Jessica R. Grisham

Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.

The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.

Obsessions and Compulsions in the Community: Prevalence, Interference, Help-Seeking, Developmental Stability, and Co-Occurring Psychiatric Conditions

OBJECTIVE It is unclear how many people in the community have obsessions and compulsions and associated levels of interference. It is also unknown what variables predict help-seeking for these symptoms, whether they are developmentally stable, and whether they increase the risk of mental disorders. METHOD The authors analyzed data from the prospective longitudinal Dunedin study of an unselected birth cohort. The presence of obsessions and compulsions and mental disorders was assessed using the Diagnostic Interview Schedule (DIS) at ages 11, 26, and 32. Data on interference and help-seeking were obtained at ages 26 and 32. RESULTS Obsessions and compulsions were frequent in individuals with mental disorders other than obsessive-compulsive disorder (OCD) and among people without mental disorders. Even in the latter group, these symptoms caused significant interference. The presence of anxiety/depression and of obsessions (particularly aggressive and shameful thoughts), but not compulsions, was associated with help-seeking. Harm/checking was the most prevalent symptom dimension. Symptom dimensions were temporally stable and associated with increased comorbidity. Obsessive-compulsive symptoms at age 11 predicted a high risk of an adult OCD diagnosis as well as elevated adult symptom dimensions. CONCLUSIONS Obsessions and compulsions are common in the adult population, have their roots in childhood, and are associated with interference, risk for disorders, and help-seeking. Subclinical obsessions and compulsions should be taken into account in research, intervention, and DSM-V.

Assessment of dysfunctional beliefs in borderline personality disorder

This study had two aims: to test the hypothesis that borderline personality disorder (BPD) patients hold numerous dysfunctional beliefs associated with a variety of Axis II disorders, and to construct a BPD belief scale which captures these beliefs. Beliefs were measured using the Personality Belief Questionnaire (PBQ) which is designed to assess beliefs associated with various personality disorders, although not specifically BPD. Eighty-four BPD patients and 204 patients with other personality disorders (OPD) were randomly split into two study samples. Fourteen PBQ items were found to discriminate BPD from OPD patients in both samples. These items came from the PBQ Dependent, Paranoid, Avoidant, and Histrionic scales and reflect themes of dependency, helplessness, distrust, fears of rejection/abandonment/losing emotional control, and extreme attention-seeking behavior. A BPD beliefs scale constructed from these items showed good internal consistency and diagnostic validity among the 288 study patients. The scale may be used to assist in diagnosis and cognitive therapy of BPD.

Categorization and cognitive deficits in compulsive hoarding.

According to the cognitive-behavioural model of compulsive hoarding, information-processing deficits in the areas of attention, memory, decision-making, and categorization contribute to hoarding behaviour. The purpose of the current study was to examine whether individuals with compulsive hoarding exhibited impairment on executive functioning and categorization tasks. Three groups of participants were recruited (N = 60): individuals with compulsive hoarding syndrome, individuals with an Axis I mood or anxiety disorder, and non-clinical control participants. All participants completed self-report measures of cognitive difficulties, neuropsychological tests of executive functioning and decision-making, and four categorization tasks. Results suggested that hoarding participants reported more cognitive failures and more problems with attention and decision-making than non-clinical control participants. In addition, hoarding participants performed worse than both control groups on the Stockings of Cambridge (SOC), a neuropsychological test of planning ability, and were slower and more anxious during a categorization task. These findings suggest that specific deficits in executive functioning may be associated with the difficulties hoarding patients have organizing their possessions.

Deficits in emotion regulation associated with pathological gambling

OBJECTIVES The concept of emotion regulation features in many models of psychopathology and it has been proposed that individuals with poorly regulated emotions often engage in maladaptive behaviours to escape from or down-regulate their emotions, creating risk for a range of disorders. One such disorder may be pathological gambling. To our knowledge, no study had assessed the use of emotion-regulation strategies in this population. The goal of the present study was therefore to examine emotion-regulation difficulties among a sample of pathological gamblers (n= 56), a mixed clinical comparison group (n= 50), and a sample of healthy community controls (n= 49). DESIGN Multivariate analysis of variance controlling for age. METHODS Participants were recruited from the community and a gambling treatment unit in Australia and completed clinical diagnostic interviews (ADIS-IV; SCIP), self-report measures of psychopathology (DASS-21), substance use (AUDIT), and emotion-regulation difficulties (DERS; ERQ). RESULTS Pathological gamblers and the clinical comparison group reported significantly less use of reappraisal as an adaptive emotion-regulation strategy, and reported a greater lack of emotional clarity and more impulsivity than individuals in the healthy community comparison group. Pathological gamblers reported a greater lack of emotional awareness compared to the healthy control group and reported differences in access to effective emotion-regulation strategies compared to both comparison groups. CONCLUSIONS The results support specific deficits of emotion regulation in pathological gamblers and emphasize the need to address these underlying vulnerabilities in addition to directly targeting gambling behaviours in therapy.

The Effects of Analytical Rumination, Reappraisal, and Distraction on Anger Experience ☆

The manner in which individuals recall negative life events has important affective consequences. The present experiment investigated the effects of emotion regulation strategies on anger experience. One hundred and twenty-one undergraduates recalled an anger-inducing memory and were instructed to engage in either analytical rumination, cognitive reappraisal, or distraction for 20 minutes. In the remaining (control) condition, participants were instructed to write about their thoughts but were not given any emotion regulation instructions. Rumination maintained anger, whereas participants in the remaining conditions reported decreased anger following the writing task. Our results suggest that reappraisal facilitates adaptive processing of anger-inducing memories and distraction facilitates rapid reductions in anger experience. These findings have implications for the management of clinical populations that commonly experience difficulty with anger regulation.

Risk factors prospectively associated with adult obsessive-compulsive symptom dimensions and obsessive-compulsive disorder.

BACKGROUND Very few longitudinal studies have evaluated prospective neurodevelopmental and psychosocial risk factors for obsessive-compulsive disorder (OCD). Furthermore, despite the heterogeneous nature of OCD, no research has examined risk factors for its primary symptom dimensions, such as contamination/washing. METHOD Potential risk factors for symptoms or diagnosis of OCD in adulthood and for specific adult obsessive-compulsive (OC) symptom dimensions were examined in the Dunedin Study birth cohort. The presence of obsessions and compulsions and psychological disorders was assessed using the Diagnostic Interview Schedule (DIS) at ages 26 and 32 years. Individuals with a diagnosis of OCD at either age (n=36) were compared to both a healthy control group (n=613) and an anxious control group (n=310) to determine whether associations between a risk factor and an OCD diagnosis were specific. RESULTS Childhood neurodevelopmental, behavioral, personality and environmental risk factors were associated with a diagnosis of OCD and with OC symptoms at ages 26 and 32. Social isolation, retrospectively reported physical abuse and negative emotionality were specific predictors of an adult OCD diagnosis. Of note, most risk factors were associated with OC symptoms in adulthood and several risk factors predicted specific OCD dimensions. Perinatal insults were linked to increased risk for symmetry/ordering and shameful thoughts dimensions, whereas poor childhood motor skills predicted the harm/checking dimension. Difficult temperament, internalizing symptoms and conduct problems in childhood also predicted specific symptom dimensions and lower IQ non-specifically predicted increased risk for most dimensions. CONCLUSIONS The current findings underscore the need for a dimensional approach in evaluating childhood risk factors for obsessions and compulsions.

Psychometric properties of the Beck Self-Esteem Scales

The psychometric characteristics of the Beck Self-Esteem Scales (BSE) are described for 360 psychiatric outpatients. Patients rated their evaluative beliefs about themselves (Self Scale) and their beliefs about how others evaluate them (Other Scale). Both measures consist of 18 pairs of adjectives, e.g., lovable-unlovable, that are rated using a 10-point scale. The coefficient alphas for the Self Scale (0.94) and the Other Scale (0.95) indicated high internal consistency. Both scales were positively associated with other measures of self-esteem and negatively associated with measures of anxiety and depression. As predicted by the cognitive theory of depression, patients with a principal mood disorder scored significantly lower on the BSE than patients with a principal anxiety disorder. In addition, the mean scores for patients with major depression and dysthymia on the Self Scale were significantly lower than the mean scores for the Other Scale.

Don't look back in anger: neural correlates of reappraisal, analytical rumination, and angry rumination during recall of an anger-inducing autobiographical memory.

Despite the enormous costs associated with unrestrained anger, little is known about the neural mechanisms underlying anger regulation. Behavioral evidence supports the effectiveness of reappraisal in reducing anger, and demonstrates that rumination typically maintains or augments anger. To further understand the effects of different anger regulation strategies, during functional magnetic resonance imaging 21 healthy male and female undergraduates recalled an anger-inducing autobiographical memory. They then engaged in three counterbalanced anger regulation strategies: reappraisal, analytical rumination, and angry rumination. Reappraisal produced the least self-reported anger followed by analytical rumination and angry rumination. Rumination was associated with increased functional connectivity of the inferior frontal gyrus with the amygdala and thalamus. Understanding how neural regions interact during anger regulation has important implications for reducing anger and violence.

Social anxiety and the effects of negative self-imagery on emotion, cognition, and post-event processing.

Numerous studies have shown that social phobia patients experience negative self-impressions or images during social situations. Clark and Wells (1995) posited that such negative self-images are involved in the maintenance of social phobia. Thus, the present study investigated the effects of negative self-imagery on cognition and emotion during and following a brief social situation. Specifically, high and low socially anxious participants (N = 77) were instructed to hold either a negative or control self-image as they engaged in a brief speech. Participants then rated their anxiety, performance, cognitions, and focus of attention. Twenty-four hours later, they returned to the laboratory and completed questionnaires assessing the amount of post-event processing (PEP) they engaged in. The results showed that, irrespective of the level of social anxiety or depressive symptoms, participants that held the negative self-image experienced higher levels of anxiety, were more self-focused, experienced more negative thoughts, rated their anxiety as more visible, appraised their performance more negatively, and engaged in more negative and less positive PEP than participants that held the control self-image. Collectively the results indicate that negative imagery is causally involved in the maintenance of social phobia, as well as in the generation of social anxiety among non-anxious individuals.