Capacity For Introspection Research Articles

Risk Factors for Depression in Children and Adolescents with High Functioning Autism Spectrum Disorders.

The objective of our study was to examine, discuss, and provide proposals on diagnostic comorbidity of depression in children and adolescents with high functioning autism spectrum disorder (HFASD) in the following aspects. (1) Prevalence. It was concluded that there are an elevated depression rate and the need for longitudinal studies to determine prevalence and incidence based on functioning level, autistic symptoms, gender, age, type of depression, prognosis, duration, and treatment. (2) Explicative Hypotheses and Vulnerability. The factors that present the greatest specific risk are higher cognitive functioning, self-awareness of deficit, capacity for introspection, stressful life events, adolescence, quality of social relationships, and alexithymia. (3) Risk of Suicide. The need for control and detection of suicidal tendencies and bullying is emphasised. (4) Depressive Symptoms. Indicators for early detection are proposed and their overlap with HFASD is analysed, examining the assessment techniques used and arguing that specific adapted tests are needed.

Modeling Cultural Competence in Teaching Humanities to Medical Students

The article highlights the issue of humanization of higher medical education, based primarily on expanding the informational content of culture competence in training humanities. Humanitarian education as a part of culture should form the capacity for introspection, self-awareness, self-reflection to personal actions and to surrounding events. Culture competence plays especially essential role in further practice of medical specialists. The background of cultural competency at higher medical universities can be understood as those acquired skills which help medical students recognize cultural differences and facilitate communication between patients, their relatives and colleagues who have various ways of understanding health, sickness and body functioning. Culture competence includes cultural knowledge, sensitivity, awareness, clinical skills and abilities which constitute rules, norms and strategies. The teachers of humanitarian disciplines should elaborate and implement into educational process confirmed strategies for empowering medical students to become active, responsible life-long learners and self-motivated, interdependent, self-aware, self-managing, self-confident, emotionally intelligent and culturally competent specialists. Learning humanitarian subjects at higher medical educational establishments can offer an exceptional opportunity to help medical students develop learning skills, especially relating to cultural competence.

Das chinesische Selbst — die psychoanalytisch orientierte Psychotherapie in der Volksrepublik China

The author has been teaching psychoanalytically oriented psychotherapy in mainland China for 20 years. The paper focuses on the problem of transferring an individual-centered therapeutic theory and technique to a culture with a collectivistic and Confucian tradition. The different structures of the Western and Asian selves with their specific styles to communicate are described as well as the tendency of the Chinese to be more prone to shamefulness. Basic psychoanalytic concepts such as abstinence, therapeutic ego-splitting, the capacity for introspection and transference, as well as the traditional Confucian longing for harmony, can meet culturally immanent therapeutic problems. A specific defense constellation, the Ah-Q mentality as a result of Daoist thinking is presented. Finally, the question is raised whether technical modifications make sense in less individualized cultures.

Quest for the Female Self-awareness in Iris Murdoch’s A Fairly Honourable Defeat

This paper is devoted to examine the reconstruction of female selfhood from the aspect of the growth of female self-consciousness in a changed and revised world through the quest for female self-awareness as an individual in Iris Murdoch’s A Fairly Honourable Defeat . Through the analysis of Iris Murdoch’s comparative characterization of the siblings Hilda and Morgan, the paper reveals that the social and economic changes in the modern world and all kinds of women’s liberation movements will necessarily lead to the improved situation of women if they have no capacity for introspection and the ability to reconcile themselves as an individual separate from the environment and other individuals. Compared with Morgan’s emotional perplexity, economic hardship, and male contempt, Hilda’s affluent life, happy marriage and her popularity among the male indicate Murdoch’s reluctant admission that women still live in the androcentric world where the women’s self-improvement are not widely welcome.

Les bienfaits de l’écriture chez les malades chroniques… où en sont les recherches ?

Ten to 20% of children and adolescents live with chronic disease. Chronic disease is defined by long-term duration and the need for specialized care. It entails functional limitations in various spheres of life as compared to the lifestyle enjoyed by the healthy population. Teenagers with chronic illness are often marginalized or rejected by their peers, simply because they are different. They have higher levels of stress (internalized and externalized anxiety, symptoms of depression) than their healthy peers (20% vs. 8%). Eighteen percent of adolescents with chronic disease require psychological intervention. In 1986, Pennebaker published a study analyzing the effects of verbal and nonverbal emotional expression among health any adults. He showed significant links between written expression of emotion (particularly of negative emotions) and positive well-being. Other researchers also found a cathartic effect of written emotional disclosure on painful or traumatic events. In France, writing is now used in various settings, such as workshops in psychiatry. Empirical studies, made in United States with adults and teenagers, have shown that expressive writing (subjective writing wherein a person expresses the wealth of emotions experienced during a particularly disturbing event) had a positive impact on psychological and physiological symptoms. Most studies, however, have been conducted in adults, while the number of pediatric studies is limited. In this paper, we will start by briefly reviewing the research in adults to better understand the process of written emotional disclosure and its impact on health. We will then examine studies in the pediatric population and in school settings, where the technique has been used to encourage participants to express their emotions and experiences. We will also examine studies that used control groups comparing expressive writing with neutral writing. The use of expressive writing in adolescents with chronic disease is shown to reduce both psychological and physiological symptoms. Expressive writing increases cognitive function by rallying coping resources within oneself, as the sheer fact of writing contributes to making sense of and finding meaning to a particular event. Expressing writing draws on the capacity for introspection and facilitates maturation. It can be seen as complementary to medical intervention, by relieving stress, anxiety, depression, and other symptoms of psychological distress.

Assessment of self-perception of transsexual persons: pilot study of 15 patients.

Background and Aims. There have been few studies in the area of Self-Perception in transsexual persons, except for the population of transsexual adolescents. Bearing in mind its importance not only in the assessment of personality but also in predicting adaptive capacity, the goal of our research is based on the examination of Self-Perception of adult transsexual persons. Method. The study was conducted using a Rorschach test, which provides an insight into various aspects of Self-Perception. The sample consisted of 15 transsexual persons, who passed the standard diagnostic procedure. Results. The results suggest that transsexual persons manage to maintain Adequate Self-Esteem. Hypervigilance Index and Obsessive Style Index are negative, while the values showing a negative quality of Self-Regard and the capacity for introspection tend to increase. In the process of Self-Introspection, negative and painful emotional states are often perceived. Conclusion. The estimation of Self-Perception in adult transsexual persons indicates a trend of subjective perception of a personal imperfection or inadequacy. This is probably the result of experiencing discomfort for a number of years due to gender incongruence and dysphoria, in particular in persons who enter the sex reassignment procedure later in their adulthood.

The concept of organizational change capacity

PurposeChange implementation presents a major challenge to managers. However, theoretical and empirical works waiver between the change management action and the management of the change/initial conditions. These opposing views reflect the theoretical instability, which characterizes work on organizational change. Faced with this theoretical mosaic, the question of knowing what the change capacity is, is fundamental. The purpose of this paper is to propose a framework for change capacity and to identify its dimensions and components.Design/methodology/approachTo deal with this stake, the author conducted a single case study and observed an organization that had acquired the status of a company with change capacity. The Renault SA group makes for an interesting case. Renault, a 100‐year‐old company, is considered to be capable of undergoing change, of following its environment and even of shaping its own environment.FindingsThe study leads to the identification of three dimensions of the change capacity. These are the context, process and learning dimensions. The context dimension consists of resources that facilitate the change process. The process dimension incorporates principles of implementing change. Finally, the learning dimension tackles the introspective capacity of the organization.Originality/valueIf the literature on change capacity focuses more on the outcome of the capability than on the capability itself, the study has enabled the proposing of a framework for change capacity and to identify its dimensions and components. This framework is interesting in two respects. First, it shows that change capacity is as much linked to its management as it is dependent on the initial conditions. Second, it provides direction towards a strategic management of change.

Eating Disorders – A Current Concern

Epidemiological data shows that Eating Disorders (ED) have been increasing over the past decades and have become one of the most common categories seen in outpatient settings. The EDNOS category – Eating Disorder Not Otherwise Specified – was included in DSM-IV, joining the traditional Anorexia and Bulimia categories. However, some controversy still exists about whether this inclusion is justified. For this reason we decided to examine the differences between ED groups and a population sample, and to compare the three subgroups using data from the Rorschach Comprehensive System. We compared 106 patients suffering from Eating Disorders with a population of 60 nonpatient subjects from a similar demographic subjects background. The ED group consists of 25 Anorexia, 27 Bulimia, and 54 EDNOS cases. We found that the three groups differ significantly from the nonpatient sample, and while they share some features, Anorexia differs from Bulimia and EDNOS. This last group presents differences in regard to introspective capacities. These differences may have an impact on therapy planning.

Estrategias de afrontamiento en enfermos alcohólicos. Diferencias según el consumo de benzodiacepinas, los trastornos de la personalidad y el deterioro cognitivo

Better coping skills are related to greater capacity for dealing with stressful situations. This relationship could be relevant for the prevention of alcohol-misuse relapse. Relapse rate is higher among severe alcoholics. The current study examines whether this may be due to a lack of coping skills in those cases. The COPE (Coping Orientations to Problems Experienced) is a questionnaire used for assessing coping strategies. COPE scores of 216 alcohol inpatients are compared while controlling for personality disorders (PDs), cognitive impairment (CI) and benzodiazepine misuse (BM). Patients with PDs score higher on the scales of Humor, Venting emotions, Substance use and Use of instrumental support. However, there are no differences in COPE scores attributable to CI or BM. Alcoholics with Personality disorders use maladaptive coping strategies. Patients presenting CI or BM have low capacity for introspection and are unable to properly evaluate their own abilities, so that they tend to give a socially favorable but unrealistic image of themselves. Longitudinal studies are needed to evaluate the predictive validity of the coping skills before training alcoholics, who are especially difficult to assess due to their lower capacity for objective self-observation.

Traumatic brain injury and sexual rehabilitation

Summary Objective This article describes the various consequences of a traumatic brain injury (TBI) on sexuality. The physical, cognitive, emotional, relational and social consequences of TBI, to which are added “secondary” conditions such as depression, anxiety and fatigue can all influence sexual function and behavior. Method A review of the clinical scientific literature along with our experience in a rehabilitation center served this analysis. Results The sequellae of a TBI, including the physical, cognitive and social consequences are described as the secondary conditions which can all contribute to the emergence and maintenance of sexual difficulties. Sexual dysfunctions affecting desire, arousal or orgasm can all appear. Disinhibition and hypersexuality are also reported and can become a social handicap for the patients and their surrounding. For those in couple, marital adjustment may become difficult. To overcome these difficulties, different therapeutic strategies can be offered and adapted according to the patient's capacity for introspection, planning and reflection. Our clinical experience leads us to favor the cognitive behavioral approach. The use of a logbook is encouraged to overcome concentration difficulties or memory problems, and the use of modeling, role playing, training with social and sexual habilities, basic sexual education and education on the specific impact of TBI on sexual function may be useful. Extinction of sexually inappropriate behaviors and reinforcement of appropriate behaviors are considered to overcome hypersexuality. Clinicians must be creative and patient. They must repeatedly verify the therapeutic gains and must repeat therapeutic advices. Discussion Sex therapy can offer a variety of therapeutic strategies to overcome sexual difficulties arising from TBI. Cognitive behavioral approaches prove useful as they are more directives and can help patients overcoming their sexual difficulties in addition to preventing these difficulties during early interventions.

Überweisungserfolg einer psychosomatisch-psychotherapeutischen Ambulanz in der Zahnheilkunde

The success of referral for psychotherapy and the predictors thereof are investigated in dentistry in an outpatient unit for psychosomatics. 238 patients were asked in a telephone interview concerning their satisfaction with the consultation as well as any change in their complaints and treatments after their contact with the outpatient unit. 82.3 % of the patients were satisfied with the consultation, and 55.9 % reported an improvement in their complaints. In 76.1 % of the patients psychotherapy was indicated, and 56.7 % showed motivation and were referred to psychotherapy. Thereof, 66.7 % actually began treatment. Introspective capacity and motivation for psychotherapy predicted successful referral. Patients suffering from somatoform disorders were significantly less motivated to begin psychotherapy and showed a tendency toward premature termination of psychotherapy. In patients with anxiety disorders, the reverse was the case. Patients who did not begin psychotherapy changed their dentist significantly more frequently. The consultation at the outpatient unit can be regarded as successful insofar as four-fifths of the patients were satisfied and two-thirds of those referred actually began psychotherapy, which in turn significantly reduces "dentist shopping."

A self-watching model of analogy-making and perception

This paper describes Metacat, an extension of the Copycat model of analogy-making. The development of Copycat focused on modelling context-sensitive concepts and the ways in which they interact with perception within an abstract microworld of analogy problems. This approach differs from most other models of analogy in its insistence that concepts acquire their semantics from within the system itself, through perception, rather than being imposed from the outside. The present work extends these ideas by incorporating self-perception, episodic memory, and reminding into the model. These mechanisms enable Metacat to explain the similarities and differences that it perceives between analogies, and to monitor and respond to patterns that occur in its own behaviour as it works on analogy problems. This introspective capacity overcomes several limitations inherent in the earlier model, and affords the program a powerful degree of self-control. Metacat's architecture includes aspects of both symbolic and connectionist systems. The paper outlines the principal components of the architecture, analyses several sample runs and examples of program-generated commentary about analogies, and discusses Metacat's relation to some other well-known models of analogy.

Comparaison des expériences dissociatives à l'adolescence entre un groupe de collégiens et un groupe clinique

Dissociation involves alterations in consciousness, memory and identity, as well as disruptions in the perception of time and the environment. They contain an inability to remember aspects of one’s life, the experience of feeling oneself in an unfamiliar situation, feelings of unreality, feeling absorbed or completely lost in an activity, and feeling of being detached or disconnected from oneself. These experiences are conceptualized as existing on a continuum ranging from non-clinical conditions to pathological dissociation. Dissociatives experiences are relatively common in the general population, occur equally often in American male and female subjects, and tend to be reported less frequently with age. Data of these experiences are unknown in French adolescent subjects. In 1994, the DSM-IV deleted the notion of hysteria and neurosis and keeps only the notion of dissociative disorders. They included now the five following categories: dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, dissociative disorder not otherwise specified (including derealization). The purpose of this study will compare the frequency of dissociative disorders between a sample of normal adolescent population and a clinical sample of adolescents. Further, results will be compared to the theoric structure of DES’s components to understand differences of dissociative experiences between the two populations. Clinical sample ( N = 55) is made up of French adolescents aged 12–17 (mean age = 14.6; 36.4% is female population). Subjects were streaming from several pedopsychiatric unities. Normal sample ( N = 96) is made up French adolescents aged 13–17 (mean age = 15.1; 51% is female population). Subjects were streaming from a secondary school. The screening tool, which was used is the dissociative experiences scale, a 28-item patient questionnaire regarding various dissociative symptoms. The subject is asked to indicate the percentage of time, to the nearest 5%, that particular symptom is experienced. The score is made by adding the various percentages and finding a mean that is expressed in numbers from 0 to 100. The mean score obtained is 26.15% for secondary school pupils sample and 19.24% for clinical sample. Comparison of the theoric three-factor solution (imaginative absorption, depersonalization-derealization, and dissociative amnesia) gives the following datas: mean score for each factor is, respectively: imaginative absorption = 32.72% for secondary school pupils group, 19.46% for clinical group; dissociative amnesia = 23.97% for secondary school pupils group, 18.31% for clinical group; depersonalization-derealization = 20.45% for secondary school pupils group, 19.65% for clinical group. DES reliability was studied through computation of Cronbach’s coefficient (0.84 for secondary school pupils and 0.92 for clinical sample). Results are paradoxical: reliability is good for the two samples and results are highest for non-clinical population, particularly for imaginative absorption component. An interpretation of this phenomena is, from the point of view of psychopathology and psychodynamics processes at adolescence, that the adolescent who is afflicted and feels psychic pain, is in difficulty to be in a good introspective capacity and to answer thinly to this sort of scale. Suffering adolescents tend to reduce score at DES, facing their own anxiety to be mad or abnormal. The authors mention so that an adolescent in a psychic good health is more able to develop an internal psychic world and can be involved to frequent moments of imaginative absorption, especially for female population (results show a significative difference).

Comparaison des exp�riences dissociatives � l'adolescence entre un groupe de coll�giens et un groupe clinique

Les auteurs s'interrogent sur d'éventuelles différences pouvant exister entre une population adolescente de collégiens et une population clinique en ce qui concerne les expériences dissociatives. L'étude permettra également d'interroger la structure théorique des composants de la DES afin de comprendre les différences relevées entre les deux groupes. L'étude utilise la version française de la Dissociative Experiences Scale (DES) pour cette comparaison. Les résultats obtenus seront référés à la structure des composants théoriques de l'outil, laquelle présente trois types d'expériences dissociatives, l' absorption dans l'imaginaire, l'amnésie dissociative et la dépersonnalisation-déréalisation . Les résultats sont paradoxaux : bien que la fidélité (consistance interne) soit bonne pour les deux groupes, les résultats à l'échelle sont globalement plus élevés dans la population des collégiens, en particulier sur le facteur absorption dans l'imaginaire . Une interprétation est proposée en regard des processus psychodynamiques de l'adolescence, en rapport avec l'incapacité de l'adolescent souffrant à pratiquer l'introspection, et à répondre finement à ce type de questionnaire. Est également évoqué le fait qu'un adolescent en bonne santé psychique développe de façon plus soutenue un monde interne imaginaire et a tendance à s'y laisser absorber de façon fréquente, surtout dans la population féminine (il existe une différence liée au sexe). Dissociation involves alterations in consciousness, memory and identity, as well as disruptions in the perception of time and the environment. They contain an inability to remember aspects of one’s life, the experience of feeling oneself in an unfamiliar situation, feelings of unreality, feeling absorbed or completely lost in an activity, and feeling of being detached or disconnected from oneself. These experiences are conceptualized as existing on a continuum ranging from non-clinical conditions to pathological dissociation. Dissociatives experiences are relatively common in the general population, occur equally often in American male and female subjects, and tend to be reported less frequently with age. Data of these experiences are unknown in French adolescent subjects. In 1994, the DSM-IV deleted the notion of hysteria and neurosis and keeps only the notion of dissociative disorders. They included now the five following categories: dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, dissociative disorder not otherwise specified (including derealization). The purpose of this study will compare the frequency of dissociative disorders between a sample of normal adolescent population and a clinical sample of adolescents. Further, results will be compared to the theoric structure of DES’s components to understand differences of dissociative experiences between the two populations. Clinical sample ( N = 55) is made up of French adolescents aged 12–17 (mean age = 14.6; 36.4% is female population). Subjects were streaming from several pedopsychiatric unities. Normal sample ( N = 96) is made up French adolescents aged 13–17 (mean age = 15.1; 51% is female population). Subjects were streaming from a secondary school. The screening tool, which was used is the dissociative experiences scale, a 28-item patient questionnaire regarding various dissociative symptoms. The subject is asked to indicate the percentage of time, to the nearest 5%, that particular symptom is experienced. The score is made by adding the various percentages and finding a mean that is expressed in numbers from 0 to 100. The mean score obtained is 26.15% for secondary school pupils sample and 19.24% for clinical sample. Comparison of the theoric three-factor solution (imaginative absorption, depersonalization-derealization, and dissociative amnesia) gives the following datas: mean score for each factor is, respectively: imaginative absorption = 32.72% for secondary school pupils group, 19.46% for clinical group; dissociative amnesia = 23.97% for secondary school pupils group, 18.31% for clinical group; depersonalization-derealization = 20.45% for secondary school pupils group, 19.65% for clinical group. DES reliability was studied through computation of Cronbach’s coefficient (0.84 for secondary school pupils and 0.92 for clinical sample). Results are paradoxical: reliability is good for the two samples and results are highest for non-clinical population, particularly for imaginative absorption component. An interpretation of this phenomena is, from the point of view of psychopathology and psychodynamics processes at adolescence, that the adolescent who is afflicted and feels psychic pain, is in difficulty to be in a good introspective capacity and to answer thinly to this sort of scale. Suffering adolescents tend to reduce score at DES, facing their own anxiety to be mad or abnormal. The authors mention so that an adolescent in a psychic good health is more able to develop an internal psychic world and can be involved to frequent moments of imaginative absorption, especially for female population (results show a significative difference).

Planned and Actual Goals in Psychodynamic Psychotherapies: Do Patients' Personality Characteristics Relate to Agreement?

The current study examined planned and actual goals in psychotherapy. Personality differences of clients were investigated using the Rorschach for two groups in which the therapists' goals either agree or do not agree before and after the therapies. Patients for whom the agreement was high were characterized by a high degree of psychological distress, problems in self-perception, openness in expressing feelings, and a good capacity for introspection. Patients for whom the agreement was low were characterized by a low stress tolerance, a poor capacity for social interaction, and an excessive control of emotional discharge. The results suggest that the possibility of carrying out the psychotherapeutic treatment according to a plan is related to the same personality characteristics that have been shown to be related to good therapeutic outcome. The question was raised as to whether it is advisable to use additional assessment instruments, such as the Rorschach, for patients with personality characteristics that hinder the therapists' understanding of their psychological problems.

Enfants d'ouvriers á l’École primaire. Langage et Mathématiques

The author analyzes the behavior of primary school, working-class children as they learn mathematics and French. Language is the operating principie in these disciplines, yet the culture of the working class relates with language in a wai that makes live oral communication important and, therey, hinders people's attainment of the metalinguistic an introspective capacities needed for this type of learning at school. It is proficiency in the written language and, first of all, in the logical structures of language what enables a person to comprehend abstract knowledge and logico-mathematical formalism.

Development of Children's Awareness of Their Own Thoughts

Two introspection tasks were given to 5-year-olds, 8-year-olds, and adults. In one, participants were first asked to think of something they liked to do and something they did not like to do, and then to say what their specific thoughts had been while they were thinking. Even the 5-year-olds were able to report some specific thought content under these highly facilitative conditions. In the other task, participants were asked to try to have no thoughts at all for a short period of time (20-25 sec). When subsequently asked whether they had had some thoughts anyway during this period, all of the adults and the majority of the 8-year-olds said they had, but only a few of the 5-year-olds did. These and other findings suggest that young children have some capacity for introspection but are generally much less aware than older children and adults of their own spontaneous, ongoing ideation.

Using Daydreams in Psychodynamic Psychotherapy

Daydreams, long recognized as containers of unarticulated, unrecognized and/or unconscious material, can be subtle but powerful tools for introducing clients to the process of exploring internal experience. They offer a crucial, relatively non-threatening path to self-understanding for individuals who come into therapy without the capacity for introspection, tolerance of affect, and sense of agency that are requisite for the process of psychodynamic psychotherapy. In part because they are often available to conscious awareness, they are an amazingly useful medium through which to help many of these clients gain access to their internal world. They encourage the development of the capacity to symbolize, to play, and eventually to embrace the “potential space” of internal experience that makes it possible to have a rich and fulfilling life in the “external” world. In this article, the author introduces the use of daydreams in psychodynamic psychotherapy, focusing specifically on three specific areas: resistance, somatization, and transference.

Introspective capacities in patients with cognitive deficits after subarachnoid hemorrhage.

Examined 58 patients after subarachnoid hemorrhage by means of neuropsychological tests, a self-report questionnaire, proxy ratings, and personality forms. The degree of cognitive impairment showed only a slight association with an impairment self-rating scale (r = .32, p > .01). On the other hand, the proxy impairment ratings correlated well with the degree of cognitive disturbance (r = .68, p < .001). Self-rated impairment correlated substantially with depression (r = .63, p < .001). A 2 x 2 analysis of variance showed a significant two-way interaction (p = .014) between depression and cognitive disturbance explaining the subjective impairment rating. Depressive patients tended to maximize their actual degree of impairment. Patients with right parietal and/or frontal infarcts showed significantly less depression and illness concern than did patients with infarcts at other locations, although both groups had a comparable degree of cognitive and self-rated impairment.

Commentary: Failure to Assess Psychopathology in Patients Presenting with Chemical Sensitivities

Mediating processes can be inferred from self-report data only if it can be assumed that the patient has a valid capacity for introspection. That assumption is invalid when beliefs can be shown to influence sensory perception and symptom reports. Another serious limitation of self-reporting is that the individual has only a limited awareness of his or her psychological state. Also, we cannot ignore the observations that come from the psychodynamic tradition, that unconscious or subconscious ideas also can affect and distort self-reporting. The lack of validity of self-reports is summarized by Brewin: "[T]he value of self-reports would appear to be more in their relation to intentional future actions than in any insight they might provide into complex feeling states or into the contingencies governing past behavior." A more objective procedure for obtaining information about EI/MCS patients' beliefs is clearly needed before their symptom reports can be taken at face value.