A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa

BACKGROUND

The purpose of this investigation was to compare a new psychotherapy for bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, 'enhanced' cognitive-behavioral therapy (CBT-E).

METHOD

Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat).

RESULTS

Both treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different.

CONCLUSIONS

ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.

A latent profile analysis of the typology of bulimic symptoms in an indigenous Pacific population: evidence of cross-cultural variation in phenomenology

BACKGROUND

Previous efforts to derive empirically based eating disorder (ED) typologies through latent structure modeling have been limited by the ethnic and cultural homogeneity of their study populations and their reliance on DSM-IV ED signs and symptoms as indicator variables.

METHOD

Ethnic Fijian schoolgirls (n=523) responded to a self-report battery assessing ED symptoms, herbal purgative use, co-morbid psychopathology, clinical impairment, cultural orientation, and peer influences. Participants who endorsed self-induced vomiting or herbal purgative use in the past 28 days (n=222) were included in a latent profile analysis (LPA) to identify unique subgroups of bulimic symptomatology.

RESULTS

LPA identified a bulimia nervosa (BN)-like class (n=86) characterized by high rates of binge eating and self-induced vomiting, and a herbal purgative class (n=136) characterized primarily by the use of indigenous Fijian herbal purgatives. Both ED classes endorsed greater eating pathology and general psychopathology than non-purging participants, and the herbal purgative class endorsed greater clinical impairment than either the BN-like or non-purging participants. Cultural orientation did not differ between the two ED classes.

CONCLUSIONS

Including study populations typically under-represented in mental health research and broadening the scope of relevant signs and symptoms in latent structure models may increase the generalizability of ED nosological schemes to encompass greater cultural diversity.

Anorexia nervosa trios: behavioral profiles of individuals with anorexia nervosa and their parents

BACKGROUND

Anorexia nervosa (AN) is associated with behavioral traits that predate the onset of AN and persist after recovery. We identified patterns of behavioral traits in AN trios (proband plus two biological parents).

METHOD

A total of 433 complete trios were collected in the Price Foundation Genetic Study of AN using standardized instruments for eating disorder (ED) symptoms, anxiety, perfectionism, and temperament. We used latent profile analysis and ANOVA to identify and validate patterns of behavioral traits.

RESULTS

We distinguished three classes with medium to large effect sizes by mothers' and probands' drive for thinness, body dissatisfaction, perfectionism, neuroticism, trait anxiety, and harm avoidance. Fathers did not differ significantly across classes. Classes were distinguished by degree of symptomatology rather than qualitative differences. Class 1 (approximately 33%) comprised low symptom probands and mothers with scores in the healthy range. Class 2 ( approximately 43%) included probands with marked elevations in drive for thinness, body dissatisfaction, neuroticism, trait anxiety, and harm avoidance and mothers with mild anxious/perfectionistic traits. Class 3 (approximately 24%) included probands and mothers with elevations on ED and anxious/perfectionistic traits. Mother-daughter symptom severity was related in classes 1 and 3 only. Trio profiles did not differ significantly by proband clinical status or subtype.

CONCLUSIONS

A key finding is the importance of mother and daughter traits in the identification of temperament and personality patterns in families affected by AN. Mother-daughter pairs with severe ED and anxious/perfectionistic traits may represent a more homogeneous and familial variant of AN that could be of value in genetic studies.

Examining a psychosocial interactive model of binge eating and vomiting in women with bulimia nervosa and subthreshold bulimia nervosa

The current study tested a psychosocial interactive model of perfectionism, self-efficacy, and weight/shape concern within a sample of women with clinically significant bulimic symptoms, examining how different dimensions of perfectionism operated in the model. Individuals with bulimia nervosa (full diagnostic criteria or subthreshold) completed measures of bulimic symptoms, multidimensional perfectionism, self-efficacy, and weight/shape concern. Among those who were actively binge eating (n=180), weight/shape concern was associated with binge eating frequency in the context of high perfectionism (either maladaptive or adaptive) and low self-efficacy. Among those who were actively vomiting (n=169), weight/shape concern was associated with vomiting frequency only in the context of high adaptive perfectionism and low self-efficacy. These findings provide support for the value of this psychosocial interactive model among actively binge eating and purging samples and for the importance of considering different dimensions of perfectionism in research and treatment related to bulimia nervosa.

Food presentation and energy intake in a feeding laboratory study of subjects with binge eating disorder

OBJECTIVE

The purpose of this study was to examine the influence of the number of foods presented and the amount of food presented on overeating or binge eating behavior in obese subjects with and without binge eating disorder (BED).

METHOD

Ten subjects (5 BED, 5 non-BED), male and female, aged 18-65, participated. Their body weight was > or =130% of their ideal body weight (IBW). They were evaluated in a feeding laboratory setting on four occasions when they were presented with (a) either one or two binge foods presented in (b) either two or four times the amount of their self-reported usual intake during a binge/overeating episode. Measurement included energy intake and self-recorded measures of hunger, fullness, anxiety, and depression.

RESULTS

The results indicated that the number and amount of food presented influenced significantly the amount of food consumed. Although subjects with BED tended to eat more than the non-BED obese, the differences did not reach statistical significance.

DISCUSSION

The results have implications for the interpretation of results obtained in feeding laboratory settings, suggesting that attention needs to be given to both the number and amount of foods presented because both variables have an impact on the amount of food eaten during overeating or binge eating episodes.

Eating disturbance and sexual trauma in childhood and adulthood

OBJECTIVE

This study examined the relationship between sexual trauma and eating disorder behavior, taking into account the effects of developmental stage of the victim and the effects of multiple sexual assaults.

METHOD

Four groups of adult women took part in this study. Subjects were either victims of childhood sexual abuse, victims of rape in adulthood, victims of both childhood sexual abuse and rape, and controls who were not traumatized sexually. All subjects were assessed with semistructured interviews and self-report inventories that assessed eating disorder behavior, general psychopathology, and impulsivity.

RESULTS

Victims of childhood sexual abuse differed from controls on measures of eating disorder behavior and individuals who had experienced both childhood sexual abuse and rape in adulthood were most likely to display eating disorder-related psychopathology. Victims of childhood sexual abuse also distinguished themselves with high levels of eating disorder behavior plus multiple forms of impulsive self-destructive behavior.

DISCUSSION

This study provides additional support for the association between childhood sexual abuse and eating disorder behavior. Childhood sexual abuse may be particularly linked to the presence of binge eating behavior and several other forms of impulsive self-destructive behavior.

Sexual trauma and personality: developmental vulnerability and additive effects

Two types of sexual trauma, sexual abuse in childhood and rape in adulthood, were investigated in terms of possible effects on personality. Four groups of participants were studied: women who had experienced sexual abuse in childhood, women who had experienced rape as adults, women who had experienced both of these sexual traumas, and a control group of women who had experienced no sexual trauma. Personality functioning was assessed using the Dimensional Assessment of Personality Pathology. Groups who had experienced childhood sexual abuse displayed the highest degree of personality disturbance; however, the additive effects of repeated sexual trauma were limited. These findings may reflect the outcome of specific adversity in childhood on the psychobiological constructs underlying personality.

An assessment of the recidivism rates of substantiated and unsubstantiated maltreatment cases

OBJECTIVE

This study assembles information about the large number of maltreatment reports that are determined by social services to be unsubstantiated. Specifically, we assess whether the status of a maltreatment case (substantiated vs. unsubstantiated) has implications for recidivism. Recidivism rates for substantiated and unsubstantiated maltreated juveniles were also compared to juvenile offenders.

METHOD

Juvenile court records for 15,812 juveniles were assessed over a 3 year period. The data included 2558 maltreatment cases. Fifty-four percent of these cases were unsubstantiated. Logistic regression analysis was employed to assess the probability of recidivism based on time one referral status.

RESULTS

Youth whose maltreatment allegations were unsubstantiated had significantly lower odds of recidivating than abused youth. Having a case recorded as unsubstantiated lowered a youth's odds of subsequent offending by 55% relative to being abused. The probability of recidivating was highest for juvenile offenders, followed in order by maltreated youth and youth whose reports were unsubstantiated.

DISCUSSION

This is one of the first studies to examine the court histories of substantiated and unsubstantiated maltreatment cases. If the subsequent outcomes following maltreatment investigations are used as an indicator of seriousness, our results suggest that assessment caseworkers are successfully sorting out the serious from the less serious cases.

Long-term follow-up of patients' status after gastric bypass

BACKGROUND

We report a long-term (13-15 year) follow-up of a cohort of 100 patients who underwent gastric bypass for morbid obesity.

METHODS

Sources of information include baseline data collected before surgery and information obtained at follow-up interview including data on weight history, psychosocial functioning, and medical complications.

RESULTS

Mean age at follow-up was 56.8 years. The mean weight loss at long-term follow-up was 29.5 kg (range -13.6 to 93.6 kg). Three subjects weighed more at long-term follow-up than before the operation. Overall, 74% of those interviewed indicated that the gastric bypass had benefited them in terms of their physical health. However, 68.8% reported continued problems with vomiting and 42.7% with "plugging". Eight had died.

CONCLUSION

The findings in this study suggest that at long-term follow-up the majority of individuals who have undergone gastric bypass feel that the procedure benefited them, although some complications including difficulties with "plugging" and vomiting were present at long-term follow-up.

Self-concept correlates of the personality disorders

This study investigated the extent to which the DSM personality disorder dimensions are associated with discrete patterns of self-concept. Participants were 366 men and women who were receiving mental health services and who completed the Wisconsin Personality Disorders Inventory to assess the personality disorders and Benjamin's INTREX questionnaire to describe their "typical" self-concepts. Although there was some overlap between categories, most were associated with fairly distinct patterns of self-concept. The disorders also clustered together in meaningful ways along the major axes of Benjamin's interpersonal model of the self-concept.

Sexual violence and weight control techniques among adolescent girls

OBJECTIVE

Research has linked childhood sexual abuse and eating disturbances among adult females. Less is known about whether sexual abuse in the form of dating violence has implications for deviant weight control techniques among adolescent girls. This study assesses the association between sexual violence and weight control practices among girls. We also attempt to untangle the effects of family environment from this association and to determine if weak impulse control mediates the association.

METHOD

Survey data were gathered from 2,629 girls in Grades 9-12 to assess health risks. Girls responded to questions regarding dating violence, unwanted sexual contact, purging, and diet pill consumption. Logistic regression was used to assess the unique contribution of sexual violence on weight control techniques.

RESULTS

Dating violence and unwanted sexual contact elevated the probability that girls would report practicing weight control techniques by 6-13%. Controls for family environment did not eliminate these associations. Weak impulse control did not significantly mediate these associations.

DISCUSSION

These findings suggest that sexual violence has immediate implications as a risk factor for weight control techniques in adolescence.

Sexual victimization and adolescent weight regulation practices: a test across three community based samples

OBJECTIVE

This study had four objectives: 1) to examine the association between sexual victimization and weight regulation across three samples of adolescent girls, 2) to assess whether sexual victimization is associated with more extreme forms of weight regulation in girls, 3) to discern whether sexual victimization has implications for the use of multiple forms of weight regulation, and 4) to address the role of physical victimization in explaining these relationships.

METHOD

Data from three separate samples of 9th-12th graders were used to test these hypotheses. Girls from the upper Midwest responded to survey questions related to victimization and weight regulation in a largely urban sample (N = 2,086), a rural sample (N = 2,629), and a statewide sample (N = 966).

RESULTS

Logistic regression revealed that sexual victimization was consistently associated with weight regulation in adolescent girls, independent of the effects of physical victimization. In the urban sample, being sexually victimized was associated with an increase in the probability of purging by 18% relative to not being sexually victimized. Sexual victimization was associated more strongly with extreme forms of weight regulation and significantly discriminated whether girls would choose multiple weight regulation forms.

CONCLUSIONS

Sexual victimization contributes unique variance to the probability that girls will practice weight regulation techniques. Data from three independent samples confirms that being violated sexually places girls at risk for various health compromising eating behaviors.

Smoking and weight control in adolescent females

This paper examines the association between smoking and various weight control techniques among adolescent girls in two school-based samples. Previous studies have relied heavily on clinical trials of adults and have focused mainly on dietary restraint rather than purging behavior. This study seeks to determine whether purging is associated with smoking and if purging and dietary restraint effects upon smoking are additive or synergistic. Data from adolescent girls were gathered from two school-based surveys conducted in the upper Midwest. Assessments were conducted for smoking, dietary restraint, diet pill use, and purging. Logistic regression was used to test for main and interaction effects. Analysis revealed significant associations between smoking and weight control. Purging was more highly associated with smoking than dietary restraint or diet pill use. The form of these associations was interactive rather than additive in both data sets. Nonpurging girls were significantly more likely to smoke if they were dieting or using diet pills than if they were not practicing dieting behavior. Thus, the effect of dieting and diet pill use on smoking is dependent on purging behavior. Weight control is associated with smoking behavior in adolescent girls but the form of these associations may be more complex than originally thought. Future research is needed to determine if there are two subtypes of smoking-weight control girls.

Relationship of childhood sexual abuse and eating disturbance in children

OBJECTIVE

To test the hypothesis that childhood sexual abuse increases the risk of eating disturbance in children.

METHOD

Data obtained from 20 sexually abused children were compared with data obtained from 20 nonabused control children. All subjects were female and between the ages of 10 and 15 years. Subjects completed a battery of tests assessing eating disorder behaviors, body image concern, and childhood trauma history.

RESULTS

Comparison of the 2 groups revealed that the abused children had higher levels of weight dissatisfaction and purging and dieting behavior. Furthermore, abused children reported eating less than control children when they felt emotionally upset. Abused children were less likely than control children to exhibit perfectionistic tendencies, but more likely to desire thinner body types.

CONCLUSIONS

This is the first controlled study to examine the relationship between childhood sexual abuse and eating disturbance which relied on children as subjects. The results support previous findings with adult subjects which indicate that a history of childhood sexual abuse is associated with weight and body dissatisfaction, along with purging and dietary restriction.

Relationship of temperament and perceptions of nonshared environment in bulimia nervosa

OBJECTIVE

Examine the relationship between temperament variables and perceptions of nonshared environment as they relate to bulimia nervosa.

METHOD

Fifty-seven adult women completed the Tridimensional Personality Questionnaire and the Sibling Inventory of Differential Experience. These measures provided assessments of frequently studied temperament traits as well as nonshared environmental factors believed to be associated with psychopathology and temperament.

RESULTS

Bulimic subjects showed higher levels of harm avoidance than did control subjects. Also, bulimic subjects perceived their fathers as less affectionate and more controlling than control subjects. Among bulimics, high levels of harm avoidance were associated with high levels of maternal affection and low levels of maternal control. Similarly, among bulimics, high levels of novelty seeking were more likely to be associated with decreased paternal control than was true for control subjects.

DISCUSSION

These findings highlight the possible relationship between particular temperamental variables and associated family responses in bulimia nervosa.

Utilization of empirically supported psychotherapy treatments for individuals with eating disorders: A survey of psychologists

OBJECTIVE

The purpose of this study was to assess the primary methods used by psychotherapists in treating individuals with eating disorders and to determine the extent to which certain empirically supported psychotherapies (i.e., cognitive behavioral therapy [CBT] and interpersonal psychotherapy [IPT]) are used in clinical settings.

METHOD

Surveys developed for this study were sent to 500 psychologists randomly selected from a list of all licensed doctoral-level psychologists in an upper midwestern state.

RESULTS

Despite the findings that CBT techniques were reported to be frequently used, most respondents identified something other than CBT or IPT as their primary theoretical approach. In addition, the majority of respondents indicated not having received training in the use of manual-based, empirically supported treatment approaches for working with individuals with eating disorders, although most reported a desire to obtain such training.

CONCLUSIONS

Although commonly referred to as the "treatments of choice" in research literature, manual-based, empirically supported approaches to working with individuals with eating disorders has not received adequate dissemination.

The neglected link between eating disturbances and aggressive behavior in girls

OBJECTIVES

Research has linked eating disturbances with behavioral impulsivity. Little is known, however, about whether eating disturbances and aggressive behavior have a tendency to co-occur in the same girls. This article assesses the eating disturbance-aggressive behavior association and then examines the extent to which these factors confer a risk on drug use and attempted suicide.

METHOD

Survey data were gathered from 3,630 girls in grades 6 through 12 in the upper Midwest. Girls responded anonymously to questions regarding binge eating and purging, dietary restriction, aggressive behavior, drug use, and attempted suicide. Logistic regression analysis was used to assess the unique contribution of demographic variables, eating disturbances, and aggression on drug use and attempted suicide.

RESULTS

Eating disturbances were significantly associated with aggressive behavior. Girls who endorsed binge eating and purging or dietary restriction had odds of aggressive behavior 2 to 4 times higher than girls who did not endorse these items. Logistic regression revealed that eating disturbances and aggressive behavior were significantly associated with both drug use and attempted suicide.

CONCLUSIONS

Eating disturbances are significantly associated with aggressive conduct in adolescent girls. The constellation of eating disturbances and aggressive behavior is associated with a greater risk of drug use and attempted suicide.

Hedonics of binge eating in women with bulimia nervosa and binge eating disorder

OBJECTIVE

Potential differences in the hedonics of binge eating between female subjects with bulimia nervosa (BN) and female subjects with binge eating disorder (BED) were examined.

METHOD

Women seeking treatment for BN (N = 29) and BED (N = 49) completed the Eating Hedonics Questionnaire.

RESULTS

Subjects in both groups reported similar precipitants and levels of distress associated with binge eating. Of interest, BED subjects were more likely to report that they enjoyed the food, the taste of the food, the smell and the texture of the food while binge eating. In addition, the BED group reported more relaxation and less physical discomfort and anxiety as a consequence of binge eating compared to the BN group.

DISCUSSION

There are interesting and potentially important differences between individuals with BN and BED in the cognitions and behaviors associated with binge eating.

Prevalence and risk factors for childhood sexual abuse in women: national survey findings

OBJECTIVE

We interviewed a U.S. national sample of women, aged 18 years and older to determine the prevalence and characteristics of childhood sexual abuse. We also examined which family and background variables were predictive of CSA in this sample.

METHOD

The study employed a series of detailed descriptive questions regarding childhood sexual experiences that were administered in a highly structured format by trained female interviewers. CSA prevalence rates were calculated using two definitions of CSA, one of which was slightly more inclusive.

RESULTS

Prevalence rates for the more inclusive CSA definition ranged from 21% to 32%, depending on how respondents who provided incomplete information about their sexual experiences were classified. The less inclusive CSA definition resulted in prevalence rates ranging from 15% to 26%. Additional information about the types of abuse experienced, perpetrator characteristics, age at first abuse, and physical and affective consequences of the abusive experiences are reported. The risk of CSA was related to higher scores on a measure of father's rejection, and the interaction between parental drinking status and whether the respondent had lived with both parents during childhood. Further analysis of this interaction suggests that when respondents reported living with both biological parents, they were most at risk for CSA when their father was a nondrinker and their mother was a drinker.

Eating disorders and comorbidity: empirical, conceptual, and clinical implications

The most common major comorbid disorders associated with eating disorders include substance use disorders, personality disorders, mood disorders, anxiety disorders, and obesity. To test conceptual models of the relationship between the eating disorders and these comorbid disorders, complex research paradigms are needed, including epidemiological studies, behavior-genetic studies, and longitudinal research designs. Comorbidity may be a significant factor to consider as approaches to the treatment of eating disorders continue to evolve.

Relationship of childhood sexual abuse and eating disorders

OBJECTIVE

To review the literature that has examined the relationship between childhood sexual abuse and the eating disorders.

METHOD

Each of the five authors reviewed all identified empirical studies to be certain that inclusion/exclusion criteria were met. Two teams of raters then independently reviewed each study to determine whether it supported any of a series of six hypotheses that had been tested in this literature.

RESULTS

This review indicates that childhood sexual abuse is a nonspecific risk factor for bulimia nervosa, particularly when there is psychiatric comorbidity. There is some indication that childhood sexual abuse is more strongly associated with bulimic disorders than restricting anorexia, but it does not appear to be associated with severity of the disturbance.

CONCLUSION

Childhood sexual abuse is a risk factor for bulimia nervosa with significant comorbidity. Further study of the nature of this relationship is warranted.

Global self-esteem as contingent on body satisfaction among patients with bulimia nervosa: lack of diagnostic specificity?

OBJECTIVE

To examine whether the self-esteem of patients with bulimia nervosa was more contingent on body satisfaction than that of nonpsychiatric control and of depressed participants.

METHODS

Patients with bulimia nervosa (selected according to DSM-III-based structured clinical interviews), those with depression (selected based on chart diagnoses), and nonpsychiatric control samples completed measures of body dissatisfaction and of global self-esteem.

RESULTS

Consistent with past work, we found that body dissatisfaction accounted for a greater amount of global self-esteem among bulimia nervosa patients, as compared to nonpsychiatric control subjects. However, the relation between global self-esteem and body dissatisfaction was similar in patients with bulimia nervosa as in those with depression. Although our depressed group possessed bulimic characteristics, this did not appear to account for our findings, in that the correlation between body dissatisfaction and self-esteem was highest among the nonbulimic depressed participants.

DISCUSSION

Our results raise questions about the specific pathognomonic quality of body satisfaction-dependent self-esteem in bulimia nervosa.

Childhood sexual abuse and bulimic behavior in a nationally representative sample

OBJECTIVES

This study examines whether childhood sexual abuse is a significant risk factor for the development of bulimic behavior in women.

METHODS

Interviews were conducted among a representative national sample of 1099 US women regarding their sexual experiences during childhood as well as their lifetime prevalence of bulimic behavior. Logistic regression was used to calculate adjusted odds ratios to measure the contribution of childhood sexual abuse to the odds of several measures of bulimic behavior in the population, controlling for the respondent's age, ethnic group, and parents' educational level. Attributable risk analyses were conducted to estimate how much risk for bulimic behavior was due to childhood sexual abuse.

RESULTS

Victims of childhood sexual abuse were significantly more likely to display bulimic behavior, and a substantial fraction of cases of bulimic behavior could be attributed to such abuse.

CONCLUSIONS

Childhood sexual abuse is a risk factor for bulimic behavior. Between one sixth and one third of the cases of significant bulimic disturbance could be attributed to childhood sexual abuse.

Clinical characteristics of eating disorder patients who report sexual or physical abuse

At initial contact in an eating disorders clinic, 712 female eating disorder patients were asked if they had been physically or sexually abused as children. They also completed a Beck Depression Inventory (BDI) and an Eating Disorders Inventory (EDI). Their eating disorder symptom frequency and severity was determined. They were asked if they had alcohol problems, had attempted suicide, or had shoplifting problems. Twenty-nine percent reported sexual abuse. Twenty-five percent reported physical abuse. There was no correlation between reports of abuse and symptom frequency or severity. The abused subjects were more depressed on the BDI and showed more psychological disturbance on the EDI. Abused subjects were much more likely than nonabused subjects to report alcohol problems, suicide attempts, or shoplifting.

Social perceptions and borderline personality disorder: the relation to mood disorders

We used the Structural Analysis of Social Behavior (SASB) to compare the social perceptions of borderline, unipolar, and bipolar-depressed inpatients. As predicted, borderline subjects differed from bipolar-depressed and unipolar subjects in their social perceptions. Borderline subjects viewed their relationships to their mother, hospital staff, and other patients as more hostile and autonomous than did mood disordered subjects. The results are discussed in terms of an integrative theory of borderline personality that considers the psychobiology of interpersonal relationships and attachment disruptions.

Social perceptions and borderline personality disorder: the relation to mood disorders

We used the Structural Analysis of Social Behavior (SASB) to compare the social perceptions of borderline, unipolar, and bipolar-depressed inpatients. As predicted, borderline subjects differed from bipolar-depressed and unipolar subjects in their social perceptions. Borderline subjects viewed their relationships to their mother, hospital staff, and other patients as more hostile and autonomous than did mood disordered subjects. The results are discussed in terms of an integrative theory of borderline personality that considers the psychobiology of interpersonal relationships and attachment disruptions.

Five-year outcome from eating disorders: relevance of personality disorders

In order to assess the relationship of personality disorder and eating disorder outcome 30 eating disordered patients were followed up 4-5 years after taking part in a study examining the prevalence of personality disorders in eating disordered individuals. Subjects with personality disorders did not differ from those without personality disorders in the amount of symptomatic change over time, although their psychopathology generally remained more severe. The relationship of personality disorder and clinical outcome ratings varied depending on the personality measure. SCID-II personality disorder diagnoses were not significantly associated with outcome ratings, but were related to a greater likelihood to be hospitalized and treated with psychotropic medications. Results with a new personality measure, the Wisconsin Personality Inventory, did display an association between personality disturbance and eating disorder outcome ratings and also suggested that borderline personality was a significant predictor of outcome.

Personality characteristics of men who physically abuse women

OBJECTIVE

Studies have suggested that personality disorders may be common among men who habitually commit domestic violence. The study reported here attempted to characterize personality traits and psychological and cognitive characteristics of men who batter women in order to distinguish them from nonbattering men.

METHODS

A group of 21 batterers were compared with a group of nonbatterers using the Minnesota Multiphasic Personality Inventory and its personality disorder scales (MMPIPDS) and the Hostility and Direction of Hostility Questionnaire. Comparability of the two groups was assessed on several demographic variables and on scores on the Revised Michigan Alcoholism Screening Test, three cognitive measures, and three measures of affective disturbance.

RESULTS

Batterers scored higher on only the borderline and antisocial MMPIPDS and on the acting-out hostility and self-criticism scales of the hostility questionnaire. Problem-solving skills for both of the groups were considerably poorer than published norms. No significant differences were found between the groups in age, race, education, socioeconomic status, alcohol abuse, performance on cognitive measures, depression scale scores, or overall scores on the MMPI. As children, batterers were more likely to have experienced physical or emotional abuse.

CONCLUSIONS

Men who commit domestic violence may be found among a larger pool of men with poor problem-solving skills, but in addition they appear to have borderline-antisocial personality traits, certain types of hostility, and histories of abuse as children that may predispose them to become violent with their female companions.

Intrafamilial sexual abuse: family-of-origin and family-of-procreation characteristics of female adult victims

We examined connections between incest victims' family-of-origin and family-of-procreation characteristics in a sample of 40 American women who were in treatment for childhood or adolescent experiences of victimization. Retrospective data on their families-of-origin were collected along with their perceptions of current relationships with family members in the three-generational system. Results showed a close association between family-of-origin and family-of-procreation characteristics, especially in the areas of intergenerational intimacy, intergenerational fusion/individuation, and personal authority. A number of significant correlations were also found between subjects' past and present relationships with family-of-origin members and the dimensions of moral and religious orientation, achievement, and intellectual and cultural orientation, conflict, and control in their family-of-procreation. Some aspects of individual adjustment, including alienation, emotional discomfort, and defensiveness, were strongly related to various family-of-origin and family-of-procreation characteristics.

Perceptions of parental relationships in the eating disorders: the relevance of depressed mood

Recent studies have suggested that subtypes of eating-disordered persons differ in their perceptions of their family environments. This study used Benjamin's (1983) Structural Analysis of Social Behavior to examine how depressed mood influenced eating-disordered subjects' ratings of their parental relationships. The results indicated that when level of mood disturbance was statistically controlled, there were no significant differences in parent ratings among restricting anorexics, bulimic-anorexics, bulimics, and normal control subjects. The results are discussed in terms of the possible relations of mood, eating disorder, and perception of family relationships.

Interpretation of transference in the psychotherapy of adolescents and young adults

There is considerable controversy in the literature surrounding the role of interpretation of transference in the expressive psychotherapy of adolescents and young adults. The authors contend that interpretation of transference is often underutilized in the psychotherapy of adolescents and that many treatments could be enriched by its inclusion. It is argued that interpretation of the transference in the immediate "here and now" of the therapeutic encounter should take precedence over genetic transference interpretation, which attempts to link current attitudes toward the therapist to archaic attitudes toward the parents. Six guidelines founded on a developmental perspective are described for exploring transference themes in this age group. While interpretation of transference is neither a panacea nor uniquely mutative with adolescents and young adults, the authors believe it has an important role to play in expressive psychotherapy if used judiciously and with foresight.

Perceptions of parental relationships in the eating disorders: The relevance of depressed mood

Recent studies have suggested that subtypes of eating-disordered persons differ in their perceptions of their family environments. This study used Benjamin's (1983) Structural Analysis of Social Behavior to examine how depressed mood influenced eating-disordered subjects' ratings of their parental relationships. The results indicated that when level of mood disturbance was statistically controlled, there were no significant differences in parent ratings among restricting anorexics, bulimic-anorexics, bulimics, and normal control subjects. The results are discussed in terms of the possible relations of mood, eating disorder, and perception of family relationships.

Hypnosis and behavioral treatment in a worksite smoking cessation program

In the initial study, 48 subjects of the total (N = 63) ultimately used, were assigned to one of three treatments: four hypnotic sessions with a booster, two hypnotic sessions, or two hypnotic and two behavioral sessions with a booster. A follow-up group was later recruited composed of 15 subjects who received four hypnotic sessions and a booster session with less time between sessions. The results indicated no difference in smoking cessation 6 months after treatment regardless of the frequency, length between sessions, or addition of behavioral methods. Successful subjects were more educated, less able to utilize their imagination, and had fewer smokers at home.

Depression and adrenal function in spinal cord injury

Of 32 patients with spinal cord injury, 14 had a DSM-III diagnosis of depressive disorder: 12 had major depression (five with melancholia) and two were dysthymic. In those with major depression, a dexamethasone suppression test lacked sensitivity (30%) and specificity (50%).

Withdrawal and matching strategies in reducing attack-instigated aggression

This article reports a conceptual replication of earlier work by Dengerink and Bertilson. For a random sample of attack-instigated subjects, the use of a withdrawal strategy by an opponent is the most effective way to reduce the subject's aggression. Dengerink and Bertilson demonstrated this effect using the Taylor reaction-time procedures. The present report of similar findings used the interpersonal communications task. A matching strategy was tested in both studies but reduced aggression more slowly than the withdrawal strategy. Matching and yoked-control groups did not differ from each other during any block of testing in these two experiments. This suggests that the reduction in shock settings by subjects in the matching condition is not due to the opponent's shock settings being contingent upon the subject's shock settings. These findings are limited to randomly selected attack-instigated subjects since Pisano and Taylor reported highly aggressive subjects, who were not attacked, reduced their aggression most rapidly to a matching strategy.

Psychological response to amputation as a function of age and time since amputation

Much of what is known about the psychological response to amputation is derived from studies of veterans. Most recent amputees come from a different group; they are typically older and have experienced medical problems prior to their amputation. In order to investigate the effects of age and time since amputation on psychological response, 66 amputees were assessed by the Symptom Checklist-90, Beck Depression Inventory and interviewed. When classified by time since amputation and by age, the results indicate that older amputees exhibited less depression and fewer psychological symptoms: in contrast, younger amputees evidenced increased depression and psychological symptomatology the longer the time since their amputation.

Depression among amputees

A 35% prevalence of major depressive disorder was found in a prospective study of 65 amputees evaluated in a Physical Medicine and Rehabilitation Department. The findings indicate significantly more alcohol abuse among the depressed group. Higher percentages of female than male amputees were found to be depressed and unmarried. The prevalence of smoking was significantly higher among those whose amputations were due to vascular disease rather than other causes (e.g., trauma). In addition to the physical care of amputees, their emotional needs and well-being merit serious consideration.

Subject selection in applied behavior analysis

Past researchers have commented on the role of specifying relevant subject characteristics in determining the generality of experimental findings. Knowledge of subject selection criteria is important in interpreting and replicating research results. Such knowledge, as compared with many other historical and demographic characteristics of the subject, is likely to be related to a procedure's effectiveness. Data indicated that the majority of articles published in the Journal of Applied Behavior Analysis do not provide an adequate description of subject selection criteria. The failure to provide detailed information concerning subject selection criteria can prevent systematic replication of research results. The relatively low cost inclusion of complete descriptions of subject selection criteria would enhance the generality of applied behavior analysis research by facilitating systematic inductive manipulations and replications.

The integrity of independent variables in behavior analysis

Establishing a functional relationship between the independent and the dependent variable is the primary focus of applied behavior analysis. Accurate and reliable description and observation of both the independent and dependent variables are necessary to achieve this goal. Although considerable attention has been focused on ensuring the integrity of the dependent variable in the operant literature, similar effort has not been directed at ensuring the integrity of the independent variable. Inaccurate descriptions of the application of the independent variable may threaten the reliability and validity of operant research data. A survey of articles in the Journal of Applied Behavior Analysis demonstrated that the majority of articles published do not use any assessment of the actual occurrence of the independent variable and a sizable minority do not provide operational definitions of the independent variable. The feasibility and utility of ensuring the integrity of the independent variable is described.