Concepts of integration and sealing over are common clinical psychiatric parlance. Our experience studying and treating acute schizophrenic patients, primarily with psychosocial techniques, has emphasized the meaningfulness of these concepts. By studying the recovered patient's attitude toward his psychotic experiences, we have obtained material from which to formulate definitions of these concepts. Integrators tend to be curious about their symptoms, regard them as part of their life's pattern, and gain information from them, resulting in a more flexible and variable attitude toward illness than patients who seal over. The latter have rather fixed, usually negative, views of their illness, and tend not to strive to understand their psychotic symptoms nor to place their psychotic experiences in perspective with their lives before and after psychosis.

Integration and Sealing Over: Clinically Distinct Recovery Styles From Schizophrenia

Thought disorder and boundary disturbances in psychosis.

The authors tested the hypotheses that the insecure attachment styles of adult patients with schizophrenia are associated with (a) diagnosis, (b) psychopathological syndromes, and (c) course of the disorder. Thirty schizophrenic and 30 age-matching control males answered a self-report questionnaire tapping secure, avoidant, and anxious/ambivalent attachment styles. The patients were diagnosed using the Structured Clinical Interview for DSM-IV (M. B. First, R. L. Spitzer, M. Gibbon, & J. B. W. Williams, 1995), and their symptoms were quantified using the Positive and Negative Syndrome Scale (PANSS; S. R. Kay, A. Fizhbein, & L. A. Opler, 1987). Patients with schizophrenia did not significantly differ from nonpatient controls in secure style mean scores, but they exceeded the latter in both avoidant and anxious/ambivalent style scores. There were no significant correlations between secure attachment style and any PANSS symptom dimensions, whereas avoidant style correlated positively with both positive and negative syndromes, and anxious/ambivalent style correlated only with positive syndrome. Compared with patients with secure style, those with insecure attachment styles were younger at onset of the illness and had longer psychiatric hospitalizations. The preliminary results suggest that the insecure types of attachment, in particular the avoidant style, are associated with schizophrenic symptomatology and course of the illness in male inpatients. Further studies using a longitudinal design on extended samples are needed to determine the direction of causality in the composite relationships among the distinct attachment styles, psychopathology, and course of schizophrenia.

Attachment patterns are associated with symptomatology and course of schizophrenia in male inpatients.

(1984). A Proposed Revision of the Psychoanalytic Concept of Primitive Mental States, Part II. Contemporary Psychoanalysis: Vol. 20, No. 2, pp. 266-343.

A Proposed Revision of the Psychoanalytic Concept of Primitive Mental States, Part II

Survival-related clinical reports are abundantly found in the works of classical, object-relational, and self psychological writers, but are underrepresented in major theoretical formulations on anxiety. Fears of being overwhelmed, merged, penetrated, fragmented, and destroyed, as contents of unconscious and conscious fantasies, are regularly interrelated with the typical dangers. Fifteen preliminary propositions invite closer study of such apprehensions and provide definitional components. Annihilation anxieties are triggered by survival threat; are found early but can be engendered throughout the life cycle; constitute a basic danger; are residuals of psychic trauma; have specifiable subdimensions; may occur in presymbolic form or be associated with fantasies in conflict/compromise formation; may arise with or without anticipation; may be accompanied by controlled or uncontrolled anxiety; are motives for defense; and may be associated with particularly recalcitrant resistances. The study of annihilation anxieties in relation to the basic danger series has both theoretical and clinical advantages, especially for understanding traumatic, anxiety, phobic, psychosomatic, addictive, narcissistic, borderline, and psychotic manifestations, as well as sexual problems (including perversions), nightmares, dissociative and panic states, and especially difficult resistances.

The Place of Annihilation Anxieties in Psychoanalytic Theory

Schizophrenia and the need-fear dilemma , Schizophrenia and the need-fear dilemma , دانشگاه علوم پزشکی ایران

Robert W. Gibson

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Schizophrenia and the Need-Fear Dilemma