Emotional risks to respondents in survey research

Some survey research has documented distress in respondents with pre-existing emotional vulnerabilities, suggesting the possibility of harm. In this study, respondents were interviewed about a personally distressing event; mood, stress, and emotional reactions were assessed. Two days later, respondents participated in interventions to either enhance or alleviate the effects of the initial interview. Results indicated that distressing interviews increased stress and negative mood, although no adverse events occurred. Between the interviews, moods returned to baseline. Respondents who again discussed a distressing event reported moods more negative than those who discussed a neutral or a positive event. This study provides evidence that, among nonvulnerable survey respondents, interviews on distressing topics can result in negative moods and stress, but they do not harm respondents.

Pain, coping and health care utilization in younger and older adults with sickle cell disease

Sickle cell disease is characterized by acute pain crises. Pain, chronic medical problems, utilization and coping were compared in younger vs older patients using questionnaires and medical record review. Groups reported similar pain intensity and medical conditions. The pattern of utilization differed such that older patients attended outpatient clinic, and younger patients went to the Emergency Department. Younger patients were more likely to cope by ignoring pain, or by using heat, cold or massage. Older patients were more likely to pray and hope. We conclude that age plays an important role in the utilization and coping of sickle cell patients.

Psychopathology in adolescents presenting for laparoscopic banding

This study documents psychological problems in obese adolescents seeking bariatric surgery with laparoscopic adjustable gastric band. Depression, self-harm, suicidal ideation, anxiety, and bullying were reported frequently. Professionals will need to carefully assess adolescents for high-risk behaviors and provide appropriate follow-up care if these individuals undergo laparoscopic banding.

Malingering dissociative identity disorder: objective and projective assessment

Verification of dissociative identity disorder presents challenges given the complex nature of the illness. This study addressed the concern that this disorder can be successfully malingered on objective and projective psychological tests. 50 undergraduate women were assigned to a Malingering or a Control condition, then completed the Rorschach Inkblot Test and the Dissociative Experiences Scale II. The Malingering group were asked to simulate dissociative identity disorder; controls received instructions to answer all materials honestly. Analysis indicated that malingerers were significantly more likely to endorse dissociative experiences on the Dissociative Experiences Scale II in the range common to patients with diagnosed dissociative identity disorder. However, on the Rorschach there were no significant differences between the two groups. Results suggest that the assessment of dissociative identity disorder requires a multifaceted approach with both objective and projective assessment tools. Research is needed to assess these issues in clinical populations.

Revision of the Word Association Test for assessing associations of patients reporting satanic ritual abuse in childhood

A growing number of psychiatric patients report satanic ritual abuse, prompting research into this controversial area. In the current study, the Word Association Test (WAT) was modified to assess experience with satanic abuse. Pilot work resulted in norms for two domains: normative and satanic. Female psychiatric patients were compared on their associations in two studies. Based on a sexual history, they were grouped into those reporting sexual abuse, those reporting satanic ritual abuse (SRA), and those without a history of sexual abuse (controls). In both studies, SRA patients gave significantly more total associations, significantly fewer normative associations, and significantly more satanic associations than did the other two groups. These results suggest that an experience base is shared by individuals reporting SRA that is not found in individuals who do not report satanic abuse (even if they do report sexual abuse). The implications of these findings are discussed from the perspective of arguments advanced by advocates and critics of SRA.

Rorschach indicators of dissociative identity disorders: clinical utility and theoretical implications

The purpose of the present study was to replicate Rorschach signs of Multiple Personality Disorder (MPD) using DSM-IV criteria of Dissociative Identity Disorder (DID). Women admitted to either an inpatient dissociative disorder's unit (n = 27) or a general psychiatric unit (n = 72) were given the Rorschach, which was scored for the Labott, Barach, and Wagner Rorschach markers of MPD. Results indicated that Rorschach signs of the three different systems were significantly better than chance at classifying patients as DID or as non-DID. The Labott system, which performed the best, was able to accurately classify 92% of the sample. These results argue for the validity of the DID diagnosis. The Rorschach signs operate independent of external bias, yet correspond to the diagnoses obtained through psychiatric evaluation in an inpatient setting. The fact that two relatively rare sets of signs (DID and Rorschach) converge in the same small sector of the psychiatric population represents evidence of linkage that is clinically meaningful and not explainable on the basis of artificial creation.

Screening for somatizing patients in the pulmonary subspecialty clinic

Somatizing patients present a history of vague, unexplained medical symptoms. This study compared somatizing patients with pulmonary control subjects by using the Diagnostic Interview Schedule (DIS-III-R), the Illness Attitude Scales (IAS), and the Minnesota Multiphasic Personality Inventory (MMPI-2). The groups differed in the number of somatization symptoms reported and in the frequency of somatization disorder diagnoses when the screening criteria were used. The somatizing group obtained higher scores on the bodily preoccupation and hypochondriacal beliefs subscales of the IAS; no differences were found on the MMPI-2. These findings indicate that the DSM-III-R somatization screening items can be useful for detecting somatization when patients present with unexplained respiratory complaints.

Authenticity of recovered sexual abuse memories: a Rorschach study

Distinguishing authentic abuse from false memory among adults who recover memories of childhood sexual trauma has far-reaching significance. This study initially examined 13 previously reported Rorschach signs of sexual abuse in women not abused, and women sexually abused (and not amnestic). The abuse signs were more prevalent in the abused group. A sexual abuse index composed of 8 signs correctly classified 93% of the abused, and 98% of the nonabused group. The index was then applied to women who recovered memories of abuse; some had analogues of dissociation in their protocols and others did not. Those exhibiting dissociative signs produced more signs of sexual abuse. The index classified 88% of the dissociative group as abused, but only 24% of the nondissociative group. The relevance of these findings for assessing authenticity of recovered memories is explored.

Health care utilization of somatizing patients in a pulmonary subspecialty clinic

Somatizing patients present with medically unexplained physical complaints, repeat clinic visits, and a history of prior extensive testing. The authors reviewed 1,908 pulmonary consultation reports for 1990-1991 for evidence of somatization, yielding a group of 41 (2%) patients for study. Billing records were obtained and were compared to asthmatic patients and those in a health maintenance organization (HMO). Health care costs for the somatizing patients were significantly higher than the average cost for HMO patients and comparable to the health costs for patients with asthma. Half of the somatizing patients had psychological problems indicated in their medical records, but few received psychiatric referral or treatment. Management of the somatizing patient within the specialty clinic and on-site psychiatric treatment are suggested as ways to decrease unnecessary health care utilization.

Rorschach indicators of Multiple Personality Disorder

The increase in reported cases of Multiple Personality Disorder underscores a great need to differentiate clearly this from other psychiatric disorders and from simulation of Multiple Personality Disorder. Two sets of Rorschach signs have been advanced as clinical markers by their developers, namely Barach and also Wagner, Allison, and Wagner. As the Wagner signs are prevalent in much of the research on Rorschach responses in Multiple Personality Disorder, the purpose of the present study was to evaluate these signs using Wagner's administration and the resulting Rorschach protocols of 16 Multiple Personality Disorder patients and 16 psychiatric controls. Analysis indicated that this system was deficient in correctly classifying these 32 protocols. A new marker, the Splitting Response, emerged, however, which was more useful. This response, in combination with at least one Dissociative response, produced an accuracy rate of 94%. These new criteria may be useful aids in the detection of Multiple Personality Disorder from Rorschach protocols. Replication is urged.

"If you love someone, you don't hurt them": a comprehensive process analysis of a weeping event in therapy

Early theorists described physical diseases (e.g., asthma, ulcers) thought to be associated with the inhibition of weeping (e.g., Alexander 1950), and catharsis theories (Breuer and Freud 1895/1955; Koestler 1964) postulated that unexpressed emotion accumulated as in a tank, and then overflowed as tears when a threshold level was exceeded. From a more biological perspective, it has been suggested that stress produces toxic chemicals in the body that become concentrated in the lacrimal gland and are released through weeping, restoring homeostasis (Frey 1985). As a result of these theories, psychotherapists tend to believe weeping is healthy for clients and that it serves to decrease depression (Trezza et al. 1988). While laboratory studies have typically not supported these ideas (e.g., Labott and Martin 1987, 1988), no studies have been performed on weeping specifically in the context of psychotherapy.

The physiological and psychological effects of the expression and inhibition of emotion

Previous work has indicated that humor enhances immunity, but the immunological effects of overt crying have not been studied. Thirty-nine women viewed sad and humorous videotapes and either inhibited or expressed overt expressions of laughter and weeping; these were observed and timed. Moods and immunity (S-IgA) were repeatedly measured. The humorous stimulus resulted in improved immunity, regardless of the overt laughter expressed; overt crying was immunosuppressive, whereas the inhibition of weeping in the context of the same sad stimulus was not. Moods were more negative following the sad stimulus and in the expression condition. The results with respect to humor are consistent with previous research; the immunosuppressive effect of overt crying is discussed in the context of various types of crying that may have different effects.

Emotional coping, age, and physical disorder

Traditional ideas suggest that emotional expression is healthy, but empirical support for this position is mixed. Adult subjects participated in a telephone interview to examine the relationships among age, emotional coping (ie, laughter and crying), physical disorder, sex, and income level. Results indicated that cry-coping in women and in low-income participants was associated with increased disorder as age increased. Humor-coping had no relationship to physical disorder across the adult lifespan. These results indicate that emotional weeping does play a role in the prediction of physical disorder, especially in certain groups. In the future, researchers need to concentrate on more subtle physiological effects as well as on the psychological and social consequences of emotional expression.

The stress-moderating effects of weeping and humor

The moderating effects of emotional weeping and humor on the impact of negative life events were examined. Subjects who reported weeping frequently showed more mood disturbance at high levels of negative events and less to low levels of negative events than those who reported less frequent weeping. Humor-coping buffered stress in all groups except for males who reported frequent crying.