Self-injurious behaviors in eating-disordered patients

High rates of self-injurious behaviors (SIBs) have been described in eating-disordered patients. The present study in 134 female inpatients suffering from an eating disorder (ED) confirmed this: 44% of the total group reported at least one form of SIB (mostly hair pulling, scratching, cutting, or bruising) with a mean age at onset of 17.5 years. No major differences have been found between the subgroups (anorexics, bulimics). The considerable number of patients who did not feel any pain during SIB showed more tendency towards dissociative experiences. Those who admitted SIB reported higher levels of psychological dysfunctioning, dissociative experiences, and impulsiveness.

Expressed Emotion in the Client-Professional Dyad

Summary: Background: This article reports on a study of the concurrent validity between the standard expressed emotion instrument, the Camberwell Family Interview (CFI), and two alternative EE measures, the Level of Expressed Emotion (LEE) and the Perceived Criticism Scale (PCS). Methods: The research sample consisted of 56 schizophrenic clients, who were residing in sheltered residences, and 56 professionals. Results: Based on the results of the correlation matrix between all the subscales of the instruments, a significantly positive relationship was found between the criticism scale of the CFI, the total score of the LEE, and the client version of the PCS. These correlations, however, were rather weak, which implies that the three instruments have little in common with each other. The professionals' version of the PCS does not appear to be an EE instrument. Conclusions: The results suggest that the CFI still remains the best instrument for assessing EE in a therapeutic relationship (between a professional and a client). If there is insufficient time to administer the CFI, then the client version of the PCS and the LEE can be used with the qualification that the PCS and LEE also measure other aspects and thus cannot completely replace the CFI. Nevertheless, the research indicates that asking the clients would seem to provide a better indication of the level of the professionals' criticism rather than asking the professionals themselves directly.

Low back pain in Flemish adolescents and the role of perceived social support and effect on the perception of back pain

AIM

To document the prevalence of low back pain (LBP) in Flemish adolescents and to recognize the association between perceived social support and affect and medical consultation and reduction of activities.

METHODS

The study comprised 620 adolescents. A questionnaire was used to elicit the characteristics of LBP. Perceived social support and affect were investigated using the Personal Resource Questionnaire (PRQ) and the Positive Affect Negative Affect Scale (PANAS), respectively. Comparisons were made between adolescents with LBP and adolescents without LBP. Within the LBP group, answers from adolescents appealing for medical advice were compared with those who did not seek advice. Another comparison was done between adolescents who reduced their activities and those who did not. Descriptive statistics, the median test for two samples, a chi2 test or Fisher's exact probability test and logistic regression analysis were used for data analysis.

RESULTS

Month prevalence of LBP was 24.7%. Thirteen adolescents visited a physician or received treatment, pain severity being the sole factor associated with the decision. Fifteen adolescents reduced their sports activities and 11 reduced or stopped other leisure activities. Pain severity and negative affect were the main associated factors.

CONCLUSION

The results of the present study encourage further research on the role of pain perception and the influence of psychosocial factors on back pain in adolescents.

Expressed emotion in the client-professional caregiver dyad: are symptoms, coping strategies and personality related?

OBJECTIVE

The aim of this study was to investigate whether the characteristics of residents and professional caregivers are associated with the professionals' expressed emotion (EE).

METHOD

Fifty-six residents in sheltered living who suffer from schizophrenia or a related psychotic disorder and their professional caregivers were enlisted. Standardised validated instruments were used to measure EE, the residents' social functioning, symptoms and social network size, and the professional caregivers' coping strategies and personality.

RESULTS

There was strong evidence that high EE was associated with the residents' age, poorer social functioning and smaller network sizes. There was no significant relationship between EE and the residents' symptoms except for excitement. Concerning the professional caregivers, high EE professionals were less open than their low EE colleagues and had a lower education level.

CONCLUSION

The residents' social functioning is an important correlate of the EE index.

Premorbid "overactive" lifestyle in chronic fatigue syndrome and fibromyalgia. An etiological factor or proof of good citizenship?

OBJECTIVE

In a former study, we have shown that patients suffering from chronic fatigue syndrome (CFS) or chronic pain, when questioned about their premorbid lifestyle, reported a high level of "action-proneness" as compared to control groups. The aim of the present study was to control for the patients' possible idealisation of their previous attitude towards action.

METHODS

A validated Dutch self-report questionnaire measuring "action-proneness" (the HAB) was completed by 62 randomly selected tertiary care CFS and fibromyalgia (FM) patients, as well as by their significant others (SOs).

RESULTS

HAB scores of the patients and those of the SOs were very similar and significantly higher than the norm values. Whether or not the SO showed sympathy for the patient's illness did not influence the results to a great extent. SOs with a negative attitude towards the illness even characterized the patients as more "action-prone."

CONCLUSIONS

These results provide further support for the hypothesis that a high level of "action-proneness" may play a predisposing, initiating and/or perpetuating role in CFS and FM.

Expressed emotion in staff-patient relationships: the professionals' and residents' perspectives

BACKGROUND

Expressed emotion (EE) is a well-established, important predictor of the relapse rate of patients suffering from schizophrenia and other severe psychiatric disorders. EE measures the quality of the social interaction between a patient and his most important (in)formal caregiver. The aim of this study was to investigate the quality of the relationship in the staff-patient dyad as measured by the concept of EE.

METHODS

EE was assessed using the Camberwell Family Interview (CFI, professionals) and the Perceived Criticism Scale (PCS, residents and professionals form) in a sample of 56 professional caregivers and their residents in nine sheltered living facilities in Flanders.

RESULTS

Depending on the instrument, high EE was found to exist in one out of six (CFI) or one out of three (PCS) relationships. There was a significant positive correlation between the resident PCS and the critical comment scale of the CFI.

CONCLUSIONS

The results of this study support the hypothesis that high levels of EE exist in some staff-resident relationships, which are mainly manifest as frequent critical comments and the presence of hostility. Emotional overinvolvement appears to be exceptional. Compared with the PCS, the CFI provides the most information about the quality of the relationship.

The Care Perception Questionnaire

Summary: Major changes have taken place over the last decade in the mental health care services in Belgium as well as in the rest of Europe. To track these developments, Shepherd and colleagues developed an instrument to assess the degree of perceived accomplishment of 11 key areas in such care. This instrument was translated and adapted as the Care Perception Questionnaire. In clinical settings the instrument can be a good tool for exploring the perspective of patients and professionals regarding the 11 key areas. However, for research purposes it is not practical to work with the 28 separate items or with the 11 key areas. The goal of this study is to reduce the 11 key areas to a smaller number of scales with good psychometric properties and with relevance to clinical practice. Using principal-component analysis by means of promax rotation and scale construction, we developed four statistically reliable and meaningful scales: (1) support in social relations and practical aid, (2) treatment and monitoring of the course of the illness, (3) information and insight, and (4) coordination and continuity of care. The relevance of the findings for clinical work and for research is discussed.

Assessment of cognitive coping styles: a closer look at situation-response inventories

Cognitive coping style approaches establish two concepts central to the understanding of people's responses to a stressful situation: "attention" and "avoidance". Theoretical frameworks corresponding to these conceptions are Sensitization-Repression (Byrne, 1961), Monitoring-Blunting (Miller, 1980), and Vigilance-Cognitive Avoidance (Krohne, 1986). Such types of cognitive coping styles are usually measured by means of situation-response inventories. In the present article, we take a closer look at this kind of coping assessment by considering the scenarios, the coping options and response formats, the dimensionality of the constructs, and published data on the reliability and the validity of seven situation-response inventories. Three important points deserve to be highlighted: (a) it probably makes little sense to assess coping style using scenarios that diverge maximally with respect to controllability and predictability since coping is not assumed to show such complete cross-situational stability; (b) similarly named inventories rely on largely different operationalizations and can hardly be considered as measuring similar constructs; and (c) monitoring/vigilance and blunting/avoidance generally emerge as independent constructs, which argues against use of summary scores.

Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care: a controlled study on prevalence and characteristics

The authors studied the prevalence and characteristics of different forms of victimization in 95 patients suffering from chronic fatigue syndrome (CFS) or fibromyalgia (FM) compared with a chronic disease group, including rheumatoid arthritis (RA) and multiple sclerosis (MS) patients, and a matched healthy control group. The authors assessed prevalence rates, nature of victimization (emotional, physical, sexual), life period of occurrence, emotional impact, and relationship with the perpetrator by a self-report questionnaire on burdening experiences. CFS and FM patients showed significantly higher prevalences of emotional neglect and abuse and of physical abuse, with a considerable subgroup experiencing lifelong victimization. The family of origin and the partner were the most frequent perpetrators. With the exception of sexual abuse, victimization was more severely experienced by the CFS/FM group. No differences were found between healthy control subjects or RA/MS patients, and between CFS and FM patients. These findings support etiological hypotheses suggesting a pivotal role for chronic stress in CFS and FM and may have important therapeutic implications.

Comparison of self-administration and face-to-face interview for surveys of low back pain in adolescents

The aim of this study was to compare self-administration with face-to-face interview in the investigation of low back pain in adolescents. Fifty-seven adolescents with low back pain (mean age 17.3 y; range 16-18) first completed a questionnaire and were then invited to an interview. Analysis included item completion, percentages of agreement and weighted kappa. Item completion rates were high and comparable between self-administration and interview. Information between both methods was analogous for severity and localization of problems, sleep behaviour, medical consultation and sports/leisure activities. Onset, progression, duration of low back pain and some items on the influence of movement/positions presented less comparable data.

CONCLUSION

Even when two different methods of data acquisition are used, results suggest that the method used does not change the interpretation of results in the case of most items.

Reliability and validity of the Critical Care Family Needs Inventory in a Dutch-speaking Belgian sample

OBJECTIVE

The purpose of the study was to provide psychometric evaluation of the Dutch version of the Critical Care Family Needs Inventory.

SETTING

The study took place in an intensive care unit of a university hospital.

PARTICIPANTS

The participant group included 200 adult family members visiting a patient within the 72-hour interval after admission to the intensive care unit.

RESULTS

Principal factor analysis with varimax rotation resulted in a 5-factor solution distinguishing 5 need types: need for information, need for comfort, need for support, need for assurance and anxiety reduction, and need for proximity and accessibility. The internal consistency of the resulting subscales ranged from 0.80 to 0.62, and all factors were significantly related to each other. The Critical Care Family Needs Inventory subscales were found to be clearly related to the demographic variables age, sex, and education level.

CONCLUSION

The reliability and validity of the Dutch-language Critical Care Family Needs Inventory as a diagnostic tool in family needs assessment are supported.

Visual analogue scale for the perceived influence of exertion and movements/positions on low back problems in surveys of adolescents

The test-retest reproducibility of visual analogue scales for the perceived influence of exertion and movements/positions on low back problems in adolescents was investigated. The study was performed on 61 adolescents with low back problems. Item completion, median score, interquartile range and weighted kappa were calculated. Results showed that visual analogue scales produce repeatable information for all items tested (weighted kappa: 0.59-0.83), except for the influence of pulling materials on back problems (0.45).

CONCLUSION

The results of this study suggest that adolescents, aged 16-18 y, can reproduce their visual analogue scores.

Attributions in chronic fatigue syndrome and fibromyalgia syndrome in tertiary care

OBJECTIVE

To evaluate the attributions of patients with chronic fatigue syndrome (CFS) and fibromyalgia (FM) consulting at a university fatigue and pain clinic.

METHODS

Consecutive attenders (n = 192) who met the CFS criteria (n = 95) or FM criteria (n = 56) or who had medically unexplained chronic pain and/or fatigue without meeting both criteria (CPF) (n = 41) were evaluated. All subjects completed an extended form of the Cause of Illness Inventory. Descriptive statistics, frequency analyses, chi-square tests, one-way analysis of variance, and sequential Fisher least significant difference tests were performed.

RESULTS

In total, 48 patients reported physical causes only and 10 patients psychosocial causes only; the majority (70%) mentioned both types of causes. With regard to the contents, "a chemical imbalance in my body" (61%), "a virus" (51%), "stress" (61%), and "emotional confusion" (40%) were reported most frequently. The diagnostic label did not have a significant influence on number and type of attributions. Small to moderate effect sizes were registered concerning the association of specific attributions and diagnosis, sex, duration of the symptoms, contact with a self-help group, and premorbid depression.

CONCLUSION

The majority of patients with CFS, FM, and CPF reported a great diversity of attributions open to a preferably personalized cognitive behavioral approach. Special attention should be paid to patients with symptoms existing for more than one year and those who had previous contacts with a self-help group. They particularly show external, stable, and global attributions that may compromise feelings of self-efficacy in dealing with the illness.

Reproducibility of a survey questionnaire for the investigation of low back problems in adolescents

A test-retest design was used to investigate the reproducibility of the results obtained using a survey questionnaire for low back problems in adolescents. A 1-wk interval between test and retest was chosen. Participants were recruited from four schools. Selection of schools was based on geographic location, size of the school and educational level. Sixty-seven adolescents (mean age = 16.62 y; SD = 0.57; range = 16-18) suffering from low back problems agreed to participate. A questionnaire on perceived characteristics of back problems and functional limitations was designed. Item completion rate and the reproducibility of results were investigated by means of percentage agreement and (weighted) kappa. High levels of reproducibility were found for items that evaluated perceived characteristics of back problems and functional limitations (Kw = 0.70-0.93). Results suggest that the questionnaire used in the present study provided reproducible information. Detailed information on low back problems in adolescents could be obtained using this questionnaire.

Antecedents, concomitants, and consequences of pediatric headache: confirmatory construct validation of two parent-report scales

The aim of the study presented is to examine the psychometric properties of two parent-report scales for the assessment of environmental factors in pediatric headache, namely, the Children's Headache Assessment Scale (CHAS) and the Illness Behavior Encouragement Scale (IBES). Data were gathered in a sample of 160 parents of children suffering from headaches regularly. The internal structure of both scales is investigated by means of confirmatory factor analysis. The internal consistency of the resulting subscales is explored and data on the convergent validity and on the relationship with demographics are presented. Both the CHAS and the IBES appear to be promising assessment tools in a behavioral approach to pediatric headache.

Coping with peer arguments in school-age children with bully/victim problems

BACKGROUND AND AIMS

This paper reports data on the relationship between bully/victim problems and the coping strategies used when confronted with a peer argument. Specifically, we examine the extent to which bully/victim problems are related to five types of coping strategies (Social Support Seeking, Problem-Solving, Distancing, Internalising and Externalising).

SAMPLE

The sample consists of 329 children (168 boys, 161 girls), drawn from the fourth- through sixth-grade classrooms of three Flemish elementary schools.

RESULTS AND CONCLUSION

In the correlational analyses, both victimisation and social neglect are shown to be related to internalising coping, whereas bullying is associated with externalising coping and with a lack of problem-solving. Moreover, a positive relationship between victimisation and social support seeking was found. Separate analyses for boys and girls and a consecutive categorical approach provide a more precise picture of the link between social coping strategies and bully/victim problems.

Self-report assessment of the DSM-IV personality disorders. Measurement of trait and distress characteristics: the ADP-IV

BACKGROUND

Self-report instruments assessing the DSM personality disorders are characterized by overdiagnosis due to their emphasis on the measurement of personality traits rather than the impairment and distress associated with the criteria.

METHODS

The ADP-IV, a Dutch questionnaire, introduces an alternative assessment method: each test item assesses 'Trait' as well as 'Distress/impairment' characteristics of a DSM-IV criterion. This item format allows dimensional as well as categorical diagnostic evaluations. The present study explores the validity of the ADP-IV in a sample of 659 subjects of the Flemish population.

RESULTS

The dimensional personality disorder subscales, measuring Trait characteristics, are internally consistent and display a good concurrent validity with the Wisconsin Personality Disorders Inventory. Factor analysis at the item-level resulted in 11 orthogonal factors, describing personality dimensions such as psychopathy, social anxiety and avoidance, negative affect and self-image. Factor analysis at the subscale-level identified two basic dimensions, reflecting hostile (DSM-IV Cluster B) and anxious (DSM-IV Cluster C) interpersonal attitudes. Categorical ADP-IV diagnoses are obtained using scoring algorithms, which emphasize the Trait or the Distress concepts in the diagnostic evaluation. Prevalences of ADP-IV diagnoses of any personality disorder according to these algorithms vary between 2.28 and 20.64%.

CONCLUSIONS

Although further research in clinical samples is required, the present results support the validity of the ADP-IV and the potential of the measurement of trait and distress characteristics as a method for assessing personality pathology.

Marital intimacy in patients with an eating disorder: a controlled self-report study

The clinical literature on married patients with anorexia nervosa or bulimia nervosa suggests a lack of intimacy in these couples. This assumption was tested by comparing the scores on the Marital Intimacy Questionnaire of 21 eating-disordered (ED) couples with those of two matched control groups of 21 maritally distressed (MD) and 21 non-distressed (ND) couples. The overall level of intimacy attained by ED couples is lower than that of ND couples but higher than that of MD couples. Whereas this quantitative difference may reflect the couples' differences in marital satisfaction (as assessed by the Maudsley Marital Questionnaire), an additional qualitative discrimination can be made between ED couples and the two control groups on account of the former group's relatively low level of openness and high level of intimacy problems.

Marital communication in eating disorder patients: a controlled observational study

In order to investigate the communication between 21 eating disorder (ED) patients and their husbands, an observational study was carried out using two matched control groups of 21 maritally distressed (MD) and 21 nondistressed (ND) couples. During some discussion tasks the interaction was videotaped and the (verbal and nonverbal) communication skills were rated afterwards according to the Kategoriensystem für Partnerschaftliche Interaktion (KPI) coding system. Unexpectedly, compared with the control groups ED couples do not show a greater disequilibrium (between patient and husband) in the emission rate of positive and negative messages. Also striking is the generally higher degree of self-disclosure in ED couples than in ND couples, but this may reflect their experience of distress. Overall and most importantly, ED couples appear to lack some of the ND couples' skills of constructive communication, but manage to avoid the destructive communication style of MD couples.

Psychological distress in husbands of eating disorder patients

Psychological distress scores of 21 eating-disordered (ED) women and their husbands were compared with those of two matched groups of 21 maritally distressed (MD) and 21 maritally nondistressed (ND) control groups. In contrast to previous clinical reports, ED husbands in the present group did not report significantly more psychological distress than did ND husbands, and actually reported less interpersonal sensitivity and hostility than did MD husbands.

Dissociative experiences and trauma in eating disorders

This study explores the relationship between traumatic experiences and dissociative phenomena in a large group of eating disorder patients (N = 98). Traumatic experiences were assessed by means of a self-report questionnaire and a clinical interview; dissociative experiences were assessed with the newly developed self-reporting Dissociation Questionnaire (DIS-Q). About 25% of the patients reported to have experienced traumatic events in their personal life and this subgroup had significantly higher scores on the DIS-Q, compared with normal control subjects. About 12% of our patient sample mentioned dissociative experiences to a degree as high as in a group of patients with dissociative disorders. Amnesia turned out to be the most specific characteristic in trauma-induced dissociation. These data suggest that trauma-induced dissociative experiences may play an important role in the development of a subgroup of patients with an eating disorder.

Etiopathogenesis of reflex sympathetic dystrophy: a review and biopsychosocial hypothesis

Reflex sympathetic dystrophy (RSD) is an enigmatic condition. Many clinicians, however, believe that psychological factors could contribute to the onset and persistence of the syndrome. In this article we critically review the evidence from psychometric and psychodynamic/biographical studies that suggests a role for such factors. An etiopathogenetic hypothesis based on the authors' clinical experience and the foregoing literature also encompasses elements of stress-coping theory, cognitive-behavioral views on chronic pain, and the psychobiological approach to sympathetic nervous system dysfunction. Implications of this model for future psychological research and the therapeutic treatment of RSD are discussed.