花澤 寿

Two hundred and ten subjects with panic disorder were studied and classified into four clinical types according to symptomatology and clinical courses. The outcomes of 181 of these subjects were categorized in three ways (good, fair, or poor). Through an examination of the relationship between these clinical types and categories of outcome, it was found that the subjects with little or no ''neurotization'' had a favorable outcome, while those with remarkable ''neurotization'' or with comorbid depressive states had an unfavorable outcome. It is suggested that concomitant ''neurotic'' symptoms, such as somatoform symptoms, as well as concomitance of depressive states, predict an unfavorable outcome of panic disorder.

In Japan, there exist considerable literatures on psychological and psychosomatic aspects of eating disorders such as Anorexia Nervosa and Bulimia, but rather little study has been done on those of obese patients. In this study, we investigated the personality traits of severely obese patients using projective techniques. The subjects were 24 inpatients of simple obesity, 5 males and 19 females, who had been treated with Very-Low-Calorie-Diet in the Second Department of Internal Medicine of Chiba University. Subjects were administered the Rorschach test, and as we examined their responses to the test, we found four types of personality in our subjects : Type I : Subjects who have neurotic personality organization. Ia) Indifferent type. They tend to deny undesirable realities and indulge in wishful thinking. They are passive, peaceful and indifferent. Ib) Immature type. They are similar to the Type Ia subjects, but are younger, more conflicting and less stable. They have difficulty expressing their emotions freely. Type II and Type III : Subjects who have more primitive personality organization. II) False stable type. They use not only neurotic defenses but also more primitive ones. While they are apparently well-adjusted to the society, most of them are suffering from psychological distress. III) Maladjusted type. They have failed to develop effective ego defenses. They can adapt themselves only to the limited and protective environment. Among these, Type I obesity seems to be the typical obesity. This is most frequent type among our subjects, and their personality traits have something in common with these characteristics which had been attributed to the fat people. Although they appear to be well-adjusted, the test results and their personal data suggest that they have only little recognition about their own difficulties, especially about their problematic eating behaviors. In addition, this limited capacity for reflection may be a factor of their poor response to the weight reduction program. In terms of Type II and Type III obesity, the results suggest that rather severe personality disorder underlies obesity. Actually, in these types of obesity, eating problem is closely related to psychological problems. Thus, in a therapeutic context, it is perhaps more productive to counteract their psychological difficulties directly. The Rorschach test demonstrates that the personality and its relation to the eating behavior of obese patients are not homogenous, but that levels of the personality organization of the obeses are various. Therefore, it is necessary to pay much more attention to the process and psychological factors of overeating, as well as the result of overeating.