Competence to make treatment decisions in anorexia nervosa: thinking processes and values

This paper explores the ethical and conceptual implications of the findings from an empirical study of decision-making capacity in anorexia nervosa. In the study, ten female patients aged 13 to 21 years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semi-structured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient participants were also tested using the MacCAT-T test of competence. This is a formalised, structured interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief self-administered questionnaires to assess their levels of psychopathology.The issues identified from the interviews are described under two headings: difficulties with thought processing, and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches or current standardised tests of competence.     

Parental burden associated with borderline personality disorder in female offspring

To identify aspects of parental burden associated with borderline personality disorder (BPD), an anonymous internet survey linked to BPD support websites was developed for parents to complete on their BPD offspring and unaffected siblings. The questions cover aspects of the child's life from pregnancy through young adulthood, and query about the impact of the child's BPD on six domains of the parent's life, including physical and emotional health, marriage, job, standard of living, social life, and career trajectory. Additionally, financial burden was assessed with questions pertaining to insurance and out-of pocket costs associated with the BPD disorder. BPD offspring were identified by meeting diagnostic criteria embedded within the survey and having been given a diagnosis of BPD by a professional at some point in their life. We report on 233 female offspring meeting strict criteria for BPD. Parents of daughters with BPD endorsed varying levels of impact on the six domains comprising burden with the largest impact on emotional health which was impacted in over 88% of the respondents. Over 50% of parents endorsed four or greater of the six burden items. Particular aspects of the offspring's BPD symptom profile correlated with intensity of parental burden included including problems in adolescence with acting out behavior (p < .000), property destruction (.003), delusional symptoms (.007), and hallucinatory symptoms (.008). A subgroup of respondents provided data on specific financial expenses. The average and median out-of-pocket expense was $60,087, and $10,000. Insurance costs totaled an average of $108,251 with a mean of $20,000. The average cost per year after diagnosis was $14,606 out-of-pocket and $45,573 billed to insurance. The median cost per year after diagnosis was $3,667 out-of-pocket, and $12,500 billed to insurance. After adjusting for household income, a female proband who had been raped incurred roughly $40,000 more in BPD-related costs, while a diagnosis of conduct disorder led to about $50,000 in additional costs. Parents of female offspring with BPD experience burden in multiple domains of their life and many have incurred substantial financial expense. Increasing awareness of co-morbid conditions in the BPD proband that significantly increase parental burden may be indicators for the provision of increased family support.     

Rocking together: dynamics of intentional and unintentional interpersonal coordination

The current study investigated the interpersonal coordination that occurred between two people when sitting side-by-side in rocking chairs. In two experiments participant pairs rocked in chairs that had the same or different natural periods. By instructing pairs to coordinate their movements inphase or antiphase, Experiment 1 investigated whether the stable patterns of intentional interpersonal coordination were consistent with the dynamics of within person interlimb coordination. By instructing the participants to rock at their own preferred tempo, Experiment 2 investigated whether the rocking chair movements of visually coupled individuals would become unintentionally coordinated. The degree to which the participants fixated on the movements of their co-actor was also manipulated to examine whether visual focus modulates the strength of interpersonal coordination. As expected, the patterns of coordination observed in both experiments demonstrated that the intentional and unintentional interpersonal coordination of rocking chair movements is constrained by the self-organizing dynamics of a coupled oscillator system. The results of the visual focus manipulations indicate that the stability of a visual interpersonal coupling is mediated by attention and the degree to which an individual is able to detect information about a co-actor's movements.     

Quality home visits: Activities to promote meaningful interactions

Examination of and support for specific practices that promote high-quality home visiting are essential as family support programs continue to expand across the country. The current study used direct observation of 91 home visits across 41 home visitors to examine relations among interaction partners, content of the interactions, the home-visitors’ activities, and quality of home-visitors’ practices and family-members’ engagement within programs funded by the Maternal, Infant, and Early Childhood Home Visiting program. More time spent in triadic interactions focused on child-related content, as measured by the Home Visit Rating Scale-Revised, was related to higher quality of family engagement in home visits, as measured with the Home Visit Observation Rating Scales. Time spent in adult-focused interactions and administrative tasks, however, was related to lower quality of home-visiting practices and family engagement. Implications for research and practice are discussed.     

The Relationship Between Male-Perpetrated Interparental Aggression,Paternal Characteristics,and Child Psychosocial Functioning

It is well established that children in homes where interparental violence is present are at increased risk for psychosocial (i.e., internalizing, externalizing, and attention) difficulties. However, previous studies have provided a limited view on the variety of factors that commonly co-occur in these environments (e.g., other characteristics of the parents and family) and how they may collectively impact children. Knowing this information could have implications for parental interventions aimed at preventing the continuation or initiation of psychosocial problems in children. Thus, the present study simultaneously examined the association between father-perpetrated interparental aggression, father characteristics, and child psychosocial functioning in a sample of 145 men arrested for domestic violence. Results showed that of all the variables examined, paternal antisocial personality traits and interpersonal hostility were uniquely associated with overall child psychosocial impairment, externalizing problems, and attention problems. Implications for intervention programs are discussed.     

The mentalistic basis of core social cognition: experiments in preverbal infants and a computational model

Evaluating individuals based on their pro‐ and anti‐social behaviors is fundamental to successful human interaction. Recent research suggests that even preverbal infants engage in social evaluation; however, it remains an open question whether infants’ judgments are driven uniquely by an analysis of the mental states that motivate others’ helpful and unhelpful actions, or whether non‐mentalistic inferences are at play. Here we present evidence from 10‐month‐olds, motivated and supported by a Bayesian computational model, for mentalistic social evaluation in the first year of life.A video abstract of this article can be viewed at http://youtu.be/rD_Ry5oqCYE     

From tarasoff to hopper: The evolution of the therapist's duty to protect third parties

The duty of therapists to protect third parties has gained national attention following the analyses of the California Supreme Court in Tarasoff v. Regents of the University of California in 1974 and in 1976. The assassination attempt by John Hinckley, Jr., has spawned yet another “duty to protect” case (Hopper v. Brady). Utilizing the issues involved in Hopper, this paper discusses the psychotherapists' duty to protect from harm the patients' potential victims. Following an analysis of Hopper, Tarasoff is extensively reviewed. The evolution of Tarasoff within California and other jurisdictions is traced. Finally, an appraisal of the current status of the therapists' duty to protect as applied to Hopper and future cases is presented.