Showing papers in "Journal of Abnormal Psychology in 2013"

Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women

Abstract: We examined prevalence, incidence, impairment, duration, and course for the proposed DSM-5 eating disorders in a community sample of 496 adolescent females who completed annual diagnostic interviews over 8 years. Lifetime prevalence by age 20 was 0.8% for anorexia nervosa (AN), 2.6% for bulimia nervosa (BN), 3.0% for binge eating disorder (BED), 2.8% for atypical AN, 4.4% for subthreshold BN, 3.6% for subthreshold BED, 3.4% for purging disorder (PD), and combined prevalence of 13.1% (5.2% had AN, BN, or BED; 11.5% had feeding and eating disorders not elsewhere classified; FED-NEC). Peak onset age was 19-20 for AN, 16-20 for BN, and 18-20 for BED, PD, and FED-NEC. Youth with these eating disorders typically reported greater functional impairment, distress, suicidality, mental health treatment, and unhealthy body mass index, though effect sizes were relatively smaller for atypical AN, subthreshold BN, and PD. Average episode duration in months ranged from 2.9 for BN to 11.2 for atypical AN. One-year remission rates ranged from 71% for atypical AN to 100% for BN, subthreshold BN, and BED. Recurrence rates ranged from 6% for PD to 33% for BED and subthrehold BED. Diagnostic progression from subthreshold to threshold eating disorders was higher for BN and BED (32% and 28%) than for AN (0%), suggesting some sort of escalation mechanism for binge eating. Diagnostic crossover was greatest from BED to BN. Results imply that the new DSM-5 eating disorder criteria capture clinically significant psychopathology and usefully assign eating disordered individuals to homogeneous diagnostic categories.

The relationship between nonsuicidal self-injury and attempted suicide: converging evidence from four samples.

Abstract: Theoretical and empirical literature suggests that nonsuicidal self-injury (NSSI) may represent a particularly important risk factor for suicide. The present study examined the associations of NSSI and established suicide risk factors to attempted suicide in four samples: adolescent psychiatric patients (n = 139), adolescent high school students (n = 426), university undergraduates (n = 1,364), and a random-digit dialing sample of United States adults (n = 438). All samples were administered measures of NSSI, suicide ideation, and suicide attempts; the first three samples were also administered measures of depression, anxiety, impulsivity, and borderline personality disorder (BPD). In all four samples, NSSI exhibited a robust relationship to attempted suicide (median Phi = .36). Only suicide ideation exhibited a stronger relationship to attempted suicide (median Phi = .47), whereas associations were smaller for BPD (median rpb = .29), depression (median rpb = .24), anxiety (median rpb = .16), and impulsivity (median rpb = .11). When these known suicide risk factors and NSSI were simultaneously entered into logistic regression analyses, only NSSI and suicide ideation maintained significant associations with attempted suicide. Results suggest that NSSI is an especially important risk factor for suicide. Findings are interpreted in the context of Joiner's interpersonal-psychological theory of suicide; specifically, NSSI may be a uniquely important risk factor for suicide because its presence is associated with both increased desire and capability for suicide.

Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: Longitudinal evidence in early adolescents and adults

Abstract: Rumination is a well-established risk factor for the onset of major depression and anxiety symptomatology in both adolescents and adults. Despite the robust associations between rumination and internalizing psychopathology, there is a dearth of research examining factors that might lead to a ruminative response style. In the current study, we examined whether social environmental experiences were associated with rumination. Specifically, we evaluated whether self-reported exposure to stressful life events predicted subsequent increases in rumination. We also investigated whether rumination served as a mechanism underlying the longitudinal association between self-reported stressful life events and internalizing symptoms. Self-reported stressful life events, rumination, and symptoms of depression and anxiety were assessed in 2 separate longitudinal samples. A sample of early adolescents (N = 1,065) was assessed at 3 time points spanning 7 months. A sample of adults (N = 1,132) was assessed at 2 time points spanning 12 months. In both samples, self-reported exposure to stressful life events was associated longitudinally with increased engagement in rumination. In addition, rumination mediated the longitudinal relationship between self-reported stressors and symptoms of anxiety in both samples and the relationship between self-reported life events and symptoms of depression in the adult sample. Identifying the psychological and neurobiological mechanisms that explain a greater propensity for rumination following stressors remains an important goal for future research. This study provides novel evidence for the role of stressful life events in shaping characteristic responses to distress, specifically engagement in rumination, highlighting potentially useful targets for interventions aimed at preventing the onset of depression and anxiety.

Constructing constructs for psychopathology: the NIMH research domain criteria.

Abstract: As a commentary for the special section on Reconceptualizing the Classification of Mental Disorders, this article begins with a description of the impetus for the U.S. National Institute of Mental Health's (NIMH) Research Domain Criteria (RDoC) initiative and provides an update of progress on that initiative to date. The commentary then engages the articles in this special section, beginning with a response to Berenbaum's concern that the RDoC approach to sorting constructs across multiple units of analysis espouses a de facto biological fundamentalism. This leads us to delineate the relationship between RDoC and the NIMH priorities relevant to this initiative. The commentary then considers how Patrick's iterative "construct-network" method can be applied to RDoC construct validation, highlighting several aspects that are particularly useful. One aspect of this work involves determining subject inclusion and exclusion criteria that provide an appropriate range of variance. Finally, this commentary considers the Bilder group's article, explicating the ways in which multilevel models can foster development of hypotheses and informatics approaches needed for further RDoC progress.

Common genetic influences on negative emotionality and a general psychopathology factor in childhood and adolescence.

Abstract: Previous research using confirmatory factor analysis to model psychopathology comorbidity has supported the hypothesis of a broad general factor (i.e., a "bifactor"; Holzinger & Swineford, 1937) of psychopathology in children, adolescents, and adults, with more specific higher order internalizing and externalizing factors reflecting additional shared variance in symptoms (Lahey et al., 2012; Lahey, van Hulle, Singh, Waldman, & Rathouz, 2011). The psychological nature of this general factor has not been explored, however. The current study tested a prediction, derived from the spectrum hypothesis of personality and psychopathology, that variance in a general psychopathology bifactor overlaps substantially-at both phenotypic and genetic levels-with the dispositional trait of negative emotionality. Data on psychopathology symptoms and dispositional traits were collected from both parents and youth in a representative sample of 1,569 twin pairs (ages 9-17 years) from Tennessee. Predictions based on the spectrum hypothesis were supported, with variance in negative emotionality and the general factor overlapping substantially at both phenotypic and etiologic levels. Furthermore, stronger correlations were found between negative emotionality and the general psychopathology factor than among other dispositions and other psychopathology factors.

The DSM-5 dimensional trait model and five-factor models of general personality.

Abstract: The current study tests empirically the relationship of the dimensional trait model proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) with five-factor models of general personality. The DSM-5 maladaptive trait dimensional model proposal included 25 traits organized within five broad domains (i.e., negative affectivity, detachment, antagonism, disinhibition, and psychoticism). Consistent with the authors of the proposal, it was predicted that negative affectivity would align with five-factor model (FFM) neuroticism, detachment with FFM introversion, antagonism with FFM antagonism, disinhibition with low FFM conscientiousness and, contrary to the proposal; psychoticism would align with FFM openness. Three measures of alternative five-factor models of general personality were administered to 445 undergraduates along with the Personality Inventory for DSM-5. The results provided support for the hypothesis that all five domains of the DSM-5 dimensional trait model are maladaptive variants of general personality structure, including the domain of psychoticism.

The structure of psychopathology: Toward an expanded quantitative empirical model.

Abstract: There has been substantial recent interest in the development of a quantitative, empirically based model of psychopathology. However, the majority of pertinent research has focused on analyses of diagnoses, as described in current official nosologies. This is a significant limitation because existing diagnostic categories are often heterogeneous. In the current research, we aimed to redress this limitation of the existing literature, and to directly compare the fit of categorical, continuous, and hybrid (i.e., combined categorical and continuous) models of syndromes derived from indicators more fine-grained than diagnoses. We analyzed data from a large representative epidemiologic sample (the 2007 Australian National Survey of Mental Health and Wellbeing; N = 8,841). Continuous models provided the best fit for each syndrome we observed (Distress, Obsessive Compulsivity, Fear, Alcohol Problems, Drug Problems, and Psychotic Experiences). In addition, the best fitting higher-order model of these syndromes grouped them into three broad spectra: Internalizing, Externalizing, and Psychotic Experiences. We discuss these results in terms of future efforts to refine emerging empirically based, dimensional-spectrum model of psychopathology, and to use the model to frame psychopathology research more broadly.

DSM-IV-TR and DSM-5 eating disorders in adolescents: prevalence, stability, and psychosocial correlates in a population-based sample of male and female adolescents.

Abstract: The current study aimed to compare the prevalence, stability, and psychosocial correlates of DSM-IV-TR and DSM-5 eating disorders, in a population-based sample of male and female adolescents followed prospectively from 14 to 20 years of age. Participants (N = 1,383; 49% male) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a prospective, population-based cohort study that has followed participants from prebirth to young adulthood. Detailed self-report questionnaires were used to assess eating disorder symptoms when participants were aged 14, 17, and 20 years. Comparisons between DSM-IV-TR and DSM-5 were conducted using McNemar chi-square tests and Fisher's exact tests. Changes in eating disorder prevalence over time were considered using generalized estimating equations. Eating disorder prevalence rates were significantly greater when using DSM-5 than DSM-IV-TR criteria, at all time points for females and at age 17 only for males. "Unspecified"/"other" eating disorder diagnoses were significantly less common when applying DSM-5 than DSM-IV-TR criteria, but still formed 15% to 30% of the DSM-5 cases. Diagnostic stability was low for all disorders, and DSM-5 binge eating disorder or purging disorder in early adolescence predicted DSM-5 bulimia nervosa in later adolescence. Cross-over from binge eating disorder to bulimia nervosa was particularly high. Regardless of the diagnostic classification system used, all eating disorder diagnoses were associated with depressive symptoms and poor mental health quality of life. These results provide further support for the clinical utility of DSM-5 eating disorder criteria, and for the significance of binge eating disorder and purging disorder.

Examination of the Section III DSM-5 diagnostic system for personality disorders in an outpatient clinical sample

Abstract: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013), includes a novel approach to the diagnosis of personality disorders (PDs) in Section III, to stimulate further research with the possibility that this proposal will be included more formally in future DSM iterations. This study provides the 1st test of this proposal in a clinical sample by simultaneously examining its 2 primary components: a system for rating personality impairment and a newly developed dimensional model of pathological personality traits. Participants were community adults currently receiving outpatient mental health treatment who completed a semistructured interview for DSM-IV PDs and were then rated in terms of personality impairment and pathological traits. Data on the pathological traits were also collected through self-reports using the Personality Inventory for DSM-5 (PID-5). Both sets of trait scores were compared with self-report measures of general personality traits, internalizing symptoms, and externalizing behaviors. Interrater reliabilities for the clinicians' ratings of impairment and the pathological traits were fair. The impairment ratings manifested substantial correlations with symptoms of depression and anxiety, DSM-5 PDs, and DSM-5 pathological traits. The clinician and self-reported personality trait scores demonstrated good convergence with one another, both accounted for substantial variance in DSM-IV PD constructs, and both manifested expected relations with the external criteria. The traits but not the impairment ratings demonstrated incremental validity in the prediction of the DSM-IV PDs. Overall, these results support the general validity of several of the components of this new PD diagnostic system and point to areas that may require further modification.

An examination of the triarchic conceptualization of psychopathy in incarcerated and nonincarcerated samples.

Abstract: The current study tested hypotheses associated with the triarchic conceptualization of psychopathy (Patrick, 2010b; Patrick, Fowles, & Krueger, 2009), which describes three distinctive, albeit related, phenotypic domains-boldness, meanness, and disinhibition. We used two samples consisting of 209 female prison inmates and 627 undergraduate students whom had been administered a range of psychopathy and psychopathy-relevant measures. Our results indicated that the triarchic domains explained variance in other psychopathy models to degrees consistent with conceptual expectations. We also examined associations between the triarchic domains and personality traits relevant to psychopathy in the female correctional sample. The results showed that boldness was preferentially associated with narcissism, thrill/adventure seeking, and low behavioral inhibition system functioning; meanness with machiavellianism, low empathy, and low behavioral inhibition system; and disinhibition with impulsivity and fun seeking.

The role of affect in the maintenance of anorexia nervosa: evidence from a naturalistic assessment of momentary behaviors and emotion.

Abstract: The current study examines the relationship of affect and eating disorder behavior in anorexia nervosa (AN) using ecological momentary assessment. Participants were 118 adult females recruited at three sites from eating disorder treatment centers and community advertisements. All participants met full Diagnostic and statistical manual of mental disorders (4th ed.) criteria or subthreshold criteria for AN. Participants were provided handheld computers and asked to report positive affect, negative affect, loss of control (LOC) eating, purging, exercise, drinking fluids to curb appetite, and weighing one's self multiple times per day as well as dietary restriction once daily over a 2-week interval. Mixed-effects models were used to examine the extent to which affective states predict dietary restriction. In addition, we used two analytic approaches to compare affect before and after other eating disorder behaviors. We found that higher daily ratings of negative affect were associated with a greater likelihood of dietary restriction on subsequent days. When examining the single rating immediately before and after behaviors, we found that negative affect increased significantly after LOC eating, purging, the combination of LOC and eating/purging, and weighing of one's self. Using this same analytic approach, we also found negative affect to decrease significantly after the consumption of fluids to curb appetite and exercise. When examining the covariation of AN behaviors and negative affect assessed multiple times in the hours and minutes before the behaviors, we found negative affect significantly increased before LOC eating, purging, the combination of LOC eating/and purging, and weighing behavior. Negative affect also significantly decreased after the occurrence of these behaviors. These findings are consistent with the idea that that negative affect is potentially a critical maintenance mechanism of some AN symptoms, but that the analytic approach used to examine affect and behavior may have significant implications on the interpretation of findings.

Attentional disengagement predicts stress recovery in depression: an eye-tracking study

Abstract: Previous research has made significant progress elucidating the nature of cognitive biases in emotional disorders. However, less work has focused on the relation among cognitive biases and emotional responding in clinical samples. This study uses eye-tracking to examine difficulties disengaging attention from emotional material in depressed participants and to test its relation with mood reactivity and recovery during and after a stress induction. Participants diagnosed with Major Depressive Disorder (MDD) and never-disordered control participants (CTL) completed a novel eye-tracking paradigm in which participants had to disengage their attention from emotional material to attend to a neutral stimulus. Time to disengage attention was computed using a direct recording of eye movements. Participants then completed a stress induction and mood reactivity and recovery were assessed. MDD compared with CTL participants took significantly longer to disengage from depression-related stimuli (i.e., sad faces). Individual differences in disengagement predicted lower recovery from sad mood in response to the stress induction in the MDD group. These results suggest that difficulties in attentional disengagement may contribute to the sustained negative affect that characterizes depressive disorders.

A construct-network approach to bridging diagnostic and physiological domains: application to assessment of externalizing psychopathology.

Abstract: A crucial challenge in efforts to link psychological disorders to neural systems, with the aim of developing biologically informed conceptions of such disorders, is the problem of method variance (Campbell & Fiske, 1959). Since even measures of the same construct in differing domains correlate only moderately, it is unsurprising that large sample studies of diagnostic biomarkers yield only modest associations. To address this challenge, a construct-network approach is proposed in which psychometric operationalizations of key neurobehavioral constructs serve as anchors for identifying neural indicators of psychopathology-relevant dispositions, and as vehicles for bridging between domains of clinical problems and neurophysiology. An empirical illustration is provided for the construct of inhibition-disinhibition, which is of central relevance to problems entailing deficient impulse control. Findings demonstrate that: (1) a well-designed psychometric index of trait disinhibition effectively predicts externalizing problems of multiple types, (2) this psychometric measure of disinhibition shows reliable brain response correlates, and (3) psychometric and brain-response indicators can be combined to form a joint psychoneurometric factor that predicts effectively across clinical and physiological domains. As a methodology for bridging between clinical problems and neural systems, the construct-network approach provides a concrete means by which existing conceptions of psychological disorders can accommodate and be reshaped by neurobiological insights.

Prediction of Psychopathology and Functional Impairment by Positive and Negative Schizotypy in the Chapmans’ Ten-year Longitudinal Study

Abstract: The present study examined the predictive validity of psychometrically assessed positive and negative schizotypy in the Chapmans’ 10-year longitudinal data set. Schizotypy provides a useful construct for understanding the etiology and development of schizophrenia and related disorders. Schizotypy and schizophrenia share a common multidimensional structure that includes positive and negative symptom dimensions. Recent cross-sectional studies have supported the validity of psychometric positive and negative schizotypy; however, the present study is the first to examine the predictive validity of these dimensions. The Chapmans’ longitudinal data provided an ideal opportunity because of the large sample size, high reassessment rate, and extended interval between assessments. A total of 534 psychometric high-risk and control participants were initially assessed, and 95% of this sample was reinterviewed 10 years later. As hypothesized, positive and negative schizotypy uniquely predicted the development of schizophrenia-spectrum disorders. At the reassessment, both positive and negative schizotypy predicted psychotic-like, schizotypal, and paranoid symptoms, as well as poorer adjustment. The positive dimension was associated with mood and substance use disorders and mental health treatment. Negative schizotypy was associated with schizoid symptoms and social impairment at the follow-up. The results extend the growing validity findings for psychometrically assessed positive and negative schizotypy by demonstrating that they are associated with the development of differential patterns of symptoms and impairment.

Language ability predicts the development of behavior problems in children.

Abstract: Prior studies have suggested, but not fully established, that language ability is important for regulating attention and behavior. Language ability may have implications for understanding attention-deficit hyperactivity disorder (ADHD) and conduct disorders, as well as subclinical problems. This article reports findings from two longitudinal studies to test (a) whether language ability has an independent effect on behavior problems, and (b) the direction of effect between language ability and behavior problems. In Study 1 (N = 585), language ability was measured annually from ages 7 to 13 years by language subtests of standardized academic achievement tests administered at the children's schools. Inattentive-hyperactive (I-H) and externalizing (EXT) problems were reported annually by teachers and mothers. In Study 2 (N = 11,506), language ability (receptive vocabulary) and mother-rated I-H and EXT problems were measured biannually from ages 4 to 12 years. Analyses in both studies showed that language ability predicted within-individual variability in the development of I-H and EXT problems over and above the effects of sex, ethnicity, socioeconomic status (SES), and performance in other academic and intellectual domains (e.g., math, reading comprehension, reading recognition, and short-term memory [STM]). Even after controls for prior levels of behavior problems, language ability predicted later behavior problems more strongly than behavior problems predicted later language ability, suggesting that the direction of effect may be from language ability to behavior problems. The findings suggest that language ability may be a useful target for the prevention or even treatment of attention deficits and EXT problems in children.

Facets of negative affect prior to and following binge-only, purge-only, and binge/purge events in women with bulimia nervosa.

Abstract: Ecological momentary assessment (EMA) data suggest that global negative affect (NA) increases prior to and decreases following episodes of binge eating and purging, providing support for the affect regulation model of BN. The current study examined whether facets of NA are differentially related to bulimic behaviors. Women with bulimia nervosa (BN; n = 133) completed a 2-week EMA protocol. Momentary assessments of 4 facets of NA (Fear, Guilt, Hostility, and Sadness) were derived from the PANAS subscales. Trajectories of the NA facets were modeled prior to and following binge-only, purge-only, and binge/purge events. Fear, Guilt, Hostility, and Sadness increased prior to and decreased following binge-only and binge/purge events. The same results were found for purge-only events, with the exception that Hostility did not increase significantly prior to purging. Notably, ratings of Guilt were higher than those of Fear, Hostility, and Sadness at the time of binge-only and binge/purge events. Furthermore, post hoc analyses demonstrate that Guilt increased prior to and decreased following the 3 behavior types, even after controlling for Fear, Hostility, and Sadness. These results provide further support for the affect regulation model of BN and also suggest that guilt may be particularly important to the pathology of BN.

The structure and predictive validity of the internalizing disorders.

Abstract: Multivariate comorbidity research indicates mood and anxiety (internalizing) disorders share one or more common liabilities, but categorical, dimensional, and hybrid accounts of these liabilities have not been directly compared. We modeled seven internalizing disorders in a nationally representative sample of 43,093 individuals via confirmatory factor, latent class, exploratory factor mixture, and exploratory structural equation modeling analyses. A two-dimensional (distress-fear) liability structure fit best and replicated across gender, assessment waves, and lifetime/12-month diagnoses. These liabilities, not disorder-specific variation, predicted future internalizing pathology, suicide attempts, angina, and ulcer.

The interactive effects of estrogen and progesterone on changes in emotional eating across the menstrual cycle.

Abstract: Studies suggest that within-person changes in estrogen and progesterone predict changes in binge eating across the menstrual cycle. However, samples have been extremely small (maximum N = 9), and analyses have not examined the interactive effects of hormones that are critical for changes in food intake in animals. The aims of the current study were to examine ovarian hormone interactions in the prediction of within-subject changes in emotional eating in the largest sample of women to date (N = 196). Participants provided daily ratings of emotional eating and saliva samples for hormone measurement for 45 consecutive days. Results confirmed that changes in ovarian hormones predict changes in emotional eating across the menstrual cycle, with a significant estradiol × progesterone interaction. Emotional eating scores were highest during the midluteal phase, when progesterone peaks and estradiol demonstrates a secondary peak. Findings extend previous work by highlighting significant interactions between estrogen and progesterone that explain midluteal increases in emotional eating. Future work should explore mechanisms (e.g., gene-hormone interactions) that contribute to both within- and between-subjects differences in emotional eating.

Quantifying the impact of recent negative life events on suicide attempts.

Abstract: The extent to which a specific negative life event (NLE) is a triggering factor for a suicide attempt is unknown. The current study used a case-crossover design, an innovative within-subjects design, to quantify the unique effects of recent NLEs on suicide attempts. In an adult sample of 110 recent suicide attempters, a timeline follow-back methodology was used to assess NLEs within the 48 hours prior to the suicide attempt. Results indicated that individuals were at increased odds of attempting suicide soon after experiencing a NLE and that this effect was driven by the presence of an interpersonal NLE, particularly those involving a romantic partner. Moreover, the relation between interpersonal NLEs and suicide attempts was moderated by current suicide planning. Interpersonal NLEs served as triggers for suicide attempts only among patients who were not currently planning their attempt. Findings suggest the importance of considering potential interpersonal NLEs when evaluating imminent risk for suicide attempts.

A psychophysiological investigation of threat and reward sensitivity in individuals with panic disorder and/or major depressive disorder.

Abstract: Heightened sensitivity to threat and reduced sensitivity to reward are potential mechanisms of dysfunction in anxiety and depressive disorders, respectively. However, few studies have simultaneously examined whether these mechanisms are unique or common to these disorders. In this study, sensitivity to predictable and unpredictable threat (measured by startle response during threat anticipation) and sensitivity to reward (measured by frontal electroencephalographic [EEG] asymmetry during reward anticipation) were assessed in 4 groups (N = 191): those with (1) panic disorder (PD) without a lifetime history of depression, (2) major depression (MDD) without a lifetime history of an anxiety disorder, (3) comorbid PD and MDD, and (4) controls. General distress/negative temperament (NT) was also assessed via self-report. Results indicated that PD (with or without comorbid MDD) was uniquely associated with heightened startle to predictable and unpredictable threat, and MDD (with or without comorbid PD) was uniquely associated with reduced frontal EEG asymmetry. Both psychophysiological measures of threat and reward sensitivity were stable on retest approximately 9 days later in a subsample of participants. Whereas the comorbid group did not respond differently on the tasks relative to the PD-only and MDD-only groups, they did report greater NT than these 2 groups (which did not differ from each other). Results suggest that heightened sensitivity to threat and reduced sensitivity to reward may be specific components of PD and MDD, respectively. In addition, relative to noncomorbid depression and PD, comorbid MDD and PD may be characterized by heightened NT, but not abnormal levels of these "specific" components.

Impaired cognitive empathy in criminal psychopathy: evidence from a laboratory measure of empathic accuracy.

Abstract: Empathy deficits feature prominently in theoretical accounts of psychopathy, yet studies that have examined various aspects of emotional processing related to empathy have produced a mixed body of findings We created a laboratory measure of cognitive empathy based on the empathic accuracy paradigm (ie, the ability to accurately infer others' emotions in a simulated interpersonal interaction) and used it to examine relationships between psychopathy (assessed with the Psychopathy Checklist-Revised) and cognitive empathy in a sample of incarcerated male offenders Psychopathy was inversely associated with empathic accuracy performance, as well as with the number of responses when rating the emotional states of others Empathic accuracy performance was most strongly associated with the behavioral/antisocial and lifestyle features of psychopathy When the emotional content of target vignettes was examined, psychopathy was associated with poorer empathic accuracy for negatively valenced emotions only (fear and sadness), although nonsignificant moderate effect sizes were also observed for joy Whereas the interpersonal/affective factor of psychopathy was associated with poor empathic accuracy for joy, the behavioral/antisocial factor was associated with poor overall empathic accuracy for negatively valenced emotions At the psychopathy facet level, the interpersonal and lifestyle features of psychopathy were associated with poor empathic accuracy for positively valenced emotions, whereas the affective and antisocial features of psychopathy were inversely associated with empathic accuracy for negatively valenced emotions In contrast to its association with poor empathic accuracy performance, psychopathy was not associated with ratings of perceived task difficulty

Tests of a direct effect of childhood abuse on adult borderline personality disorder traits: a longitudinal discordant twin design.

Abstract: We used a longitudinal twin design to examine the causal association between sexual, emotional, and physical abuse in childhood (before age 18) and borderline personality disorder (BPD) traits at age 24 using a discordant twin design and biometric modeling. Additionally, we examined the mediating and moderating effects of symptoms of childhood externalizing and internalizing disorders on the link between childhood abuse and BPD traits. Although childhood abuse, BPD traits, and internalizing and externalizing symptoms were all correlated, the discordant twin analyses and biometric modeling showed little to no evidence that was consistent with a causal effect of childhood abuse on BPD traits. Instead, our results indicate that the association between childhood abuse and BPD traits stems from common genetic influences that, in some cases, also overlap with internalizing and externalizing disorders. These findings are inconsistent with the widely held assumption that childhood abuse causes BPD, and they suggest that BPD traits in adulthood are better accounted for by heritable vulnerabilities to internalizing and externalizing disorders.

Avoidance processes mediate the relationship between rumination and symptoms of complicated grief and depression following loss.

Abstract: Ruminative coping has been associated with negative outcomes in bereavement. Rather than assuming it to be a problematic confrontation process, researchers have recently suggested rumination to be maladaptive through its links with avoidance processes. The main aim of this study was to examine, for the first time, whether the relationship between ruminative coping and symptoms of complicated grief and depression is mediated by avoidance processes (suppression, memory/experiential avoidance, behavioral avoidance, loss-reality avoidance). A sample of 282 adults (88% female, 12% male), bereaved on average 18 months previously, filled out three questionnaires at 6-month intervals. We assessed symptom levels, grief rumination, and trait rumination at baseline; avoidance processes after 6 months; and symptom levels after 12 months. When controlling for initial symptom levels, experiential avoidance mediated the link between grief rumination and complicated grief, and experiential avoidance and behavioral avoidance mediated the link between grief rumination and depression. Post hoc analyses showed suppression may also mediate the link between grief rumination and symptoms of complicated grief, but not depression. Loss-reality avoidance was no significant mediator of these relationships. This study provides initial evidence that rumination during bereavement increases and perpetuates symptoms of psychopathology, because it is linked with specific avoidance processes. Bereaved individuals with problematic grief and (chronic) rumination may benefit from therapy focused on countering avoidance tendencies.

Predictors of first lifetime onset of major depressive disorder in young adulthood.

Abstract: The first onset of major depressive disorder (MDD) most frequently occurs in young adulthood. However, few studies have examined predictors of first lifetime MDD during this high-risk period. The present study examined a broad range of demographic, clinical, and psychosocial variables as prospective predictors of first onset of MDD in a large community sample of young adults (N = 502) from the Oregon Adolescent Depression Project. Between ages 19-31, 35.3% of the sample had a first lifetime MDD episode. Female gender, familial loading of mood disorders, history of childhood sexual abuse, prior history of anxiety disorder, poor self-reported physical health, and subthreshold depressive symptoms significantly predicted MDD onset. In a multivariate model, female gender, familial loading of mood disorders, and subthreshold depression each contributed unique variance in predicting first lifetime MDD. This model had a moderate-to-large effect in predicting MDD onset. Gender did not moderate the other predictors, and the magnitude of the effects did not diminish over the course of the follow-up. These findings indicate that a number of risk factors significantly predict first lifetime MDD in young adulthood, and that simple multivariate risk models may be useful for identifying individuals at high risk for MDD.

Distinguishing healthy adults from people with social anxiety disorder: evidence for the value of experiential avoidance and positive emotions in everyday social interactions.

Abstract: Despite the increased attention that researchers have paid to social anxiety disorder (SAD), compared with other anxiety and mood disorders, relatively little is known about the emotional and social factors that distinguish individuals who meet diagnostic criteria from those who do not. In this study, participants with and without a diagnosis of SAD (generalized subtype) described their daily face-to-face social interactions for 2 weeks using handheld computers. We hypothesized that, compared with healthy controls, individuals diagnosed with SAD would experience fewer positive emotions, rely more on experiential avoidance (of anxiety), and have greater self-control depletion (feeling mentally and physically exhausted after socializing), after accounting for social anxiety, negative emotions, and feelings of belonging during social interactions. We found that compared with healthy controls, individuals with SAD experienced weaker positive emotions and greater experiential avoidance, but there were no differences in self-control depletion between groups. Moreover, the differences we found could not be attributed to comorbid anxiety or depressive disorders. Our results suggest that negative emotions alone do not fully distinguish normal from pathological social anxiety, and that assessing social anxiety disorder should include impairments in positive emotional experiences and dysfunctional emotion regulation (in the form of experiential avoidance) in social situations.

Smoker reactivity to cues: effects on craving and on smoking behavior.

Abstract: We assessed craving and smoking in response to smoking-relevant cues. Two hundred seven daily smokers viewed images related to 1 of 6 cue sets (cigarettes, positive and negative affect, alcohol, smoking prohibitions, and neutral cues) in separate sessions. Compared with neutral cues, cigarette cues significantly increased craving, and positive affect cues significantly decreased craving. When subjects were then allowed to smoke during continuing cue exposure, cues did not affect the likelihood of smoking or the amount smoked (number of cigarettes, number of puffs, puff time, or increased carbon monoxide). However, craving intensity predicted likelihood of smoking, latency to smoke, and amount smoked, with craving increases after cue exposure making significant independent contributions. Some craving effects were curvilinear, suggesting that they are subject to thresholds and might not be observed under some circumstances.

Quarrelsome behavior in borderline personality disorder: influence of behavioral and affective reactivity to perceptions of others

Abstract: We examined how the amplification of 3 within-person processes (behavioral reactivity to interpersonal perceptions, affect reactivity to interpersonal perceptions, and behavioral reactivity to a person's own affect) accounts for greater quarrelsome behavior among individuals with borderline personality disorder (BPD). Using an event-contingent recording (ECR) methodology, individuals with BPD (N = 38) and community controls (N = 31) reported on their negative affect, quarrelsome behavior, and perceptions of the interaction partner's agreeable-quarrelsome behavior in interpersonal events during a 20-day period. Behavioral reactivity to negative affect was similar in both groups. However, behavioral reactivity and affect reactivity to interpersonal perceptions were elevated in individuals with BPD relative to community controls; specifically, individuals with BPD reported more quarrelsome behavior and more negative affect during interactions in which they perceived others as more cold-quarrelsome. Greater negative affect reactivity to perceptions of other's cold-quarrelsome behavior partly accounted for the increased quarrelsome behavior reported by individuals with BPD during these interactions. This pattern of results suggests a cycle in which the perception of cold-quarrelsome behavior in others triggers elevated negative affect and quarrelsome behavior in individuals with BPD, which subsequently led to more quarrelsome behavior from their interaction partners, which leads to perceptions of others as cold-quarrelsomeness, which begins the cycle anew.

Exploring the relationship between negative urgency and dysregulated eating: etiologic associations and the role of negative affect.

Abstract: Negative urgency (i.e., the tendency to engage in rash action in response to negative affect) has emerged as a critical personality trait contributing to individual differences in binge eating. However, studies investigating the extent to which genetic and/or environmental influences underlie the effects of negative urgency on binge eating are lacking. Moreover, it remains unclear whether negative urgency-binge eating associations are simply a result of the well-established role of negative affect in the development/maintenance of binge eating. The current study addresses these gaps by examining phenotypic and etiologic associations between negative urgency, negative affect, and dysregulated eating (i.e., binge eating, emotional eating) in a sample of 222 same-sex female twin pairs from the Michigan State University Twin Registry. Negative urgency was significantly associated with both dysregulated eating symptoms, even after controlling for the effects of negative affect. Genetic factors accounted for the majority (62-77%) of this phenotypic association, although a significant proportion of this genetic covariation was due to genetic influences in common with negative affect. Nonshared environmental factors accounted for a relatively smaller (23-38%) proportion of the association, but these nonshared environmental effects were independent of negative affect. Findings suggest that the presence of emotion-based rash action, combined with high levels of negative affect, may significantly increase genetic risk for dysregulated eating.

Cognitive factors maintaining persecutory delusions in psychosis: the contribution of depression.

Abstract: Depression is common in people with schizophrenia, but how it might directly contribute to the persistence of psychotic symptoms has rarely been tested. The key aim of the present study was to test whether depression and associated cognitive processes predict the maintenance of persecutory delusions. Three groups of participants were tested at baseline: 60 patients with persecutory delusions in the context of a schizophrenia spectrum diagnosis, 30 patients with depression, and 30 nonclinical controls. They completed interviewer and self-report assessments of depression and paranoia, and measures of six cognitive factors (schematic beliefs, experiential avoidance, autobiographical memory, problem solving, rumination, worry style). The patients with persecutory delusions were then assessed again, six months later. It was found that 50% of the patients with persecutory delusions met diagnostic criteria for major depression. Cognitive processes found to be associated with depression across the groups were negative schematic beliefs about the self, experiential avoidance and rumination, but not autobiographical memory or problem solving. The severity of initial depression in patients with persecutory delusions predicted the persistence of paranoia over six months. A number of cognitive factors also predicted the persistence of persecutory delusions, including negative schematic beliefs about the self, worry, and problem-solving difficulties. In conclusion, depression is common in patients with current persecutory delusions, and it shows similar cognitive features to major depressive disorder. The results of this study indicate that depression and related processes may contribute to the maintenance of paranoia. Trials are warranted of depression-related therapeutic techniques for people with persecutory delusions.

Suicide attempts in women with eating disorders.

Abstract: We evaluated whether the prevalence of lifetime suicide attempts/completions was higher in women with a lifetime history of an eating disorder than in women with no eating disorder and assessed whether eating disorder features, comorbid psychopathology, and personality characteristics were associated with suicide attempts in women with anorexia nervosa, restricting subtype (ANR), anorexia nervosa, binge-purge subtype (ANBP), lifetime history of both anorexia nervosa and bulimia nervosa (ANBN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD). Participants were part of the Swedish Twin study of Adults: Genes and Environment (N = 13,035) cohort. Lifetime suicide attempts were identified using diagnoses from the Swedish National Patient and Cause of Death Registers. General linear models were applied to evaluate whether eating disorder category (ANR, ANBP, ANBN, BN, BED, PD, or no eating disorder [no ED]) was associated with suicide attempts and to identify factors associated with suicide attempts. Relative to women with no ED, lifetime suicide attempts were significantly more common in women with all types of eating disorder. None of the eating disorder features or personality variables was significantly associated with suicide attempts. In the ANBP and ANBN groups, the prevalence of comorbid psychiatric conditions was higher in individuals with than without a lifetime suicide attempt. The odds of suicide were highest in presentations that included purging behavior (ANBN, ANBN, BN, and PD), but were elevated in all eating disorders. To improve outcomes and decrease mortality, it is critical to be vigilant for suicide and identify indices for those who are at greatest risk.