Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample

Sleep disturbance and emotion dysregulation have been identified as etiologic and maintaining factors for a range of psychopathology and separate literatures support their relationships to anxiety, depression, PTSD, and alcohol dependence (AD) symptom severity. Previous studies have examined these relationships in isolation, failing to account for the high rates of comorbidity among disorders. It is not yet known whether these processes uniquely predict symptom severity in each of these domains. Participants were 220 patients in residential substance abuse treatment, who had experienced a potentially traumatic event and exceeded screening cutoffs for probable PTSD and problematic alcohol use. Controlling for emotion dysregulation and the interrelationships among the outcome variables, insomnia was uniquely associated with anxiety (B = .27, p < .001), depression (B = .25, p < .001), PTSD (B = .22, p < .001), and AD (B = .17, p = .01) symptom severity. Similarly, controlling for insomnia, emotion dysregulation was uniquely associated with anxiety (B = .40, p < .001), depression (B = .47, p < .001), PTSD (B = .38, p < .001), and AD (B = .26, p < .001) symptom severity. Insomnia and emotion dysregulation appear to be transdiagnostic processes uniquely associated with symptom severity across a number of different domains and might be important treatment targets for individuals with PTSD and AD.     

Personal disturbance scale: factor structure confirmed in a large nonclinical sample

The two-component structure of anxiety and depression items of the short form Personal Disturbance Scale, reported in an earlier clinical study of 480 adult psychiatric patients, was substantially replicated in a large nonclinical sample of 758 adults.     

Borderline personality as a self-other representational disturbance

A great deal has been written about the nature of borderline personality. We maintain that borderline psychopathology emanates from particular disturbances in mental representations-impairment in the ability to maintain and use benign and integrated internal images of self and others-and that these troubled ways of thinking drive the troubled interpersonal relations, affective instability, and impulsivity associated with borderline. Aspects of borderline self-other representational disturbances are present across a wide theoretical spectrum, and a number of research methodologies already exist to assess the phenomena. We conclude that borderline attributes exist on continua, and summarize important features as: (1) unstable mental images of self and others, often marked by self-loathing and attributions of malevolence to others; (2) interactions with others organized around a fundamental need for care that is felt to be necessary for basic functioning; (3) fear of others based on expectations of being mistreated and disappointed and/or terror of having one's identity subsumed by another person; (4) difficulty considering multiple and/or conflicting perspectives, with a tendency toward concrete, all-or-none, or black-and-white, thinking and distortion of reality; and (5) sadomasochistic interpersonal interactions in which a person alternatively inflicts suffering on others and suffers at the hands of others.     

Obsessive-compulsive disorder as a disturbance of security motivation

The authors hypothesize that the symptoms of obsessive-compulsive disorder (OCD), despite their apparent nonrationality, have what might be termed an epistemic origin--that is, they stem from an inability to generate the normal "feeling of knowing" that would otherwise signal task completion and terminate the expression of a security motivational system. The authors compare their satiety-signal construct, which they term yedasentience, to various other senses of the feeling of knowing and indicate why OCD-like symptoms would stem from the abnormal absence of such a terminator emotion. In addition, they advance a tentative neuropsychological model to explain its underpinnings. The proposed model integrates many previous disparate observations and concepts about OCD and embeds it within the broader understanding of normal motivation.     

The SCL-90-R as a screening instrument for severe personality disturbance among outpatients with mood and anxiety disorders

Our objective was to examine whether the SCL-90-R, a widely used self-report measure of distress and psychopathology, could screen for personality disorders in general and for severe personality disturbance (SPD) in particular, at the time when patients seek treatment for a state (mood or anxiety) disorder. The SCL-90-R was administered to 112 consecutive outpatients with various mood and anxiety disorders. The personality severity index (PSI) score, defined as the mean value of the scores on the SCL-90-R subscales of interpersonal sensitivity, hostility, and paranoid ideation, was compared with the current symptom index (CSI) score, defined as the mean value of the scores on the remaining six SCL-90-R subscales. A positive screen was considered if PSI > CSI. SPD was defined as the presence of any DSM-III-R Cluster A and/or Cluster B personality disorder. The accuracy of the screen was verified by means of the Structured Clinical Interview for DSM-III-R Personality Disorders. The sensitivity of the PSI > CSI criterion to screen for SPD was 89.4%, while its sensitivity to screen for any DSM-III-R personality disorder was 72.9%. The SCL-90-R subscales that contributed the most to the screening discriminability of this SCL-90-R-derived screening measure were hostility, paranoid ideation, somatization, and obsessive-compulsive behavior. The SCL-90-R may be used to screen for SPD in routine work with outpatients with mood and anxiety disorders, but the results of the screening need to be verified because of the possibility of false negatives and false positives, although that possibility is apparently low. These findings may have important prognostic and treatment implications.     

Everyday risk taking as a function of regulatory focus

Uncertainty is an inherent aspect of everyday life. However, faced with uncertainty, some individuals take risks more eagerly than others. Regulatory focus theory may explain such differences because risky behavior may arise naturally from the eagerness of promotion focused individuals, while safe behavior may arise naturally from the vigilance of prevention focused individuals. A highly relevant real-life context for studying risk is mobility, as engaging in traffic inherently carries uncertainty about negative outcomes. We present two studies showing a direct link between regulatory focus and risky behavior going beyond traditional laboratory approaches. In both naturalistic speeding behavior (Study 1) and simulated risk taking (Study 2) promotion focus was positively, and prevention focus was negatively related to actual risky behavior.     

Severe disturbance or trauma-induced adaptive reaction: a Rorschach child case study

In interpreting children's Rorschachs, it is often difficult to discriminate between a severe disturbance and an adaptive reaction to a trauma. To explore this difficult differential diagnostic issue, a child was tested three times. It was suggested that complexity, references to the trauma, and evidence of psychological disturbance are associated with an attempt to master the trauma. Rorschach data were presented and were found to be consistent with these speculations. The author concluded that such "openness" to an environmental stress may allow an adaptive reaction and that understanding Rorschach data in context helps to reduce ambiguity and to recognize the test's limitations.     

Visuospatial ability, accuracy of size estimation, and bulimic disturbance in a noneating-disordered college sample: a neuropsychological analysis

The relationship between visuospatial ability and size accuracy in perception was assessed in 69 normal college females. In general, correlations indicated small associations between visuospatial defects and size overestimation and little relationship between visuospatial ability and level of bulimic disturbance. Implications for research on the size overestimation of body image are addressed.     

The non-mirroring mother and the missing paternal dimension in a case of narcissistic disturbance

SUMMARY

Heinz Kohut (1971, 1972, 1977), has developed an innovative framework for understanding the dynamics and genesis of disturbances in the sense of self — broadly speaking, the area of narcissistic disturbance. He has emphasized the failure of the primary objects (in his terms ‘selfobjects’) to be available as responsive mirroring figures who can also be idealized. The role of oedipal conflict is specifically de-emphasized. In this paper a patient is described for whom the factors noted by Kohut were relevant, but as well as these, issues related to a failure to negotiate the oedipal position and a denial of the primal scene were also crucial. These phenomena are not described in Kohut's writings. For this patient, the exclusion or foreclosure of the ‘paternal dimension’ (Chiland 1982) left her with a fundamental defect in psychic structure with profound ramifications. In addition various features of the transference pointed to a failure of early communication via projective identification and maternal containment, of the kind described by Bion (1962). This process is compared with that subsumed by Kohut's concept of mirroring.     

Residential and community treatment services utilized by a sample of youth with severe emotional disturbances

Analyzed case records to determine the costs and service usage patterns for a group of 25 youth randomly selected from the case load of a regional mental health agency. Study participants had extensive histories of publicly supported psychiatric hospitalizations. An average of 36.2 contacts per youth (905 total contacts) with human services providers were documented. Approximately 2 out of every 5 contacts resulted in out-of-home placements. The estimated cost of providing services to the 25 youth exceeded 3 million dollars. The types and costs of treatment services provided to study participants are discussed.