Customizing treatment of chronic fatigue syndrome and fibromyalgia: the role of perpetuating factors.

Background: Syndromes characterized by chronic, medically unexplained fatigue, effort- and stress-intolerance, and widespread pain are highly prevalent in medicine.

Results: In chronic fatigue syndrome (CFS) and fibromyalgia (FM), various perpetuating factors may impair patients' quality of life and functioning and impede recovery. Although cognitive-behavioral and graded-exercise therapy are evidence-based treatments, the effectiveness and acceptability of therapeutic interventions in CFS/FM may largely depend on a customized approach taking the heterogeneity of perpetuating factors into account.

Personality and intrapersonal and interpersonal functioning of women starting their first IVF treatment.

Background: IVF treatment involves a reassessment of issues concerning autonomy and relatedness. This study aims to extend prior studies on the psychological impact of IVF/ICSI by studying the association between the personality dimensions of Self-Criticism and Dependency with the psychological well-being and quality of the couple relationship for women starting their first IVF treatment.

Methods: This is a cross-sectional study of 68 women starting their first IVF treatment at the Leuven University Fertility Centre of the University of Leuven, Belgium.

[Fifty years of psychiatry at the interface between psyche and soma: a SWOT analysis].

During the past 50 years the border area between psychiatry and somatic medicine has undergone remarkable changes. Theories have become better-founded, both psychologically and neurobiologically, research has become more sophisticated, and liaison-psychiatrists and health psychiatrist/behavioural medicine psychologists have played an increasingly active role in this domain. At the beginning of the 21st century modern psychosomatic medicine is facing new challenges; these include how to create a workable diagnostic classification system, how to instruct and educate both health professionals and lay-persons to an adequate level, how to utilize innovative research paradigms without having recourse to reductionism and how to implement in medical practice treatments that are geared to the needs of the individual patient.

The relationship between fibromyalgia and major depressive disorder: a comprehensive review.

Objective: A large body of evidence suggests that the relationship between major depressive disorder (MDD) and fibromyalgia (FM) is complex. Improved understanding of this relationship promises to provide clinicians with better assessment and treatment options for both disorders.

Method: This paper reviews research on the prevalence, etiology and pathogenesis, clinical characterization, and treatment of FM and MDD, as well as studies that examined the relationship between these disorders.

Maladaptive perfectionism as an intervening variable between psychological control and adolescent depressive symptoms: a three-wave longitudinal study.

Maladaptive perfectionism has been postulated as an intervening variable between psychologically controlling parenting and adolescent internalizing problems. Although this hypothesis has been confirmed in a number of cross-sectional studies, it has not yet been examined from a longitudinal perspective. Findings from this 3-wave longitudinal study show that parental psychological control (as indexed by parent and adolescent reports) at age 15 years predicted increased levels of maladaptive perfectionism 1 year later.

Well-being and relationship satisfaction of couples dealing with an in vitro fertilization/ intracytoplasmic sperm injection procedure: a multilevel approach on the role of self-criticism, dependency, and romantic attachment.

Objective: To extend existing research on the psychological impact of IVF by studying the association between the psychosocial factors of self-criticism and dependency, and romantic attachment, with the well-being and relationship satisfaction of couples across the different phases of IVF/intracytoplasmic sperm injection (ICSI) treatment.

Design: Prospective, three-wave study (i.e.

Perceived parental psychological control and eating-disordered symptoms: maladaptive perfectionism as a possible intervening variable.

Recent developmental theorizing conceptualizes perfectionism as a mediator of the relation between intrusive parenting and psychopathology. Research addressing this hypothesis in relation to eating disorders (EDs), however, is lacking. This case-control study (a) examined mean-level differences between ED patients and normal controls in psychologically controlling parenting and perfectionism and (b) addressed the intervening role of perfectionism in associations between psychological control and ED symptoms, distinguishing between maladaptive and relatively more adaptive types of perfectionism.

Psychodynamic and cognitive-behavioral approaches of obsessive-compulsive disorder: is it time to work through our ambivalence?

This paper provides an overview of the growing convergence among psychodynamic and cognitive-behavioral approaches of Obsessive-Compulsive Disorder (OCD). From a traditional psychoanalytic point of view, OCD is mainly conceptualized in terms of a constant conflict between feelings of love and hate. More recent psychodynamic theories of OCD, such as the object-relational model, focus on the role of ambivalent mental representations or cognitive-affective schemas of self and others.

Equifinality, multifinality, and the rediscovery of the importance of early experiences: pathways from early adversity to psychiatric and (functional) somatic disorders.

Most current mainstream research, diagnostic assessment, and treatment strategies focus on specific psychiatric disorders--on diagnoses that are based on manifest symptoms within a categorical, atheoretical approach. This disorder-centered approach has been antithetical to psychoanalytic views, which are fundamentally person centered, focusing on the dynamics of individual lives. Growing realization of the high comorbidity among psychiatric disorders has led to the need to include developmental considerations and hierarchical models in the classification and treatment of psychopathology.

Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: should we treat low effort capacity or reduced effort tolerance?

Aim: The aetiology, pathophysiology, diagnostic delineation and treatment of chronic fatigue syndrome (CFS) remain a matter of debate. Here some aspects of the debate are elucidated, with a particular focus on the patients' decreased motor performance.

Hypothesis: The pathophysiological basis of decreased motor performance in CFS may, theoretically, involve three components: (1) a peripheral energetic deficit (impaired oxidative metabolism and/or physical deconditioning); (2) a central perceptual disturbance (higher effort sense or increased 'interoception'); and (3) a fundamental failure of the neurobiological stress system, leading to an abnormal 'sickness response'.

Looking back towards the future: is it time to change the DSM approach to psychiatric disorders? The case of depression.

With plans underway for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the debate between proponents of a theoretical, descriptive approach of mental disorders versus an etiologically based classification system has been revitalized. This paper critically reviews findings from three related research areas that have begun to question the theoretical, descriptive approach to mental disorders of DSM-III and its successors: (a) research concerning the underlying assumptions of DSM, (b) findings from treatment research, and (c) recent biopsychosocial research. Research on depression is used as a paradigmatic example, but the extent to which these findings may generalize to other disorders is also discussed.

Mechanical stress activates platelets at a subhemolysis level: an in vitro study.

A feasibility study is performed to quantify sheep platelets (PLTs) and to identify the relationship between PLT count and hemolysis as a consequence of mechanical stress. Six adult, healthy Dorset sheep have been used for in vitro blood sampling test procedures in a hemoresistometer device (HRM). In each experiment, blood of the same animal was exposed to six different shear rates.

Stress, depression and fibromyalgia.

There is increasing evidence that stress and depression may play a crucial role in the aetiology and pathophysiology of fibromyalgia (FM). We first review recent studies on the possible role of life stress, including childhood trauma, in FM. Subsequently we focus on clinical and aetio-pathogenetic links between stress, depression and pain.

Dependency and self-criticism: relationship with major depressive disorder, severity of depression, and clinical presentation.

Dependency and self-criticism have been proposed as personality dimensions that confer vulnerability to depression. In this study we set out to investigate the diagnostic specificity of these personality dimensions and their relationship with gender differences, severity of depression, and specific depressive symptoms. Levels of dependency and self-criticism as measured by the Depressive Experiences Questionnaire (DEQ) were compared among patients with major depressive disorder (MDD; n=93), mixed psychiatric patients (n=43), university students (n=501), and community adults (n=253).

Personality prototypes in eating disorders based on the Big Five model.

A three factor model of personality pathology was investigated in a clinical sample of 335 female eating disordered patients. Cluster analysis of the Big Five NEO-FFI scales (Costa & McCrae, 1992) yielded three distinct personality profiles, which were consistent with previous studies: (1) a resilient/high functioning cluster with no clinical elevations on the NEO-FFI scales; (2) an undercontrolled/emotionally dysregulated cluster with elevated scores on the Neuroticism scale and low scores on Conscientiousness and Agreeableness; (3) an overcontrolled/constricted cluster showing high scores on Neuroticism and Conscientiousness and low scores on Openness to Experience. Comparing the three personality prototypes with respect to Axis I and Axis II disorders,resilients reported systematically less clinical and personality problems than both undercontrollers and overcontrollers.

Minding the gap between positivism and hermeneutics in psychoanalytic research.

Two quite different cultures are to be found within psychoanalysis, one more clinical in orientation, more focused on meaning and interpretation, and relying primarily on the traditional case study method, the other more research-oriented, focused on cause-and-effect relationships, and relying primarily on methods borrowed from the natural and social sciences. The history of this divide is reviewed and arguments, pro and con, about the potential contributions of specific types of empirical investigation are discussed. Increasingly, it seems, criticisms concerning the scientific status of psychoanalysis are being responded to by empirical research.

In search of a new balance. Can high "action-proneness" in patients with chronic fatigue syndrome be changed by a multidisciplinary group treatment?

Objective: The purpose of this study is to investigate changes in action-proneness (a cognitive and behavioral tendency toward direct action) after a multidisciplinary group intervention, including cognitive behaviour therapy (CBT) and graded exercise therapy (GET).

Methods: Patients with chronic fatigue syndrome (n=62) completed three versions of a Dutch self-report questionnaire evaluating action-proneness retrospectively that is (1) before illness onset, (2) before treatment and (3) after treatment. Significant others (n=62) also gave their opinion about the patients' action-proneness at time points 1 and 2.

Depression research and treatment: are we skating to where the puck is going to be?

This paper critically reviews empirical findings regarding current key assumptions underlying the nature and treatment of depression which heavily rely on the DSM approach. This review shows that empirical evidence provides little support for these assumptions. In response to these findings, an etiologically based, biopsychosocial, dynamic interactionism model of depression is proposed.

The intergenerational transmission of perfectionism: parents' psychological control as an intervening variable.

The present study investigated the role of parental (adaptive and maladaptive) intrapersonal perfectionism as a predictor of parental psychological control and the role of parents' psychological control in the intergenerational transmission of perfectionism in a sample of female late adolescents and their parents. First, parental maladaptive perfectionism, but not parental adaptive perfectionism, significantly predicted parents' psychological control even when controlling for parents' neuroticism. This relationship was found to be stronger for fathers than for mothers.

The role of life stress in fibromyalgia.

This paper focuses on recent evidence of etiopathogenetic links between fibromyalgia and life stress. From an etiologic point of view, studies concerning the role of adverse life events, personality and lifestyle factors, post-traumatic stress, and negative childhood experiences are reviewed. From a pathogenetic point of view, neurobiologic links between stress and fibromyalgia symptoms, notably chronic pain and fatigue are highlighted.