Kathryn H. Gordon

Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts

Non-suicidal self-injury (NSSI) is a prevalent behavioral problem, yet many fundamental aspects of NSSI remain unknown. This case series study reports on the diagnostic correlates of adolescents with a recent history of NSSI and examines the relation between NSSI and suicide attempts. Data are from clinical interviews with 89 adolescents admitted to an adolescent psychiatric inpatient unit who engaged in NSSI in the previous 12 months. Results revealed that 87.6% of adolescents engaging in NSSI met criteria for a DSM-IV Axis I diagnosis (M=3.0, S.D.=2.2, range=0 to 8 diagnoses), including externalizing (62.9%), internalizing (51.7%), and substance use (59.6%) disorders. Most adolescents assessed also met criteria for an Axis II personality disorder (67.3%). Overall, 70% of adolescents engaging in NSSI reported a lifetime suicide attempt and 55% reported multiple attempts. Characteristics of NSSI associated with making suicide attempts included a longer history of NSSI, use of a greater number of methods, and absence of physical pain during NSSI. These findings demonstrate the diagnostic heterogeneity of adolescents engaging in NSSI, highlight the significant overlap between NSSI and suicide attempts, and provide a point of departure for future research aimed at elucidating the relations between non-suicidal and suicidal self-injury.

Suicidal Desire and the Capability for Suicide: Tests of the Interpersonal-Psychological Theory of Suicidal Behavior among Adults.

The interpersonal-psychological theory of suicidal behavior (T. E. Joiner, 2005) proposes that an individual will not die by suicide unless he or she has both the desire to die by suicide and the ability to do so. Three studies test the theorys hypotheses. In Study 1, the interaction of thwarted belongingness and perceived burdensomeness predicted current suicidal ideation. In Study 2, greater levels of acquired capability were found among individuals with greater numbers of past attempts. Results also indicated that painful and provocative experiences significantly predicted acquired capability scores. In Study 3, the interaction of acquired capability and perceived burdensomeness predicted clinician-rated risk for suicidal behavior. Implications for the etiology, assessment, and treatment of suicidal behavior are discussed.

Suicidal ideation in college students varies across semesters: The mediating role of belongingness

The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that the need to belong is fundamental; when met it can prevent suicide and when thwarted it can substantially increase the risk for suicide. We investigate one source of group-wide variation in belongingness among college students--changes in the social composition of college campuses across academic semesters--as an explanation for variation in suicidal ideation across the academic year. Our results indicate that in a sample of college students at a large southern state university (n = 309), suicidal ideation varied across academic semesters, with highest levels in summer compared to both spring and fall. Differences in suicidal ideation between summer and spring were, in large part, accounted for by belongingness. Theoretical, as well as practical, implications are discussed regarding mechanisms for seasonal variation in suicidal ideation.

Eating Disorder Symptoms among Undergraduate Varsity Athletes, Club Athletes, Independent Exercisers, and Nonexercisers

OBJECTIVE To examine whether differences in eating disorder symptoms exist between women who are varsity athletes, club athletes, independent exercisers, and nonexercisers and to determine whether sports anxiety moderates any observed between-group effects. METHOD Two hundred seventy four female undergraduates completed the eating disorders inventory and the physical activity and sport anxiety scale and reported their exercise habits. RESULTS Women who participated in sports tended to have higher levels of eating disorder symptomatology than those who did not. Higher levels of sports anxiety were predictive of higher levels of bulimic symptoms and drive for thinness. Finally, the interaction of sports anxiety and level of athletic participation significantly predicted body dissatisfaction and bulimic symptoms. CONCLUSION Coaches and clinicians should be aware that athletes experience higher rates of eating disorder symptoms than nonathletes. Moreover, sports anxiety should be considered as a possible target of therapy among athletes.

Psychological correlates of purging disorder as compared with other eating disorders: An exploratory investigation

OBJECTIVE Keel et al. introduced the diagnostic category of purging disorder (PD), an eating disorder characterized by recurring purging behaviors in the absence of objective binges. The current study sought to investigate psychological correlates among individuals with a lifetime diagnosis of PD as compared to those with other eating disorders, and those with no eating disorder. METHOD The current sample included 294 ethnically diverse undergraduate women. Subjects diagnosed with different types of eating disorders [i.e., anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD)] were compared to one another, as well as to individuals with no eating disorder on a variety of indices. RESULTS Women with PD displayed similar levels of drive for thinness as women with AN and BED. Individuals with BN and BED exhibited anxiety levels significantly higher than those with PD. Those with PD displayed levels of impulsivity that were significantly higher than those of individuals with AN or BED, but significantly lower than those of individuals with BN. They also displayed similar levels of bulimic symptoms as those with AN and BED; however, analysis of item 53 on the EDI revealed that those with PD had similar levels of purging ideation as those with BN. Women with any eating disorder diagnosis were more likely to have a comorbid Axis I disorder than women in the non-eating disorder group. CONCLUSION Our data replicated and extended the findings of Keel et al. and gave further support to the validity and distinctiveness of PD.

Does Time Between Application and Case Assignment Predict Therapy Attendance or Premature Termination in Outpatients

This study assessed whether timeliness of case assignment predicted 2 types of patient termination: nonattendance to therapy before intake but after completing the application process and premature termination once therapy had begun. The patients in this study represented all adults applying to an outpatient clinic for therapeutic services over a 5-year period (N 313, 142 male). Results indicated that the timeliness of case assignment was a significant predictor of whether a patient attended intake, with those enduring a longer delay in case assignment more likely to not pursue therapeutic services. Timeliness of case assignment was not related to premature termination from therapy. Potential moderators, including patient ethnicity, gender, age, personality disorder diagnosis, and symptom severity, did not affect the relationship between the variables of interest.

A test of an interactive model of bulimic symptomatology in adult women

An interactive model of bulimic symptom development, first suggested by Vohs et al. (1999), was tested in adult women (mean age = 45.19). The following hypothesis was examined in a longitudinal design over 2.5 years: Women high in perfectionism, low in self-esteem, and who perceive themselves as overweight would be the most likely to experience an increase in bulimic symptoms. Results supported the model with regard to maintenance and exacerbation, but not onset, of bulimic symptoms. Furthermore, the interactive model was tested to see if it showed specificity to bulimic, versus depressive or anxious, symptoms. Some support for the models specificity to bulimic symptoms was observed; however, the increase of anxious symptoms was also observed. Clinical and theoretical implications are discussed.

Examination of Racial Differences on the MMPI-2 Clinical and Restructured Clinical Scales in an Outpatient Sample

The current study examined the possibility of differential predictive accuracy of selected Minnesota Multiphasic Personality Inventory—Second Edition (MMPI-2) clinical and Restructured Clinical (RC) scales in a group of Black and White mental health center clients. Results indicate that Black clients scored higher than White clients on one non-K-corrected clinical scale and 4 RC scales. All these differences produced medium effect sizes and were clinically significant according to Greenes (1987) criterion. These differences, however, were not accompanied by differential predictive accuracy of the scales in Black versus White clients. Although additional research is needed, especially on the RC scales, this study indicates that the MMPI-2 is not a biased predictor of symptomatology for Black versus White test takers.

Attributional style, hope, and initial response to selective serotonin reuptake inhibitors youth psychiatric inpatients

We investigated the role of attributional style in inpatients’ initial response to treatment, particularly to SSRIs, and explored possible psychological factors implicated in response to SSRIs. One hundred youth psychiatric inpatients completed questionnaires at admission and discharge on attributional style, hopelessness, self-esteem, and depressive symptoms; medication status was recorded. Change in depressive symptoms from admission to discharge varied depending on negative attributional style status and treatment group status. Patients with a relatively positive attributional style and who were on SSRI medicines experienced the largest decreases in depression from admission to discharge, as well as the lowest absolute depression level at discharge. Depression changes were less pronounced in other patients, including those on SSRIs with a negative attributional style. Psychological processes corresponding to these changes appeared to involve increased hope, not enhanced self-esteem. Attributional style may moderate initial SSRI treatment response, an effect that appears to correspond with increased hope.

Self-competence and the prediction of bulimic symptoms in older women

Previous research in undergraduate women has demonstrated that an individuals level of self-competence was a stronger predictor of bulimic symptom change than their level of self-liking (Bardone, Perez, Abramson, & Joiner, 2003). The authors examined whether self-competence would similarly predict bulimic symptom change in a sample of older women. In April 2000, a large group of adults attending mood disorder conferences completed questionnaires about eating disorder symptoms and self-esteem. Approximately 2.5 years later, 150 women, 45 years of age and older, were contacted for a follow-up study. Eighty-eight women completed follow-up eating disorder and self-esteem measures. Consistent with prior research, self-competence emerged as a stronger predictor of bulimic symptom change than self-liking, such that lower self-competence was associated with an increase in bulimic symptoms. The results indicate that self-competence may serve as a useful prognostic indicator and therapeutic target for older women seeking treatment for eating disorders.