Using Structural Analysis of Social Behavior (SASB) Measures of Self- and Social Perception to Give Interpersonal Meaning to Symptoms

Structural analysis of social behavior: Using cluster analysis to examine personality profile associated with diabetes onset

OBJECTIVE

In this study we tested whether some intrapsychic behaviors of structure of personality can be associated with the onset of Type 2 diabetes (T2-DM).

METHODS

T2-DM Patients (n. 257) and Healthy subjects (n = 258). Test: Social schedule (demographic variables); SASB-Form- Questionnaire A (describing intrapsychic behaviors of personality structure - 8 Clusters-Cl -).

RESULTS

From the logistic model emerged that in subjects with profile 2 "Low Affiliation and Autonomy" compared to profile 2 "Low Autonomy and Self-Care" considering age, education and living conditions effects, the association to the onset of diabetes increases (OR: 1.668). Subjects with profile 2 "Low Affiliation and Autonomy" show low assertiveness and autonomy (SASB-Cl 1); have a medium-low ability to accept and support themselves (medium-low-SASB-Cl 3,4); do not improve their leisure activities or interpersonal relationships because they are too scheduled by things to do (SASB-Cl 4, Cl5); have self-critical behavior (SASB-Cl 6 medium) and self-neglectful behavior - ignore illnesses at an emotional and physical level (Cl8). They occasionally incur in self-destructive behaviors (Cl 7). They may experience self-exhaustion and mild to moderate depression. These are the intrapsychic behaviors associated with onset of diabetes. Another variable associated with the onset of diabetes is high educational level.

CONCLUSIONS

These results suggest that certain personality traits have a great association with T2-DM onset. Furthermore the analysis of intrapsychic modalities in association with the onset of diabetes could constitute a further screening aimed at primary prevention.

Differential Associations of Intrapersonal and Interpersonal Emotion Regulation with Generalized Anxiety and Social Withdrawal Among Children

Anxiety and social withdrawal are common internalizing problems among children linked to poor emotion regulation (ER). We investigated how specific components of ER (emotion awareness, emotion regulation strategy) are associated with generalized anxiety and social withdrawal in the two ER domains (intrapersonal and interpersonal). Study participants were 398 fourth- and fifth-grade students (49% girls) and 22 teachers from a Midwestern state in the United States. Study constructs were measured with student self-report, peer nominations, and teacher reports. We found anxiety was linked to poorer intrapersonal emotion awareness and greater use of adaptive and maladaptive intrapersonal regulation strategies. Social withdrawal was associated with poorer interpersonal emotion awareness and lower use of supportive and unsupportive interpersonal regulation strategies. Social withdrawal was also negatively associated with intrapersonal, adaptive strategy. The findings highlight the relevance of intrapersonal and interpersonal domains of ER in helping anxious and socially withdrawn children regarding their unique emotion regulation difficulties.

Correlates of Chronic Suicidal Ideation Among Community-Based Minor-Attracted Persons

Elevated suicidal risk has been documented in adults who are sexually attracted to minors but the topic has not been adequately investigated, particularly outside the context of the criminal justice system. In this study, risk factors for chronic suicidal ideation were assessed in 333 community-based minor-attracted persons (95% male) via an online survey. Chronic suicidal ideation was endorsed by 38.1% of the participants but was associated neither to history of sexually engaging with a child nor to prior contact with the criminal justice system. In bivariate logistic regression analyses, significant unadjusted correlates included young age, less education, prior mental health treatment, weaker attraction to adult women, history of sexual abuse in the participants' own childhood, and the psychosocial effect of perceived stigma against pedophilia. In multivariable analysis, all these factors except education were uniquely associated with suicidal ideation. These results identify meaningful clinical risk factors and treatment targets in this population.

Risk perception in paranoia and anxiety: Two investigations across clinical and non-clinical populations

Objectives

It is common, among clinical and non-clinical populations alike, for paranoia and anxiety to co-occur. It has been suggested that anxiety and its related appraisal styles may contribute to development of paranoia. We aimed to evaluate different aspects of risk perception in relation to paranoia and anxiety and to identify specific aspects that may differentiate paranoia from anxiety. This paper consists of two inter-related studies.

Methods

Study 1 compared 30 patients with persecutory delusions, 21 patients with generalized anxiety disorder and 52 healthy controls. Study 2 compared 30 non-clinical individuals with high levels of paranoia and anxiety, 28 individuals with high anxiety only and 36 healthy controls. Within each study, the two symptomatic groups were matched on level of anxiety. Four dimensions of risk perception (i.e. likelihood, harm, controllability, and intentionality) were compared across groups, as measured by the locally validated Risk Perception Questionnaire.

Results

In both studies, the paranoia and the anxiety groups reported an elevated perceived likelihood of negative events than controls respectively. Only the paranoia groups reported an elevated perceived harm of neutral events than controls. In Study 2, the two at-risk groups attributed more harm and intentionality to negative events than controls.

Conclusion

Although perception of negative events was characteristic in anxiety (with or without paranoia), a biased perception of neutral events as risky was unique to the addition of paranoia. Implications to the transdiagnostic and continual view of psychopathology, and mechanism-based interventions were discussed.

Self- and other-perceptions of interpersonal problems: Effects of generalized anxiety, social anxiety, and depression

Despite attention on overlap and distinction between generalized anxiety disorder (GAD), social anxiety disorder (SAD), and major depressive disorder (MDD), interpersonal specificity (distinct, prototypical interpersonal features) between the disorders has been understudied. There is emerging evidence for such specificity (e.g., Erickson et al., 2016), but most studies relied on self-report, and not all studies controlled for shared variance between the disorders, complicating interpretation of findings. The present study extended the literature by examining unique interpersonal correlates of GAD, SAD, and MDD symptoms on self- and informant-report, and how self-informant agreement (both mean-level and correlation) in perception of interpersonal affiliation, dominance, and distress varied as a function of the symptoms. 369 college-aged participants (43% with clinical-level symptoms for at least one of the disorders (GAD, SAD, MDD), 57% non-disordered) and up to three of their significant others rated participants' interpersonal problems (interpersonal behaviors that were difficult to engage in or engaged in excessively). We found evidence for exploitable tendencies in GAD, socially avoidant and nonassertive tendencies in SAD, and coldness in MDD based on self-report, but not on informant-report. Although self-other correlation was positive across outcomes, participants endorsed higher affiliation and interpersonal distress and lower dominance relative to informants. GAD, SAD, and MDD symptoms showed distinct moderating effects on these self-informant discrepancies. GAD symptoms predicted over-endorsing affiliation, SAD predicted under-endorsing dominance and affiliation, and MDD predicted no discrepancies in affiliation and dominance. The results speak to potential differentiation of the disorders based on distinct patterns of self-other discrepancy in interpersonal perceptions.

Evaluating reliable and clinically significant change in eating disorders: comparisons to changes in DSM-IV diagnoses

Assessing clinically meaningful change is valuable for treatment planning, monitoring course of illness and evaluating outcome. Although DSM eating disorder (ED) diagnoses have been criticized for poor clinical utility, instability, and uncertainty, remission/change of diagnosis is often the standard for evaluating outcome. We tested the validity of the clinically significant reliable change index (CS/RCI) compared to change in DSM-IV ED-diagnoses. We investigated if CS/RCI was concordant to diagnostic change and compared explained variance on measures at follow-up. Using a database for specialized ED treatment in Sweden the sample contained 1042 female patients (246 adolescents/796 adults). CS/RCI was calculated for the Clinical Impairment Assessment (CIA) and the Eating Disorder Examination Questionnaire (EDE-Q). CS/RCI explained more variance in gain scores for psychopathology measures than diagnostic change (DSM-IV). Average agreement between diagnostic change and CS/RCI was 62% and 60% for CIA and EDE-Q, respectively. Diagnostic change always resulted in more positive outcome than CS/RCI. Together with clinical judgment, CS/RCI is a valuable method for determining clinically significant changes in clinical practice and research. It is economically sound and results are easily interpreted and communicated to patients.

Worry and generalized anxiety disorder: a review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment

Generalized anxiety disorder (GAD) is associated with substantial personal and societal cost yet is the least successfully treated of the anxiety disorders. In this review, research on clinical features, boundary issues, and naturalistic course, as well as risk factors and maintaining mechanisms (cognitive, biological, neural, interpersonal, and developmental), are presented. A synthesis of these data points to a central role of emotional hyperreactivity, sensitivity to contrasting emotions, and dysfunctional attempts to cope with strong emotional shifts via worry. Consistent with the Contrast Avoidance model, evidence shows that worry evokes and sustains negative affect, thereby precluding sharp increases in negative emotion. We also review current treatment paradigms and suggest how the Contrast Avoidance model may help to target key fears and avoidance tendencies that serve to maintain pathology in GAD.

Clinical characteristics and distinctiveness of DSM-5 eating disorder diagnoses: findings from a large naturalistic clinical database

BACKGROUND

DSM-IV eating disorder (ED) diagnoses have been criticized for lack of clinical utility, diagnostic instability, and over-inclusiveness of the residual category "ED not otherwise specified" (EDNOS). Revisions made in DSM-5 attempt to generate a more scientifically valid and clinically relevant system of ED classification. The aim with the present study was to examine clinical characteristics and distinctiveness of the new DSM-5 ED diagnoses, especially concerning purging disorder (PD).

METHODS

Using a large naturalistic Swedish ED database, 2233 adult women were diagnosed using DSM-5. Initial and 1-year follow-up psychopathology data were analyzed. Measures included the Eating Disorder Examination Questionnaire, Structural Eating Disorder Interview, Clinical Impairment Assessment, Structural Analysis of Social Behavior, Comprehensive Psychiatric Rating Scale, and Structured Clinical Interview for DSM-IV Axis I Disorders.

RESULTS

Few meaningful differences emerged between anorexia nervosa binge/purge subtype (ANB/P), PD, and bulimia nervosa (BN). Unspecified Feeding and Eating Disorders (UFED) showed significantly less severity compared to other groups.

CONCLUSIONS

PD does not appear to constitute a distinct diagnosis, the distinction between atypical AN and PD requires clarification, and minimum inclusion criteria for UFED are needed. Further sub-classification is unlikely to improve clinical utility. Instead, better delineation of commonalities is important.

Level of agreement between self and spouse in the assessment of personality pathology

Informant reports can provide important information regarding the presence of pathological personality traits, and they can serve as useful supplements to self-report instruments. Ratings from a spouse may be a particularly valuable source of personality assessment because spouses are very well acquainted with the target person, have typically known the person for a long time, and witness behaviors across a variety of situations. In the current study, self- and spouse report measures based on the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) personality disorder criteria were collected from a nonclinical sample of 82 couples (N = 164). Agreement between self- and spouse report for several pathological personality factors was significant and somewhat higher than has been found for self and peer agreement. Nevertheless, the magnitude of self-spouse agreement was still moderate in size (mean r = .36). Findings are discussed with regard to using spouse report in the assessment of personality pathology.

Internalized representations of early interpersonal experience and adult relationships: a test of copy process theory in clinical and non-clinical settings

Studies connecting childhood experience and adult psychopathology often focus on consequences of abuse and neglect. Copy process theory (Benjamin, 2003) states that constructive as well as destructive experiences shape adult behavior with surprising interpersonal specificity. Childhood perceptions and social learning are encoded in memory and then "copied" in 3 basic ways in subsequent relationships: Identification (behaving as he or she behaved), Recapitulation (behaving as one behaved when with him or her), and Introjection (treating oneself as he or she was treated). The first step in evaluating copy process theory is to verify that the predicted correspondence between adult relational patterns and internal representation of early experience can be observed in different adult samples. Remembered interpersonal patterns from childhood and perceptions of adult relational patterns were measured using the Structural Analysis of Social Behavior (SASB). Strong evidence was found for each copy process in a sample of psychiatric inpatients (N = 161) and a college sample (N = 133). Positive and negative behaviors were copied in both. Evidence suggests that gender, patient status, and rated state may influence whether, and in which forms, copying occurs.

The Use of Structural Analysis of Social Behavior (SASB) as an Assessment Tool

Structural analysis of social behavior (SASB) is a model that can be used to assess interpersonal and intrapsychic interactions in terms of three underlying dimensions: (a) focus (other, self, introject), (b) affiliation-hostility (love-hate), and (c) interdependence-independence (enmeshment-differentiation). Assessment of individuals or groups in terms of these dimensions can be made by self-ratings on the SASB Intrex questionnaires, ratings by others using the same questionnaires, or by objective observer ratings. Data generated by questionnaires or formal codes yield identical summary parameters, making it possible to compare directly objective observer assessments with self-ratings, if desired. The goal of this chapter is to help the reader understand the structure of SASB, become aware of how it has been used in studying interpersonal and intrapsychic events, assess its validity, assess the substance and relevance of criticisms, and consider future possibilities.