Common problems and coping strategies II: Findings with adolescent suicide attempters

This study investigated the most common precipitants of adolescent suicide attempts and the strategies used to cope with such problems. Adolescent suicide attempters were compared with both distressed and nondistressed nonsuicidal adolescents on problems reported and coping strategies utilized. All three groups reported four problems as occurring most frequently: school, parents, friends, or boyfriend/girlfriend. The suicide attempters and distressed controls reported problems with parents more frequently than did nondistressed controls, while this latter group reported problems at school more frequently than did suicide attempters or distressed controls. Suicide attempters used social withdrawal, problem solving, and emotional regulation more than did nondistressed controls, but not more frequently than distressed controls. Distressed controls used wishful thinking and resignation more than did suicide atempters. Results are discussed in terms of the similarities between suicide attempters and nonsuicidal distressed adolescents and the need to more closely investigate specific subgroups of suicide attempters.     

Accurate diagnosis of personality disorders: Some critical factors

Issues pertaining to the accurate diagnosis of personality disorders are discussed from a scientist-practitioner perspective. An attempt is made to distinguish state (Axis I) from trait (Axis II) disorders, and personality (“normal”) from personality disorders (“abnormal”). The reliability and validity of personality disorder diagnoses are explored, and the four criteria for all personality disorder diagnoses are clarified: These criteria are: 1) presence of psychological symptomology, 2) stability over time, 3) consistency across situations, and 4) under-responsiveness to currently available treatments. Also, a distinction is made between categorical and dimensional diagnostic criteria, similar to the distinction between personality type and trait approaches. Recommendations are provided for improving the clinical and empirical work in this area, and implications for treatment are discussed.     

Facilitating autonomy in passive-dependent persons: An integrative model

Passive and dependent qualities are commonly found in psychiatric patients suffering from a variety of disorders. While such tendencies are often secondary to an Axis I clinical syndrome, they are occasionally more persistent and refractory. The present article attempts to provide therapeutic guidelines useful when working with clients displaying stable personality traits of passivity and dependency. An attempt is made to adapt and combine several therapeutic techniques to be applicable to passive-dependent clients. More specifically, problem-solving approaches and self-control strategies can be used to facilitate autonomy if precautions are taken to reduce the dogmatic and didactic styles commonly employed with these techniques. The Socratic method of interviewing is posited as a useful means of developing problem-solving skills without creating unnecessary dependence on the therapist. Self-control strategies can help reduce the reliance on others as the primary source of satisfaction for dependent clients. In this way, passive-dependent clients may become more self- reliant and autonomous in their daily functioning.The author would like to thank Patti Watson, Katie Brooks, and Estyn Williams for comments made on an earlier draft of this article.     

Depression in patients with spinal cord injuries: A synthesis of cognitive and somatic processes

Depression in some patients with spinal cord injuries may be clinically significant and, when present, should be treated to decrease morbidity including decreased physical functioning. Depression associated with spinal cord injury (SCI) may be misevaluated, due to (1) nonspecific multifactorial production of depression symptoms and (2) SCI-specific decrease in somatic sensory central nervous system input. The Somatic Suppression Hypothesis suggests that SCI patients have difficulty experiencing any intense emotion because of suppression of physiological arousal. In addition, cognitive processes that may reduce depression in SCI patients include: (1) attribution of somatic symptoms of depression to medical (biological) causes, (2) realistic, positive expectations for physical improvement, and (3) the perception that the disability of the SCI is only minimally related to the patient’s self-care after complete evaluation. Health personnel should accept lack of depression in SCI, and should encourage positive realistic expectations of recovery.     

Social skills and depression in adolescent suicide attempters

The relationship among depression, social skills, and suicidal behavior was examined in a sample of 41 adolescents hospitalized in a general medical setting following a suicide attempt. These subjects were compared to 40 nonsuicidal psychiatrically hospitalized adolescents. Level of depression, assessed using the Children's Depression Inventory (CDI), and social skills, assessed via the Matson Evaluation of Social Skills with Youngsters (MESSY), were evaluated for all subjects. The suicide attempters and psychiatrically hospitalized patients were not found to differ on either the CDI or MESSY. However, multiple regression analyses revealed the factor scores of the MESSY to be related to depression in both patient groups. The data provide support for the relationship between social skills and depression. Results are also discussed in terms of the similarities between adolescent suicide attempters and nonsuicidal psychiatrically disturbed adolescents.     

Who's to blame: Attributions regarding causality in spouse abuse

Spouse abuse is examined from the perspective of attribution theory. Aggressors are seen as attributing their violent behavior to external causes, whether by projecting their negative traits onto their spouses or by finding excuses which blame temporary environmental factors. In contrast, victims often attribute the abuse to defects within themselves or situational factors affecting their spouses. The attribution process seems affected by the frequency, intensity and duration of the abuse, with temporal factors playing an important role in the woman's internalizing style. Furthermore, inadequate early coping efforts play a powerful role in establishing cognitive-perceptual patterns that serve to perpetuate the abuse.     

Treatment of suicidal patients: a risk-benefit analysis

A therapist may be held liable when a patient commits suicide if previous suicidal tendencies were observed but reasonable precautions were not taken. In order to reduce liability and enhance treatment effectiveness, therapeutic decisions can be critiqued by estimating the risks and benefits associated with different courses of action. An evaluation of risks and benefits can be used to guide decisions regarding assessment, hospitalization, medications, and discharge from the hospital. A risk-benefit analysis can help therapists utilize a broad range of treatment options while allowing patients the maximum degree of autonomy. Additionally, all aspects of treatment should be well documented, including information about the specific course of action chosen, other treatment options considered, and the therapeutic rationale for deciding which treatment plan was best suited to the patient's needs.