Rachel Calam

Eating disorders and perceived relationships with parents.

Many clinicians have theorized about the role of family dynamics in the development of eating disorders (e.g., Minuchin, Rosman & Baker, 1978; Palazzoli, 1974). On the same theme, in recent years, a major research study has produced unequivocal evidence for the therapeutic value of family therapy, at least with the younger client (Russell, Szmukler, Dare & Eisler, 1987). However, there are still relatively few data on the nature of family interaction patterns in patients with an eating disorder. To date, there have been two reports on the use of the Parental Bonding Instrument (PBI) (Parker, Tupling & Brown, 1979) with this clinical population. The present report is the third and largest such study, contrasting 98 patients with anorexic and bulimic eating disorders and 242 comparison subjects. In line with the two previous studies, eating-disordered patients recalled that both parents were lower in perceived care/warmth and, in line with the second study, they recalled that their fathers (but not their mothers) were more overprotective. The latter finding appears an intriguing one and requires further exploration.

Sexual experience and eating problems in female undergraduates

Interrelationships between problems associated with eating and sexual experience were examined in a nonclinic population. The Eating Attitudes Test and a Sexual Events Questionnaire were used with a sample of 130 female undergraduates. The data confirmed the hypothesis that there is a significant association between unwanted sexual experience and eating problems. It is suggested that sexual abuse may act as one of a number of setting conditions for the development of eating problems and that intrafamilial and extrafamilial experiences may differentially affect the type of symptomatology exhibited.

Psychological Disturbance and Child Sexual Abuse: A Follow-Up Study.

OBJECTIVE The aim of this prospective study was to identify risk factors for the development of psychological disturbance in sexually abused children, enabling recognition of the need for appropriate psychological intervention and provision. METHOD A city-wide study of children aged 16 or under was carried out, with all cases of CSA requiring investigation within 12 months included. Data were collected on 144 children from police, social services, and pediatricians. Follow-up was by questionnaire and interview with involved professionals at 4 weeks, 9 months, and 2 years post investigation. RESULTS Initially, two-thirds of children showed emotional or behavioral indicators of disturbance, commonly sleep disturbance, temper tantrums, and depression. Over time, there was a substantial increase, with anxiety and depression, suicide attempts, substance abuse, lack of interaction with peers and sexualized behavior showing increases over the studys duration. Age, gender, abuse, and perpetrator characteristics did not show strong effects initially. Children involved in criminal proceedings were at particular risk. No improvement was evident over time. CONCLUSIONS In the absence of clear risk factors other than initial disturbance, process models involving cognitive factors may be helpful in explaining disturbance, and the need for early identification of disturbance and intervention is highlighted.

A Review of Parenting Programs in Developing Countries: Opportunities and Challenges for Preventing Emotional and Behavioral Difficulties in Children

Many children in developing countries are at risk of emotional and behavioral difficulties, which are likely to be elevated due to the effects of poverty. Parenting programs have shown to be effective preventative strategies in high-income countries, but to date the research on their effectiveness in lower-income countries is limited. International organizations such as the World Health Organization have called for the implementation of programs to prevent behavioral difficulties through the development of stable relationships between children and their parents. The aim of the present paper was to review the literature on parenting programs in developing countries in order to identify challenges, opportunities and directions for further research. First, reports of international organizations were reviewed in order to gain a preliminary overview of the field. In a second stage, a non-systematic review was carried out. Databases were searched in order to identify empirical evaluations of parenting programs in low-income countries. Finally, a systematic review was carried out to specifically identify evaluations of programs targeting emotional or behavioral outcomes. Only one study had a strong methodology among those designed to prevent emotional and behavioral outcomes. Opportunities for further program development and research are identified.

NEW DEVELOPMENTS IN COGNITIVE-BEHAVIOURAL CASE FORMULATION. EPIDEMIOLOGICAL, SYSTEMIC AND SOCIAL CONTEXT: AN INTEGRATIVE APPROACH

The historical origins of the case formulation approach to assessment and treatment are described and its role in clinical practice and research discussed. It is argued that treatment based on individual case formulations should not be precluded from clinical trials. The empirical evidence for the reliability and efficacy of case formulation is reviewed. The evidence that an idiosyncratic case formulation approach to treatment has any advantage over a standard protocol is equivocal; however, the studies that have been carried out are under powered and potentially suffer from a Type II error. The standard procedure for case formulation is briefly described and the argument advanced that this method of clinical assessment should be soundly based upon empirical evidence and hypothesis testing and not on speculation. Three modifications are suggested to the current practice of case formulation. These are: 1) the conceptualization of dysfunctional systems in the maintenance of clinical problems; 2) the historical background of a clinical problem should be described in terms of vulnerabilities and epidemiological evidence-base; and 3) the pivotal role of social behaviour and context should be emphasized and accommodated in a formulation. The advantages of a case formulation, in providing an understanding of the maintenance of clinical problems, in providing an integrated approach to intervention are outlined.

Can technology and the media help reduce dysfunctional parenting and increase engagement with preventative parenting interventions

In an evaluation of the television series “Driving Mum and Dad Mad,” 723 families participated and were randomly assigned to either a standard or technology enhanced viewing condition (included additional Web-support). Parents in both conditions reported significant improvements from pre- to postintervention in their childs behavior, dysfunctional parenting, parental anger, depression, and self-efficacy. Short-term improvements were maintained at 6-months follow-up. Regressions identified predictors of program outcomes and level of involvement. Parents who watched the entire series had more severe problems at preintervention and high sociodemographic risk than parents who did not watch the entire series. Few sociodemographic, child, or parent variables assessed at preintervention predicted program outcomes or program engagement, suggesting that a wide range of parents from diverse socioeconomic status benefited from the program. Media interventions depicting evidence-based parenting programs may be a useful means of reaching hard to engage families in population-level child maltreatment prevention programs.

Childhood asthma, behavior problems, and family functioning

BACKGROUND Studies of families of asthmatic children indicate associations between psychological factors and asthma symptoms. OBJECTIVE We investigated relations between psychosocial factors and the development of respiratory symptoms within a large prospective cohort study. METHODS The children were prenatally assigned to high, medium, or low risk for asthma development on the basis of parental atopy and family history of allergic disease. When the children were 3 years of age, parents completed the Eyberg Child Behavior Inventory (ECBI), Family Relationships Index (FRI), Hospital Anxiety and Depression Scale (HAD), and General Health Questionnaire (GHQ). RESULTS Data from 663 participants were analyzed. ECBI intensity scores were significantly higher for children with parentally reported respiratory symptoms. Symptomatic low-risk children (both parents nonatopic, no family history of allergic disease) were particularly likely to have elevated behavior problem ratings. None of the other family psychosocial variables showed this pattern. Child behavior problems were, however, significantly positively correlated with the other family psychosocial variables. Logistic regression indicated that behavior problem scores were associated with 3 or more attacks of wheeze (P =.03, OR = 1.023), irrespective of risk group. CONCLUSIONS Children at 3 years of age with symptoms suggestive of asthma are at elevated risk of behavior problems. Children from families without a history of asthma and allergic diseases may be particularly vulnerable to behavioral disturbance. Families may benefit from additional advice on management of their childs behavior, particularly if parents do not have the experience of having the illness themselves.

Are eating and psychosocial characteristics in early teenage years useful predictors of eating characteristics in early adulthood? A 7-year longitudinal study.

OBJECTIVES This longitudinal research aimed to determine the utility of psychosocial and eating characteristics in early teenage years in predicting eating attitudes and behaviors in early adulthood. METHOD Self-esteem, perfectionism, family function, and eating attitudes were measured at 12 years and eating attitudes and behavior were assessed at 19 years. Sixty-three women (71.6%) remained in the study over the 7 years. RESULTS Bulimic attitudes in early teenage years were related to subsequent bulimic features, while restrictive attitudes were more closely related to later purging behaviors. Self-esteem and perfectionism were only weakly linked with subsequent eating. However, different perceived family characteristics at the first stage were associated with specific aspects of eating in early adulthood. CONCLUSIONS There is consistency of eating characteristics across time, but psychosocial characteristics have a more limited predictive power. Future longitudinal studies should begin earlier in childhood if psychosocial factors are to be useful predictors of eating psychopathology in adulthood.

Family adaptability and cohesion: Relation to eating attitudes and disorders

Clinicians have suggested that anorexic and bulimic disorders are associated with abnormal family interaction. This study used the FACES II questionnaire to test that hypothesis. Anorexic and bulimic women perceived their families as lower in adaptability (rigid) and cohesion (disengaged) than comparison women. However, there were no linear relationships between perceived family interaction and scores on the EAT-40. The FACES II is poorly associated with measures of eating attitudes but has a more clinically valid association with diagnosed eating disorders.

The prediction of parasuicide repetition in a high‐risk group

OBJECTIVES This study explores whether the specificity of risk assessment for parasuicide repetition can be improved by measurement of two psychological variables (over-generality of autobiographical memory and future fluency for positive events) in the immediate aftermath of the index parasuicide. DESIGN In a longitudinal study, parasuicide patients deemed to be at high risk of repetition on the basis of sociodemographic factors (Kreitman & Foster, 1991) were followed-up over a 12-month period. METHOD As soon as practicable after taking a deliberate drug overdose, patients completed the Autobiographical Memory Test, the Personal Future Test and the Beck Hopelessness Scale. The relative power of each of these measures, together with the number of sociodemographic risk factors, in predicting parasuicide repetition was investigated using a forward step-wise logistic regression analysis. RESULTS The most potent short-term predictor of parasuicide repetition was found to be scores on the Beck Hopelessness Scale, whereas in the longer term the number of previous para-suicides was the major predictor. CONCLUSION For the heterogeneous parasuicide population as a whole, psychological variables are unlikely to improve upon the Beck Hopelessness Scale, sociodemographic risk factors and clinical interview in the prediction of parasuicide repetition.