Comorbidity of Pediatric Obsessive–Compulsive Disorder and Anxiety Disorders: Impact on Symptom Severity and Impairment

This study explored the impact of comorbidity on symptom severity and treatment outcome in a sample of 75 pediatric Obsessive–Compulsive Disorder (OCD) patients. Forty received cognitive–behavioral therapy (CBT). Overall, 56% had a comorbid disorder. Results revealed that youth with comorbid disorders (anxiety or otherwise) endorsed significantly more anxiety symptoms than youth with OCD only. Youth with comorbidities instead of or in addition to anxiety exhibited more severe OCD symptoms than youth with OCD alone or an anxiety-only comorbidity. Youth in the comorbidities instead of or in addition to anxiety group had the poorest CBT response relative to the other groups. These results suggest that relative to those with OCD alone or with an anxiety disorder comorbidity, youth with comorbidities instead of or in addition to anxiety have a differing clinical presentation (e.g., more severe symptoms) and worse psychotherapy outcome.

Anxiety Sensitivity Moderates Relations Among Tobacco Smoking,Panic Attack Symptoms,and Bodily Complaints in Adolescents

The present study evaluated associations among smoking and anxiety sensitivity (fear of anxiety and anxiety related sensations) in predicting panic attack symptomatology, somatic complaints, and depressive symptomatology in a community sample of adolescents (ages 12 to 17 years; N=206). As predicted, the combination of high levels of anxiety sensitivity and being a current smoker predicted panic symptomatology and somatic complaints, but not depressive symptomatology. These findings suggest anxiety sensitivity may moderate the relation between smoking and prototypical panic psychopathology variables (panic attacks and somatic complaints) even after controlling for gender and negative affectivity, and that these associations are specific to panic-relevant processes. The primary implication of the study findings is that there may be segments of the adolescent population who are at relatively greater risk for panic-related problems by virtue of individual differences in AS and smoking status.

Associations Between Symptoms of Borderline Personality Disorder,Externalizing Disorders,and Suicide-Related Behaviors

Borderline personality disorder and externalizing disorders are associated with suicide-related behaviors. The present study examined whether symptoms of borderline personality disorder mediate the relationship between externalizing disorders and suicide-related behaviors. Diagnostic interviews were administered to 344 participants (n = 233 women). Results indicated that symptoms of antisocial personality disorder, alcohol use disorders, and drug use disorders each were significantly associated with suicide threats and self-injurious behavior in women and symptoms of antisocial personality disorder were associated with suicide attempts in women. With the exception of the association between symptoms of alcohol dependence and self-injurious behaviors, borderline personality disorder symptoms mediated or partially mediated all associations between externalizing disorders and suicide-related behaviors in women. These results highlight the importance of assessment and treatment of borderline personality disorder symptoms in individuals with externalizing disorders, particularly in the presence of suicide-related behaviors.

Trait Anger and Axis I Disorders: Implications for REBT

Anger has a prominent role in basic theories of emotion. And while many psychiatric disorders can be conceived of as emotional disorders (e.g., depressive disorders, anxiety disorders), there are no disorders for which anger is the cardinal feature. We analyzed diagnostic data on 1,687 (as later) psychiatric outpatients and looked at the co-occurrence of high trait anger (as assessed by criterion 8 of Borderline Personality Disorder) and Axis I disorders, and Borderline and Antisocial Personality Disorders. The purpose was to examine whether dysfunctional anger met criteria necessary to be considered a valid diagnostic category. Results showed that high trait anger was not fully accounted for by any particular Axis I diagnosis, or any set of Axis I diagnoses, or by the combination of Axis I diagnoses and Borderline and Antisocial PDs. Trait anger also accounted for significant amounts of unique variance in several indicators of psychiatric impairment and psychosocial functioning. We describe the anger disorder diagnoses of Eckhardt and Deffenbacher (Anger disorders: Definition, diagnosis and treatment. Taylor & Francis, Bristol, PA, 1995), and discuss the implications of those diagnoses for the practice of REBT and CBT.

Adrenocortical Functioning in Boys with Attention-Deficit/Hyperactivity Disorder: Examining Subtypes of ADHD and Associated Comorbid Conditions

Disruptions to hypothalamic-pituitary-adrenal (HPA) axis function have been associated with varying forms of psychopathology in children. Studies suggesting children with ADHD have blunted HPA function have been complicated by the prevalence of comorbid diagnoses and heterogeneity of ADHD. The goals of this research were to assess the relations between waking and stress–response salivary cortisol levels and comorbid disruptive behavior (DBD) and anxiety (AnxD) disorders and problems in boys with ADHD, and to examine whether cortisol levels varied across ADHD subtypes. One hundred seventy elementary school-age boys with ADHD provided salivary cortisol at waking and in reaction to venipuncture. Parent reports were used to assess boys’ psychiatric diagnoses and severity of behavioral problems. Boys’ comorbid AnxD and anxiety problems were associated with greater cortisol reactivity, whereas boys’ comorbid DBD and oppositional problems predicted diminished adrenocortical activity. Reactive cortisol increases were greatest in boys with ADHD and comorbid AnxD, but without DBD. ADHD subtypes were not differentially associated with waking, pre-stress baseline, or reactive cortisol levels. However, comorbid DBD predicted decreased cortisol reactivity in boys with inattentive and hyperactive subtypes of ADHD, but not in boys with combined subtype of ADHD. The results clarify previous patterns of distinct and divergent dysregulations of HPA function associated with boys’ varying kinds of psychopathology.

Fear and Disgust Responding to Heterogeneous Blood-Injection-Injury Stimuli: Distinctions from Anxiety Symptoms

Discrepancies exist in the literature regarding the unique role of disgust in Blood-Injection-Injury (BII) phobia. The present study attempts to clarify the discrepancy using a sample of analogue BII phobics (n = 40) and nonphobics (n = 40) who completed a series of questionnaires and were exposed to blood, mutilation, and injection pictures. The findings revealed that BII phobics reported greater disgust and contamination fears than nonphobics after controlling for anxious symptoms. When rating phobia-relevant pictures, BII phobics responded with greater fear and disgust than nonphobics after controlling for baseline anxiety scores. Furthermore, disgust was the dominant emotional response for BII phobics for the blood and mutilation stimuli. However, no differences were found between fear and disgust within the BII group when rating injection stimuli. The implications of these findings for better understanding the potential unique role of disgust in the etiology, maintenance, and treatment of BII phobia are discussed.

Depressed Adolescents and Comorbid Psychiatric Disorders: Are There Differences in the Presentation of Depression?

Patterns and correlates of comorbidity, as well as differences in manifest depressive profiles were investigated in a sample of depressed adolescents. A sub-sample of the youth were characterized as belonging to either a Pure depression group, an Internalizing group (depression and co-occurring internalizing disorders), or an Externalizing group (depression and co-occurring externalizing disorders). Item response theory (IRT) and differential item functioning (DIF) were used to assess whether the depressed adolescents from the different comorbidity groups presented with different depressive symptoms. Results indicated that the comorbidity groups were meaningfully distinct in terms of psychosocial correlates as well as showed differences in depressive symptom profiles as informed by DIF analyses. In particular, the comorbidity groups differed in terms of presentation of psychomotor changes and cognitive impairments. Implications for assessment are discussed.

Comorbidity of Personality Disorders and Somatization Disorder: A Meta-analytic Review

Meta-analysis of studies assessing the comorbidity of somatization disorder (SD) with one or more personality disorders (PDs) revealed that-contrary to the assertions of the Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision)-SD co-occurs with the majority of Axis II PDs. Although comorbidity effect sizes (rs) linking SD with paranoid PD and obsessive-compulsive PD were small, effect sizes for antisocial, borderline, narcissistic, histrionic, avoidant, and dependent PD yielded rs about or above 0.20. Comorbidity information in future versions of the DSM should be revised to reflect the greater number of PDs empirically linked with SD.

Logic in the study of psychiatric disorders: executive function and rule-following

Executive function has become an important concept in explanations of psychiatric disorders, but we currently lack comprehensive models of normal executive function and of its malfunctions. Here we illustrate how defeasible logical analysis can aid progress in this area. We illustrate using autism and attention deficit hyperactivity disorder (ADHD) as example disorders, and show how logical analysis reveals commonalities between linguistic and non-linguistic behaviours within each disorder, and how contrasting sub-components of executive function are involved across disorders. This analysis reveals how logical analysis is as applicable to fast, automatic and unconscious reasoning as it is to slow deliberate cogitation.

The Structure of Self-Consciousness in Children and Young Adolescents and Relations to Social Anxiety

Decades of research have examined the structure of self-consciousness in adults and its relationship to social anxiety. This study examined the structure of self-consciousness via the Self-Consciousness Scales (Fenigstein et al., J. Consult. Clin. Psychol. 43:522–527, 1975) in a school sample of 175 children and young adolescents (92 girls; mean age = 11.5). Confirmatory factor analysis best supported a five-factor solution (Internal State Awareness, Self-Reflectiveness, Appearance Consciousness, Style Consciousness and Social Anxiety). Although some factor based subscales evidenced low internal consistencies, convergent and discriminant correlations with self-report measures of social phobia, negative affect, and positive affect as well as parent-report measures of internalizing and externalizing problems provided additional support for the five-factor model. Future studies should further examine the multidimensional nature as well as the developmental course of self-consciousness and its relation to social anxiety longitudinally.

Exploring Criterion Confounding in the Measurement of Binge Eating Symptoms and Negative Affect

Common measures of eating disorder symptoms contain affect-related items. When associations between negative affect and eating disorder symptoms are examined, criterion confounding is possible. The current study explored whether criterion confounding biases estimates of relations between symptoms of binge eating and negative affect. Data were collected from first-year university student women via 14-day web-based daily diaries. The Minnesota Eating Behavior Survey (MEBS) measured daily symptoms of binge eating, and the Positive and Negative Affect Schedule (PANAS) measured daily negative affect. The inclusion of affect-related items in the MEBS biased mean level tests of negative affect, correlations of negative affect with symptoms of binge eating, and associations between the likelihood of reporting behavioral symptoms of binge eating and same-day negative affect. Converging results demonstrated the need to measure associated features and risk factors separately from problematic eating behavior symptoms.

Towards a New Epistemology of Mathematics

In this introduction we discuss the motivation behind the workshop “Towards a New Epistemology of Mathematics” of which this special issue constitutes the proceedings. We elaborate on historical and empirical aspects of the desired new epistemology, connect it to the public image of mathematics, and give a summary and an introduction to the contributions to this issue.

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Are There Stable Factors in Preadolescent Girls’ Externalizing Behaviors?

Relatively little is known about the factor structure of disruptive behavior among preadolescent girls. The present study reports on exploratory and confirmatory factor analyses of disruptive girl behavior over four successive data waves as rated by parents and teachers in a large, representative community sample of girls (N = 2,451). Five factors were identified from parent ratings (oppositional behavior/conduct problems, inattention, hyperactivity/impulsivity, relational aggression, and callous-unemotional behaviors), and four factors were identified derived from teacher ratings (oppositional behavior/conduct problems/callous-unemotional behaviors, inattention, hyperactivityimpulsivity, and relational aggression). There was a high degree of consistency of items loading on equivalent factors across parent and teacher ratings. Year-to-year stability of factors between ages five and 12 was high for parent ratings (ICC = 0.70 to 0.88), and slightly lower for teacher ratings (ICC = 0.56 to 0.83). These findings are discussed in terms of possible adjustment to the criteria for children's disruptive behavior disorders found in the Diagnostic and Statistical Manual for Mental Disorders.

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Disgust Sensitivity and Psychopathological Symptoms: Distinctions from Harm Avoidance

The present study examined the relationship between disgust sensitivity and symptoms of somatization, obsessive-compulsive disorder (OCD), interpersonal sensitivity, depression, anxiety, anger/hostility, phobic anxiety, paranoid ideation, and psychoticism in a community sample. Participants (n = 121) completed the Disgust Scale-2, the Symptom Checklist-90, and the harm avoidance subscale of the Temperament and Character Inventory. Disgust sensitivity was found to be correlated with a broad range of psychopathological symptoms. However, results also indicated that these correlations were partially mediated by harm avoidance. That is, when controlling for levels of harm avoidance, the association between disgust sensitivity and psychopathological symptoms was either substantially reduced or became nonsignificant. These findings suggest that the tendency towards behavioral inhibition to avoid punishment and non-reward may partially account for the association between disgust sensitivity and a broad range of psychopathological symptoms.

A Comparison of the Factorial Structure of DSM-IV Criteria for Generalized Anxiety Disorder Between Younger and Older Adults

The controversy concerning the validity and reliability of generalized anxiety disorder (GAD) appears to be particularly relevant in the elderly, since physical symptoms associated with GAD can readily be considered as the consequences of normal aging. This study aims to analyze the structure invariance of a questionnaire assessing the DSM-IV diagnostic criteria across samples of older adults and college students. Ninety-seven adults aged 65 or over and 130 college students completed the Worry and Anxiety Questionnaire (WAQ). The results revealed that factorial invariance could be assumed and, in addition, that scores for severity of GAD symptoms were higher in younger subjects than in older ones. The results support the applicability of DSM-IV criteria for GAD in elderly people, as the factorial structure of the WAQ was the same for this age group as for younger adults. A higher degree of GAD severity was found in the younger sample.

Die Geschichte der „Stellungnahme zur psychoanalytischen Therapie“

Ohne Zusammenfassung

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Dignity and the right to be lesbian or gay

Richard Mohr emphasizes the importance of dispelling false beliefs about lesbians and gay men, and establishing legislation that protects the rights of sexual minorities. He argues that homophobic policies originate in the belief that gay men and lesbians are categorically less morally valuable than others, rather than deserving of unequal treatment because of their behaviors or actions. In response, I show that homophobic panic over lesbian or gay sex acts is actually quite influential, and argue that Mohr fails to take account of the political and philosophical significance of sexual freedom, and the inextricability of sexual being and sexual doing.

Bootstrapping and knowledge of reliability

This is a critical discussion of a paper on the problem of bootstrapping by Jose Zalabardo.

Aktuelle Probleme der Krankenhausplanung in der Psychosomatischen Medizin und Psychotherapie

Ohne Zusammenfassung

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Graduate employment status and health: a longitudinal analysis of the transition from student

The prevalence of unemployment and underemployment was explored longitudinally in 248 recent graduates (73 males and 175 females) over an 18–24 month transition from final year student to 9–12 months post-graduation. Over this period changes in levels of psychological distress, health behaviours, social support, optimism and achievement motivation were measured. Results show that both unemployment and underemployment have deleterious effects on psychological and physical health, social support, optimism and achievement motivation.