Jill Lobbestael

DISENTANGLING THE RELATIONSHIP BETWEEN DIFFERENT TYPES OF CHILDHOOD MALTREATMENT AND PERSONALITY DISORDERS

This study investigated the relationship between five forms of childhood maltreatment (sexual, physical and emotional abuse, emotional and physical neglect) and 10 personality disorders (PDs). PDs were assessed by means of SCID II, and childhood maltreatment was retrospectively measured with the Interview for Traumatic Events in Childhood. Both PDs and childhood maltreatment were expressed continuously, and relations were assessed by means of structural equation modelling in a sample of 409 participants. Results indicated that sexual abuse was associated with symptoms of paranoid, schizoid, borderline, and avoidant PD; physical abuse with antisocial PD; emotional abuse with paranoid, schizotypal, borderline, and cluster C PD; and emotional neglect with histrionic and borderline PD. No independent relationships between physical neglect and PDs were found. The findings provide clear, albeit retrospective, evidence that different forms of childhood maltreatment have differential effects on PD pathology.

A Validation Study of the Dutch Childhood Trauma Questionnaire-Short Form: Factor Structure, Reliability, and Known-Groups Validity.

The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is a 28-item retrospective self-report questionnaire designed to assess five dimensions of childhood maltreatment: (1) Physical Abuse, (2) Emotional Abuse, (3) Sexual Abuse, (4) Physical Neglect, and (5) Emotional Neglect. A March 2009 MEDLINE search found 141 references to the CTQ-SF, whereas no other self-report measure of childhood maltreatment listed in a recent review of childhood trauma assessment tools (Roy & Perry, 2004) was referenced more than 15 times. The CTQ-SF (Bernstein & Fink, 1998; Bernstein et al., 2003) has been translated into German (Bader, Schafer, Schenkel, Nissen, & Schwander, 2007; Driessen et al., 2000; Driessen, Schroeder, Widmann, von Schonfeld, & Schneider, 2006; Gast, Rodewald, Nickel, & Emrich, 2001; Kersting et al., 2003; Krischer & Sevecke, 2008; Moehler, Biringen, & Poustka, 2007; Schafer et al., 2006, 2007; Spitzer, Barnow, Gau, Freyberger, & Grabe, 2008; Woller, Hartkamp, & Tress, 2007), Norwegian (Fosse & Holen, 2002, 2006, 2007), Turkish (Aslan & Alparslan, 1999; Mirsal, Kalyoncu, Pektas, Tan, & Beyazyurek, 2004; Sar, Akyuz, Kundakci, Kiziltan, & Dogan, 2004; Sar, Akyuz, Kugu, Ozturk, & Ertem-Vehid, 2006; Sar, Unal, & Ozturk, 2007; Ucok & Bikmaz, 2007), Spanish (Basurte, Diaz-Marsa, Martin, & Carrasco, 2004), French (Collin-Vezina, Cyr, Pauze, & McDuff, 2005; Perroud et al., 2008), Haitian Creole (Martsolf, 2004), Portuguese (Grassi-Oliveira, Stein, & Pezzi, 2006), Italian (Sarchiapone, Carli, Cuomo, & Roy, 2007), and Dutch (Arntz, 1999; Arntz, Dietzel, & Dreessen, 1999; Arntz, Meeren, & Wessel, 2002; Giesbrecht, Merckelbach, Kater, & Sluis, 2007; Lobbestael, Arntz, & Bernstein, in

Minimization of childhood maltreatment is common and consequential: results from a large, multinational sample using the childhood trauma questionnaire

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale—originally designed to assess a positive response bias—are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ’s MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ’s discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias—as detected by the MD subscale—has a small but significant moderating effect on the CTQ’s discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.

An empirical test of schema mode conceptualizations in personality disorders.

Although the use of schema modes in schema-focused therapy (SFT) has been very popular since its introduction, Youngs schema mode concept remained largely empirically untested. In order to provide insight into the mode conceptualization of personality disorders (PDs), the current study assessed the relationships between 14 schema modes and all PDs. Relationships between dimensional PD scores and self-reported mode scores were tested in a mixed study group of 489 participants, consisting of axis I and axis II patients, and non-patients. Psychopathology was assessed by means of the Structured Clinical Interview for DSM-IV axis I and axis II disorders (SCID I and SCID II) or the Structural Interview for DSM-IV Personality Disorders (SIDP-IV), and modes were assessed by the Schema Mode Inventory. Kendalls partial tau coefficients, controlling each PD-mode correlation for all other PD scores, indicated unique mode profiles for all PDs and corroborated most of the hypothesized PD-mode correlations, supporting the construct validity of the mode model. Nevertheless, the high number of correlations found for some PDs raises concerns about the specificity of the mode model. Implications for both research and therapy are discussed.

Reliability and Validity of the Short Schema Mode Inventory (SMI)

BACKGROUND This study presents a new questionnaire to assess schema modes: the Schema Mode Inventory (SMI). METHOD First, the construction of the short SMI (118 items) was described. Second, the psychometric properties of this short SMI were assessed. More specifically, its factor structure, internal reliability, inter-correlations between the subscales, test-retest reliability and monotonically increase of the modes were tested. This was done in a sample of N = 863 non-patients, Axis I and Axis II patients. RESULTS Results indicated a 14-factor structure of the short SMI, acceptable internal consistencies of the 14 subscales (Cronbach alphas from .79 to .96), adequate test-retest reliability and moderate construct validity. Certain modes were predicted by a combination of the severity of Axis I and II disorders, while other modes were mainly predicted by Axis II pathology. CONCLUSIONS The psychometric results indicate that the short SMI is a valuable measure that can be of use for mode assessment in SFT.

How to push someone's buttons: A comparison of four anger-induction methods

This study compared the effects of four ways of inducing anger: film, stress interview, punishment, and harassment. Sixty-four healthy participants were randomly assigned to one of these conditions. Effects were examined by means of self-report and physiological measures (blood pressure, heart rate, skin conductance level, and skin conductance response). All four methods produced comparable levels of self-reported anger, while harassment and interview produced the largest cardiovascular effects, and electrodermal activity increased more in reaction to harassment, interview, and punishment conditions compared to film. Thus, physiological reactivity was especially increased by anger-induction methods that included personal contact (harassment and interview). Regarding specificity of self-reported emotions, fear and frustration were the only emotions out of nine non-target emotions that increased in comparable degree to anger following film, interview, and punishment, while harassment produced more self-reported anger than fear. Possible explanations and further recommendations are discussed.

Early maladaptive schemas in depressed patients: Stability and relation with depressive symptoms over the course of treatment

BACKGROUND Early maladaptive schemas (EMSs) are hypothesized to be stable, trait-like, enduring beliefs underlying chronic and recurrent psychological disorders. We studied the relation of EMSs with depressive symptom severity and tested the stability of EMSs over a course of evidence-based outpatient treatment for depression in a naturalistic treatment setting. METHODS The sample consisted of depressed outpatients (N=132) treated at a specialized mood disorders treatment unit in The Netherlands. Participants completed measures of depressive symptom severity and maladaptive schemas before treatment and 16-weeks after starting with treatment. RESULTS Specific maladaptive schemas (failure, emotional deprivation, abandonment/instability) were cross-sectionally related to depressive symptom severity. Moreover, the schema domain impaired autonomy & performance at pre-treatment related positively to depression levels at the 16-week follow-up assessment, whereas the schema domain overvigilance & inhibition at pre-treatment related negatively to depression levels at the follow-up assessment when controlling for pre-treatment depression severity. Finally, all EMSs demonstrated good relative stability over the course of treatment. CONCLUSIONS Our results suggest that specific EMSs are related to depressive symptom severity in clinically depressed patients, that specific schema domains predict treatment outcome, and that schemas are robust to change over time, even after evidence-based outpatient treatment for depression.

Out of control: Evidence for anterior insula involvement in motor impulsivity and reactive aggression

Inhibiting impulsive reactions while still defending ones vital resources is paramount to functional self-control and successful development in a social environment. However, this ability of successfully inhibiting, and thus controlling ones impulsivity, often fails, leading to consequences ranging from motor impulsivity to aggressive reactions following provocation. Although inhibitory failure represents the underlying mechanism, the neurocognition of social aggression and motor response inhibition have traditionally been investigated in separation. Here, we aimed to directly investigate and compare the neural mechanisms underlying the failure of inhibition across those different modalities of self-control. We used functional imaging to reveal the overlap in neural correlates between failed motor response inhibition (measured by a go/no-go task) and reactive aggression (measured by the Taylor aggression paradigm) in healthy males. The core overlap of neural correlates was located in the anterior insula, suggesting common anterior insula involvement in motor impulsivity as well as reactive aggression. This evidence regarding an overarching role of the anterior insula across different modalities of self-control enables an integrative perspective on insula function and a better integration of cognitive, social and emotional factors into a comprehensive model of impulsivity. Furthermore, it can eventually lead to a better understanding of clinical syndromes involving inhibitory deficits.

The relationship between adult reactive and proactive aggression, hostile interpretation bias, and antisocial personality disorder

Reactive aggression (RA) refers to angry responses to provocation or frustration, while proactive aggression (PA) denotes nonemotional, instrumental, and unprovoked aggression. The current study examined personality-related and cognitive correlates of both aggressive types. Respectively, the predictive values of antisocial personality disorder (ASPD), and of hostile interpretation bias, which is the tendency to interpret ambiguous stimuli in a hostile manner, were studied. The sample consisted of n = 37 male adult patients with mixed diagnoses and n = 29 male nonpatients that responded to vignettes and pictures of ambiguous situations, using both open and closed answer formats. ASPD was assessed by means of the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), and the Reactive Proactive Questionnaire (RPQ) measured RA and PA. Results showed that although both RA and PA types were predicted by ASPD traits, RA was additionally predicted by a hostile interpretation bias. These findings suggest that reducing hostile bias is a promising avenue for clinical treatment of ASPD-patients high in RA.

Emotional, cognitive and physiological correlates of abuse-related stress in borderline and antisocial personality disorder

Childhood abuse is an important precursor of borderline personality disorder (BPD) and antisocial personality disorder (ASPD). The current study compared the emotional reactivity to abuse-related stress of these patients on a direct and an indirect level. Changes in self-reported affect and schema modes, psychophysiology and reaction time based cognitive associations were assessed following confrontation with an abuse-related film fragment in patients with BPD (n=45), ASPD (n=21), Cluster C personality disorder (n=46) and non-patient controls (n=36). Results indicated a hyperresponsivity of BPD-patients on self-reported negative affect and schema modes, on some psychophysiological indices and on implicit cognitive associations. The ASPD-group was comparable to the BPD group on implicit cognitions but did not show self-reported and physiological hyper-reactivity. These findings suggest that BPD and ASPD-patients are alike in their implicit cognitive abuse-related stress reactivity, but can be differentiated in their self-reported and physiological response patterns.