The secluded minds of violent patients

In this paper, I will present two violent patients suffering from severe Personality Disorders, illustrating the changes that can arise during the course of several years' psychoanalytic treatment in high security hospital. Progress was monitored using the Operationalised Psychodynamic Diagnostics (OPD) system. The clinical presentations will indicate how secluded these patients' minds are to themselves and to those involved in their care. The psychoanalytic treatment, as one part of the overall treatment, is described to show how the secluded parts of the patients'' minds can be approached, including references to the regular regressions that arise, provoked by ‘getting better’.     

Relations Between Parenting Behavior and SES in a Clinical Sample: Validity of SES Measures

Two common methods of measuring socioeconomic status (SES) were examined in relation to observed parenting behaviors in a clinical sample of 89 mothers of 3- to 6-year-olds referred for treatment of oppositional defiant disorder. Families were 74% Caucasian, 9% African American, 5% Hispanic, 1% Asian, and 11% Biracial. Most children were male (75%). Parenting behaviors were measured with the Dyadic Parent–Child Interaction Coding System (DPICS) categories of prosocial talk and negative talk. Analyses were conducted with SES measured in two ways: (a) the Hollingshead Four-Factor Index of Social Status (HI) was correlated with parenting behaviors; and (b) family income, parent education (5 categories), and parent occupation (5 categories) were used to predict parent behavior. SES was significantly positively related to maternal prosocial talk. When SES was operationalized as income, occupation, and education, the model predicted three times more variance in maternal prosocial talk than the HI alone. SES was not related to maternal negative talk by either measure of SES.     

Reflective measurement models,behavior domains,and common causes

Causal theories of measurement view test items as effects of a common cause. Behavior domain theories view test item responses as behaviors sampled from a common domain. A domain score is a composite score over this domain. The question arises whether latent variables can simultaneously constitute domain scores and common causes of item scores. One argument to the contrary holds that behavior domain theory offers more effective guidance for item construction than a causal theory of measurement. A second argument appeals to the apparent circularity of taking a domain score, which is defined in terms of a domain of behaviors, as a cause of those behaviors. Both arguments require qualification and behavior domain theory seems to rely on implicit causal relationships in two respects. Three strategies permit reconciliation of the two theories: One can take a causal structure as providing the basis for a homogeneous domain. One can construct a homogeneous domain and then investigate whether a causal structure explains the homogeneity. Or, one can take the domain score as linked to an existing attribute constrained by indirect measurement.     

You can't miss what you've never had: Can you?: The challenges and struggles of single parenthood from a psychoanalytic perspective

The issue of the growth of single-parent families has been in the forefront of political, social and moral debate in recent years. Children from single-parent families tend to be over-represented in clinic populations. Yet this state of My being may be no more potentially pathological than the nuclear family, which can become conceptually idealized The aim of this paper is to look behind the statistics and examine the impact on children of life in a single-parent family, to explore how this may be managed, and to look for potentiating factors which can enable good-enough development to unfold. Case material is used to illustrate the theme.     

Mirroring,imitation, identification: the sense of self in relation to the mother's internal world

The phenomenon of neonatal imitation, and the use of mutual imitation by mother and baby in the service of attunement, are considered in relation to psychoanalytic theories of mirroring, imitation and identification. Material from infant observation and from the treatment of two children on the autistic spectrum is discussed in terms of the suggestion that developmental imitation implies a perceived position of balance between the external baby and the mother's supposed internal occupant. This is seen as making possible introjective identification and assimilation, with the enrichment of the sense of identity, in contrast to the kind of imitation involving mimicry, in which adhesive or projective identification may be operative.     

Trait anxiety and trait anger measured by ecological momentary assessment and their correspondence with traditional trait questionnaires

Ecological momentary assessments (EMA) of anxiety and anger/hostility were obtained every 25–30 min over two 24-h periods, separated by a median of 6 months, from 165 employees at a university in the Northeast. We used a multilevel trait-state-error structural equation model to estimate: (1) the proportion of variance in EMA anxiety and anger/hostility attributable to stable trait-like individual differences; (2) the correspondence between these trait-like components of EMA anxiety and anger/hostility and traditional questionnaire measures of each construct; and (3) the test–retest correlation between two 24-h averages obtained several months apart. After adjustment for measurement error, more than half the total variance in EMA reports of anxiety and anger/hostility is attributable to stable trait-like individual differences; however, the trait-like component of each construct is only modestly correlated with questionnaire measures of that construct. The 6-month “test–retest” correlations of latent variables representing the true 24-h EMA average anxiety and average anger are quite high (r ? 0.83). This study represents the longest follow-up period over which EMA-based estimates of traits have been examined. The results suggest that although the trait component (individual differences) of EMA momentary ratings of anxiety and anger is larger than the state component, traditional self-report questionnaires of trait anxiety and anger correspond only weakly with EMA-defined traits.     

Parental Attitudes,Beliefs, and Responses to Childhood Obsessive Compulsive Disorder: The Parental Attitudes and Behaviors Scale

ABSTRACT

This paper documents preliminary examination of the factor structure and psychometric properties of the Parental Attitudes and Behaviors Scale (PABS), an OCD-specific measure of parental attitudes, beliefs, and behavioral strategies related to childhood OCD. Employing a sample of 123 youth (mean age = 11.7; 59% male, 79% Caucasian) diagnosed with OCD in an outpatient child anxiety clinic, we used exploratory factor analysis to produce a 3-factor solution representing the following domains of parental responses to childhood OCD: accommodation, empowerment, and hostility/blame. These scales demonstrated adequate internal consistency and concurrent validity, providing preliminary evidence for the psychometric integrity of the PABS.     

Psychological and behavioural effects of bone density screening for osteoporosis

Abstract

To examine the psychological effects of bone density measurement, 298 women were assessed two weeks before the bone density scan, immediately before the scan, after the results, a week later and three months later. For the group as a whole, ratings of anxiety and perceived vulnerability were lower at the three month follow-up than at the initial assessment. Women who received a low bone mineral density (BMD) result were more anxious and reported more osteoporosis-preventive behaviours at the three month follow-up than women who received a high BMD result; these differences had not been apparent at the initial assessment Women with low BMD results had higher ratings of perceived vulnerability after the scan, although for some of these ratings there were group differences before the scan. Women with a low BMD result showed a decrease in ratings of the seriousness of a below-average result, which may reflect minimization of the health threat     

Development and validation of an appearance motivation attitudes scale for sun protection

A reliable two-factor instrument measuring appearance motivation attitudes for sun protection was developed using a longitudinal sample of beachgoers. At baseline, data on sun protection and appearance motivation attitudes were collected on 2324 individuals. Principal components analyses (PCA) indicated a two-factor solution measuring attitudes toward tan attractiveness and skin protection with only 2 items loading on the skin protection factor. At 12-months, the instrument was revised and shortened but including 3 new skin protection items. Split-half analyses were conducted to further refine and develop the instrument. PCA on half of the sample revealed a two-factor solution, which was confirmed using structural equation modeling on the remaining half. This resulted in a two correlated-factor, 10-item measure. Each factor was summed to create two scales. Both scales were internally consistent and demonstrated good external validity, correlating with sun protection specific Transtheoretical model variables. The tan attractiveness attitudes scale significantly improved prediction of sun protection outcomes over 24 months, over and above TTM variables.     

Improving self-report measures of non-adherence to HIV medications

The aim of this article is to clarify what factors should be measured to assess non-adherence to an antiretroviral medication regimen among individuals with the Human Immunodeficiency Virus (HIV). In order to consider a patient as non-adherent, a clear operational definition of medication non-adherence should be formulated. This definition should specify the medication to be taken, the medical advice to be followed as well as the behaviors a patient should adopt in a given period of time. Techniques aimed at reducing the influence of several potential biases in self-report questionnaires, such as forgetfulness and social desirability, are also reviewed.