Somatization: a debilitating syndrome in primary care.

Somatization is a significant problem for clinical medicine. Unlike somatization disorder, which is relatively rare, abridged somatization, a less severe form of somatization, is prevalent in primary care clinics. The authors examined the clinical status and functioning of patients diagnosed with a depression or anxiety disorder comorbid with abridged somatization and compared them with patients diagnosed with a depression or anxiety disorder alone. The authors examined severity of physical functioning and psychopathology in relation to diagnostic status. Patients diagnosed with both abridged somatization and a depression or anxiety disorder were more physically impaired and more anxious than those diagnosed with a depression or anxiety disorder alone. The results suggest that abridged somatization frequently coexists with depression and anxiety and thus complicates the presentation of these disorders.

Cognitive behavior therapy for somatization disorder: a preliminary investigation.

Patients diagnosed with somatization disorder have high rates of disability and often prove refractory to treatment. This preliminary investigation examines the effect of a 10-session cognitive behavior therapy (CBT) protocol on the physical discomfort and disability of severely impaired somatizers. The severity of patients' physical discomfort and disability was assessed at baseline, post-treatment, and eight months following treatment. Patients reported significant improvement in symptomatology and physical functioning between baseline and post-treatment as well as between baseline and follow-up. The findings suggest that CBT might benefit patients diagnosed with somatization disorder and should be subjected to a controlled treatment trial.

Immigration and mental health: Mexican Americans in the United States.

The Hispanic population in the United States continues to expand rapidly due primarily to a large flow of immigrants from Mexico. Historical observations of disadvantage in the immigrant population, when compared to the native population, had helped to shape prevailing theories on immigration and mental health. However, data emerging from new research on Mexican Americans have come to challenge the old idea that immigrants are necessarily disadvantaged. The goal of this article is to review these new studies critically, to draw conclusions concerning the relationship between immigration and psychopathology, and to offer potential explanations for the major findings. We review five recent large-scale studies that examined the prevalence of mental disorders among Mexican-born immigrants and U.S.-born Mexican Americans in the United States. Results of these studies are inconsistent with traditional tenets on the relationship among immigration, acculturation, and psychopathology. They show that Mexico-born immigrants, despite significant socioeconomic disadvantages, have better mental health profiles than do U.S.-born Mexican Americans. Possible explanations for the better mental health profile of Mexican immigrants include research artifacts such as selection bias, a protective effect of traditional family networks, and a lower set of expectations about what constitutes "success" in America. The elevated rates of psychopathology in U.S.-born Mexican Americans may be related to easier access to abused substances and an elevated frequency of substance abuse among the U.S.-born.

The abused child as parent: the structure and content of physically abused mothers' perceptions of their babies.

OBJECTIVE: The major aim of the study was to provide an empirical answer to the following question: Does a mother's history of being physically abused as a child have a discernible impact on the structure and content of her perceptions and beliefs concerning her own child? METHOD: Free-response memories and current descriptions of babies, self, and significant others such as parents were compared longitudinally in two groups of mothers when their babies were 6 months, 1 year, and 2 years old. One group of mothers consisted of individuals who reported being physically abused as children; the control group consisted of mothers who were not physically abused. The two groups were comparable with respect to age of baby, race, and socioeconomic status. RESULTS: Abused mothers were found to differ significantly from control mothers in the structure and content of their free-response perceptions of their own babies. More specifically, abused mothers lagged behind controls in how well-differentiated were their negative perceptions of their babies. Differentiation in this study is operationally defined as the number of unique clusters that underlie a mother's perceptions of her baby, when social perception data is analyzed using cluster analysis (HICLAS). The greater the number of clusters observed, the greater is the differentiation. On the other hand, abused mothers were comparable to controls with respect to differentiation of positive perceptions of babies. CONCLUSIONS: The findings constitute a discovery about the structural organization of social cognition in mothers at-risk for child abuse. Implications of the findings for theory and future research are briefly discussed, as are limitations of the current study.

Self-complexity and the persistence of depression.

Self-complexity, a measure of the structure of cognition involving the self, was used to predict the persistence of depression in patients diagnosed with major depression. Self-descriptions offered by depressed patients were analyzed using a clustering algorithm to model cognitive structure. Indices of positive and negative self-complexity, derived from the resulting models, were used to predict depressive symptomatology 9 months after the onset of a major depression. Negative self-complexity uniquely predicted subsequent levels of depression even after the effects of initial levels of depression, self-evaluation, and dysfunctional attitudes were statistically removed. Highly complex negative self-representation appears to be associated with poor recovery from a major depressive episode. Future studies examining the relationship between cognition and psychopathology should investigate, in addition to its content, the formal and structural properties of cognition.

A hierarchical classes analysis (HICLAS) of primary care patients with medically unexplained somatic symptoms.

This study used a clustering model, Hierarchical Classes Analysis (HICLAS), to examine patient groupings in a multiethnic sample of 1456 patients using primary care services at a university-affiliated community clinic in southern California. Somatic symptoms, psychiatric diagnoses and disability were studied using a survey instrument that included portions of the Composite International Diagnostic Interview (CIDI), the Diagnostic Interview Schedule (DIS) and the RAND-MOS Short Form Health Survey's (SF-36) 'physical functioning' dimension. HICLAS identified 11 clusters of patients with distinct patterns of medically unexplained somatic symptoms. These patient clusters varied with respect to psychiatric diagnoses and symptoms, gender, immigration status and disability. Results of this study suggest that the type of presenting symptom(s) and their various combinations may have diagnostic and prognostic value in primary care settings. These new findings may lead to further refinement of current diagnostic constructs for somatizing syndromes.

Possible selves in major depression.

Ratings of possible selves and resultant self-concept discrepancies were examined in 25 patients diagnosed with major depression and 25 control subjects. Self-concept discrepancies significantly discriminated patients from controls. The presence of negative features in the self-schema was a stronger indicator of depressive symptomatology than was the absence of positive self-appraisal. Depressives' future projections of self were less pessimistic than predicted by cognitive theories of depression.

The abused child as parent.

Free-response memories and current descriptions of self, parents, babies, and significant others generated by 55 mothers who were physically abused as children were compared with memories and descriptions by 46 mothers who were not physically abused. The two groups of mothers were matched for age of baby, race, and socioeconomic status. It was found that clusters of negative attributes pervaded the memories and perceptions that abused mothers had of others, particularly parents. Moreover, the degree of negative elaboration (i.e., the number of negative clusters attributed to others) discriminated the abused and control groups almost perfectly. It was also found for both groups that the more elaborated the positive view of self and others, the more secure the attachment of infant to mother. In addition, patterns of identification and description were dramatically different between the two groups: Unlike the comparison mothers, abused mothers tended to disidentify with their own mothers and to be inconsistent in their characterization of them.

Self-complexity, self-evaluation, and depression: an examination of form and content within the self-schema.

Six studies examined the relationship between self-complexity and variables related to self-evaluation. Self-complexity was found to comprise two components: positive self-complexity and negative self-complexity. Positive self-complexity was sensitive to methodological factors, namely, variations in stimulus materials used for self-ratings. Negative self-complexity was relatively stable in the face of different rating stimuli and tasks and was related to trait measures of self-evaluation, psychic distress, and psychopathology. These findings were observed and replicated. Higher negative self-complexity was associated with increases in depression symptoms over time. Higher negative self-complexity also predicted a poorer prognosis and less complete recovery from depression in a clinical sample. Results are discussed in light of related research and possible social-cognitive mechanisms.

Perception of self and other in major depression.

Previous research on the nature of person perception in depression has been inconclusive. This investigation differs from earlier studies in that extensive free-response descriptions of other people and self were collected from patients with major depression and from nonpsychiatric control Ss. In comparison with control Ss, depressed patients described fewer positive aspects not only of self but also of parents and significant others and reported more negative aspects of these people. Cluster analysis (HICLAS) also showed that more cognitive differentiation of negative self-perceptions (negative self-complexity) was characteristic of clinical depression. In both control Ss and patients, a positive (or negative) view of self was highly correlated (.85 or more) with a positive (or negative) view of parents and significant others. These correlations were significantly stronger than those between self and less important others.

The relationship of bystander intervention variables to adolescents' responses to suicidal peers.

This study sought to understand factors that might enhance suicide prevention programs by investigating the responses of adolescents to potentially suicidal peers in analogue situations embodying variables from the social psychological research on bystander intervention. 314 high school students were randomly assigned one of four vignettes about a troubled peer under conditions of high or low diffusion of responsibility (respondent was alone or one of a group) and high or low ambiguity (confronted by a troubled peer or heard an essay written by a peer). Students' statements concerning the likelihood of suicide and their level of concern in the situation provided evidence for the internal validity of the vignettes. Results included significant main effects of ambiguity (more likely to tell an adult than simply talk to the peer in low vs high ambiguous conditions) for males and females, and of diffusion (more likely to ignore or do nothing than talk or tell in high vs low diffuse situations) for males. Students' estimates of how other students would respond corresponded with findings from social comparison research and suggested the operation of an erroneously perceived social norm of no response to a troubled peer by those who indicated that they would ignore the peer. The results have implications for the application of social psychological models to social influence-based prevention efforts to enhance adolescents' roles in the prevention of youth suicidal behavior.

Emotion differentiation. A correlate of symptom severity in major depression.

The relationship of emotion differentiation to symptom severity in depression was investigated. The subjects were 25 patients diagnosed with unipolar major depression. Subjects were clinically assessed using the Schedule for Affective Disorders and Schizophrenia and the Hamilton rating scales for anxiety and depression. In addition, subjects completed a number of self-report measures of symptoms and attitudes. Twelve basic emotion terms were incorporated into free-response attribute lists which subjects used to rate aspects of themselves and of other significant people in their lives. A clustering algorithm (HICLAS) was used to derive a social perception structure from this data for each subject. The differentiation of negative emotion within an individual's structure (NES) was measured by dividing the number of attribute categories containing negative emotions by the total number of categories in that person's structure. The results indicated that NES is a significant correlate of depressive symptomatology independent of self-esteem and other variables. Relatively undifferentiated emotion structure (low NES) was associated with significantly higher levels of depressive symptomatology.

Self-structure in borderline personality disorder.

Self-structural theory is applied to the interpersonal aspects of borderline personality disorder. The notion of interpersonal contrasting, a cognitive maneuver, is introduced to account for the sharp changes between divergent self-states characteristic of the disorder. The theory and three prototypical self-states are illustrated with data from a borderline patient by means of a procedure derived from the theory.

DSM-III-R as a taxonomy. A cluster analysis of diagnoses and symptoms.

While there have been many applications of cluster analysis in psychiatric classification research, there are no studies in which cluster analysis is used to discover the taxonomic structure implicit in the DSM-III itself. In order to do so, the symptom index in the DSM-III-R manual was summarized in a two-way matrix of disorders by symptoms and then analyzed using a hierarchical classes model and companion algorithm (HICLAS) that permits overlap among classes. A novel feature of this model is that superordinate-subordinate relationships among diagnostic and symptom classes are explicitly represented. The HICLAS analysis revealed that there are several discrete symptom classes in DSM-III-R and that many psychiatric disorders can be modeled as combinations of one or more of these classes. The disorders associated with these symptom classes tend to fit the hierarchical classes model relatively well, particularly the mood disorders and the psychotic disorders. However, disorders such as adjustment, personality, and sexual disorder fit the model poorly or not at all. The results are in line with the conjecture that the taxonomic model implicit in DSM-III-R is a hybrid of discrete symptom classes and some other structure, perhaps a dimensional one.

The promotion of social competence: longitudinal study of a preventive school-based program.

A two-year, intensive, elementary school-based primary prevention program aimed at the promotion of social competence was followed up six years later. Findings suggest beneficial effects for program recipients on indices of social adjustment and psychopathology when compared to controls, although overall strength of effects was not large and notable gender differences emerged.

A typology of psychiatric reactions to motor vehicle accidents.

Perhaps owing to their commonness, nonserious motor vehicle accidents, i.e. those not resulting in death or major bodily injury, have received scant systematic study in the psychiatric literature. However, patients presenting with lingering psychiatric distress following such accidents are seen commonly in practice. The authors reviewed the patterns of presentation and background circumstances in a series of 55 such cases, presenting at varying periods of time after the incident. They found such patients to cluster into four distinct groups. The most common presentation was that of a depressive syndrome, outnumbering those with features of posttraumatic stress disorder by 3:1.

A Set-Theoretical Model of Person Perception.

A set-theoretical structural model of person perception is presented in which self and other people that the individual knows are partitioned into person classes and the attributes that are perceived to describe self and others are partitioned into attribute classes. A novel feature of the model is that superset-subset relationships among person classes and among attribute classes are explicitly represented. The model was tested empirically by fitting it to free-response descriptions of self and others made by 14 college students, using HICLAS, a computer algorithm for the model. It was found that persons in superordinate classes and in classes with many elements were in general perceived by the subjects to be the most significant and important persons in their lives. These persons included self, nuclear and extended family, lovers and friends. Persons in subordinate classes that contained few elements were generally perceived as the least significant/important persons and included disliked and/or superficially known people. It was also found that the set theoretical analysis provided a significantly better account of the data than did hierarchical clustering.

Self-structure in schizophrenia.

This study used a set-theoretical model to construct self-perception structures and person-perception structures for 10 recently hospitalized schizophrenic patients, 10 nonschizophrenic patients recently hospitalized for depression, and 10 nonpsychiatric subjects. Overall self-perception structures were significantly less elaborated in the schizophrenic patients when compared with either the psychiatric or the nonpsychiatric comparison group. No comparable differences were found for measures taken from the person-perception structures. The degree of elaboration of self in the particular context of self as psychiatric patient was found to be correlated (r = .74, p less than .01) with Global Assessment Scale ratings of current functional level in the schizophrenic group.