Becoming their mother: Knowledge, attitudes, and practices of orphanage personnel in Ukraine.

Institutional caregiving can have adverse effects on children, yet little is known about the caregivers of institutionalized young children. We surveyed staff in three Ukrainian Baby Homes about their attitudes toward the nature of their work and the needs of the young children in their care. Seventy-one caregivers completed anonymous, semistructured surveys. Popular reasons for working in Baby Homes included benefits and convenient work shifts, morality, and affection for children. Caregivers reported both favorable aspects of the work (enjoyment of children, professional satisfaction) and work difficulties (conflicts, lack of cooperation, little administrative support). In addition, they noted deficiencies in care: high caregiver-child ratio, frequent care disruptions, and lack of stimulation. Direct caregivers (in-room "nannies," educators, and nurses) and other providers (e.g., clinic nurses, physicians, therapists) differed in university-degree attainment, professional motivation, enjoyment of children, professional satisfaction, and perceptions of self as substitute mother. A number of potential "windows for change" were identified, including recognition of deficiencies in institutional care and possibilities for improvement. Implications for interventions are discussed, including the need to consider lack of staff support, high emotional stress, internal conflicts, beliefs and attitudes about institutionalized children and their biological parents, and differences in staff educational achievement.

A personality classification system for eating disorders: a longitudinal study.

BACKGROUND: Studies of eating disorders (EDs) suggest that empirically derived personality subtypes may explain heterogeneity in ED samples that is not captured by the current diagnostic system. Longitudinal outcomes for personality subtypes have not been examined. METHOD: In this study, personality pathology was assessed by clinical interview in 213 individuals with anorexia nervosa and bulimia nervosa at baseline. Interview data on EDs, comorbid diagnoses, global functioning, and treatment utilization were collected at baseline and at 6-month follow-up intervals over a median of 9 years. RESULTS: Q-factor analysis of the participants based on personality items produced a 5-prototype system, including high-functioning, behaviorally dysregulated, emotionally dysregulated, avoidant-insecure, and obsessional-sensitive types. Dimensional prototype scores were associated with baseline functioning and longitudinal outcome. Avoidant-Insecure scores showed consistent associations with poor functioning and outcome, including failure to show ED improvement, poor global functioning after 5 years, and high treatment utilization after 5 years. Behavioral dysregulation was associated with poor baseline functioning but did not show strong associations with ED or global outcome when histories of major depression and substance use disorder were covaried. Emotional dysregulation and obsessional-sensitivity were not associated with negative outcomes. High-functioning prototype scores were consistently associated with positive outcomes. CONCLUSIONS: Longitudinal results support the importance of personality subtypes to ED classification.

Personality pathology and substance abuse in eating disorders: a longitudinal study.

OBJECTIVE: Substance abuse has been shown to predict poor outcome in eating disorder (ED) samples, and prior cross-sectional data on personality subtypes of EDs suggest that substance abuse is associated with dysregulated and possibly avoidant-insecure subtypes. This study investigates longitudinal associations between personality and substance use. METHOD: Personality pathology and substance use were assessed in 213 individuals with anorexia nervosa and bulimia nervosa at baseline; substance use was assessed at regular follow-up intervals over a 9-year period. RESULTS: Of the five personality factors identified, the obsessional-sensitive and high-functioning types were negatively associated with substance abuse at baseline, while the behaviorally dysregulated type was positively associated with substance abuse at baseline. Longitudinal associations were observed, suggesting that obsessional-sensitive personality type was protective against the development of substance abuse. Longitudinal associations between the other personality types and substance abuse were nonsignificant after baseline substance abuse history was included as a covariate in the model. CONCLUSION: Substance use demonstrates cross-sectional associations with personality style, but substance abuse history appears to be the most important predictor of future substance abuse in women with eating disorders.