Michael W. Wiederman

The self-harm inventory (SHI): Development of a scale for identifying self-destructive behaviors and borderline personality disorder

Intentional self-harm behavior is an important clinical phenomenon that appears highly related to borderline personality disorder (BPD). Self-harm behavior in the context of borderline personality probably exists along a continuum from graphic, self-harm behavior to milder forms of self-sabotaging behavior that might be viewed as self-defeating Relatively little attention has been paid to developing a self-report measure of intentional self-harm, particularly as a screening device for detecting BPD. In Study 1, an initial list of self-harm behaviors encountered in clinical practice was narrowed to those behaviors related to BPD in a sample comprised of adults from both a mental health and non-mental health setting. All participants (N = 221) underwent a semistructured diagnostic interview for BPD. Using a cut-off score of 5 on the resulting 22-item Self-Harm Inventory (SHI), 83.7% of research participants were correctly classified as having BPD or not. In Study 2, women (N = 285) sampled from an outpatient medical setting completed the SHI and a widely used self-report measure of BPD. The SHI cut-off score resulted in correct classification of 87.9% of the individuals. In Study 3, using a sample of adults involuntarily hospitalized for psychiatric reasons (N = 32), the SHI performed at least as well as another self-report measure of BPD in diagnosing participants (the final diagnosis was based on a semistructured interview). The results are discussed with regard to potential advantages and utility of the SHI and need for further validation.

Cognitive Distraction and Women's Sexual Functioning

Past research on the role of cognitive distraction in sexual dysfunction typically has focused on males and has been conducted in the laboratory using artificial stimuli. In the current study ,young adult women (N = 74) with coital experience completed questionnaires regarding cognitive distraction and their sexuality. Those women who reported greater cognitive distraction during sexual activity with a partner also reported relatively lower sexual esteem, less sexual satisfaction, less consistent orgasms, and higher incidence of pretending orgasm even after the womens general affect, sexual desire, general self-focus, general sexual attitudes, and body dissatisfaction were statistically controlled. Results are discussed with regard to directions for future research and implications for sex therapy.Past research on the role of cognitive distraction in sexual dysfunction typically has focused on males and has been conducted in the laboratory using artificial stimuli. In the current study, young adult women (N = 74) with coital experience completed questionnaires regarding cognitive distraction and their sexuality. Those women who reported greater cognitive distraction during sexual activity with a partner also reported relatively lower sexual esteem, less sexual satisfaction, less consistent orgasms, and higher incidence of pretending orgasm even after the womens general affect, sexual desire, general self-focus, general sexual attitudes, and body dissatisfaction were statistically controlled. Results are discussed with regard to directions for future research and implications for sex therapy.

Women's body image self‐consciousness during physical intimacy with a partner

In Western cultures, womens bodies are objectified more so than mens, and other writers have noted the multiple ways that such objectification may negatively impact womens lives. As womens sexual desirability is often equated with physical attractiveness and thinness, it is surprising that previous investigations have not included womens body image self‐consciousness during physical intimacy with a partner. In the current set of studies, a 15‐item measure of the construct was developed and shown to have excellent psychometric properties. Approximately one third of college student women indicated experiencing body image self‐consciousness during physical intimacy with a heterosexual partner at least some of the time. Even after statistically controlling for actual body size, measures of general body image, general sexual anxiety, and general well‐being, scores on the new measure were predictive of heterosexual experience, sexual esteem, sexual assertive‐ness, and avoidance of sexual activity. Results are discussed with regard to implications and directions for future research.

Body size, physical attractiveness, and body image among young adult women: Relationships to sexual experience and sexual esteem

Although links between womens sexuality and body size, attractiveness, and body image may seem apparent, little empirical work has been conducted on this topic. In the current study, young adult women (N = 192) completed questionnaires and were weighed and rated for facial attractiveness. In general, current body size, experimenter‐rated facial attractiveness, and self‐rated facial and bodily attractiveness were related in some ways to current relationship status and sexual experience. General body dissatisfaction, avoidance of social settings due to appearance concerns, and degree of investment in ones physical appearance were unrelated to relationship status and sexual experience. Higher sexual esteem was related to subjective views of attractiveness, but not to actual body size or experimenter ratings of facial attractiveness.

Undergraduate Students' Perceptions of Child Sexual Abuse: Effects of Age, Sex, and Gender-Role Attitudes.

OBJECTIVE The present study examined how sex of the child and the adult and age of the child influence perceptions regarding the abusiveness of adult-child sexual interactions and attributions of blame and responsibility to the adult in such incidents. The relationship of gender-role attitudes to perceptions of child sexual abuse was also investigated. METHOD Undergraduate students (N = 404) read one of eight vignettes depicting a sexual interaction between a child and an adult in which sex of the child, age of the child, and sex of the adult were manipulated. Respondents then answered questions regarding their perceptions of the abusiveness of the incident and attributions of responsibility and blame to the adult. RESULTS Scenarios depicting a 15-year-old were rated as less abusive, and less responsibility was attributed to the adult, relative to vignettes involving a 7-year-old. Respondents also rated scenarios depicting opposite-sex interactions as less abusive relative to scenarios describing same-sex interactions. When vignettes depicted a 15-year-old, less blame was attributed to the adult relative to when vignettes depicted a 7-year-old with an adult of either sex, with the least amount of blame being attributed to the adult involved with an adolescent of the opposite-sex. Gender-role attitudes were not significantly related to ratings of abusiveness or attributions of responsibility and blame. CONCLUSIONS These findings suggest that age of the child may influence ratings of abusiveness and attributions of responsibility and blame. Ratings of abusiveness and attributions of blame also appear to be influenced by the sex pairing in the interaction.

Substance use and impulsive behaviors among adolescents with eating disorders.

Results of past research suggest that the existence of bulimic behaviors (binge eating and/or purging) may be an indicator of increased likelihood of substance use. We investigated incidence of substance use among adolescent girls (mean age = 15.4 years) with anorexia nervosa (n = 59) or bulimia nervosa (n = 58). The incidence of substance use among girls with anorexia nervosa was low, particularly after removing those anorexic adolescents with bulimic symptoms. Nearly one-third of girls with bulimia nervosa had smoked tobacco cigarettes, had used marijuana, and were drinking alcohol at least weekly. Among those exhibiting bulimic symptoms, increased experience with use of different substances was related to increased incidence of attempted suicide, stealing, and sexual intercourse but was unrelated to age or incidence of intentional self-harm behavior. Our findings are discussed in relation to the results of past research and the clinical implications of our data.

Substance use among women with eating disorders

OBJECTIVE The results of past research suggest that bulimics are more likely than anorexics to engage in substance use, and that binge eating and/or purging may be an indicator of increased likelihood of substance use. We further investigated substance use among women with eating disorders. METHOD We compared women with anorexia nervosa (n = 134) to women with bulimia nervosa (n = 320) with regard to history of substance use and investigated potential relationships between eating disorder symptom presentation and substance use. RESULTS Even after controlling for age and eating disorder symptom severity, women with bulimia nervosa were more likely than those with anorexia nervosa to have used alcohol, amphetamines, barbituates, marijuana, tranquilizers, and cocaine. Independent of diagnostic category, severity of caloric restriction was predictive of amphetamine use, severity of binge eating was predictive of tranquilizer use, and severity of purging was predictive of alcohol, cocaine, and cigarette use. DISCUSSION Results are discussed in relation to the results of past research and with an emphasis on the importance of considering eating disorder symptom presentation in addition to formal eating disorder diagnosis.

Body dissatisfaction, bulimia, and depression among women: the mediating role of drive for thinness.

OBJECTIVE Past research has called into question the apparent relationship between body dissatisfaction and bulimia among women once effects of depression are statistically controlled. We further investigated interrelations among body dissatisfaction, depression, and bulimia, as well as considered individual differences in drive for thinness, within two samples of young adult women. METHOD The first sample included women diagnosed with anorexia nervosa (n = 91) or bulimia nervosa (n = 142), whereas the second sample included college student women (N = 228). Respondents completed self-report measures of bulimia, drive for thinness, negative affect, and body dissatisfaction. RESULTS At the univariate level, all of the above constructs were significantly related to body dissatisfaction. In multiple regression analyses using depression and bulimia as predictors of body dissatisfaction, both were uniquely related to body dissatisfaction. These findings were similar to the results of previous research. However, when drive for thinness was added to the regression equations, drive for thinness was a unique predictor of body dissatisfaction whereas bulimia was not (neither was depression among college women). DISCUSSION Bulimia, depression, and body dissatisfaction may be the results of incorporation of cultural standards regarding thinness, hence the apparent relationships among these variables. The role of drive for thinness in the pathogenesis of depression and body dissatisfaction among women needs to be investigated further.

Health Care Utilization and History of Trauma among Women in a Primary Care Setting

Participants were 150 women seen consecutively by a female family physician in an HMO setting for nonemergent medical care. Each participant completed a questionnaire that explored three areas of trauma. Twelve months after the administration of the questionnaire, medical records of each participant were reviewed for several measures of health care utilization (i.e., number of telephone contacts, physician visits, ongoing prescriptions, acute prescriptions, specialist referrals). Age, education, and current marital status were unrelated to medical utilization. Participants’ acknowledged history of physical and emotional abuse significantly correlated with most measures of health care utilization, whereas sexual abuse generally did not. The implications of these findings are discussed.

PHYSICAL ATTRACTIVENESS, BODY IMAGE, AND WOMEN'S SEXUAL SELF-SCHEMA

Recently, Andersen and Cyranowski (1994) presented a self-report measure of womens sexual self-schema, or cognitive view of the self regarding sexuality. In the current study, we investigated potential relationships between womens sexual self-schema and physical attractiveness, body size and shape, and body image. Young adult women (N = 199) completed questionnaires and were weighed, measured, and rated for facial attractiveness. Results revealed that sexual self-schema was unrelated to body size or shape, general body dissatisfaction, history of teasing about weight, and degree of investment in personal appearance. Sexual self-schema scores significantly correlated with experimenter-rated facial attractiveness, self-rated facial and bodily attractiveness, and degree of social avoidance due to concerns over personal appearance, however. In a multiple regression analysis, only self-rated facial attractiveness and social avoidance were unique predictors. Results are discussed with regard to implications for the development of womens sexual self-schema and directions for future research.