Personality Disorders and Spinal Cord Injury: A Pilot Study

A substantial body of research has found that spinal cord injury (SCI) patients have relatively high degrees of energy, impulsivity, and risk-taking (W. Fordyce, 1964; G. P. Taylor, 1970; B. Woodbury, 1978). The present study endeavors to extend our knowledge to the personality disorder (PD) domain. Forty SCI participants and 40 matched controls were given a semistructured diagnostic interview and a self-report personality disorder instrument. Findings indicated that 27.5% of SCI patients, and a similar number of controls, have PDs. Unexpectedly, impulsive/externalizing disorders (histrionic, narcissistic, antisocial, and borderline) were not unusually high in SCI patients, and were not higher than controls. Avoidant and depressive disorders were unexpectedly high.     

Crisis Support and Coping as Mediators of Well-Being in Persons with Spinal Cord Lesion

This study aims to investigate whether crisis support and coping mediate symptoms of posttraumatic stress disorder (PTSD) in individuals with spinal cord lesions (SCL). PTSD, crisis support, and coping were assessed an average of 83 days after the injury (T1), at discharge from the rehabilitation center (T2), and an average of 121 days following discharge (T3). Sixty-nine newly injured paraplegics and tetraplegics completed the questionnaire at T1, 40 (58%) at T2, and 38 (55%) at T3. Individuals with PTSD experienced significantly lower levels of social support, and used more emotional coping than did those without PTSD. On the basis of logistic regression analyses, emotional coping and the interaction between negative response and emotional coping predicted PTSD. Emotional coping is a strong predictor of PTSD in persons with new SCL.     

Staff survey results and characteristics that predict assault and injury to personnel working in mental health facilities

The purpose of this study was to complete a mental health staff opinion survey to identify patient and staff characteristics associated with staff assault and injury in psychiatric treatment settings and to develop a model of prediction for staff assault and injury utilizing these survey variables. The data consisted of opinion surveys sent to staff of 15 child, adolescent, and adult psychiatry inpatient units in the United States. Multivariate logistic regression was used to determine the level of assault and staff‐reported injury prediction that could be obtained from the staff‐completed opinion survey. Responses indicated a high prevalence of reported aggression, with 62.3% of staff endorsing verbal and physical aggression, property destruction, and self‐injurious behavior as being prevalent at their site, whereas only 4.1% rated none of these as prevalent. Staff working with children and adolescents in settings with high rates of psychiatric diagnoses reported increased frequency of assault and injury compared with those working with adults. Younger, less experienced staff reported higher rates of assault and injury. Staff working with female patients reported similar rates of assault and injury to those working with males. A logistic regression analysis using staff‐reported survey results of both staff and patient characteristics predicted assault correctly 73.7% of the time and injury 66.1% of the time. Resources for violence prevention and staff training programs in violence prevention are needed in child and adolescent psychiatry wards. Results are consistent with theories emphasizing the importance of negative emotions and affects, impulsivity, and frustration in goal‐directed activities in human aggression. Aggr. Behav. 29:31–40, 2003. © 2003 Wiley‐Liss, Inc.     

Do beliefs about aggression predict physical aggression to partners?

Three hypotheses concerning the association between instrumental (I) and expressive (E) beliefs about aggression and physical aggression were assessed among a sample comprising students (n=40), women from a domestic violence shelter (n=29), and male prisoners (n=46), all of whom had committed at least one act of physical aggression to a partner. Participants completed an adapted version of the EXPAGG [Archer and Haigh (1997a): British Journal of Social Psychology 35:1–23] to measure I and E beliefs about aggression, the Conflict Tactics Scale (CTS) [Straus (1979): Journal of Marriage and the Family 41:75–88] for themselves and their partner, and measures of fear and injuries resulting from partner violence. I beliefs predicted self‐reported physical aggression to the partner, most CTS acts of physical aggression, and injuries to the partner, with only minor and limited associations for E beliefs. Correlations for the student and prisoner samples, and for men and women, showed different strengths. The findings supported a general link between I beliefs and aggression but offered no support for the predictions that the link would be restricted to men or to men who showed a persistent pattern of violence to their partners. Aggr. Behav. 29:41–54, 2003. © 2003 Wiley‐Liss, Inc.     

Validation of the Multidimensional Blood/Injury Phobia Inventory: Evidence for a Unitary Construct

The Multidimensional Blood/Injury Phobia Inventory (MBPI) was developed from a theoretical framework to characterize a broad range of feared stimuli and phobic reactions associated with this pathology. The MBPI consists of 40 items that cross 4 types of stimulus content (injections, hospitals, blood, injury), 5 types of phobic responses (fear, avoidance, worry, fainting, disgust), and a self versus other focus. This study reports on administration of the MBPI to 558 undergraduates, 9 of whom had blood/injury phobia. The instrument had a Cronbach's alpha of .91 and demonstrated good concurrent validity, convergent validity, and discriminant validity. One large factor emerged in an unrotated principal components analysis, suggesting that blood/injury phobia is a unitary psychometric construct. Exploratory factor analyses revealed a 6-factor solution defined by stimulus content domains and fainting, each of which may be important to consider clinically when assessing the unique concerns of treatment-seeking individuals.     

Neurocognitive outcomes following pediatric brain injury: A developmental approach

Developmental neuropsychologists postulate that “immaturity” of the cerebral cortex should no longer be perceived as a protective factor. They argue that injury to the young brain may affect new learning by disrupting the skills in the midst of being acquired and skills that are yet to be developed. Cognitive deficits or weaknesses that are not detectable in the acute phase following a traumatic brain injury (TBI) may emerge over development as more complex skills are needed, thereby creating a developmental lag between children who sustained a pediatric TBI and typical age peers. This literature review was conducted to evaluate the developmental perspective on neurocognitive recovery/development following a TBI. Overall, the described findings support a developmental view and suggest that predictions of prognosis should be based on the child's remaining ability to learn.     

Psychological Variables Associated with Pain Perceptions Among Individuals with Chronic Spinal Cord Injury Pain

Structural equation modeling was used to examine the relationships between selected psychological variables and pain perceptions in 103 individuals experiencing chronic pain following traumatic spinal cord injury (SCI). Previous studies have suggested strong relationships between psychological variables and chronic SCI pain, but further delineation of such relationships is needed in order ultimately to develop more effective pain management strategies for individuals afflicted with such pain. Anger was found to be significantly related to perceptions of pain (p < .05), but neither guilt nor anger suppression was significantly associated with perceived pain. Internal health locus of control was associated with decreased pain perceptions (p < .05), but there was no significant relationship between internal health locus of control and anger. Punishing responses from significant others to pain complaints were related to feelings of guilt (p < .05) and perceived pain (p < .05), but this relationship was not mediated by guilt.     

Traumatic brain injury: Implications for practice

This article presents a brief overview of the prevalence and history of traumatic brain injury (TBI), discusses the multidimensional effects of TBI, describes the current focus of TBI rehabilitation, and summarizes outcomes from (re)habilitation work with individuals with traumatic brain injury. The importance of this critical area to rehabilitation personnel is discussed, along with suggestions for future research and evaluation studies.     

Executive function outcomes of children with traumatic brain injury sustained before three years

Traumatic brain injury (TBI) is a common cause of disability in childhood. While the outcomes of TBI sustained in school years has been heavily researched, very little is known about the impact of TBI in infants and young children. The aim of this study was to investigate the impact of TBI on executive function (EF) in children who sustained a TBI before 3 years of age. A group of 55 children, 19 with a mild TBI, 16 children with a moderate-severe TBI, and 20 uninjured comparison children participated. The EF of children aged 3 to 6 years were compared using child-based measures of attentional control and information processing. Parents completed questionnaires rating their child's EF. Severity groups differed on the child-based EF measure of attentional control with children with TBI performing below the control group. There were no significant group differences for information processing or parent-rated EF. It appears that children who sustain a TBI before the age of 3 years display impairments in some areas of attentional control 3–4 years postinjury. The findings fit with the existing EF literature for older children.