Human figure drawings of gender-problem children: A comparison to sibling,psychiatric, and normal controls

The Draw-a-Person test was used to evaluate a number of questions regarding children referred for potential problems in their gender-identity development (N = 36). Sibling (N = 31), psychiatric (N = 23), and normal (N = 30) children served as comparison groups. The major results included the following: (1) The gender-referred children were more likely to draw an opposite-sex person when requested to "draw a person" than were the other three groups; (2) the gender-referred children who drew an opposite-sex person were more likely to play with opposite-sex toys and dress-up apparel on a free-play task than were the gender-referred children who drew a same-sex person; (3) the gender-referred children drew taller opposite-sex persons than same-sex persons; (4) using Koppitz's (1968) criteria, the normal children had a smaller proportion of emotional disturbance indicators in their same-sex drawings than did the other three groups. These findings were discussed with regard to psychometric and interpretive issues in the assessment of children with atypical gender-role behavior.     

Assessing the Level of Structural Integration Using Operationalized Psychodynamic Diagnosis (OPD): Implications for DSM-5

A key ingredient in the current proposal of the DSM-5 Work Group on Personality and Personality Disorders is the assessment of overall severity of impairment in personality functioning: the Levels of Personality Functioning Scale (LPFS). The aim of this article is to contribute a conceptual and empirical discussion of the LPFS from the perspective of the Operationalized Psychodynamic Diagnosis (OPD) system (OPD Task Force, 2008 ). First, we introduce the OPD Levels of Structural Integration Axis (OPD-LSIA), a measure of individual differences in severity of personality dysfunction that is rooted in psychodynamic theory. We show that the OPD-LSIA is reliable, valid, and highly associated with observer ratings of personality disorders. In the second part, we present results from an OPD expert consensus study exploring potential limitations of the current LPFS item set from the perspective of the OPD-LSIA. We conclude with highlighting implications for future revisions of the DSM-5 proposal.     

Transference Focused Psychotherapy for Patients with Comorbid Narcissistic and Borderline Personality Disorder

Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experience with and research data on patients with comorbid narcissistic personality disorder/borderline personality disorder (NPD/BPD). We briefly review object relations formulations of severe narcissistic pathology, as well as recent research in attachment and the allied concept of mentalization, which have provided a new lens through which to view narcissistic disorders. The research findings from two randomized clinical trials demonstrating the efficacy and effectiveness of TFP are presented. The data from the two Randomized Clinical Trials (RCT) allowed for the study of the characteristics of the subgroup of borderline personality disorder patients who have comorbid NPD/BPD. Findings on comorbidity, attachment status, capacity for mentalization, and level of personality organization of borderline patients with comorbid NPD/BPD, compared with borderline patients without comorbid narcissistic pathology (BPD), are presented. Clinical implications of the observed group differences are discussed, with a focus on refinements in the technique of TFP. Clinical case material is presented to illustrate the specific challenges posed by narcissistic patients to carrying out TFP in each phase of treatment.     

Intraorganizational and interorganizational job change: A discriminant analysis

Using March and Simon's (1958) participation model as a framework, this study employs the 1973–77 Quality of Employment Survey panel data to compare the determinants of intraorganizational and interorganizational job change. Two discriminant functions were significant, the first distinguishing between intraorganizational changers and stayers and the second between interorganizational changers and stayers. Moreover, the variables that distinguished between intraorganizational changers and stayers were either different from or opposite in influence to those distinguishing between interorganizational changers and stayers.     

Dispositional aspects of body focus and idiopathic environmental intolerance attributed to electromagnetic fields (IEI‐EMF)

Body focus is often considered an undesirable characteristic from medical point of view as it amplifies symptoms and leads to higher levels of health anxiety. However, it is connected to mindfulness, well‐being and the sense of self in psychotherapy. The current study aimed to investigate the contribution of various body focus related constructs to acute and chronic generation and maintenance of medically unexplained symptoms (MUS). Thirty‐six individuals with idiopathic environmental intolerance to electromagnetic fields (IEI‐EMF) and 36 controls were asked to complete questionnaires assessing negative affect, worries about harmful effects of EMFs, health anxiety (HA), body awareness, and somatosensory amplification (SSA), and to report experienced symptoms evoked by a sham magnetic field. Body awareness, HA, SSA, and EMF‐related worries showed good discriminative power between individuals with IEI‐EMF and controls. Considering all variables together, SSA was the best predictor of IEI‐EMF. In the believed presence of a MF, people with IEI‐EMF showed higher levels of anxiety and reported more symptoms than controls. In the IEI‐EMF group, actual symptom reports were predicted by HA and state anxiety, while a reverse relationship between symptom reports and HA was found in the control group. Our findings show that SSA is a particularly important contributor to IEI‐EMF, probably because it is the most comprehensive factor in its aetiology. IEI‐EMF is associated with both a fear‐related monitoring of bodily symptoms and a non‐evaluative body focus. The identification of dispositional body focus may be relevant for the management of MUS.     

Assessing the Level of Structural Integration Using Operationalized Psychodynamic Diagnosis (OPD): Implications for DSM–5

In order to investigate the state-trait anxiety distinction in emotionally disturbed and normal children, the responses of 120 emotionally disturbed children and 126 normal children to the State-Trait Anxiety Inventory for Children (Spielberger, 1973) were factor analyzed separately. For the emotionally disturbed group two A-State and two A-Trait factors were found with the A-State factors accounting for significantly more of the variance than did A-Trait factors. For the normal group four A-State and two A-Trait factors were found, but there was not a significant difference between the amount of variance accounted for by A-State and A-Trait factors. Results were discussed as supporting the state-trait distinction and as having several implications for future research on anxiety.     

医学伦理学——欧洲与中国的桥

跨文化医学伦理学研究,要求我们以理智的方式去应对全球化。既要维护多样性,又要明确共同利益、亦要追求共同目标。任何文化都不能强行提出一些标准去规范国际间的生物医学。自主权应坚持义务论的解释,否则一个强势风气将会支配利益的选择解释,将文化多样性在伦理学中铸成一个统一的模式,形成自主权的“通货膨胀倾向”。     

The emergent father role

Using data collected before and after birth of a couple's first child, change in each parent's view of men as fathers was investigated in a short-term longitudinal study. Semantic differential scales tapped the man's image of self as father, the woman's image of husband as father, and each parent's rating of the baby's adjustment. Interview questions provided information on circumstances of the birth, the father's early child care activities, and parents' previous child care experience. Men's judgments of their own effectiveness as fathers declined from before the birth to afterward. Wives' judgments of their husbands' effectiveness as fathers also declined over that same period, but wives rated husbands higher than husbands rated themselves at both times. A single-equation multiple regression model, adapted from a structural model, was estimated to explain change in both spouses' ratings of the man's paternal role competence. It revealed that working-class spouses agreed on the basis for their judgments of the father's role performance, in that both judged him mainly in terms of how much he participated in child care. Middle-class spouses disagreed on the basis for their judgments of fathers, however. The middle-class men rated their own performance in the father role mainly in terms of the baby's adjustment; if they judged the baby to be happier, they judged themselves to be more competent as fathers. The middle-class women did not rate fathers on that basis. Instead, the middle-class women's ratings responded to the circumstances of the birth and to the father's participation in child care chores. Findings are discussed in terms of family role theory, social-class differences in the father's role, and recent change in expectations for men's parental role.This research was supported by NIMH Grant No. MH15735 and earlier by NICHD Grant No. HD 13103.     

Behandlungsleitlinie Persönlichkeitsstörungen

The S2 guidelines for the treatment of personality disorders (PD) are summarized. In the diagnostic assessment of personality disorders a clinical interview should be supplemented by (semi-) structured clinical interviews and self-report measures for the categorical and dimensional assessment of PDs. The results of the assessment process should be communicated to the patient based on a psycho-educational framework. The diagnosis should always be linked to the patient’s individual history. Psychotherapy is the treatment of choice for personality disorders. A detailed analysis of the patient’s problems as well as the definition of a hierarchy of treatment goals are part of the process of treatment planning. For three PDs empirical evidence for treatment approaches is available: (1) dialectical behavior therapy, mentalization-based therapy, schema focused therapy and transference focused therapy all proved beneficial in the treatment of borderline personality disorder. Cognitive-behavior therapy proved helpful in the treatment of (2) dissociative personality disorder and (3) avoidant personality disorder. There is limited evidence for interpersonal therapy and psychodynamic therapies in the treatment of avoidant personality disorder.