John W. Lawrence

Self-Discrepancies and Affect: Incorporating the Role of Feared Selves

The authors examined ought, ideal, and feared self-discrepancies as predictors of agitation- and dejection-related affects. Overall, discrepancy from feared selves predicted anxiety and guilt, preempting the role of discrepancies from ought selves; ideal and feared discrepancies both predicted depression. Further analyses revealed interactions between actual-ought and actual-feared discrepancies in predicting anxiety and guilt. Among participants who were relatively near their feared selves, discrepancies from ought selves were unrelated to these affects. In contrast, among those whose feared selves were more distant, ought discrepancies did predict agitation-related affect, consistent with self-discrepancy theory. Discussion centers on a view in which an avoidance motive (feared self) dominates anxiety and guilt if the feared element is nearby but in which an associated approach motive (ought self) dominates anxiety and guilt if the feared element is more remote.

Personality predictors of injury-related posttraumatic stress disorder

This longitudinal, cohort study examined the effect of personality traits on the emergence of posttraumatic stress disorder (PTSD) in a recently traumatized, civilian, mixed-gender sample with significant injuries. Burn survivors (N = 70) were administered the NEO-Personality Inventory (NEO-PI) and the Structured Clinical Interview for DSM III-R (SCID) at hospital discharge and readministered the SCID 4 and 12 months later. Overall, the sample of burn survivors scored significantly higher on neuroticism and extraversion and lower on openness, agreeableness, and conscientiousness relative to a normative national sample. Furthermore, multivariate analysis of variance revealed that PTSD symptom severity groups (i.e., single symptom, multiple symptoms, subthreshold PTSD, PTSD) were differentially related to neuroticism and extraversion. Planned comparisons indicated that neuroticism was higher and extraversion was lower in those who developed PTSD compared with those who did not develop PTSD.

Visible vs hidden scars and their relation to body esteem

This study examined the relationship among burn scarring, severity and visibility, and body esteem. Previous work addressing this question has relied on case studies and small samples. We mailed a survey to 2500 members of a national burn survivor support group. Survivors were asked to complete and

Effect of early body image dissatisfaction on subsequent psychological and physical adjustment after disfiguring injury.

Objective The impact of body image dissatisfaction on quality of life after severe burn injury was investigated after controlling for other determinants of outcome (ie, injury, distress, and preburn quality of life). Methods The postburn quality of life (2-months postdischarge) of groups with and without body image dissatisfaction was studied after controlling for preburn quality of life (measured 2–3 days postadmission). The patient population (N = 86) was 77.9% men, had an average total body surface area burned of 17.02%, and average full-thickness burn of 6.09%. Forty percent had facial injuries, 68.6% required surgery, most were injured by flame (39.5%), and 76.8% were employed. Results Multivariate analysis of covariance (covarying preburn level of Mental quality of life, facial injury, and size of burn) contrasting body image dissatisfaction groups found significantly lower psychosocial adjustment at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 3.61;p < .01). A second MANCOVA (covarying the preburn level of Physical quality of life and both facial injury and size of burn) found significantly lower physical functioning at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 2.78;p < .03). Adding two more covariates (depression and posttrauma distress) eliminated the effect of body image dissatisfaction on postburn Physical but not Mental adjustment. Conclusions Body image dissatisfaction affects quality of life after severe burn injury. Distress moderates this impact on aspects of physical but not psychosocial health.

Preburn psychiatric history affects posttrauma morbidity.

A sample of inpatient, burn-injured adults (N = 95) were assessed upon discharge, and 4 and 12 months later with a structured interview and DSM-III-R criteria. The prevalence of disorder in this sample was contrasted with published data on a representative national community-dwelling comparison group in the National Comorbidity Study. The prevalence of lifetime affective, alcohol, and substance use disorders was significantly higher, and lifetime anxiety disorders significantly lower, in the burn-injured sample. The 12-month postburn prevalences of alcohol, and substance use disorders were significantly greater in the burn-injured sample. The risk of postburn disorder was significantly greater for the subjects who had a preburn history of affective, alcohol, or substance use disorder. The risk for developing posttraumatic stress disorder (PTSD) was elevated in the subjects with a preburn affective disorder but not preburn anxiety disorder. Finally, postburn PTSD was associated with a greater length of stay, and greater preburn comorbidity predicted preburn employment status and tended to lengthen hospitalization.

Personality, coping, chronic stress, social support and PTSD symptoms among adult burn survivors: a path analysis.

This paper presents a longitudinal study of the relationship between personality, coping, chronic stress, social support and posttraumatic stress disorder (PTSD). A hypothesized model of the relationship between the predictor variables and PTSD symptoms was proposed. Path analyses was completed to test the model. One hundred fifty-eight adult burn survivors completed questionnaires measuring each of the variables in the hospital. Of those 124 and 94 completed the PTSD measure at 1 month and 6 months postdischarge, respectively. The hypothesized model fit the data at each time point with slight variations. The model accounted for 46 and 29% of the variance of PTSD symptoms at hospitalization and 1 month. Neuroticism was the most important personality dimension in predicting PTSD. Avoidant Coping and Social Support mediated a high percentage of the relationship between Neuroticism and PTSD. The best predictor of PTSD symptoms at 1 and 6 months was PTSD symptoms at hospitalization.

Development and Validation of the Satisfaction with Appearance Scale: Assessing Body Image among Burn-Injured Patients.

The Satisfaction With Appearance Scale (SWAP) is a 14-item questionnaire, assessing both the subjective appraisal and social-behavioral components of body image among burn survivors. Burn survivors requiring hospitalization (n = 165) completed a packet of psychometric instruments, including the SWAP at 1-week postdischarge. The SWAP demonstrated a high level of intemal consistency (Cronbachs alpha, r a = .87; the mean interitem correlation, r ii = .32, the mean item-total correlation, r ii = .53). Eighty-four participants were retested approximately 2 months after the initial assessment to evaluate test-retest reliability (r ii , = .59). A principal-components analysis with a varimax rotation yielded 4 easily interpretable factors accounting for 66% of the total variance. The correlations of the SWAP total score with other selected psychometric measures provided evidence for both convergent and discriminant validity. This initial evaluation of the SWAP suggests that it is both a reliable and valid measure of body image for a burn-injured population.

Coping with body image changes following a disfiguring burn injury

The influence of emotion-focused coping on distress following disfiguring injury was examined. Two types of emotion-focused coping (i.e., venting emotions vs. mental disengagement) were assessed in 78 patients with burn injury at baseline during acute hospitalization. Body image dissatisfaction (BID) was assessed 1 week and 2 months following discharge. Use at baseline of both venting emotions and mental disengagement, compared with use of only one or neither of these coping methods, was associated at the 2-month postdischarge follow-up with significantly higher BID related to nonfacial aspects of appearance and with a greater negative social impact of disfigurement. D. M. Wegners (1994) theoretical model of mental control and a proposed motivational analysis are used to interpret these findings.

The Reliability and Validity of the Perceived Stigmatization Questionnaire (PSQ) and the Social Comfort Questionnaire (SCQ) among an Adult Burn Survivor Sample.

In this study, 361 adult burn survivors completed the Perceived Stigmatization Questionnaire (PSQ), the Social Comfort Questionnaire (SCQ), and other measures. Both the PSQ and SCQ had good internal consistency indices. Factor analysis of the PSQ yielded 3 factors (absence of friendly behavior, confused/staring behavior, and hostile behavior). The SCQ had 1 factor. Conjoint factor analysis with measures of related constructs (body esteem, body-esteem importance, depression, social support) suggested that PSQ and SCQ measure distinct constructs. Correlations with the related psychosocial constructs and burn characteristics suggested the PSQ and SCQ have good convergent and discriminant validity. Limitations of the study are discussed.

THE 1998 CLINICAL RESEARCH AWARD SLEEP DISTURBANCE AFTER BURN INJURY : A FREQUENT YET UNDERSTUDIED COMPLICATION

This study investigated the frequency of sleep disturbance of burn survivors at 3 time points: during hospitalization (time 1: n = 237), 1 week after discharge (time 2: n = 149), and 2 months after discharge (time 3: n = 91). Predictors of sleep disturbance and its relationship to quality of life are explored. Measures of sleep, post-traumatic stress disorder, depression, anxiety, pain, and quality of life were administered at each time point. Fifty percent of participants had sleep disturbance while in the hospital and 1 week after discharge. Forty percent of participants continued to have sleep disturbance 2 months after discharge. In regression equations, emotional distress was a better predictor of sleep disturbance than pain and total body surface area burned at each time point. Sleep disturbance was significantly negatively correlated with all aspects of quality of life represented on the SF-36 Health Survey. Sleep disturbance is a common and often chronic postburn complication that warrants further research.