Types of alcoholics: concurrent and predictive validity of some common classification schemes

This study evaluated the discriminative power and predictive validity of five common typological schemes used to classify alcoholics for theoretical or clinical purposes. A heterogenous sample of 321 alcoholics was classified according to primary vs secondary alcoholism, parental alcoholism, Fellinek's gamma-delta distinction, gender, and subtypes derived from MMPI profiles. A prospective longitudinal cohort design was employed to compare the relative ability of these typologies to differentiate alcoholics according to natural history, alcohol-related consequences, response to treatment, and post-treatment adjustment. The findings indicate that while 'one-dimensional' typologies discriminate subgroups in terms of etiological variables, presenting symptoms, and drinking patterns, none of the classification systems emerges as a strong predictor of outcome status. In addition, these typologies do not discriminate well with respect to the alcoholic's drinking patterns and presenting symptoms, except in areas closely connected with the model (e.g. alcoholics with antisocial personality (ASP) indicate more social problems related to alcohol use than do primary alcoholics). Because there is a great deal of overlap among certain subtypes identified within different typological models (e.g. alcoholics with primary ASP tended to have a positive family history and a gamma pattern of impaired control), we hypothesize that empirical clustering techniques that search for naturally occurring commonalities among alcoholics may be a better way to identify homogeneous subtypes.

Personal crisis: growth or pathology?

PURPOSE

The aim of this article is to present an emerging theoretical framework for viewing certain types of personal crises as developmentally healthy rather than as psychopathological. These types of crises are referred to as "spiritual emergence" and "spiritual emergency."

SEARCH METHODS USED

Selected literature from psychology, psychiatry, and philosophy is used to describe the new paradigm, which views the development of human consciousness across the life span as going beyond the well-adjusted and productive adult ego. The intent is to introduce this paradigm and some of its implications for further critical consideration by health promotion professionals. It is not the authors' purpose to critically evaluate the relevant theoretical literature in this article.

SUMMARY OF IMPORTANT FINDINGS

The new paradigm represents an expanded theory of human development that explicitly recognizes a spiritual dimension in personal growth and health. Within this paradigm, spiritual emergence and spiritual emergency are viewed as signs of transitional, personal growth rather than as symptoms of psychopathology. Accordingly, signs of growth need to be differentiated from symptoms of pathology. The first step in doing this is to contextualize human experience in a larger developmental framework.

MAJOR CONCLUSIONS

Health promotion professionals may benefit personally and professionally by being aware of the new developmental paradigm which differentiates spiritual growth from pathological symptoms. Further theoretical clarification and research will be needed before detailed recommendations for practice can be made.

In the genes or in the stars? Children's competence to consent

Children's competence to refuse or consent to medical treatment or surgery tends to be discussed in terms of the child's ability or maturity. This paper argues that the social context also powerfully influences the child's capacity to consent. Inner attributes and external influences are discussed using an analogy of the genes and the stars.

Personal and parental alcohol abuse, and victimization in obese binge eaters and nonbingeing obese

Current obesity research has begun to emphasize the importance of pretreatment assessment and more individually tailored treatment protocols. Obese binge eaters have been identified as a subgroup of the obese who do not respond well to standard behavioral treatment programs. We were interested in identifying variables that are important to consider when assessing and treating obese binge eaters. The present study assessed the prevalence of personal alcohol abuse, parental alcohol abuse, and victimization in 62 males and 274 females seeking treatment for obesity. Obese binge eaters (OBE) had significantly greater rates of personal alcohol abuse, parental alcohol abuse, and victimization than the nonbingeing obese (NBO) in our sample. Further studies of the OBE population are recommended.

A comparison of women seeking drug and alcohol treatment in a specialist women's and two traditional mixed-sex treatment services

The paucity of research on the treatment needs of women with substance abuse problems has been a serious impediment to the development of empirically validated treatment programmes. Women continue to be seriously under-represented as research subjects and clients of treatment services. This study compares the characteristics of 80 women attending a specialist women's treatment service with those of eighty women attending two traditional mixed-sex treatment agencies. Women attending a gender-sensitive service were significantly more likely to have dependent children, to be lesbian, to have a maternal history for drug or alcohol problems and to have suffered sexual abuse in childhood. These results suggest that gender-sensitive treatment services may be recruiting women who might not otherwise have sought treatment for their substance dependence problems.

Obsessive-compulsive disorder in childhood and adolescence: a clinical study

The clinical records of 72 children and adolescents aged 5-18 with a diagnosis of OCD were examined. Mean age of onset was 11 years. Repeating, cleaning and checking were the most common compulsions. Twenty percent of subjects showed obsessions unrelated to compulsions. In 53% of cases stress situations preceded the disorder. Seventy-seven percent of subjects suffered some other psychiatric disorder, lifetime or current, particularly anxiety and affective disorders. The majority (57%) had some first-degree relative with a psychiatric diagnosis. Family conflicts, social withdrawal and poor school performance were also common features.

Mothers with hostile, Type A predisposing child-rearing practices

The authors examined characteristics of Finnish mothers (N = 924) who use hostile child-rearing practices (i.e., they ignore the child, are punitive and irritable, and perceive the child as a burden), practices that have been shown (Räikkönen & Keltikangas-Järvinen, 1992) to predispose children to Type A behavior. The results of this study indicate that two factors--Type A behavior in the mothers and the mothers' sociodemographic background (low occupational status, low educational level and young age)--increase the probability of the mothers' treating their children in a hostile manner. Also, the mothers of boys in this study reported more hostile child-rearing practices than the mothers of girls did.

A population-based survey of the characteristics of high school students with and without a history of suicidal behavior

In a sample of 570 15- and 16-year-old normal high school students, the characteristics of those with and without a history of suicidal behavior were compared. In a written inquiry, information was obtained on family background, emotional and behavioral problems, sexual and physical abuse and suicidal thoughts and behavior. Differences between the students with and without a history of suicidal behavior were statistically analyzed for boys and girls separately by a matched control design. The results for both boys and girls indicated that the experience of sexual abuse, feelings of loneliness, depressed mood, low self-esteem and the use of drugs were particularly strongly related to suicidal thoughts and behavior; for girls, physical abuse and for boys, low self-reported academic achievement appeared to be clearly related aspects. Furthermore, the strong interrelations between all of these variables is underlined, suggesting a multi-problem background of youngsters with a history of suicidal behavior.

Moratorium-achievement (MAMA) cycles in lifespan identity development: value orientations and reasoning system correlates

Three important questions emerging in identity research are: Why do only some persons with Foreclosed identities move on to Identity Achievement? Why do some Identity Achievement persons move "back" to Foreclosure? How can life-span identity re-formulation be accounted for? This study proposes that individual's positions on two variables, "instrumental vs. experiential orientation" and formistic vs. dialectrical thinking, may be important in answering these questions. Among 60 university students, 23 males and 37 females, those in an identity status characterized by formation and maintenance of structure (Foreclosure) were instrumentally-oriented while those characterized by openness to change and revision (Moratorium) were experientially-oriented. Similarly, more Moratoriums than other statuses were high in dialectic thinking. These results are discussed in terms of their theoretical implications for life-span identity development.

Juvenile sex offenders: similar to, or different from, other incarcerated delinquent offenders?

The purpose of the present study was to compare incarcerated juvenile sex offenders to incarcerated youth who committed confrontational but nonsex offenses, and to those youth who committed only nonconfrontational, nonsex offenses. Furthermore, comparisons were made between two subtypes of sex offenders: those youth convicted for rape or sodomy vs those convicted for child molestation. Eighty-three male juvenile delinquents served as participants. Teachers within the correctional facility completed an instrument which allowed the examination of the two areas of interest: externalizing problems and internalizing problems. The results indicated that sex offenders generally, and particularly those who had committed only sex offenses, were perceived as having fewer externalizing and internalizing problems. No differences emerged between the two subtypes of sex offenders. Implications, as well as limitations, of the findings are discussed.

Sources of distress among New Zealand adolescents

This study examined sources of distress experienced by 15-year-old adolescents in a large sample from the general population. We identified four types of stressful life circumstances relating to problems of self-image and independence, academic and physical competence, parental conflict, and moving residence and schools. Girls reported higher levels of distress for the first three types of circumstance. Reports of distress were associated with poor family social support, maternal depression and parental separation. Both DSM-III disorder and poor social competence were associated with differential patterns of distress. Lastly, poor social competence and high distress were independent and additive predictors of mental health disorders.

The Parental Bonding Instrument in adolescent patients with anorexia nervosa

The Parental Bonding Instrument (PBI) was administered to 54 adolescent patients with anorexia nervosa. Scores were compared with those of matched groups of normal and of nonanorectic adolescents referred for assessment to an adolescent psychiatric unit. Significant differences between the 3 groups were demonstrated with respect to care and protection dimensions. Overall scores of subjects in the anorectic group resembled those of normals rather than those of referred patients. Anorexia nervosa patients described their fathers and mothers as being more caring and their mothers as being less overprotective than did psychiatrically referred peers. The study raised questions concerning the use of the PBI in adolescents, in particular those with anorexia nervosa, and the role of the family in the aetiogenesis of this condition.

Gender differences in the clinical expression of schizophrenia

Gender differences have been reported for a variety of clinical measures in patients with schizophrenia. Clinical characterization may be helpful in identifying symptom clusters which can then be linked to underlying brain function. In this study 74 men and 33 women meeting DSM-IIIR criteria for schizophrenia were studied off medication and rated on measures of symptom type and severity, as well as premorbid and current function. Men were more severely impaired in ratings of negative symptoms, while positive symptoms were not significantly different. There were also differences in premorbid and current functioning, with women manifesting better social functioning than men.

An adoption and a cross-fostering study of the Minnesota Multiphasic Personality Inventory (MMPI) Psychopathic Deviate Scale

The first of two complementary studies compared biological and adoptive parents of teenage adoptees with either higher (n = 21) or low (n = 51) MMPI Psychopathic Deviate (Pd) scale scores. In comparison to biological mothers of the low-Pd adoptees, biological mothers of the high-Pd adoptees obtained significantly higher MMPI scores on six of eight clinical scales. Fewer differences existed between the corresponding groups of adoptive mothers, but adoptive mothers of the high Pd's did obtain significantly higher scores on the Pd and Hypomania scales. Substantial genetic correspondences also existed for Harris-Lingoes content subscales, with fewer correspondences between adoptees and their adoptive mothers. There were indications that adoptive mothers of the high-Pd children had personality traits which may have made them less effective in attenuating early signs of antisocial behavior. The second study employed a cross-fostering design dividing all biological and adoptive mothers (n = 138 each) by their respective median Pd raw scores to examine effects on offspring. Results confirmed the effect of biological mother Pd score, but only a trend suggested an adoptive mother effect, with no hint of an interaction.

Family change, parental discord and early offending

The relationship between exposure to family change, exposure to parental discord during the period from birth to 10 years and risks of offending by the age of 13 years was studied in a birth cohort of New Zealand children. This analysis showed that while exposure to parental discord during middle and early childhood led to increased risks of early offending, exposure to family change in the absence of parental discord did not lead to increased risks of offending. The results also suggested that children with a history of early conduct problems were particularly susceptible to parental discord but that the effects of discord did not vary with the child's gender. These results persisted when errors of measurement in the reporting of offending were taken into account using latent class methods.

Children's drawings of topics differing in emotional significance--effects on placement relative to a self-drawing: a research note

Children aged 4-6 years were asked to add drawings of someone they liked and someone they disliked to a picture of themselves. Liked figures were drawn closer than disliked figures to the self-figure only when the procedure was standardized and controlled so as to equate the tasks of positioning each of the added figures. With unmatched positioning tasks there was no effect of significance of figure on placement. The data demonstrate that a child's emotional attitude to a figure can affect its placement in a drawing, but that the effect is weak and easily masked.

The psychological adjustment of offspring of adults with obsessive-compulsive disorder: a brief report

This study describes the prevalence of emotional and behavioural problems in the offspring of parents who are members of the Obsessive-Compulsive Neurosis Support Group in South Australia. The results suggest that the offspring of adults with obsessive-compulsive disorder do not have more problems than other children and adolescents in the community. The study also highlights potential benefits of collaborative research conducted by research groups and self-help organisations.

Reciprocated self-disqualification among parents of schizophrenics

Is deviant parental communication an interactional phenomenon? If it is, is this interaction stronger or weaker among parents of schizophrenics (S) than among parents of non-schizophrenic psychiatric controls (NS) and normals (N)? These two questions were investigated by using sequential analysis of parental interaction during Spouse Rorschach. Parents' deviant communication was measured by the self-disqualification (SD) category in the Relationship Control Coding System. Results showed that self-disqualification clearly depended on the quality of the previous parental communication: an SD utterance greatly increased the probability of an SD response from the spouse among S (n = 17), NS (n = 15) and N (n = 14). However, this increased probability was significantly higher among S parents. Furthermore, S parents' communication was significantly less dependent on their own previous communication than NS and N parents' communication was. However, the sheer magnitude of parental SD communication was a significant predictor of offspring diagnosis even when the interaction between the spouses was controlled for. Thus, the results indicate that the high rate of deviant communication among S parents is partly due to individual characteristics of the parents and partly due to reciprocation of the other spouse's deviant communication. The results are discussed with reference to possible gene-environment interaction in both schizophrenia and deviant communication.

The four faces of Eve: A typological analysis of women's personality at midlife

In an analysis of adult personality structure, types are defined as prototypes rather than as discrete categories. Using inverse factor analyses of archival Q-sort descriptions, 4 type factors were replicated in a cross-validation design. These prototypes are interpreted as Individuated, Traditional, Conflicted, and Assured and are related to Rank's (1945) theoretical analysis of different modes of adjustment. These prototypes capture particular combinations of personality dimensions, such as Ego Resiliency, Ego Control, and the Big Five, and converge with the types identified by Block (1971). Further analyses using 13 clusters of scales from 3 broad-band self-report inventories validated the Q-sort-based interpretations and showed a distinct and theoretically consistent patterning for each of the types.

The biology of personality

Historically, models of personality have generally postulated, or assumed, a link with biology. This century has witnessed a major revision of these ideas with both behavioural and psychoanalytic theorists emphasising life experiences as being largely responsible for behaviour as adults. Challenges to this assumption of the overwhelming importance of life experiences are reviewed. An extensive body of data now exists suggesting that biology contributes significantly to individual variability. This biological contribution occurs at a relatively low level in the central nervous system, best defined as temperament. Further research has suffered from the lack of a cohesive psychobiological model. Cloninger's tridimensional theory of personality is presented as a model which attempts to bridge the gap between theoretical temperamental traits, neurotransmitter function and clinical psychiatry. It is to be hoped that new theoretical models will be formulated which will focus on the importance of temperamental variables in psychiatric disorders.

[Study on the relationship between toddler temperament and development (first report)--the correlation among toddler temperament, maternal perception and rearing environment]

The purpose of this study is to clarify how a child's temperament and maternal perception influences the rearing environment. As the conceptual framework, we used A.J. Sameroff's transactional model and Miyake's conceptual model of mother and child. The following process was hypothesized: toddler temperament influences maternal perception, which in turn influences rearing environment under which children are developing. Questionnaires concerning toddler temperament, maternal perception and rearing environment were sent to mothers whose children were scheduled to receive 1 year and 6 months child health examinations, and results from 306 mothers and children who answered the questionnaires were analyzed. The results were as follows: (1) Child temperament showed a tendency to accord with maternal perception of how easy it is to handle him/her. (2) Maternal perception was related to rearing environment. (3) Temperamental characteristics were related to rearing environment. (4) While the influence of child temperament and maternal perception on the rearing environment was not shown to be strong, the hypothesized process of this study was supported to a certain degree. From these results, it appears that it is important to pay attention to a child's temperament as a contributing factor in the health practice of mother and child.

Dependency conflict, marital threat, and alcohol consumption in a middle-aged sample

The hypothesis that dependency conflict is associated with higher levels of alcohol consumption when dependency needs are threatened or thwarted was tested with a sample of 672 middle-aged, married adults with college-age children. The subjects' current level of alcohol consumption was predicted based on the present level of threat to the marital relationship (assessed by reports from several family members) and on indices of dependency need and inhibition of dependent behavior estimated from sibship size, sibship density, and sibling position. A multiple regression analysis yielded a significant two-way interaction (p less than .05) between marital threat and subject sex, and a significant three-way interaction of dependency need, inhibition of dependent behavior, and marital threat. High marital threat was associated with higher levels of alcohol consumption in men and slightly lower levels of alcohol consumption in women. Additionally, when dependency need was high, alcohol consumption was generally low, except when both inhibition of dependent behavior and marital threat were high. However, when dependency need was low, the highest alcohol consumption score occurred when marital threat was low and inhibition was high.

Developmental level as a predictor of alcoholism treatment response: an attempted replication

Over 12 years ago, a developmental level (DL) cognitive measure derived from the Rorschach was found to be a powerful predictor of alcohol-related outcomes following behaviorally oriented inpatient alcoholism treatment. These findings represent the strongest evidence of a relationship between cognitive functioning and treatment response. The current pilot study attempted to determine whether the large effects previously obtained with the DL measure could be replicated. The Rorschach was administered during the first week of treatment to 20 male alcoholic patients attending 1-month day hospital rehabilitation program. The Addiction Severity Index (ASI) was administered upon entry into treatment and a follow-up ASI was also administered 7 months after treatment entry. A higher DL was found to be significantly related to less recent drinking and intoxication at baseline as well as to lower alcohol-related problem levels in general. However, all of the relationships between DL and alcohol-related behaviors at follow-up were found to be either small or in a direction opposite to that hypothesized. Some of the reasons for the discrepancy between the findings of the current study and the earlier study are discussed.