Linking dimensions and dynamics in psychopathology research: An example using DSM-5 instruments

The DSM-5 includes two measures to assess dimensions of personality pathology (Personality Inventory for DSM-5; PID-5) and cross-cutting symptoms of psychopathology (DSM-5 Cross-cutting Symptom Measure; CCS). Few studies have evaluated these measures in an ecologically valid context. Participants (N = 248, student sample) completed self-report versions of the DSM-5 measures, and then completed a two-week daily diary of internalizing and externalizing outcomes. The CCS scales evidenced convergent and discriminant validity with these outcomes, PID-5 Negative Affectivity and Detachment were related to internalizing outcomes, and PID-5 Antagonism was related to externalizing outcomes. We also demonstrated the benefit of linking static dimensions to temporally-dynamic processes by examining how PID-5/CCS dimensions moderated the within-person associations among daily cognitive distortions and internalizing and externalizing outcomes.     

A Holistic Client Functioning Profile Comparison of People With Serious Mental Illness

Among a sample of 196 participants, small differences in holistic client functioning, as measured by standardized Adult Needs and Strengths Assessment (Lyons & Walton, 1999) and symptom severity scores, emerged across 3 diagnostic categories of serious mental illness (SMI; i.e., depression, bipolar disorder, and schizophrenia). However, sizable variations in symptom severity were evident across diagnoses of SMI, despite study participants receiving a similar configuration and intensity of recovery-oriented usual-care services. These results may evidence previous concerns surrounding the transdiagnosis of SMI, overlapping criteria and symptomatology among disorders in the Diagnostic and Statistical Manual of Mental Disorders, and mental health treatment and service practices in the United States. Implications for counselor practice are discussed.     

The Relationship of Offense-Specific Forgiveness to Posttraumatic Stress Disorder Symptoms in College Students

The relationship between offense-specific forgiveness and post-traumatic stress disorder (PTSD) symptoms was examined in a cross-sectional survey of 178 college students reporting interpersonal trauma exposure, that is, a trauma exposure in which they identified a specific perpetrator. Higher levels of offense-specific forgiveness were significantly related to lower levels of PTSD symptoms. In path analyses, however, when gender and offense severity were allowed to directly predict both forgiveness and PTSD symptoms, the relationship was reduced to marginal significance. Exploratory analyses revealed that within the five most-commonly endorsed trauma subtypes, the relationship between forgiveness and PTSD symptoms may differ in strength and direction as a function of trauma type. Implications for research and treatment are discussed.     

Attachment Disruptions,IQ, and PTSD in African American Adolescents: A Traumatology Perspective

Attachment disruptions, other traumas, posttraumatic stress disorder (PTSD), and intelligence quotient (IQ) were measured in a sample of 181 African American adolescents. Path analysis was utilized to test the effects of different types of attachment disruptions on IQ and PTSD. Findings supported that mother and father abandonments and being in foster care are associated with decreased perceptual reasoning, processing speed, and working memory, and increased discrepancy between perceptual and verbal toward decreased perceptual reasoning. Such suppression and discrepancy contribute to poor academic achievement. Results validated the traumatology perspective on attachment disruptions as traumas that are associated with PTSD, suppression of most IQ potentials, and with potential brain hemispheric desynchronization. The ramifications of these results for helping African American adolescents are discussed.     

Investigating Treatment Outcomes Across OCD Symptom Dimensions in a Clinical Sample of OCD Patients

Despite the heterogeneous nature of obsessive-compulsive disorder (OCD), many self-report assessments do not adequately capture the clinical picture presenting within each symptom dimension, particularly unacceptable thoughts (UTs). In addition, obsessions and ordering/arranging compulsions are often underrepresented in samples of treatment outcome studies for OCD. Such methodological discrepancies may obscure research findings comparing treatment outcomes across OCD symptom dimensions. This study aimed to improve upon previous research by investigating treatment outcomes across OCD symptom dimensions using the Dimensional Obsessive-Compulsive Scale, which offers a more comprehensive assessment of UTs. The study included a primarily residential sample of 134 OCD patients. Results indicated that there were no significant differences in treatment outcomes across symptom dimensions. However, the severity of UTs remained significantly greater than other symptom dimensions at both admission and discharge. Thus, it is possible that UTs may exhibit uniquely impairing features, compared with other symptom dimensions. It is also possible that these findings may reflect the characteristics of the residential OCD samples. These speculations as well as implications for OCD treatment and future research are discussed.     

SPONTANEOUS “CURES”: NORMAN REIDER'S FORGOTTEN PAPER,PART II

Part I of this paper combined an introduction to Norman Reider's original 1955 paper with a republication of the paper itself. Part II is a discussion of the complexities of a comparison of past and present psychoanalytic literature. The concept of enactment is proposed as one of many possible alternative views in considering Reider's notion of spontaneous “cures.” A careful consideration of these spontaneous cures within the ordinary ups and downs of any psychoanalytic treatment sheds important light on our continuing confusion about how we define the term cure, and therefore about the nature of change during psychoanalytic treatment. This alternative perspective is only one of many plausible ones for present‐day readers. The purpose of this republication is not to propose an explanation for “what really happened” with Reider and his patients; rather, it is to reconsider the fallacy of evaluating his paper outside its historical context and thereby failing to appreciate his courage in presenting what at the time were radical views. Questions about the complexity and confusion regarding cure and change require reexamination of the neglect of epistemology on the part of psychoanalysis in prolonging the confusion about distinguishing psychotherapy and psychoanalysis.     

Assessing Sexual Orientation Symptoms in Obsessive-Compulsive Disorder: Development and Validation of the Sexual Orientation Obsessions and Reactions Test (SORT)

Obsessive-compulsive disorder (OCD) includes many symptom presentations, which creates unique diagnostic challenges. Fears surrounding one’s sexual orientation are common within OCD (also called SO-OCD), but SO-OCD is consistently misdiagnosed by physicians and psychologists. To address this issue, we describe the development of a self-report measure for assessing SO-OCD to help distinguish OCD from distress caused by a sexual orientation identity crisis. The current paper details two studies that established the psychometric properties and clinical utility of this measure. In Study 1, the factor structure, validity, and reliability were examined for the measure’s 12 items in a sample of 1,673 university students. The results revealed a two-factor solution for the measure (Factor 1: Transformation Fears; Factor 2: Somatic Checking) and preliminary evidence of validity and reliability. In Study 2, the measure was tested with LGBTQ and heterosexual community samples and clinical samples of individuals with SO-OCD and other types of OCD. The two-factor solution and evidence of validity and reliability were supported in these samples. Cut-off points were established to distinguish between community members and SO-OCD sufferers, as well as between those experiencing SO-OCD and other types of OCD. Limitations and future directions are discussed.     

Latent structure of the Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) in South African mortuary workers

This study applied confirmatory factor analysis (CFA) to determine the dimensionality of PTSD symptoms as measured by the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5, Weathers et al., 2013). Participants were 150 trauma-exposed mortuary workers. Six alternative factor solutions resulted from the CFA; including Dysphoria model (four-factor), Dysphoric Arousal model (five-factor), Anhedonia model (six-factor), Externalising model (six-factor), and Hybrid model (seven-factor). Compared to the other models, the five-factor Dysphoric Arousal model had superior fit to the data. Overall, the current results provide evidence for the factorial validity and reliability of scores for the PCL-5 for research use in the South African context.     

Patient and spouse perceptions of the patient's heart disease and their associations with received and provided social support and undermining

Numerous empirical studies have investigated the relationships between cardiovascular diseases (CVD) and patients’ psychological well-being, with a focus almost exclusively on its dark side. Very little is known on the impact of illness severity on both negative and positive indicators of patients’ well-being, as well as on the psychosocial variables that may mediate this association. Aim of the study was to investigate the impact of illness severity on depression as well as on health satisfaction and life satisfaction of patients undergoing a cardiovascular rehabilitation. It also aimed at testing the mediation of illness perception and self-efficacy beliefs in managing cardiac risk factors. The study involved 172 patients (mean age?=?66.43?years; SD?=?9.99?years; 76.2% men). Illness severity was measured in terms of left ventricular ejection fraction at discharge from the cardiology department, whereas all psychological dimensions were assessed one week later. Results showed significant relationships among illness severity, depression and health satisfaction that were fully mediated by illness perception and self-efficacy beliefs, but not significant relation between disease severity and life satisfaction (χ ²(1)?=?2.30, p?=?n.s.). Overall, findings underline the importance of working on illness perception and self-efficacy beliefs to contrast depression and to improve health and life satisfaction in patients with CVD.     

Rumination and symptom reports in children and adolescents: Results of a cross-sectional and experimental study

This study explores the relationship between a ruminative response style and symptom reports in children and adolescents of grades 5, 7 and 9 from German secondary schools. Questionnaires were used to assess rumination and symptom reports. A group of children and adolescents (N?=?140) were asked to think first about the items before responding to them (increased attention condition), while a second group (N?=?260) served as control group (standard condition). The assumption was that rumination and also additional attention to the symptoms by instruction would increase the reported frequency of experiencing somatic and psychological symptoms. The results showed significant relations between symptom reports and rumination, which increased with grade. There were sex differences for somatic symptom reports with increased symptom frequencies in girls, which were mediated by rumination. Moreover, instructing participants to think first about the items led to an increase in reported symptoms. It is concluded that an increased attention to symptoms of distress increases symptom reports, which may be induced momentarily by instruction and also more generally by a ruminative response style. Conclusions regarding prevention and concerning instructions in symptom report questionnaires are outlined.