Cross-cultural clinical judgment bias in personality disorder diagnosis by forensic psychiatrists in the UK: a case-vignette study

Previous research in the UK has suggested that cross-cultural bias in personality disorder diagnosis might partly account for the smaller proportion of Black, relative to White, patients with personality disorder in secure psychiatric hospitals. Using the case-vignette method, we investigated cross-cultural clinical judgment bias in the diagnosis of personality disorder in African Caribbean men by 220 forensic psychiatrists in the UK. In the vignette describing possible DSM-IV antisocial personality disorder, Caucasians were 2.8 times more likely to be given a diagnosis of personality disorder than African Caribbeans. Diagnosis also varied according to the ethnicity of the clinicians. No cross-cultural bias was found in the vignette describing possible DSM-IV borderline personality disorder. These findings are important in relation to recent policies for offenders and others with personality disorder, and to the current focus on delivering race equality in mental health services in the UK. Ongoing debates about the strengths and limitations of the case-vignette method are also discussed.     

Cognitive vulnerability in children at risk for depression

Cognitive, developmental, and psychodynamic theories all hypothesize that negative self-concepts acquired in childhood may induce vulnerability to depression. Children at risk because of maternal major affective disorder, compared with children of medically ill and normal mothers, were examined for evidence of negative cognitions about themselves, and were found to have more negative self-concept, less positive self-schemas, and more negative attributional style. It was further predicted that negative cognitions about the self would be related to maternal depression and chronic stress, and to the quality of perceived and actual interactions with the mother. In general, the predicted associations were obtained, supporting speculations about how maternal affective disorder is associated with stress and with relatively negative and unsupportive relationships with children that in turn diminish children's self-regard.This research was supported by a William T. Grant Foundation award to Dr. Hammen and a Veterans Administration Merit Award to Dr. Hiroto.     

Personality, learning style and work performance

Just over two hundred telephone sales staff completed the Eysenck Personality Inventory (EPI) and Honey and Mumford's Learning Styles Questionnaire (LSQ). Extraversion was highly correlated both positively and negatively with three of the four LSQ measures. The lie scale from the EPI was also systematically correlated with the Activist and Reflector scales of the LSQ. Both the EPI and LSQ traits were modestly correlated with two criteria: ratings of Actual Performance and Development Potential. Regressions were used to determine the best predictors of the two ratings measures. Personality variables (extraversion, neuroticism) and certain learning styles (reflector, pragmatist) were statistically significant predictors of rated performance, though they accounted for less than 10% of the explained variance. The results concur with recent meta-analytical studies that show personality variables account for a small but important amount of variance in measures of work performance.     

Self-of-the-Therapist Work: A Balance Between Removing Restraints and Identifying Resources

The authors propose that self-of-the-therapist work is most productive when therapists and supervisors approach family of origin issues and historical life events in a balanced way and suggest that they move to an approach that ideally liberates restraints posed by self-of-the-therapist issues, while at the same time accesses resources available to therapists because of the same issues. This is a shift from the primarily restraint focus that has dominated self-of-the-therapist work. This paper also provides personal experiences of the authors, guidelines on how to create safety and balance, as well as practical examples of self-of-the-therapist exercises.     

Clinical psychologists' attitudes to lesbians

This study begins the process of examining clinical psychologists' competence in dealing with lesbian clients by assessing their attitudes to lesbians and lesbianism. Attitudinal questionnaires were sent to 200 chartered clinical psychologists and 69 (34.5%) were returned. Respondents displayed generally positive attitudes, with only two out of 12 attitudinal items failing to attract attitudinally positive responses from more than three-quarters of the sample. Yet, because of the possible unrepresentativeness of the sample and the potentially tenuous attitude–behaviour link, it is recommended that consideration of lesbian issues should be explicitly addressed in clinical psychology training.     

Behavioral Couples Treatment for Substance Use Disorder: Secondary Effects on the Reduction of Youth Internalizing Symptoms

This study examined the secondary effects of Behavioral Couples Treatment (BCT) for parents with substance use disorder on youth reports of internalizing symptoms (i.e., depressive and anxiety symptoms). Participants were 59 triads (father, mothers, and youth; 32 girls, 27 boys) in which one or both parents met criteria for drug or alcohol use disorder (or both). Mothers, fathers, and youth completed pretreatment, post-intervention, and 6-month post-intervention follow-up assessments. Two piecewise latent growth models examined whether number of sessions attended was associated with parents’ relationship satisfaction or its growth over time, and in turn if parents’ relationship satisfaction was uniquely associated with youth depressive/anxiety symptoms or their growth over time. A significant indirect effect at post-intervention revealed the number of sessions attended contributed to decreases in youth depressive symptoms via increases in mothers’ and fathers’ relationship satisfaction. Mothers’ relationship satisfaction uniquely mediated the relationship between number of sessions attended and youth depressive symptoms at post-intervention. With regards to fathers, there was a non-significant trend such that increases in sessions attended was associated with decreases in youth depressive symptoms post- intervention via increasing relationship satisfaction among fathers. Findings suggest that BCT may have protective secondary effects in reducing youth reports of depressive symptoms among couples in which one or both parents have substance use disorder.