Convergence of self-report scales and Rorschach indexes of psychological distress: the moderating role of self-disclosure

In this study, we addressed the weak associations found in research between self-report measures and the Rorschach test (Exner, 1978, 1991), from the perspective of Bornstein's (2002) "process dissociation framework." Specifically, in the study, we focused on the associations between self-report measures of psychological distress and their corresponding Rorschach indexes while inspecting the moderating role of self-disclosure. A total of 59, nonpatient Israeli adults participated in a 2-session study. In the first session, they completed self-report scales measuring self-disclosure and psychological distress (suicidality, depression, and loneliness). In the second session, the Rorschach test was administered and coded. The participants were divided into high and low self-disclosure groups. A convergence between self-report and Rorschach measures of psychological distress was found only among high self-disclosers. In the discussion, we address the theoretical and clinical implications of these findings.     

Anxiety and defensiveness: individual differences in affective startle modulation

Anxious individuals selectively attend to threatening information, and defensiveness may influence the experience and expression of anxiety. Fifty-eight undergraduates scoring high and low on measures of anxiety and defensiveness viewed pleasant, neutral, and unpleasant pictures. Acoustic startle probes were presented 60, 240, or 2,000 ms after picture onset. At 60 ms and 240 ms, repressors (low anxiety, high defensiveness) showed weaker blinks during both pleasant and unpleasant compared to neutral pictures, suggesting enhanced early attention to affective stimuli, regardless of valence. At 2,000 ms, high-anxious but not low anxious participants showed potentiated startle responses during unpleasant compared to pleasant pictures. Although this result replicated previous research on anxiety and valence modulation of startle, exploratory analyses suggested that the valence effect was restricted to trait anxious individuals tending toward a defensive coping style. Across probe conditions, defensiveness was associated with heightened startle reactivity independent of self-reported anxiety and foreground stimulus characteristics.

Food and violence: Childhood violence and emotional abuse as complicating factors in the inpatient treatment of eating disorders

SUMMARY

This paper considers the treatment, on an inpatient eating disorders ward, of patients who have suffered violence and emotional abuse during childhood. The complex web of relationships surrounding these patients is discussed, and it is suggested that there are multiple transferences — to the institution, to various members of staff, and to other patients — and that splitting of these transferences is inevitable. Staff experience powerful countertransference feelings, related to the patient's violent history. A central task for the staff team as a whole is to understand and contain the patient's disturbance — taking on, tolerating, and processing the projections. This demands the close working-together of the members of the multidisciplinary team, so that staff can together openly examine the patient's interaction with them and their own emotional responses to the patient and to other members of staff. If these responses are not understood by the ward staff, they can lead to conflict and inappropriate decisions. On the other hand, if the staff team together can build up a picture of the patient's relationships on the ward, and their meaning for the patient, this picture, like a particular projection of the world in an atlas, provides a ‘map’ of the patient's inner world. This ‘map’ can be used by the staff team in navigating their interactions with the patient. It can also assist the psychotherapist in her work to help the patient recognise and, eventually, own the split-off parts of herself.     

MMPI-2 in the inpatient assessment of women with eating disorders

The MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) reveals similar patterns across all Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) eating-disorder diagnoses. In this study, 550 women with eating disorders completed the MMPI-2. The 3 highest mean elevations for all eating-disorder diagnostic groups occurred on the same scales in the same order: 2, 7, and 3. The modal code for all groups was 2-7/7-2. However, multivariate analyses using the 16 validity and clinical scales, as well as the 27 content and supplementary scales, indicated that the MMPI-2 also distinguishes among eating disorders, especially in that patients with restricting anorexia report less psychopathology than other groups. These results are compared with the results of past eating-disorder research that used the older MMPI (Hathaway & McKinley, 1983).     

MMPI-A in the inpatient assessment of adolescents with eating disorders.

The MMPI-A (Butcher et al., 1992), like the older MMPI (Hathaway & McKinley, 1983), distinguishes between anorexia and bulimia. In this study, 245 adolescent girls diagnosed with anorexia, bulimia, or eating disorder not otherwise specified completed the MMPI-A. Multivariate analyses revealed significant differences between anorexia and bulimia on the MMPI-A's validity, clinical, content, and supplementary scales, particularly suggesting multiple impulse control problems among bulimic patients. However, profiles were also more homogeneous across eating disorder groups than in studies using the older MMPI, with high points involving some combination of Scales 1, 2, 3, and 0 for two thirds of the patients in this study. Implications are considered for understanding the common and differential psychopathology of eating disorders.     

Changes of attachment status among women with personality disorders undergoing inpatient treatment

Background: Attachment has increasingly received attention in psychotherapy and has been used as a predictor of process and outcome. Studies investigating changes of attachment styles during psychotherapy are very rare. Method: Forty women with either borderline (BPD) or avoidant personality disorders (AVPD), treated as inpatients, were investigated using an attachment interview (interpersonal relations assessment (IRA)), and questionnaires to determine therapy outcome at the beginning and after seven weeks of therapy. The IRA uses similar questions as the adult attachment interview (AAI) and is used as the basis for the adult attachment prototype rating (AAPR), a procedure to assign individuals to prototypical categories of attachment. Results: The study showed that the therapy in general was effective. In contrast to other studies, we did not find many women classified as secure at the end of their therapy. Comparisons of pre‐post‐ratings revealed instead that clients within both subgroups received higher ratings for the avoidant prototypes at the end of therapy, indicating deactivation of attachment. Changes from ambivalent to avoidant attachment were linked with better outcome among women with borderline personality disorder (BPD). Conclusions: This study adds further evidence to the result that attachment styles do not change dramatically during a time‐limited psychological treatment of personality disorder. Instead, the study showed that features of preoccupied/ambivalent attachment were less significant after seven weeks of therapy. For women with BPD, these changes were linked with a more favourable outcome which might reflect a more structured and deactivated attachment status as a result of inpatient therapy.     

Personality disorders in a Dutch forensic psychiatric sample: convergence of interview and self-report measures

Convergence of PDQ-R- and SIDP-R-derived personality disorder diagnoses was studied in a sample of 85 forensic psychiatric patients. For categorical diagnoses, the mean kappa was .34, but on a dimensional level convergence was somewhat higher. Paranoid, antisocial and borderline personality disorders had prevalence rates around 40%; the other personality disorders occurred with much lower frequency. The PDQ-R yielded more diagnoses, except for antisocial, histrionic, narcissistic, and sadistic personality disorder. Because the latter disorders are among the most prevalent in forensic settings, and because they have important risk and treatment implications, the PDQ-R is not suitable as a screening device in forensic populations. Semistructured interviews that make use of collateral information are recommended for diagnosing personality disorders in forensic subjects.     

The MMPI and Jesness Inventory as measures of effectiveness on an inpatient conduct disorders treatment unit

There is a paucity of research on the effectiveness of inpatient treatment of conduct disorders. The purpose of the present study was to determine what effect a locked behavioral/cognitive treatment setting would have upon the Minnesota Multiphasic Personality Inventory (MMPI) and Jesness Inventory scores of adolescent inpatients. Fifty consecutive admissions (30 males, 20 females) to a conduct disorders unit were administered the MMPI and Jesness Inventory pre- and posttreatment. Statistically significant changes were found on both inventories. Males responded to treatment more favorably than did females. Improvement on the test scores could not conclusively be linked to the treatment due to the absence of a control group; however, combined with previous research, the results indicate areas of improvement in the sample's pathology.     

The effect of inpatient cognitive-behavioral therapy for eating disorders on temperament and character

Personality traits seem to have an important role in the development, clinical expression, course, and treatment response in eating disorders (EDs). We investigated the effects of an inpatient cognitive-behavioral treatment (CBT) on the measures of temperament and character (Temperament and Character Inventory (TCI)) in 149 consecutive patients with EDs. Baseline assessment included anthropometry, the Eating Disorder Examination (EDE), the Beck Depression Inventory (BDI), and the TCI. Treatment was based on the transdiagnostic cognitive behavior theory and treatment of ED, adapted for an inpatient setting. Treatment effects were tested by paired ANOVA, adjusted for covariates. No effects were found on Novelty Seeking, Reward Dependence, and Cooperativeness. Harm Avoidance (F=18.17, p<0.001), Persistence (F=7.71, p=0.006), Self-Directedness (F=27.55, p<0.001), and Self Transcendence (F=16.38, p<0.001) significantly changed after treatment. Changes in TCI scores were wholly dependent on the changes in BDI and EDE, and independent of ED diagnosis and behavior and of BMI changes. We conclude that in ED, a few scales of both temperament and character are significantly modified by CBT, in relation to changes in psychopathology and depression, independently of nutrition. These results are relevant for future studies based on TCI.     

Self-induced vomiting in eating disorders: Associated features and treatment outcome

Self-induced vomiting is adopted by people with a variety of eating disorders (ED) to control body shape and weight. We tested the prevalence, the associated features and the role on treatment outcome of self-induced vomiting in 152 ED patients consecutively admitted to an inpatient cognitive-behavioral treatment (CBT), based on the transdiagnostic CBT for ED. The Eating Disorder Examination, together with the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Temperament and Character Inventory were recorded at entry and at end of treatment. Self-induced vomiting was reported in 35.5% of cases, and 21.1% had multiple purging with vomiting. Individuals with vomiting and those with multiple purging had significantly higher BMI and a higher frequency of bulimic episodes, but individuals with multiple purging were also characterized by higher levels of depression, longer ED duration, more severe ED psychopathology and lower self-directness. Individuals with vomiting had higher eating concern and novelty seeking compared with those without purging behaviors. However, the three groups had similar dropout rates and outcomes in response to inpatient CBT, in keeping with the transdiagnostic theory of EDs.     

Age-related differences in affective and cognitive empathy: self-report and performance-based evidence

The correlation between age and empathy is not clear, with prior findings yielding mixed and inconsistent results. Here, we distinguished between two aspects of empathy and respectively investigated the effects of age on the affective and cognitive facets of empathy using a self-report measure (interpersonal reactivity index, IRI) and performance-based tasks (viewing films). The results showed that older adults manifested age-related deficits in both trait and state cognitive empathy, with the latter being positively associated with memory. Otherwise, the overall affective empathy increased in the elderly, but the age-related differences in affective empathy may be qualified by the valence of the film clips. Specifically, older participants showed more empathic concern (EC) and less personal distress (PD) to other people’s emotions than the younger participants for the distress film. Interestingly, for the amusing film, older participants demonstrated more EC and PD. Overall, the two aspects of empathy have different development trajectories.     

Personality traits,types, and disorders: an examination of the relationship between three self-report measures

As part of an assessment centre 431 candidates completed three self-report measures: one of personality disorders (Hogan Development Survey, HDS; Hogan & Hogan, 1997), one of personality traits (NEO-PI, Costa & McCrae, 1992), and one of personality type (MBTI; Briggs & Myers, 1987). Correlational and regressional analysis tested various hypotheses about the overlap between the different dimensions and confirmed previous research using different instruments (Saulsman & Page, 2004). Results revealed highest correlation between the HDS and NEO, showing neuroticism correlating (as predicted) with excitable (borderline) and cautious (avoidant); introversion correlating with avoidant (cautious), schizoid (detached), and (negatively) with colourful (histrionic); openness correlating with schizotypal (imaginative) and conscientiousness with diligent (obsessive–compulsive). Many of the ‘overlaps’ were suggested by Widiger, Trull, Clarkin, Sanderson, and Costa (2002). The overlap and lack of overlap is considered at the psychometric and conceptual level. Copyright © 2005 John Wiley & Sons, Ltd.     

Mispredicting distress following romantic breakup: Revealing the time course of the affective forecasting error

People evidence significant inaccuracies when predicting their response to many emotional life events. One unanswered question is whether such affective forecasting errors are due to participants’ poor estimation of their initial emotional reactions (an initial intensity bias), poor estimation of the rate at which these emotional reactions diminish over time (a decay bias), or both. The present research used intensive longitudinal procedures to explore this question in the wake of an upsetting life event: the dissolution of a romantic relationship. Results revealed that the affective forecasting error is entirely accounted for by an initial intensity bias, with no contribution by a decay bias. In addition, several moderators of the affective forecasting error emerged: participants who were more in love with their partners, who thought it was unlikely they would soon enter a new relationship, and who played less of a role in initiating the breakup made especially inaccurate forecasts.     

Field reliability of comprehensive system scoring in an adolescent inpatient sample

The extent to which the Comprehensive System for the Rorschach is reliably scored has been a topic of some controversy. Although several studies have concluded it can be scored reliably in research settings, little is known about its reliability in field settings. This study evaluated the reliability of both response-level codes and protocol-level scores among 84 adolescent psychiatric inpatients in a clinical setting. Rorschachs were originally administered and scored for clinical purposes. Among response codes, 87% demonstrated acceptable reliability(> .60), and most coefficients exceeded .80. Results were similar for protocol-level scores, with only one score demonstrating less than adequate reliability. The findings are consistent with previous evidence, indicating reliable scoring is possible even in field settings.