A long-term follow-up study of a cohort of referrals to an adult mental health clinical psychology department.

The study, using the SCL-90-R, investigated the long-term outcome of clinical psychology interventions with adults by contacting 95 clients between five and eight years after initial contact. Post-treatment improvements in global psychological well-being were generally maintained at long-term follow-up. About a quarter of clients, however, did not report any improvement in the initial problem and about a half had received help from other services since ending contact with the department. The study provides encouraging evidence of long-term benefits for many clients, but we suggest a reconsideration of the optimal provision of psychological help for people whose problems may be enduring and/or recurrent.

Self-esteem, eating problems, and psychological well-being in a cohort of schoolgirls aged 15-16: a questionnaire and interview study.

OBJECTIVE: This study aimed to investigate the extent of eating problems and their association with self-esteem in girls aged 15-16. METHOD: Six hundred and nine schoolgirls aged 15-16 completed a questionnaire examining eating behavior, self-esteem, and general psychological well-being. A subsample of 31 girls was subsequently interviewed in terms of eating behavior and self-esteem. RESULTS: The questionnaire findings revealed that 56% of girls felt too fat and had used some form of weight control strategy. In addition, 32% scored above the Hospital Anxiety and Depression Scale (HADS) threshold for anxiety and 43% reached the Rosenberg Self-Esteem Scale criterion for low self-esteem. Interviews confirmed that those showing abnormal eating behavior in the questionnaires did indeed show greater eating pathology as well as lower self-esteem. Interviews also revealed that those with high levels of eating concern showed greater levels of global self-dissatisfaction and higher dissatisfaction with their physical appearance and family relationships. DISCUSSION: The results suggest that preventative interventions targeted at girls with low self-esteem may be appropriate.

A prospective study of self-esteem in the prediction of eating problems in adolescent schoolgirls: questionnaire findings.

A number of authors have emphasized the importance of self-esteem in the aetiology of the eating disorders anorexia nervosa and bulimia nervosa. Evidence for such theorizing, however, mainly derives from clinical observations on people being treated for eating disorders. This study is the first prospective study to investigate the role of self-esteem in aetiology prior to the onset of an eating disorder. Self-esteem was measured in 594 schoolgirls aged 11-12 using the Rosenberg Self-Esteem Scale (Rosenberg, 1965). Almost 400 of these girls were successfully followed up at age 15-16 and they completed a questionnaire examining eating and other psychological problems. Results showed that girls with low self-esteem at age 11-12 were at significantly greater risk of developing the more severe signs of eating disorders, as well as other psychological problems, by the age of 15-16. It is argued that more research is needed to replicate and extend these findings. The results also give weight to the case for examining the potential role of self-esteem enhancement in the prevention of eating disorders.

Rigidity of construing of self and significant others and psychological disorder.

This study was designed to test the hypothesis that more rigid construing of self and others is more common in non-psychotic psychological disorder than in the general population. Thirty-one adult referrals to either a psychiatric day hospital or a clinical psychology service were compared with 31 matched normal controls using a repertory grid. There was no support for the hypothesis, but there was evidence of greater negativity of self-construing in the client group. The implications of these findings for clinical practice are discussed.

The clinical psychologist in general practice: a six-year study of consulting patterns for psychosocial problems.

Three quarters of the patients in a group practice referred to a clinical psychologist during a three-year period showed marked reductions in the consulting and psychotropic drug prescription rates in the six months after treatment compared with the six months leading up to treatment. However, the rates for the whole practice revealed a general falling trend over the period of study. Furthermore, examination of the records of all patients with at least one psychosocial problem over a six-year period during which they were registered with the practice has shown that encounters for psychosocial problems tended to be concentrated in a relatively short period - the ;worst year' - rather than being evenly distributed over the whole six years. It is concluded that the natural history of most psychological disorders is one of crisis and remission and that no benefit has been demonstrated from individual therapy by clinical psychologists.

Subclinical anorexia nervosa.

The Eating Attitudes Test (Garner & Garfinkel, 1979) was administered to 578 students (446 females and 132 males) at a College of Technology and to 14 "control" subjects fulfilling strict diagnostic criteria for anorexia nervosa. Although no male students scored highly, a total of 28 female students (6.3% of the female student sample) scored in the "anorexic" range. These "high scorers", together with a random control group of 28 "non-high scorers", were subsequently interviewed. Interview revealed that the symptoms of anorexia nervosa were common in the high scoring group but virtually absent in the student control group. It is concluded that a substantial proportion of post-pubertal females (approximately 5%) develop a subclinical form of anorexia nervosa. The implications of these findings are discussed in relation to the aetiology, prevention and treatment of disturbances in eating behaviour.

Compulsory admissions in a London borough: I. Social and clinical features and a follow-up.

This study examines the role that clinical and social factors play in compulsory admissions to hospital in a London borough. 150 patients compulsorily admitted under a section of the Mental Health Act 1959 were compared with 100 informally admitted patients. Significant differences in social-demographic and clinical characteristics are described as well as differences in outcome on follow-up. A long-term unwillingness on the part of the compulsory patients to engage in follow-up services was evident. These differences still held when the compulsory patients were compared with a group of informal patients matched for age, sex and diagnosis. Patients referred by the police and admitted under Section 136 of the Mental Health Act showed those features associated with compulsory admission in general to the most severe degree.

A reappraisal of body perception disturbance in anorexia nervosa.

Previous research has suggested that patients suffering from anorexia nervosa tend to overestimate their body size, whereas normal females tend to be very accurate in this respect. This paper presents the results of further investigations of body perception amongst anorexic and normal females. The results, in contrast to earlier findings, indicate no such difference between groups. Detailed analysis of the data, however, points to the likelihood of certain differences between the present group of anorexic patients and previous groups. Moreover, it seems that body perception disturbance is not a consistent feature of anorexia nervosa and is only present amongst some patients at certain stages during their illness. On subdividing the anorexic group it was demonstrated that patients who vomit tend to overestimate their size more than do non-vomiters. It also seems likely that normal females are far from homogeneous in terms of body perception. In line with previous findings, a direct relationship was found between marked overestimation of body size and an early relapse. Evidence is also discussed which suggests that body perception disturbance is not specific to anorexia nervosa and may reflect an abnormal sensitivity about body size associated with such factors as the anticipation of an undesired change in weight, extreme concern about slimness and anxiety about putting on weight.