Development and validation of the Eating Disorder Diagnostic Scale: a brief self-report measure of anorexia, bulimia, and binge-eating disorder

This article describes the development and validation of a brief self-report scale for diagnosing anorexia nervosa, bulimia nervosa, and binge-eating disorder. Study 1 used a panel of eating-disorder experts and provided evidence for the content validity of this scale. Study 2 used data from female participants with and without eating disorders (N = 367) and suggested that the diagnoses from this scale possessed temporal reliability (mean kappa = .80) and criterion validity (with interview diagnoses; mean kappa = .83). In support of convergent validity, individuals with eating disorders identified by this scale showed elevations on validated measures of eating disturbances. The overall symptom composite also showed test-retest reliability (r = .87), internal consistency (mean alpha = .89), and convergent validity with extant eating-pathology scales. Results implied that this scale was reliable and valid in this investigation and that it may be useful for clinical and research applications.     

Stability of formal thought disorder and referential communication disturbances in schizophrenia

This study examined the degree to which different types of communication disturbances in the speech of 48 schizophrenia patients and 28 controls were variable and state related versus stable and traitlike. Clinically rated formal thought disorder and 5 types of referential disturbance showed substantial stability within participants over time. The sixth type of referential disturbance, the vague reference, was not stable over time. Formal thought disorder was associated with the severity of core psychotic symptoms in patients. whereas referential disturbances showed little or no association with positive or negative symptom severity. Furthermore, changes in psychotic symptoms over time were accompanied by corresponding changes in formal thought disorder but not referential disturbances. These results support the idea that some types of referential disturbances are traitlike and may be reflective of vulnerability as well as manifest illness.     

Seasonal eating patterns in Norway: a non-clinical population study

Seasonal deviations in normal eating habits have been associated with seasonal affective disorder (SAD) and bulimia nervosa (BN). Two studies on seasonal variation in eating habits are reported in this paper. In Study 1, seasonal patterns of eating disturbances were measured cross-sectionally in 6313 participants using an eating disturbance scale (EDS-5) and a modified version of the Seasonal Pattern Assessment Questionnaire (SPAQ). Eating disturbance scores were predicted by seasonal sensitivity scores from the SPAQ, gender, age, and light. Study 2 used a longitudinal design in which 908 participants were given the EDS-5 every month from November 1993 to January 1995. Scores on the EDS-5 fluctuated with the season of the year, with higher EDS-5 scores in winter and lower in summer. The results suggest that seasonal fluctuations affect only a subset of the total population.     

Identification of preschool children at risk for emotional and behavioral disorders: development and validation of a universal screening system

Three studies were designed to measure various indicators of the reliability and validity of the Preschool Behavior Screening System (PBSS) as a screening instrument for emotional and behavioral disorder risk status of children of preschool age. Study 1 and Study 2 served to establish evidence for content validity. Study 3 investigated one type of reliability evidence (i.e., internal consistency) and four types of validity evidence (i.e., internal structure validity, validity evidence based on external relations, concurrent validity, and cross-informant agreement).Teachers and parents of children (N = 113) enrolled in preschool and childcare programs completed Phase 1 and Phase 2 of the PBSS and the Behavior Assessment System for Children (BASC-2). Cross-informant agreement between parent and teacher ratings on the PBSS was generally moderate, and internal consistency was high. PBSS Phase 1 and PBSS Phase 2 were correlated in the expected directions, and sensitivity and negative predictive value were high. Results suggest that the PBSS may yield psychometrically sound scores for helping states meet child-find requirements. Directions for future development of the PBSS are provided.     

The Development of the Inventory of Problems–29: A Brief Self-Administered Measure for Discriminating Bona Fide From Feigned Psychiatric and Cognitive Complaints

This article describes the development of the Inventory of Problems–29 (IOP–29), a new, short, paper-and-pencil, self-administered measure of feigned mental and cognitive disorders. Four clinical comparison simulation studies were conducted. Study 1 (n = 451) selected the items and produced an index of potential feigning. Study 2 (n = 331) scaled this index to produce a probability score, and examined its psychometric properties. Study 3 tested the generalizability of Study 2's findings with 2 additional samples (ns = 128 and 90). Results supported the utility of the IOP–29 for discriminating bona fide from feigned psychiatric and cognitive complaints. Validity was demonstrated in feigning mild traumatic brain injury, psychosis, posttraumatic stress disorder, and depression. Within the independent samples of Studies 2 and 3, the brief IOP–29 performed similarly to the MMPI–2 and Personality Assessment Inventory, and perhaps better than the Test of Memory Malingering. Classifications within these samples with base rates of .5 produced sensitivity, specificity, positive predictive power, and negative predictive power statistics of about .80. Further research is needed testing the IOP–29 in ecologically valid field studies.     

Cognitive impairments and disordered speech in schizophrenia: thought disorder, disorganization, and communication failure perspectives

This article posits that basic cognitive impairments in schizophrenia are more highly related to speech disorder measured as communication failures than speech disorder measured as thought disorder or disorganization. The author tested 47 schizophrenia patients and 36 control participants for sustained attention, sequencing, and conceptual sequencing ability. Their speech was also rated for communication failures, thought disorder, and conceptual disorganization. Attention and sequencing impairments, examined hierarchically, explained a substantial 38% of the variance in the communication measure of speech disorder but little of the variance in formal thought disorder or conceptual disorganization. The author concludes that (a) impairments in attention and sequencing abilities contribute substantially to schizophrenic communication failures, and (b) it is important to consider lower level cognitive "3rd variables" when examining higher level cognitive associates of speech disorder.     

Thought Disorder on the WAIS-R Relative to the Rorschach: Assessing Identity-Disordered Adolescents

Clinical researchers have noted that compared with other diagnostic groups, adults with Borderline Personality Disorder tend to demonstrate relatively more thought disorder on unstructured projective tests (e.g., Rorschach) than on structured objective tests of cognitive performance (e.g., Wechsler Adult Intelligence Scale; WAIS). Using archival data, our study found evidence that adolescents with Identity Disorder tend to exhibit this same phenomenon. The records of 62 adolescent inpatients who had been administered the WAIS or WAIS-R and the Rorschach were examined. Of the 62 cases, 25 were diagnosed with Identity Disorder, 14 with Conduct Disorder (Group Type), 15 with Oppositional Defiant Disorder, and 8 with Schizophreniform Disorder. For each participant, the WAIS or WAIS-R and the Rorschach were scored according to the Thought Disorder Index (TDI; Johnston & Holzman). Adolescents with Identity Disorder revealed a significantly larger discrepancy between TDI scores on the WAIS or WAIS-R and TDI scores on the Rorschach than did adolescents with other diagnoses. The findings suggested that the discrepancy between the degree of thought disorder on structured versus unstructured psychological tests (i.e., differential decompensation) is related to diagnosis.     

Concealing negative evaluations of a romantic partner's physical attractiveness

Two studies provided evidence that people hide their negative evaluations of their romantic partner's physical attractiveness. This pattern was found using self‐reports of concealment (Study 1) and a behavioral observation measure (Study 2). Participants who engaged in this deception also exhibited elevated speech disfluencies, which is a deception cue. Moderators of concealment were examined. Concealment was especially pronounced for participants high in care for the partner's welfare (Studies 1 and 2), low in commitment (Studies 1 and 2), and high in attractiveness ideals (Study 2). Results suggest that people use deception to regulate their romantic partner's feelings, but that long‐term orientation or desire to maintain closeness may curtail use of this strategy.     

Sociotropy and perceptions of interpersonal relationships as predictors of eating disturbances among college women: two prospective studies

The authors examined the relationship between sociotropy and perceptions of interpersonal relationships and subsequent eating disorder symptoms among young women. In Study 1, 118 women from a liberal arts college in northern Wisconsin completed self-report measures of sociotropy, perceived close social support, and eating disorder symptoms. The women returned 6 weeks later to complete the same measures. After controlling for initial levels of reported eating disturbances, higher levels of Time 1 sociotropy and reductions in perceived social support at Times 1 and 2 made unique contributions to eating disturbances at Time 2, although the interaction of Time 1 sociotropy and Time 2 social support did not add to the model. In Study 2, 138 women completed measures of eating disturbances, sociotropy, and interpersonal hassles on two occasions, 10 weeks apart. Self-reported eating pathology at Time 1 accounted for most of the variance in Time 2 eating disorder symptoms, but increased eating disturbances also were predicted by measures of interpersonal hassles. A final regression analysis using combined samples indicated that both T1 and T2 measures of interpersonal functioning made unique contributions to changes in reported eating disturbances. In sum, the findings suggested that perceptions of reduced support in close relationships and increased interpersonal hassles contribute to increases in reported eating disturbances among college-aged women, independent of baseline levels of eating disturbances and a highly sociotropic personality style.     

Role of structure in disordered thinking in borderline and schizophrenic disorders

Qualitative studies have noted that individuals with "borderline" psychopathology exhibit extreme thought disorder on unstructured tests, yet manifest relatively normal performance on more structured tests of cognitive performance. The present study provides empirical support for this clinical observation. Borderline syndrome patients, defined by DSM-III criteria for borderline personality disorder and/or schizotypal personality disorder, demonstrated significantly greater thought disorder on the Rorschach, as measured by Johnston and Holzman's (1979) Thought Disorder Index (TDI), than did nonpsychiatric controls and were indistinguishable from patients with schizophrenic disorder of relatively recent onset. Borderline patients did not differ from controls on a structured test of cognitive slippage. Further examination of the role of structure in the assessment and treatment of borderline syndrome disorders seems warranted.     

Verbal communication impairments and cognitive control components in people with schizophrenia

Schizophrenia involves multiple communication impairments, including (a) disorganized speech, or formal thought disorder (FTD); and (b) decreased speech output, or poverty of speech. Both FTD and poverty of speech have been hypothesized to be associated with deficits in executive functioning or cognitive control. The current study examined whether FTD and poverty of speech were differentially associated with two distinct aspects of cognitive control, working memory and controlled retrieval. Compared with control participants (n = 30), people with schizophrenia (n = 47) exhibited poorer performance on both working memory and controlled retrieval tasks. However, only FTD (and not poverty of speech) was associated with poor working memory. In contrast, only poverty of speech (and not FTD) had a significant zero-order association with poor controlled retrieval. At the same time, working memory and controlled retrieval interacted to predict FTD, with the highest amount of FTD associated with both poor working memory and poor controlled retrieval. In contrast, psychometric control tasks were not associated with FTD or poverty of speech. This research suggests that FTD and poverty of speech are differentially associated with deficits in distinct aspects of cognitive control.     

The moment‐to‐moment pitch dynamics of child‐directed speech shape toddlers’ attention and learning

Young children have an overall preference for child‐directed speech (CDS) over adult‐directed speech (ADS), and its structural features are thought to facilitate language learning. Many studies have supported these findings, but less is known about processing of CDS at short, sub‐second timescales. How do the moment‐to‐moment dynamics of CDS influence young children's attention and learning? In Study 1, we used hierarchical clustering to characterize patterns of pitch variability in a natural CDS corpus, which uncovered four main word‐level contour shapes: ‘fall’, ‘rise’, ‘hill’, and ‘valley’. In Study 2, we adapted a measure from adult attention research—pupil size synchrony—to quantify real‐time attention to speech across participants, and found that toddlers showed higher synchrony to the dynamics of CDS than to ADS. Importantly, there were consistent differences in toddlers’ attention when listening to the four word‐level contour types. In Study 3, we found that pupil size synchrony during exposure to novel words predicted toddlers’ learning at test. This suggests that the dynamics of pitch in CDS not only shape toddlers’ attention but guide their learning of new words. By revealing a physiological response to the real‐time dynamics of CDS, this investigation yields a new sub‐second framework for understanding young children's engagement with one of the most important signals in their environment.     

Diversity not quantity in caregiver speech: Using computational modeling to isolate the effects of the quantity and the diversity of the input on vocabulary growth

Children who hear large amounts of diverse speech learn language more quickly than children who do not. However, high correlations between the amount and the diversity of the input in speech samples makes it difficult to isolate the influence of each. We overcame this problem by controlling the input to a computational model so that amount of exposure to linguistic input (quantity) and the quality of that input (lexical diversity) were independently manipulated. Sublexical, lexical, and multi-word knowledge were charted across development (Study 1), showing that while input quantity may be important early in learning, lexical diversity is ultimately more crucial, a prediction confirmed against children’s data (Study 2). The model trained on a lexically diverse input also performed better on nonword repetition and sentence recall tests (Study 3) and was quicker to learn new words over time (Study 4). A language input that is rich in lexical diversity outperforms equivalent richness in quantity for learned sublexical and lexical knowledge, for well-established language tests, and for acquiring words that have never been encountered before.     

The role of affective instability and impulsivity in predicting future BPD features

Models of borderline personality disorder (BPD) suggest that extreme levels of affective instability/emotional dysregulation, impulsivity, or the combination of these two traits account for the symptoms characteristic of BPD. The present study utilized longitudinal data to evaluate the ability of Personality Assessment Inventory-Borderline Features (PAI-BOR; Morey, 1991) subscale scores to predict BPD features two years later as a test of these models of BPD. Participants were 156 male and 194 female young adults who completed the PAI-BOR at age 18 and again two years later. Three models were compared: (a) Wave 1 affective instability scores predicting Wave 2 BPD features (AI model); (b) Wave 1 self-harm/impulsivity scores predicting Wave 2 BPD features (IMP model); and (c) both Wave 1 affective instability and self-harm/impulsivity scores predicting Wave 2 BPD features (AI-IMP model), all controlling for stabilities and within-time covariances. Results indicated that the AI model provided the best fit to the data, and improved model fit over a baseline stabilities model and the other models tested. These results are consistent with Linehan's theory (1993) that emotional dysregulation drives the other BPD symptoms.     

Laryngeal anesthetization for the treatment of acquired disfluency: a case study

The subject of this case study is an adult who became severely disfluent after a motor vehicle accident in which he did not suffer significant injuries. His disfluency persisted for 4 months notwithstanding a short trial of speech therapy. Hyperfunctional phonation subsystem disturbances were identified on follow-up evaluations. Laryngeal anesthetization was achieved via a transcutaneous lidocaine injection. The patient improved dramatically within 15 min of the procedure. More than 18 months later, he has retained normal speech fluency without any additional post-injection intervention. Theoretical discussions are rendered to help interpret this treatment outcome. EDUCATIONAL OBJECTIVES: The reader will be able to describe (1) the laryngeal movements and adjustments commonly associated with stuttered speech; (2) the speech dysfunctions a patient evidenced following a motor vehicle accident; and (3) the author's treatment rationale for resolving the patient's speech disorder.     

Disorganization and Individual Psychotherapy for Schizophrenia: A Case Report of Metacognitive Reflection and Insight Therapy

Despite being a characteristic symptom of schizophrenia, implications for therapy with persons experiencing prominent disorganization have received less attention in the psychotherapy literature than have other aspects of the disorder. As such, formal thought disorder may be viewed largely as a barrier to effective participation in therapy. In contrast, though, a range of writers from varied traditions have stressed that this feature of schizophrenia is meaningful and improved coherence of speech is an important and viable component of treatment and recovery. This paper suggests that an emergent integrative psychotherapy, metacognitive reflection and insight therapy (MERIT), may be well-suited for work with persons experiencing disorganization symptoms. A brief overview of MERIT is provided, followed by a case report of an 18-month course of therapy with a man with severely disorganized speech.     

Emotional correlates of the different dimensions of schizotypal personality disorder

Two studies explored which different dimensions of schizotypal personality disorder (SPD) were associated with negative affect, attention to emotions, clarity of emotions, and emotional intensity/instability. Study 1 included 247 college students, and questionnaires were used to measure SPD. Study 2 included 225 community residents, oversampling for individuals with elevated levels of SPD, and semistructured diagnostic interviews were used to measure SPD. In both studies (a) higher levels of negative affect were associated with higher levels of both cognitive-perceptual and interpersonal symptoms, (b) cognitive-perceptual disturbances were associated with greater attention to emotion, whereas interpersonal disturbances were associated with less attention to emotion, and (c) lower levels of emotional clarity were associated with higher levels of suspiciousness.     

Interrater reliability and coding guide for nonpsychotic formal thought disorder

Reliable and valid assessment of abnormal speech patterns may enable earlier recognition of nonpsychotic disorders through characteristic speech patterns. This study sought to establish interrater reliability using a standardized guide for scoring. A scoring guide defining 27 elements (e.g., inappropriate self-reference, simple loss of goal, circumstantiality) of disordered thought was developed. The seminal work of Andreasen's and Holzman's groups provided 12 elements, and 15 new elements were suggested by clinical literature. Audiotaped interviews with 12 psychiatric inpatients, adults of both sexes and various ages hospitalized for acute management of nonpsychotic psychiatric disorders, provided speech samples for observation of disordered thought by two independent raters. Using the guide's definitions and accompanying examples of elements of disordered thought, reliability in scoring was high (kappa of .85 for agreement on the presence of any abnormal speech element and kappa values from .66 to 1.00 for agreement on the presence of individual elements).     

Assessment of disordered thinking in children and adolescents: the rorschach perceptual-thinking index.

The new Rorschach Perceptual-Thinking Index (PTI; Exner, 2000a, 2000b) was designed to assess thought disorders more accurately than the Schizophrenia Index (SCZI; Exner, 1993). Using a sample of child and adolescent inpatients, we examined the relation of Rorschach variables (PTI, SCZI, M-, and X- %) to thought disorder indexes on a behavior rating scale (Behavior Assessment System for Children; Reynolds & Kamphaus, 1992) and a self-report measure (Personality Inventory for Youth; Lachar & Gruber, 1995). Results indicate that, when used in a categorical manner, the PTI differentiated between those patients with and without elevated thought disorder scores on the other measures. Of all Rorschach variables, M- was most related to the other measures, indicating that this variable may be a particularly robust indicator of thought disorder among children and adolescents.     

‘Beauty is in the eye of the beer holder’: People who think they are drunk also think they are attractive

This research examines the role of alcohol consumption on self‐perceived attractiveness. Study 1, carried out in a barroom (N= 19), showed that the more alcoholic drinks customers consumed, the more attractive they thought they were. In Study 2, 94 non‐student participants in a bogus taste‐test study were given either an alcoholic beverage (target BAL [blood alcohol level]= 0.10 g/100 ml) or a non‐alcoholic beverage, with half of each group believing they had consumed alcohol and half believing they had not (balanced placebo design). After consuming beverages, they delivered a speech and rated how attractive, bright, original, and funny they thought they were. The speeches were videotaped and rated by 22 independent judges. Results showed that participants who thought they had consumed alcohol gave themselves more positive self‐evaluations. However, ratings from independent judges showed that this boost in self‐evaluation was unrelated to actual performance.