Consistency of reporting sexual and physical abuse during psychological treatment of personality disorder: an explorative study.

The objective of this study was to assess the prevalence of decreasing, consistent and increasing reports of sexual and physical abuse after 12 months of long-term psychological treatment of personality disorders, to investigate demographic and clinical characteristics predictive of inconsistency of reporting abuse, and to explore whether autobiographical memory may account for this inconsistency. In 229 clinical participants with an SCID II diagnosed personality disorder, 180 (78.6%) reported the same instances of invasive sexual and/or physical abuse on a trauma questionnaire (SPAQ) at baseline and follow-up, 25 (10.9%) decreased and 24 (10.4%) increased their abuse reports. Consistency of reporting abuse did not differ between schema-focused therapy, clarification-oriented psychotherapy and treatment-as-usual. Current depressive episode (SCID-I) and decreased capacity to produce specific negative memories on the Autobiographical Memory Test were characteristic of decreasing abuse reporters, while increasing abuse reporters showed higher levels of Cluster A personality pathology (in particular schizotypal traits) on the Assessment of DSM-IV Personality Disorders (ADP-IV). These results suggest that even in treatment procedures directed at exploring someone's personal past with abuse-related imagery consistency of reporting abuse is quite stable. However, certain clinical characteristics may make some persons more likely to change their trauma reports. Moreover, reduced negative memory specificity may represent an avoidant strategy associated with no longer reporting instances of abuse.

Effects of sad mood on autobiographical memory in older adults with and without lifetime depression.

OBJECTIVES: The main objective of this study was to determine whether reduced autobiographical memory specificity is also a marker for depression in older adults. To answer this question two experiments and a prospective longitudinal clinical study were executed with the autobiographical memory task (AMT) as measure for memory specificity. The objective of the 1st experimental study was to assess the influence of a negative mood induction versus the effect of multiple testing in a neutral condition in 58 never depressed (ND) elderly. In the 2nd experimental study a negative mood was induced in 63 participants remitted from depression (RD) compared to 60 matched ND controls. All participants were 55 and older. Lastly, the predictive value of the AMT for the course of depressive symptoms was assessed in the RD individuals over a 14-17 months follow-up (FU) period. RESULTS: Performance did not improve with repeated testing, but a trend was found suggesting fatigue. There was no difference between the RD and ND group on baseline AMT. The mood induction had no effect on the AMT regardless of clinical history. Changes in the level of depressive symptoms at the 14-month FU were predicted by residual symptoms at baseline and the number of previous depressive episode, but not by baseline AMT, changes in AMT or mood after mood induction. CONCLUSION: The results of this study suggest that memory specificity on the AMT may not be a useful marker for vulnerability for clinical depression in older adults.

Word use of outpatients with a personality disorder and concurrent or previous major depressive disorder.

In a recent study, Rude, Gortner, and Pennebaker (2004) found word use to be related to depression and vulnerability to depression in the essays of college students. We sought to replicate and extend these findings in a clinical sample. Written essays of 304 psychiatric outpatients with a personality disorder and a mixed psychiatric profile on DSM-IV axis-I and 108 healthy controls were examined with word count software. Data on the tendency to be discrepant about the current self compared to a more ideal self were also gathered. We found that psychiatric outpatients in general used more words referring to the self and negative emotion words and fewer positive emotion words, compared to healthy controls. However, word-use proved unrelated to depression specifically. Actual-ideal self discrepancies were related to patient status and to current depression. Contrary to our hypothesis, these discrepancies did not correlate with the use of words referring to the self. We conclude that the negative content and self-focus of written essays and high levels of discrepancy reflect a negative thinking style that is common to a range of psychiatric disorders rather than being specific to depression.

Reduced specificity of autobiographical memory in Cluster C personality disorders and the role of depression, worry, and experiential avoidance.

The study objective was to investigate whether, compared with nonclinical controls, participants with an avoidant, dependent, or obsessive-compulsive Cluster C personality disorder (PD) manifested reduced levels of memory specificity and whether the association of Cluster C PDs with memory specificity is mediated by repetitive negative thoughts and experiential avoidance. The Autobiographical Memory Test (R. J. McNally, N. B. Lasko, M. L. Macklin, & R. K. Pitman, 1995) was administered along with self-report measures (translated into Dutch) for repetitive, uncontrollable, and negative thinking in the form of worry (Penn State Worry Questionnaire; T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec, 1990) and experiential avoidance (Acceptance and Action Questionnaire; S. C. Hayes et al., 2004) to 294 clinical participants diagnosed with Axis I disorders (assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders [SCID-I]; M. B. First, R. L. Spitzer, M. Gibbon, & J. B. W. Williams, 1994) and Axis II disorders (assessed with the SCID-II; M. B. First, R. L. Spitzer, M. Gibbon, & J. B. W. Williams, 1997)--202 with avoidant, 49 with dependent, and 120 with obsessive-compulsive PD--and to 108 matched nonclinical controls. Participants with a Cluster C PD showed lower levels of memory specificity than did nonclinical controls. Depression and worry mediated the effect of Cluster C PDs on memory specificity. Besides depression severity, repetitive, uncontrollable, and negative thinking may constitute a general mechanism mediating the association of various Axis I and II disorders with memory specificity.

Different flying histories in flying phobics: association with psychopathology and treatment outcome.

INTRODUCTION: Passengers experiencing fear of flying can threaten the safety of a flight, its passengers, and crew. In the present study we investigated the effect of different flying histories on the nature and treatment of fear of flying and attempted to determine the following: 1) the prevalence of different flying histories in a sample of self-referred flying phobics; 2) the demographic and psychopathologic characteristics of flying phobics differing with respect to flying history; and 3) the predictive value of different flying histories for treatment outcome. METHODS: Of 2001 self-referred adults who applied for a flying treatment program, 85.6% reported that they had flown before and that their flights had been uneventful; 8.7% had no previous experience with flying; 5.7% had flown before and had experienced an eventful (5.4%) or even a traumatic flight (0.3%). RESULTS: Participants who had never flown before reported higher levels of fear of flying (FAS, FAM, VAFAS), agoraphobia (FSS-III), and general anxiety (SCL-90). Moreover, these subjects showed significantly more anxiety reduction following a 1- or 2-d group treatment than the other participants (statistically corrected for any pretreatment differences). CONCLUSIONS: For participants who had never flown before, anxiety probably primarily reflects more generalized avoidance tendencies and a proneness to over-predict the magnitude and intensity of their fear.

Personality disorders in the elderly compared to four younger age groups: a cross-sectional study of community residents and mental health patients.

The notion is expressed in the DSM-IV that some personality disorders (PDs) tend to remit with age whereas other types do not. This notion is supported by the literature and the study reported here. Studies published between 1951 and 2000 show that (1) in old age, PDs are prevalent both in normal subjects and to a greater extent in the mentally ill; (2) the evidence for general age-relatedness of PDs is scarce and contradictory; (3) there is evidence for specific age-relatedness of PDs in old age. This empirical study focused on the prevalence of PDs in five different age groups ranging from adolescence to old age. It included both community residents (N = 623, aged 17-87), and mental health patients (N = 315, aged 18-86). Dimensional scores for PDs were assessed by means of the DSM-III-R- and ICD-10- based self-report Questionnaire of Personality Traits (VKP) (Duijsens, Eurelings-Bontekoe & Diekstra, 1996). There was consistent evidence for a specific effect of aging: community residents in the oldest age group reported more schizoid and more obsessive-compulsive characteristics compared to one or more of the younger age groups. Older mental health patients showed more schizoid disorder characteristics and fewer high-energy disorder characteristics compared to one or more of the younger patient groups.