Wisdom at the end of life: Hospice patients’ reflections on the meaning of life and death

The processes of aging and confronting mortality are often accompanied by unique psychological challenges. From the perspective of positive psychology, such challenges can yield opportunities for growth, including increased wisdom. This qualitative study explored 15 terminally ill hospice patients’ perspectives on wisdom, the dying process, and the meaning of life using consensual qualitative research methods. Most participants cited humility as a key component of wisdom, emphasizing that “Wisdom is when we realize ‘I don’t really know much’.” Other components of wisdom included self-knowledge, rationality, experiential learning, listening to and learning from others, and sharing knowledge with others. Participants also suggested that the process of facing illness and death presents opportunities for positive growth, including changing priorities and learning to appreciate life more fully in the present moment. In considering the sources of meaning in their lives, participants emphasized relational connections, personal growth, spirituality, vocational fulfilment, and living a full life. Participants also shared their reflections on important past experiences and regrets. Lastly, participants offered advice to others based on their experiences facing illness and mortality. Implications for psychological care of the dying and future research are discussed.     

Gender differences in false memory production

The present study investigated differences in false memory production between men and women, using the Deese/Roedgier McDermott (DRM) paradigm. Five word lists were used (MAN, GIRL, BREAD, BLACK, HIGH) and it was predicted that males would produce more false memories for the MAN word list while females will produce more false memories for the GIRL word list. Results did not confirm our predictions. Gender was neither a significant main effect, nor did it interact with any factors. Test and List x Test were the only significant main or interaction effects, respectively. Results are discussed as they relate to gender differences in cognitive processing.     

Genetic architecture of context processing in late middle age: more than one underlying mechanism

Studies comparing young and older adults suggest a deficit in processing context information as a key mechanism underlying cognitive aging. However, the genetic architecture of context processing has not been examined. Consistent with previous results, we found evidence of functionally dissociable components of context processing accuracy in 1127 late middle-aged twins ages 51-60. One component emphasizes use of context cues to prepare responses (proactive cognitive control), and the other emphasizes adjustment of responses after probes are presented (reactive control). Approximately one-quarter of the variance in each component was accounted for by genes. Multivariate twin analysis indicated that genetic factors underlying two important components of context processing were independent of one another, thus implicating more than one underlying mechanism. Slower reaction time (RT) on noncontext processing trials was positively correlated with errors on the strongly proactive control component on which young adults outperform older adults, but RT was negatively correlated with errors on the strongly reactive control component on which older adults perform better. Although this RT measure was uncorrelated with chronological age in our age-homogeneous sample, slower RT was associated with performance patterns that were more like older adults. However, this did not generalize to other processing speed measures. Genetic correlations, which reflect shared genetic variance, paralleled the phenotypic correlations. There was also a positive genetic correlation between general cognitive ability and accuracy on the proactive control component, but there were still mostly distinct genetic influences underlying these measures. In contrast, the reactive control component was unrelated to general cognitive ability.     

Prevalence of DSM-IV borderline personality disorder in two community samples: 6,330 English 11-year-olds and 34,653 American adults

This study had two main objectives. The first was to assess the prevalence of DSM-IV borderline personality disorder and its constituent symptoms in a community sample of late-latency children. The second was to compare these rates to those found in a community sample of American adults. A birth cohort of 6,330 11-year-old children in Bristol, England, was interviewed concerning borderline psychopathology in 2002-2004. A community sample of 34,653 American adults was interviewed about borderline psychopathology in 2004-2005. Rates of chronic emptiness, physically self-damaging acts, and stormy relationships were very similar in both samples (<2% difference). However, a significantly higher percentage of children than adults reported being angry and moody. In contrast, a significantly higher percentage of adults than children reported being paranoid/dissociated, having a serious identity disturbance, being impulsive, and making frantic efforts to avoid abandonment. In addition, a significantly higher percentage of adults than children met DSM-IV criteria for BPD (5.9% vs. 3.2%). Statistically significant but clinically minor gender differences were also found between girls and boys as well as men and women. Taken together, the results of this study suggest that late-latency children are about half as likely as adults to meet DSM-IV criteria for BPD. They also suggest that gender does not play a defining role in symptom expression.     

Examining classification criteria: a comparison of three cut score methods

This study compared 3 different methods of creating cut scores for a screening instrument, T scores, receiver operating characteristic curve (ROC) analysis, and the Rasch rating scale method (RSM), for use with the Behavioral and Emotional Screening System (BESS) Teacher Rating Scale for Children and Adolescents (Kamphaus & Reynolds, 2007). Using the BESS norm data set, we compared the methods across 7 classification indices. Additional information about accuracy was used with a subset of children who had been given a prior diagnosis for selected disorders. The results showed that the methods were generally in concordance, with similarities identified across methods. RSM and ROC analysis methods performed similarly, with both methods identifying the same optimal cut-point. The method based on T scores appeared to be more conservative, identifying a lower cut score as optimal.     

Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity

Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities.     

A Pilot Study of Psychotherapist Trainees' Alpha-Amylase and Cortisol Levels During Treatment of Recently Suicidal Clients With Borderline Traits

Psychotherapists often experience stress while providing psychotherapy, in particular when working with difficult presentations such as suicidality. As part of a larger study on the treatment of recently suicidal college students with borderline traits, 6 therapists in training collected their own salivary samples for alpha-amylase (AA) and cortisol (C) analyses immediately before and after sessions with 2 selected clients. On average, samples were collected for the same therapist-patient dyad throughout the year-long study to ensure that data reflected therapist responses across stages of treatment. Therapists also completed a working alliance questionnaire and rated perceived session difficulty immediately after each selected session. Contrary to expectations, therapists demonstrated elevated levels of stress as measured by AA and C at presession relative to postsession levels. Greater session difficulty was related to more pronounced declines in AA, whereas a stronger working alliance was linked to more pronounced reductions in C. Results suggest that physiological stress responses while working with recently suicidal clients with borderline traits occur primarily in terms of session anticipatory anxiety, whereas AA and C changes may be affected differently by factors such as session difficulty and working alliance. This is a pilot study, limited by its sample size, but the design, findings, and inclusion of physiological measures present an initial step in an essential line of research.     

Is Character Fate,or Is There Hope to Change My Personality Yet?

Different perspectives on personality development propose a range of possible degrees to which traits are free to change, from hardly at all to very much. This essay reviews the empirical evidence on just how consistent and changeable personality traits are across the life course. To gain a thorough perspective on personality trait development, we review developmental studies that focus on three different types of change: rank‐order consistency, mean level change, and individual level change. Starting in late childhood, personality traits exhibit modest levels of rank‐order consistency that increase with age. In addition personality traits show mean level changes, especially in young adulthood, that are consistent with the idea of increasing maturity. Finally, despite these general trends in personality continuity and change, there is evidence that individuals may change in ways that contradict general trends and that these individual differences in change are related to life experiences.     

The relationship of impairment to personality disorder severity among individuals with specific axis I disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

The present study examined one dimensional approach to personality disorders (PDs) in a large (n = 43,093), nationally representative sample of the U.S. population. Respondents were classified in four personality severity categories (no PD, subthreshold PD, simple PD, complex PD). Linear regression analyses were conducted to examine mental disability by PD severity for major DSM-IV substance use, mood and anxiety disorders. Significant increases in disability were observed between no PD and simple PD and between simple PD and complex PD for each Axis I disorder except drug dependence, but few differences in disability were found between no PD and subthreshold PD. This study found support for the clinical utility of the dimensional classification of PD severity with regard to the distinction between simple and complex PD and for a combined no PD-subthreshold PD level of severity. Future planned analyses will address the clinical utility of the classification prospectively, with a full battery of all Axis II PDs.