The child's experience of Munchhausen syndrome by proxy

This paper examines the emotional impact of Munchhausen syndrome by proxy on a child aged 6 who had been poisoned by her mother. It describes her treatment in child psychotherapy over twenty months at the Cassel Hospital where the family worked towards her successful rehabilitation home. The work with her showed her experience of dangerous relationships in her family that left her distrustful of any new relationship, and doubtful of her capacity to be close without being destructive. Like her parents, she was terrified of facing the murderous feelings in the family, retreating into denial when life was too painful. The paper describes three phases of treatment: fear of separation and preoccupation with the trauma of poisoning, ambivalence about facing the destructiveness in the family and the move into more appropriate latency behaviour as she prepared to go home with her parents. It concludes with an overview of the impact of Munchhausen syndrome by proxy on the developing child, as shown in this treatment: the delay in emotional and cognitive development, the interference with the capacity to relate, the retreat into illness under stress, and the fear of permanent damage caused by the emotional and physical abuse.     

On not being able to enter Noah's Ark

The paper describes the psychoanalytic psychotherapy of a patient who had originally been referred at the age of 15 because of his social isolation. In fact, he suffered from high-functioning Asperger's syndrome and lived in an almost delusional world populated by a number of imaginary companions, which he used to counteract a deep void and sense of deadliness within him. After five years of therapy, the patient was able to move on, allowing him to be successful in his academic studies, and to abandon his imaginary friends. This paper focuses on a subsequent phase of the therapy when the patient, as a young man, began to show an interest in and attraction to the world of intimate relationships. The paper is grounded in Meltzerian theory, especially his ideas about the role of beauty in the mother–child relationship, and about the world of intimate links as opposed to conventional ones.     

‘A kaleidoscope of themes’: intensive psychotherapy with a girl on the autistic spectrum

This paper is an account of the intensive psychotherapy of a young girl on the autistic spectrum. It describes her confusing presentation and how this suggested a tendency to oscillate between mainly unintegrated states of mind. Important themes that emerged included the phantasy of inhabiting a claustrum; the use of adhesive identification to defend against the bodily felt terror of separation; and fear of damage to the maternal object. The paper also discusses the trans-generational aspects of her difficulties and considers how her therapy helped growth to take place.     

Development and validation of the Granada Burnout Questionnaire in Spanish police

The goal of the present study is to develop a questionnaire, with proper psychometric properties and current norms, to evaluate the burnout syndrome in Spain. The operative definition of burnout proposed by Maslach and Jackson is used to define three dimensions (Emotional exhaustion, Depersonalization and Personal accomplishment). A total of 2,403 national Spanish police participated. Evidence of construct validity was checked through cross validation (showing a good fit of the three factors model to the data). Using the MBI, NEO-FII and CECAD evidence of convergent validity and criteria validity were developed (showing that the relations are similar to the ones that appear in other research). The discrimination, mean, standard deviation, and typical error of the average of the items composing the various dimensions were analyzed. Both the Cronbach's alpha coefficient and the conditional standard error of measurement (CSEM) were calculated for each of the dimensions. The results showed good internal consistency (all α values > .85). Finally, the questionnaire was scaled using T scores. The psychometrical properties reported here support the use of this new questionnaire for the burnout evaluation in Spanish police.     

Extended network learning error: A new way of conceptualising chronic fatigue syndrome

Abstract

The cause of chronic fatigue syndrome (CFS) is controversial: psychological, hypothalamic and immune mechanisms have been proposed as well as the possibility of some form of interaction between these mechanisms. Patients' own conceptual models vary and sometimes adversely affect self-management. This paper suggests an interactional way of conceptualising CFS using developments in complexity theory (networks, parallel processing or connectionism). I propose that the neurological, immune and endocrine systems are pan of a single, self-regulatory, extended brain-body network. Furthermore, that CFS is caused by self-organisational change in this extended network created by normally adaptive error-sensitive learning rules that malfunction when physiological and psychological challenges coincide. This psychoneuroimniunoendocrinological model shows how previously proposed mechanisms could interact to cause CFS. explains the heterogeneity of the presentation of the disease, and provides a conceptual model that may be acceptable to patients but is also consistent with effective self-management.     

Cognitive-affective assets and vulnerabilities: Two factors influencing adaptation to Fibromyalgia

The present article describes the associations between hostility and serum lipids in Coronary Artery Disease (CAD) patients. A sample of 212 male coronary patients was used of which 127 recently suffered a Myocardial Infarction (MI), and 85 had undergone either a Coronary Artery Bypass Grafting (CABG) or a Percutaneous Transluminal Coronary Angioplasty (PTCA). Total Cholesterol (TC), High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL) and triglyceride concentrations were measured as well as four hostility factors: ‘Negative Affectivity’ (NA), ‘Anger-In’ (AI), ‘Anger-Out’ (AO) and Coping, i.e. behaviors to control feelings of anger and anxiety. The results indicated that the effects of hostility on lipids were mediated by various factors such as body weight in relation to body length (BMI), Socio-Economic Status (SES), Left Ventricle Ejection Fraction (LVEF) and Age. In subgroups of highly exhausted patients or of patients scoring high on the Type A Behavior Pattern (TABP), however, more direct (unilinear) associations between lipids and hostility were found. The findings of the present study confirm the rather weak association between hostility and blood lipids found elsewhere. Furthermore, a low level of triglycerides was consistently associated with low AO, be it again in interaction with BMI (AO × BMI), both in the group of non-MI patients and in the total sample for those patients who score high on vital exhaustion and/or TABP. This finding provides an extra argument against the popular notion of the healthfulness under all circumstances of anger expression. Until now the exact role of triglycerides as a function of anger/hostility has been under-explored. This issue merits further attention in future research.     

Testing an Adaptationist Theory of Trait Covariation: Relative Bargaining Power as a Common Calibrator of an Interpersonal Syndrome

This article provides the first test of an adaptationist ‘common calibration’ theory to explain the origins of trait covariation, which holds that (i) personality traits are often facultatively calibrated in response to cues that ancestrally predicted the reproductive payoffs of different trait levels and (ii) distinct traits that are calibrated on the basis of common input cues will exhibit consistent patterns of covariation. This theory is applied to explain the covariation within a ‘personality syndrome’ encompassing various interpersonal trait dimensions (e.g. extraversion, emotionality and attachment styles). Specifically, it is hypothesized that these traits are inter‐correlated because each is calibrated in response to relative bargaining power (RBP)—a joint function of one's ability to benefit others and harm others. Path analyses from a correlational study compellingly supported this theoretical model: Objective and self‐perceived measures of RBP‐enhancing phenotypic features (physical attractiveness and physical strength) influenced an internal regulatory variable indexing RBP (i.e. self‐perceived RBP), which in turn had robust effects on each of the focal personality traits. Moreover, in support of the theory's core postulate, controlling for self‐perceived RBP greatly reduced the covariation within the interpersonal syndrome. These novel findings illustrate the promise of an evolutionary psychological approach to elucidating trait covariation. Copyright © 2013 John Wiley & Sons, Ltd.     

Effects of Comt Genotype on Behavioral Symptomatology in the 22q11.2 Deletion Syndrome

The 22q11.2 Deletion Syndrome (DiGeorge/velocardiofacial syndrome) is associated with elevated rates of psychosis, and is also characterized by severe attentional difficulties and executive dysfunction. Behavioral manifestations of this syndrome could result from haploinsufficiency of the catechol-O-methyltransferase (COMT) gene, located within the 22q11 region. The goal of the present study was to examine COMT genotype in relation to behavioral symptomatology in this syndrome. Val^158/108Met was genotyped in 38 patients (16 Met/-, 22 Val/-) with confirmed 22q11.2 deletions who had received the Child Behavior Checklist (CBCL) as part of a comprehensive evaluation. Results indicated that the Val genotype was associated with significantly greater internalizing and externalizing behavioral symptomatology in children with 22q11.2 deletions. Val allele status was associated with a greater-than-four-fold increase in risk for clinically significant behavior problems in children with this syndrome. These data are consistent with previous findings of increased psychopathology associated with the Val genotype in normal individuals and suggest that a functional genetic polymorphism in the 22q11 region may influence behavior in individuals with COMT haploinsufficiency.     

Impact of cognitive profile on social functioning in prepubescent females with Turner syndrome

Social deficits are prevalent in Turner syndrome (TS); however, the extent to which these difficulties are secondary to characteristic cognitive impairments is not well known. Here, we sought to establish the relative contribution of executive functions, visuospatial abilities, and IQ to social difficulties in young girls with TS. Forty TS girls and 19 typically developing (TD) children were assessed with the Social Responsiveness Scale (SRS), the Motor-Free Visual Spatial Test (MVPT-3), the Behavior Rating Inventory of Executive Function (BRIEF), and an IQ test. Hierarchical multiple regression analyses were conducted with the SRS subscales as outcome variables. In a first step, the cognitive factors were entered (verbal IQ, BRIEF global score, MVPT-3, and age), followed by the group variable in a second step. In comparison to TD, TS participants were significantly impaired on all main measures. All six regression models with the SRS subscales were significant and revealed that global executive functions explained the largest portion of the variance on all subscales and the total score. Even after controlling for cognitive elements, the group factor still explained a significant portion of the variance of the Social Cognition, Social Awareness, and Autistic Mannerisms subscales. In contrast, the group factor was not a significant predictor of Social Motivation and Social Communication scores. These results suggest that executive dysfunctions play a role in social impairments encountered in TS, but also that some specific aspects of social behavior are altered beyond what can be attributed to cognitive difficulties in this population.     

Working Memory In Individuals With Fragile X Syndrome

The present research tests the hypothesis that fragile X syndrome (FXS) is associated with a deficit in working memory (WM) and the deficit is more pronounced the higher the control requirements of the task. To this purpose, 15 boys with FXS and 15 typically developing children, matched for mental age, assessed with Logical Operation Test, were tested with batteries of 4 verbal and 4 visuospatial WM tasks requiring different levels of control. Children with FXS showed a performance equal to controls, in WM tasks requiring low and medium-low control but significant impairment in correspondence with greater control requirements. Results show that boys with FXS present a WM deficit only when high control is required by the task, supporting the hypothesis that control can be a critical variable distinguishing WM functions and explaining intellectual differences. On the contrary the hypothesis that the FXS is associated with a visuospatial deficit was not supported.