Exposure to Violence, Posttraumatic Stress Symptoms, and Borderline Personality Pathology Among Adolescents in Residential Psychiatric Treatment: The Influence of Emotion Dysregulation.

Exposure to violence during adolescence is a highly prevalent phenomenon associated with a range of deleterious outcomes. Theoretical literature suggests that emotion dysregulation is one consequence of exposure to violence associated with the manifestation of posttraumatic stress symptoms (PTSS) and borderline personality (BP) pathology. Thus, the goal of the present study was to examine the mediating role of emotion dysregulation in the relation between exposure to violence and both PTSS and BP pathology in a sample of 144 adolescents (age 10- to 17-years; 51% male; 55% African American) admitted to a psychiatric residential treatment center. Exposure to violence was associated with greater emotion dysregulation, which, in turn, was associated with greater PTSS and BP pathology. Furthermore, emotion dysregulation mediated the associations between exposure to violence and both PTSS and BP pathology. Findings suggest the importance of assessing and treating emotion dysregulation among violence-exposed adolescents in psychiatric residential treatment.

Adolescent Reactions to Maternal Responsiveness and Internalizing Symptomatology: A Daily Diary Investigation.

A daily diary methodology was employed to gather teens' perceptions of maternal responsiveness to daily stressful events and teens' reactions to maternal responsiveness in a diverse sample (792 entries from 104 teens; 81% African American, mean age 13.7 years). Additionally, parents and teens completed baseline reports of internalizing symptoms. Diary findings were congruent with prior studies employing self-report measures of global maternal responses to emotion (e.g., higher probability of Accepting reactions to supportive responses, higher probabilities of Attack, Avoid-Withdraw reactions to non-supportive responses). Elevated baseline internalizing symptoms were related to perception of elevated Punish and Magnify responses during the week, and more Avoidant (Avoid-Withdraw and Avoid-Protect) reactions to responsiveness. Results are discussed in the context of reciprocal emotion socialization processes.

Intergenerational Transmission of Emotion Dysregulation Through Parental Invalidation of Emotions: Implications for Adolescent Internalizing and Externalizing Behaviors.

We examined parent emotion dysregulation as part of a model of family emotion-related processes and adolescent psychopathology. Participants were 80 parent-adolescent dyads (mean age = 13.6; 79 % African-American and 17 % Caucasian) with diverse family composition and socioeconomic status. Parent and adolescent dyads self-reported on their emotion regulation difficulties and adolescents reported on their perceptions of parent invalidation (i.e., punishment and neglect) of emotions and their own internalizing and externalizing behaviors. Results showed that parents who reported higher levels of emotion dysregulation tended to invalidate their adolescent's emotional expressions more often, which in turn related to higher levels of adolescent emotion dysregulation. Additionally, adolescent-reported emotion dysregulation mediated the relation between parent invalidation of emotions and adolescent internalizing and externalizing behaviors. Potential applied implications are discussed.

Perceptions of Parental Awareness of Emotional Responses to Stressful Life Events.

There is a need to better understand family processes related to recovery from past stressful life events. The present study aimed to investigate links between perceptions of parental awareness regarding stressful life events, continued event-related rumination, and current symptoms of depression. Students at a diverse, urban university completed a life events checklist and a semi-structured interview regarding family processing of stressful life events, as well as self-report measures of event-related rumination and depression. Results indicated that perceptions of mothers' and fathers' awareness of sadness regarding stressful life events as well as mothers' and fathers' verbal event processing predicted symptoms of event-related rumination and depression. Results support the inclusion of perceptions of parental awareness in the understanding of how emerging adults continue to cope with past stressful life events.

Pediatric oncologists' practices of prescribing selective serotonin reuptake inhibitors (SSRIs) for children and adolescents with cancer: a multi-site study.

OBJECTIVE: To survey pediatric oncologists regarding prescription of selective serotonin reuptake inhibitors (SSRIs) and related medications for the treatment of depression and anxiety disorders in children with cancer. Specifically, we sought to determine (a) how frequently pediatric oncologists prescribed SSRIs and what were the most commonly prescribed agents; (b) how decisions were made to prescribe, particularly whether mental health professionals were consulted; (c) how patients were monitored while on the agents; and (d) how the FDA black box warning has affected prescribing practices. METHOD: Oncologists from nine children's cancer centers (N = 151) from across the U.S. were surveyed, responding to either on-line or paper versions of a questionnaire developed for this study. RESULTS: A majority of oncologists (71%) reported prescribing SSRIs for their patients. Oncologists reported difficulties differentiating symptoms of depression from aspects of cancer treatment. Mental health practitioners are consulted occasionally but not routinely, and oncologists reported a need for increased mental health resources. Approximately half of oncologists (51%) reported that the FDA black box warning had not affected their practice. In addition, only 28% reported monitoring patients on SSRIs at FDA recommended intervals, and only 9% indicated assessing for suicidality. CONCLUSIONS: Prescription of SSRIs is a common practice of pediatric oncologists, often without consultation with mental health professionals. Post-prescription monitoring appears to be suboptimal, and does not follow FDA guidelines.

Emotion dysregulation as a mechanism through which parental magnification of sadness increases risk for binge eating and limited control of eating behaviors.

The present study examined whether emotion dysregulation mediates the relation between parent responses to emotion and disordered eating behaviors (e.g., binge eating and compensatory actions). One hundred eighteen college students (48% racial/ethnic minority; mean age=21) reported on their current difficulties regulating emotions, current disordered eating behaviors, and perceptions of their parents' responses to their emotions when they were growing up. Five parental response types to two emotions and three types of disordered eating behaviors (i.e., binge eating, compensatory actions, and lack of control) were assessed. Difficulties regulating emotion partially mediated the relation of parental magnification of sadness (i.e., matching with greater intensity) to binge eating and limited control of eating behaviors. This study identified a specific parenting practice which may contribute to the development of disordered eating behaviors and a potential mechanism to explain this relation. These findings also highlight family emotion-related processes as important for better understanding disordered eating behaviors.

Emotion regulation as a mediator of the relation between emotion socialization and deliberate self-harm.

This study examined (a) whether retrospective reports of specific parent responses to sadness (i.e., reward, punishment, neglect, override, magnification) were related to deliberate self-harm (DSH) and (b) whether difficulties regulating emotions (i.e., difficulties monitoring, evaluating, and modifying emotions) mediated those relations. One hundred eighteen college students completed measures of parental emotion socialization, emotion regulation difficulties, and DSH. Parental reward and override of sadness were directly related to lower DSH scores. Parental punishment and neglect of sadness were related to higher DSH scores, and these associations were mediated by difficulties evaluating emotions. In other words, parental punishment and neglect of sadness may place individuals at risk for DSH by fostering negative evaluations of emotional experiences and the belief that nothing can be done to effectively manage emotions.