Defining recovery from an eating disorder: Conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity

Conceptually, eating disorder recovery should include physical, behavioral, and psychological components, but such a comprehensive approach has not been consistently employed. Guided by theory and recent recovery research, we identified a “fully recovered” group (n = 20) based on physical (body mass index), behavioral (absence of eating disorder behaviors), and psychological (Eating Disorder Examination-Questionnaire) indices, and compared them with groups of partially recovered (n = 15), active eating disorder (n = 53), and healthy controls (n = 67). The fully recovered group was indistinguishable from controls on all eating disorder-related measures used, while the partially recovered group was less disordered than the active eating disorder group on some measures, but not on body image. Regarding psychosocial functioning, both the fully and partially recovered groups had psychosocial functioning similar to the controls, but there was a pattern of more of the partially recovered group reporting eating disorder aspects interfering with functioning. Regarding other psychopathology, the fully recovered group was no more likely than the controls to experience current Axis I pathology, but they did have elevated rates of current anxiety disorder. Results suggest that a stringent definition of recovery from an eating disorder is meaningful. Clinical implications and future directions regarding defining eating disorder recovery are discussed.     

Identity formation in Italian emerging adults: A cluster-analytic approach and associations with psychosocial functioning

The present study examined identity formation in Italian emerging adults using an integrative identity model including commitment making, identification with commitment, exploration in depth, exploration in breadth, and ruminative exploration. Participants were 1,130 university students, aged 18–30 years. In line with previous research, results indicated that, by means of cluster analysis, six identity statuses could be derived: achievement, foreclosure, moratorium, diffused diffusion, carefree diffusion, and undifferentiated. Each of these identity statuses exhibited a distinct profile in terms of self-esteem, anxiety, depression, and need satisfaction. Suggestions for future research and limitations are discussed.     

Sluggish cognitive tempo in children and adolescents with higher functioning autism spectrum disorders: Social impairments and internalizing symptoms

Sluggish cognitive tempo (SCT) was introduced in 1980s in the field of attention deficit hyperactivity disorder (ADHD). Studies indicate that symptoms of SCT are separate from symptoms of ADHD and independently associated with multiple domains of functioning in clinical groups and in typical development. We assessed whether similar pattern would apply to higher functioning autism spectrum disorders (ASD). Children with higher functioning ASD (N = 55; 5?15 years) were divided into the ASD+High SCT (n = 17), the ASD+Medium SCT (n = 18) and the ASD+Low SCT (n = 20) groups based on parent‐rated daydreaming and slowness on the Five to Fifteen questionnaire (FTF). The groups were compared on SCT‐related impairments found in previous studies: social skills, academic functioning, psychiatric symptoms, and processing speed. Assessment methods were the FTF, the Development and Well‐Being Assessment, and the Coding subtest of the WISC‐III. The ADHD symptoms were statistically controlled due to the overlap between SCT and ADHD. The ASD+High SCT and ASD+Medium SCT groups were significantly more likely to have the most pronounced social impairments, and the ASD+High SCT group had significantly higher rate of internalizing disorders compared to the ASD+Low SCT group. Our results suggest that children with higher functioning ASD and high or medium levels of SCT symptoms could be at higher risk for psychosocial impairments than children with higher functioning ASD with low levels of SCT symptoms. Co‐occurring ADHD symptoms do not explain the finding. Recognizing SCT symptoms in higher functioning ASD would be important to targeting preventive support.     

Neuropsychological functioning among the nonpsychotic relatives of schizophrenic patients: a 4-year follow-up study

In a prior study of 54 relatives of patients with schizophrenia and 72 control participants, 3 neuropsychological functions met the criteria for risk indicators of the schizophrenia genotype: executive functioning, memory, and auditory attention. In an assessment of the stability of these findings, the sample was reexamined 4 years after the initial assessment. Three test scores were found to differ between groups (Immediate Verbal Memory, Delayed Verbal Memory, and Dichotic Listening Digits Detected) or to show a significant Group x Gender interaction (immediate and delayed verbal and visual memories). None of the test scores showed Group x Time interactions, suggesting that the discriminating power of the tests was stable over time. Evidence for deficits in working memory and rule learning on the object alternation test was also found. These results support the idea that neuropsychological dysfunction among relatives of patients with schizophrenia is a stable trait caused by the familial predisposition to schizophrenia.     

Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.

The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.     

Trichotillomania: impact on psychosocial functioning and quality of life

This study explored the impact of hair pulling on psychosocial functioning for patients diagnosed with trichotillomania (TTM; n = 28). TTM patients were compared to age and gender-matched groups of psychiatric patients without TTM (n = 28) and nonpsychiatric control volunteers (NC, n = 28) on measures of psychological distress, functioning/quality of life, and self-esteem. Results indicated that TTM patients reported more severe psychosocial impairments than did NC volunteers; however, these differences were mediated by differences in level of depression. Regression analyses indicated significant relationships between some measures of psychosocial functioning and severity of hair pulling, independent of level of depression. Finally, an interview of the impact of hair pulling on 6 domains of daily functioning (negative affect/negative self-evaluations, grooming, recreational activities, social interaction, work/housework productivity, and physical health) indicated common and wide-ranging impairments for both lifetime and current (i.e., past week) ratings. These results highlight the importance of promoting and improving resources for the clinical care of TTM patients, and provide some directions for clinicians to enhance assessment of interference caused by TTM.     

Effects of personal meaning among patients in primary and specialized care: associations with psychosocial and physical outcomes

Personal meaning is thought to serve as an important resource among individuals adapting to the demands of illness. However, some work in this area has been marked by vague conceptualization, or use of assessment instruments that are confounded by well-being. This investigation evaluated relationships between psychosocial and physical outcomes and one theoretically important dimension of attained global meaning - perceptions of life purpose and commitment. Study 1 evaluated 175 patients followed in a primary care gynaecological practice. Study 2 assessed 104 cancer patients in a specialized stem cell transplantation centre. In both samples, personal meaning was concurrently associated with reduced emotional distress, enhanced coping efficacy, and closer intimate relationships, after controlling for social desirability bias and relevant demographic and medical covariates. Associations with lower distress and improved coping efficacy remained significant after additionally controlling for other psychosocial resource variables (i.e. social support, religiousness, emotional control). Personal meaning appears to be independently related to concurrent psychosocial adjustment in a range of medical settings.     

Examining a dimensional representation of depression and anxiety disorders' comorbidity in psychiatric outpatients with item response modeling

The current study replicated, in a sample of 2,300 outpatients seeking psychiatric treatment, a previous study (R. F. Krueger & M. S. Finger, 2001) that implemented an item response theory approach for modeling the comorbidity of common mood and anxiety disorders as indicators along the continuum of a shared latent factor (internalizing). The 5 disorders examined were major depressive disorder, social phobia, panic disorder/agoraphobia, specific phobia, and generalized anxiety disorder. The findings were consistent with the prior research. First, a confirmatory factor analysis yielded sufficient evidence for a nonspecific factor underlying the 5 diagnostic indicators. Second, a 2-parameter logistic item response model showed that the diagnoses were represented in the upper half of the internalizing continuum, and each was a strongly discriminating indicator of the factor. Third, the internalizing factor was significantly associated with 3 indexes of social burden: poorer social functioning, time missed from work, and lifetime hospitalizations. Rather than the categorical system of presumably discrete disorders presented in DSM-IV, these 5 mood and anxiety disorders may be alternatively viewed as higher end indicators of a common factor associated with social cost.     

Pattern of comorbidity among anxious and odd personality disorders: the case of obsessive-compulsive personality disorder

The aim of this study was to examine the pattern of comorbidity among obsessive-compulsive personality disorder (OCPD) and other personality disorders (PDs) in a sample of 400 psychiatric inpatients. PDs were assessed using the Semistructured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Odds ratios (ORs) were calculated to determine significant comorbidity among OCPD and other axis II disorders. The most elevated odds ratios were found for the cooccurrence of OCPD with cluster A PDs (the "odd" PDs, or paranoid and schizoid PDs). These results are consistent with those of previous studies showing a higher cooccurrence of OCPD with cluster A than with cluster C ("anxious") PDs. In light of these observations, issues associated with the nosologic status of OCPD within the Diagnostic and Statistical Manual of Mental Disorders clustering system remain unsettled.     

Three-way interaction of neuroticism,extraversion, and conscientiousness in the internalizing disorders: Evidence of disorder specificity in a psychiatric sample

It is well-established that neuroticism, extraversion, and conscientiousness are individually associated with internalizing disorders, but research suggests that these main effects may be qualified by a three-way interaction when predicting depression. The current study was the first to examine this three-way interaction in a psychiatric sample (N = 463) with a range of internalizing symptoms as the outcomes. Using two omnibus personality inventories and a diagnostic interview, the expected three-way interaction emerged most consistently for symptoms of major depression, and there was also evidence of synergistic effects for post-traumatic stress disorder and generalized anxiety disorder. Findings indicate that, even in a clinically-distressed and currently-disordered sample, high levels of extraversion and conscientiousness protect against distress disorders for those with high levels of neuroticism.     

The role of recollection in source memory: an examination of schizophrenia patients and their first-degree relatives

Source recognition memory deficits have repeatedly been observed in people with schizophrenia (SZ), and have also recently been observed in their first-degree relatives. These deficits have been hypothesized to result, at least in part, from impairments in the conscious recollection process. Although other processes are clearly also affected in SZ, it has been proposed that impairments in the conscious recollection process could be a parsimonious explanation for the source memory deficits observed in their relatives. Here, we tested 25 patients with SZ and 34 of their non-affected parents, as well as two groups of matched healthy controls, on a short-term associative memory task that shares the characteristics of standard source recognition tasks but minimizes the need for recollection of stored information from memory. This task was administered in order to determine if deficits can still be observed in these people when involvement of the conscious recollection process is minimized. We observed deficits on our short-term source memory task in people with SZ, but their first-degree relatives did not share this deficit. These results support the idea that multiple memory processes supporting associative/source memory are affected in SZ, whereas the source memory deficits previously observed in relatives of SZ seem specific to tasks that rely on the conscious recollection process.     

The influence of comorbidity on treatment outcome for children and adolescents with anxiety disorders

There have been a growing number of studies showing that cognitive behavioural treatment packages for children with anxiety disorders are highly effective. Clinically, it is often assumed that treatment outcome is less successful, or that treatment needs to be altered when faced with the existence of comorbid conditions. To date, only one study has directly addressed this question in the child anxiety literature. The present study compared the treatment outcome and maintenance following a brief, group program for the reduction of child and adolescent anxiety disorders in anxious children with versus without comorbid disorders. There was no significant difference in response to treatment at the end of the program and few differences at 12-month follow-up. The only indication of an impact of comorbidity was a suggestion that children with a comorbid condition did not do as well at follow-up. However, this result was only shown on some parent-report measures and not on self-report measures. Overall, the results indicate that treatment for child and adolescent anxiety disorders produces broadly comparable results regardless of the existence of comorbid disorders.     

Parenting stress and competence among mothers of young children with substance use disorders: The roles of trauma and reflective functioning

Posttraumatic stress symptoms are prominent in the lives of parents of young children with substance use disorders (SUD). Parenting experiences, particularly stress and competence, impact parenting behaviors and concomitant child growth and development. Factors that promote positive experiences of parenting, such as parental reflective functioning (PRF), and protect the mother and child from negative outcomes are crucial to understand to develop effective therapeutic interventions. The current US study analyzed baseline data from a parenting intervention evaluation to examine how length of substance misuse, PRF, and trauma symptoms were associated with parenting stress and parenting sense of competence among mothers in treatment for SUDs. Measures included the Addiction Severity Index, PTSD Symptom Scale-Self Report, Parental Reflective Functioning Questionnaire, Parenting Stress Index/Short Form, and Parenting Sense of Competence Scale. The sample included 54 predominantly White mothers with SUDs who had young children. Two multivariate regression analyses found that (1) lower parental reflective functioning and higher posttraumatic stress symptoms were associated with higher parenting stress, and (2) only higher posttraumatic stress symptoms were associated with lower levels of parenting sense of competence. Findings underscore the importance of addressing trauma symptoms and PRF when aiming to improve parenting experiences for women with an SUD.     

Introduction to special series on college students with ADHD: psychosocial issues, comorbidity, and treatment

Increasing empirical attention has been focused on college students with ADHD in recent years. In this special series, five studies are included that address psychosocial issues, comorbidity, and treatment of college students with ADHD. The nature and results of each study are briefly described. This special series of articles significantly advances our knowledge of critical issues with respect to psychosocial functioning, alcohol/substance use, comorbidity, and treatment of ADHD in college students.     

An investigation into the psychosocial functioning of creative children: The impact of ADHD symptomatology

This study examined the relationship among creativity, ADHD symptomatology, temperament, and psychosocial functioning by comparing four groups of children aged 10–12 years: (1) 29 ADHD children without creativity, (2) 16 highly creative children displaying ADHD symptomatology, (3) 18 highly creative children without ADHD symptomatology, and (4) 30 normal controls. Children completed the TTCT, Child Depression Inventory, Revised Child Manifest Anxiety Scale, and Rosenberg Self‐Esteem Scale. Parents completed the Junior Temperament and Character Inventory, Family Environment Scale, and the parent version of the Kastan Children's Attributional Style Questionnaire. Parents completed the Conner's Rating Scales and Child Behavior Checklist, and teachers completed the Child Behaviour Checklist. Results showed that the presence of ADHD symptomatology in creative children was related to their temperamental characteristics, and parent reports of children's levels of anxiety and depression. However, family environment and mother's attributions did not appear to be related to the presence of ADHD symptomatology in creative children. These findings have implications for the development and management of creative children.     

Young adult follow-up of hyperactive children: self-reported psychiatric disorders,comorbidity, and the role of childhood conduct problems and teen CD

We report on the psychiatric disorders present at young adult follow-up (Mean age 20–21 years; 13 + year follow-up) and the comorbidity among them for a large sample of hyperactive (H; N = 147) and community control (CC; N = 71) children. The H group had a significantly higher risk for any nondrug psychiatric disorders than the CC group (59% vs. 36%). More of the H group met criteria for ADHD (5%); major depressive disorder (26%); and histrionic (12%), antisocial (21%), passive–aggressive (18%), and borderline personality disorders (14%) at follow-up than the CC group. Severity of childhood conduct problems contributed to the risk for passive–aggressive, borderline, and antisocial personality disorders. But it only affected risk for antisocial personality after controlling for severity of teen conduct disorder (CD), which also contributed to the risk for these same 3 disorders. Examination for comorbidity among these disorders indicated that presence of either borderline or antisocial personality disorder significantly increased the risk for major depression and the other significant personality disorders. More of the hyperactive group had received various forms of mental health treatment during and since leaving high school than the control group. Results suggest that hyperactive children are at significant risk for at least 1 nondrug disorder in young adulthood, principally major depression and several personality disorders, and that this risk is largely mediated by severity of CD at adolescence.     

Distinct patterns of organized activity participation and their associations with school readiness among Chinese preschoolers

Organized extracurricular activities (EAs) constitute an important part of many young children's lives. However, the role of EAs in children's development during early childhood is poorly understood. The current study examined the associations between EA participation and a range of school readiness outcomes in a sample of 345 urban Chinese preschoolers. Using three waves of data collected on EA participation and applying growth mixture modeling, we discovered two distinct trajectory classes with respect to the breadth of EA participation as well as two classes for EA attendance intensity. With a series of covariates controlled for, children's greater initial levels of or rates of increase in EA breadth were related to better early math skills. Greater probabilities of belonging to the higher-intensity class were also associated with better early math skills in children. However, EA participation did not predict other aspects of children's school readiness, including Chinese reading, receptive vocabulary, expressive language, social skills, and problem behaviors. This study extends existing EA literature, which has primarily focused on school-aged populations in Western contexts, by demonstrating substantial individual variations in Chinese preschoolers' trajectories of EA participation. Our findings suggest that EAs seem to have little unique contribution to children's school readiness except for early math skills.     

The generation effect and the modeling of associations in memory

The search of associative memory (SAM) model of Gillund and Shiffrin (1984) was applied to data of two experiments that examined the generation effect (Slamecka & Graf, 1978). Subjects studied a list of related word pairs, in which they either read both words in the pair or generated the righthand response term using the left-hand stimulus term plus the response word fragment as generation cues. Experiment 1 manipulated encoding condition within subjects and used an incidental learning procedure. Experiment 2 manipulated encoding condition between subjects and used an intentional learning procedure. Memory was tested with recognition, cued recall, and free recall. A higher order association model gave a better and more parsimonious fit to the results than did an item-level association model. The relationship between various versions of SAM and current accounts of the generation effect are discussed, particularly the two-factor theory of Hirshman and Bjork (1988).     

Interpersonal functioning and depressive symptoms in childhood: Addressing the issues of specificity and comorbidity

Research has supported linkages between depression and social impairment in youngsters, but has often focused on depressive symptoms in isolation. We collected data on depressive, anxiety, and externalizing symptoms in 161 school children. Information about interpersonal competence was gathered from several sources, including children, teachers, and behavioral observations. Depressive symptoms were found to be related to difficulties in multiple areas of competence, including maladaptive social problem-solving styles, conflict-negotiation and affect-regulation deficits, and peer rejection. Comparisons of the relative contributions made by depressive and anxiety symptoms to the prediction of functioning yielded some evidence for a specific relation between depressive symptoms and impairment. Children with cooccurring internalizing and externalizing symptoms generally suffered from the most social dysfunction. If replicated in clinical samples, findings such as these may help to guide intervention efforts with depressed children.We thank Daphne Isenberg, Margie Limon, Leslie Scher, and Jennifer Silverman for their assistance in various aspects of this study. We would also like to express our appreciation to the participating children and teachers and to the UCLA Bruin Kids Day Camp.