Relational self-evaluations in dissociation: Implicit self-rejection?

OBJECTIVE: Schematic self-knowledge consists of internal representations that shape perceptions of how the self is related to one's surroundings and other people. These representations may include dysfunctional implicit self-evaluations, such as associations of the self with negative attributes like shame, in trauma-spectrum disorders. The current study examines whether a negative relational self-association, that is, linking the self with rejection, characterizes dissociation. METHOD: One hundred six community participants with diverse early interpersonal experiences and mental health outcomes were recruited. Implicit relational self-evaluation was assessed by single-target implicit association tests. Dissociation and common psychopathological and psychosocial correlates such as anxiety, depression, self-esteem, and adverse interpersonal experiences were measured using standardized scales. RESULTS: Individuals with more dissociative symptoms responded faster when pairing self-pronouns with rejection-related words than with acceptance-related words. The correlation between dissociation and this self-rejection association remained significant when statistically controlling for adverse interpersonal experiences and for depression, anxiety, and self-esteem. CONCLUSION: A self-association with being rejected characterized individuals prone to dissociation. This dysfunctional implicit self-evaluation may bias perceptions of other people's attitudes toward themselves, prompting maladaptive social behaviors that can hinder the development and maintenance of relationships in dissociative people. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Early relational trauma and self representations: Misattributing externally derived representations as internally generated.

OBJECTIVE: Early relational trauma has been posited to be responsible for dysfunctional self schema as negative feedback derived from abusive close others may influence the development of self-evaluation. However, the association between early relational trauma and negative self-evaluation has proven inconsistent. In addition to the evaluative aspect, early relational trauma may impact on the procedural aspect of self schema, with a difficulty in differentiating mental representations derived from others from those generated internally by the self. METHOD: To test this hypothesis, the authors adopted a source attribution paradigm tapping on the distinction between mental representations generated by the self or derived from another person in a nonclinical sample, together with scales measuring self-evaluation and early relational experiences. RESULTS: The results showed that individuals with early relational trauma tended to attribute the representations externally derived as internally generated, although there were no associations between early relational trauma and self-evaluation. Importantly, early relational trauma had unique contribution to source misattribution independent from common covariates including early nonrelational trauma, parental dysfunction, general memory function, and negative affect states. CONCLUSIONS: Erroneously identifying information derived from other people as self-generated may be a specific sociocognitive propensity linked to early relational trauma and may impact upon the development of self schema. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Alexithymia and anesthetic bladder capacity in interstitial cystitis/bladder pain syndrome.

OBJECTIVE: In contrast to the inconsistent results of organic causes, it has been found that psychological risk factors are reliably related to functional somatic syndromes (FSSs), including interstitial cystitis/bladder pain syndrome (IC/BPS). Compared to patients with acute cystitis, a subgroup of IC/BPS patients with a history of childhood relational trauma reported intensified unregulated affective states (i.e., anxiety and depression) and trauma-related psychopathology (i.e., dissociation). Nevertheless, it remains unknown whether psychosocial risk factors can be separated from bladder-centric factors. This study aimed to verify whether psychosocial factors such as alexithymia, which is a key psychological factor of FSSs, are less likely to be linked to a low bladder capacity in patients with IC/BPS. METHODS: Ninety-four female IC/BPS patients were recruited from the outpatient departments of urology, obstetrics, and gynecology. Anxiety, depression, dissociation, childhood relational trauma, and alexithymia were assessed using standardized scales, and anesthetic bladder capacity was examined by cystoscopic hydrodistention. RESULTS: Positive correlations were found between anesthetic bladder capacity and the psychosocial variables, including alexithymia. An increased bladder capacity was associated with anxiety, dissociation, and childhood relational trauma, and a combination of high cognitive and low affective alexithymia mediated the correlations between bladder capacity and the psychosocial variables. CONCLUSIONS: Psychosocial variables that are associated with an aversive childhood relational environment and affect dysregulation may constitute a pathogenic trajectory that differs from bladder-centric defects such as a lower bladder capacity. The findings of this study support the notion that IC/BPS in some patients may be due to an FSS.

Childhood trauma perpetrated by close others, psychiatric dysfunction, and urological symptoms in patients with interstitial cystitis/bladder pain syndrome.

BACKGROUND: A psychosocial phenotype of interstitial cystitis/bladder pain syndrome (IC/BPS), a urogenital condition without known organic causes, was proposed. While psychosocial variables, including interpersonal maltreatment and negative affect, were studied in association with IC/BPS, the specificities of the relationships between childhood trauma by close others, psychiatric dysfunctions (negative affect and post-traumatic psychopathology), and urogenital symptoms have not been established. METHODS: 94 IC/BPS patients were recruited together with 47 patients with acute cystitis who served as clinical controls. Standardized scales were used to assess various potentially traumatizing events in childhood and adulthood as well as psychiatric (dissociation and negative affect) and urogenital symptoms. RESULTS: Among the potentially traumatizing events, those perpetrated by close others during childhood were found to be the most salient features discriminating the IC/BPS group from the control group. When divided into 2 subgroups according to their history of childhood trauma by close others, only IC/BPS patients with childhood trauma by close others had more dissociative and anxiety symptoms compared with the control group. These two subgroups did not differ in urogenital symptom severity. CONCLUSIONS: Childhood trauma by close others, rather than other types of interpersonal trauma, was a differentiating characteristic in IC/BPS patients, and a childhood trauma related psychosocial phenotype with a distinct clinical profile of dissociation and anxiety proneness was identified. Future studies should investigate whether a distinct set of pathogenic factors exists in IC/BPS patients with a history of childhood trauma by close others, even if this subgroup is not readily differentiated by urogenital symptoms.

The neonatal resuscitation algorithm organized cart is more efficient than the airway-breathing-circulation organized drawer: a crossover randomized control trial.

INTRODUCTION: Although there is consensus on the resuscitation of newborns, there is no standardization on how resuscitation equipment should be organized. This might lead to difficulty and inefficiency in retrieval of the right equipment during resuscitation. The neonatal resuscitation carts organized in accordance with the American Academy of Pediatrics (AAP) Neonatal Resuscitation Program (NRP) algorithm might result in more efficient retrieval of resuscitation equipment. OBJECTIVES: To compare user preference and lengths of time required to retrieve standard resuscitation equipment from an NRP Cart versus a generic storage drawer. STUDY DESIGN: A prospective, randomized, controlled, and crossover trial was conducted during simulation-based NRP provider courses in the Accident & Emergency Training Centre from September to October 2013. The mean time of accurate equipment retrieval and ease of use, which was rated by the participants using a five-point Likert scale (1=most difficult, 5=easiest to use), were compared using the Wilcoxon signed-rank test because of right skew. RESULTS: A total of 55 individuals participated in this study. The mean length of time required for equipment retrieval from the NRP Cart was significantly less than that from the drawer (Z=-3.90, P<0.01, median=36.23 s, interquartile range=97 s). In general, the NRP Cart was 32% faster than the drawer when extensive resuscitation equipment was required. All the participants rated the NRP Cart as easier to use than the drawer, with a median score of 4 for NRP Cart and 3 for the drawer (Z=-4.10, P<0.01, interquartile range=2). CONCLUSION: The NRP Cart was superior to the generic drawer in terms of the speed of equipment retrieval and user acceptability.