Anger-associated panic attacks in Cambodian refugees with PTSD; a multiple baseline examination of clinical data

Despite the increasing recognition of the importance of anger as a key aspect of post-traumatic stress disorder (PTSD), the presence of anger-induced panic attacks has been understudied in traumatized groups. The present investigation determines the prevalence of anger-associated panic attacks among Cambodian refugees suffering from PTSD. Specific characteristics of these episodes that were examined included frequency, symptoms, and cognitions (in particular, fear of death from bodily dysfunction). In a survey of 100 Khmer patients suffering PTSD, 58% reported anger-associated panic attacks in the last month. These attacks occurred at a mean rate of 6.2 attacks a month and were characterized by extreme arousal and in 81% of these cases, fears of death due to bodily dysfunction during the anger-induced panic. Mechanisms for this high rate of fear of death during anger arousal are discussed with a focus on culture-specific catastrophic cognitions.     

Sequential evaluation of behavioral treatments and methylphenidate dosage for children with attention deficit hyperactivity disorder

We used a sequential approach to evaluate the relative and combined effects of different types of behavioral treatments, as well as dosage of methylphenidate (MPH), on the disruptive behavior of 3 students who had been diagnosed with attention deficit hyperactivity disorder. Results showed that individualized behavioral treatments produced decreases in disruptive behavior equivalent to MPH for all 3 participants and demonstrated the need to evaluate behavioral treatments and medication dosage on an individual basis.     

General self-efficacy,dental anxiety and multiple fears among 20-year-olds in Norway

This paper examines the extent to which low general self-efficacy and painful dental and medical experiences are related to dental anxiety, multiple fears and to avoidance of dental care. A total of 754 20-year-olds completed a series of questionnaires, including the General Self-efficacy Scale (GSE), Geer Fear Scale (GFS) and Dental Fear Survey (DFS). Females had lower self-efficacy, higher dental anxiety and higher scores on the GFS than males. Multivariate analyses (linear stepwise regression) indicated that painful dental experiences, a high score on the GFS and negative opinions about own dental health explained 37% of the variance in DFS scores. Self-efficacy had no predictive power for dental anxiety, and only dental anxiety had predictive power for dental avoidance behavior. Thirty-eight percent of the total variance in GFS scores was explained by the following variables: being a female, high dental anxiety (DFS), low general self-efficacy (GSE) and low educational level of the mother.     

Subfactors of DSM-IV Conduct Disorder: Evidence and Connections with Syndromes from the Child Behavior Checklist

Is conduct disorder (CD) as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) a unitary entity, or do variants of CD exist? We addressed this question, using data collected from the parents of 1,669 Australian boys, aged 6–17. Parents were interviewed to assess DSM-IV Conduct Disorder (DSM-IV CD) criteria. Results revealed 2 subfactors of DSM-IV CD symptoms, made up of overt behaviors (e.g., initiating physical fights) and covert behaviors (e.g., stealing without confrontation). Ordinary least squares regressions showed the 2 CD subfactors to be significantly and uniquely predicted by Child Behavior Checklist (CBCL; T. M. Achenbach, 1991a, 1991b) syndromes labeled Aggressive Behavior and Delinquent Behavior, respectively. The results are discussed in terms of the utility of differentiating these 2 variants of CD in future editions of the DSM.     

Listening comprehension and working memory are impaired in attention-deficit hyperactivity disorder irrespective of language impairment

This study investigated listening comprehension and working memory abilities in children with attention-deficit hyperactivity disorder (ADHD), presenting with and without language impairments (LI). A 4-group design classified a community sample (n = 77) of boys aged 9–12 into ADHD, ADHD + LI, LI, and Normal groups. Children completed tests of basic language and cognitive skills, verbal and spatial working memory, and passage-level listening comprehension. Multivariate analyses and post hoc comparisons indicated that ADHD children who did not have co-occurring LI comprehended factual information from spoken passages as well as normal children, but were poorer at comprehending inferences and monitoring comprehension of instructions. ADHD children did not differ from normal children in verbal span, but showed significantly poorer verbal working memory, spatial span, and spatial working memory. The ADHD + LI and LI groups were most impaired in listening comprehension and working memory performance, but did not differ from each other. Listening comprehension skills were significantly correlated with both verbal and spatial working memory, and parent–teacher ratings of inattention and hyperactivity/impulsivity. Findings that children with ADHD but no LI showed subtle higher-level listening comprehension deficits have implications for both current diagnostic practices and conceptualizations of ADHD.     

Demographic characteristics,social competence,and behavior problems in children with gender identity disorder: a cross-national,cross-clinic comparative analysis

This study examined demographic characteristics, social competence, and behavior problems in clinic-referred children with gender identity problems in Toronto, Canada (N = 358), and Utrecht, The Netherlands (N = 130). The Toronto sample was, on average, about a year younger than the Utrecht sample at referral, had a higher percentage of boys, had a higher mean IQ, and was less likely to be living with both parents. On the Child Behavior Checklist (CBCL), both groups showed, on average, clinical range scores in both social competence and behavior problems. A CBCL-derived measure of poor peer relations showed that boys in both clinics had worse ratings than did the girls. A multiple regression analysis showed that poor peer relations were the strongest predictor of behavior problems in both samples. This study—the first cross-national, cross-clinic comparative analysis of children with gender identity disorder—found far more similarities than differences in both social competence and behavior problems. The most salient demographic difference was age at referral. Cross-national differences in factors that might influence referral patterns are discussed.     

Treatment of Prostitution Using Integrative Therapy Techniques: A Case Study

This case study examines a pattern we believe to be common among female prostitutes: a woman (Bonnie) who, like most prostitutes, is a survivor of childhood sexual abuse. Bonnie's prostitution is part of the unconscious repetition compulsion common in trauma victims; by prostituting herself, Bonnie re-creates the scenario of sexual abuse that occurred during her childhood, while maintaining an illusion of control over the situation. We maintain that an effective approach to treatment for Bonnie is integrative therapy, a type of psychological counseling designed to address the major aftereffects of sexual abuse: dissociation from the body and sexuality in general; a profound sense of powerlessness; critically low valuation of the self; and mistrust and fear of intimacy. Bonnie's story shows the dynamics of both prostitute behavior and integrative therapy, providing an example we believe to be applicable far beyond this case study.     

From I: A/M to “Who am I?”—Aggregation/Massification and Trauma-Based Affects and Object Relations in Groups: A Response to Earl Hopper

Hopper's portrayal of the fourth basic assumption of Incohesion: Aggregation/Massification has two components: (1) a revision of Turquet's theory of BA Oneness to incorporate the polarity of aggregation and massification stemming from annihilation anxiety; and (2) a conception of the difficult patient as having an encapsulated psychosis. Hopper's theory of the encapsulated psychosis offers an important but incomplete perspective in explaining borderline and narcissistic pathology, as well as psychological trauma. In this response to Hopper, I suggest that the fourth assumption is in fact a still more primitive state of boundary opening and closing. I also see a need to differentiate trauma as such from borderline pathology, and further hold that the relationship between Hopper's British Independent theory and trauma theories based on dissociation needs to be clarified.     

Depression and Self-Esteem in Boys with Attention-Deficit/Hyperactivity Disorder: Associations with Comorbid Aggression and Explanatory Attributional Mechanisms

It was tested whether boys with attention-deficit/hyperactivity disorder (ADHD), subgrouped by aggressive status, would show higher rates of depressive symptomatology and lower levels of self-esteem than would comparison boys and, in a subsample, explored attributional mechanisms that may be related to such internalizing features. Study 1 utilized 114 boys with ADHD (all prior recipients of stimulant medication) and 87 comparison boys, aged 7–12 years. Aggressive boys with ADHD reported more symptoms of depression than did nonaggressive boys with ADHD, who, in turn, reported more depression than did comparison boys. Effect sizes were moderate to large and did not vary with a depression rating scale uncontaminated by ADHD-related items. For self-esteem, the most pronounced effect was that aggressive boys with ADHD showed lower levels than did nonaggressive ADHD or comparison boys; effects were again moderate to large. Study 2 participants were a subsample of boys with ADHD from Study 1 (N = 27). We probed causal attributions in ADHD-related domains through responses to hypothetical vignettes, in which the protagonist's medication status (medicated, not medicated) was crossed with type of outcome (good, bad). Medication-related attributions were frequent. In describing the protagonist's success in relation to medication treatment, the sample showed significant associations between (a) medication-related attributions and (b) increased depressive symptomatology as well as decreased self-esteem. We discuss attributional processes that may help to explain the variation in internalizing symptoms among children with ADHD.     

Social Anxiety Disorder in Childhood and Adolescence: Current Status and Future Directions

This paper reviews the current status of research on the phenomenology, etiology, maintenance, assessment, and treatment of childhood and adolescent social anxiety disorder (SAD). Despite being one of the most prevalent disorders of childhood and adolescence, SAD paradoxically stands as one of the least recognized, researched, and treated pediatric disorders. The small treatment outcome literature provides preliminary support to the effectiveness of various forms of cognitive behavior therapy. The majority of studies to date, however, are limited by inadequate control conditions. Other findings include some support for the utility of parental involvement in treatment, significant advancements in outcome measures (e.g., normative comparisons, indices of naturalistic social functioning), and impressive durability of gains for the majority of treatments. Future directions are suggested, including experimental and naturalistic studies of developmental pathways and maintenance factors, the incorporation of positive psychology constructs (e.g., positive emotions, hope, self-control) in treatment and prevention, and the continued delineation of differences between child, adolescent, and adult manifestations of SAD.