Our purpose was to measure quality of life (QOL) and work productivity (WP) in persons with panic disorder. Eighty-four panic disorder patients with limited psychiatric comorbidity for ten U.S. outpatient mental health centers were evaluated in a cross-sectional design. Patients self-administered the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Work Productivity and Impairment (WPAI) questionnaire. The independent effects of psychiatric comorbidity were addressed through entry criteria, stratification, and regression analyses. QOL scores are significantly below age and sex-adjusted population norms on all SF-36 measures (p < .01). We note far greater impairment on measures of mental and emotional versus physical well-being. The unemployment rate among these patients is 25%, and only 57% are employed full-time. Those who are employed rated their WP as low. This sample of outpatients suffer marked QOL and employment impairment, which is only partially explained by the presence of psychiatric comorbidity.

This article introduces strategies for deepening the understanding of paraphilias and the therapeutic process of treating them. The case study explores a young man's compulsive sexual fantasies over the Internet, his compulsive masturbation, and his pedophilic and paraphilic fantasies as adaptations from early developmental conflicts. A therapeutic process supports this young man's understanding of his rejection of himself and promotes acceptance of developmentally appropriate and integrated sexual expression. In particular, this case discussion addresses three aspects in them ultiplicity of one's sexuality: the sexual self, the “voices” of sexuality, and the “dance” of sexuality. Additionally, management of transference and countertransference are discussed as means of strengthening the therapeutic alliance.

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