James C. Hamilton

The Utian Quality of Life (UQOL) Scale: Development and validation of an instrument to quantify quality of life through and beyond menopause

ObjectiveQuality of life (QOL) is an outcome variable requiring measurement in clinical care or pivotal regulatory trial research. Current menopause QOL measures are mostly life phase or disease symptom inventories or scores. Believing that QOL should refer more to “sense of well-being,” we have developed the Utian QOL scale (UQOL) that is strongly based on perception of sense of well-being as distinct from menopausal symptoms. DesignA pool of items sampling various aspects of well-being was developed. Peri- and postmenopausal women (n = 327) responded to the items, and their responses were subjected to a factor analysis. Four factors emerged, each representing a QOL domain. The resulting 23-item instrument was validated in a geographically and socioeconomically diverse sample of peri- and postmenopausal women using the Short Form-36, an established, frequently used QOL inventory. QOL domains were subjected to confirmatory factor analyses, formal item analysis was completed, and the measure was assessed for reliability and validity, including a second sample of women (n = 270). ResultsWomen (n = 597; mean age, 52.9 years) from 12 communities across the United States completed the measure. The UQOL seems to reflect four components of QOL: occupational QOL, health QOL, emotional QOL, and sexual QOL. The questionnaire and scoring system are presented. ConclusionWe are reporting on the process of validating an instrument for quantifying sense of well-being in a perimenopausal population. Substantial reliability and validity estimates for the scale and its subscales support the UQOL as a valuable new tool for use in clinical research and practice.

Preliminary evidence for the role of self-regulatory processes in sensation seeking

Two possible motives for sensation seeking behavior, escape from self-awareness and compensatory self-regulation, were investigated in two studies. In Study I a questionnaire was developed to identify the putative escape and compensation motives suspected to contribute to sensation seeking behaviors. In Study II the factor structure of this new measure, called the Risk and Excitement Inventory (REI), was cross-validated using confirmatory factor analysis, and construct validity was examined. Together these studies suggest that the REI comprises two reliable factors, compensation and escape from self-awareness. Study II showed that these factors have a reasonable degree of construct validity. Limits of the measure and the model are discussed, and suggestions are offered for future research.

Somatoform, factitious, and related diagnoses in the national hospital discharge survey: addressing the proposed DSM-5 revision.

BACKGROUND The DSM-5 working group on the somatoform (SFD) and factitious (FD) disorders has recommended substantial revisions of these categories. The recommendations are based, in part, on anecdotal evidence that the diagnoses are infrequently used. OBJECTIVE To assess the assignment rates for SFD, FD, and related diagnoses among general medical inpatients. METHOD The National Hospital Discharge Survey was queried for instances of SFD and FD, along with related diagnoses identifying medical cases in which psychological factors play a role. Diagnoses of major depression and generalized anxiety disorder were queried for comparison purposes. RESULTS The target diagnoses were assigned far less frequently than published prevalence and recognition rates suggest. Nearly half of the assigned target diagnoses were generic diagnoses (esp. physiological malfunction due to psychological factors) other than SFD or FD. However, the apparent degree of underassignment of the target diagnoses was not dramatically greater than the underassignment observed for major depression and generalized anxiety disorder. CONCLUSION The results provide empirical support for the impression that physicians do not assign SFD and FD diagnoses in recognized cases, but do not strongly support the assertion that these diagnoses are uniquely problematic.

Serial factitious disorder and Munchausen by proxy in pregnancy

Factitious disorder, including Munchausen syndrome, is seldom documented among pregnant patients but can have powerful consequences. We report on a 44‐year‐old woman who, over a period of two decades, self‐induced labour and delivery in five consecutive pregnancies. She precipitated labour by rupturing her own amniotic sac with a fingernail or cervical manipulation, or misappropriating and self‐administering prostaglandin suppositories from the hospital unit on which she worked as a nurse. Preterm deliveries resulted in fetal demise in one case and in neonatal intensive care treatment for two of the offspring. One of the surviving children has cerebral palsy attributable to the mothers factitious illness behaviour, which raises the spectre of Munchausen by proxy maltreatment. The patient sought attention and care through the ruses, which have never been uncovered by her obstetric and gynaecologic caregivers. Indeed, she underwent an unnecessary hysterectomy because of the illusion of heavy menstrual bleeding. Most recently, the patient has been engaging in surreptitious autophlebotomy to force blood transfusions.

The role of perceived sleep norms in subjective sleep appraisals and sleep-related illness behavior

The present investigation sought to extend extant research on subjective sleep complaints by examining their relation to perceived sleep norms. Results from two studies showed that individuals’ distress and illness behavior in response to symptoms of fatigue and non-restorative sleep was influenced by their perceptions of peer norms for those symptoms. Individuals who believed they experienced a greater degree of fatigue and non-restorative sleep than their peers reported more distress arising from those symptoms, and were also more likely to seek social support and medical treatment for them. Furthermore, participants who scored higher in neuroticism were more likely to believe they experienced worse fatigue and non-restorative sleep than their peers, and thus reported higher symptom-related distress, and higher likelihood of engaging in illness behaviors. These results provide preliminary evidence of the clinical relevance of perceived norms in the way individuals respond to and manage sleep related problems.

Family Experience in a Regional Participant Contact Registry for Research on Intellectual Disability.

Participant recruitment is one of the most significant challenges in research on intellectual disability (ID). One potential solution is to develop a participant contact registry, which allows the researcher to contact participants directly rather than recruiting through multiple schools or service agencies. The authors describe the development of one such registry and results of a survey of registry families. Results suggest that families joined the registry to help others, they hope research in the ID field improves the daily lives of individuals with ID and their families, and they find research participation to be a positive experience. However, logistic concerns can be an important barrier to their research participation, and they would like more information about the research study both before and after participating.

How do videogame players identify their actions? Integrating Action Identification Theory and videogame play via the Behavior Identification Form - Gamer

Abstract How does a videogame player identify the actions of their character in a videogame, and do those identifications have meaningful implications or effects on cognition? The principles of Action Identification Theory (Vallacher & Wegner, 1985) were utilized in the present research to understand how players identify their actions when playing a violent videogame. A new measure, the Behavior Identification Form – Gamer, was created and tested for reliability and validity across three studies. The BIF-G demonstrated acceptable reliability along with convergent and incremental validity from the original Behavioral Identification Form. Results indicated that those who played videogames more, as well as those who, played more diverse types of videogames, thought of their game actions more abstractly than those who played less or played fewer types. In addition, those who thought of their game actions more abstractly performed better while playing games compared to those who viewed actions more concretely. The implications of these results are applied to the current debate regarding violent videogame plays impact on aggressive thoughts and actions. The utility of viewing this relationship through the lens of Action Identification Theory is also discussed.

The Behavioral Treatment of Suspected Conversion Disorder in Children: Providing an Exit Strategy

ABSTRACT We describe the treatment of a preadolescent who presented with nonepileptic seizures. He had received a diagnosis of conversion disorder from the referring provider. We implemented a treatment strategy that construed a negative reinforcer of the absence of seizure-like behaviors (restricting then reintroducing screen time contingent upon seizure-free status) as an active neurological treatment (resting his brain) for his seizures. His seizures abated immediately and had not returned at 1-month or 1-year follow-up. The case illustrates the importance of providing face-saving ways for patients to relinquish the sick role. We also discuss possible alternative approaches to diagnosis in cases like this one. Specifically, we address negative consequences of biases in the Diagnostic and Statistical Manual of Mental Disorders that promote the view that excessive illness behavior is the product of unconscious processes and that discourage recognition that the illness behavior may be intentional and strategic.

Factitious Disorder, Munchausen Syndrome, Munchausen by Proxy, and Malingering

This article describes psychological disorders involving exaggerated, fabricated, simulated, and induced medical problems. Factitious disorder and Munchausen syndrome are characterized by feigning or inducing illness or injury in oneself for primarily psychological benefits. Factitious disorder imposed on another and Munchausen by proxy are characterized by feigning or inducing illness or injury in another person, most commonly a child or dependent adult, for primarily psychological benefits. Malingering, although not a psychiatric diagnosis, is characterized by feigned illness or injury for primarily material benefits.