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Biomedical subjects

C M Grilo

Publications and source records attributed to C M Grilo.

At least 37 records · Page 2Linked to original sources

Gender differences in violence exposure and violence risk among adolescent inpatients.

Gender-specific rates of violence exposure and violence perpetration among psychiatrically ill adolescents has received little scientific attention. We examined 130 adolescent inpatients and found no difference between male and female subjects with respect to self-reported violence potential or actual violence perpetration. Female inpatients, however, were significantly more often victims of sexual assault, and male inpatients were significantly more often victims of physical assault. For male inpatients, a history of violence perpetration in one area was closely linked with a history of violence victimization in the same area. Alternatively, patterns of victimization and perpetration among female inpatients were less predictable and had crossover to victimization and perpetration experiences in other areas. Correlational analyses revealed that violence risk was associated with a broad range of internalizing and externalizing psychopathology. Significant associations with hopelessness, suicidality, and childhood trauma differentiated the violence risk of male and female inpatients. We propose a hypothesis for understanding these differences and conclude that although psychiatrically ill adolescent male and female patients may commonly fall victim to differing forms of violence, both genders are at equal risk for actual violence perpetration.

Adolescent↗

Schizotypal Personality Questionnaire-Brief: factor structure and convergent validity in inpatient adolescents.

We examined the internal consistency, factor structure, and validity of the Schizotypal Personality Questionnaire-Brief (SPQ-B). Two hundred thirty-seven psychiatrically hospitalized adolescents were administered the SPQ-B and a battery of well-established self-report instruments. The SPQ-B demonstrated adequate internal consistency. Exploratory factor analysis provided mixed support for the SPQ-B 3-factor structure of interpersonal deficits, cognitive-perceptual deficits, and disorganization. The Interpersonal and Cognitive-Perceptual subscales demonstrated convergent and discriminant relationships with other measures of interpersonal impairment and cognitive abnormalities. We concluded that the SPQ-B is a promising measure for evaluating schizotypal personality disorder features, specifically interpersonal and cognitive-perceptual deficits, with adolescent psychiatric inpatients.

Adolescent↗

Applicability of personality disorder criteria in late adolescence: internal consistency and criterion overlap 2 years after psychiatric hospitalization.

We examined internal consistency and criterion overlap of DSM-III-R personality disorder criteria in late adolescence, 2 years after psychiatric hospitalization. A total of 60 adolescents were assessed with the Personality Disorder Examination. Within-category cohesiveness (internal consistency) was evaluated by coefficient alpha and mean intercriterion correlation (MIC). Between-category criterion overlap was evaluated by examining intercategory mean intercriterion correlations (ICMIC) between all pairs of disorders. Internal consistency was low, with alpha less than .70 for all except borderline and dependent personality disorders. For most disorders, MIC values were higher than ICMIC values. Our findings suggest that personality disorder criteria sets have limited internal consistency in older adolescents. Although the criteria for most personality disorders correlate better with each other than with the criteria for other personality disorders, suggesting some degree of discriminant validity, comparison of these results with a similar analysis performed shortly after hospital admission raises questions about personality disorder construct validity during adolescence.

Adolescent↗

Stability and course of personality disorders: the need to consider comorbidities and continuities between axis I psychiatric disorders and axis II personality disorders.

The literature pertaining to the stability and course of personality disorders is briefly reviewed. Available data suggest that PD diagnoses demonstrate only moderate stability and that--although generally associated with a plethora of negative outcomes--they can show improvement over time. This paper highlights the pervasiveness of diagnostic co-occurrence and its implications for continued investigation of the question of PD stability. In addition to examining the stability (and outcome) of PDs, longitudinal studies need to consider continuities between diagnoses. The Collaborative Longitudinal Personality Disorder Study (CLPS) is described briefly vis-a-vis some of these major issues.

Comorbidity↗

The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence.

OBJECTIVE: To describe baseline diagnostic co-occurrence in the Collaborative Longitudinal Personality Disorders Study. METHOD: Six hundred and sixty-eight patients were reliably assessed with diagnostic interviews for DSM-IV Axis I and II disorders to create five groups: Schizotypal (STPD), Borderline (BPD), Avoidant (AVPD), Obsessive-Compulsive (OCPD) and Major Depressive Disorder (MDD) without personality disorder (PD). RESULTS: Mean number of Axis I lifetime diagnoses was 3.4; STPD and BPD groups had more diagnoses than AVPD, OCPD, and MDD groups. Significant Axis I co-occurrences emerged for Social Phobia/ AVPD, PTSD/BPD and Substance Use/BPD. Mean number of co-occurring PDs was 1.4; STPD had more than BPD group which had more than AVPD and OCPD groups. Significant PD co-occurrence emerged for: STPD/ Paranoid and Schizoid PDs, BPD with Antisocial and Dependent PDs, and lower frequency for OCPD/Antisocial PD. CONCLUSION: Diagnostic co-occurrences generally followed base rates, while significant departures resemble those of controlled literature.

Follow-Up Studies↗

Teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in binge eating disorder.

OBJECTIVE: The primary goal of this study was to examine associations among teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in women with Binge Eating Disorder (BED). RESEARCH METHODS AND PROCEDURES: Subjects were 115 female adults who met DSM-IV criteria for BED. Measurements assessing teasing history (general appearance [GAT] and weight and size [WST] teasing), current eating disorder psychopathology (binge frequency, eating restraint, and concerns regarding eating, shape, and weight), body dissatisfaction, and psychological functioning (depression and self-esteem) were obtained. RESULTS: History of GAT, but not WST, was associated with current weight concerns and body dissatisfaction, whereas both GAT and WST were significantly associated with current psychological functioning. Patients with earlier onset of obesity reported more WST than patients with later onset of obesity, but the groups did not differ significantly in GAT, current eating disorder psychopathology, body dissatisfaction. or psychological functioning. Obese women reported more WST than non-obese women, but no differences in GAT or the other outcome variables were observed. Higher frequency of GAT was associated with greater binge frequency in obese women, and with greater eating restraint in non-obese women. DISCUSSION: Although physical appearance teasing history is not associated with variability in most eating disorder psychopathology, it is associated with related functioning, most notably body dissatisfaction, depression, and self-esteem. Our findings also suggest that the age of onset of obesity and current body mass index status in isolation are not associated with eating psychopathology or associated psychological functioning in adult patients with BED.

Adult↗

On the relation of attempting to lose weight, restraint, and binge eating in outpatients with binge eating disorder.

OBJECTIVE: To examine the relationship among attempts to lose weight, restraint, and eating behavior in outpatients with binge eating disorder (BED). RESEARCH METHODS AND PROCEDURES: Participants were 93 consecutive outpatients evaluated for a clinical trial who met Diagnostic and Statistical Manual, Fourth edition criteria for BED. The Eating Disorder Examination Interview was administered to assess attempts at weight loss, restraint, different forms of overeating, and the attitudinal psychopathology of eating disorders (i.e., concerns regarding eating, shape, and weight). In addition, the Three-Factor Eating Questionnaire was used to assess cognitive restraint, hunger, and disinhibition. Psychometrically established measures were given to assess body dissatisfaction, depression, and self-esteem. RESULTS: The majority of participants (75.3%; N = 70) reported attempting to lose weight, but only 37.6% (N = 35) reported dietary restraint on at least half the days of the month. Dietary restraint and cognitive restraint were not associated with any form of binge eating or overeating. Dietary restraint and cognitive restraint were positively correlated with weight concern, shape concern, and body dissatisfaction, and negatively correlated with body mass index. To further examine the interplay between attempting to lose weight and restraint, three study groups were created: unrestrained nonattempters (21.5%, N = 20), unrestrained attempters (40.9%; N = 38), and restrained attempters (34.4%; N = 32). The three groups did not differ significantly on binge eating or other eating behaviors; however, significant differences were observed for weight concern, shape concern, and body dissatisfaction. DISCUSSION: Attempts to lose weight and restraint are not synonymous for patients with BED. Although 75.3% of BED patients reported that they were attempting to lose weight, only 37.6% reported dietary restraint on at least half the days of the previous month. While restraint was negatively associated with body mass index, it was not related to binge eating or overeating. Our findings raise questions about prevailing models that posit restraint as a predominant factor in the maintenance of binge eating in BED.

Adult↗

Onset of dieting vs binge eating in outpatients with binge eating disorder.

OBJECTIVE: To examine the potential significance of the sequence of the onset of dieting and binge eating in binge eating disorder (BED). DESIGN: BED patients were interviewed and completed a battery of psychometrically well-established measures of current eating behaviors, eating disorder psychopathology, and associated psychological functioning. SUBJECTS: Participants were 98 consecutive outpatients with BED evaluated for a clinical trial. MEASURES: Interview data, self-report measures and measured body weight were examined. RESULTS: Participants who reported that dieting preceded binge eating (DIETfirst, 65%) were compared to those who reported that binge eating preceded their first diet (BINGEfirst, 35%). The study groups did not differ in demography, current or highest body mass index, current eating behaviors or psychopathology, or psychological functioning. The two groups did not differ in age of first diet; however, the BINGEfirst group was significantly younger when first overweight, at onset of binge eating, and at onset of BED diagnosis. The BINGEfirst group reported a higher frequency of being teased about their weight. CONCLUSIONS: A substantial subgroup of BED patients report that binge eating preceded their first diet. This finding, which replicates previous reports for BED and appears higher than that generally reported for bulimia nervosa, may have implication for etiologic models of binge eating.

Adolescent↗

Gender differences in the associations between posttraumatic stress symptoms and problematic substance use in psychiatric inpatient adolescents.

This study examined gender differences in the associations between posttraumatic stress symptoms and problematic substance use in psychiatrically hospitalized adolescents. Ninety-five adolescent inpatients (38 boys, 57 girls) were systematically evaluated with a battery of psychometrically well-established self-report measures to assess trauma exposure, posttraumatic stress symptoms, problematic alcohol and drug use, and internalizing and externalizing psychopathology. Twenty-three percent (N = 22) of patients met DSM-IV-based symptom criteria for PTSD, and 37% (N = 35) and 34% (N = 32) of patients endorsed problematic levels of drug and alcohol use, respectively. Posttraumatic stress symptoms were significantly associated with problematic drug and alcohol use in girls but not in boys. There were no significant gender differences in posttraumatic stress symptoms and/or problematic substance use, to account for the gender differences in the association between PTSD and substance use. Our findings suggest that the link between substance abuse and PTSD may be especially salient for female adolescents.

Adolescent↗

Self-help and guided self-help treatments for bulimia nervosa and binge eating disorder.

This article reviews the use of self-help and guided self-help treatments for bulimia nervosa (BN) and binge eating disorder (BED). Available data suggest that self-help and guided self-help treatments based on empirically-supported cognitive behavioral therapies (CBT) have efficacy for binge eating problems. Emerging findings from initial studies suggest that the magnitude of the differences in outcomes between certain guided-self-help CBT programs and therapist-led CBT may not be substantial, although further research is clearly indicated. Initial data suggest that self-help and guided self-help CBT programs may not only demonstrate "efficacy" but also "effectiveness"-i.e., utility in "real-world" primary care or community settings. Implications for clinical practice and for future research are discussed.

Journal Article↗

Factor analysis of the DSM-III-R borderline personality disorder criteria in psychiatric inpatients.

OBJECTIVE: The goal of this study was to examine the factor structure of the DSM-III-R criteria for borderline personality disorder in young adult psychiatric inpatients. METHOD: The authors assessed 141 acutely ill inpatients with the Personality Disorder Examination, a semistructured diagnostic interview for DSM-III-R personality disorders. They used correlational analyses to examine the associations among the different criteria for borderline personality disorder and performed an exploratory factor analysis. RESULTS: Cronbach's coefficient alpha for the borderline personality disorder criteria was 0.69. A principal components factor analysis with a varimax rotation accounted for 57.2% of the variance and revealed three homogeneous factors. These factors were disturbed relatedness (unstable relationships, identity disturbance, and chronic emptiness); behavioral dysregulation (impulsivity and suicidal/self-mutilative behavior); and affective dysregulation (affective instability, inappropriate anger, and efforts to avoid abandonment). CONCLUSIONS: Exploratory factor analysis revealed three homogeneous components of borderline personality disorder that may represent personality, behavioral, and affective features central to the disorder. Recognition of these components may inform treatment plans.

Adolescent↗

Comorbidity of borderline personality disorder with other personality disorders in hospitalized adolescents and adults.

OBJECTIVE: The authors examined the comorbidity of borderline personality disorder with other personality disorders in a series of consecutively admitted adolescents. For comparison, the comorbidity of borderline personality disorder with other personality disorders was also examined in a series of adults consecutively admitted to the same hospital during the same period. METHOD: A total of 138 adolescents and 117 adults were reliably assessed with the Personality Disorder Examination, a semistructured diagnostic interview for DSM-III-R personality disorders. Sixty-eight adolescents and 50 adults met the diagnostic criteria for borderline personality disorder. The co-occurrence of other personality disorders in the group of subjects with borderline personality disorder was statistically compared to that in the group without borderline personality disorder, for adolescents and adults separately. RESULTS: For the adults, Bonferroni-corrected chi-square analysis revealed significant diagnostic co-occurrence with borderline personality disorder for antisocial personality disorder only. For the adolescents, borderline personality disorder showed significant co-occurrence with schizotypal and passive-aggressive personality disorders. CONCLUSIONS: In the adults, borderline personality disorder was significantly comorbid only with another cluster B disorder. The adolescents, by comparison, displayed a broader pattern of comorbidity of borderline personality disorder, encompassing aspects of clusters A and C. These results suggest that the borderline personality disorder diagnosis may represent a more diffuse range of psychopathology in adolescents than in adults.

Adolescent↗

The Collaborative Longitudinal Personality Disorders Study: reliability of axis I and II diagnoses.

Both the interrater and test-retest-retest reliability of axis I and axis II disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Fair-good median interrater kappa (.40-.75) were found for all axis II disorders diagnosed five times or more, except antisocial personality disorder (1.0). All of the test-retest kappa for axis II disorders, except for narcissistic personality disorder (1.0) and paranoid personality disorder (.39), were also found to be fair-good. Interrater and test-retest dimensional reliability figures for axis II were generally higher than those for their categorical counterparts; most were in the excellent range (> .75). In terms of axis I, excellent median interrater kappa were found for six of the 10 disorders diagnosed five times or more, whereas fair-good median interrater kappa were found for the other four axis I disorders. In general, test-retest reliability figures for axis I disorders were somewhat lower than the interrater reliability figures. Three test-retest kappa were in the excellent range, six were in the fair-good range, and one (for dysthymia) was in the poor range (.35). Taken together, the results of this study suggest that both axis I and axis II disorders can be diagnosed reliably when using appropriate semistructured interviews. They also suggest that the reliability of axis II disorders is roughly equivalent to that reliability found for most axis I disorders.

Diagnosis, Differential↗

The Collaborative Longitudinal Personality Disorders Study: development, aims, design, and sample characteristics.

This paper describes the aims, background, design, and methods used in a collaborative longitudinal study of Axis II personality disorders (PDs). This study examines the putative stability of selected PD diagnoses and criteria, what factors affect their course, and whether their stability and course distinguishes them from a representative Axis I disorder. This article also describes the acquisition and demographics of the sample on whom the study is being done. A prospective, repeated measures investigation of the stability of PDs is now underway at multiple clinical settings in four collaborating urban sites in Boston. New Haven, New York, and Providence. Diagnostic assignments are based on semistructured interview assessments (by clinically trained raters) and confirmed by at least one additional contrasting diagnostic method. The sample consists of 668 treatment seeking and reliably diagnosed adults recruited from a broad range of clinical sites. By design, patients in the sample met standards for one of five diagnostic subgroups: (a) schizotypal (N = 86); (b) borderline (N = 175); (c) avoidant (N = 157); (d) obsessive-compulsive (N = 153) personality disorders or a control group having (e) major depressive disorder without personality disorder (N = 97).

Adolescent↗

Shame and its psychopathologic correlates in two women's health problems: binge eating disorder and vulvodynia.

Shame is thought to be a ubiquitous and destructive psychological process associated with psychiatric and medical conditions. This study examined its nature in two contrasting health problems that influence women's self-evaluations of their bodies and attractiveness, namely an eating disorder (a psychiatric disorder with medical implications) or vulvodynia (i.e., vulvar pain; a newly identified medical condition with psychiatric implications). A community sample of adult women without medical conditions served as an additional comparison group. Participants were 203 adult females: 72 with DSM-IV-defined Binge Eating Disorder (BED), 57 with vulvodynia, and 74 non-patient controls. The three study groups differed significantly: the BED group reported greater shame than the vulvodynia group, and the BED and vulvodynia groups reported greater shame than the control group. Higher levels of shame were associated with higher levels of symptomatic functioning within each group.

Adult↗

Applicability of personality disorder criteria to hospitalized adolescents: evaluation of internal consistency and criterion overlap.

OBJECTIVE: The authors examined the applicability of personality disorder criteria to adolescent inpatients by evaluating internal consistency and criterion overlap. METHOD: Thirty-eight adolescents and 28 adults were assessed with the Personality Disorder Examination. Within-category cohesiveness (internal consistency) of the criteria was evaluated by examining intercriterion correlations as well as coefficient alpha. In addition, between-category criterion overlap was evaluated by examining "intercategory" intercriterion correlations between all pairs of disorders. Separate analyses were conducted for adolescents and adults, and the groups were compared. RESULTS: Internal consistency appeared to be lower in adolescents, as measured by intercriterion correlation and coefficient alpha, with the largest differences being identified for most cluster B disorders. Intercategory analysis indicated that criterion overlap may be greater among adolescents. CONCLUSIONS: Overall, this psychometric analysis suggests that there may be limitations to the DSMs approach to categorizing personality disorders. For both adolescents and adults, modest degrees of within-category cohesiveness (internal consistency) and between-category criterion overlap were observed. Comparatively, personality disorder criteria in adolescents tended to have lower internal consistency and less discriminant validity. The data raise questions about the construct validity of these disorders--or the applicability of these criteria--within this age group.

Adolescent↗

Concurrent and predictive validity of the personality disorder diagnosis in adolescent inpatients.

OBJECTIVE: The authors investigated the concurrent and predictive validity of the DSM-III-R diagnosis of personality disorder in adolescents by means of baseline and follow-up assessments of inpatients treated at the Yale Psychiatric Institute. METHOD: One hundred sixty-five hospitalized adolescents were reliably assessed by using a structured interview for personality disorder diagnoses as well as two measures of impairment and distress--the Global Assessment of Functioning Scale and the SCL-90-R. Two years after initial assessment, 101 subjects were independently reassessed with the same measures; their functioning was also assessed at this time. RESULTS: At baseline, adolescents with personality disorders were significantly more impaired than those without personality disorders. At follow-up, adolescents with a personality disorder diagnosis at baseline had used significantly more drugs and had required more inpatient treatment during the follow-up interval. Over time, the scores on the Global Assessment of Functioning Scale and SCL-90-R of adolescents diagnosed with a personality disorder at baseline became more similar to the scores of adolescents without a personality disorder. CONCLUSIONS: The diagnosis of personality disorder in adolescent inpatients has good concurrent validity; however, the predictive validity of the diagnosis is mixed.

Adolescent↗

Psychological and behavioral functioning in adolescent psychiatric inpatients who report histories of childhood abuse.

OBJECTIVE: The purpose of this study was to examine psychological and behavioral functioning in psychiatrically hospitalized adolescents who report histories of childhood abuse. METHOD: Three hundred twenty-two subjects completed an assessment battery of psychometrically well-established instruments. Childhood abuse was assessed by using the childhood abuse scale of the Millon Adolescent Clinical Inventory. Childhood abuse scores of 30 or less and 70 or greater were used to create two study groups--no abuse (N = 93) and high abuse (N = 70), respectively. The two study groups were compared demographically and on the battery of instruments. RESULTS: The two groups differed substantially on most measures of psychological disturbance examined by the assessment battery. When age and depression level were controlled, the high-abuse group was characterized by significantly higher levels of dependency, suicidality, violence, impulsivity, substance use problems, and borderline tendency. Correlational analyses with the entire study group (N = 322) revealed that higher levels of these psychological problems were positively associated with higher levels of childhood abuse. CONCLUSIONS: Psychiatrically hospitalized adolescents who report childhood abuse present with a constellation of symptoms that, after removing the effects of depression, are consistent with borderline personality in statu nascendi.

Adolescent↗