Distress Symptomatology Research Articles

College females with maltreatment histories have atypical autonomic regulation and poor psychological wellbeing.

This study uniquely examined the impact of maltreatment (without a diagnosis of posttraumatic stress disorder [PTSD]) on physiological responses to a physical and an emotional stressor. The study sample was composed exclusively of women, because men may differ in maltreatment experience and neural regulation of physiological reactivity. Participants were 60 female college students. A significant proportion of the participants reported experiencing childhood maltreatment without a history of PTSD. Participants completed measures assessing psychological and PTSD symptomatology. Heart rate was monitored before, during, and after riding a stationary bike (physical stressor) and viewing a video of a child being maltreated (emotional stressor). Baseline and stressor related patterns of heart rate and respiratory sinus arrhythmia (RSA) were quantified from the beat-to-beat heart rate. Women with maltreatment histories reported more psychological distress and PTSD symptomatology, had lower levels of RSA and faster heart rate, and reacted to the stressors with atypical vagal regulation of RSA and heart rate. Accompanying psychological difficulties, women with maltreatment histories exhibit atypical physiological regulation to stressors consistent with clinical observations of lower thresholds to defensiveness and other manifestations of compromised resilience. The findings are consistent with polyvagal theory, which emphasizes the role of the "vagal brake" in social engagement and coregulation behaviors-features frequently compromised in survivors of emotional and physical abuse. Future research should investigate whether these features of atypical autonomic regulation are lead indicators of mental and physical health risks and whether these features can be reversed. (PsycINFO Database Record

Increased Pain Sensitivity in Accident-related Chronic Pain Patients With Comorbid Posttraumatic Stress.

Posttraumatic stress disorder (PTSD) is prevalent in chronic pain, and associated with increased pain, hyperalgesia, and psychological distress. This study aimed to investigate antinociceptive and pronociceptive pain mechanisms, pain intensity, and psychological distress (depression, anxiety, pain catastrophizing, and fear of movement) in patients with accident-related chronic spinal pain with (N=44) and without (N=64) comorbid PTSD characteristics. Cuff algometry was performed on lower legs to assess pressure pain threshold (cPPT), tolerance (cPTT), temporal summation of pain (increase in pain scores to 10 repeated stimulations), and conditioning pain modulation (increase in cPPT during cuff pain conditioning on the contralateral leg). Warmth detection threshold and heat pain threshold at the hand were also assessed. Clinical pain intensity (numerical rating scale), psychological distress, and PTSD symptomatology (ICD-11) were assessed with questionnaires. Mediation analyses were performed to investigate possible psychological mediators in the associations between PTSD and pain (intensity and mechanisms). Patients with PTSD demonstrated increased pain intensity, and psychological distress as well as reduced warmth detection threshold and cPTT compared with patients without PTSD (P<0.05). No significant differences in cPPT, heat pain threshold, temporal summation of pain, and conditioning pain modulation were found. The association between PTSD and pain intensity was mediated by pain catastrophizing, and fear of movement mediated the association with cPTT. The association between PTSD and pain intensity is in accordance with the mutual-maintenance and fear-avoidance models. Future studies should investigate changes in pain intensity and mechanisms after treatment targeting comorbid PTSD in chronic pain patients.

Attentional Avoidance is Associated With Increased Pain Sensitivity in Patients With Chronic Posttraumatic Pain and Comorbid Posttraumatic Stress.

Posttraumatic stress disorder (PTSD) is common in chronic posttraumatic pain. Theoretical models suggest that attentional biases (AB) contribute to the development and maintenance of chronic pain and PTSD; however, the influence of AB on clinical and heat pain sensitivity in chronic posttraumatic pain patients is unknown. This study investigated AB for linguistic pain-related stimuli and trauma-related stimuli, and clinical and thermal sensitivity in patients with chronic posttraumatic pain with and without PTSD. In total, 34 patients with chronic posttraumatic cervical pain performed the visual attentional probe task assessing patterns of selective attentional responding to trauma cues and to pain cues. The task used short (500 ms) and long (1250 ms) stimulus exposure durations to ensure sensitivity to both the orienting and maintenance of attention. Heat pain threshold was assessed at the nonpainful hand. Clinical pain intensity, psychological distress (anxiety, depression, and disability), and PTSD symptomatology were assessed with questionnaires. The Pain/PTSD group (N=14) demonstrated increased clinical and heat pain sensitivity as well as psychological distress compared with the Pain/No-PTSD group (N=20; P<0.05). AB scores were significantly different between groups (P=0.04). Irrespective of stimulus exposure duration, the Pain/PTSD group demonstrated attentional bias away from trauma and pain cues (avoidance), whereas the Pain/No-PTSD group demonstrated attentional bias toward pain cues (vigilance). Attentional avoidance of pain cues was associated with increased pain intensity and heat pain sensitivity (P<0.02). These results suggest that attentional avoidance is associated with increased chronic posttraumatic pain. The causal contribution of attentional avoidance to pain outcomes remains unclear.

Pathological grooming: Evidence for a single factor behind trichotillomania, skin picking and nail biting.

Although trichotillomania (TTM), skin picking (SP), and nail biting (NB) have been receiving growing scientific attention, the question as to whether these disorders can be regarded as separate entities or they are different manifestations of the same underlying tendency is unclear. Data were collected online in a community survey, yielding a sample of 2705 participants (66% women, mean age: 29.1, SD: 8.6). Hierarchical factor analysis was used to identify a common latent factor and the multiple indicators and multiple causes (MIMIC) modelling was applied to test the predictive effect of borderline personality disorder symptoms, impulsivity, distress and self-esteem on pathological grooming. Pearson correlation coefficients between TTM, SP and NB were between 0.13 and 0.29 (p < 0.01). The model yielded an excellent fit to the data (CFI = 0.992, TLI = 0.991, χ2 = 696.65, p < 0.001, df = 222, RMSEA = 0.030, Cfit of RMSEA = 1.000), supporting the existence of a latent factor. The MIMIC model indicated an adequate fit (CFI = 0.993, TLI = 0.992, χ2 = 655.8, p < 0.001, df = 307, RMSEA = 0.25, CI: 0.022–0.028, pclose = 1.000). TTM, SP and NB each were loaded significantly on the latent factor, indicating the presence of a general grooming factor. Impulsivity, psychiatric distress and contingent self-esteem had significant predictive effects, whereas borderline personality disorder had a nonsignificant predictive effect on the latent factor. We found evidence that the category of pathological grooming is meaningful and encompasses three symptom manifestations: trichotillomania, skin picking and nail biting. This latent underlying factor is not better explained by indicators of psychopathology, which supports the notion that the urge to self-groom, rather than general psychiatric distress, impulsivity, self-esteem or borderline symptomatology, is what drives individual grooming behaviours.

Relación del estilo de liderazgo transformacional con la salud y el bienestar del empleado: el rol mediador de la confianza en el líder

This study examined the relationship between transformational leadership and employee well-being indicators in developing countries, as well as the mediation role of trust in the leader. Five hundred ninety-seven employees of Colombian and Mexican organizations answered a questionnaire. Results indicated that transformational leadership relates positively with job satisfaction and negatively with distress symptomatology. No relationship was established between transformational leadership and psychological well-being. Trust in the leader mediated totally the relationship between transformational leadership and job satisfaction and symptoms of distress. These results confirm the previously described relationship between transformational leadership, less distress, and higher job satisfaction. However, it suggests too that the possible effect of transformational leadership on employees health and well-being would be limited to promoting affective aspects of well-being, but not psychological well-being. This result invites to a thorough review of the meaning and use of the concepts affective and psychological well-being and the differences between them.

Compulsive buying in university students: its prevalence and relationships with materialism, psychological distress symptoms, and subjective well-being

BackgroundCompulsive buying has become a severe problem among young people. The prominent role that psychological variables play in this phenomenon support their consideration in establishing a risk profile for compulsive buying that serves as a guide for the development of prevention and treatment programs with guarantees of effectiveness. However, there are only a small number of studies in existence which have explored the compulsive buying prevalence among students, and none of them have been conducted in a Mediterranean country. ObjectivesThis study aims to estimate the compulsive buying prevalence in a sample of university students from the region of Galicia (Spain). We also intend to determine if statistically significant differences exist between compulsive buyers and non-compulsive buyers in relation with gender, materialistic values, psychological distress symptoms and subjective well-being. Lastly, the clarification of which of the determinants examined represent risk or protection factors for compulsive buying constitutes another important objective of this paper. MethodsA total sample of 1448 university students participated in this study. They answered a battery of self-reports assessing gender, compulsive buying propensity, materialism, distress symptomatology, and well-being. Participants were initially classified as either compulsive buyers or non-compulsive buyers. Both groups were compared for the aforementioned variables through chi-square testing or variance analyses. Then, a multivariate logistic regression analysis was conducted to determine which of these determinants make up a risk profile for compulsive buying. ResultsThe estimated prevalence of compulsive buying in the sample of university students considered was 7.4%. Statistically significant differences between compulsive buyers and non-compulsive buyers were detected for gender, and each and every one of the psychological variables explored. Specifically, it was confirmed that compulsive buyers obtained significantly higher scores in materialism's dimensions of importance, success, and happiness, and in the psychological distress symptoms of anxiety, depression, obsession-compulsion, hostility, and somatization. On the contrary, they presented significantly lower levels in self-esteem, life satisfaction, and optimism. Results of the logistic regression analysis confirmed that high scores in the importance dimension of materialism, in combination with the experiencing of symptoms of anxiety, depression, obsession–compulsion, hostility, and somatization, would constitute risk factors in relation with this phenomenon, and high levels of life satisfaction would act as a protection factor as for compulsive buying in the sample of students considered. ConclusionsCurrent findings revealed that 7.4% of the large sample of Spanish university students considered were classified as compulsive buyers. Additionally, it was confirmed that while materialism and psychological distress symptoms would represent vulnerability determinants increasing the propensity for compulsive buying, the high scores in life satisfaction would act to decrease the likelihood of becoming a compulsive buyer. Accordingly, our results suggested that prevention and intervention efforts in relation with compulsive buying among young people should include specific components aimed at the reduction of the importance assigned to money and possessions, and also at the relief of psychological distress symptoms.

Illness Uncertainty, Global Psychological Distress, and Posttraumatic Stress in Pediatric Cancer: A Preliminary Examination Using a Path Analysis Approach.

To investigate the relationship of illness uncertainty (IU) to global psychological distress (GPD) and posttraumatic stress symptomatology (PTSS) using a path analysis approach. Participants were 105 caregivers (MAge = 36.9 years, standard deviation [SD] = 8.7) of children (MAge = 8.6 years, SD = 5.0) with newly diagnosed cancer. A path analysis model examined the indirect and direct effects of each IU subscale on PTSS through GPD. The final model accounted for 47.30% of the variance in PTSS, and the ambiguity facet of IU had a significant indirect effect on PTSS through GPD. Lack of clarity and unpredictability were not significant predictors. Ambiguity experienced by parents may be salient in the development of PTSS. Future research should examine these relationships longitudinally in larger samples to better understand adjustment in parents of children with cancer.

A person-centered approach to examining heterogeneity and subgroups among survivors of sexual assault.

This study identified subgroups of female sexual assault survivors based on characteristics of their victimization experiences, validated the subgroup structure in a second cohort of women recruited identically to the first, and examined subgroups' differential associations with sexual risk/safety behavior, heavy episodic drinking (HED), psychological distress symptomatology, incarceration, transactional sex, and experiences with controlling and violent partners. The community sample consisted of 667 female survivors of adolescent or adult sexual assault who were 21 to 30 years old (M = 24.78, SD = 2.66). Eligibility criteria included having unprotected sex within the past year, other HIV/STI risk factors, and some experience with HED, but without alcohol problems or dependence. Latent class analyses (LCA) were used to identify subgroups of women with similar victimization experiences. Three groups were identified and validated across 2 cohorts of women using multiple-group LCA: contact or attempted assault (17% of the sample), incapacitated assault (52%), and forceful severe assault (31%). Groups did not differ in their sexual risk/safety behavior. Women in the forceful severe category had higher levels of anxiety, depression, and trauma symptoms; higher proportions of incarceration and transactional sex; and more experiences with controlling and violent partners than did women in the other 2 groups. Women in the forceful severe category also reported a higher frequency of HED than women in the incapacitated category. Different types of assault experiences appear to be differentially associated with negative outcomes. Understanding heterogeneity and subgroups among sexual assault survivors has implications for improving clinical care and contributing to recovery.

The inoculating role of previous exposure to potentially traumatic life events on coping with prolonged exposure to rocket attacks: A lifespan perspective

Relatively little research have addressed the effect of prolonged exposure to rocket attacks with a lifespan perspective and only a handful of these studies focused on the effect of this exposure as a function of aging. The present study examined the effects of seven years of rocket attacks fired toward the south of Israel on adult participants of different ages. We examined whether potentially traumatic life events (PTLEs) unrelated to rocket attacks moderated the association between post-traumatic stress (PTS) symptoms and age. Data were obtained from a 2007 telephone survey using the Random Digit Dialing method and including 343 individuals (76.7% participation rate). Exposure to rockets, PTLEs, global distress, and post-traumatic symptomatology were assessed. Older age was associated with a higher level of PTS symptoms. Higher PTLE levels attenuated the association between age and PTS symptoms. Our results suggest that age is a risk factor for developing PTS symptoms under prolonged exposure to rocket attacks. However, previous levels of exposure to other negative events, as well as gender, appear to inoculate a person to stress, thus modulating the age-PTS association.

The Grief and Meaning Reconstruction Inventory (GMRI): Initial Validation of a New Measure

Although increasing numbers of grief theorists, researchers, and therapists have begun to focus on the quest for meaning in lives disrupted by loss, no convenient and psychometrically validated measure of meanings made specifically in bereavement has been available to guide their efforts. To construct such a measure, the authors began with a systematic content analysis of sense-making, benefit finding, and identity reconstruction themes gleaned from the narrative responses of a sample of 162 adults who were diverse in their age, ethnicity, relationship to the decedent, cause of death, and severity of their grief response. These were then formulated into a set of 65 candidate items in a Likert scale format representing the level of the respondent's endorsement of the item in the past week. Subsequent administration to a second sample of 300 bereaved respondents permitted factor analysis of this pilot version of the Grief and Meaning Reconstruction Inventory (GMRI), and reduced the items to 29, which loaded on 5 distinct factors, labeled Continuing Bonds, Personal Growth, Sense of Peace, Emptiness and Meaninglessness, and Valuing Life. Both the overall GMRI and its constituent factors showed good internal consistency and strong convergent validity in the form of negative correlations with established measures of bereavement-related negative emotions, symptoms of complicated grief, and more general psychological distress and mental health symptomatology, and positive correlations with grief related personal growth. The authors close by noting several specific research and clinical applications of the measure, which could play a useful role in testing and refining contemporary models of meaning made in the wake of loss.

Self-reported psychotic-like experiences in individuals with obsessive-compulsive disorder versus schizophrenia patients: Characteristics and moderation role of trait anxiety

Psychotic-like experiences (PLEs) have been found to manifest themselves on a continuum spanning both the general and clinical populations. Despite robust evidence that anxiety disorders are associated with increased risk of PLEs, little is known about their characteristics in obsessive compulsive disorder (OCD). Therefore, this study aimed to explore the phenomenological similarities and differences of PLEs in OCD versus schizophrenia patients and healthy controls, and to test the impact of distress symptomatology on PLEs in OCD patients. The survey included the Peter et al. Delusion Inventory, the Launay–Slade Hallucinations Scale, the Beck Depression Inventory II, the Spielberger State-Trait Anxiety Inventory, and measures of severity of OCD and schizophrenia symptoms. Considering the clinical groups as a whole, few differences were found for both delusions and hallucination-like experiences. Nevertheless, after controlling for emotional distress differences between OCD and schizophrenia patients in some PLEs became significant. Moreover, obsessive symptoms moderated by anxiety trait predicted levels of delusion-like experiences in OCD patients. This study highlights PLEs are also present in OCD patients, in particularly in presence of higher emotional distress and that anxiety trait plays a relevant role in the development and maintenance of delusion-like experiences in OCD patients.

Children’s Attributions of Community Violence Exposure and Trauma Symptomatology

This study examines the association between community violence exposure and trauma symptomatology among young children (6–16 years; N = 120). Further, the study explores whether children’s attributions of violence mediate the relationship between their exposure and their trauma symptoms. Youth completed the Kid-SAVE measure of exposure to violence, the CAPS measure of attributions/perceptions, and the Trauma Symptom Checklist for Children (TSCC). Multiple regression analyses supported the expectation that exposure to violence would produce more negative perceptions and were associated with higher TSCC symptom scores. Exposure to violence both directly and indirectly (through the negative attributions) led to higher symptom reports, and this effect was separate from the child’s report of having been a victim of aggression or violence. Implications of this study include targeting children’s attributions within treatment modalities for youth to reduce distress and post-traumatic stress symptomatology.

Profile and predictors of global distress: Can the DT guide nursing practice in prostate cancer?

This study examines the ability of the distress thermometer to accurately identify patients with higher symptoms, unmet needs and psychological morbidity. Baseline data collected as part of a randomized controlled trial evaluating a nurse-led supportive care intervention for men with prostate cancer commencing radiotherapy at a specialist cancer hospital in Melbourne, Australia. Measures assessed global distress (DT), anxious and depressive symptomatology (HADS), prostate-cancer specific quality of life (EPIC-26), unmet supportive care needs (SCNS-SF34R) and cancer treatment-related concerns (CATS). Following descriptive and correlational analysis, hierarchical multiple regression was employed to examine the contribution of variable sets to explaining variance in DT scores. Less than 20% of men reported DT scores of 4 or higher, indicating overall low distress. The DT accurately identified almost all men reporting HADS score indicative of anxious or depressive symptomatology, suggesting it accurately identifies psychological morbidity. Importantly, the DT identified a further group of distressed men, not identified by HADS, whose distress related to unmet needs and prostate cancer-specific issues, indicating the DT is superior in identifying other forms of distress. While the hierarchical multiple regression confirmed anxious and depressive symptomatology as the best predictor of distress score, many other scales are also good predictors of DT scores, supporting the argument that distress is multi-determined. Nurses can be confident that the DT accurately identifies patients with psychological morbidity and importantly identifies other patients with distress who may require intervention. A distress score of 4 or higher identified participants with higher physical symptomatology, higher unmet needs, more concerns about treatment and poorer quality of life. The low prevalence of distress reaching cut off scores suggests nurses would not be overwhelmed by the outcomes of screening and could use the score to prioritise the patients who need greater attention at entry to radiotherapy services.

Bereavement, religion, and posttraumatic growth: A matched control group investigation.

This study examined the intersection between bereavement, religion, and posttraumatic growth (PTG). A total of 369 young adults completed the Brief Multidimensional Measure of Religiousness/Spirituality (Fetzer Institute/NIA, 1999) and the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996), divided equally into three groups: one bereaved by a violent loss (accident, suicide, or homicide) in the prior two years, one bereaved by a nonviolent death in the prior two years, and a third, nonbereaved group that experienced a general life stressor in the two years preceding the study. Individuals in the two bereaved groups generally endorsed greater religiousness when compared with persons in the nonbereaved group (as assessed by daily spiritual experiences, organizational religiousness, religious coping, forgiveness, and religious support). In addition, survivors who had lost loved ones to a violent death had higher scores across all domains of PTG and reported more distress symptomatology. When controlling for demographics and other study variables, bereavement status and religion factors significantly increased the explained variance in participants’ perceptions of PTG and psychological distress. Although the study design restricts the ability to draw any causal conclusions, these findings highlight the possible spiritual impact of bereavement and how specific dimensions of religion can contribute to growth and healing in the adjustment process.

Overall mental distress and health-related quality of life after solid-organ transplantation: results from a retrospective follow-up study

BackgroundOur retrospective follow-up study aimed to explore the degree of overall mental distress in a cohort of solid-organ transplantation (SOT) recipients after liver, heart or lung transplantation. Furthermore, we investigated how overall mental distress is linked to health-related quality of life.Methods123 SOT patients treated during the study period were enrolled in this investigation at a mean of 24.6 months (SD=11.6) after transplantation. Before transplantation, the Transplant Evaluation Rating Scale (TERS) was used to classify the level of adjustment in psychosocial functioning among transplantation candidates. After transplantation, recipients completed a research battery, which included the SCL-90-R, and the SF-36.Results39 (31.7%) transplantation recipients had clinically significant overall mental distress as measured on the Global Severity Index of the SCL-90-R. Obsessive-compulsive symptoms (92.3%), somatization symptoms (87.2%), anxiety symptoms (84.6%), depression symptoms (82.1%) and phobic anxiety symptoms (69.2%) were a frequent finding.Transplantation recipients with overall mental distress had significant lower levels of adjustment in psychosocial functioning before transaplantation than those without overall mental distress as measured in the TERS. Transplantation-related overall mental distress symptomatology was associated with maximal decrements in health-related quality of life.ConclusionTransplantation recipients may face major transplantation- and treatment-related overall mental distress and impairments to their health-related quality of life. Further, overall mental distress is a high-risk factor in intensifying impairments to patients’ overall quality of life.

Peritraumatic Dissociation as a Mediator of Peritraumatic Distress and PTSD: A Retrospective, Cross-Sectional Study

The objective of the present article was to examine the mediational significance of peritraumatic dissociation in the relationship between peritraumatic distress and posttraumatic stress disorder (PTSD). A total of 71 individuals with spinal cord injuries completed interviews and questionnaires measuring PTSD symptomatology, peritraumatic dissociation, and peritraumatic distress. Peritraumatic dissociation was found to partially mediate the relationship between peritraumatic distress and PTSD symptomatology. These findings provide support for the hypothesis that peritraumatic distress and peritraumatic dissociation significantly impact PTSD severity. The findings also support the hypothesis that peritraumatic dissociation is provoked by peritraumatic distress. The results further indicate that although peritraumatic dissociation seems to be a significant risk factor for PTSD, it is not necessary for the development of PTSD; the presence of peritraumatic distress may be sufficient. These findings highlight the importance of investigating peritraumatic reactions after a traumatic event in order to identify individuals at risk for developing PTSD. Such a practice may help prevent the development of chronic conditions.

Duty‐related trauma exposure in 911 telecommunicators: Considering the risk for posttraumatic stress

Peritraumatic distress may increase the risk for posttraumatic stress disorder (PTSD) in police officers. Much less is known about emotional reactions and PTSD symptomatology in 911 telecommunicators. The current study assessed duty-related exposure to potentially traumatic calls, peritraumatic distress, and PTSD symptomatology in a cross-sectional, convenience sample of 171 telecommunicators. Results showed that telecommunicators reported high levels of peritraumatic distress and a moderate, positive relationship was found between peritraumatic distress and PTSD symptom severity (r = .34). The results suggest that 911 telecommunicators are exposed to duty-related trauma that may lead to the development of PTSD, and that direct, physical exposure to trauma may not be necessary to increase risk for PTSD in this population.

Resource Loss as a Predictor of Posttrauma Symptoms Among College Women Following the Mass Shooting at Virginia Tech

We examined risk factors for posttrauma symptomatology, 2 and 6 months following the April 2007 mass shooting at Virginia Tech. Using a conservation of resources framework and a Web-based survey methodology, we prospectively evaluated the relations among preshooting distress, social support, resource loss, and posttrauma symptomatology in a sample of 293 female students enrolled at the university at the time of the shootings. Structural equation modeling supported that preshooting social support and distress predicted resource loss postshooting. Resource loss predicted symptomatology 2 months and 6 months after the shooting. Implications of the results for research and intervention following mass trauma are discussed.

School-Based Intervention for the Treatment of Tsunami-Related Distress in Children: A Quasi-Randomized Controlled Trial

Background: On December 26, 2004, a tsunami hit the southern coast of Sri Lanka, leaving thousands dead and injured. Previous research has found significant mental health problems among children exposed to major disasters. School-based universal interventions have shown promise in alleviating distress and posttraumatic symptomatology in children and adolescents. This study evaluated the efficacy of a school-based intervention in reducing stress-related symptomatology among Sri Lankan children exposed to the tsunami. Methods: In a quasi-randomized controlled trial 166 elementary school students (ages 9–15) with significant levels of tsunami exposure and previous traumatic background were randomly assigned to a 12-session structured program ‘ERASE Stress Sri Lanka’ (ES-SL) or to a waiting list (WL) religious class control group. Students were assessed 1 week prior and 3 months after the intervention on measures of posttraumatic symptomatology [including posttraumatic stress disorder (PTSD) and severity of posttraumatic symptomatology], depression, functional problems, somatic problems and hope. Results: This study shows a significant reduction on all outcome variables. PTSD severity, functional problems, somatic complaints, depression and hope scores were all significantly improved in the ES-SL group compared to the WL group. No new cases of PTSD were observed in the experimental group. Conclusion: This study adds to the growing body of evidence suggesting the efficacy of school-based universal approaches in helping children in regions touched by war, terror and disaster and suggests the need to adopt a two-stage approach toward dealing with trauma-exposed students, namely, starting with a universal intervention followed by targeted specialized interventions for those still suffering from posttraumatic distress.

Changes in Implicit and Explicit Measures of Ego Functions and Distress Among Two Eating Disorder Subgroups: Outcomes of Integrative Treatment

The study examined changes in ego functions and mental distress among eating disorder (ED) adolescent inpatients following integrative treatment. Participants included 31 restricting anorexia nervosa and 25 bingeing/purging spectrum ED inpatients. Rorschach Comprehensive System (CS; Exner, 2003) and self-report measures were administered on admission and discharge. We found that improvement in ego functions, mental distress and ED symptomatology occurred in both ED groups at discharge. Nevertheless, the two ED subgroups exhibited different configurations of change as well as varying patterns of relations between changes in mental distress and ego functions and improvement in ED symptoms. These data further indicate that the restricting and bingeing/purging patients may require different treatment approaches.