Nonsuicidal Self‐Injury in Adolescents: Characterization of the Disorder and the Issue of Distress and Impairment

Nonsuicidal self‐injury disorder (NSSID) is a condition in need of further study to assess the validity of the potential diagnosis and its suggested criteria. This study examined the NSSID diagnosis and investigated the distress/impairment criterion by comparing community adolescents who met all criteria for NSSID (n = 186) to adolescents with five or more nonsuicidal self‐injury (NSSI) episodes (n = 314), and to a group of adolescents who met all criteria but negated that their NSSI caused them any distress or impairment, thus failing to meet criterion E (n = 29). The NSSID group delimited from the ≥ 5 NSSI group by reporting significantly more frequent and severe self‐injurious thoughts and behaviors, as well as having more experiences of negative life events and higher levels of trauma symptoms. There were also some differences between the NSSID group and adolescents without distress/impairment, which together contribute valuable information on the potential NSSID diagnosis, as well as the discussion of criterion E.     

The mental health of unaccompanied refugee minors on arrival in the host country

Despite increasing numbers of unaccompanied refugee minors (UM) in Europe and heightened concerns for this group, research on their mental health has seldom included the factor “time since arrival.” As a result, our knowledge of the mental health statuses of UM at specific points in time and over periods in their resettlement trajectories in European host countries is limited. This study therefore examined the mental health of UM shortly after their arrival in Norway (n = 204) and Belgium (n = 103) through the use of self‐report questionnaires (HSCL‐37A, SLE, RATS, HTQ). High prevalence scores of anxiety, depression and posttraumatic stress disorder (PTSD) symptoms were found. In addition, particular associations were found with the number of traumatic events the UM reported. The results indicate that all UM have high support needs on arrival in the host country. Longitudinal studies following up patterns of continuity and change in their mental health during their trajectories in the host country are necessary.     

Effects of cognitive behavioural therapy and return-to-work intervention for patients on sick leave due to stress-related disorders: Results from a randomized trial

The aim of this study was to evaluate specific effects for patients with adjustment or exhaustion disorder, the Stress subgroup (n = 152), regarding symptom severity and sick leave after CBT, a return-to-work intervention (RTW-I), and a combination of them (COMBO), using data from a randomized trial. In the original study, primary care patients on sick leave (N = 211) were randomized to CBT (n = 64), RTW-I (n = 67), or COMBO (n = 80). Blinded Clinician Severity Rating (CSR) of symptoms and sick leave registry data were primary outcomes. Subgroup analyses showed that for the Stress subgroup, CBT led to greater reduction of symptoms than RTW-I posttreatment, but COMBO did not differ from CBT or RTW-I. Regarding sick leave, there was no difference between treatments in the Stress subgroup. An exploratory analysis of the treatment effects in a subgroup of patients with depression, anxiety or insomnia indicates that RTW-I reduced sick leave faster than CBT. We conclude that CBT may be promising as an effective treatment of stress and exhaustion disorder.     

The style of planning action (STOP) questionnaire in OCD spectrum disorders

This article describes the exploratory and confirmatory validation of an everyday style of planning (STOP) questionnaire in a tic disorder (n = 88), Tourette syndrome (n = 76), body-focused repetitive behaviour group (n = 121), obsessive compulsive disorder (n = 251) and a non-clinical control group (n = 127).Exploratory factor analysis was performed on half of the sample and confirmatory analysis on the other half. A three factor solution accounted for 38% of the variance. The factors were labelled respectively: overcomplication, overpreparation, and overactivity. The internal consistency for the overcomplication score and total score was high and for the other two scales, satisfactory. Test–retest was satisfactory and the subscales discriminated amongst clinical groups, and clinical groups from controls. All subscales became significantly less pathological following cognitive behavioural treatment. Convergent validity showed strong correlations with depression, anxiety and perfectionism but not impulsivity. The study confirms style of action as an important characteristic of obsessive compulsive spectrum disorders. Further analysis of the structure of each factor is warranted.     

Suicidality in Bipolar Disorder: The Role of Emotion‐Triggered Impulsivity

A growing body of research suggests that impulsive responses to emotion more robustly predict suicidality than do other forms of impulsivity. This issue has not yet been examined within bipolar disorder, however. Participants diagnosed with bipolar I disorder (n = 133) and control participants (n = 110) diagnosed with no mood or psychotic disorder completed self‐report measures of emotion‐triggered impulsivity (Negative and Positive Urgency Scales) and interviews concerning lifetime suicidality. Analyses examined the effects of emotion‐triggered impulsivity alone and in combination with gender, age of onset, depression severity, comorbid anxiety, comorbid substance use, and medication. A history of suicide ideation and attempts, as well as self‐harm, were significantly more common in the bipolar disorder group compared with the control group. Impulsive responses to positive emotions related to suicide ideation, attempts, and self‐harm within the bipolar group. Findings extend research on the importance of emotion‐triggered impulsivity to a broad range of key outcomes within bipolar disorder. The discussion focuses on limitations and potential clinical implications.     

Dietary patterns are associated with the prevalence of alexithymia

Recent evidence supports the association between healthy dietary patterns and a reduced risk of depression. The objective was: (1) to examine the associations between dietary patterns and alexithymic features; and (2) investigate whether these possible associations are explained by depressive symptoms in a cross‐sectional study among the Finnish general population aged 25–65 years. The study population was a part of the population‐based Kuopio Depression Study (KUDEP) conducted in central‐eastern Finland (n = 1747). Dietary data were collected using a food frequency questionnaire and dietary patterns from 22 predefined food groups, which were extracted by factor analysis. Alexithymia was assessed using the 20‐item Toronto Alexithymia Scale (TAS‐20) and depression using the 21‐item Beck Depression Inventory (BDI‐21). Altogether, 173 of the study subjects (9.9%) were alexithymic. Three dietary patterns were identified: “prudent,” “Western” and “traditional.” Lower scores for a healthy prudent dietary pattern and higher scores for an unhealthy Western dietary pattern were associated with an increased likelihood of belonging to the alexithymic group among subjects with elevated depressive symptoms. Among subjects without depressive symptoms, alexithymia was associated with lower scores in the prudent dietary pattern, but also with higher scores in the traditional dietary pattern. General population subjects with alexithymic features may have unhealthier dietary patterns than non‐alexithymic subjects.     

Visual attention and academic performance in children with developmental disabilities and behavioural attention deficits

Despite well‐documented attention deficits in children with intellectual and developmental disabilities (IDD), distinctions across types of attention problems and their association with academic attainment has not been fully explored. This study examines visual attention capacities and inattentive/hyperactive behaviours in 77 children aged 4 to 11 years with IDD and elevated behavioural attention difficulties. Children with autism spectrum disorder (ASD; n = 23), Down syndrome (DS; n = 22), and non‐specific intellectual disability (NSID; n = 32) completed computerized visual search and vigilance paradigms. In addition, parents and teachers completed rating scales of inattention and hyperactivity. Concurrent associations between attention abilities and early literacy and numeracy skills were also examined. Children completed measures of receptive vocabulary, phonological abilities and cardinality skills. As expected, the results indicated that all groups had relatively comparable levels of inattentive/hyperactive behaviours as rated by parents and teachers. However, the extent of visual attention deficits varied as a result of group; namely children with DS had poorer visual search and vigilance abilities than children with ASD and NSID. Further, significant associations between visual attention difficulties and poorer literacy and numeracy skills were observed, regardless of group. Collectively the findings demonstrate that in children with IDD who present with homogenous behavioural attention difficulties, at the cognitive level, subtle profiles of attentional problems can be delineated.     

Patients with chronic fatigue syndrome do not score higher on the autism‐spectrum quotient than healthy controls: Comparison with autism spectrum disorder

Clinically, there is an overlap of several symptoms of chronic fatigue syndrome (CFS ) and autism spectrum disorder (ASD ), including fatigue; brain “fog”; cognitive impairments; increased sensitivity to sound, light, and odour; increased pain and tenderness; and impaired emotional contact. Adults with CFS (n = 59) or ASD (n = 50) and healthy controls (HC ; n = 53) were assessed with the Autism‐Spectrum Quotient (AQ ) in a cross‐sectional study. Non‐parametric analysis was used to compare AQ scores among the groups. Univariate analysis of variance (ANCOVA ) was used to identify if age, sex, or diagnostic group influenced the differences in scores. Patients with ASD scored significantly higher on the AQ than the CFS group and the HC group. No differences in AQ scores were found between the CFS and HC groups. AQ results were influenced by the diagnostic group but not by age or sex, according to ANCOVA . Despite clinical observations of symptom overlap between ASD and CFS , adult patients with CFS report few autistic traits in the self‐report instrument, the AQ . The choice of instrument to assess autistic traits may influence the results.     

Social competence group intervention (SOCO) for children with autism spectrum disorder: A pilot study

This study aimed to describe concept of social competence as a theoretical background for social skills group intervention for children with autism spectrum disorder (ASD). A model of social competence comprised of three components: social skills, social performance, and social adjustment. We also examined the feasibility and preliminary efficacy of the manualized Social Competence group intervention for children with autism spectrum disorder (SOCO) using a variety of outcome measures. The nine-month intervention included children groups, parental support groups and co-operation with teachers. A pilot study involved 23 children aged 7 to 12 years (n = 16 intervention, n = 7 control) and intervention outcomes were measured with questionnaires for parents and teachers, neuropsychological tests, and observations. The parents of the intervention group reported improvements in social skills and social adjustment, whereas the teachers reported increases in social performance. Findings also indicated that affect recognition skills, social overtures, and reactions to peers were improved in the intervention group. Although the evidence of the pilot study should be considered as preliminary, it gives some indication of the feasibility of the SOCO group intervention and supports the usability of the theoretical background and approach for multiple outcome measures.     

Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome

Symptoms of Exhaustion Syndrome (ES) and Chronic Fatigue Syndrome (CFS) are overlapping and create difficulties of differential diagnosis. Empirical studies comparing ES and CFS are scarce. This study aims to investigate if there are any emotional differences between ES and CFS. This cross‐sectional study compared self‐reported alexithymia and observer‐rated emotional awareness in patients with ES (n = 31), CFS (n = 38) and healthy controls (HC) (n = 30). Self‐reported alexithymia was measured with the Toronto Alexithymia Scale‐20 (TAS‐20) and emotional awareness with an observer‐rated performance test, the Level of Emotional Awareness Scale (LEAS). Additionally, depression and anxiety were scored by the Hospital Anxiety and Depression Scale (HADS). Results show that patients with ES expressed higher self‐reported alexithymia in the TAS‐20 compared to HC, but had similar emotional awareness capacity in the observer‐rated performance test, the LEAS. Patients with CFS expressed more difficulties in identifying emotions compared to HCs, and performed significantly worse in the LEAS‐total and spent more time completing the LEAS as compared to HC. Correlation and multiple regressions analyses revealed that depression and anxiety positively correlated with and explained part of the variances in alexithymia scores, while age and group explained the major part of the variance in LEAS. Findings of this study indicate that emotional status is different in patients with ES and CFS with respect to both self‐reported alexithymia and observer‐rated emotional awareness. Emotional parameters should be approached both in clinical investigation and psychotherapy for patients with ES and CFS.     

Effectiveness of cognitive behavioral therapy on health‐related quality of life: An evaluation of therapies provided by trainee therapists

The present study was carried out to examine the treatment effect of cognitive behavioral therapy provided by trainee therapists at a university clinic, focusing on health‐related quality of life (HRQOL) optimism and symptoms. The study was conducted through a repeated measures design and included a treatment group (n = 21), which received cognitive behavioral therapy for an average of 10.7 therapy sessions and a control group (n = 14), that was put on a wait list for 8.6 weeks on average. After treatment, the treatment group improved significantly concerning general health (p = 0.028) and optimism (p = 0.027). In addition, clients improved in several areas within mental health and displayed some reduction in anxiety symptoms. Concurrently, the results also indicated some improvement within the control group, which may have been caused by the initial therapeutic contact, expectancy effects or spontaneous remission. The study concluded that cognitive behavioral therapy provided by trainee therapists may have a positive effect on areas within HRQOL and optimism.     

Conscious knowledge influences decision‐making differently in substance abusers with and without co‐morbid antisocial personality disorder

Decision‐making impairment, as measured by the Iowa Gambling Task (IGT), is a consistent finding among individuals with substance use disorder (SUD). We studied how this impairment is influenced by co‐morbid antisocial personality disorder (ASPD) and conscious knowledge of the task. Three groups were investigated: SUD individuals without co‐morbid ASPD (n = 30), SUD individuals with co‐morbid ASPD (n = 16), and healthy controls (n = 17). Both SUD and SUD+ASPD participants had poor overall IGT performance. A block‐by‐block analysis revealed that SUD participants exhibited slow but steady improvement across the IGT, whereas SUD+ASPD participants exhibited initial normal improvement, but dropped off during the last 40 trials. Conscious knowledge of the task was significantly correlated to performance for controls and SUD participants, but not for SUD+ASPD participants. Our findings suggest that decision‐making proceeds differently in SUD and SUD+ASPD individuals due to differences in acquisition and application of conscious knowledge.     

Dispositional aspects of body focus and idiopathic environmental intolerance attributed to electromagnetic fields (IEI‐EMF)

Body focus is often considered an undesirable characteristic from medical point of view as it amplifies symptoms and leads to higher levels of health anxiety. However, it is connected to mindfulness, well‐being and the sense of self in psychotherapy. The current study aimed to investigate the contribution of various body focus related constructs to acute and chronic generation and maintenance of medically unexplained symptoms (MUS). Thirty‐six individuals with idiopathic environmental intolerance to electromagnetic fields (IEI‐EMF) and 36 controls were asked to complete questionnaires assessing negative affect, worries about harmful effects of EMFs, health anxiety (HA), body awareness, and somatosensory amplification (SSA), and to report experienced symptoms evoked by a sham magnetic field. Body awareness, HA, SSA, and EMF‐related worries showed good discriminative power between individuals with IEI‐EMF and controls. Considering all variables together, SSA was the best predictor of IEI‐EMF. In the believed presence of a MF, people with IEI‐EMF showed higher levels of anxiety and reported more symptoms than controls. In the IEI‐EMF group, actual symptom reports were predicted by HA and state anxiety, while a reverse relationship between symptom reports and HA was found in the control group. Our findings show that SSA is a particularly important contributor to IEI‐EMF, probably because it is the most comprehensive factor in its aetiology. IEI‐EMF is associated with both a fear‐related monitoring of bodily symptoms and a non‐evaluative body focus. The identification of dispositional body focus may be relevant for the management of MUS.     

Suicidal Ideation,Posttraumatic Stress,and Substance Abuse Based on Forcible and Drug‐ or Alcohol‐Facilitated/Incapacitated Rape Histories in a National Sample of Women

Mental health symptoms differ among women with forcible rape (FR ) compared to drug‐ or alcohol‐facilitated/incapacitated rape (DAFR /IR ) histories, but differences in suicidal ideation are unknown. The differences in suicidal ideation based on FR and DAFR /IR history were examined in national samples of college (n  =  2,000) and household‐residing (n  =  3,001) women. For both college women and household‐residing women, FR and DAFR /IR were associated with recent suicidal ideation. Differences emerged when examined indirectly through recent posttraumatic stress disorder, drug abuse, and alcohol abuse. Therefore, it is important to examine both FR and DAFR /IR when assessing suicidal ideation.     

Tool use in neurodegenerative diseases: Planning or technical reasoning?

Recent works showed that tool use can be impaired in stroke patients because of either planning or technical reasoning deficits, but these two hypotheses have not yet been compared in the field of neurodegenerative diseases. The aim of this study was to address the relationships between real tool use, mechanical problem‐solving, and planning skills in patients with Alzheimer's disease (AD, n = 32), semantic dementia (SD, n = 16), and corticobasal syndrome (CBS, n = 9). Patients were asked to select and use ten common tools, to solve three mechanical problems, and to complete the Tower of London test. Motor function and episodic memory were controlled using the Purdue Pegboard Test and the BEC96 questionnaire, respectively. A data‐transformation method was applied to avoid ceiling effects, and single‐case analysis was performed based on raw scores and completion time. All groups demonstrated either impaired or slowed tool use. Planning deficits were found only in the AD group. Mechanical problem‐solving deficits were observed only in the AD and CBS groups. Performance in the Tower of London test was the best predictor of tool use skills in the AD group, suggesting these patients had general rather than mechanical problem‐solving deficits. Episodic memory seemed to play little role in performance. Motor dysfunction tended to be associated with tool use skills in CBS patients, while tool use disorders are interpreted as a consequence of the semantic loss in SD in line with previous works. These findings may encourage caregivers to set up disease‐centred interventions.     

Universal parent support groups for parents of adolescents: Which parents participate and why?

Leader‐led parent support groups, offered universally to parents of adolescents, are increasingly common, yet little is known of the parents who use this support. The study presented here explored the characteristics of parents of 10‐ to 17‐year‐olds (N = 192) who had enlisted in universal support groups and their reasons for enrollment. Sociodemographic factors (parents’ country of origin, educational level, long‐term sick‐leave or unemployment, and marital status) were compared to the general population (Statistics Sweden, 2012 ) and parents’ psychological health and children's psychiatric symptoms were compared to a control group (the BITA study). Results showed that support group parents reported more psychosocial difficulties, such as higher frequency of long‐term sick‐leave or unemployment, more symptoms of anxiety and depression and more psychiatric symptoms in their children than parents in general. While about a fifth of the parents had problem‐oriented (targeted) reasons for enrollment, most parents had general (universal) reasons. Thus, the universal approach does seem to reach its intended recipients.     

Physicians’ gender bias in the diagnostic assessment of medically unexplained symptoms and its effect on patient–physician relations

Nonspecific, functional, and somatoform (NFS) syndromes is an umbrella term for various diagnoses with medically unexplained symptoms. These syndromes are more prevalent among women than among men, and associated with negative preconceptions that can impede rehabilitation. In two studies, we quantitatively assess how patients’ gender affects the diagnostic assessment of NFS syndromes, as well as the healthcare experiences of individuals diagnosed with NFS syndromes. In the first study, our vignette‐based experiment showed that Swedish general practitioners (N = 90) were gender biased in their diagnostic assessment of NFS syndromes, such that a female patient with back pain was more likely to be assigned a NFS syndrome compared to an otherwise identical male patient. In the second study, a large community sample of Swedish individuals with medically explained (n = 432) and unexplained pain (n = 521) evaluated their treating physician's relational conduct. Even after accounting for a variety of sociodemographic variables and other pain characteristics, women with at least one NFS syndrome percieved their physician's relational conduct as significantly poorer than other women as well as men with and without NFS syndromes. When women's pain is more likely than men's to be assessed as NFS, their rehabilitation could be prolonged as pertient alternative diagnoses and treatments are omittied and their negative healthcare experiences lower their volition to partake and persevere in treatment.     

Insomnia Symptoms,Nightmares, and Suicide Risk: Duration of Sleep Disturbance Matters

Duration of insomnia symptoms or nightmares was investigated to see if it was related to suicide risk independent of current insomnia symptoms, nightmares, anxiety symptoms, depressive symptoms, and posttraumatic symptoms. The cross‐sectional study involved analyses of survey responses from undergraduate students who endorsed either insomnia symptoms (n = 660) or nightmares (n = 312). Both insomnia symptom and nightmare duration were significantly associated with suicide risk independent of current insomnia symptoms or nightmares, respectively. Relations were also significant after controlling for anxiety symptoms, depressive symptoms, and posttraumatic symptoms. Results suggest that duration of sleep disturbance is relevant when assessing suicide risk.     

An open trial of mindfulness‐based stress reduction for young adults with social anxiety disorder

The present study investigated mindfulness‐based stress reduction (MBSR) for young adults with a social anxiety disorder (SAD) in an open trial. Fifty‐three young adults in a higher education setting underwent a standard eight‐week MBSR program. Eight participants (15%) did not complete the program. Participants reported significant reductions in SAD symptoms and global psychological distress, as well as increases in mindfulness, self‐compassion, and self‐esteem. Using intention‐to‐treat (ITT) analyses, effect sizes ranged from large to moderate for SAD symptoms (Cohen's d = 0.80) and global psychological distress (d = 0.61). Completer analyses yielded large effect sizes for SAD symptoms (d = 0.96) and global psychological distress (d = 0.81). The largest effect sizes were found for self‐compassion (d = 1.49) and mindfulness (d = 1.35). Two thirds of the participants who were in the clinical range at pretreatment reported either clinically significant change (37%) or reliable improvement (31%) on SAD symptoms after completing the MBSR program, and almost two thirds reported either clinically significant change (37%) or reliable improvement (26%) on global psychological distress. MBSR may be a beneficial intervention for young adults in higher education with SAD, and there is a need for more research on mindfulness and acceptance‐based interventions for SAD.