Maladaptive Actions Research Articles

Comparison of Alternate Personality Models in Psychopathology Assessment

This study assessed the results from the parallel application of two alternate personality models, the Zuckerman-Kuhlman trait model and Bond's Defense Styles, in a sample of 268 Greek medical students (172 women, M age = 22.0 yr., SD = 1.1; 95 men, M age = 22.3 yr., SD = 1.2) in relation to psychopathological symptoms, so as to clarify whether this practice yielded accurate results while avoiding shared variance. Data from both models are cross-checked with canonical correlation analysis to validate whether there was significant conceptual overlap between them that would mean that their parallel use is an ineffective research practice. Following this analysis, factors from both models are utilized to predict variance in sample psychopathology, so as to compare their relative usefulness. Results indicated that the two models did not share a significant amount of variance, while a combination of personality aspects from both models, including Impulsive Sensation-Seeking, Neuroticism-Anxiety, Aggression-Hostility, and Sociability traits and Maladaptive Action, Image Distorting, and Adaptive Action defense styles, predicted high variance in psychopathology symptoms.

Coping with health-stressors and defence styles associated with health-related quality of life in patients with systemic lupus erythematosus

This study aimed to assess the association of coping with health-stressors and defence styles with health-related quality of life (HRQOL) in systemic lupus erythematosus (SLE). In 56 SLE patients we assessed disease activity (SLEDAI), functional limitations (HAQ), psychological distress (SCL-90-R), defence styles (Defence Style Questionnaire), hostility (HDHQ), coping with health-stressors (Sense of Coherence scale) and HRQOL (WHOQOL-BREF). Two hundred and eight rheumatologic patients (168 with rheumatoid arthritis [RA] and 40 with primary Sjögren's syndrome [SS]) served as disease controls. SLE patients' HRQOL was similar to that of patients with RA and primary SS after adjusting for demographic and disease variables. Psychological distress was significantly associated with most aspects of HRQOL, but sense of coherence mediated the relationship of psychological distress with Physical HRQOL; this mediation effect was unique to SLE, as mediation analyses showed. Maladaptive action defence style was also significantly associated with Environment HRQOL independently of psychological distress (p < 0.024). These findings indicate that, apart from the early assessment and treatment of psychological distress, clinicians and consultation-liaison psychiatrists should bear in mind the SLE patients' psychological resources and coping capacities to deal with the stress of the disease, since such traits, although usually underestimated, are strongly independently associated with HRQOL.

Altered cingulate sub-region activation accounts for task-related dissociation in ERN amplitude as a function of obsessive-compulsive symptoms

Larger error-related negativities (ERNs) have been consistently found in obsessive-compulsive disorder (OCD) patients, and are thought to reflect the activities of a hyperactive cortico-striatal circuit during action monitoring. We previously observed that obsessive-compulsive (OC) symptomatic students (non-patients) have larger ERNs during errors in a response competition task, yet smaller ERNs in a reinforcement learning task. The finding of a task-specific dissociation suggests that distinct yet partially overlapping medio-frontal systems underlie the ERN in different tasks, and that OC symptoms are associated with functional differences in these systems. Here, we used EEG source localization to identify why OC symptoms are associated with hyperactive ERNs to errors yet hypoactive ERNs when selecting maladaptive actions. At rest, OC symptomatology predicted greater activity in rostral anterior cingulate cortex (rACC) and lower activity in dorsal anterior cingulate cortex (dACC). When compared to a group with low OC symptom scores, the high OC group had greater rACC reactivity during errors in the response competition task and less deactivation of dACC activity during errors in the reinforcement learning task. The degree of activation in these areas correlated with ERN amplitudes during both tasks in the high OC group, but not in the low group. Interactive anterior cingulate cortex (ACC) systems associated avoidance of maladaptive actions were intact in the high OC group, but were related to poorer performance on a third task: probabilistic reversal learning. These novel findings link both tonic and phasic activities in the ACC to action monitoring alterations, including dissociation in performance deficits, in OC symptomatic participants.

Defense Mechanisms Associated With Borderline Personality Disorder

This study assessed the defensive functioning of 290 criteria-defined borderline patients and compared it to that of 72 patients with other forms of axis II psychopathology. The Defense Style Questionnaire (DSQ), a self-report measure with demonstrated criterion validity and internal consistency, was administered to 362 axis II inpatients diagnosed using semistructured interviews of proven reliability. Borderline patients had significantly higher scores than axis II comparison subjects on three of the four defense styles assessed by the DSQ: self-sacrificing, maladaptive action, and image-distorting defenses. They also had significantly higher scores than axis II comparison subjects on eight of the 19 defense mechanisms studied. More specifically, borderline patients had significantly higher scores on one neurotic-level defense (undoing), four immature defenses (acting out, emotional hypochondriasis, passive aggression, and projection), and two image-distorting/borderline defenses (projective identification and splitting). In contrast, axis II comparison subjects had a significantly higher score than borderline patients on one mature defense (suppression). When all significant defenses were considered together, three were found to be significant predictors of a borderline diagnosis: acting out, emotional hypochondriasis, and undoing. This model has both good sensitivity (.95) and positive predictive power (.86). Taken together, the results of this study suggest that the defensive profile of borderline patients is distinct from that of patients with other forms of axis II pathology. They also suggest that the defensive triad of acting out, emotional hypochondriasis, and undoing may serve as a useful clinical marker for the borderline diagnosis, particularly in settings where the base rate of the disorder is high.

Schizophrenia: A Computational Reinforcement Learning Perspective

As one of the most complex neurocognitive disorders, schizophrenia (SZ) is a devastating condition for which the underlying sources are far from being fully understood. Indeed, it is likely that there are multiple etiologies to the disease and heterogeneity within the population. Moreover, it is impossible to understand from a purely mechanistic basis how a patient would come to believe so strongly in delusions as to, for example, gouge out his own eyes. Nevertheless, science marches forward, and the last 30 years or so have produced a wealth of knowledge regarding some of the risk factors, genetics, pharmacology, cognitive deficits, and underlying neurobiology associated with the disease. In part because of the efficacy of antipsychotic treatments via dopamine D2 receptor blockade, the majority of this research focuses on dysfunctions of the dopaminergic system, in both frontal cortex and basal ganglia, thought to be related to negative and positive symptoms, respectively. At the neurocognitive level,muchof the focushasbeenondysfunctionwithin dorsolateralprefrontal cortical circuits and their contributions to working memory, cognitive control, and attentional shifting. While dopamine plays a critical role in all these processes, it is perhaps more centrally related to aspects of motivational processing, which is surprisingly understudied in SZ. Indeed, it is possible to account for many of the frontal-dependent cognitive deficits in SZbypositingamore coredeficit in themotivational ‘‘gating’’ system for determining which information patients should ‘‘care’’ about and what they might ignore. Given the complexity of neural circuits involved in both cognitive and motivational functions, it becomes dauntingly difficult to capture the possible interactions of these circuits, and particularly how they are disrupted in SZ, with simple verbal depictions and static anatomical diagrams. Here I consider the potential application of computational neural network models as a principled and dynamic tool for exploring these interactions and psychopathology associated with dopaminergic dysfunction in SZ and which can lead to new testable predictions at both the neural and behavioral levels. These models enable one to simulate various anatomical and physiological pieces of data, using mathematical equations that capture how groups of neurons communicate activity to other neurons within and between brain areas. By incorporating aspects of neuronal physiology, connectivity, and synaptic plasticity within the basal ganglia–frontal cortical system, one can examine dynamics of this circuitry and how it may go awry. At the same time, it is not tractable to try to incorporate every known biological detail into a model, particularly when the goal is to discover how an entire system of brain regions interact to produce behavior. Thus, the models are also constrained by the need to account for existing data at these higher levels, such as effects of focal lesions or pharmacological manipulation on behavior. Critically, the models make new predictions about how the system works that would likely not have emerged otherwise and often were not conceived by the modeler prior to being built. Models can then be tested and refined and their implications explored in neurological conditions. To sum up a large body of basic research, models of frontostriatal function have generally suggested that these circuits support the following—(1) action selection: as in when making a choice among multiple competing alternatives and (2) reinforcement learning: as in modifying expectations and behavior following positive and negative outcomes. For the former process, ‘‘actions’’ to be selected include both lower level motor programs, consistent with the traditionally ascribed role of the basal ganglia in motor control, and higher level cognitive actions, such as when and when not to update/manipulate the contents of working memory. Reinforcement learning then operates on these actions such that adaptive actions are more likely to be repeated, whereas maladaptive actions are suppressed. Critically, according to both the models and available electrophysiological evidence, positive outcomes are reflected in terms of deviations from current expectations, a term referred to as a ‘‘positive prediction error,’’ and are encoded by phasic bursts of dopamine. Similarly, negative prediction errors are encoded by phasic dips or pauses in dopaminergic activity. These phasic bursts and dips modify corticostriatal synaptic plasticity, allowing the system To whom correspondence should be addressed; tel: 520-626-4787, fax: 520-621-9306, e-mail: mfrank@u.arizona.edu. Schizophrenia Bulletin doi:10.1093/schbul/sbn123

Aldosterone—A Hormone of Cardiovascular Adaptation and Maladaptation

Aldosterone stimulates reabsorption of sodium, sustaining blood volume and pressure in the face of salt deprivation or extracellular fluid depletion. The steroid also stimulates excretion of potassium, protecting extracellular fluid from excessive levels of that ion. These two actions are relatively rapid and clearly adaptive when appropriately initiated and terminated, but maladaptive when prolonged or excessive, causing hypertension and electrolyte imbalance. Aldosterone and other mineralocorticoids exert slower, direct effects on cells in the heart, kidneys, and vessels, leading to hypertrophy, fibrosis, and dysfunction contributing to degenerative cardiovascular diseases. The maladaptive actions of aldosterone are exacerbated by sodium chloride, angiotensin, endothelin, and certain growth factors. Damage can be minimized by antagonists of aldosterone receptors, inhibitors of the renin system, depletion of salt, and repletion of potassium and magnesium. Specific inhibitors of fibrosis and hypertrophy, and more effective inhibitors of the renin system should be useful in the future.

Phase-Oriented Treatment of Structural Dissociation in Complex Traumatization: Overcoming Trauma-Related Phobias

ABSTRACT The theory of structural dissociation of the personality proposes that patients with complex trauma-related disorders are characterized by a division of their personality into different prototypical parts, each with its own psychobiological underpinnings. As one or more “apparently normal” parts (ANPs), patients have a propensity toward engaging in evolutionary prepared action systems for adaptation to daily living to guide their actions. Two or more “emotional” parts (EPs) are fixated in traumatic experience. As EPs, patients predominantly engage action systems related to physical defense and attachment cry. ANP and EP are insufficiently integrated, but interact and share a number of dispositions of the personality (e.g., speaking). All parts are stuck in maladaptive action tendencies that maintain dissociation, including a range of phobias, which is a major focus of this article. Phase-oriented treatment helps patients gradually develop adaptive mental and behavioral actions, thus overcoming their phobias and structural dissociation. Phase 1, “symptom reduction and stabilization,” is geared toward overcoming phobias of mental contents, dissociative parts, and attachment and attachment loss with the therapist. Phase 2, “treatment of traumatic memories,” is directed toward overcoming the phobia of traumatic memories, and phobias related to insecure attachment to the perpetrator(s), particularly in EPs. In Phase 3, “integration and rehabilitation,” treatment is focused on overcoming phobias of normal life, healthy risk-taking and change, and intimacy. To the degree that the theory of structural dissociation serves as an integrative heuristic for treatment, it should be compatible with other theories that guide effective treatment of patients with complex dissociative disorders.

Defense mechanisms in inflammatory bowel disease

Although psychiatric disturbances and personality features are possibly involved in inflammatory bowel disease, little attention has been given to the potential role of defense mechanisms in the formation, course, or prognosis of the disease. The purpose of the present study was to determine whether certain defense styles and ego mechanisms of defense are associated with inflammatory bowel disease, including both ulcerative colitis and Crohn's disease. Seventy-six consecutive unselected outpatients participated in the study. The sample consisted of 39 patients with Crohn's disease, 33 with ulcerative colitis, and 4 with an intermediate form of inflammatory bowel disease. The Symptom Distress Checklist (SCL-90-R), Defense Style Questionnaire (DSQ), and Hostility and Direction of Hostility Questionnaire (HDHQ) were used. Crohn's disease patients presented a more immature defensive profile than ulcerative colitis patients, using a "maladaptive action" style, as well as "consumption" and "pseudo-altruism" defense mechanisms more often. These differences were statistically significant and they were independent of age, sex, educational level, disease extension, and pharmacologic treatment. A significant positive correlation was also found between disease activity and defensive profiles in both ulcerative colitis and Crohn's disease patients. In contrast, there was no statistically significant difference between ulcerative colitis and Crohn's disease patients in terms of psychiatric symptoms. Crohn's disease patients presented a different and more immature defensive profile than patients with ulcerative colitis. In addition, the more psychologically mature inflammatory bowel disease patients had lower rates of relapses and surgical operations, providing evidence that these aspects of personality are likely to influence the patients' adaptation to the disease.

Psychosocial characteristics of inner-city children with asthma: a description of the NCICAS psychosocial protocol. National Cooperative Inner-City Asthma Study.

Previous research has demonstrated a significant reciprocal relationship between psychosocial factors and asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated both asthma-specific and non-specific psychosocial variables, including asthma knowledge beliefs and management behavior, caregiver and child adjustment, life stress, and social support. This article presents these psychosocial characteristics in 1,528 4-9-year-old asthmatic urban children and their caretakers. Caretakers demonstrated considerable asthma knowledge, averaging 84% correct responses on the Asthma Information Quiz. However, respondents provided less than one helpful response for each hypothetical problem situation involving asthma care, and most respondents had more than one undesirable response, indicating a potentially dangerous or maladaptive action. Both adults and children reported multiple caretakers responsible for asthma management (adult report: average 3.4, including the child); in addition, children rated their responsibility for self-care significantly higher than did adults. Scores on the Child Behavior Checklist indicated increased problems compared to normative samples (57.3 vs. 50, respectively), and 35% of children met the criteria for problems of clinical severity. On the Brief Symptom Inventory, adults reported elevated levels of psychological distress (56.02 vs norm of 50); 50% of caretakers had symptoms of clinical severity. Caretakers also experienced an average of 8.13 undesirable life events in the 12 months preceding the baseline interview. These findings suggest that limited asthma problem-solving skills, multiple asthma managers, child and adult adjustment problems, and high levels of life stress are significant concerns for this group and may place the inner-city children in this study population at increased risk for problems related to adherence to asthma management regimens and for asthma morbidity.

Dysfunctional control by client verbal behavior: The context of reason-giving

Dysfunctional control exerted by reason-giving in adult psychopathology is interpreted from a radical behavioral perspective. Verbal-social contingencies which support the establishment of reason-giving and its control over maladaptive actions are reviewed. A contextual approach to psychotherapy, comprehensive distancing, which attempts to weaken dysfunctional verbal control is described briefly. Data relevant to therapeutic process are presented. The overall results suggest that comprehensive distancing facilitates therapeutic change through a process consistent with a behavioral analysis of reason-giving. Suggestions for further research and radical behavioral approaches to psychotherapy are discussed.

Empirical study of self-rated defense styles.

A self-administered questionnaire that would indicate a person's perception of his or her habitual defensive style was constructed and tested. The hypotheses assessed were that defenses cluster so as to constitute "styles" and that these styles can be ranked as more or less adaptive. The sample comprised 98 psychiatric patients and 111 nonpatients. The tools used were (1) a questionnaire measure of self-appraisal of defensive style, (2) a questionnaire measure of ego adaptation, and (3) a sentence completion measure of ego development. The results, which argued strongly for the validity of a questionnaire measure of perceived defensive style, also showed that such defenses tend to cluster into styles that can be ranked on a developmental continuum, from "maladaptive action patterns," through "image-distorting" defenses, "self-sacrificing" defenses, and "adaptive" defenses.

Emergency decision making: a theoretical analysis of responses to disaster warnings.

This article presents a theoretical model of emergency decision making that focuses on the decision maker's answers to basic questions evoked by warnings or signs of danger. Effective emergency decisions are most likely to be made, according to the theory, when a vigilant coping pattern is dominant, which requires that the following four mediating conditions are met: 1) awareness of serious risks if no protective action is taken; 2) awareness of serious risks if any of the salient protective actions is taken; 3) moderate or high degree of hope that a search for information and advice will lead to a better (i.e., less risky) solution; and 4) belief that there is sufficient time to search and deliberate before any serious threat will materialize. When one or another of these conditions is not met, a defective coping pattern, such as defensive avoidance or hypervigilance, will be dominant, which generally leads to maladaptive actions. In addition to suggesting new interventions for facilitating adaptive behavior in emergencies, the theoretical model provides a basis for integrating disparate findings from psychological research on the effects of warnings and confrontations with danger.