Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

The Relations among Maternal Depressive Disorder, Maternal Expressed Emotion, and Toddler Behavior Problems and Attachment

Direct and indirect relations among maternal depression, maternal Expressed Emotion (EE: Self- and Child-Criticism), child internalizing and externalizing symptoms, and child attachment were examined. Participants were mothers with depression (n?=?130) and comparison mothers (n?=?68) and their toddlers (M age?=?20 mo.; 53% male). Assessments included the Diagnostic Interview Schedule (maternal depression); the Five Minute Speech Sample (EE); the Child Behavior Checklist (toddler behavior problems); the Strange Situation (child attachment). Direct relations were significant linking: 1) maternal depression with both EE and child functioning; 2) Child-Criticism with child internalizing and externalizing symptoms; 3) Self-Criticism with child attachment. Significant indirect relations were found linking maternal depression with: 1) child externalizing behaviors via Child-Criticism; 2) child internalizing behaviors via Self- and Child-Criticism; and 3) child attachment via Self-Criticism. Findings are consistent with a conceptual model in which maternal EE mediates relations between maternal depression and toddler socio-emotional functioning.     

Child Maltreatment and Emergent Personality Organization: Perspectives from the Five-Factor Model

The Five-Factor Model was used to examine personality organization in 211 six-year-old children (135 maltreated and 76 nonmaltreated). Longitudinal assessments were conducted at ages 7, 8, and 9. Six-year-old maltreated children exhibited lower agreeableness, conscientiousness, and openness to experience and higher neuroticism than did nonmaltreated children. Maltreated children also were more frequently represented in less adaptive personality clusters than were their nonmaltreated counterparts. A particularly vulnerable profile occurred predominantly among maltreated children and was related to experiencing both abuse and neglect. Child maltreatment and personality clusters were related to individual differences perceived by peers. Longitudinal stability of the personality dimensions also was assessed. At age nine, evidence was found for maintenance of the organization of the personality clusters obtained at age six and for continuity of maltreated children's personality liabilities.     

A review of research on chaplains and community-based clergy in the Journal of the American Medical Association, Lancet, and the New England Journal of Medicine: 1998-2000

Based on the content analysis of quantitative research appearing in three medical journals, the authors conclude that, despite the shared ideal of providing spiritual care to patients on the part of physicians and chaplains, there is little attention given in these journals demonstrating and promoting this shared perspective. Suggestions for future research that would focus on this common medicine/religion interface and concern are noted.     

An empirical analysis of driver perceptions of the relationship between speed limits and safety

In recent decades, it has become more common for speed limits to be set for political reasons rather than for safety reasons. As a consequence, the motoring public seems to have increasingly begun questioning the rationality of speed limits. This is evident in observed speed data that show that the majority of drivers routinely exceed posted speed limits. A key motivating factor in drivers’ tendency to exceed the speed limit is that they believe that the excess speed does not threaten safety. This paper, specifically studies this matter by using a survey that asked drivers how fast above the speed limit they feel they can drive before safety is threatened. A probabilistic model is estimated using data gathered from 988 drivers in Indiana. Estimation findings show that drivers’ perception of the speed above the speed limit at which they will receive a speeding ticket is a critical determinant of what they believe is a safe speed – suggesting that enforcement plays an important role in safety perceptions. Other variables found to be significant factors in determining the speed above the speed limit at which safety is first threatened include age, gender, being previously stopped for speeding, and drivers’ ethnicity.     

The impact of financial and nonfinancial incentives on business-unit outcomes over time

Unlike previous behavior management research, this study used a quasi-experimental, control group design to examine the impact of financial and nonfinancial incentives on business-unit (21 stores in a fast-food franchise corporation) outcomes (profit, customer service, and employee turnover) over time. The results showed that both types of incentives had a significant impact on all measured outcomes. The financial incentive initially had a greater effect on all 3 outcomes, but over time, the financial and nonfinancial incentives had an equally significant impact except in terms of employee turnover.     

Pilot programs in newborn screening

The term "pilot study" has been used over the years to describe the evaluation of the many elements involved in deciding whether a proposed condition should be added to a newborn screening (NBS) panel, and until recently, was unilaterally used to describe the evaluation of the assay to be used before the condition was officially adopted by a state for its newborn screening panel. Since Guthrie's introduction of screening for PKU, each time a new condition was added to the panel, the screening assay itself was validated through a population-based trial, in which the test was performed with de-identified samples to avoid association between the test result and the infant. This is considered by the laboratory as the "pilot phase" of adding a new condition. To advance the science of NBS, especially to accommodate new technologies that may provide new types of information (genetic versus physiological) for each new condition, pilot programs are essential. Involvement of the clinical community serves to improve these evaluations and provides the needed clinical validation of decisions made as a result of it. This paper describes the historical context of pilot programs in population-based NBS that utilize laboratory-based markers as indicators of concern; specifically, three applications that demonstrate different approaches to the use of pilots in adding conditions to a NBS panel are described.