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Biomedical subjects

P E Mullen

Publications and source records attributed to P E Mullen.

At least 19 recordsLinked to original sources
PubMed2001

Child sexual abuse and later disordered eating: a New Zealand epidemiological study.

OBJECTIVE: This community-based study examined how some women who have experienced childhood sexual abuse (CSA) develop an eating disorder (ED), whereas others develop depression and anxiety, and others show no adverse psychological sequelae. METHODS: A two-stage random community sampling strategy was used to select two groups of women: (1) women with CSA prior to age 16 years and (2) a comparison group of women reporting no abuse. Both groups completed the Parental Bonding Instrument (PBI), the Present State Examination, and additional ICD-10 eating disorders questions. Information on the nature and frequency of the CSA was obtained at interview. CSA women with ED (CSA+ED) were compared with CSA women without ED (CSA-noED) and with CSA women with anxiety and/or depression (psychiatric comparison group). RESULTS: Higher rates of EDs in women who have experienced CSA were confirmed in this study. Belonging to a younger age cohort, experiencing menarche at an early age, and high paternal overcontrol on the PBI independently increased the risk of developing an ED in women who had experienced CSA. Low maternal care was specifically associated with the development of anorexia nervosa, whereas early age of menarche differentiated women with bulimia nervosa. Younger age and early age of menarche also differentiated the CSA+ED women from the psychiatric comparison group. DISCUSSION: Early maturation and paternal overcontrol emerged as risk factors for ED development in women with CSA. Although these variables are also risk factors in the general population, women with CSA may be vulnerable to ED development because these risk factors are particular domains of concern that emanate from experiences of CSA.

Adolescent↗
PubMed2001

Stalking: new constructions of human behaviour.

OBJECTIVE: In the last decade stalking has emerged as a significant social problem, which now constitutes a specific form of criminal offence in most English-speaking nations. This paper examines why stalking has become a major social problem and why it should be of particular concern to mental health professionals. METHOD: Using the extant literature, the history of the emergence of stalking as social, legal and behavioural science discourses is presented. An attempt is made to understand the social and cultural forces which shaped our current understanding of the phenomenon of stalking. RESULTS: Stalking flourishes in a variety of contexts; the social conditions conducive to such behaviour include greater instability in intimate relationships, a culture of blame and entitlement and a growing social anxiety that emphasizes vulnerability to crime and suspicion regarding the intentions of strangers. Stalking is now an established category whose utility is in directing social, legal and health energies to support victims and relieve stalkers of their burden of pursuit. CONCLUSIONS: Stalking is a curious construction born of a range of tensions in contemporary culture but has proved to be a useful label and a useful concept. In part due to the emergence of the concept of stalking, laws are now available to protect, and services increasingly geared to support, the victims of persistent harassment.

Female↗
PubMed2001

A study of women who stalk.

OBJECTIVE: The authors examined whether female stalkers differ from their male counterparts in psychopathology, motivation, behavior, and propensity for violence. METHOD: Female (N=40) and male (N=150) stalkers referred to a forensic mental health clinic were compared. RESULTS: In this cohort, female stalkers were outnumbered by male stalkers by approximately four to one. The demographic characteristics of the groups did not differ, although more male stalkers reported a history of criminal offenses. Higher rates of substance abuse were also noted among the male stalkers, but the psychiatric status of the groups did not otherwise differ. The duration of stalking and the frequency of associated violence were equivalent between groups. The nature of the prior relationship with the victim differed, with female stalkers more likely to target professional contacts and less likely to harass strangers. Female stalkers were also more likely than male stalkers to pursue victims of the same gender. The majority of female stalkers were motivated by the desire to establish intimacy with their victim, whereas men showed a broader range of motivations. CONCLUSIONS: Female and male stalkers vary according to the motivation for their pursuit and their choice of victim. A female stalker typically seeks to attain a close intimacy with her victim, who usually is someone previously known and frequently is a person cast in the professional role of helper. While the contexts for stalking may differ by gender, the intrusiveness of the behaviors and potential for harm does not.

Adolescent↗
PubMed2000

Community care and criminal offending in schizophrenia.

BACKGROUND: The introduction of community care in psychiatry is widely thought to have resulted in more offending among the seriously mentally ill. This view affects public policy towards and public perceptions of such people. We investigated the association between the introduction of community care and the pattern of offending in patients with schizophrenia in Victoria, Australia. METHODS: We established patterns of offending from criminal records in two groups of patients with schizophrenia over their lifetime to date and in the 10 years after their first hospital admission. One group was first admitted in 1975 before major deinstitutionalisation in Victoria, the second group in 1985 when community care was becoming the norm. Each patient was matched to a control, by age, sex, and place of residence to allow for changing patterns of offending over time in the wider community. FINDINGS: Compared with controls, significantly more of those with schizophrenia were convicted at least once for all categories of criminal offending except sexual offences (relative risk of offending in 1975=3.5 [95% CI 2.0-5.5), p=0.001, in 1985=3.0 [1.9-4.9], p=0.001). Among men, more offences were committed in the 1985 group than the 1975 group, but this was matched by a similar increase in convictions among the community controls. Those with schizophrenia who had also received treatment for substance abuse accounted for a disproportionate amount of offending. Analysis of admission data for the patients and the total population of admissions with schizophrenia showed that although there had been an increase of 74 days per annum spent in the community for each of the study population as a whole, first admissions spent only 1 more day in the community in 1985 compared with 1975. INTERPRETATION: Increased rates in criminal conviction for those with schizophrenia over the last 20 years are consistent with change in the pattern of offending in the general community. Deinstitutionalisation does not adequately explain such change. Mental-health services should aim to reduce the raised rates of criminal offending associated with schizophrenia, but turning the clock back on community care is unlikely to contribute towards any positive outcome.

Adult↗
PubMed2000

Reactive psychoses revisited.

OBJECTIVE AND METHOD: This paper describes the overlap between reactive (psychogenic) psychosis and other brief psychotic episodes, and explores the gradual disappearance of reactive psychoses as a distinct nosological entity from international classifications. Clinical and conceptual issues concerning reactive psychosis are examined on the basis of a critical review of major classical and modern papers. A brief illustrative case history is also provided. RESULTS: Reactive psychoses are conceptualised as severe disturbances of mental state, on occasion chameleon-like in their shifting form and content, arising in response to a stressful event or life situation. Reactive psychoses have an abrupt onset and usually run their course to complete resolution in a matter of days or weeks. Precipitants include overwhelming fear, threat of imminent destruction, social isolation (as can occur with imprisonment, immigration or deafness), bereavement and intense sexual or interpersonal conflicts. The emergence of a reactive psychosis usually occurs against the background of a predisposing vulnerability in terms of personality disorder, organic impairment, or a history of sensitising experiences, occasionally operating in combination. CONCLUSIONS: The increasing failure to recognise reactive psychoses diminishes clinical psychiatry because it removes an important opportunity for understanding mental disorder in terms of an integration, and totalisation, of developmental history, psychological makeup, social context and current realities, and in so doing lessens our awareness of the links between psychosis and our common humanity.

Adaptation, Psychological↗
PubMed2000

Mass homicide: the civil massacre.

Seven cases of mass homicide in Australia, New Zealand, and Britain between 1987 and 1996 are presented. These cases add to the world literature on these rare crimes and balance previous, mostly North American reports. These acts were committed by socially unsuccessful, self-absorbed, and resentful individuals. Lengthy fantasy comprising identification, modeling, and rehearsal preceded the incidents, even where the final acts had impulsive elements. Most had a long-standing fascination with firearms fueling their fantasies and providing the means for mass killing. Their targets were mostly unprotected strangers. Overt suicidal intent or a preparedness to die while committing the homicides was invariable. Ethological theories of status acquisition may provide a useful understanding of mass homicide.

Adult↗
PubMed2000

Same-gender stalking.

Although stalkers most commonly target victims of the opposite gender, the results of larger and less selective studies suggest that same-gender stalking occurs with greater frequency than formerly thought. This study reviews the exiguous literature on same-gender stalking and presents the findings from a clinical study of 29 same-gender stalking cases that were referred to a forensic psychiatry center. The demographic characteristics, behavior, motivations, and psychopathology of same-gender stalkers are compared with a sample of 134 opposite-gender stalkers. The two groups were similar in many respects, with some discrepancies evident in the prior relationship between victim and stalker, harassment methods, and stalking motives. The impact of same-gender stalking on its victims is examined, and the implications of these findings are discussed.

Adolescent↗
PubMed1999

The long-term impact of childhood sexual abuse in Australian women.

OBJECTIVE: The aim of this study was to examine the association between childhood sexual abuse (CSA) and a range of adverse adult outcomes in a community sample of women using multivariate analysis which accounted for a number of potential confounding effects. METHOD: Retrospective study of cross-sectional data on the long-term impact of CSA, collected as part of a larger two-stage case-control study of the possible relationship between CSA and alcohol abuse. Data were appropriately weighted to adjust for the different selection probabilities of cases and controls. RESULTS: Significant associations were found between reporting CSA and experiencing domestic violence, rape, sexual problems, mental health problems, low self-esteem, and problems with intimate relationships even after taking into account a range of family background factors. Women who had experienced abuse involving intercourse were the most vulnerable to these negative outcomes. CONCLUSIONS: The findings indicate that the influence of CSA on adverse long-term effects is mediated and influenced both by the severity of the abuse experiences and by a range of family and social background factors.

Adolescent↗
PubMed1999

Study of stalkers.

OBJECTIVE: This clinical study ws devised to elucidate the behaviors, motivations, and psychopathology of stalkers. METHOD: It concerned 145 stalkers referred to a forensic psychiatry center for treatment. RESULTS: Most of the stalkers were men (79%, N = 114), and many were unemployed (39%, N = 56); 52% (N = 75) had never had an intimate relationship. Victims included ex-partners (30%, N = 44), professional (23%, N = 34) or work (11%, N = 16) contacts, and strangers (14%, N = 20). Five types of stalkers were recognized: rejected, intimacy seeking, incompetent, resentful, and predatory. Delusional disorders were common (30%, N = 43), particularly among intimacy-seeking stalkers, although those with personality disorders predominated among rejected stalkers. The duration of stalking was from 4 weeks to 20 years (mean = 12 months), longer for rejected and intimacy-seeking stalkers. Sixty-three percent of the stalkers (N = 84) made threats, and 36% (N = 52) were assaultive. Threats and property damage were more frequent with resentful stalkers, but rejected and predatory stalkers committed more assaults. Committing assault was also predicted by previous convictions, substance-related disorders, and previous threats. CONCLUSIONS: Stalkers have a range of motivations, from reasserting power over a partner who rejected them to the quest for a loving relationship. Most stalkers are lonely and socially incompetent, but all have the capacity to frighten and distress their victims. Bringing stalking to an end requires a mixture of appropriate legal sanctions and therapeutic interventions.

Adolescent↗
PubMed1999

Stalking: false claims of victimisation.

BACKGROUND: False allegations of victimisation although uncommon are important to recognise. This paper examines those who falsely claim to have been the victims of stalking. AIMS: To highlight the phenomenon of false victims of stalking. METHOD: Twelve individuals who falsely claimed to be victims of stalking were compared with a group of 100 true stalking victims. RESULTS: False stalking victims presented for help earlier than real victims and were less likely to claim harassment via letters. They reported equivalent levels of violence directed at themselves but seldom claimed others were attacked. Five types of false claimants were recognisable. False victims consumed more medical services than genuine stalking victims and they were more likely to be embroiled in legal action. They reported similar levels of distress with suicidal ruminations in over 40%. CONCLUSIONS: The current interest in stalking is promoting false claims of being stalked. Early identification of these cases and appropriate intervention are essential to both minimising abuses of resources available to true victims and equally to ensure appropriate care for those who express their own disordered state in false claims of victimisation.

Adult↗
PubMed1998

The relationship between childhood sexual abuse and alcohol abuse in women--a case-control study.

AIMS: The aim of this paper was to examine the association between reporting childhood sexual abuse (CSA) and alcohol abuse in a community sample of women using multivariate analysis which took into account a range of potential confounding variables (such as a family history of alcoholism) and effect modifiers (such as having an alcoholic partner). DESIGN: A two-stage retrospective case-control study was used to investigate the relationship between reporting CSA and alcohol abuse in women. PARTICIPANTS: Seven hundred and ten women randomly selected from the Australian federal electoral rolls. MEASUREMENTS: The Alcohol Use Disorders Identification Test (AUDIT) was used to measure alcohol abuse. A series of questions based on those developed by Wyatt (1985) were used to ascertain the prevalence of CSA. FINDINGS: The final model showed that the relationship between a history of CSA and alcohol abuse reflected a complex interaction between CSA and a range of other factors in a woman's background. CSA was not by itself a significant predictor of alcohol abuse (OR = 0.61; 95% CI = 0.31-1.20). However, a history of CSA became significant in combination with co-factors which included: having a mother who was perceived as cold and uncaring; having an alcoholic partner; and believing that alcohol is a sexual disinhibitor. CONCLUSION: This study indicates that CSA alone is not a causative factor in the development of alcohol abuse among women and highlights the importance of examining the family background of women with alcohol problems.

Adolescent↗
PubMed1998

Sudden death in psychiatric patients.

BACKGROUND: The present study investigated histories of prior psychiatric treatment in cases of sudden death reported to the coroner. METHODS: A matching survey linked the register of deaths reported to the coroner with a comprehensive statewide psychiatric case register covering both in-patient and community-based services. RESULTS: Sudden death was five times higher in people with histories of psychiatric contact. Suicide accounted for part of this excess mortality but deaths from natural causes and accidents were also elevated. Schizophrenic and affective disorders had similar suicide rates. Comorbid substance misuse doubled the risk of sudden death in affective and schizophrenic disorders. CONCLUSIONS: The rates of sudden death are sufficiently elevated to raise questions about current priorities in mental health care. There is a need both for greater attention to suicide risk, most notably among young people with schizophrenia, to the early detection of cardiovascular disorders and to the vigorous management of comorbid substance misuse.

Accidents↗
PubMed1997

The impact of stalkers on their victims.

BACKGROUND: This paper examines the social and psychological impact on victims of stalking. METHOD: A group of 100 victims of stalking completed a 50-item questionnaire on their experiences. RESULTS: The majority of the victims were subjected to multiple forms of harassment including being followed, repeatedly approached and bombarded with letters and telephone calls for periods varying from a month to 20 years. Threats were received by 58 subjects, and 34 were physically or sexually assaulted. All but six victims made major changes in their social and work lives, with 53% changing or ceasing employment and 39% moving home. Increased levels of anxiety were reported by 83%, intrusive recollections and flashbacks by 55%, with nightmares, appetite disturbances and depressed mood also being commonly reported. Suicidal ruminations were acknowledged by 24% of victims. The criteria for a diagnosis of post-traumatic stress disorder were fulfilled in 37% of subjects, with a further 18% having the clinical features but not qualifying for a stressor involving threatened or actual physical harm. CONCLUSIONS: The study indicates the extent of the social and psychological damage sustained by those subjected to persistent stalking, and underlines the inadequacy of the current legal and medical responses to the needs of these victims.

Communication↗
PubMed1997

A reassessment of the link between mental disorder and violent behaviour, and its implications for clinical practice.

OBJECTIVE AND METHOD: This review examines the central studies which, over the last decade, have investigated the association between mental illness and rates of violent behaviours. The clinical and public policy implications of such research is then examined. RESULTS: Recent research appears to have established a modest association between having a mental illness and an increased propensity to violence. CONCLUSIONS: The increased risk of violence is mediated, in part at least, by the active symptoms of illness. The most effective response to the risks of dangerous behaviour in the mentally ill is not to return to policies of greater control and containment but to improve the care, support and treatment delivered to patients in the community. Those at high risk need to be targeted for priority follow-up and intensive support. We need, as a profession, to become as aware of the risks in our patients of violence towards others as we currently are of the risks of suicidal behaviour. We also need to develop responses which effectively manage such patients, to their benefit and ultimately to the benefit of potential victims.

Australia↗
PubMed1996

The long-term impact of the physical, emotional, and sexual abuse of children: a community study.

The associations between giving a history of physical, emotional, and sexual abuse in children and a range of mental health, interpersonal, and sexual problems in adult life were examined in a community sample of women. Abuse was defined to establish groups giving histories of unequivocal victimization. A history of any form of abuse was associated with increased rates of psychopathology, sexual difficulties, decreased self-esteem, and interpersonal problems. The similarities between the three forms of abuse in terms of their association with negative adult outcomes was more apparent than any differences, though there was a trend for sexual abuse to be particularly associated to sexual problems, emotional abuse to low self-esteem, and physical abuse to marital breakdown. Abuse of all types was more frequent in those from disturbed and disrupted family backgrounds. The background factors associated with reports of abuse were themselves often associated to the same range of negative adult outcomes as for abuse. Logistic regressions indicated that some, though not all, of the apparent associations between abuse and adult problems was accounted for by this matrix of childhood disadvantage from which abuse so often emerged.

Adolescent↗
PubMed1996

The 'anatomy' of female child sexual abuse: who does what to young girls?

OBJECTIVE: This paper aims to describe the characteristics of sexually abusive acts experienced by female children in order to identify those perpetrators who inflict intrusive and repeated child sexual abuse (CSA). METHOD: Data were collected from a random New Zealand sample of women aged 18 to 65 years who reported CSA, and a similar number of non-abused comparison women. Information on the perpetrator, the type of CSA, and perpetrator strategies were cross-tabulated. RESULTS: The perpetrators were usually young men, well known to the victim or her family. Greater CSA intrusiveness was statistically associated with greater CSA frequency. Father/stepfather abusers were most likely to perpetrate intrusive and frequent CSA. However, family associates and non-paternal relatives were numerically more often reported as perpetrators than fathers/stepfathers. Stranger-perpetrators featured infrequently. CONCLUSION: We conclude that the most frequent and invasive CSA comes from someone well known to the child, particularly a family member or trusted friend. A focus by the courts or health professionals on either incest only (i.e. CSA between biological relatives) or 'stranger danger' will overlook the large categories of CSA perpetrated by secondary relative and family friend abusers.

Adolescent↗