Astrid Bock

[Facial expressions of negative emotions in clinical interviews: The development, reliability and validity of a categorical system for the attribution of functions to facial expressions of negative emotions].

OBJECTIVES The development (Study 1) and validation (Study 2) of a categorical system for the attribution of facial expressions of negative emotions to specific functions. METHOD The facial expressions observed inOPDinterviews (OPD-Task-Force 2009) are coded according to the Facial Action Coding System (FACS; Ekman et al. 2002) and attributed to categories of basic emotional displays using EmFACS (Friesen & Ekman 1984). In Study 1 we analyze a partial sample of 20 interviews and postulate 10 categories of functions that can be arranged into three main categories (interactive, self and object). In Study 2 we rate the facial expressions (n=2320) from the OPD interviews (10 minutes each interview) of 80 female subjects (16 healthy, 64 with DSM-IV diagnosis; age: 18-57 years) according to the categorical system and correlate them with problematic relationship experiences (measured with IIP,Horowitz et al. 2000). RESULTS Functions of negative facial expressions can be attributed reliably and validly with the RFE-Coding System. CONCLUSIONS The attribution of interactive, self-related and object-related functions allows for a deeper understanding of the emotional facial expressions of patients with mental disorders.

Levels of Structural Integration and Facial Expressions of Negative Emotions

OBJECTIVES For a clinically relevant understanding of facial displays of patients with mental disorders it is crucial to go beyond merely counting frequencies of facial expressions, but include the contextual information of the expression. We assume that patients with different levels of structural integration differ in the contextual embedding of their negative facial expressions of emotions. METHODS Facial affective behaviour of 80 female participants during an OPD interview was analysed using FACS (Facial Action Coding System) and the RFE coding system (Referencesof- Facial-Expression coding system; Bock et al. 2015).Using the RFE coding system, 2192 negative facial expressions of emotions were attributed to different references (e.g., interactive, self-related, object-related) by relying on contextual variables. RESULTS Pure frequency of negative facial affect was not related to level of structural integration. Negative facial expressions of emotions directed towards the interviewer (interactive reference), as well as negative facial expressions directed towards the displayers whole self were associated with lower levels of structural integration. In contrast, negative facial affects directed to single aspects of the self, to single aspects of objects, or to external situations were associated with higher levels of structural integration. CONCLUSIONS The differentiation of references of facial affective behavior allows a deeper understanding of the connection between facial displays and structural levels of psychic integration.

Written on the Face: Self- and Expert-Rated Impairments in Personality Functioning Are Differently Related to the Expression of Disgust Toward an Interviewer

Although current theories suggest that impairments in personality functioning are at the core of personality pathology, there is a lack of research on how these impairments play out behaviorally. The aim of the present study was to investigate disgust expressions as indicators of personality dysfunction. Facial expressions were investigated in a sample of 78 female participants during an in-depth clinical interview and coded with the Facial Action Coding System. Personality dysfunction was assessed with self- and expert ratings. By applying a joint regression analysis, the authors found that disgust expressions toward the interviewer were positively associated with expert ratings but negatively associated with self-ratings. In other words, disgust expressions were indicative of an underestimation of personality dysfunction by participants as compared with experts. This suggests that interactional expressions of disgust might be a behavioral marker of personality dysfunction when individuals are unaware of or deny impairments.

Prävalenz und Charakteristika von Mobbingerfahrungen in einer klinischen Stichprobe von Jugendlichen

Prevalence and characteristics of peer victimisation in adolescent psychiatric inpatients Abstract. OBJECTIVE Repeated and long-lasting victimisation, as defined by bullying, represents a wide spread health hazard. The aim of the present study was to present the prevalence of bullying in adolescent psychiatric inpatients. We analysed relations between bullying and sociodemographic and psychopathological variables. Furthermore, we investigated the number and nature of bullies, feasible resources, and parental perception on bullying in adolescence. METHOD In total, 128 adolescent inpatients were surveyed with a bullying questionnaire and youth self-report. In addition, their clinical symptomatology was investigated. RESULTS Bullying affected one third of our sample. Male and female victims showed significantly more internal problems. Girls in addition revealed more external behaviour problems. Unlike non-suicidal, self-harming behaviour, suicidal ideation and suicidal behaviour occurred significantly more in patients with bullying experience. CONCLUSION A significant number of adolescent in our sample experienced bullying and associated psychological strains. This should especially be considered in child and adolescent anamnesis.

Pathological Internet Use—An Important Comorbidity in Child and Adolescent Psychiatry: Prevalence and Correlation Patterns in a Naturalistic Sample of Adolescent Inpatients

Background Few studies have examined the prevalence of problematic internet use (PIU) in young people undergoing inpatient treatment in child and adolescent psychiatry centers. The aims of our study were thus (a) to assess the frequency of comorbid PIU in a sample of adolescent psychiatric inpatients and compare it with a control group of nonreferred adolescents and (b) to gain insights into correlations between PIU and psychiatric comorbidities. Methods 111 child and adolescent psychiatry inpatients (CAP-IP, mean age 15.1 ± 1.4 years; female : male 72.4% : 27.6%) undergoing routine psychodiagnostics were screened for the presence of PIU. The widely used Compulsive Internet Use Scale (CIUS) was chosen for this purpose. Prevalence rates of PIU were then compared to matched nonreferred control subjects from a school sample. Additionally, comorbidities of inpatients with PIU were compared to inpatients without PIU. Results Our inpatient sample showed a much higher prevalence of PIU than that found in previous populational samples of young people. Compared with a matched school sample, addictive internet use was 7.8 times higher and problematic internet use 3.3 times higher among our adolescent sample. PIU was significantly associated with characteristic patterns of psychopathology, that is, suicidality, difficulties in establishing stable and consolidated identity, and peer victimization. Conclusion PIU among adolescents undergoing inpatient psychiatric treatment is much more frequent than among their peers in the general population and is associated with specific patterns of psychopathology.

NONSUICIDAL SELF-INJURY IN A NATURALISTIC SAMPLE OF ADOLESCENTS UNDERGOING INPATIENT PSYCHIATRIC TREATMENT: PREVALENCE, GENDER DISTRIBUTION AND COMORBIDITIES

BACKGROUND A growing body of research points toward nonsuicidal self-injury (NSSI) in adolescents as an important and frequent health-related risk factor. In 2013, NSSI was proposed in section 3 of the DSM-5 as a new diagnostic entity warranting further study. In line with that goal, the present study was conducted in order to evaluate prevalence, gender distribution and comorbidities of NSSI in a sample of adolescent psychiatric inpatients. SUBJECTS AND METHODS The study included 130 adolescents (mean age 15.09 years, SD ± 1.47; 71.5% female) undergoing inpatient psychiatric treatment at a specialized facility. The factors assessed were sociodemographic data, the presence of NSSI according to the proposed DSM-5 criteria, clinical psychiatric diagnosis, the presence of suicidality and the presence of personality disorder. RESULTS A large percentage, 38.5%, of the sample fulfilled DSM-5 criteria for NSSI, and more than half (50.8%) of the adolescents indicated having injured themselves at least once in the past. Patients with NSSI were predominantly young women and clustered in a spectrum of diagnostic entities including not only borderline personality disorders but also substance use disorders and affective disorders. A strong association was found between suicidality (suicidal ideation, history of suicide attempt) and NSSI. CONCLUSIONS In line with previous findings, NSSI among adolescent psychiatric inpatients was found to be a frequent phenomenon associated with a broad spectrum of comorbidities. Moreover, while NSSI is conceptualized as an act without suicidal intent, it commonly occurs in patient groups with suicidal ideation or with a history of suicide attempts.

Mentalisierungsbasierte Therapie einer Jugendlichen mit Störung des Sozialverhaltens

Mentalization Based Treatment of an Adolescent Girl with Conduct Disorder This paper will give a short overview on the theoretical concept of mentalization and its specific characteristics in adolescence. A previous study on Mentalization based treatment for adolescents (MBT-A) demonstrated the effectiveness of MBT-A for the treatment of adolescents with symptoms of deliberate self-harm (Rossouw u. Fonagy, 2012). Based on the results of this study Taubner, Gablonski, Sevecke, and Volkert (in preparation) developed a manual for mentalization based treatment for adolescents with conduct disorders (MBT-CD). This manual represents the foundation for a future study on the efficacy of the MBT-A for this specific disorder in young people. The present case report demonstrates the application of specific MBT interventions, as well as the therapeutic course over one year in a 16-year old girl who fulfilled all criteria of a conduct disorder. During the course of treatment, the de-escalating relationship-oriented therapeutic approach can be considered as a great strength of MBT-A, especially for patients with conduct disorders. The clinical picture, as well as the psychological assessment, showed a positive progress over the course of treatment. Despite frequent escalations, forced placements due to acute endangerment of self and others, and a precarious situation with the patients place of residence towards the end of therapy, MBT-A treatment enabled the patient to continually use the evolved mentalizing capabilities as a resource.