Parent-Rated Anxiety Symptoms in Children with Pervasive Developmental Disorders: Frequency and Association with Core Autism Symptoms and Cognitive Functioning

Background In addition to the core symptoms, children with Pervasive Developmental Disorders (PDD) often exhibit other problem behaviors such as aggression, hyperactivity, and anxiety, which can contribute to overall impairment and, therefore, become the focus of clinical attention. Limited data are available on the prevalence of anxiety in these children. We examined frequency and correlates of parent-rated anxiety symptoms in a large sample of children with PDD. Methods The goals of this study were to examine the frequency and correlates of parent-rated anxiety symptoms in a sample of 171 medication-free children with PDD who participated in two NIH-funded medication trials. Twenty items of the Child and Adolescent Symptom Inventory (CASI) were used to measure anxiety. Results Forty three percent of the total sample met screening cut-off criteria for at least one anxiety disorder. Higher levels of anxiety on the 20-item CASI scale were associated with higher IQ, the presence of functional language use, and with higher levels of stereotyped behaviors. In children with higher IQ, anxiety was also associated with greater impairment in social reciprocity. Conclusion Anxiety is common in PDD and warrants consideration in clinical evaluation and treatment planning. This study suggests that parent ratings could be a useful source of information about anxiety symptoms in this population. Some anxiety symptoms such as phobic and social anxiety may be closer to core symptoms of PDD. Further efforts to validate tools to ascertain anxiety are needed, as are studies to empirically test approaches to treat anxiety in PDD.     

Impaired self-reflection in psychiatric disorders among adults: A proposal for the existence of a network of semi independent functions

Self-reflection plays a key role in healthy human adaptation. Self-reflection might involve different capacities which may be impaired to different degrees relatively independently of one another. Variation in abilities for different forms of self-reflection are commonly seen as key aspects of many adult mental disorders. Yet little has been written about whether there are different kinds of deficits in self-reflection found in mental illness, how those deficits should be distinguished from one another and how to characterize the extent to which they are interrelated. We review clinical and experimental literature and suggest four different forms of deficits in self-reflection: (a) sense of ownership of one’s own thoughts and actions, (b) emotional awareness, (c) distinction between fantasy and reality and (d) the integration of a range of different views of oneself and others. We propose how these different impairments in self-reflection are linked with one another.     

The stability of alexithymia during work in a high‐stress environment: A prospective study of Swedish peacekeepers serving in Kosovo

Larsson, M. R., Bäckström, M., Michel, P.‐O. & Lundh, L.‐G. (2010). The stability of alexithymia during work in a high‐stress environment: A prospective study of Swedish peacekeepers serving in Kosovo. Scandinavian Journal of Psychology. We applied a prospective design to reinvestigate the issue whether the sub‐domains of alexithymia could be considered stable traits or distress‐related states. Assessments of alexithymia and subjective distress were conducted before deployment to Kosovo in a sample of male peacekeepers. A second assessment was conducted approximately six months later during the final phase of service. The results showed evidence of moderate to high relative stability in all alexithymic sub‐domains. It was also found that a relative change in subjective distress predicted a relative change in difficulty identifying feelings and difficulty describing feelings but not in externally oriented thinking. We suggest therefore that the alexithymic sub‐domains could be considered relatively stable traits but that the level of difficulty identifying and describing feeling varies with the level of subjective distress.     

A re-evaluation of the psychometric properties of the Basic Character Inventory

The aim of this study was to re-evaluate the psychometric properties of the Basic Character Inventory (BCI). In a rather large sample of 503 subjects (323 women and 180 men, 88 non-psychotic psychiatric inpatients and 415 non-patients) factor analysis resulted in three factors with personality traits almost identical with the BCI Oral, Obsessive and Hysterical scales. BCI seems to be a fruitful and reliable assessment instrument for personality traits and character types as outlined in psychoanalytic theory. However, some of the trait subscales ought to be scrutinized in future psychometric re-evaluative studies of BCI on new, large samples. Another factor analysis showed that the BCI Oral scale, together with all the ten subscales of the psychiatric Symptom Check-list 90 (SCL-90), loaded on the first factor, and the BCI Obsessive and Hysterical scales loaded on the second factor, but with different signs. Orality seems to be related to psychopathology.     

Personality disorder cognitions in the eating disorders

The eating disorders are frequently found to be comorbid with Axis II cluster B and C personality disorders. It is important to identify the personality-level cognitions that typify these disorders. This study of a clinical group examines the personality disorder cognitions in the eating disorders. The cognitions that were most relevant to the eating disorder pathology were those relating to avoidant and obsessive-compulsive personality disorder. Other personality disorder cognitions were associated with comorbid psychopathology in largely clinically meaningful ways. These findings extend our understanding of the comorbidity of eating disorders and personality pathology, suggesting that some cases need to be assessed and formulated with such cognitions in mind. Treatment strategies are required that address both the eating and the personality pathology, while considering the impact of these cognitions on the therapeutic relationship.     

Structure factorielle et qualités psychométriques du questionnaire d’auto-évaluation pour adolescents (Youth Self-Report) d’Achenbach et Rescorla

IntroductionRecent research on the prognostic significance of subthreshold comorbid disorders highlighted the need for instruments allowing for the comprehensive exploration of symptomatology of adolescents.ObjectiveTo verify the factor structure and psychometric properties of the Achenbach and Rescorla's Youth Self-Report French translation, which allows this investigation.MethodWe had 1450 adolescents 11–17- year old (747 girls) complete the YSR in secondary schools in the Paris metropolitan area.ResultsConfirmatory Factor Analyses and Exploratory Structural Equation Modeling supported the 8-syndrome structure. However, since ESEM allows cross-loadings, the number of indicators for each factor in the ESEM models is much higher than in the CFA models. Internal consistency and test-retest reliability were satisfactory, and multigroup analyses confirmed the metric and scalar invariance across age and gender of most of the items examined (70 out of 89). We can therefore affirm that girls score lower on Social problems than boys, 15–17-year-old adolescent score higher on Thought problems, Attention problems, and Rule-Breaking Behavior than the younger, and these differences are substantive and independent of differential item functioning.ConclusionThese results are likely to encourage the use of YSR in research and clinical practice with French-speaking adolescents.     

Comments concerning Iverach, et al., Screening for personality disorders among adults seeking speech treatment for stuttering [J. Fluency Disorders 34 (2009) 173-186

Iverach, Jones, O’Brian, Block, Lincoln, and Harrison (2009) indicate the high co-occurrence of one or more Personality Disorders (PD) for adults who stutter. The findings of Iverach et al. argue against many years of research and the experiences of skilled clinicians who have considered the relationship between stuttering and anxiety/negative affectivity. The results of Iverach et al. are questioned based on several methodological issues.Educational objectives: 1. To explain why the unusually high occurrence of personality disorders (PD) for individuals who stutter found by Iverach et al. (2009) may be questionable based on methodological approach. 2. To explain the heightened levels of anxiety experienced by many individuals who stutter as a natural and reasonable response to a chronic and serious problem such as stuttering. 3. To debate the potential for the inaccurate diagnosis of Axis II Personality Disorders to unnecessarily stigmatize individuals who stutter.     

Comorbidity between and within childhood externalizing and internalizing disorders: reflections and directions

The term and concept of lcomorbidity has been mired in controversy, although there is little question that the existence of covariation among psychiatric diagnoses poses significant challenges to current models of psychiatric classification and diagnosis. The papers in this Special Section underscore a number of important issues relevant to the comorbidity between and within childhood externalizing and internalizing disorders, and illustrate both methodological and substantive reasons for such comorbidity. Weiss, Susser, and Catron's distinction among common, broad-band specific, and narrow-band specific features provides a helpful framework for understanding the comorbidity of childhood externalizing and internalizing disorders (B, Weiss, K. Susser, & T. Catron, 1998). Hierarchical models of psychopathology help to dissolve the distinction between splitters and lumpers and point to variables that may elucidate the etiology of externalizing and internalizing disorders.     

Family Correlates of Oppositional and Conduct Disorders in Children With Attention Deficit/Hyperactivity Disorder

Comorbidities among children with ADHD are key determinants of treatment response, course, and outcome. This study sought to separate family factors (parental psychopathology and parenting practices) associated with comorbid Oppositional Defiant Disorder (ODD) from those associated with Conduct Disorder (CD) among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n = 149) were diagnosed using DSM-IV criteria. Parents completed measures of parenting practices. Comorbid ODD and CD were significantly associated with maternal negative/ineffective discipline. Comorbid CD, but not ODD, was significantly associated with lack of maternal warmth and involvement, paternal negative/ineffective discipline, and with paternal Antisocial Personality Disorder (APD). However, the risk of CD posed by parenting appeared concentrated among children without a father having APD. While consistent discipline appears important for addressing comorbid ODD and CD, paternal psychopathology and the quality of the relationship between mother and child may pose risk specifically for comorbid CD. Efforts to prevent and/or treat CD should consider not only provision of structure and prudent discipline, but also the affective qualities of the relationship between the primary caretaker and child.     

Psychopathology in anxiety disorders

Complaints of anxiety, often meetingDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III), criteria for anxiety disorder, are among the most common problems presenting to health practitioners. In spite of the frequency of anxiety and anxiety disorders, little is known about the basic psychopathology of these conditions that would lead to the development of more efficient and effective treatments and possible preventive efforts. Recently, there has been an increase in research on the psychopathology of anxiety disorders from biological, psychological, and social perspectives. The National Institute of Mental Health's Clinical Research Branch sponsored a 2-day workshop of investigators representing diverse research approaches to discuss emerging issues and research practices within the anxiety disorders. Discussions centered on a review of the general areas of classification, phenomenology, and etiology. A selective summary of this workshop is presented along with recommendations for specific research directions.     

Sex-specific clinical correlates of hoarding in obsessive-compulsive disorder

Little is known about whether the clinical correlates of hoarding behavior are different in men and women with obsessive-compulsive disorder (OCD). In the current study, we evaluated the association of hoarding with categories of obsessions and compulsions, psychiatric disorders, personality dimensions, and other clinical characteristics separately in 151 men and 358 women with OCD who were examined during the OCD Collaborative Genetics Study. We found that, among men but not women, hoarding was associated with aggressive, sexual, and religious obsessions and checking compulsions. In men, hoarding was associated with generalized anxiety disorder and tics whereas, among women, hoarding was associated with social phobia, post-traumatic stress disorder, body dysmorphic disorder, nail biting, and skin picking. In women but not men, hoarding was associated with schizotypal and dependent personality disorder dimensions, and with low conscientiousness. These findings indicate that specific clinical correlates of hoarding in OCD are different in men and women and may reflect sex-specific differences in the course, expression, and/or etiology of hoarding behavior in OCD.     

An empirical test of schema mode conceptualizations in personality disorders

Although the use of schema modes in schema-focused therapy (SFT) has been very popular since its introduction, Young's schema mode concept remained largely empirically untested. In order to provide insight into the mode conceptualization of personality disorders (PDs), the current study assessed the relationships between 14 schema modes and all PDs. Relationships between dimensional PD scores and self-reported mode scores were tested in a mixed study group of 489 participants, consisting of axis I and axis II patients, and non-patients. Psychopathology was assessed by means of the Structured Clinical Interview for DSM-IV axis I and axis II disorders (SCID I and SCID II) or the Structural Interview for DSM-IV Personality Disorders (SIDP-IV), and modes were assessed by the Schema Mode Inventory. Kendall's partial tau coefficients, controlling each PD-mode correlation for all other PD scores, indicated unique mode profiles for all PDs and corroborated most of the hypothesized PD-mode correlations, supporting the construct validity of the mode model. Nevertheless, the high number of correlations found for some PDs raises concerns about the specificity of the mode model. Implications for both research and therapy are discussed.     

The ability to process emotional information predicts loss aversion

On the basis of previous research it was hypothesized that alexithymia is associated with a higher tolerance for losses. This hypothesis is extended to explore whether the putative link between loss aversion and alexithymia remains once traits associated with risk taking (sensation seeking) and broad based personality traits (the Big 5) are controlled. Participants (N = 260) completed indices of alexithymia, sensation seeking and the Big 5 and both a riskless (endowment effect) and risky (lottery task) measure of loss aversion. It was found that the higher the alexithymia score the lower the loss aversion for both riskless and risky decisions even when sex, sensation seeking and the Big 5 are taken into account. The implications for this finding are discussed in the light of a neurological explanation of the relationship between alexithymia and loss aversion.     

情绪障碍及其干预:心理表象的视角

心理表象在多种情绪障碍中均表现出病理性特点。研究者基于心理表象主要对创伤后应激障碍、抑郁心境、双相障碍情绪和社交焦虑进行了心理病理学解释,尤其关注闪回和过度概化记忆等两种典型症状,并且重视心理表象在情绪症状维持中的作用。概括而言,研究者强调记忆形成与提取过程的异常、认知与行为的保护性策略的负强化、对事件及自我的认知偏差等三类因素对情绪障碍的致病作用。目前,针对或运用心理表象的干预与训练方法包括减少消极表象、改变消极表象内容、提高积极表象能力、提高记忆的具体性等四类。未来应注重侵入性表象的功能分析以及相关的心理病理学模型研究,并拓展干预与训练研究。