Fear Subscale Research Articles

Low Rates of Human Immunodeficiency Virus Testing Among Adolescent Gay, Bisexual, and Queer Men

PurposeAdolescent gay and bisexual men (AGBM) are disproportionately affected by human immunodeficiency virus (HIV), but little is known about testing rates among men aged 18 years and under or about the barriers that they face when contemplating an HIV test. Therefore, we investigate here the testing behaviors and barriers among a diverse national sample of AGBM. MethodsA total of 302 AGBM aged 14–18 years were recruited via Facebook ads to participate in an mHealth (text messaging-based) HIV prevention program. Recruitment was stratified to ensure approximately 50% were sexually inexperienced. ResultsOnly 30% of sexually active participants had ever been tested for HIV, and nearly half of them did not know where they could go to get tested for HIV (42.9%). Based on exploratory factor analysis, nine questions assessing potential barriers to HIV testing factored into three subscales: external factors, fear, and feelings of invincibility. Among sexually active participants, those who had never tested for HIV had significantly greater scores on the external factors (odds ratio, 1.63; 95% confidence interval, 1.01–2.66) and fear (odds ratio, 1.88; 95% confidence interval, 1.11–3.19) subscale. Older (16–18 years old) youth were especially likely to be affected by external factor barriers, and fear was associated with never testing among gay-identified individuals. ConclusionsHIV testing rates were low among AGBM. Several modifiable barriers emerged, especially a lack of knowledge about the closest testing site. Interventions and programs that target high school–age adolescents could address external barriers by introducing HIV testing services into high schools.

Psychometric properties of the Modified Tonic Immobility Scale. [Propiedades psicométricas de la Escala de Inmovilidad Tónica: algunos problemas

The Tonic Immobility Scale has been only studied in abuse and/or sexual assault survivors, but tonic immobility (TI) also occurs after other types of traumatic events. Consequently, we modified the scale for this purpose and studied its factor structure, internal consistency, and convergent, discriminant and criterion validity in 392 university students, most of whom had suffered one or more traumatic events of various kinds. The Fear subscale of the Modified Tonic Immobility Scale (MTIS) showed very low internal consistency, and must be eliminated or reformulated. Discrimination indices of items 5 and 8 were very low, and these items must be reformulated or removed. After removing the five previous items, the shortened version of the MTIS had a one-factor structure, although model fit was not completely satisfactory. This scale showed acceptable levels of reliability, convergent validity with post-traumatic symptomatology, discriminant validity with measures of depression and anxiety, and criterion validity differentiating between groups that had and had not experienced traumatic events. The psychometric properties of the shortened version of the MTIS should be studied further. It may also be advisable to add new items of TI in order to establish whether this is a construct with more than one dimension.

Contribution of problem-solving skills to fear of recurrence in breast cancer survivors

Although fear of recurrence is a major concern among breast cancer survivors after surgery, no standard strategies exist that alleviate their distress. This study examined the association of patients' problem-solving skills and fear of recurrence and psychological distress among breast cancer survivors. Randomly selected, ambulatory, female patients with breast cancer participated in this study. They were asked to complete the Concerns about Recurrence Scale (CARS) and the Hospital Anxiety and Depression Scale. Multiple regression analyses were used to examine their associations. Data were obtained from 317 patients. Patients' problem-solving skills were significantly associated with all subscales of fear of recurrence and overall worries measured by the CARS. In addition, patients' problem-solving skills were significantly associated with both their anxiety and depression. Our findings warrant clinical trials to investigate effectiveness of psychosocial intervention program, including enhancing patients' problem-solving skills and reducing fear of recurrence among breast cancer survivors.

COGNITIVE-BEHAVIORAL GROUP THERAPY VERSUS GROUP PSYCHOTHERAPY FOR SOCIAL ANXIETY DISORDER AMONG COLLEGE STUDENTS: A RANDOMIZED CONTROLLED TRIAL

Data entry errors were noted in the 2011 article titled “Cognitive-Behavioral Group Therapy versus Group Psychotherapy for Social Anxiety Disorder among College Students: A Randomized Controlled Trial” by Bjornsson et al. (Depression and Anxiety, 28: 1034–1042). However, there were no changes to any of the findings or conclusions of the study. We present the corrected data below: In Table 3, seven individuals (31.8%) in the cognitive-behavioral group therapy group had avoidant personality disorder versus six individuals (26.1%) in the group psychotherapy group. We present the corrected data in the following subsection of the Results Section. There was an overall improvement by time across treatment conditions on the Clinical Global Impression Scale (F(1, 39) = 9.70, P < .01) and the Liebowitz Social Anxiety Scale (LSAS) total score (F(1, 39) = 40.58, P < .001). There were no statistically significant differences between the two treatments, when regressing treatment on posttreatment ratings, and controlling for baseline LSAS scores, on the fear subscale (t(38) = 1.35, P = .19), the avoidance subscale (t(38) = 0.24, P = .81), or the total score (t(38) = 0.82, P = .42). There was an overall improvement by time across treatment conditions, on the Social Phobia Scale (SPS); F(1, 38) = 49.49, P < .001, the Social Interaction Anxiety Scale (SIAS); F(1, 39) = 33.32, P < .001, and the Brief Fear of Negative Evaluation Scale (BFNE); F(1, 39) = 23.44, P < .001. Consistent with the independent assessment interview data, there were no differences between the two treatments as measured by self-report questionnaires. For example, when regressing treatment on posttreatment ratings, and controlling for baseline scores, on the SPS scale (t(37) = 0.07, P = .94), the SIAS scale (t(38) = −0.21, P = .83) and the BFNE scale (t(38) = 0.40, P = .69), there were no statistically significant differences (see Table 4). Tables 3 and 4 have now been corrected, and are presented below.

Psychological Factors Predict Eating Disorder Onset and Maintenance at 10‐year Follow‐up

The present study sought to identify psychological factors that predict onset and maintenance of eating disorders. Secondary analyses were conducted using data from an epidemiological study of health and eating behaviours in men and women (N = 1320; 72% female) to examine the prospective and independent influence of the Eating Disorder Inventory Perfectionism, Interpersonal Distrust, and Maturity Fears subscales in predicting the onset and maintenance of eating disorders at 10-year follow-up. Multivariate models indicated higher Perfectionism (p = .025), lower Interpersonal Distrust (p < .001), and higher Maturity Fears (p = .037) predicted increased risk for eating disorder onset at 10-year follow-up, but only Perfectionism (p = .004) predicted eating disorder maintenance. Differential prediction of eating disorder onset versus maintenance highlights potentially different psychological foci for prevention versus treatment efforts.

The Effects of 5-HTR1A Polymorphism on Cingulum Connectivity in Patients with Panic Disorder

ObjectiveSerotonin-1A receptors (5-HTR1A) is suggested to be involved in the etiology of several psychiatric disorders including panic disorder (PD). A few imaging studies have suggested the alterations of the cingulum bundle in PD. The objective of this study is to examine the structural changes of cingulum related to the 5-HTR1A polymorphism rs6295 in the patients with PD.MethodsThirty-two right-handed patients with PD [11 men, 21 women; 40.34±13.17 (mean±SD) age] who met the diagnostic criteria in Structured Clinical Interview for DSM-IV were examined by means of MRI at 3 Tesla. We divided the patients with PD into CC genotype group and non CC genotype group (GG/CG genotype group) of the 5-HTR1A rs6295 polymorphism to compare the cingulum white matter connectivity.ResultsTract-based spatial statistics showed significantly increased fractional anisotropy (FA) values in cingulate gyrus process of left cingulum in 5-HTR1A CC genotype compared to GG/CG genotype in PD. Significant positive correlations were shown between the Albany Panic and Phobia Questionnaire (APPQ) interoceptive fear subscale scores, the Anxiety Sensitivity Inventory-Revised fear of publicly observable anxiety reaction subscale scores and FA values of cingulate gyrus process of left cingulum in 5-HTR1A rs6295 GG/CG genotype group. In CC genotype group, APPQ total, APPQ agoraphobia subscale and APPQ social phobia subscale scores also showed significant positive correlations with FA values of hippocampal process of right cingulum.ConclusionThis preliminary study suggests that 5-HTR1A polymorphism may be associated with the cingulum white matter connectivity in PD.

“If I feel disgusted, I must be getting ill”: Emotional reasoning in the context of contamination fear

Patients suffering from anxiety disorders have been shown to infer danger on the basis of their anxiety responses “if I feel anxious, there must be danger.” This tendency logically hampers the identification of false alarms and may thus act in a way to confirm the a priori threat value of the feared stimuli/situations. Since disgust is assumed to play a critical role in the persistence of contamination fears in OCD, the question rises whether individuals suffering from fear of contamination perhaps similarly infer danger on the basis of their disgust response: “If I feel disgusted, it must be contagious.” Therefore, this study tested whether indeed disgust-based reasoning might be involved in fear of contamination. On the basis of the contamination fear subscale of the Padua Inventory (PI), we selected a group of participants scoring higher than the established clinical range (n = 31, PI > 13) and a group of participants low (n = 27, PI < 5) in contamination fear. Each participant was presented with a series of 2 times 4 types of scripts that systematically varied in the absence/presence of objective threat of contamination and the absence/presence of the actor's disgust response. Following each script, participants rated their perceived threat of contamination/illness. In line with the hypothesis that disgust-based reasoning might be involved in fear of contamination, specifically high contamination fearful individuals inferred risk of becoming ill on the basis of experienced disgust (in addition to objective threat), as was evidenced by a significant Group (high vs. low) × Threat (yes vs. no) × Disgust response (yes vs. no) interaction. This finding might not only help to explain the persistence of contamination fears, but also provides some fresh clues to improve currently available treatment options.

Positive emotions and life satisfaction in Palestinian children growing up amid political and military violence: a pilot study

Background Exposure to war has mostly negative psychological effects on children, according to the results of several studies undertaken in the occupied Palestinian territory (oPt). Political and military violence has been sustained in the oPt since the intifada (uprising) of 2000; according to the results of a study in the West Bank, the frequency of mild post-traumatic stress disorder was 73% (41% medium and severe) of 174 people. Additionally, direct and indirect exposure to trauma is associated with disruption of sleep and concentration, somatic symptom disorders, impulsive behaviours, and depression. Data for the resilience of Palestinian children or how they cope positively with trauma have been reported in few studies; in a study in the Gaza Strip, 21% of 640 children were judged resilient. We therefore assessed wellbeing in Palestinian children exposed to war in the oPt. Methods In this pilot study, wellbeing was assessed in 74 Palestinian children (aged 7–15 years, 43 boys and 31 girls) living in a refugee camp in Tulkarm, West Bank, with questionnaires administered during a summer camp run by a non-governmental organisation in 2010. Children were selected after meetings with their families and in accord with the recommendations of local institutions that had been in charge of the children during the school year. The children answered an open question What makes you feel good? and completed three self-report assessments. Positive and negative affect schedule-children (PANAS-C) was used to assess the intensity of positive and negative emotions; multidimensional students' life satisfaction scale for schoolchildren's contentedness with five domains (self, family, friends, school, and environment); and faces scale for self-perceived happiness. The qualitative data were analysed for thematic content, and self-report measures were analysed quantitatively (correlation and linear regression). The research was undertaken in accord with the ethics committee guidelines of the University of Milano-Bicocca, Milan, Italy. Parents provided verbal informed consent; the children could participate or withdraw from the study of their own volition and decline to answer any of the questions. Findings The children had healthy measurements for wellbeing in terms of positive emotions and life satisfaction, with 64 (86%) of 74 obtaining almost maximum scores for happiness. Personal factors (Spearman's rank correlation coefficient; p=0) and social factors—family (p=0·014) and friends (p=0·006)—were positively correlated with life satisfaction. The linear regression analyses showed that positive emotions significantly contributed to the contentedness of the children (p=0·015). No significant differences were noted in wellbeing as a function of sex. However, girls had greater ability than did boys in benefiting from both social relationships and personal resources. Girls had significantly greater satisfaction with both their friends and their lives overall, particularly with respect to family, educational, religious, and social dimensions. Significant differences were noted with respect to age in the PANAS-C scores for overall negative affect (Student's t test for two independent samples; p=0·1) and for the anxiety or fear subscale (p=0·024 or p=0·094, respectively). Specifically, older children (aged 11–15 years) obtained higher scores on both the negative emotion and anxiety or fear scales. Younger children (aged 7–10 years) had slightly but significantly higher scores for self-perceived happiness than did older children (p=0·043). Interpretation Our results, although exploratory, provide valuable guidance for clinical work, particularly with respect to the importance of social networks and the effects that they have on positive emotions in Palestinian children and adolescents. Clinical interventions should be targeted at strengthening aspects of positive functioning, rather than at correcting behaviours or cognitive and emotional states that are unequivocally thought to be maladaptive. Funding FSE-Dote Ricercatore, a programme of the Lombardy Region, Milan, Italy.

Treatment Improves Symptoms Shared by PTSD and Disordered Eating

Eating disorders and posttraumatic stress disorder (PTSD) are debilitating conditions that frequently co-occur. Although the two disorders have different clinical presentations, they share associated features, including cognitive disturbances, emotion dysregulation, dissociation, and impulsivity. We hypothesized that reductions in PTSD symptoms following cognitive processing therapy (CPT) and its treatment components (CPT without the written account or the written account only) would be associated with improvements in symptoms common to PTSD and eating disorders. Participants in the current investigation included women with PTSD (N = 65) who reported a history of rape or physical assault, were in a randomized dismantling study of CPT, and completed the Eating Disorder Inventory-2 (EDI-2) at pre- and posttreatment. Latent growth modeling results indicated that decreases in PTSD symptom scores were significantly associated with reductions in the Impulse Regulation, Interoceptive Awareness, Interpersonal Distrust, Ineffectiveness, and Maturity Fears subscales of the EDI-2. Thus, PTSD treatment affected symptoms shared by PTSD and eating disorders. Currently, there are no clear guidelines for treatment of comorbid PTSD and eating disorders. Traditional CPT may impact symptoms common to both, but additional therapy may be needed for specific disordered eating attitudes and behaviors.

Perceived Effort of Walking: Relationship With Gait, Physical Function and Activity, Fear of Falling, and Confidence in Walking in Older Adults With Mobility Limitations

Although clinicians have a number of measures to use to describe walking performance, few, if any, of the measures capture a person's perceived effort in walking. Perceived effort of walking may be a factor in what a person does versus what he or she is able to do. The objective of this study was to examine the relationship of perceived effort of walking with gait, function, activity, fear of falling, and confidence in walking in older adults with mobility limitations. Design This investigation was a cross-sectional, descriptive, relational study. The study took place at a clinical research training center. The participants were 50 older adults (mean age=76.8 years, SD=5.5) with mobility limitations. The measurements used were the Rating of Perceived Exertion (RPE) for walking; gait speed; the Modified Gait Abnormality Rating Scale; energy cost of walking; Late Life Function and Disability Instrument (LLFDI) for total, basic, and advanced lower-extremity function and for disability limitations; activity and restriction subscales of the Survey of Activities and Fear of Falling in the Elderly (SAFFE); activity counts; SAFFE fear subscale; and Gait Efficacy Scale (GES). The relationship of the RPE of walking with gait, function, activity, fear, and confidence was determined by using Spearman rank order coefficients and an analysis of variance (adjusted for age and sex) for mean differences between groups defined by no exertion during walking and some exertion during walking. The RPE was related to confidence in walking (GES, R=-.326, P=.021) and activity (activity counts, R=.295, P=.044). The RPE groups (no exertion versus some exertion) differed in LLFDI scores for total (57.9 versus 53.2), basic (68.6 versus 61.4), and advanced (49.1 versus 42.6) lower-extremity function; LLFDI scores for disability limitations (74.9 versus 67.5); SAFFE fear subscale scores (0.346 versus 0.643); and GES scores (80.1 versus 67.8) (all P<.05). Limitations The range of RPE scores for the participants studied was narrow. Thus, the real correlations between RPE and gait, physical function, and psychological aspects of walking may be greater than the relationships reported. The perceived effort of walking was associated with physical activity and confidence in walking. Reducing the perceived effort of walking may be an important target of interventions to slow the decline in function of older adults with mobility limitations.

A cross-cultural comparison between EDI results of Romanian and German students

The sociocultural changes in Eastern Europe might be accompanied by a rise in symptoms of eating disorders among female population. The aim of this study was to investigate differences in eating attitudes and behaviors between nonclinical samples from Romania and Germany, using the Eating Disorder Inventory (EDI). The Romanian students showed significantly higher values on five EDI-subscales. The largest effects were observed for the perfectionism and maturity fears subscales, with age and BMI as covariates not influencing these results. The present findings correlate with those of a number of other studies, which showed EDI differences between different countries and cultures.

Attentional control affects the relationship between tonic immobility and intrusive memories

Background and objectivesCognitive control and tonic immobility (TI) have both been implicated in the development of PTSD, but it is not known how these factors are related. The present study investigated if a specific form of cognitive control (attentional control) would moderate the relationship between TI and intrusive memories. MethodsParticipants (N = 43) completed the Attentional Control Scale (ACS) before watching an aversive film. They completed the Tonic Immobility Scale (TIS, with an immobility and fear subscale: TIS-TI and TIS-Fear) afterwards and recorded intrusive memories of the film in the subsequent week. ResultsTIS-TI was related to intrusion frequency, while ACS was not. However, ACS had a moderating role; the relationship between TIS-TI and intrusion frequency was significant in low ACS but not in high ACS participants. The TIS-Fear subscale was not related to intrusion frequency in low ACS or high ACS participants. LimitationsReplication of the results is merited in selected extreme groups and males. ConclusionsThe results may imply that enhanced attentional control serves as a protective factor against the development of intrusive memories after trauma.

Fear in Arthroplasty Surgery: The Role of Race

Understanding the difference in perceived functional outcomes between whites and blacks and the influence of anxiety and pain on functional outcomes after joint arthroplasty may help surgeons develop ways to eliminate the racial and ethnic disparities in outcome. We determined the difference in functional outcomes between whites and blacks and assessed the influence of fear and anxiety in total joint arthroplasty outcomes in 331 patients undergoing primary hip and knee arthroplasty. WOMAC, Quality of Well Being, SF-36, and Pain and Anxiety Symptoms Scale (PASS) were administered pre- and postoperatively (average 5-year followup). For the SF-36 General Health Score, blacks reported having worse perceived general health than whites before surgery. Regardless of time, blacks scored worse than whites for all measures except for the SF-36 physical function and general health scores. Blacks had a greater fear score (ie, that associated with the procedure) and total PASS score. For both races, there was a low association between the fear dimensions and dependent measures before and after surgery. Black patients undergoing hip and knee arthroplasty had lower scores than whites in most outcome measures regardless of time of assessment. We found higher fear levels before joint arthroplasty in blacks compared with whites. After surgery, blacks had much higher associations of the fear subscale, cognitive subscale, and total PASS score with the WOMAC physical function, pain, and total scores. Level II, prospective controlled cohort study. See Guidelines for Authors for a complete description of levels of evidence.

Relations among Need for Power, Affect and Attitudes toward Animal Cruelty

ABSTRACTPrevious research has investigated the relationship between empathy with humans and attitudes toward animals. Developing a better understanding of this relationship, as well as other related variables, may assist in the prevention of antisocial behavior. The purpose of the current study was to investigate the relationship between sensitivity toward the mistreatment of animals, negative affect, and need for power. Participants were 198 Introductory Psychology students, 98 (49.5%) women and 100 (50.5%) men. They completed three questionnaires: the Need for Power (nPower) subscale of the Index of Personal Reactions (IPR); the Positive and Negative Affect Schedules—Expanded form (PANAS-X); and the Cruelty subscale of the Attitudes Toward the Treatment of Animals Scale (ATTAS). Results indicated that, among men, individual differences in the affect subscales of Sadness, Hostility, Fear, and Fatigue, in addition to nPower, were significantly correlated with cruelty attitudes. Linear regression showed that both Hostility and nPower emerged as significant predictors of cruelty attitudes. Further analyses revealed a significant Hostility × nPower interaction, with Hostility related to animal cruelty only among men with low nPower scores. Among women, only the affect subscale of Serenity was correlated with animal cruelty. Implications and recommendations for future research are discussed.

Sibling death and death fear in relation to depressive symptomatology in older adults.

Previously overlooked factors in elders' depressive symptomatology were examined, including death fear, sibling death, and sibling closeness. Participants were 150 elders (61 men, 89 women) aged 65-97 years with at least one sibling. Measures were proportion of deceased siblings, sibling closeness, the Death Fear Subscale of the Death Attitude Profile-Revised, and the Center for Epidemiological Studies-Depression scale (20-item adult form). Age and education were exogenous variables in a structural equation model. Death fear, sibling closeness, and proportion of dead siblings were directly related to depression, with path coefficients of .42, -.24, and .13, respectively. Proportion of dead siblings had indirect effects on depression, as did age and education. Depressive symptomatology in old age is influenced by death fear related to sibling death as well as by poor relationships with them; it must be understood within a situational context including death fear and sibling relationships.

Measuring barriers to incontinence care seeking

The objective of this study was to establish the factor validity of a modified Melnyck's Barrier Scale and estimate its reliability in an ethnically heterogeneous incontinent female population. Computer assisted telephone interviews (CATI) were conducted on a nonprobability sample of 275 incontinent females (95 Caucasian, 95 African American, 80 Hispanic, 5 Other). Study participants were asked to rate the degree to which barrier items affected their seeking medical care for incontinence on a 4-point Likert scale ranging from 0 (none) to 3 (greatly). A confirmatory factor analysis was conducted to confirm the structure of the modified Melnyk's Barrier Scale and assess its fit in our racially heterogeneous incontinent female population. Cronbach's alpha coefficients were estimated to establish the reliability of the final barrier measurement model and its subscales. The 14-item modified Melnyk's Barrier Scale contained 3 items that loaded on the inconvenience factor (factor loadings 0.659-0.812). Three items loaded on the relationship factor (factor loadings 0.452-0.796). Two items loaded on the site-related factor (factor loadings 0.554-0.960). Three items loaded on the cost factor (factor loadings 0.481-0.891). Three items loaded on the fear factor (factor loadings 0.457-0.624). Cronbach's alpha coefficient for the final 14-item modified Melnyk's Barrier Scale was 0.828 (Inconvenience subscale 0.79, Relationship subscale 0.68, Site related subscale 0.69, cost subscale 0.71, fear subscale 0.57). We offer the Barriers to Incontinence Care Seeking questionnaire (BICS-Q) to epidemiologic researchers, given its factor validity and reliability, to operationalize barriers when studying relationships between ethnicity and health care disparities.

Prenatal Exposure to Maternal Depression and Cortisol Influences Infant Temperament

Accumulating evidence indicates that prenatal maternal and fetal processes can have a lasting influence on infant and child development. Results from animal models indicate that prenatal exposure to maternal stress and stress hormones has lasting consequences for development of the offspring. Few prospective studies of human pregnancy have examined the consequences of prenatal exposure to stress and stress hormones. In this study the effects of prenatal maternal psychosocial (anxiety, depression, and perceived stress) and endocrine (cortisol) indicators of stress on infant temperament were examined in a sample of 247 full-term infants. Maternal salivary cortisol and psychological state were evaluated at 18-20, 24-26, and 30-32 weeks of gestation and at 2 months postpartum. Infant temperament was assessed with a measure of negative reactivity (the fear subscale of the Infant Temperament Questionnaire) at 2 months of age. Elevated maternal cortisol at 30-32 weeks of gestation, but not earlier in pregnancy, was significantly associated with greater maternal report of infant negative reactivity. Prenatal maternal anxiety and depression additionally predicted infant temperament. The associations between maternal cortisol and maternal depression remained after controlling for postnatal maternal psychological state. These data suggest that prenatal exposure to maternal stress has consequences for the development of infant temperament.

Emotion Situation Knowledge in Elementary School: Models of Longitudinal Growth and Preschool Correlates

AbstractWe examined individual differences in developmental trajectories of emotion situation knowledge (ESK), at three time points throughout elementary school in a sample of children from economically disadvantaged families. Results showed that ESK and the subscales of joy, fear, anger, shame and interest exhibited positive growth from the first to the fifth grade, whereas scores on the sad subscale declined slightly. Preschool verbal ability predicted first grade scores for joy, fear, and anger, and growth in scores for shame across time. Preschool negative emotional intensity predicted slower growth in overall ESK and the anger and shame subscales. Taken together, these results broaden our basic knowledge of how children's use of situational cues to infer others' emotions develops in middle and late childhood.

Levels of Death Anxiety: A Comparison of American and Lithuanian Health and Social Service Personnel

Globalization, coupled with increased attention to issues surrounding death, highlights the need to explore cultural influences on the social, personal, and psychological consequences of death. This study compared the responses of 82 American and 119 Lithuanian health and social service personnel on seven subscales of the Multidimensional Fear of Death Scale. Lithuanian participants were more likely to express fear of the dying process and fear of the unknown and were less likely to fear the dead than were Americans. The findings suggest that different historical and environmental experiences with death may influence anxiety about various dimensions of death. Cultural differences in the dimensions of death anxiety among health and social service providers in the two nations suggest the importance of differential training based on specific cultural knowledge to improve the quality of care.

Trends in eating disorder symptomatology in an outpatient clinic: 1988–1998

Eating disorders treatment has been altered by changes in the health care system. In addition, there has been a major emphasis on prevention in recent years. Yet, there are few investigations of the effects of these changes on the severity of patients' symptomatology at intake. This study examined differences in symptoms among women who presented to an outpatient clinic between 1988 and 1998. Patients were divided into Cohort 1 (1988–1992) and Cohort 2 (1993–1998). Patients with anorexia nervosa (AN) in Cohort 2 had significantly lower body mass indices (BMIs) at intake. Moreover, a greater number of patients with AN in Cohort 2 had BMIs≤15, suggesting severe malnourishment. Cohort 2 patients with bulimia nervosa obtained higher scores on the Interpersonal Distrust, Interoceptive Awareness, and Maturity Fears subscales of the Eating Disorder Inventory. There were no cohort differences in eating disorder duration, exercising, laxative or diuretic use, or self-induced vomiting. These results provide some evidence that the severity of eating symptomatology has increased in recent years.