A skin for the imaginal

This paper focuses on the development of internal space, the evolution of psychological boundaries and the capacity for symbolization as they first arise during infancy. The concept of the psychic skin as an early form of psychological boundary is presented. The development of the psychic skin, or psychological container, is necessary for imaginal processes to function for the purpose of psychological growth and development. Infant observation material utilizing the Tavistock model and analytical material from an adolescent analysis is presented to help elucidate the theoretical concepts.     

Threat-Related Attentional Bias in Anxious Youth: A Review

The research literature suggests that children and adolescents suffering from anxiety disorders experience cognitive distortions that magnify their perceived level of threat in the environment. Of these distortions, an attentional bias toward threat-related information has received the most theoretical and empirical consideration. A large volume of research suggests that anxiety-disordered youth selectively allocate their attention toward threat-related information. The present review critically examines this research and highlights several issues relevant to the study of threat-related attentional bias in youth, including the influences of temperament, trait anxiety, and state anxiety on threat-related attentional bias. It furthermore identifies the need for developmental and methodological considerations and recommends directions for research.     

Personal standards and evaluative concerns dimensions of "clinical" perfectionism: a reply to Shafran et al. (2002, 2003) and Hewitt et al. (2003)

Shafran, Cooper, and Fairburn (2002, 2003) provided a cognitive-behavioral analysis of "clinical" perfectionism, a construct they considered to involve both the determined pursuit of self-imposed standards and extremely vulnerable self-evaluation. They argued against a multidimensional perspective to studying perfectionism. We respond to Shafran et al. (2002, 2003) and Hewitt, Flett, Besser, Sherry, and McGee's (2003) reply to Shafran et al. (2002) by considering the theoretical, empirical, and clinical implications of findings identifying two higher-order dimensions of perfectionism reflecting personal standards (PS) and self-critical evaluative concerns. Analyses of data from two diverse study groups, a college student sample (N = 527) and a clinical sample of patients with binge eating disorder (N = 236), revealed that self-criticism accounts for the relation between perfectionism measures and depressive, anxious, and eating disorder symptoms. We conclude that possessing high PS is not by itself maladaptive. Rather, self-critical evaluative tendencies are more relevant than PS to the critical processes Shafran et al. (2002) suggested contribute to the maintenance of clinical perfectionism.     

The post-event processing questionnaire in a clinical sample with social phobia

Post-event processing (PEP) involving rumination about perceived inadequacy in a past social situation has been proposed as an important maintaining factor in social phobia. The three aims of this study were to examine (a) the factor structure and internal reliability of a modified version of the Post-Event Processing Questionnaire [Rachman, S., Grüter-Andrew, J., & Shafran, R. (2000). Post-event processing in social anxiety. Behaviour Research and Therapy, 38, 611-617] in a clinical sample with social phobia (N=117), (b) the associations between PEP and symptoms of anxiety and depression, and (c) the relationship between perspective-taking ('field' and 'observer') and anxiety. Principal axis factor analysis yielded a highly reliable one-factor solution in our clinical sample, which generally replicated Rachman et al.'s findings with a sample of undergraduate students. PEP was most strongly and independently associated with state anxiety when depression, general anxiety and stress were controlled for. Contrary to expectations, PEP was not related to measures of social anxiety. The relationship between perspective-taking and anxiety was more complex than expected. Theoretical implications of these findings are discussed with reference to contemporary cognitive-behavioural models of social phobia.     

Size of drawings influences body size estimates by women with and without eating concerns

Research has inconsistently shown that women, particularly those with eating concerns, inaccurately estimate their body size. In the present study, drawings of female bodies, ranging from emaciated to obese, were presented to women with and without eating concerns. Drawings approximated the women's actual height or were reduced (15.7 cm). Women selected the drawing that represented how they thought they looked (cognitive rating), felt they looked (affective rating), and would like to look (desired rating). Women tended to select larger drawings when reduced-size drawings were used. Participants with eating concerns overestimated their body size and were more dissatisfied with their body size than participants without eating concerns. Size of drawings and the presence of eating concerns did not affect ratings of the size of a neutral object. Women did not demonstrate a generalized problem in estimating size. Overestimation of body size may be exaggerated in research that used reduced-size drawings.     

Change in sociocultural ideal male physique: An examination of past and present action figures

The physical dimensions of five contemporary action figures were measured and compared to their original counterparts to determine whether their physiques have become more muscular from their original designs. The circumferences of the neck, chest, arm, forearm, waist, thigh, and calf were measured three separate times using a Scale Master II model 6325. The mean score was then used in subsequent analyses. Except for the waist, it was determined that the body parts of current action figures were significantly larger when compared to those of their original counterparts. The results of this study indicate that action figures have become more muscular and larger over the last 25 years. Furthermore, the increase in action figure dimensions may contribute to the multifactoral development of an idealized body type that focuses on a lean, muscular physique. This occurrence may particularly influence the perceptions of preadolescent males.     

Clinical perfectionism: a cognitive-behavioural analysis

This paper reviews the characteristics of clinical perfectionism and proposes a new definition of the phenomenon. It is suggested that the defining feature of clinically significant perfectionism is the overdependence of self-evaluation on the determined pursuit (and achievement) of self-imposed personally demanding standards of performance in at least one salient domain, despite the occurrence of adverse consequences. It is suggested that such clinical perfectionism is maintained by the biased evaluation of the pursuit and achievement of personally demanding standards. Specifically, it is suggested that people with perfectionism react to failure to meet their standards with self-criticism. If they do meet their standards, the standards are re-evaluated as being insufficiently demanding. Anorexia nervosa and bulimia nervosa are considered to have a particular relationship to perfectionism, with both disorders often being direct expressions of perfectionism. Under these circumstances self-evaluation is dependent on the pursuit and attainment of personally demanding standards in the domain of control over eating, shape and weight. The implications of this analysis for research and practice are considered.     

Rationale and principles for early intervention with young children at risk for anxiety disorders

Anxiety disorders are one of the most prevalent categories of disorder among adults and children. Children of parents with anxiety disorders are known to be at higher risk for anxiety disorders themselves, with manifestations of this risk often appearing in toddlerhood or early childhood. Yet because affected parents are often unskilled in anxiety management, they often have difficulty in helping their young children learn to manage anxiety. Literature on the course of anxiety disorders through childhood and on effective cognitive-behavioral interventions suggests that preventive interventions even with very young children could potentially be of benefit in mitigating the course of these often debilitating disorders. This paper outlines the rationale for offering early or preventive interventions to preschool-age children at risk and their parents and discusses means of identifying children to target for intervention and the importance of parental involvement. Drawing upon the literature on parental factors in childhood anxiety disorders as well as on effective intervention strategies with preschool-age children, it delineates principles for intervention with parents and effective components of intervention with youngsters in this age range.     

Negative body image and disordered eating behavior in children and adolescents: what places youth at risk and how can these problems be prevented?

In this review, we examine the prevalence of negative body image and disordered eating behaviors (i.e., excessive dieting, binge eating, inappropriate weight loss techniques) in children and adolescents. We also explore correlates and predictors of the development of these problems, including individual, familial, and social factors, as well as discuss factors that may serve a protective function. In addition, we critically evaluate the psychoeducational programs that have been developed to prevent the onset of these problems and reduce the severity of symptoms in children and adolescents. Moreover, we suggest several possible strategies for how such prevention programs can be modified to enhance their efficacy. Finally, likely moderator and mediator variables of the effectiveness of such programs are proposed.     

A measure for the assessment of eating disorders: reliability and validity studies of the Rating of Anorexia and Bulimia interview - revised version (RAB-R)

The Rating of Anorexia and Bulimia interview (RAB) is a Swedish semi-structured interview for clinical and research purposes for a wide range of eating disorder symptoms and related psychopathology. The objectives were to evaluate the reliability and validity of a revised RAB version (RAB-R). The RAB-R was assessed in terms of internal consistency, inter-rater and test-retest reliability, and criterion and convergent validity. Samples included a clinical sample of eating disorder patients (n = 71) and a sample of randomly drawn female controls (n = 31). The RAB-R showed satisfactory internal consistency, inter-rater and test-retest reliability, correlated well with related measures, and discriminated between patients and normal controls. We conclude that the RAB-R is a promising interview instrument and continued evaluation should focus on comparing subgroups of eating disorder patients with other clinical groups.