Identifying Personality Pathology Associated With Major Depressive Episodes: Incremental Validity of Informant Reports

Major limitations are associated with the use of a single source of information to assess personality pathology. The construct validity of standardized interviews and informant reports on personality pathology has been established relative to other measures of personality pathology, but it is also important to consider these measures in relation to other constructs that should be related to personality pathology. One example is major depression. In this study, we evaluated whether less common clinical methods of assessment for measuring the same personality pathology constructs, including semistructured interviews and informant reports, demonstrate unique validity, using major depressive episode (MDE) as the external criterion. This analysis focuses on a representative, community-based sample of 1,437 participants and informants. We conducted a hierarchical logistic regression analysis and determined the order of entering the predictor variables based on likelihood of being used in a clinical setting as well as empirical recommendations. Each step of our regression model significantly increased our ability to predict lifetime MDE, including self, interviewer, and informant reports of personality pathology. Overall, these findings indicate that multiple sources of personality assessment provide unique information about the relationship between maladaptive personality traits and a history of MDE. Thus, semistructured diagnostic interviews and informant reports can be used as a resource to improve the validity of personality assessments.     

Religious Coping,Body Dissatisfaction,and Bulimic Symptomatology

The authors explored the association among body dissatisfaction, religious coping, and bulimic symptomatology. The results suggest that spiritual discontent religious coping was detrimental for the college female participants (N= 398) when considered in relationship to bulimic symptomatology. Implications of the findings for theory refinement, future research, and clinical practice are discussed.     

Using music to decrease disruptive vocalizations in a man with dementia

Music played through headphones was noted to reduce the disruptive chanting and speech‐like vocalizations of a 68‐year‐old man who lived in a secure dementia unit. We conducted a variety of assessment procedures, including a functional analysis ‘alone’ condition, to identify why this simple intervention may have been effective for this individual. The data suggest that music provided an alternative source of auditory stimulation to that produced by automatically reinforced vocal behavior. Copyright © 2010 John Wiley & Sons, Ltd.     

Private Terrors Sexualized Aggression and a Psychoanalyst's Fear of Her Patient

This clinical paper explores the meanings and evolution of an analyst's reaction of fear in relation to her patient's sexualized aggression. From both an intrapsychic and an intersubjective perspective, the author analyzes the coconstruction of this transference—countertransference phenomenon. Case vignettes illustrate the author's attempts to address her patient's sexualized aggression while struggling to free herself from the feelings of intimidation and fearfulness stirred by his sadomasochistic fantasies and patterns of interaction. The analyst's unconscious identification with the patient's disowned femininity and narcissistic vulnerability is seen as central to this countertransference “stranglehold.” Release from the analyst's masochistic position comes through a shift in her own affective participation. The importance of the analyst's recognizing her own unconscious contributions to this sadomasochistic dynamic is emphasized and elaborated. Discussion also focuses on the relevance of gender to the issue of countertransference fear, as illustrated in this particular male patient—female analyst dyad.     

Exploring Mindfulness With Occupational Therapists Practicing in Mental Health Contexts

Mindfulness, defined as “a purposeful, non-anxious, reflective presence,” (Epstein, 2003a Epstein, R. M., 2003a. Mindful practice in action (I): Technical competence, evidence-based medicine, and relationship-centered care, Families, Systems, &; Health 21 (1) (2003a), pp. 1–9.[Crossref] , [Google Scholar], p. 1) has been identified as a potentially key practice skill of effective health care practitioners working in mental-health settings. The purpose of this mixed-methods study was to explore the cultivation and use of mindfulness in the clinical practice and everyday lives of occupational therapists who practice in mental health. Results revealed that mindfulness is perceived as being an important clinical quality, which enhances therapist well-being and effectiveness, and contributes to improved client outcomes. Relevance to occupational therapy practice philosophies and directions for future research are discussed.     

Exploring Emotion-Regulation and Autonomic Physiology in Metastatic Breast Cancer Patients: Repression, Suppression, and Restraint of Hostility

We examined relationships between three emotion-regulation constructs and autonomic physiology in metastatic breast cancer patients (N = 31). Autonomic measures are not often studied in breast cancer patients and may provide evidence of an increase in allostatic load. Patients included participated as part of a larger clinical trial of supportive-expressive group therapy. Systolic and diastolic blood pressure and heart rate were assessed at a semi-annual follow-up. We averaged 3 resting assessments and used measures of Repression, Suppression, Restraint of Hostility, and Body Mass Index as predictors of autonomic response. We found that higher repression was significantly associated with higher diastolic blood pressure, while higher restraint of hostility was significantly associated with higher systolic blood pressure. A repressive emotion regulation style may be a risk factor for higher sympathetic activation possibly increasing allostatic load, while restraint of hostility may be a protective factor for women with metastatic breast cancer.     

Relationship between patient characteristics and treatment allocation for patients with personality disorders

Within a large multi-center study in patients with personality disorders, we investigated the relationship between patient characteristics and treatment allocation. Personality pathology, symptom distress, treatment history, motivational factors, and sociodemographics were measured at intake in 923 patients, who subsequently enrolled in short-term or long-term outpatient, day hospital, or inpatient psychotherapy for personality pathology. Logistic regressions were used to examine the predictors of allocation decisions. We found a moderate relationship (R(2) = 0.36) between patient characteristics and treatment setting, and a weak relationship (R(2) = 0.18) between patient characteristics and treatment duration. The most prominent predictors for setting were: symptom distress, cluster C personality pathology, level of identity integration, treatment history, motivation, and parental responsibility. For duration the most prominent predictor was age. We conclude from this study that, in addition to pathology and motivation factors, sociodemographics and treatment history are related to treatment allocation in clinical practice.     

Neurobiological and memory models of risky decision making in adolescents versus young adults

Predictions of fuzzy-trace theory and neurobiological approaches are examined regarding risk taking in a classic decision-making task--the framing task--as well as in the context of real-life risk taking. We report the 1st study of framing effects in adolescents versus adults, varying risk and reward, and relate choices to individual differences, sexual behavior, and behavioral intentions. As predicted by fuzzy-trace theory, adolescents modulated risk taking according to risk and reward. Adults showed standard framing, reflecting greater emphasis on gist-based (qualitative) reasoning, but adolescents displayed reverse framing when potential gains for risk taking were high, reflecting greater emphasis on verbatim-based (quantitative) reasoning. Reverse framing signals a different way of thinking compared with standard framing (reverse framing also differs from simply choosing the risky option). Measures of verbatim- and gist-based reasoning about risk, sensation seeking, behavioral activation, and inhibition were used to extract dimensions of risk proneness: Sensation seeking increased and then decreased, whereas inhibition increased from early adolescence to young adulthood, predicted by neurobiological theories. Two additional dimensions, verbatim- and gist-based reasoning about risk, loaded separately and predicted unique variance in risk taking. Importantly, framing responses predicted real-life risk taking. Reasoning was the most consistent predictor of real-life risk taking: (a) Intentions to have sex, sexual behavior, and number of partners decreased when gist-based reasoning was triggered by retrieval cues in questions about perceived risk, whereas (b) intentions to have sex and number of partners increased when verbatim-based reasoning was triggered by different retrieval cues in questions about perceived risk.     

Gender Bias in Leader Selection? Evidence from a Hiring Simulation Study

The present research investigated factors that might affect gender discrimination in a hiring simulation context from the perspectives of social role theory and the shifting standards model. Specifically, the experimental study investigated whether gender biases are evident in the screening and hiring stage of the personnel selection process depending on the applicants?? social role and evaluators?? gender. A sample of German undergraduate business students (54 women, 53 men) was asked to make a personnel selection decision (short-listing or hiring) about a fictitious applicant (man or woman) in a specific role (leader or non-leader) for a managerial position. Consistent with social role theory??s assumption that social role information is more influential than gender information, participants selected applicants described as leaders over applicants described as non-leaders, regardless of applicant gender. In addition, in the presence of role information, female applicants portrayed as leaders were similarly short-listed and hired as male applicants with the same credentials. In the absence of role information, female applicants were similarly short-listed as male applicants; however, male applicants were hired over female applicants, albeit by male participants only. This is consistent with the shifting standards model??s assumption that group members are held to a higher standard to confirm traits on which they are perceived to be deficient: Male participants hired female applicants portrayed as non-leaders with less certainty than their male counterparts possibly due to higher confirmatory standards for leadership ability in women than men. The research and practice implications of these results are discussed.