Pensamento fanático: 1984/2020 / Phantastic thinking: 1984/2020 / Pensamiento fanático: 1984/2020

O presente trabalho propõe o estudo de alguns aspectos relacionados aos preconceitos e ao pensamento fanático, partindo da descrição do "duplipensar" feita por George Orwell em seu livro 1984. Assim, o trabalho se detém no vértice que estuda esses fenômenos do ponto de vista de distúrbios nos processos de pensamento, destacando a dificuldade em estabelecer causas específicas. A importância dos fatores sócio-culturais é discutida, na medida em que não existimos isoladamente. Da mesma forma, a presença desses fenômenos nas instituições psicanalíticas também é abordada, concluindo com alguns tópicos para futuras discussões sobre o tema (AU)

This work proposes to study some aspects related to prejudices and fanatical thinking, having as a starting point the description of "doublethinking" made by George Orwell in his book 1984. The essay therefore focuses on the authors that study these phenomena from the point of view of abnormalities in the thought processes, highlighting the difficulty in establishing specific causes. The importance of socio-cultural factors is discussed, as we do not exist in isolation. Likewise, the presence of these phenomena in psychoanalytic institutions is also addressed, concluding with some topics for future discussions (AU)

El presente trabajo propone el estudio de algunos aspectos relacionados con los prejuicios y el pensamiento fanático, a partir de la descripción del doblepensar hecha por George Orwell en su libro 1984. Así, el trabajo se detiene en el vértice que estudia estos fenómenos desde el punto de vista de las perturbaciones en los procesos de pensamiento, destacando la dificultad para establecer causas específicas. Se discute la importancia de los factores socioculturales, ya que no existimos de forma aislada. Asimismo, se aborda también la presencia de estos fenómenos en las instituciones psicoanalíticas, concluyendo con algunos temas para futuras discusiones sobre la cuestión (AU)

Prospective associations between disgust proneness and OCD symptoms: Specificity to excessive washing compulsions.

Although considerable evidence has linked disgust proneness (DP) to obsessive-compulsive disorder (OCD), few studies have examined the extent to which DP predicts OCD symptoms over time. Further, it remains unclear if DP is a risk factor for the contamination subtype of OCD specifically or if it is prospectively associated with other OCD symptom subtypes. The present study sought to address these gaps in the literature with a large sample of unselected community participants (n = 497) that completed measures of DP and OCD symptoms monthly over a 6-month period. Latent growth analysis revealed that initial levels of DP were associated with higher initial level of total OCD symptoms when controlling for depression, but not the slope of change in total OCD symptoms over time. Initial levels of total OCD symptoms were also associated with higher initial levels of DP when controlling depression, but not the slope of change in DP over time. Examination of symptom specificity revealed that initial levels of DP were associated with initial levels of washing, neutralizing, obsessing, ordering, and hoarding symptoms. However, initial levels of DP were associated only with the slope of change in the washing subtype when controlling for depression such that high initial levels of DP were associated with steeper increases in washing symptoms of OCD over the 6-month period. These findings suggest that although DP may have concurrent associations with symptoms of OCD more broadly, prospective associations are specific to the contamination/washing subtype of OCD. The implications of these findings for the etiology and treatment of contamination-based OCD are discussed.

Orthorexia nervosa: A review of psychosocial risk factors.

Orthorexia nervosa (ON) is a condition described as a pathological obsession with healthy eating. This paper will review the prevalence of ON and how ON is measured. The primary objective is to critically analyze findings on the psychosocial risk factors associated with ON, to consider its relation to other mental disorders, and to offer directions for future research. The key words "orthorexia" and "orthorexia nervosa" were searched in the databases PsycINFO and MEDLINE/PubMed. This paper reviewed peer-reviewed articles published up until December 31st, 2018. Quality assessment was conducted on each study reviewed. Results identified psychometric problems with the most common measure of ON. Gender and self-esteem were generally found to be unrelated to ON. Perfectionism, obsessive-compulsive traits, psychopathology, disordered eating, history of an eating disorder, dieting, poor body image, and drive for thinness were positively associated with greater ON. Findings between ON and the following risk factors were mixed: age, SES, BMI, belonging to a health-related field, exercise engagement, vegetarianism/veganism, body dissatisfaction, and alcohol, tobacco, and drug use. We discuss how the literature on risk factors informs understanding the nature of psychopathology of ON. Strengths and limitations of studies are reviewed and directions for future research are identified. Suggestions are made for more psychometrically valid assessment measures of ON that include questions about impairment, so that ON etiology can be accurately studied.

People behind unhealthy obsession to healthy food: the personality profile of tendency to orthorexia nervosa.

PURPOSE: Our aim was to measure the personality profile of people with high orthorexic tendency using an assessment method which is acknowledged in the research of the classical eating disorders (anorexia nervosa, bulimia nervosa) and obsessive-compulsive disorder (OCD). METHODS: In our research, 739 participants completed a self-administered, online questionnaire consisting of two measures: Temperament and Character Inventory-56 (TCI-56) and Ortho-11-Hu. RESULTS: The orthorexia nervosa (ON) grouping variable has a significant effect on three factors of TCI: MANOVA revealed higher harm avoidance (F (2, 736) = 19.01, p < 0.001, η2 = 0.05), lower self-directedness (F (2, 736) = 22.55, p < 0.001, η2 = 0.06), and higher transcendence (F (2, 736) = 3.05, p = 0.048, η2 = 0.01) in the higher ON group, compared to the lower ON group, regardless of the effect of the risk groups. CONCLUSIONS: According to earlier studies, high harm avoidance and low self-directedness are relevant factors of anorexia nervosa, bulimia nervosa, and OCD, but now it also seems to be an important parameter of orthorexia. Nevertheless, higher transcendence may be a unique feature, which suggests that orthorexia seems to be an independent phenomenon. LEVEL OF EVIDENCE: V, descriptive cross-sectional study.

Confirmatory factor analyses of the ORTO 15-, 11- and 9-item scales and recommendations for suggested cut-off scores.

AIMS: To explore the validity and recommend cut-off scores in an English-speaking sample for 9, 11, and 15-item versions of the ORTO measure for orthorexia, a proposed eating disorder characterised by a pathological obsession with consuming only 'healthy' foods. MATERIALS AND METHODS: The sample comprised of 585 participants (82.4% female) who completed an online questionnaire containing the ORTO-15, Eating Attitudes test, Obsessive Compulsive Inventory Revised. A series of Confirmatory Factor Analyses were conducted to test model fit. Binary logistic linear regression and receiver-operating-characteristics (ROC) analyses were used to obtain cut-offs. RESULTS AND CONCLUSION: Results showed that none of the three published versions (9, 11, and 15-item) of the ORTO produced an acceptable model. Subsequent exploratory and confirmatory factor analyses yielded a seven-item version of the ORTO (ORTO-7) with a strong and stable factor structure. Analysis of cut-offs revealed that a cut-off score of equal or greater than 19 on the ORTO-7 represents probable orthorexia. LEVEL OF EVIDENCE: Level V, descriptive study.

An unhealthy health behavior: analysis of orthorexic tendencies among Hungarian gym attendees.

AIM: In the present study, we aim to assess the prevalence and certain psychological and other correlates of orthorexic tendencies: health and exercise behaviors and demographic variables among gym attendees in Hungary. METHODS: Altogether, responses of 207 gym attendees who filled out an online questionnaire (03/2017-10/2017) were analyzed. The mean age was 31.9 years; most were female and college educated, and about half resided in the capital city. Frequencies and means were calculated for the sample; and univariate linear regression and ANOVA were carried out. Finally, multivariate linear regression was used to assess the relationship between the dependent variable (Orto-11-Hu) and the independent variables (Eating Disorder Inventory, Maudsley Obsessional-Compulsive Inventory, health and exercise habits, and demographics). RESULTS: The mean score for the Orto-11-Hu was 27.7. In the multivariate analysis, two eating disorder characteristics (drive for thinness and interpersonal distrust), age, exercising more than once a day, and yoga practice were significantly associated with higher orthorexic tendencies. There was a lack of correlation between any obsessive-compulsive traits. CONCLUSIONS: Our data suggest and overlap between certain eating disorder traits, and a link between ON and frequent exercising and younger age. Further research is needed to investigate whether these correlates are found not only in a specific fitness-oriented population, but also in the general population. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Impulse control disorders in patients with prolactinoma receiving dopamine agonist therapy: a prospective study with 1 year follow-up.

OBJECTIVE: To assess prospectively the prevalence of impulse control disorders (ICD), psychiatric symptoms, and their clinical correlates in patients with prolactinoma receiving dopamine agonists (DA) in comparison to those with non-functioning pituitary adenomas (NFA) and healthy controls (HC). METHODS: A total of 25 patients with prolactinoma, 31 with NFA, and 32 HCs were included in the study. All patients and controls were screened for the presence of ICDs and other psychiatric disorders using revised version of Minnesota Impulsive Disorders Interview (MIDI-R), Barratt Impulsiveness Scale (BIS-11), Symptom Check List (SCL-90-R) questionnaire and Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS: We detected two new cases (8%) of ICD associated with DAs. Both cases presented with hypersexuality, which reversed totally or decreased upon discontinuation of the drug. The re-challenge of the DA in a smaller dose has led to either no symptoms or weaker symptoms than before. There was an increase in the number of patients who screened positive on obsession, interpersonal sensitivity, paranoid ideation, and additional items subscales of SCL-90-R in comparison to HCs at the end of the study period (p < 0.05 for all). Likewise, cumulative DA dose was positively correlated to obsession, interpersonal sensitivity, paranoid ideation, hostility, phobic anxiety subscales, and GSI scores of SCL-90-R (p < 0.05 for all). CONCLUSIONS: DAs are associated with a small but substantial short-term risk of ICD development and a broad range of psychiatric symptoms in patients with prolactinoma receiving DAs.

Intermittent theta-burst transcranial magnetic stimulation for autism spectrum disorder: an open-label pilot study

Objective: Theta-burst stimulation (TBS) modulates synaptic plasticity more efficiently than standard repetitive transcranial magnetic stimulation delivery and may be a promising modality for neuropsychiatric disorders such as autism spectrum disorder (ASD). At present there are few effective interventions for prefrontal cortex dysfunction in ASD. We report on an open-label, pilot study of intermittent TBS (iTBS) to target executive function deficits and restricted, repetitive behaviors in male children and adolescents with ASD. Methods: Ten right-handed, male participants, aged 9-17 years with ASD were enrolled in an open-label trial of iTBS treatment. Fifteen sessions of neuronavigated iTBS at 100% motor threshold targeting the right dorsolateral prefrontal cortex were delivered over 3 weeks. Results: Parent report scores on the Repetitive Behavior Scale Revised and the Yale-Brown Obsessive Compulsive Scale demonstrated improvements with iTBS treatment. Participants demonstrated improvements in perseverative errors on the Wisconsin Card Sorting Test and total time for the Stroop test. The iTBS treatments were well tolerated with no serious adverse effects. Conclusion: These preliminary results suggest that further controlled interventional studies of iTBS for ASD are warranted.

Atypical symptom presentations in children and adolescents with obsessive compulsive disorder.

BACKGROUND: Common symptom presentations in youth with Obsessive Compulsive Disorder (OCD) are easily recognized and are included in the Children's Yale Brown Obsessive Compulsive Scale (CY-BOCS) symptom checklist. However, some youth may occasionally present with atypical or unusual symptoms that are less readily recognized as OCD and may be confused with other disorders that sometimes overlap, such as autism spectrum disorder or even psychosis. METHODS: Case synopses which are thematically linked and exemplify and illustrate two distinct types of unusual or atypical symptom presentations are described. These symptoms are embedded in the subjects' broader clinical picture, that more correctly identifies the atypical symptoms as a variant feature of OCD rather than some other diagnostic condition. RESULTS: We describe twenty-four children with OCD. Twelve children had obsessions related to adverse experiences of places, times or other people that were felt as horrific, abhorrent or disgusting. These obsessions led to contamination fears of any thoughts or actions associated with those places, events or people. In those whose OCD was a reaction to another person, the contamination obsession often took the form of fear of acquiring an unwanted trait or characteristic by association, which was then avoided. Twelve other youth had obsessions driven by a primary sensory experience that was intolerable, including tactile, olfactory, and auditory stimuli. These sensory experiences were sometimes linked to specific objects or people, driving time-consuming repetitive behaviors to avoid or alleviate the sensory discomfort. CONCLUSION: Recognition of atypical presentations of OCD, such as fear of contamination by association with adverse experiences and primary sensory intolerance leading to OCD will help clinicians to better identify and treat these unique symptoms.

Is the prevalence of orthorexia nervosa in an Australian university population 6.5%?

PURPOSE: To survey Australian adults at a Sydney university about: their tendencies towards the proposed health food eating disorder, orthorexia nervosa (and to estimate the prevalence of this condition), their eating behaviours, and their body image. METHODS: A pilot, cross-sectional and descriptive online survey was conducted on staff and students at the University of New South Wales, Sydney. The primary outcome was the score on the most commonly used and validated measure of orthorexic behaviours, the ORTO-15. The point prevalence of orthorexia nervosa was estimated using the ORTO-15 cut-off score of < 35. Other outcomes were the Eating Attitudes Test-26 and the Body Shape Questionnaire-34. RESULTS: In the sample of 92 Australian adults recruited at a university, there was a point prevalence rate for orthorexia nervosa of 21% when using the ORTO-15 cut-off value of < 35. If criteria A and B of proposed diagnostic criteria for the condition were also taken into consideration (i.e. someone with orthorexia nervosa would display disordered healthy eating tendencies; as well as were: underweight, or had marked concern with their body shape, or had significant impairment of functioning in work life or social life), the true prevalence rate could be considered to be 6.5%. CONCLUSIONS: Using the ORTO-15 tool alone may overestimate the true prevalence of orthorexia nervosa. Further research into the accurate diagnosis and treatment of orthorexia nervosa is needed. LEVEL OF EVIDENCE: Level V, descriptive study.

Orthorexia nervosa in a sample of Portuguese fitness participants.

PURPOSE: Orthorexia Nervosa (ON) is described as an obsessive behaviour motivated by great concern for following a healthy diet. Although it was first described in 1997, ON remains inconspicuous and poorly characterized in the literature. The aims of this study were to evaluate the prevalence of ON in a sample of ambulatory individuals and to investigate their common characteristics, attempting to better characterize this entity. METHODS: A non-random sample of 193 adult gym members answered a questionnaire based on a Portuguese version of ORTO-15, supplemented with additional questions. Possible associations between the different variables and pathological scores on ORTO-15 were analysed using logistic regression models. RESULTS: ON behaviour was documented in 51.8% of the sample, mean age 30.96 years (± 1.03 years), and this condition tended to be correlated with younger ages. Physical appearance and frequent exercising were also associated with ON, while no correlation between orthorexic tendencies and both gender and educational field was found. Furthermore, consumption of special food, dissatisfaction with physical appearance and frequent exercising could predict the presence of ON in the sample. CONCLUSIONS: Despite the use of a convenience sample, results place us in a different perspective, considering the idea that orthorexic individuals are exclusively concerned about pursuing a pure diet. The presence of ON was associated with other non-dietary behaviours allied to a healthy lifestyle and aesthetic concerns. LEVEL OF EVIDENCE: Level V: Descriptive study.

Obsession with perfection: Body dysmorphia.

The deeply rooted fascination with beauty penetrates society worldwide. The indulgence to look and feel beautiful pervades all ages, genders, and nationalities, with research conferring a remarkable tendency to agree on measures of attractiveness among these disparate groups. Research has found that beautiful people do, in fact, receive more desirable outcomes in life and job satisfaction, family formation, and overall happiness. Humans have a tendency to respond to attractive persons more favorably, driving many patients to our clinics. Although some dissatisfaction with one's appearance is common and normal, excessive concern with certain facial or body attributes can be sign of an underlying disorder. Body dysmorphic disorder (BDD) is a disorder of self-perception. It is the obsession with perfection. Defined as the impairing preoccupation with a nonexistent or minimal flaw in appearance, BDD affects 0.7-2.4% of the general population and a much larger percentage of those attempting to receive aesthetic treatments. Clinicians should be aware of this disorder and remain vigilant because such patients will not be satisfied with corrective procedures. Although not involving cosmetic intervention, the treatment of BDD does involve psychiatric referral and psychopharmacologic therapy, with patients receiving these having a much better prognosis.

Obsessive slowness presenting as catatonia in a patient with Borderline Intelligence.

Obsessive slowness is described to be a syndrome of extreme slowness in ways various tasks are performed. Its existence as an independent syndrome is challenged by authors, who regard it to be a part of obsessive compulsive disorder. We describe here a case of a 24-year-old male patient who presented with catatonic symptoms. Diagnostic difficulties and management issues are highlighted.

[Weight control behaviors in dieting adolescent girls and their relation to body dissatisfaction and obsession with thinness]. / Conductas de control de peso en mujeres adolescentes dietantes y su relación con insatisfacción corporal y obsesión por la delgadez.

INTRODUCTION: Obsession with thinness and body dissatisfaction can lead adolescents to follow unsupervised diets, which could result in risky weight control behaviors such as fasting, vomiting, use of diuretics and laxatives. The aim of the current study is to examine weight control behaviors in dieting adolescents and relate them to body dissatisfaction (BD) and obsession with thinness (OT). METHODS: A cross-sectional study was conducted on 439 adolescents from Valparaiso public schools to investigate risky weight control behaviors due to BD and OT scales from the Eating Disorders Inventory-2 (EDI-2), comparing restrained eaters and non-restrained eaters. RESULTS: A total of 43% adolescents had followed a weight loss diet without medical supervision. The dieters had higher BD and OT values. Moderate to severe food restriction, based on expert judgment, was observed in 29.6%, and differences in the presence and severity of purging behaviors were found between the 2 groups. CONCLUSIONS: One third of the adolescents studied followed diets without professional supervision and had higher BD and OT values, as well as risky weight control behaviors. Overweight and obese adolescents followed more restrictive diets and developed riskier weight control behaviors.

Conductas de control de peso en mujeres adolescentes dietantes y su relación con insatisfacción corporal y obsesión por la delgadez / Weight control behaviors in dieting adolescent girls and their relation to body dissatisfaction and obsession with thinness

Introducción: La obsesión por la delgadez y la insatisfacción corporal pueden llevar a las adolescentes a seguir dietas sin supervisión, lo que podría asociarse además a conductas riesgosas de control de peso, tales como ayuno, vómitos, uso de diuréticos y laxantes. El objetivo fue explorar conductas de control de peso en adolescentes dietantes y relacionarlas con insatisfacción corporal (IC) y obsesión por la delgadez (DT). Pacientes y Método: Estudio transversal en 439 adolescentes de colegios públicos de Valparaíso diseñado para indagar conductas de control de peso riesgosas a través de escalas de IC y DT del Cuestionario de Trastornos Alimentarios (EDI-2), comparando dietantes y no dietantes. Resultados: El 43% había realizado dieta sin supervisión médica. Las dietantes presentan valores superiores en DT e IC. El 29,6% de ellas presenta restricción alimentaria de riesgo moderado a alto, tomando como base el criterio de expertos, y se encuentran diferencias en la presencia y severidad de las conductas purgativas de control de peso entre los dos grupos estudiados. Conclusiones: Un tercio de las adolescentes estudiadas hacen dietas sin supervisión profesional, presentan mayor IC y DT y conductas riesgosas de control de peso. Aquellas con sobrepeso y obesidad realizan dietas más restrictivas y conductas de control de peso más riesgosas.

Introduction: Obsession with thinness and body dissatisfaction can lead adolescents to follow unsupervised diets, which could result in risky weight control behaviors such as fasting, vomiting, use of diuretics and laxatives. The aim of the current study is to examine weight control behaviors in dieting adolescents and relate them to body dissatisfaction (BD) and obsession with thinness (OT). Methods: A cross-sectional study was conducted on 439 adolescents from Valparaiso public schools to investigate risky weight control behaviors due to BD and OT scales from the Eating Disorders Inventory-2 (EDI-2), comparing restrained eaters and non-restrained eaters. Results: A total of 43% adolescents had followed a weight loss diet without medical supervision. The dieters had higher BD and OT values. Moderate to severe food restriction, based on expert judgment, was observed in 29.6%, and differences in the presence and severity of purging behaviors were found between the 2 groups. Conclusions: One third of the adolescents studied followed diets without professional supervision and had higher BD and OT values, as well as risky weight control behaviors. Overweight and obese adolescents followed more restrictive diets and developed riskier weight control behaviors.

Construção e validação da Escala de Obsessões e Compulsões para adolescentes / Development and validation of the Scale of Obsessions and Compulsions for adolescents / Construcción y validación de la Escala de Obsesiones y Compulsiones para adolescentes

Há uma escassez de instrumentos próprios para avaliação do Transtorno Obsessivo Compulsivo na adolescência. O objetivo deste artigo é apresentar a construção e evidências de validade de estrutura interna da Escala para Avaliação de Obsessões e Compulsões para adolescentes de 11 a 17 anos de idade. A escala foi respondida por 1022 alunos de escolas públicas e particulares com idade média de 14,2, sendo 54% do sexo feminino. Análises fatoriais indicaram que a escala é composta por dois fatores. O Fator 1 concentra sentenças que representam fenômenos cognitivos e sensações relacionados à obsessão/compulsão. Já o Fator 2 refere-se a ações que podem ser indicadoras de compulsão. A escala apresenta bons indicadores de precisão. Uma das limitações é o fato de os dados serem exclusivos da população gaúcha. Novos estudos são recomendados para verificar a validade clínica da escala e a possibilidade de ampliar as evidências de validade para outras populações...

There is a shortage of instruments for assessment of Obsessive-Compulsive Disorder in adolescence. The aim of this paper is to present the construction and evidence of validity of the internal structure of the Scale for the Assessment of Obsessions and Compulsions of Teens from 11 to 17 years old. The scale was answered by 1022 students from public and private schools, with an average age of 14.2, 54% female. Factor analysis indicated that the scale consists of two factors. Factor 1 focuses sentences that represent cognitive phenomena and sensations related to the obsession / compulsion. Already Factor 2 refers to actions that may be indicators of compulsion. The scale has good accuracy indicators. One limitation is that the data is exclusive of the state's population. Further studies are recommended to investigate the clinical validity of the scale and the possibility of expanding the evidence of validity for other populations...

Hay una escasez de instrumentos para la evaluación de los Trastorno Obsesivo Compulsivo en la adolescencia. El objetivo de este trabajo es presentar la construcción y evidencia de la validez de la estructura interna de la Escala para la Evaluación de Obsesiones y compulsiones de los adolescentes de 11 a 17 años de edad. La escala fue respondida por 1.022 estudiantes de escuelas públicas y privadas, con una edad media de 14,2, 54% mujeres. El análisis factorial indicó que la escala se compone de dos factores. Factor 1 se centra frases que representan fenómenos cognitivos y sensaciones relacionadas con la obsesión / compulsión. Ya Factor 2 se refiere a las acciones que pueden ser indicadores de la compulsión. La escala tiene buenos indicadores de precisión. Una limitación es que los datos son exclusivos de la población del estado. Se recomiendan más estudios para investigar la validez clínica de la escala y la posibilidad de ampliar la evidencia de validez para otras poblaciones...

Rumination, psychological distress and post-traumatic growth in women diagnosed with breast cancer.

OBJECTIVE: Rumination, the repetitive and recursive rehearsal of cognitive content, has been linked to depression and anxiety in physically well populations, and to post-traumatic growth (PTG) in physical illness populations. Women diagnosed with breast cancer may experience both psychological distress and PTG. As rumination may influence outcomes through distinct pathways, this study investigated the association of intrusion, brooding and instrumental subcomponents of rumination with psychological distress and PTG in the breast cancer context. METHODS: Women diagnosed with primary breast cancer (n = 185), mean age 55.98 years (SD = 9.26), completed an online survey including the Multi-dimensional Rumination in Illness Scale, Depression Anxiety and Stress Scales, Post-traumatic Growth Inventory, Medical Outcomes Social Support Survey, demographic and health-related questions. RESULTS: As predicted, regression analyses indicated that brooding was positively related to depression, anxiety and stress, but was also negatively related to the PTG dimensions of new possibilities and spiritual growth. Partially supporting the study hypotheses, intrusion was positively associated with stress and the PTG of relating to others and new possibilities. As hypothesised, instrumental rumination was positively associated with all five dimensions of PTG. CONCLUSIONS: Rumination is a key consideration in both positive and negative psychological responses of women diagnosed with breast cancer. Associations of specific components of rumination with varying psychological outcomes suggest differential paths by which the specific subcomponents of rumination exert this influence.

Disorders as undifferentiated selfobject formations: treatment of a multidisordered patient.

This paper offers a new understanding of disorders as undifferentiated selfobject formations. A treatment example of a multipledisordered patient is presented to illustrate how disorders diminished as a result of this understanding. This paper highlights the developmental importance of the undifferentiated selfobject and suggests that early interruptions of this discovery experience that take place during the infant's positive moments of freedom and enthusiasm are traumatic. If they go beyond the tolerance of the infant, they can be imprinted as unconscious core traumatic experiences. They remain as implicit memories that can act as warnings of repetitions of the trauma that occurred at the time of freedom and enthusiasm in the act of discovering. It can be suggested that the threat of repetitions of the traumatic loss is associated with these positive moments of discovery. This threat directs the needed self-sustaining undifferentiated selfobject discovery experience away from the positive, thereby leaving the posttraumatic effects of the loss as the focus of discovery. This focus leads to destructive preoccupations and obsessions that are considered disorders such as depression, suicidal thinking, self-mutilation, and eating disorders. Once patients understand the importance of the undifferentiated selfobject discovery need, the delinking of the undifferentiated selfobject from the negative preoccupations takes place. As a result, disorders diminish, and patients begin to consider positive possibilities for their lives. This paper suggests that early interferences in the development of the undifferentiated selfobject lead to the formation of disorders. A treatment of a multidisordered patient is presented to illustrate how this understanding was central to the diminishing of the disorders.

Exploring patterns of unwanted behaviours in adults with Prader-Willi syndrome.

BACKGROUND: Obsessive-compulsive (O-C) traits, and excessive food intake are well known behavioural manifestations among individuals with Prader-Willi Syndrome (PWS). Other unwanted behaviours are also frequently observed, but they need a more specific investigation, especially in the adult population. METHODS: The behaviour of 31 PWS adults was investigated via the Symptom Checklist-90-Revised (SCL-90-R), the Yale-Brown Obsessive Compulsive Scale Symptom Checklist (Y-BOCS-SC), and the Prader-Willi Behavioural Checklist (PBC). The PBC is a quick screening questionnaire prompted specifically for the investigation on adults with PWS. RESULTS: Statistical clustering revealed two patterns of unwanted behaviours from the PBC. Behaviours belonging to the first cluster (e.g., Excessive food intake, Skin picking) appear to be linked to the usual phenotypic manifestation of PWS. By contrast, many other behaviours (e.g., some O-C symptoms and aggressive actions) could show a relationship also to individual psychopathologies. CONCLUSIONS: Both internal (Anxiety and Depression) and external (Hostility) difficulties in managing impulses should account for individually distinct behaviours in adults with PWS.