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PubMed1989

Disclosure of child sexual abuse. For better or for worse.

The data presented here offer a longitudinal perspective on sexually abused children. Disclosure data are postulated to be important variables in the short-term and long-term victim-to-patient process. Fifty-five per cent of the 156 children seen purposefully disclosed their sexual abuse, most frequently to their mothers. Children who never told, but were seen after accidental disclosures, showed less distress, whether hiding minor or major forms of sexual abuse. This finding support the clinical impression that disclosure adds extra stress on children and cannot be expected of every victim. A history of past mental health intervention did not seem to enhance the child's ability to tell. Education of all professionals is critical. Approximately 18 months after the end of the crisis intervention offered at intake, 115 of the 156 cases were re-evaluated. Overall, most children showed improvements on standardized tests, but 24 per cent got worse. Specific symptoms were found to cluster in four groups: acute anxiety, characterologic, family dynamics, and specific symptoms related to sexual abuse (sexual maladjustment, prostitution, revictimization, sexually assaultive behavior). Although the data seem to support the notion that crisis intervention by trained clinicians is helpful, it is too early to tell if the ominous findings described in adult survivors can really be decreased. The impact of disclosing child sexual abuse on entire families should not be underestimated, even in cases of extrafamilial abuse. The poor ratings parents gave law enforcement, judicial, and Child Protective Service professionals may be linked to the reluctance of victims to disclose their abuse and underscores the need to review current procedures and practices. Overall, a great majority of parents did see the sexual abuse as harmful to the child and to the family, but they were evenly divided about whether the disclosure was harmful or helpful to the child and family. A final word of caution comes from the 19 per cent of adolescents who regretted their disclosures. For clinicians and for researchers, the data presented here lead to further questions. A longer follow-up period is needed to assess whether these victims will be similar to the adults described in the literature or will become survivors with less pathology and less pain.

Adolescent↗

PubMed1997

Patterns of disclosure and perceptions of the human immunodeficiency virus in infected elementary school-age children.

OBJECTIVE: To investigate the patterns of disclosure and perceptions of human immunodeficiency virus (HIV) status in a group of HIV-infected elementary school-age children. DESIGN: A survey. SETTING: A referred care university hospital center. PATIENTS: All HIV-infected children born before August 31, 1985, and scheduled for ambulatory follow-up between 1984 and 1993 were eligible for the study. A total of 35 HIV-infected (21 asymptomatic and 14 symptomatic) elementary school-age children (aged 5-10 years) were examined between 1990 and 1993. MAIN OUTCOME MEASURES: Semistructured qualitative interviews were used, 1 with the children and 1 with their parents or caregivers. In addition, 3 drawings per child were also analyzed. RESULTS: Partial disclosure was observed in 14 (40%) of the children, and full disclosure of the diagnosis of acquired immunodeficiency syndrome was given to 6 (17%) of the children. Secrecy regarding serostatus was the strategy used by 15 (43%) of the parents or caregivers involving either complete nondisclosure (n = 8) or deception by means of attributing the symptoms to another condition, medical or other (n = 7). Perceived health status and clinical status differed for 11 (31%) of the children. Eight children did not identify any illness causality, and most of the others gave prelogical or concrete-logical explanations. Few children were aware of their parent's infection or disease. CONCLUSION: Human immunodeficiency virus-infected elementary school-age children were exposed to various disclosure patterns regarding their HIV infection or disease, and most children (26/35 [74%]) reported stressful experiences due to HIV regardless of the disclosure patterns.

Art↗

PubMed1998

Development of the Marital Self-disclosure Questionnaire (MSDQ).

This research describes the development of the Marital Self-Disclosure Questionnaire (MSDQ), a brief, self-report measure of the quantity and quality of marital self-disclosure. Consisting of 40 true-false items, the MSDQ provides a global index of marital self-disclosure as well as assesses four facets of self-disclosure between spouses: Relationship, Sex, Money, and Imbalance. Results indicate that the MSDQ scales are reliable, and preliminary data suggest that the MSDQ may have validity for distinguishing among groups hypothesized to differ in terms of marital distress and self-disclosure. Further evaluation of the MSDQ for its clinical and research utility appears to be warranted.

Adult↗

PubMed1976

The relationship of self-disclosure to personality, adjustment and self-actualization.

This study tested the hypothesis that a high level of self-disclosure is indicative of psychological adjustment and self-actualization. The self-disclosure scale, Social Avoidance and Distress, Fear of Negative Evaluation, Alienation and Repression-Sensitization scales were administered to 60 Ss. The results for all scales indicated that a high level of disclosure was associated with adjustment as measured by these scales. A second group of 94 Ss completed the self-disclosure scale and the Personal Orientation Inventory, a measure of self-actualization. The results indicated that high disclosers compared to low disclosers had achieved a higher level of self-actualization. That is, there were significant correlations between self-disclosure and measures of self-actualization such as Time Competence, Internal Support, Existentiality, Self-Acceptance and Capacity for Intimate Contact.

Female↗

PubMed2004

Physicians don't ask, sometimes patients tell: disclosure of sexual orientation among women with breast carcinoma.

BACKGROUND: The disclosure of sexual orientation to physicians is uncertain and the reasons are poorly understood. The current study was undertaken to describe the disclosure of sexual orientation among sexual minority women with breast carcinoma. METHODS: Individual semi-structured interviews were conducted with a sample of 39 sexual minority women with a diagnosis of breast carcinoma who lived in New England. Transcribed interviews were analyzed using qualitative data analysis software. Through constant comparison methods, themes related to disclosure were identified from the narrative data. RESULTS: Sexual minority patient-provider relationships were marked by apprehension, and providers did not inquire about sexual orientation. The majority of women actively disclosed their sexual orientation, whereas 11 women passively refused disclosure. CONCLUSIONS: Providers should create opportunities for the disclosure of sexual orientation to provide more comprehensive care.

Adult↗

PubMed2002

An examination of willingness to self-disclose in women with bulimic symptoms considering the context of disclosure and negative affect levels.

OBJECTIVE: This study explored the relationship between bulimic symptoms and self-disclosure. It examined whether women who reported greater bulimic symptomatology were generally less willing to self-disclose in intimate relationships or whether reluctance to disclose was confined to eating and weight concerns. METHOD: Women with high and low scores on the Bulimia Test Revised (BULIT-R) were compared on self-disclosure about three topics (daily activities, eating, and weight) and sexual and relationship issues to three targets (mother, friend, and partner). RESULTS: There were significant main and interaction effects for BULIT-R score, target, and topic of self-disclosure. When depression was controlled for, it partially explained the association between bulimic behavior and self-disclosure. DISCUSSION: Results supported a contextual model of self-disclosure. Compared with nonbulimic women, women with bulimic symptoms were less willing to self-disclose certain topics to particular targets. Levels of depression explained low willingness to disclose on topics unrelated to eating and weight to some targets.

Adult↗

PubMed2003

Patient self-disclosure: a review of the research.

Research shows that whereas most patients disclose deeply personal experiences in therapy, a significant proportion conceal some significant information. Findings also indicate that there are several categories of nondisclosed information (secrets, things left unsaid, and client reactions); that patients tend to withhold immediately experienced negative reactions; that disliked characteristics of oneself and parents are among the most thoroughly discussed issues in therapy while sex, aggression, and personal failure are least discussed; that men and women disclose to the same extent and on similar topics; that shame inhibits disclosure of negative affect; that a strong therapeutic alliance, overall tendency to be disclosing, and time in therapy facilitate disclosure; and that the discrepancy between disclosure and patients' ratings of salience of disclosure is a more powerful predictor of outcome than disclosure alone.

Female↗

PubMed2003

Therapist self-disclosure with children, adolescents, and their parents.

Many therapists who work with children and adolescents make extensive use of self-disclosure. However, these interventions have received little attention in the literature, and the basis for using them has not been well established. A developmental/relational perspective on the therapeutic process provides a cogent foundation using therapist self-disclosure with children, adolescents, and their parents. Therapist self-disclosure facilitates the negotiation of many important therapeutic tasks. Clinicians working with children and adolescents almost always work concurrently with parents, yet the nature of this work has not been clearly conceptualized. I advance a collaborative model for parent work, highlighting the essential role of therapist self-disclosure. Extensive clinical examples of therapist self-disclosure with children, adolescents, and their parents are provided.

Adolescent↗

PubMed2002

Disclosure to therapists: what is and is not discussed in psychotherapy.

This study used the 80-item Disclosure to Therapist Inventory-R to investigate the nature of patient disclosure within therapy. Participants (45 men, 102 women) were all currently in therapy. A Principal Components Analyses with varimax rotation yielded nine meaningful factors; mean disclosure scores were lowest for the factors of Sexuality and Procreation and highest for the factors of Negative Affect and Intimacy. Specific items most extensively discussed included characteristics of parents that are disliked, and aspects of one's personality that are disliked or worrisome. No significant differences were found in overall degree of disclosure as a function of patient gender or shame-proneness; disclosure was, however, found to be positively correlated with strength of the therapeutic alliance.

Adolescent↗

PubMed2006

What do we tell the children? Contrasting the disclosure choices of two HD families regarding risk status and predictive genetic testing.

Above all else, predictive genetic testing provides information. Gaining insight into the psychosocial effects of this information is a primary goal of genetic counseling. For individuals utilizing predictive genetic testing, the acquisition of genetic information requires choices regarding disclosure within the family. This study uses a phenomenological methodology to explore the contrasting choices of two sets of HD parents regarding the disclosure of genetic risk status to their children. Additionally, the children (now adults) discuss their lived experience growing up with contrasting disclosure dynamics, and their current views regarding the use of predictive genetic testing for themselves. The primary finding of this study is that all of the adult children now express preference for early disclosure of genetic risk and an open/supportive communication style regarding HD. This finding has value for clinicians working with HD families who must make decisions regarding disclosure issues related to predictive genetic testing.

Adaptation, Psychological↗

PubMed2005

Detecting deception via strategic disclosure of evidence.

Deception detection research has largely neglected an important aspect of many investigations, namely that there often exists evidence against a suspect. This study examined the potentials of timing of evidence disclosure as a deception detection tool. The main prediction was that observers (N = 116) would obtain higher accuracy rates if the evidence against the suspects (N = 58) was presented in a late rather than early stage of the interrogation. This prediction was based on the idea that late evidence disclosure would trigger lack of consistencies between the liars' stories and the evidence; this could be used as a cue to deception. The main prediction received support. Late disclosure observers obtained an overall accuracy of 61.7%, compared to 42.9% of Early disclosure observers. Deceptive statements were identified with high accuracy (67.6%) in Late disclosure, indicating that the technique in this form is beneficial mainly for pinpointing lies.

Adult↗

PubMed1994

Self-disclosure and nursing students: the replication of a Jourard study.

A person's willingness to disclose things about him or herself is an important facet of all social interaction. In professional helping relationships effective management of treatment and therapy may depend ultimately on a person's self-disclosures. Sidney Jourard claimed in 1971 that "disclosure begets disclosure". It is important therefore to explore professional helpers' willingness to disclose things about themselves, as this may influence the dialogue which they have with their clients and patients. In this paper we describe a replication of a small study carried out by Sidney Jourard in 1961. An opportunistic sample of 25 undergraduate nursing students was asked to complete Jourard's self-disclosure questionnaire. Analysis of the findings suggested that, overall, the students in this study were more self-disclosing than was the case in the earlier study. Other findings are noted as are the limitations of this form of exploration of self-disclosure.

Adolescent↗

PubMed2006

Emergency physicians and disclosure of medical errors.

Error in medicine is a subject of continuing interest among physicians, patients, policymakers, and the general public. This article examines the issue of disclosure of medical errors in the context of emergency medicine. It reviews the concept of medical error; proposes the professional duty of truthfulness as a justification for error disclosure; examines barriers to error disclosure posed by health care systems, patients, physicians, and the law; suggests system changes to address the issue of medical error; offers practical guidelines to promote the practice of error disclosure; and discusses the issue of disclosure of errors made by another physician.

Communication↗

PubMed2005

Emotional disclosure for whom? A study of vagal tone in bereavement.

Recent investigations have shown little evidence that written disclosure benefits bereaved individuals over a control condition. The present study hypothesized that the effectiveness of written disclosure for bereavement may be moderated by vagal tone, as indexed by respiratory sinus arrhythmia (RSA). Vagal tone has been identified as an important individual difference in depression. The present study investigated 35 bereaved participants in a longitudinal design, with participants writing each week for 3 weeks, and then participating in follow-up sessions 1 week and 1 month later. As with previous studies, bereaved participants showed improvement, although no differential improvement was seen in the emotional Disclosure group compared to a Control writing group. As hypothesized, however, those participants with the highest RSA benefited most from the written disclosure, while RSA level did not predict outcome in the control condition. Future research should investigate whether vagal tone moderates the impact of written disclosure for non-bereaved individuals.

Affect↗

PubMed1998

The disclosure decision: concerns and issues of parents of children conceived through donor insemination.

OBJECTIVE: The purpose of our study was to examine the disclosure decision by parents of children conceived by donor insemination. STUDY DESIGN: A qualitative component of a self-administered questionnaire mailed to 184 couples who had become parents by donor insemination encouraged respondents to volunteer their written comments, concerns, or opinions about their disclosure decision. RESULTS: A total of 70 men and 86 women submitted written comments indicating that 54% did not plan to disclose the donor insemination treatment (nondisclosers), 30% indicated they would (disclosers), and 16% remained undecided. The only significant relationship between the disclosure decision and expressed concern was with regard to confidentiality and honesty (chi2 = 99.9, p < 0.05). CONCLUSIONS: Whether parents viewed the disclosure issue as one of honesty (disclosers) or confidentiality (nondisclosers) was the major determinant in the decision of whether to tell children about their donor insemination origin. There was no association between disclosure status or gender and expressed concerns about parenting, children, or family relations.

Adult↗

PubMedDate not supplied

Changes in disclosure of information to cancer patients in a general hospital in Japan.

The disclosure of information to cancer patients is one of the most important issues in oncological practice. In Japan, as in some other countries, few cancer patients were ever given a truthful statement of their diagnosis. However, today more and more patients are being informed of their diagnosis and prognosis. This study investigates the nature of these changes in disclosure policy and suggests possible explanations. We reviewed the medical and nursing charts of 122 adult cancer patients admitted to our hospital in 1993 and 137 admitted in 1998. We examined the information they had been given, and their sociodemographic and medical characteristics. The diagnosis of cancer was shared with 27% of patients in 1993. In 1998, however, 71% were informed of their cancer, and 10% were also told they had a poor prognosis. The rate of disclosure was lower for older patients and those with advanced cancer in both 1993 and 1998. In 1998 the rate was higher in patients undergoing chemotherapy and/or surgery. The higher level of disclosure in 1998 was due basically to the growing importance of informed consent. Psychiatric referrals increased from 2% in 1993 to 10% in 1998. Psychiatrists may have contributed to these changes in the disclosure of information.

Adult↗

PubMed2002

Responsibility and cancer disclosure in Japan.

In Japan, as in many countries around the world, cancer patients are often not told the truth about their illness. Despite polls showing a majority of those surveyed wish to be told, surveys of physicians indicate only a small percentage will tell, especially when the cancer is advanced or terminal. We interviewed physicians from various specialties with experience managing advanced or terminal cancer patients to investigate their approaches to cancer disclosure. Our analysis reveals physicians divide into two groups: those who usually do not tell (non-tellers) such patients and those who usually do tell (tellers). Non-tellers reported the shock of disclosure inhibits telling patients, families' wishes for non-disclosure cannot be ignored, and most patients themselves do not wish to be told. Tellers asserted disclosure is unavoidable and patients want to be told, few problems result when they tell, and telling has many advantages such as not having to lie to the patient. Despite the experience of non-tellers, most physicians continue to follow the traditional approach, for advanced or terminal cancers. Physicians, as well as families and patients, display an aversion to taking responsibility for the potential risks of disclosure, and this may perpetuate the status quo.

Adult↗

PubMed1998

Cancer disclosure in Japan: historical comparisons, current practices.

Although Japanese physicians historically have not disclosed cancer diagnoses to patients, pressures upon physicians to disclose have increased in recent years. We questioned physicians practicing at a private medical hospital in rural Japan about their current approach to cancer disclosure. We compared their responses with responses of physicians in a 1991 study conducted in Japan, and two studies conducted in the United States, in 1961 and in 1977. Seventy-seven clinically active physicians with experience treating cancer patients responded (73% response rate). Forty percent of respondents reported usually telling patients of a cancer diagnosis, over three times more than the 13% who reported such a policy in Japan in 1991. Physicians were significantly more likely (P < 0.001) to make exceptions than physicians in the previous Japanese study, and physicians in the previous U.S. studies. Respondents reported considering more factors in deciding whether to tell than participants in the 1977 U.S. study. Factors predicting an increased probability of disclosure included age (in a hyperbolic relationship), improved prognosis, breast or cervical cancer, and social status and religion (by a minority of respondents). Increase in a substitute decision maker's age was predictive for physicians not to involve the person in decision-making. Most respondents reported their disclosure policy is based on clinical experience. More respondents indicated a likelihood of changing in the future than respondents in the previous U.S. studies. These data suggest Japanese physicians are moving away from a rigid policy of nondisclosure to a policy of selective disclosure, but they have not adopted universal cancer disclosure as practiced in many Western countries. Since young age and advanced age predicted self-reports of not disclosing cancer diagnoses, these data raise the question of whether nondisclosure by age groups represents age discrimination or compassionate medical care tailored to individual patient needs.

Academic Medical Centers↗