Evolution of changes introduced in successive revisions of the hitherto existing classifications, as well as the three most recent ones: JCD-10, DSM-IV and the classification proposed by the World Association of Sexology, are discussed in the paper. Controversions and objections most frequently raised by sexologists (from beyond the Anglo-Saxon scientific community mostly) are presented.
Results of the first Polish report on "Sex Life of Poles – 1992", based on a survey of a representative sample of general population, are presented in the paper. The survey has shown that the total of 46% of women and 62% of men complain of various sexual problems and dysfunctions. An increase in the morbidity rate of male patients aged 40-44 should be noted.
The paper deals with new theoretical approaches to sexual dysfunctions and with recent methods of treatment including: training, psychotherapy, pharmacotherapy, vacuum pumps, surgery. Their efficacy and consequences are also discussed.
Personality traits and behavior patterns constituting a 14-item profile of a sex offender are presented in the paper. Out of 30 male sex offenders under study 67% indicated the presence of at least 8 such traits. The finding slightly differ from the research results obtained at the University of Minnesota.
The following issues are discussed in the paper: problems of the BCS treatment from the perspective of the victim, perpetrators and therapists; goals and methods of BCS treatment exemplified by particular cases; the current status of therapeutic services in Poland. Although there has been a substantial improvement of relevant theoretical knowledge, nevertheless due to scarcity of specialists, facilities, and professional training courses, virtually neither perpetrators nor victims of the BCS can receive the help they need.
Forms, range and type of long-term sequelae of child abuse we discussed in the paper, following an analysis of 768 cases. The analysis suggests that a lesser range of pathological sequels of child sexual abuse is associated with: fewer contacts with the penal system, positive relations with the perpetrator, absence of any other traumas, successful heterogeneous relations in adolescence, avoiding mass-media "coverage" of the incident, and finally, with cultural determinants.
The paper presents results of a research on homosexually oriented women, which is a pioneer study in the Polish literature. Subjects were 30 female homosexuals, compared to a control group of 30 heterosexual women. The findings indicate that 80% of female homosexuals were afraid of a negative reaction of their social environment, 60% had guilt feelings connected with their homosexuality, 63% perceived negative consequences of their sexual orientation for their life, 57% revealed maternity needs, 73% – neuroticism, one third of the subjects reported drug use, 43% manifested antisocial behaviors, 53% had suicidal tendencies, while only 40% received psychotherapy.
The problems of disclosing one's homosexuality to family members are discussed on the grounds of a study of 60 homosexuals. In the study psychological interview and the Family Relations Test by E. Belle and J. Anthony were used. A positive reaction of parents was found in less than one third of cases; sons were more likely to meet with parental acceptance; parental attitudes toward homosexuality were differentiated.
Various strategies used by female homosexuals to cover their homosexual orientation ("by-passing", "apparent mysteriousness", "separation", "restriction") as well as various forms of "coming out" are discussed in the paper. Data obtained from 30 female homosexuals indicate that in 47% of cases parents (usually mothers) knew about their daughter's homosexuality, 57% of subjects reported their readiness to come out, and almost one third were rejected by their parents.
The paper outlines expectations of homosexually oriented patients seeking the help of sexologist, as well as available forms of treatment: aimed at psychosexual re-orientation, treatment of sexual dysfunctions, treatment of homosexual partners, focusing on homosexual patients' self-acceptance and their specificity.
Various definitions and classifications of transsexualism proposed in the literature are discussed in the paper. Pointing out the difficulties connected with finding appropriate terms, the author in his everyday clinical practice uses the following diagnostic categories: the gender disapproval syndrome, male-to-female (or female-to-male) transsexualism.
In the study a group of 37 transsexuals was compared to a control group of 100 marital couples. Obtained data indicate that F/M transsexuals have an active, comprehensive sex life and their sexual performance patterns, as regards their sexual needs intensity, are similar to these of the control group.
Subjects in the study were 57 female-to-male transsexuals, as well as 25 men and 21 women of heterosexual orientation. BAEP morphology at the brain s stem level was found to be congruent with the subjects' biological sex and not with their psychological orientation. The findings indicate that in disorders connected with transsexualism higher levels of the central nervous system are involved.
Occurrence of visual hallucinations in patients without disturbances of consciousness is a source of serious diagnostic difficulties. The Charles Bonnet syndrome, described mostly in the elderly with vision defects, is a specific form of visual hallucinosis. Diagnostic problems with this syndrome due to its unknown etiology and the lack of commonly accepted diagnostic criteria, were discussed and exemplified by a case in which the Charles Bonnet syndrome preceded delirium by many weeks in the course of a generalized neoplastic disease. Antiepileptic drugs, especially carbamazepine, were found to be efficacious in such cases.
An attempt was made to assess the effect of psychotropic drug use on offenders' mental status at the moment of committing a criminal act. On the grounds of an analysis of 40 psychiatric court opinions on persons who had been under the influence of various psychotropic drugs at the moment of committing the criminal act they were accused of – it was found that the issue of these drugs effect on the offenders' mental status was either left out or insufficiently taken into account in the testimonials. An assessment of cause and determinants of this phenomenon was made, and its significance for accountability evaluation was emphasized.
Three separate studies on eating disorders prevalence in Poland are presented. Two popular questionnaires for the assessment of attitudes and behaviors toward eating (EAT-26 and BITE), as well as the HAD questionnaire for the assessment of anxiety and depression levels, were used in the research. A cross-sectional comparison of female university students and workwomen indicated that the frequency of inappropriate attitudes and behaviors for the two groups was 4% (using BITE) and 9% (using EAT-26), while respective values were several times higher among university students. It was found that inappropriate eating-related attitudes and behaviors were accompanied by increased anxiety and depression levels, significantly higher in workwomen. A prospective study carried out on female secondary school students indicated that the frequency of inappropriate attitudes and behaviors toward eating was 10% (as assessed by EAT-26), while the sub-clinical syndrome prevalence was 2,1 % (as evaluated by clinical examination). A considerable variability of not only attitudes and behaviors toward eating, but also of the diagnostic categories assumed for the research purposes was found during a 10-month follow-up period. The risk factors for eating disorders described in the literature were not confirmed by the author's research results. The prevalence of disturbed attitudes and behaviors toward eating in a sample of teenage secondary school students was under 1% (as assessed by EAT-26).
Sources and the nature of ethical errors (abuses) and doubts in the clinical practice in psychiatry are considered in the paper. The author point to the lack of clear-cut definitions of health and disease, to the specific (communicatory) function of symptoms of mental disorders, to the role of the therapist as the basic "tool" of therapy, and to hermetic closure of many psychiatric institutions. Typical examples of ethical abuse occurring in particular diagnostic categories and in successive stages of the patient-doctor relationship are described. It is emphasized that errors in the relationship with psychotic and non-psychotic patients are different, and very easy to commit in the latter case. (Eds.)
The author – who is the Supreme Court judge – points out inadequacy of the current legislation on involuntary confinement (civil commitment) in psychiatry. The need for statutory regulations in this respect is emphasized. Detailed provisions proposed in the project of the Mental Health Act are discussed. (Eds.)
The project of the Mental Health Act was criticised by the authors who pointed out contradictions in terms of the proposed provisions, ambiguity of the Act regulations and their disagreement with other legal acts, as well as the unjustified granting the mentally disturbed broader rights than these vested in other persons under similar circumstances. Moreover, the authors suggest that acceptance of these statutory regulations may lead to a decisional paralysis in some specific situations under the Act provisions.