mean PAS score of 155, and a mean eye-roll of 3.7. The Pearson Correlation Coefficients were computed for the eye-roll scores vs. the PAS scores, and showed a correlation of 0.55, with a significance of p < 0.0001. These results indicate a high positive correlation between the eye-roll sign and the PAS, spanning through the entire dissociative continuum. Further studies are needed to correlate the eye-roll sign with the Dissociative Experiences Scale (DES), and other measurements of dissociation.

Covert multiple personality underlying eating disorders.

Frequently, MPD patients present themselves to the clinician with a variety of psychophysiological symptoms. Eating-disorder symptoms may be one of these, and may include the following: binge eating, self-induced vomiting, laxative abuse, excessive exercising, body image distortion, self-starvation, fluctuations in body weight, and nausea. Following are five cases in whom the pathological eating behavior was a manifestation of an underlying multiple personality disorder. The pathological eating behavior was so severe that some patients matched DSM-III-R diagnostic criteria for an eating disorder. Clinicians dealing with eating disorders should be aware that some patients may represent a subgroup in whom the underlying cause for the eating disorder may be MPD. These patients seldom respond to conventional treatment modalities used in eating-disorders programs, and only when the underlying multiplicity is identified and treated by a trained clinician, will the patient's eating-disorder symptoms improve.

A practical approach in the treatment of self-inflicted violence.

After a brief review of the literature on self-inflicted violence, a practical approach to the treatment of patients who show self-injurious behavior and self-mutilation is developed. The treatment model uses therapeutic interventions based on a biopsychosocial understanding of the person and applies knowledge from the biological, psychological-behavioral, and social fields. Interventions discussed include ego strengthening, planning for substitute behaviors, therapeutic imagery, ego-state therapy, reframing, cognitive syllogism, behavioral reinforcement and extinction, and use of behavioral contracts. The case examples presented illustrate the importance of the therapist/patient relationship, which is based on trust, respect, and caring but also on patient responsibility for change.

Hypnosis: lingering myths and established facts.

This paper reviews some historical aspects of hypnosis, discusses and clarifies the lingering misconceptions and the established facts. Moreover, the paper clarifies the predominant school of thought regarding the issue of hypnotizability and the relevance of hypnotizability scales for research and clinical practice. The paper concludes with a review of using hypnosis as a diagnostic and therapeutic tool.

The use of hypnosis with eating disorders.

This paper reviews the literature on the use of hypnosis in the assessment and treatment of eating disorders. It proposes that patients with eating disorders ought to be investigated as to the underlying dynamics behind the eating disorders symptoms. Following a thorough assessment, a number of hypnotherapeutic techniques are explained and discussed, such as: general relaxation and calmness, guided imagery, teaching self-hypnosis, ego-strengthening, direct and indirect suggestions for healing and recovery, cognitive restructuring and reframing, symbolic guided imagery, age progression ("back from the future" technique), metaphorical prescriptions, age regression and abreactions, and ego state therapy. Verbatim examples of these techniques are given as illustrations of how to use them.

Therapeutic imagery enhanced by hypnosis.

This paper has reviewed the history of using imagery as a powerful change and healing agent in humans. It has been a rather underused technique in the practice of Western medicine and psychiatry. I hope that the specific examples and techniques described herein will stimulate and motivate the reader to adopt them in their clinical practice and creatively develop new strategies and techniques applicable in other fields such as sports, the arts, education, and the human life cycle.

Development of an Analog Alexithymia Scale. Testing in a nonpatient population.

The present study describes a new self-administered Analog Alexithymia Scale (AAS). A nonpatient sample representing a broad range of ages and socioeconomic groups was used. Scores were normally distributed with 6.8% of subjects in the alexithymic range. Retest reliability was encouraging. The correlation between the AAS and the Schalling-Sifneos Personality Scale was low. Validity has not been established for either test. Factor analyses suggest distinct clinical components, the differentiation of which might facilitate understanding of the psychologic and neurophysiologic underpinnings of alexithymia. There is a need for a clinical standard for validating self-administered scales.

Indications of physical, sexual, and verbal victimization in projective tree drawings.

Several facets of the Tree-Scar-Trauma hypothesis were addressed. The first inquiry was whether scars, knotholes, and/or broken branches on a drawn tree are indicative of previous victimization. A statistically significant relationship between these variables was found. The study also examined differences between mental health patients (N = 56) and control subjects (N = 215) with regard to their abuse history and tree drawings. No significant differences between these two populations were found. A modification of Buck's (1948) hypothesis with regard to the relationship between the location of traumatic indicators on projective tree drawings and age of traumatization was tested and not validated. However, the association between the duration of physical abuse and the number of indicators on the tree was statistically significant.