Body-Related Emotions in Posttraumatic Stress Disorder Following Childhood Sexual Abuse

Traumatic experiences are associated with emotions such as anxiety, shame, guilt, disgust, and anger. For patients who have experienced child sexual abuse, these emotions might be triggered by perceptions of their own body. The aim of this study was to investigate the extent of the association of the body to traumatic experiences and to discern the emotions linked to trauma-associated body areas. Ninety-seven female participants were assigned to four groups: post-traumatic stress disorder following child sexual abuse with co-occurring borderline personality disorder, post-traumatic stress disorder following child sexual abuse without co-occurring borderline personality disorder, borderline personality disorder without post-traumatic stress disorder, and healthy controls. Participants rated 26 body areas regarding their association with trauma and 7 emotions. Emotions were assessed by questionnaires. Results suggest that specific areas of the body are associated with trauma and linked to highly aversive emotions. In post-traumatic stress disorder patients, the areas associated with highly negative emotions were the pubic region and inner thighs. Thus, the patient’s body may act as a trigger for traumatic memories.     

Personality at Face Value: Facial Appearance Predicts Self and Other Personality Judgments among Strangers and Spouses

Character judgments, based on facial appearance, impact both perceivers’ and targets’ interpersonal decisions and behaviors. Nonetheless, the resilience of such effects in the face of longer acquaintanceship duration is yet to be determined. To address this question, we had 51 elderly long-term married couples complete self and informant versions of a Big Five Inventory. Participants were also photographed, while they were requested to maintain an emotionally neutral expression. A subset of the initial sample completed a shortened version of the Big Five Inventory in response to the pictures of other opposite sex participants (with whom they were unacquainted). Oosterhof and Todorov’s (in Proc Natl Acad Sci USA 105:11087–11092, 2008) computer-based model of face evaluation was used to generate facial trait scores on trustworthiness, dominance, and attractiveness, based on participants’ photographs. Results revealed that structural facial characteristics, suggestive of greater trustworthiness, predicted positively biased, global informant evaluations of a target’s personality, among both spouses and strangers. Among spouses, this effect was impervious to marriage length. There was also evidence suggestive of a Dorian Gray effect on personality, since facial trustworthiness predicted not only spousal and stranger, but also self-ratings of extraversion. Unexpectedly, though, follow-up analyses revealed that (low) facial dominance, rather than (high) trustworthiness, was the strongest predictor of self-rated extraversion. Our present findings suggest that subtle emotional cues, embedded in the structure of emotionally neutral faces, exert long-lasting effects on personality judgments even among very well-acquainted targets and perceivers.     

Confronting Myths and Stereotypes About Borderline Personality Disorder

SUMMARY

The clinician treating a patient with borderline personality disorder (BPD) is often faced with complicated challenges, from making and communicating an accurate diagnosis, to implementing an appropriate, informed plan for treatment. Myths and stereotypes about BPD, and the individuals who may carry the diagnosis, likely complicate effective recognition and treatment of the disorder. BPD has been a controversial diagnosis among clinicians since its inception, and it is poorly understood among the general public. Pressures to avoid an explicit exploration of the diagnosis stemming from myths and stereotypes about the disorder can come from a number of sources, including other clinicians, family members and patients themselves. The results of minimizing or ignoring the contribution of borderline pathology may be detrimental. Clinical decisions based on outmoded thinking about diagnosis, prognosis, treatment efficacy, and availability of resources may deny patients optimal care. Integrating current findings into consideration of a BPD diagnosis and design of appropriate treatment, free of misconceptions about the condition, may help limit the untoward effects associated with failure to appreciate elements of borderline personality.     

Borderline Personality Disorder

SUMMARY

Our knowledge about borderline personality disorder (BPD) has taken some unexpected turns: BPD is less stable, it is more genetic, and it is more treatable than we would ever have imagined even 15 years ago. These developments have profound implications for understanding and treatment of individuals with BPD.     

Family Experience of Borderline Personality Disorder

Individuals with borderline personality disorder (BPD) struggle with unbearable emotions that arise out of interpersonal difficulties. Self‐harm and suicidal behaviours serve to regulate these emotions and to gain a sense of well‐being and control in a treatment context where hospital admissions are avoided by mental health services. Clinician engagement with families may be constrained by their knowing the accepted etiology of the disorder, which includes a causal link with the family environment. Other constraining factors include the negativity of those with BPD toward their family, and their clinicians' diagnostic uncertainty or confusion. This qualitative study explored the experience of families whose close relative with BPD has a long history of self‐harm and/or suicide attempts. Family members were found to have chronic and traumatic stress. Family roles and relationships were strained, as were relationships between the family and the mental health system. The findings of this study indicate that treatment for BPD needs to adopt a systemic approach that considers individuals and their significant family relationships, as well as relationships between the family and treatment providers.     

Schizoid Personality Traits Among the Homeless Mentally III: A Quantitative and Qualitative Report

This paper examines the interplay among schizoid personality traits, chronicity of homelessness, and engagement in treatment in a homeless mentally ill population. Both qualitative and quantitative information will be provided about a sample of 125 homeless mentally ill individuals receiving psychiatric treatment in a comprehensive services drop-in clinic. Naturalistic observations and a case vignette suggested that schizoid traits were prevalent and may have been playing a role in treatment engagement and chronicity of homelessness. This hypothesis was tested using quantitative research methods. The results showed that schizoid personality disorder and schizoid personality traits were prevalent in the sample. The presence of schizoid traits was positively correlated with chronicity of homelessness. Further, two schizoid traits (being content without sexual involvement with others, and lacking close friends or confidants) were positively correlated with remaining in treatment at 3 months. Implications of these findings for future research and treatment design will be discussed.     

Schizoid Personality Traits Among the Homeless Mentally Ill: A Quantitative and Qualitative Report

This paper examines the interplay among schizoid personality traits, chronicity of homelessness, and engagement in treatment in a homeless mentally ill population. Both qualitative and quantitative information will be provided about a sample of 125 homeless mentally ill individuals receiving psychiatric treatment in a comprehensive services drop-in clinic. Naturalistic observations and a case vignette suggested that schizoid traits were prevalent and may have been playing a role in treatment engagement and chronicity of homelessness. This hypothesis was tested using quantitative research methods. The results showed that schizoid personality disorder and schizoid personality traits were prevalent in the sample. The presence of schizoid traits was positively correlated with chronicity of homelessness. Further, two schizoid traits (being content without sexual involvement with others, and lacking close friends or confidants) were positively correlated with remaining in treatment at 3 months. Implications of these findings for future research and treatment design will be discussed.     

Making a (False) Impression: The Role of Business Experience in First Impressions of CEO Leadership Ability

Recent studies have demonstrated that judgments of business leaders’ faces predict their organizations’ financial performance. To date, these predictions have been derived exclusively from the impressions of naïve perceivers. Here, we tested how perceivers’ knowledge and experience in business might relate to their judgments of CEOs’ leadership ability from nonverbal facial cues. In Study 1, business students performed similarly to non-business students when rating faces for leadership ability. Business professionals with many years of experience exhibited significantly lower accuracy than professionals without business experience in Study 2, however. Following previous research demonstrating that experience in a particular domain can ironically reduce the accuracy of individuals’ judgments, our findings suggest that perceivers’ experience in executive business management positions may inhibit them from accurately judging leadership ability from nonverbal information. Domain-specific knowledge may therefore impair the accuracy of first impressions.     

ATTITUDES TOWARD THE MENTALLY ILL:

Labeling theory posits that people labeled mentally ill experience negative societal reactions. Past research on this question is contradictory, due primarily to methodological problems. This study overcomes some of these problems by having respondents indicate their willingness to interact with a person with a specific mental disorder, or with an identically behaving person with a specific physical disorder. As expected, respondents reject the mentally ill significantly more than identically behaving physically ill persons, as supports labeling theory. Respondents also consider the mentally ill less predictable and to have less positive outcomes than those with physical illness. These beliefs highly correlate with rejection and account for some, but not all, of the effects of label on rejection.     

Characterization of psychiatrically hospitalized college students

Abstract

Objective: To characterize contemporary college students requiring psychiatric hospitalization. Participants and methods: Sociodemographic and diagnostic information was gathered retrospectively and analyzed from the electronic medical records (EMRs) of the consecutive inpatient hospitalizations of 905 college students admitted to a psychiatric inpatient unit. Results: Significantly more females compared to males experienced the following: more hospitalizations, more family and financial stressors, more depression, and less psychotic and bipolar disorder. The most frequent diagnosis was a depressive disorder, followed by bipolar disorder, psychotic disorder, and personality disorder, most frequently borderline personality disorder. Half of participants had comorbid diagnoses with substance abuse most common. More than two-thirds of students endorsed social or intimate relationship, academic, and family challenges as psychosocial stressors. In all, 15% of participants had repeat admissions. Conclusions: The present study provides demographic data from a sample of psychiatrically hospitalized college students. Findings can help improve screening and identification of decompensation in college students.     

Nonverbal Decoding on Facebook: Applying the IPT-15 and the SSI to Personality Judgments

This study uses the lens model paradigm to explore whether two interpersonal sensitivity tests [i.e., Interpersonal Perception Task (IPT-15), Social Skills Inventory (SSI)] are associated with the accuracy of personality judgments made from Facebook (FB) profile pages. Target participants’ (N = 100) personality, self-monitoring, and FB honesty were self-reported, and the FB profile of each target was downloaded. Observers (N = 35) completed the IPT-15 and SSI and then estimated each profile owner’s personality from the profile pages. Observers’ scores on the IPT-15 were positively associated with the accuracy of estimates of targets’ extraversion and neuroticism. Observers’ SSI-ES scores were positively associated with the accuracy of estimates of targets’ agreeableness, conscientiousness, and openness. Characteristics of targets, such as self-monitoring, FB honesty, and overall FB use, also affected the accuracy of estimates. Results demonstrate that offline measures of sensitivity are associated with the accuracy of online personality judgments.     

The Relative Salience of Physiognomic Cues in Differentiating Faces: A Methodological Tool

This research utilized a novel methodology to explore the relative salience of facial cues to age, sex, race, and emotion in differentiating faces. Inspired by the Stroop interference effect, participants viewed pairs of schematic faces on a computer that differed simultaneously along two facial dimensions (e.g., race and age) and were prompted to make similarity judgments about the faces along one of the dimensions (e.g., race). On a second round of trials, judgments were made along the other dimension (e.g., age). Analysis of response speed and accuracy revealed that participants judged the race of the faces more quickly and with fewer errors compared to their age, gender, or emotional expression. Methodological and theoretical implications for studying the role of facial cues in social perception are discussed.     

Mental Illness and the Criminal Justice System

This is the second essay in a two‐part series exploring the relationships between mental illness, criminal behavior, and the criminal justice system. The number of mentally ill persons in prisons and jails has increased substantially over the last several decades, and there are currently more people with mental illness behind bars than there are in mental hospitals. In this essay, we place these trends within a broader historical context of the social control of mental illness in the United States. We identify how and why mentally ill persons have come to be overrepresented in the criminal justice system and highlight the unique challenges this population poses for police, courts, and correctional facilities. Finally, we review several recent innovations in policy and practice that may help alleviate that burden of criminal justice involvement on mentally ill offenders, as well as the burden of mentally ill offenders on the criminal justice system.     

Psychological Assessment through Performance-Based Techniques and Self-Reports: A Case Study of a Sexually Abused Girl at Preschool Age

We investigated the implicit psychological and behavioral consequences of sexual abuse in an adolescent girl who suffered child sexual abuse at preschool age in this case report. We report the manifestations of this abuse on her personality and psychological functioning using a structured clinical interview and a comprehensive psychological battery including the Beck Anxiety Inventory, the Beck Depression Inventory, the Standard Progressive Matrices, Rorschach Ink Blots, and the Schema Mode Inventory. These investigations were useful in formulating both a diagnosis and a management plan. The girl fulfilled diagnostic criteria for a major depressive episode and borderline personality disorder. This combination of psychological testing may be useful in establishing an accurate multiaxial diagnosis and for understanding the behavioral and psychological sequelae of child sexual abuse in similar cases. The study further suggests that schema-focused therapy is a useful therapeutic tool for individuals who have suffered child sexual abuse at an early age and who have borderline personality disorder.     

Psychological assessment through performance-based techniques and self-reports: a case study of a sexually abused girl at preschool age

We investigated the implicit psychological and behavioral consequences of sexual abuse in an adolescent girl who suffered child sexual abuse at preschool age in this case report. We report the manifestations of this abuse on her personality and psychological functioning using a structured clinical interview and a comprehensive psychological battery including the Beck Anxiety Inventory, the Beck Depression Inventory, the Standard Progressive Matrices, Rorschach Ink Blots, and the Schema Mode Inventory. These investigations were useful in formulating both a diagnosis and a management plan. The girl fulfilled diagnostic criteria for a major depressive episode and borderline personality disorder. This combination of psychological testing may be useful in establishing an accurate multiaxial diagnosis and for understanding the behavioral and psychological sequelae of child sexual abuse in similar cases. The study further suggests that schema-focused therapy is a useful therapeutic tool for individuals who have suffered child sexual abuse at an early age and who have borderline personality disorder.     

Gay, Straight, or Somewhere in Between: Accuracy and Bias in the Perception of Bisexual Faces

Sexual orientation can be accurately identified from photos of faces, but previous work has focused exclusively on straight versus gay and lesbian individuals. Across three studies, the current work investigated the facial perception of bisexual men and women, a less socially salient category. Although participants could identify straight and gay men at above-chance levels in a trichotomous categorization task, bisexual men were categorized only at chance (Study 1). Participants perceived bisexual men to be significantly different from straight men, but not gay men (Study 2). Similarly, whereas bisexual and lesbian women were not rated differently, both groups were distinguishable from straight female targets (Study 3). These findings suggest a straight-non straight dichotomy in the categorization of sexual orientation.     

Relationship Quality and Stability in Couples When One Partner Suffers From Borderline Personality Disorder

The main goal of the present study was to examine and compare the psychosocial functioning of 35 couples including a woman diagnosed with borderline personality disorder (BPD) to that of a nonclinical control sample of 35 couples. The BPD status of women from the clinical group and the prevalence of personality disorder in their partner were ascertained through the SCID-II. Participants completed self-report measures of couple functioning. A majority of couples in which the woman suffered from BPD (68.7%) evidenced frequent episodes of breakups and reconciliations and, over an 18-month period, nearly 30% of these couples dissolved their relationship. Nearly half of the men involved in a romantic relationship with a woman suffering from BPD met criteria for one personality disorder or more. As compared with nonclinical couples, clinical couples showed lower marital satisfaction, higher attachment insecurity, more demand/withdraw communication problems, and higher levels of violence.     

Differential Labeling of Mental Illness Revisited: Patterns Before and After the Rise of Managed Care

With the National Comorbidity Survey of the early 1990s, Thoits (2005) recently showed that lower-status mentally ill individuals were not more often hospitalized or pressured into psychiatric treatment than comparably ill persons of higher status, disconfirming a central hypothesis of labeling theory. However, that finding may have been due to changes in the mental health treatment system introduced by the spread of managed care. The differential labeling hypothesis is reexamined here with data from the Epidemiological Catchment Area Studies (ECA) collected in the early 1980s before managed-care plans began to dominate the insurance marketplace and from the National Comorbidity Survey Replication conducted in the early 2000s when managed care had saturated the market. Little systematic support for the differential labeling hypothesis was found in the three studies, although, over time, the higher rates of mental hospitalization among less educated and low-income individuals found in the ECA survey disappeared. Trends across the studies suggest that educated and affluent persons with psychiatric problems more frequently sought hospital care. These findings further undermine the validity of the differential labeling hypothesis and suggest that service utilization or treatment-seeking factors may help explain mental hospitalization rates.     

Meeting the Needs of the Mentally Ill Homeless in Massachusetts-Based Emergency Shelters

A statewide survey (response rate = 79.5%) of the emergency shelters designed for homeless individuals was conducted in Massachusetts to determine the prevalence of serious mental illness among residents and extent to which they received psychiatric services. An average prevalence rate of 22%, ranging from 1% to 70%, was reported despite the fact that 87% of the shelters restricted admission of those exhibiting severe behavioral problems. Nearly three-quarters of the shelters reported providing some mental health services as part of their program, and 80% had established ties with professional mental health agencies. Linkages with these mental health agencies greatly enhanced placement options for mentally ill persons. When queried on the most pressing community-based service needed for the homeless mentally ill, nearly two-thirds of the shelters reported a need for additional housing alternatives.