Personality organization as an aspect of back pain in a medical setting.

The MMPI profiles of 74 low back pain patients who had previously been classified as "functional,"organic," or "mixed" were sorted into six profile groups. The six profile groups were those used by Pichot, Perse, Lekous, Dureau, Perez, and Rychewaert (1972); denial, "conversion V" without defensiveness, "conversion V" with defensiveness, depressed/anxious, psychotic and normal. Results indicate that all six profile types are well represented in the low back pain group. Evidence is also presented which shows that each of the pathological MMPI profile types examined across "functional," "organic," and "mixed" classification is significantly more elevated than a normal profile group on two scales (Lb, DOR) designed to measure functional aspects of pain. Pathological MMPI profile groups did not differ significantly from each other on the "functional" pain scales. The data presented in this study point to the relationship of various forms of psychopathology with "functional pain." The findings of this study would not support a homogeneous "pain personality" for low back pain patients. However, combined "conversion V" profiles accounted for 58% of the "functional" group, 45% of the "mixed" group and 35% of the "organic" group.     

Comment on Bohannon (2011): "Five-repetition sit-to-stand test: usefulness for older patients in a home-care setting"

Bohannon (2011) found that the five-repetition sit-to-stand test had limited usefulness for older patients in a home-care setting because most of the patients were not able to perform the test. However, the five-repetition sit-to-stand test can be modified in several ways, if assessment of lower limbs' performance is required by functional testing. Depending on the cohort and on parameters of interest, functional tests and objective biomechanical measures can be used.     

Rorschach and pain characteristics of patients with low back pain and "conversion V" MMPI profiles

Two studies examined the relationship between Rorschach determinants, MMPI scale scores, and pain reports in order to clarify the meaning of the MPI "conversion V" pattern among patients with low back pain. Study I showed that patients without demonstrable organic disease of the back produce Rorschach response summaries marked by lower F+%, lower Sum C, and higher F% than patients with demonstrable organic disease. Study 2 showed that only the increase in F% was associated with significant elevations of the MMPI Hs and Hy scales. The results suggest that elevated MMPI "conversion V" profiles are indicative of psychological disturbance among patients with low back pain. It is unlikely, however, that the disturbance is hysterical. Instead, the psychopathology is probably marked by tension and constraint rather than the over-reactivity of hysteria. The implications of these findings for diagnosis are discussed.     

Asymmetry of doubt in medical self-diagnosis: the ambiguity of "uncertain wellness".

In 2 studies Ss received a clear or an unclear diagnosis, indicating either disease or no disease. In Experiment 1, Ss responded to a hypothetical bacteria test. In Experiment 2, Ss performed 2 saliva tests purportedly measuring risk for pancreatic disorders. Responses to the unclear well diagnosis were unique in several ways. Ss thought the test more invalid, inferred a greater likelihood of illness from a 2nd identical result, saw the disorder as more pernicious, and held no self-protective beliefs about the test or the disease. Moreover, desire for treatment among these Ss was as great as among those receiving a clear diagnosis of illness. Possible mechanisms are discussed, as are potential applications to clinical issues and to the development and maintenance of hypochondriacal health concerns.     

Effectiveness of dialectical behaviour therapy for borderline personality disorder in an inpatient setting

This study evaluates the effectiveness of dialectical behaviour therapy (DBT) for borderline personality disorder (BPD) in an unselected, comorbid population seeking 3-month inpatient treatment. We studied 50 consecutively admitted individuals (44 women, six men) with BPD as defined by DSM-IV at three time points (at admission, at discharge, and at the 15-month follow-up). For the clinical diagnoses, we used the Structured Clinical Interview for DSM-IV (SCID) and compared the frequencies of comorbid axis I and axis II disorders at admission and at the 15-month follow-up. Overall, participants showed a high degree of comorbidity. Psychopathology was significantly reduced at post-treatment and at follow-up. Effect sizes for outcome measures were within the range of those of previous studies. Our findings support the notion that the results of the DBT efficacy research can be generalized to an inpatient setting and to patients with BPD disorder with high comorbidity.     

The relationship between personality organization as assessed by theory-driven profiles of the Dutch Short Form of the MMPI and self-reported features of personality organization

In this study, we investigated the relationships between features of personality organization (PO) as assessed by theory driven profiles of the Dutch Short Form of the MMPI (DSFM; Luteijn & Kok, 1985) and 2 self-report measures of personality pathology, that is, the Dutch Inventory of Personality Organization (Berghuis, Kamphuis, Boedijn, & Verheul, 2009) and the Dutch Schizotypy Personality Questionnaire-Revised (Vollema & Hoijtink, 2000), in a sample of 190 outpatient psychiatric patients. Results showed that the single scales of all 3 measures segregated into 2 theoretically expected and meaningful dimensions, that is, a dimension assessing severity of personality pathology and an introversion/extraversion dimension. Theory-driven combinations of single DSFM subscales as a measure of level of PO distinguished characteristics of patients at various levels of PO in theoretically predicted ways. Results also suggest that structural personality pathology may not be fully captured by self-report measures.     

Constitutional hypermobility as a problem in the rehabilitation of "vertebragenous" pain syndromes

Load-dependent pain in the locomotion system in generally a sign of muscular incoordinations. The type of muscle disturbance is used as an indicant for purposeful physiotherapy. Patients with "constitutional hypermobility" belong to the physiotherapeutic problem patients. Such patients show signs of minimal brain dysfunction like those described by Janda for adults. It is suspected that constitutional hypermobility is only a single expression of a complex motor control disturbance in which muscular hypotonia plays an important role. This always involves considerable problems in connection with rehabilitation.     

Detecting back irrelevant responding on the Personality Assessment Inventory in a psychiatric inpatient setting

The present studies focus on strategies for detecting back irrelevant responding (BIR) on the Personality Assessment Inventory (PAI; L. C. Morey, 1991). Moderate BIR levels can greatly affect the clinical scales of the PAI. Further, the PAI's Inconsistency and Infrequency validity scales are less than optimal for detecting BIR. L. C. Morey and C. J. Hopwood (2004) developed an alternative strategy for detecting BIR that involves comparison of 2 scales from the PAI short-form with the same 2 scales from the PAI full-instrument. The present study examines how different BIR levels affect the clinical, treatment, and interpersonal scales of the PAI in 2 psychiatric inpatient samples. The effectiveness of various strategies for detecting BIR in an inpatient setting is also discussed. Consistent with previous research, moderate rates of BIR impacted several PAI scales in a meaningful way. The Inconsistency and Infrequency validity scales of the PAI were relatively ineffective for detecting low-to-moderate BIR levels. Conversely, the short-form full-instrument comparison strategy was much more sensitive to BIR. Finally, a new BIR detection indicator is presented that improves sensitivity rates for detecting all BIR levels in an acute setting. The implications of these results for detecting BIR in inpatient settings are discussed.     

Efficiency of a strategy for detecting back random responding on the personality assessment inventory

The efficiency of a new strategy to identify back random responding (BRR) on the Personality Assessment Inventory (L. C. Morey, 1991) was studied using random manipulations of item responses from community (904 adult nonpatients) and clinical (1,079 adult patients) respondents. The strategy involved a comparison of short-form and full-instrument T scores on 2 scales found to be particularly sensitive to BRR in a recent study. This strategy was found to be reasonably sensitive and specific to even relatively low levels of BRR.     

A further footnote to Freud's "fragment of an analysis of a case of hysteria".

While ther is no evidence that Freud ever had in analysis a leading political figure, he did analyze the sister of one, and made her the basis of an important case study. Dora's brother, Otto Bauer, was an influential Marxist theoretician and leader of the Austrian Socialist Party from 1918 to 1934. Freud's Dora case illuminates the psychodynamics of Otto Bauer's life and career, and a re-examination of the case together with recent research also provides us with new information about Freud's analysis of Dora and the milieu in which they both lived.