Self-Efficacy and Health Behaviours

Finding Your Confidence

Finding Your Confidence

Confidence is necessary to achieve success in life. Some effective confidence tips must be followed if you genuinely want to gain accomplishment in your work. So how do you build your confidence that will work for you in any situation? Initially, make an effort to spend time with confident people. Their vigor and strength is so stirring that you will surely feel yourself more powerful just by listening to their talk. To build confidence it is vital that you are in the midst of self-assuring people.

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Competing Classifications

Fatigue loss of energy Weight appetite loss gain Insomnia hypersomnia Observed agitation retardation Low self-esteem guilt Impaired thinking concentration Suicidal thoughts Weight and appetite change Sleep disturbance Subjective or objective Agitation retardation Low self-esteem confidence Self reproach guilt Impaired thinking concentration Suicidal thoughts

Box 15 Dimensions of stigma

Sometimes coping with stigma surrounding the disorder is more difficult than living with any limitations imposed by the disorder itself. Stigmatized individuals are often rejected by neighbours and the community, and as a result suffer loneliness and depression. The psychological effect of stigma is a general feeling of unease or of not fitting in , loss of confidence, increasing self-doubt leading to depreciated self-esteem, and a general alienation from the society. Moreover, stigmati-zation is frequently irreversible so that, even when the behaviour or physical attributes disappear, individuals continue to be stigmatized by others and by their own self-perception.

Structured Analysis of Social Behavior

Active-love Reactive-love Active self-love Active-love Reactive-love Active self-love of self-regard that endure across the life span. Thus, those who are loved by their caretakers tend to love themselves, and those who are ignored by their caretakers tend to neglect their own welfare. The SASB model provides a consistent reference point throughout this text.

BRelationship Between Levels of Needs

(2) These basic physiological needs have a greater priority over those higher on the pyramid. They must be met before the person can move on to higher level needs. In other words, a person who is starving will not be concentrating on building his self-esteem. A patient in severe pain will not be concerned with improving his interpersonal relationships.

Some methodological considerations

There are now a number of investigator-based instruments covering areas ranging from 'expressed emotion' (e.g. critical comments, warmth, etc.), attitudes to self (e.g. self-esteem), plans and concerns (e.g. commitment to various roles), behavioural systems (e.g. styles of attachment), experience of adversity in childhood (e.g. sexual and physical abuse), and characteristics of non-family groups (e.g. restrictiveness of a psychiatric ward regimen). Each of the instruments with their component scales can be used with some confidence because of the kind of methodological safeguards already noted and because a fair amount of replicable and theoretically relevant findings have emerged. Particularly important was the development in the 1960s of the clinically informed interview-based Present State Examination ( PSE) by Wing et al. JJ later amended to deal with a 12-month period 18 and psychosocial measures such as that of 'expressed emotion' . M d 19) and the Life Events and Difficulties...

Chapter References

Brown, G.W., Bifulco, A., and Andrews, B. (1990). Self-esteem and depression 3. Aetiological issues. Social Psychiatry and Psychiatric Epidemiology, 25, 235-43. 55. Brown, G.W., Andrews, B., Harris, T.O., Alder, Z., and Bridge, L. (1986). Social support, self esteem and depression. Psychological Medicine, 16, 813-31.

Physician as Catalyst

The first category, called Not Interested, includes patients who are not interested or able to deal with their weight at this time. They are focused on other life issues and do not want to deal with their weight. Work and family may consume their energy in just trying to get through the day. Some may have low self-esteem regarding their weight having tried various weight loss products or programs and failed, they do not want to fail again. Whatever the reason, dealing with weight is not on their radar screen at this time. These patients either fall into the pre-contemplation stage of change, or think about change but do not want to attempt it now. For those in this category, I express my concern about their weight and let them know the clinic has an effective obesity treatment program. Unfortunately, the majority of obese patients in my clinic are in this category.

S Evidence statements

Three RCTs that assessed the utility of neuropsychological compensatory training, psychotherapy and coping skills training for persons with MS were identified (Ib). The first RCT assessed the effectiveness of traditional psychotherapy compared to participation in a 'current affairs' topic group or no intervention. The results showed psychotherapy to be superior on two of the four outcome measures assessed, namely depression and locus of control. However, it had no significant effect on either anxiety levels or levels of self-esteem.18 The second RCT examined a coping skills group compared to non-directive peer telephone support. The coping skills group entailed formal therapist support and considerable contact time, whilst the telephone support group was informal and only entailed one hour a month. No overall differences between the groups were observed on any of the five outcome measures.19 The last RCT compared neuropsychological compensatory training to supportive psychotherapy....

Focus on Social Interaction

An intelligent young woman, Linda, sought guidance concerning a girlfriend, Cathy, a social isolate who almost never came out of her dorm room except to attend classes and eat hurried meals at the cafeteria. Although the other girls on her floor had tried to approach her, Linda was the only one Cathy had let approach her and only then after two years of living on the same floor. If the other girls tried, Cathy would explain in a nervous voice that her classes had extensive reading requirements and that she needed complete privacy to study. In fact, Linda revealed, Cathy felt an extreme sense of inferiority and feared that if she ever became involved with the other girls, she would eventually find them making fun of her behind her back. Such fears of shame and humiliation, associated with an alienated self-image, are common in the avoidant personality.

Borderline personality disorder

The improvement of temperament through the use of medications is only a partial treatment strategy because, as previously noted, the character variables determine whether or not an individual has a personality disorder. Psychodynamic therapy may address the chaotic pattern of object relations and the deficiencies in self-esteem and self-cohesiveness. Although no systematic study has been conducted with the combined use of dynamic psychotherapy and medication, one follow-along study using a pre-post design with twice-weekly dynamic therapy appeared to produce substantial and durable changes after 12 months of treatment. (53 While the conceptual model of temperament and character provides a basis for the combination of medication and psychotherapy, further research is necessary to demonstrate the efficacy of the two-pronged approach.

What is the evidence that early life experiences influence the development of negative cognitive structures

In one study using an undergraduate sample, very limited support was found for a mediating relationship of cognitive variables between reports of maladaptive parenting and subsequent depression (Whisman & McGarvey, 1995). Moreover, among depressed patients, a history of developmental adversity, most notably sexual abuse, is associated with more dysfunctional cognitive styles (Rose et al., 1994). In another study using a young adolescent sample, self-worth was found to mediate between reports of maternal parenting and depressive symptoms (Garber & Robinson, 1997 Garber et al., 1997). To date, only limited innovative work is beginning to address cognitive mechanisms directly. This work tentatively suggests that maladaptive beliefs about the self and others may emerge early in the development of at-risk children (e.g., Bartholomew & Horowitz, 1991 Coyne & Whiffen, 1995 Taylor & Ingram, 1999).

Dealing with dependent misuse

Persistent misuse of volatile substances is a complex behaviour frequently associated with low self-esteem, family problems, isolation and psychological difficulties. These are also factors that may also be associated with the problematic use of legal and illegal drugs, and indeed, a large proportion of people who misuse volatile substances also misuse other drugs. Chronic VSA is thus intertwined with social and psychological problems and with the misuse of illegal drugs. Therefore, counselling services for young people should not be narrowly focused on volatile substances, but should be able to deal with VSA in the context of a range of problematic behaviours.

Information and education

Two RCTs were identified that assessed patient support through education or the provision of information in people with MS104,105 (Ib). The first study examined the effectiveness of an educational program for newly diagnosed patients with MS.105 The results indicated no significant differences between the groups on measures of physical and occupational functioning, emotional well-being and general contentment, nutrition and health or family and social relationships. A positive effect was observed for levels of patients' self-worth. However, the sample size was too small for any robust conclusions to be drawn. The second study assessed the provision of an information booklet to aid medication compliance.104 The results showed that the booklet had a positive effect on patients' understanding of medication information, but had no effect on either correct medication usage or their level of medication compliance.

Major depression with or without melancholia

ICD-10 requires six of the ten symptoms in Table. Negative beliefs such as 'loss of self-esteem' or 'inappropriate guilt' are the core symptoms of major depression. Inappropriate guilt is experienced as punishment for past misdeeds (prior to the current episode of depression). The prevailing element of negative beliefs is a sense of loss which is associated with lower self-esteem experienced retrospectively.(9) The symptom which discriminates best between anxiety states and major depressive disorder is guilt. (1

The Sequence of Techniques From the Immediate Problem to Underlying Issues

A sophomore presented at the university counseling center complaining of stuttering during her speech class. Her next speech, due in three weeks, was to be the longest yet, and she felt terrified. By using guided imagery to recreate the actual event of giving a speech, Jenna was able to explore changes in her anxiety level and automatic thoughts on a moment-to-moment basis, from preparing the speech the night before, to getting up to give the speech, to saying her first words, to starting to stutter, and then to finishing and sitting down again. Most of these cognitions focused on making a fool of herself. To deal with the immediate threat, the upcoming speech, graded exposure through imagery was used to help extinguish her anxiety reaction. Although the speech was not the very best in the class, it was also not the catastrophe she feared. Following this, therapy began to focus more broadly on self-esteem issues that had punished all attempts at self-assertion almost from her earliest...

Impairment in social and familial relationships

Difficulties in social functioning are concomitant to depressive disorders. (5,Z,62) Previous research found that patients experienced a reduction of social relationships, with feeling of social discomfort, loneliness, and boredom.(6) Depressed patients seem lower in social self-confidence, they socialize less, and participate in social interaction less fully than do never-depressed persons.(62) In other words, depressed individuals do not make active effort to develop and sustain reciprocally supportive social relationships. The concept of social support has been widely used to predict general health and more specifically psychiatric symptoms. (63 Previous research revealed that the degree of integration in a social network, or structural support, have a direct positive effect on well being, reducing negative outcomes in both high- and low-stress life events. Among depressed individuals, dysfunctioning in social activities has been found to persist a long time after remission from...

Dysfunctional cognition

According to the helplessness model of depression,(89) vulnerability to depression derives from a habitual style of explaining the causes of life events, known as attributional style. A large body of research found that individuals suffering from depression think more negatively than healthy individuals. Specifically, depressed patients have a tendency to make internal, stable, and global causal attributions for negative events, and to a lesser extent, the attribution of positive outcomes to external, specific, and unstable causes. In other words, depressed patients have a low self-esteem.(9 Thus, when thinking about the self, past, current, and future circumstances, depressed patients emphasize the negative, and this process is likely to contribute to the perpetuation of their depressed mood. However, the role of self-esteem in depression has not yet been well established. A controversy persists as to whether low self-esteem is a consequence of depression or a vulnerability factor of...

Psychological treatments

Formal psychotherapy may be offered as the only treatment to individuals with milder depressions or in combination with medication in those with moderate and severe disorders. More than 20 per cent of couples report marital discord in association with depressive disorders and so marital or family approaches should always be considered as an alternative to individual therapy. Individual treatments, such as cognitive therapy, may particularly benefit milder depressions. There are a number of features that identify potentially effective psychological approaches to depression. (56) The therapy should be highly structured and based on a coherent model. It should provide the patient with a clear rationale for the interventions made and the therapy should promote independent use of the skills learned. Change should be attributed to the individual's rather than the therapist's skillfulness and the therapy should enhance the individual's sense of self-efficacy. Clearly cognitive therapy,...

Benefits Of Weight Loss

Despite the expectations of the individual, the likelihood that an obese person will achieve sufficient weight loss to reach an 'ideal' body weight is remote (25). However, this does not imply that treating obesity is fruitless, as there is evidence that even a modest weight loss of 5-10 in obese diabetic subjects can produce clinical benefits. Improvements have been noted in all modifiable risk factors such as HbA1c levels, hypertension, dyslipidaemia, self-esteem and overall quality of life. Moreover, improvements in these risk factors have a favourable effect on mortality. A retrospective study of Type 2 diabetic patients receiving standard dietetic advice showed a mean weight loss of 2.6 kg for those with a BMI 25-30 kg m2 and a loss of 6.8 kg for those with a BMI 30kg m2 after 1 year. For the average patient each kilogram of weight loss was associated with a three- to four-month prolonged survival and a 10 kg weight loss predicted the restoration of about 35 in life expectancy...

Positive affect PA and negative affect NA

There are, however, slightly different conceptualisations of anhedonia. One focuses on anhedonia as a broad category, encompassing general apathy with a marked lack of motivation to engage in almost all activities (Klinger, 1993) and diminished interest or pleasure in activities, reflecting a generalised lack of PA (Watson & Clark, 1988 Watson et al., 1995a b). This definition views depression as the result of reductions in a range of PAs such as joy, energy, enthusiasm, alertness, self-confidence, and interest. Others (e.g., Willner, 1993) have suggested that anhedonic patients can remain 'interested' in hedonic experiences (they would like to engage in certain activities), but anticipate that they will be unable to enjoy them if they do engage in them. Loss of interest or lack of motivation may develop from repeated experiences of wanting but failing to feel pleasure or reward from various activities (Snaith et al., 1995).

Tools for Increasing Physical Activity

Another tool is the Physician-based Assessment and Counseling for Exercise (PACE) program. This intervention is based on the Stages of Change theory of behavior change 37 . Strategies for behavioral counseling for PA are developed using the social cognitive theory, which suggests that a person's behavior is the result of the interaction between personal, social, and environmental conditions. Accomplishment of behavior change is found through goal setting, reducing barriers, strengthening self-efficacy, and developing social support 38 . The PACE program contains a provider's manual, assessment forms, and counseling protocols. This is an interactive program between the patient, the physician, and the nurse in an attempt to optimize the brief appointment time between the physician and patient. The intervention requires 2 to 5 minutes of the physician's time 38 .

Box 54 Relative contraindications to ECT

In severe forms of mania, the inflated self-esteem may develop into delusions. Genetic and anatomical factors are important in the development of mania secondary to neurological disease.33 A study of mania following closed head injury reported that six of 66 patients (9 ) had features of mania at some stage during a 12 month follow-up period, this figure being higher than has been reported in other brain-injured people. In this study mania was associated with temporal basal polar lesions no links were established with severity of brain-injury or previous personal or family history of psychiatric disorder.34

Albert Ellis and Carl Rogers Finding Your Own Therapeutic Style

The common factors approach seeks to identify what is common to all therapies and then associate these factors with positive outcomes. Common factors enthusiasts are often fond of noting that most psychotherapies appear to be about equally effective. One of the original common factors proponents, Garfield (1957), for example, notes that treatment begins when an individual experiences a degree of discomfort sufficient to lead to consultation with a therapist as a socially sanctioned healer. Patients are universally afforded the opportunity to express their difficulties, to confide personal matters, and to unburden themselves of confusing or troubling thoughts and feelings. In turn, the therapist exhibits attentive interest and asks questions that elaborate what is presented. Further, every patient develops a relationship with the therapist. Most are good alliances with a reasonable level of mutual respect and trust. The patient gains the opportunity to rethink both self and situation...

Involuntary subordination

Evidence that some kind of internal regulator or mental mechanism(s) for subordination is operative in depression is offered by findings that depression is associated with seeing oneself as inferior, subordinate, or subordinated with increased inclination to behave submissively, and to withdraw from conflicts with more powerful others (Allan & Gilbert, 1997) and with failed efforts to be assertive (Arrindell et al., 1990). Vulnerability to depression has long been linked with low self-esteem (e.g., Brown & Harris, 1978), but self-esteem is itself rooted in social rank (social comparison) judgements (Price, 2000). Whether self-esteem is trait-like or state-like, low self-esteem seems to operate like a subordinate defensive strategy in that it is associated with damage-limitation strategies (trying to stop bad things from happening) rather than a PA-enhancement strategy (Baumeister et al., 1989). In line with the idea that damage-limitation (subordinate) strategies are important in some...

Field performance of botanical pesticides

However, the objectives of 'East' and 'West' were quite different. Scientists in India aimed at achieving the Gandhian self-reliance in pest management at village level. The developing countries of Africa, Asia and Central America and the Caribbean adopted the Indian policy, and started to scientifically explore their own folk practices, while concentrating on neem cultivation and utilization. Today, the Indian scientists are integrating products of high technology and indigenous practices in pest management with remarkable success.

Definitions and Epidemiology

Fecal incontinence is defined as the impaired ability to control gas or stool to allow evacuation at a socially acceptable time and place. It has been shown in a number of studies that incontinence affects self-confidence and personal image, and can lead to social isolation causing a significant impact on quality of life.1-5 The true prevalence of fecal incontinence is unknown because it is thought to be greatly underreported. In a community survey of 7000 patients in the United States, 2.2 of patients reported incontinence to liquid or solid stool or gas.2 In other pop

Histrionic Personality Disorder

Theorized Pattern in Later Life and Possible Impact of Aging Older adults with Histrionic Personality Disorder are often described by their adult children as acting like spoiled children. Their self-centeredness and shallowness do not appear to diminish with age. Older individuals with this disorder are particularly intolerant of the physical changes that come with age (e.g., wrinkles, hair loss, sagging body parts) since their self-worth is based largely on superficial characteristics such as physical appearance. Because of their lifelong reliance on their physical attributes to attract attention, older histrionics may respond to normal physical changes by becoming excessive users of plastic surgery and other antiaging techniques. One of our older patients spent down her entire savings on surgery to prevent becoming an icky old lady.

Other Types Of Exercise

Some exercises can improve balance. For example, you can use balance boards, Swiss balls, and variable surfaces to assist in balance training. However, balance problems are individual, and a balance training program should be designed by your healthcare professional to address your specific needs and maximize safety. A study evaluating a structured Awareness through Movement program to improve balance demonstrated improvements in balance, balance confidence, and self-efficacy.

Defeats and provoking agents

If humans carry within them a potential defeat strategy (no different from saying we have anger-attack strategies or anxious-flight strategies coded in the limbic system), it seems to operate by downgrading PA, and explorative and social engagement (Gilbert et al., 2002). Clearly, in humans, the elicitors and modulators of an involuntary defeat strategy are much more complex than they are in animals. Nonetheless, the typical elicitors of depression have the essence of 'defeat' about them. For example, Brown et al. (1987) and Brown et al. (1988) found that it is only life events that have long-term negative consequences that are related to depression. Such events include loss of resources and setbacks that force people to lower their standard of living (e.g., Ganzini et al., 1990) direct attacks on self-esteem that are shaming and humiliating, such as criticism and general putting-down in salient relationships (e.g., Belsher & Costello, 1988 Brown et al., 1995 Hooley & Teasdale, 1989)...

Models of psychotherapy

The model is a useful one even within a more limited outpatient psychotherapeutic setting. Some patients will readily identify their distress when overwhelmed by powerful sexual feelings or when confronted with personal and social responsibilities perceived as the result of growing up. The aims of the psychotherapy are to support the patient while she is beginning to abandon the psychobiological regression of anorexia nervosa. In addition she is encouraged to broaden her perception of herself in ways that are no longer wholly dependent on her physical appearance but include an improved sense of competence and self-esteem. She is helped to tackle personal and social problems from which she had previously escaped so that she can address her own and her parents' concerns about sexuality.

Cognitivebehavioural therapy

The patient's weight and food intake is monitored at each session and she is told her weight at each session. She is encouraged to think of food as medication and to follow a meal plan. She is encouraged to keep a daily written record of all food and liquid consumed. The patient is educated in the disturbances of bodily and psychological function consequent on the state of starvation. The content of the therapy may be divided into two 'tracks'. The first track includes an examination of the behaviours adopted by the patient in order to reduce her weight or maintain it at a low level. The second track is more concerned with psychological themes such as self-esteem, perfectionism, interpersonal functioning, and family conflicts. By asking the patient to give her reasons for specific behaviours, the therapist discovers faulty beliefs and assumptions on her part. For example, the 'anorexic wish' is the patient's wish to recover from her disorder without gaining weight. She is gently...

General psychopathology

Much more common than frank personality disorders are two traits which are also seen in anorexia nervosa.(22) The first is low self-esteem. This generally antedates the eating disorder, although it is often exaggerated by it. Many patients with bulimia nervosa describe long-standing doubts about their worth and ability, irrespective of their accomplishments. The second is perfectionism, that is, imposing on oneself inordinately high personal standards in a range of domains (e.g. work, sport, personal conduct). Since many of these standards are unachievable, it is common for these patients to give long histories of having viewed themselves as perpetually failing.

Behaviour Modification

Whilst medication can play a part in providing 'windows' of attention in order for children with AD HD to learn, these are crutches rather than cures and need to be used alongside some form of behavioural intervention. Personally I dislike the terms 'behaviour modification' or 'behavioural intervention'. As parents, we naturally and automatically carry out these 'interventions' daily - and not only with our AD HD children. However, children with AD HD have often received a diagnosis after several years of conflict with family members, difficulties at school and much negativity. Our job as parents is to avoid that spiral of negativity and devise strategies that work towards changing children's behaviours and building back up their self-esteem. Many children work well with reward schemes such as earning tokens towards a bigger reward (Joe being one of them). One thing to remember however is that it is not only the child who needs to learn to change his or her behaviour. As parents, we...

Affecting the minds and emotions of others and the development of experiences of self

Let us take a closer look at the social relationship regulators of PA and NA and how these are related to the development of self-schema. Evolutionary theorists point out that much of our social behaviour is designed to affect the minds of others and particularly their feelings towards us. Gilbert (1989, 1997, 2001b Gilbert & McGuire, 1998) suggested that internal models of self-worth are (in part) built up from experiences of successfully stimulating positive emotions in the minds of others. This process begins early in life, perhaps even from the first facial communications between infant and parent. For example, a mother's smile can induce a smile in the infant. Not only does the mother's smile activate PA in the infant, but also the infant's response involves the activation of various neural pathways of affect and psychomotor movement to produce the smile (Schore, 1994,2001). In effect, the parent is stimulating and coordinating the maturation of various neuropathways and, in so...

Orgasmic disorders in women

Orgasm is the reflexive culmination of arousal manifested by rhythmic vaginal wall contractions and the release of muscular tension accompanied by varying degrees of pleasure. Achieving orgasm reliably, usually highly valued by women, is associated with enhanced self-esteem, confidence in one's femininity, and the desire to increase sexual activity.(49) The persistent and recurring difficulty achieving orgasm is labelled anorgasmia. Table 5 lists the diagnostic criteria for anorgasmia set forth in DSM-IV and ICD-10.

Variations of the Antisocial Personality

Antisocial Personality Disorder

As a blend of the antisocial and paranoid or sadistic personalities, malevolent antisocials are often seen as the least attractive antisocials. Belligerent, rancorous, vicious, malignant, brutal, callous, vengeful, and vindictive, they perform actions charged with a hateful and destructive defiance of conventional social life. Like the paranoid, they anticipate betrayal and punishment. Rather than merely issue verbal threats, however, they seek to secure their boundaries with a cold-blooded ruthlessness that avenges every mistreatment they believe others have inflicted on them in the past. For them, tender emotions are a sign of weakness. They interpret the goodwill and kindness of others as hiding a deceptive ploy for which they must always be on their guard. Where sadistic traits are prominent, they may display a chip-on-the-shoulder attitude and a willingness to confirm their strong self-image by victimizing those too weak to retaliate or those whose terror might prove particularly...

Health Impact of Obesity

Obesity can negatively impact a young person's health in many ways besides the neurological, cardiovascular, and metabolic effects. The patient is at risk for developing hepatic steatosis, polycystic ovary disease, and orthopedic problems like slipped capital femoral epiphysis, pseudotumor cerebri, and sleep apnea 45 . Finally, the psychosocial trauma of low self-esteem and social isolation can significantly impact the quality of the child's life. Having a chronic disease like obesity, with or without comorbidities, can be traumatic for a pre-adolescent or an adolescent. In one cross-sectional study by Schwimmer et al., 106 severely obese children and adolescents aged 5 to 18 years ranked their health-related quality of life the same as did children and adolescents with cancer 46 .

Nonprescription Drugs

Ethanol produces central nervous system depression over a wide range of doses. Its effects are additive or sometimes more than additive with other central nervous system depressants. Symptoms often associated with acute alcohol intoxication include increase in self-confidence, loss of inhibitions, euphoria, and loss of judgment. With increasing doses motor and intellectual impairment become prominent. Chronic abuse of ethanol leads to severe liver impairment (see Chapter 35).

Vocational activities employment and education

Many people who develop or have MS will be finishing education or training, or will be in employment. In some people the MS will have little impact, but for most people MS will have some impact. It is important to minimise the impact if possible because being in employment has many health benefits and among other things enables an individual to retain self-esteem, social contacts, financial independence and a valued place in society. The importance of vocational rehabilitation services for people with MS at all stages but especially in the early stages was emphasised many years ago,17 and has been reiterated recently.259

Longterm vulnerability factors

The conflicts suicidal patients experience in the days before attempted suicide deliberate self-harm are not different from the same conflicts they have experienced over and over again. Not only recent life events, but also the life events that occurred in their past are important. (32,) Many suicide attempters, males as well as females, have had traumatic childhood experiences, including physical and emotional neglect, broken homes, other unstable parental conditions, violence, sexual and physical abuse, incest, parents who had psychiatric treatment, who were alcoholics and or addicted to opiates. Women who have been abused have a much greater probability of becoming a repeater later. In addition they often develop poor relationships, lack self-esteem, and experience overwhelming feelings of helplessness and hopelessness. Any trigger, for example an argument with a friend, may be sufficient to provoke suicidal ideation and behaviour.

How to Maintain Weight Loss

Overall, patients who have undertaken repeated diets quickly regain the kilos they have lost. When facing the yo-yo phenomenon, eating disorders should be investigated. This is associated with a feeling of restriction, nibbling or compulsions, and has the effect of making patients feel guilty and reducing their self-esteem. Behavioral work, combined with a hypocaloric diet and a program of physical activity, allows weight loss to be maintained 12 . It involves only a small loss of weight but helps alleviate eating disorders, depression and anxiety. A prospective study with a 5-year follow-up 13 confirms that this multidisciplinary approach is entirely beneficial in the long term. Fifty percent of patients maintained their weight loss, and even continued to lose weight. Lately, Wadden et al. 14 confirmed that the combination of medication and group lifestyle modification resulted in more weight loss than either medication or lifestyle modification alone.

Variations of the Compulsive Personality

Bureaucratic compulsives ally themselves with traditional values, established authorities, and formal organizations. Most other compulsive subtypes feel conflicted, angered, and even oppressed by these influences, although their overt awareness of this conflict is suppressed. Bureaucratic compulsives are somewhat more aware of this conflict than their counterparts, and instead of allowing their feelings to cause even the slightest difficulty, they wholeheartedly embrace the order and structure inherent in recognized institutions, authorities, and social mores. They flourish in organizational settings, feeling comforted, strengthened, and empowered by clearly defined superior and subordinate relationships, definite roles, and known expectations and responsibilities. Once established, they function loyally and dependably. In effect, these individuals use highly developed and formalized external structures to compensate for the internal sense of ambivalence and indecisiveness that...

Beliefs and healthrelated behaviour

Even though health psychologists acknowledge the importance of situational, dispositional, and sociocultural factors as determinants of health-related behaviour, most current research has a primary focus on the role of beliefs in explaining variance in health-related behaviour. The most widely used explanatory approaches have been described generically as 'social cognition models' (see Conner and Norman (4) for an excellent overview). These models are based on the premise that, when a person is faced with having to make a decision about a particular health behaviour (e.g. attend for a screening test wear a seat belt, etc.), their decision making and behaviour can be best understood in terms of their perceptions or beliefs about the health issue and the behaviour in question. The best known models here are the Health Belief Model,(28) Theory of Reasoned Action Theory of Planned Behaviour,(29) and Protection-Motivation Theory.(30) Broadly these models locate the strength of certain...

The Accuracy Mandate

Pharmacists pride themselves on their ability to get the right drug, in the right strength, to the right patient, with the right directions, at the right time. No pharmacist wants to make a mistake. The core responsibility in pharmacy is technical accuracy in order processing. Pharmacists suffer loss of self-esteem, as well as professional and social censure, when an error occurs. Yet, despite the many incentives to avoid error in pharmacy, the occurrence of pharmacy error appears to be on the increase (U.S. General Accounting Office, 2000). Because there is no comprehensive database of pharmacy errors, it is difficult to know whether the perceived increase in error reflects an increase in prescription volume alone, or whether the rate of error is actually increasing along with the increase in prescription volume. It is quite clear that pharmacy errors are a problem warranting significant attention from the profession and its regulators. Any tendency within the profession to move...

Strategies for assessing psychotherapy outcome

Once a particular experimental design has been decided upon, the next crucial question in evaluating psychotherapy pertains to the selection of instruments for the study. Instruments include those needed to adequately select a patient population, such as measures of psychiatric diagnoses and initial symptomatology. Therapeutic change is often evaluated on a broad range of measures including dimensional measures of symptoms, personality, self-esteem, quality of life, and functioning in a variety of areas (for example, social and occupational functioning). In addition, the impact of treatment on specific theoretical constructs (mediators) can be examined. Discussion of each of these domains follows.

Substance use problems

Participants in a recent assessment conference 6 recommended that measures of self be included in outcome batteries, citing research evidence linking attitudes about self to the maintenance of behavioural change in areas of anxiety, depressive, and personality disorders. Furthermore, many psychotherapies explicitly attempt to improve self-esteem, self-concept, and self-confidence, and therefore it is relevant to examine the extent to which treatment successfully impacts on these domains. One of the oldest and most widely used measures of self-esteem is the Rosenberg Self-Esteem Scale,(47) an easily administered 10-item Likert-type scale yielding a unidimensional indicator of global self-esteem. More recent work in this area aims to distinguish other self-related constructs (such as self-concept) from self-esteem, develop more theoretically based multifactorial models, and improve upon the psychometrics of earlier measures. (48) Some resulting scales, such as the Beck Self-Concept...

Siblings of children with ADHD

If someone's belongings go missing in our house Joe gets the blame. If food has disappeared Joe gets the blame. If something is broken in our house.Joe gets the blame When the all too familiar screech of Joe reverberates throughout the house, it also serves another gives Joe the attention he craves. All of you parents with children with AD HD know there is nothing they like more than attention - whether it is positive or negative, any attention will do Most of the time it is probably Joe who is the perpetrator of such 'crimes', however I am sure that there are many times when Joe has been blamed for something he didn't do and all this does, I am sure, is lower his already battered self-esteem. As parents, it is our job to make our children feel loved, cherished and full of worth - something I try very hard to do. Children with AD HD experience an onslaught of negativity that makes building their confidence akin to building a house upon the sand .once the floods of...

Early Historical Forerunners

In spite of an apparent dearth of reported clinical cases of narcissistic personality disorder across the globe, this potential for excessive self-regard leading to involuntary self-destructiveness is apparently well recognized across culture and time. Ancient Greek mythology teaches us the perils of excessive hubris (roughly translated as lack of humility ) in the myth of Narcissus, a beautiful young man who, though loved by everyone, will not love anyone in return. His refusal eventually catches the ire of the goddess Aphrodite, who curses him. Ironically, he gazes into a pool and falls desperately in love with his own reflection. Each day is spent alone with his reflection, pining after what he cannot possess. Not knowing that it is his own image that he loves, he proceeds to seek oneness with his self-glorified image, and he promptly drowns himself in the pool. The myth thus seems to say that narcissists are unaware both of the intensity of their own self-love and how it affects...

Epidemiology and Demographics

Psychological testing on women with vulvar vestibulitis has found higher rates of introversion, somatization, and interference with sexual function. Overall levels of psychological distress, negative feelings toward sex, self-esteem, and marital satisfaction are conflicted in the literature with some studies showing no difference from matched controls and others finding opposite results. Furthermore, the order of causation remains unclear, with many authors suggesting a circular relationship of the physical condition and psychological changes.8-10

Patients who do not respond

There are no evidence-based guidelines for the treatment of patients who do not respond to cognitive-behaviour therapy. There are various logical alternatives including adding an antidepressant drug (fluoxetine 60 mg being an appropriate choice (l9i) and switching to interpersonal psychotherapy (29 (see Chapter.6.3.3) since both are treatments for bulimia nervosa in their own right. Modifying cognitive-behaviour therapy is also an option. For example, components of the treatment may be intensified (for example, by adding exposure with response prevention procedures (12 or more emphasis on body image(17 ) or cognitive-behaviour therapy may be broadened to address more general issues such as self-esteem, mood regulation, and interpersonal functioning.

Central characteristics of cognitive therapy

Nonetheless, cognitive therapy, has real advantages for depressed patients. Its structure discourages rumination and lack of direction, and helps patients to focus on their difficulties. Its emphasis on a warm therapeutic relationship encourages empathy, while its goal orientation implies that change is possible. The coherent model of human functioning, on which it is based, allows many issues to be addressed, including depression itself, other comorbid conditions, problems in living, long-standing difficulties (such as low self-esteem), the patient's responses to therapy and therapist, and the therapist's responses to the patient. Finally, its emphasis on collaboration and on transfer of knowledge and skill empowers patients to become their own therapists and take control of their lives.

Interpersonal Functioning

The third phase of the treatment is targeted on the interpersonal difficulties that precipitate or resulted from the disorder. This is where cognitive strategies address core beliefs and schemata. The goals for this phase of the treatment include the experience of increased self-efficacy and the rebuilding of a more solid and autonomous sense of self. This takes account of the impact of the illness, which often occurs in a developmentally critical time when self-esteem and identity are formed. It further appears that the impact of mania and depression at an early age are significant, as they dramatically affect important developmental milestones such as educational achievements, early work experience, and important interpersonal relationships. Essential cognitive structures such as dysfunctional core beliefs will probably become self-perpetuating. Examples of these beliefs include a distorted sense of autonomy or personal capability, vulnerability to harm or illness, and a sense of...

Review of the First Visit

Upon entering the examination room, you should have the patient look at the Battle in the Mind form (Figure 8.4). The physician should review the patient's list of motivators and barriers for completeness from the first visit and ask if there has been any change or movement on the Likert scale in either category. Remind the patient that the battle between the pros and the cons in terms of weight loss and weight control never goes away, even after successful weight loss. At times the patient's reasons for wanting to lose weight or to keep it off will be powerful, and the patient's self-confidence will be high.

Changes In The Concept Of The Individual And The Location Of Risks To Health

Changing views about individual identity are reflected in contemporary cultural views about the nexus of health risks. Ogden writes that, following the paradigm shifts discussed above, current models emphasise that health risks and health-related behaviours are inherent within the individual, who has personal control and responsibility over his or her own (healthy or unhealthy) lifestyle. If this model were applied to a person with BD, it would suggest that individuals have the ability to control their own behaviour and to manage and master health treatments. In this context, risks to health are viewed as a breakdown in self-control and self-efficacy. Ogden terms this the creation of the risky self , which is implicit in both the concept of the expert patient (Donaldson, 2001) and the definition of recovery , which are discussed in the next sections.

Combinations Of Perspectives

The four perspectives described above are often combined. For example, an empathic and concerned GP tends to begin her discussion with a patient with symptoms of depression and or anxiety by investigating the patient's environmental stresses (a situational orientation). At subsequent meetings the physician is likely to look at the cognitions the patient has (a cognitive and emotional orientation). To begin to discuss the patient's cognitions at the first meeting could be disastrous to the patient's self-confidence. Also, trying to alter the patient's cognitions requires that a trusting relationship has been established. If a change in the symptoms cannot be observed after a number of meetings with the patient the GP might prescribe an antidepres-sant (the GP here would be taking a biological perspective). Later the GP might try to follow the recovery process by analysing the patient's symptoms (a symptom perspective), social functioning (a situational orientation) and psychological...

How A Combination Of Dimensions In The Analysis Of Therapies Would Influence The Way Drug Clinical Trials Are Designed

Practically no clinical trial of drugs in this field is based on pharmacological treatment alone. In almost all clinical trials pharmacological treatment is combined with psychological counselling. This means that in clinical trials we need to combine the perspectives discussed above. Not only the severity and frequency of symptoms but also improvements in coping strategies, self-confidence and social activities should be included as outcome measures in clinical trials. To understand how the patient is affected by negative events and difficulties during treatment, life event scales'' ought to be used before and during treatment in clinical trials (29). What is important is to analyse how a group of primary care patients with specific characteristics, e.g. symptoms, social capacity, social resources, coping strategies, sense of meaning, self-confidence and the events and difficulties they have experienced or experience at the start of the study, will recover in terms of symptoms,...

Monitoring Caloric Intake and Physical Activity

Finally, the caloric and physical activity log is a powerful relapse prevention tool. Almost every obese patient who comes to the physician's office for help in losing weight has lost weight at some time in the past. Patients describe losing 20 lb of their 50-lb goal when something happened so that they regained 12 of the 20 lost pounds and became discouraged by the weight regain. The experience of weight loss followed by weight regain erodes the patient's self-confidence. When this happens the patient becomes discouraged.

Behavioural treatment

Parent-training programmes improve the parents' child-management skills,( .93, 94) enhance their self-confidence, and reduce the child's stress( 95) and oppositional behaviour 19 The important advantages of parent training are its relatively low cost its ability to be delivered in the community rather than in clinics, thereby reducing barriers to participation and its adaptability to the needs of specific ethnic or cultural groups. ( 92)

Child characteristics

Significant cognitive attributional bias has been shown in aggressive children and youths. They are more likely to perceive neutral acts by others as hostile, and are more likely to believe conflicts can be satisfactorily resolved by aggression. As the individual becomes more disliked and rejected by his peers, the opportunity for seeing things this way increases.(39) By the late teenage years these youths can have a highly suspicious attitude, and be quick to perceive disrespect from others and sometimes react explosively. Social skills are lacking. Emotional processes in antisocial children have been little studied, although self-esteem is often low and coexistent misery common. Youths with conduct disorder have been shown to plan their lives less than controls, so that they are more driven by events than in control of them. However, autonomic arousal has shown a consistent, albeit modest, association with persistent antisocial behaviour in young people. Their pulse rates are lower,...

Aetiology of depression

There is reasonably consistent evidence from clinical and community-based case-control studies that, as with adult depression, recent undesirable life events focused on the child and carrying a significant degree of negative impact are associated with the onset of an episode in children and adolescents. (6 6 65 and 66 Recent events occur, in the main, against a background of other more chronic or long-term family and peer group difficulties, which appear additive in their risk effects for onsets 666. and 68) The exact nature of the psychosocial mechanisms that result in onsets of first-episode depressions in young people remains unclear, but adverse social environments are known to lower self-esteem and increase the levels of depressive symptoms in adolescents. (69,Z9 However, negative cognitions in young children are not permanent internal constructs resistant to change, rather there is an active mutually interdependent system throughout the developing years between differing types...

Parental physical illness

Parental cancer is likely to be associated with depression and marital difficulties, both risk factors for the child's problems. The balance of evidence indicates that their children are at increased risk of developing psychological disturbance (60) and lower self-esteem 61.) The impact of parental cancer on family communication and child outcomes may vary according to the child's developmental level, their gender, the presence of disability in the child, and the parent's level of psychological distress and marital discord 62,63) Much of the research concerning heart disease has focused on the effects of bereavement on children (see Chapter 9, .3. .,5.) but less on ongoing influences. Children whose parents have coronary heart disease are, in common with those whose parents have diabetes, at risk for obesity.(82) A study in Finland(83) looked at behavioural outcomes for children who had a parent with coronary heart disease, comparing the children with matched controls from a...

Moral development adolescence and criminal responsibilities

Little is known about personality development during adolescence and the factors which lead to serious antisocial behaviour. ( 4) Theorists have described adolescent personality development from the perspectives of psychosexual development, ego development and defensive operations, identity formation, cognitive development, object relations, and, more latterly, self-psychology. The development tasks of adolescence centre on autonomy and connection with others, rebellion and development of independence, development of identity, and distinction from and continuity with childhood. We need to define and understand normal functioning and development before we can intervene with those who have been designated 'abnormal'. In dealing with self-image, major bodily changes, impulse control, emotional tone, social relationships, morals, sexual attitudes, family relationships, mastery (the adaption of the adolescent to an immediate environment), and educational or vocational goals, 'normal'...

Different approaches to psychotherapy

There is a wide variety of jargon associated with various types of psychotherapy. Each approach has its own 'language' and associated special techniques. However, there is no evidence that any one method is better than another, and it would appear that the personal preference of the professional involved is more important in determining which approach is used rather than the characteristics of the child. Whichever approach is used it is likely that there will be the same common themes in the focus of treatment. Common themes include dealing with feelings of anxiety and insecurity, difficulties in relationships, low self-esteem, and a feeling of failure. These emotions are often generated by difficulties with aggression, jealousy, sexuality, and death.

Behavioural phenotypes

Children with Prader-Willi syndrome have mild mental retardation, increased appetite, and virtually all have obsessive thoughts about food and a preoccupation with seeking food.(38 Continuous supervision and control of eating is necessary to prevent life-threatening obesity. (39 Hyperphagia is probably associated with hypothalamic dysfunction 40,41 Children with Prader-Willi syndrome also frequently present with other serious emotional and behavioural problems. At least 50 per cent have other obsessive-compulsive difficulties such as questioning, writing, orderliness, and cleanliness behaviours which seriously interfere with daily life. (42) Impulsive behaviour problems such as aggression, temper, skin picking, and defiance are also common and persistent difficulties. (38) Anxiety, low self-esteem, and sadness become more prevalent in older adolescents and adults where paradoxically it is more likely in those who are relatively thinner. (38 Risk of psychosis and pervasive...

Personality disorders

Various investigators have reported personality disorders among the mentally retarded. Corbett (U) found impulsive, immature, and anxiety-prone types, Reid and Ballinger(l2) found significant personality disorders in more than half of their sample of 100 hospitalized adults, mostly of the explosive and hysterical types. Zigler and Burack(l3) identified several personality characteristics such as overdependancy, low ideal self-image, limited levels of aspiration, and an externally directed style of problem solving. Goldberg et al 1.4) found a high prevalence of personality disorders among mildly as well as moderately retarded individuals. The relevance of the concept of personality disorder with regard to the mentally retarded has, however, been questioned by a number of investigators. ( 5, 6.and 17

Special Issues Concerning Living Donors

Two techniques of assessing risk to potential donors involve the consideration of (a) whether the body can naturally replace the donated material and (b) the invasiveness, discomfort, and risks of the procedures used in obtaining tissues or organs. Similarly, psychological benefits have been found in significant increases in donor self-esteem and confidence.32

Emphasis upon quality of life

As pointed out by Longo 2 , patients experience the diagnosis of cancer as one of the most traumatic events that has ever happened to them. Independent of prognosis, the diagnosis brings with it a change in a person's self image and in his or her role in the home and workplace (p. 491).

Rehabilitation in hospital prison and the community

In addition to the dangers of loss of personal responsibility and self-reliance another toxic influence of long-term institutional confinement is the disruption of contact with the outside community and the erosion of appropriate living skills. Providing a long-term care environment which approximates closely to the realities of community living is essential. Work, education (essential to so many who have never realized their potential), and recreation ideally need to be pursued in different spaces from sleeping and the daily domestic round. Responsibility for personal care in domains such as cooking, washing, and housekeeping should fall to the patient as soon as possible. To counteract the baleful influence of a virtual total separation from the community a gradual phased introduction of activities outside the institutional boundaries needs to be introduced as soon as is practicable and consistent with both the patient's clinical state and public safety. (3 36 To the limitations on...

The Self Defeating Masochistic Personality

How might such vulnerabilities arise One possibility is child abuse (Chabrol et al., 1995). The literature on childhood victimization suggests that children chronically victimized by their peers suffer from deficits in self-esteem. Perhaps children with low self-esteem are unable to fight back for some reason or more readily become the focus of teasing or scapegoating. In fact, chronic victimization by peers during the school years is associated with a variety of adjustment problems (Egan & Perry, 1998). Studies have found that submissiveness and physical weakness, for example, may lead to increased victimization over time (Hodges, Malone, & Perry, 1997 Schwartz, Dodge, & Coie, 1993). Egan and Perry (1998) tested two hypotheses First, low self-regard promotes victimization by peers over time, and second, a child's level of self-regard modulates the impact of victimization. Results suggest that low self-regard, particularly when assessed as a child's self-perceived social competence...

Counselling in the workplace

A number of private and public sector organizations now have in-house counselling services. In the early 1980s the Post Office, one of the largest employers in the United Kingdom, recognized that there was a need to provide some form of emotional and psychological support to their employees.(69) Mental health issues, mainly anxiety and depression, formed 46 per cent of the caseload to the in-house counselling service, others being relationship problems, alcohol problems, bereavement, assault, physical illness or disability, and social problems. The effectiveness and benefits of the service from the individual client's viewpoint was assessed by comparing psychological test measurements of well being and attitudes of clients with a matched control group. After counselling, the client group showed improvements in all areas of psychological well being and behaviour. There was a decline in clinical anxiety levels, somatic anxiety, and depression and an increase in self-esteem. There was...

The Evolutionary Neurodevelopmental Perspective

Self-Image Some infants display hyperirritability, crankiness, tension, and withdrawal behaviors from the first days of postnatal life. The apparent avoidant constitutional disposition of these babies may then prompt rejecting and hostile attitudes from the caregivers. But it is neither necessary, nor sufficient, to be possessed of such a disposition. Normal, attractive, and healthy infants may also encounter parental devaluation, hypercriticism, and rejection. Reared in a family setting in which they are belittled, abandoned, and censured, these youngsters will have their natural robustness and optimism crushed and acquire in its stead attitudes of self-deprecation and feelings of social alienation. These harsh, self-critical attitudes may then have far-reaching and devastating consequences. The child who belittles his or her own worth will not be possessed of a self capable of healing psychological wounds or gaining rewards unobtainable from others. They are caught in a web of...

Depressive Personality Disorder Dsmivtr Appendix B

The central feature of Depressive Personality Disorder is a pervasive pattern of depressive, pessimistic cognitions and behaviors beginning by early adulthood. The negativism of the individual is thought to be a chronic and unremitting trait and not limited to transient states, nor are the symptoms thought to be elicited only in response to depressing news or events in the individual's life. The person's mood is characterized by a general sense of gloom and joylessness. There is not necessarily a sense of apprehension, as that would connote the person anticipates dread or catastrophe in the near future. With the depressive personality type, it is as if they know dread and catastrophe are certain, so there is no need for apprehension. Their gloominess pervades their sense of self and extends to others. They have a very low self-esteem and a pervasive sense of worthlessness. This describes the individual who experiences life through a gray filter. People with Depressive Personality...

The fear of being scooped

Can one become immune to scoopophobia An amateurish little survey suggests to me that some of those who have initiated new fields of inquiry in the neurosciences are more resistant to scoopophobia. Hence genuine self-confidence can obviously help, almost by-definition. (For a historical sampler of prioritymania among scientific giants, see Merton 1957.) Disregard for scoopophobia does not ensure that the fearless individual will be well remembered and cited. Actually, E.O. Wilson (cited in Weiner 1999) remarked that 'Progress in a scientific discipline can be measured by how quickly its founders are forgotten'. Another defence mechanism is the ostrich solution, namely, not to read the literature. Some of my best friends follow this practice. It might provide temporary, illusory relief, but also waste time and money and bounce back as a boomerang of unpleasant surprise. Not reading the literature might have been a privilege of the old days in neuroscience for example, Loewi (1936), who...

Cluster A personality disorders Paranoid personality disorder JLC

Personailty Disorder Table

Mistrust and lack of confidence may reflect deficits arising in early developmental stages and resulting in a lack of basic self-confidence. (7) Lack of protective care and affective support in childhood could perhaps facilitate the development of paranoid features. Paranoids blame others for their shortcomings. They are querulous and quick to counter-attack, so that they may become involved in frequent litigation. Since they do not confide in others, paranoids need self-confidence and a sense of autonomy and independence. They need to control people who might be harmful. While they do not accept criticism, they are highly critical.

Variations of the Avoidant Personality

Avoidant Personality Subtypes

As the self-esteem of the hypersensitive avoidant approaches collapse, many take on more severe paranoid features and come to believe that their pathetic self is the product of covert actions by others to undermine them or make them inhibit themselves. Those with preexisting paranoid traits may find it easier to believe that others are the cause of their inadequacy, an external attribution, than to believe that they are naturally inadequate, an internal attribution. The former shifts the blame and perhaps allows a remedy the latter leads only to resignation. Avoidants who have paranoid traits, therefore, may find that these traits intensify as conditions become more stressful.

Psychoanalytic objectrelations theories overview and critique

Psychoanalytic object-relations theories may be defined as those that place the internalization, structuralization, and reactivation in the transference and countertransference of the earliest dyadic object relations at the centre of their clinical formulations, and of their thinking about motivation, pathogenesis, development, and psychic structure. Internalization of object relations refers to the concept that, in all interactions of the infant and child with the significant parental figures, what the infant internalizes is not merely an image or representation of the other ('the object' of fear, hatred or desire), but the relationship between the self and the other, in the form of a self-image or self representation linked to an object image or object representation by the affect that dominates their interaction. This internal structure replicates in the intrapsychic world both real and phantasied relationships with significant others.

Challenges to Overcome for Long Term Success

The second challenge for an obese patient is the need to obtain social support or at least to understand how lack of social support can hamper the patient's weight loss success. How will significant persons in the patient's life respond to a thinner, typically more energetic, and frequently more attractive individual in place of the person who was obese, especially if the significant other person is obese as well It is not unusual for an obese spouse or key family member to become jealous or envious of the person who lost a large amount of weight. The significant person may be threatened by the patient's increase in self-esteem or the way others respond to that person as they lose weight. Either consciously or unconsciously, an individual may try to sabotage the patient's weight loss efforts. Statements like, I loved you just the way you were, or buying the patient foods high in calories as an expression of caring might be sending a message that change is threatening to the key...

Selfappreciation monitoring and control of ones own memory

The self-belief and predictions about one's own memory could sometimes be deceiving (e.g. Herrmann 1982 Benjamin et al. 1998), but still, in many situations they are well above chance level, and sometimes are dependable indeed (e.g. Kelemen and Weaver 1997). Thus, while keeping in mind occasional criticism concerning the research methodology and the conclusions (e.g. Cavanaugh and Perlmutter 1982), metamemory is now regarded not only as a theoretical concept but also as a concrete cognitive faculty that we routinely use in real-life. It improves throughout childhood and probably remains fairly stable in normal ageing, in spite of some decline in self-confidence (Cohen 1996). How is it at all possible for us to know whether we know or do not know an item in memory without specifically retrieving that item, is mostly still a mystery. Understanding the processes and mechanisms involved is bound to tell us a lot about how acquisition, storage, and retrieval really work in a complex brain....

The Psychodynamic Perspective

In fact, histrionic personalities are often shocked when asked to confront their provocative sexual messages. Apparently, conscious awareness of the instrumental use of the physical body is completely incompatible with a self-image of sweet innocence, an But do they follow through and sustain that initial impression Are they good lovers Apparently, the answer is no. Apt and Hurlbert (1994) studied a sample of women who had been diagnosed as histrionic using the MCMI-II and compared them to a matched sample of other nonhistrionic women in a series of measures of sexual behaviors and attitudes. Histrionic women were found to have significantly lower sexual assertiveness, greater ero-tophobic attitudes toward sex, lower self-esteem, and greater marital dissatisfaction they were found to be more preoccupied with sexual thoughts and they reported having lower sexual desire and more sexual boredom. They also reported a greater incidence of orgasmic dysfunction and indicated a greater...

Problems of children and adolescents with sensory impairment

Whilst the degree of deafness alone is not an important aetiological factor for psychiatric disorder, other features related to deafness are ( T.a.ble 4.). They include impaired communication, intelligence (which is inversely related to psychiatric disorder), and the type of school attended. (28) The effects of schooling are somewhat contradictory, with some evidence that deaf children at deaf schools are at lower risk than those in mainstream schools where they are more frequently bullied, have fewer friends, and a poorer self-image.(30) However, other evidence, which does not include direct interviews with the children, suggests that children in deaf schools are at greater psychiatric risk.(28)

The Cognitive Perspective

The interpersonal strategy of dependents, designed to secure care and protection, has important negative consequences for their self-image and cognitive development. The helpless fa ade that dependents project eventually works its way into their self-concept. You cannot act helpless without believing it to some extent yourself. Dependents usually describe themselves as weak, fragile, inadequate, inept, or incompetent. When their incapacities become too clearly focused, anxiety and panic may result. To keep their vulnerability controlled, many dependents prefer not to look too deeply into themselves, preferring instead to limit their awareness to the pleasantries of life, seeing only the good and never the bad. When difficulties are acknowledged, it is often with a saving silver lining that effectively undoes the problem by assuming that things will work out in the end. Denial, discussed in the psychodynamic perspective, thus gradually develops into a broader cognitive style. A full...

The Cognitive Behavioural Model Of Bipolar Disorder

Beck's (1979) cognitive behavioural model suggests that depressed mood is mediated by particular patterns of thinking that accentuate mood shifts. Individuals who are depressed become more negative in how they perceive themselves, others, and the world in general as a result, they are prone to systematic cognitive distortions in that they tend to overgeneralise, self-blame, jump to negative conclusions, and view things in black- and-white terms. The avoidance of social contacts and other safety behaviours often result as an interaction of mood shifts and negative thinking patterns. These cognitive styles of depression are thought to arise out of early learning experiences. Beck suggested in his cognitive model that mania is a mirror image of depression, as determined by a hyperpositive triad of self, others, and the future. Scott and colleagues (2000) found that individuals with bipolar disorder demonstrated lower levels of self-esteem, over-general memory, poorer problem-solving...

Introduction to Personality Disorders and Aging

Exasperating These are just a few of the words clinicians commonly use to describe their interactions with patients who have a personality disorder. Now, on top of this already challenging clinical situation, add in the common stressors associated with aging physical declines, social losses, reduced independence, financial stressors, and cognitive declines. Adults with personality disorders are woefully ill prepared to meet these challenges of aging. Their interpersonal worlds are characterized by dysfunction, conflict, distance, or chaos, and they often lack the necessary social support networks that help buffer stress. Intrapsychically, they arrive at later life with lifelong coping deficits and, in most cases, diminished self-esteem due to a lifetime of problems and failures. They are often defeated and demoralized. Sadly, they can often be described as surviving not thriving with age. They are the problem cases that cause considerable consternation on the part of the...

The Interpersonal Perspective

Histrionics have many distinctive interpersonal qualities, most notably their self-image and the immediate impression they make on others. At least at a conscious level, they usually see themselves as attractive, friendly, and fun to be around. In the beginning, they can seem most charming. The ease with which they open up and relate their feelings seems to establish a quick intimacy that is both alive and refreshing, qualities that alone are often very attractive. More severe histrionics, however, inevitably become volatile, provocative, theatrical, and capacious. Their one-on-one charm becomes a talent for grabbing the headlines, marketed to entire social groups. If not the life of the party, the histrionic at least has a retinue of smiling followers eager for eye contact. To make themselves more appealing, they may alternate playing the naive, innocent waif and the worldly sophisticate, tailoring their display as the audience desires. Attentiveness to such signals allows them to...

Comparison of the brief psychodynamic psychotherapies

Brief psychodynamic psychotherapy for depression, narcissistic disturbances, panic disorder, substance abuse, and post-traumatic stress disorder have been described 2 26) Horowitz et a .(27) have described brief psychotherapy focused on the stress responses evidenced by various personality styles. He emphasizes that this psychotherapy is directed towards dealing with the process of the stress response and not character change. However, his outcomes indicate that selected character changes are possible in some areas. The distinction between recovery from a disruption in homoeostatic balance, reconstitution of self-esteem and self-concept, and changes in character structure require further exploration.

The DSM Multiaxial Model

Axis Psychological Disorderrs

Because narcissists consider themselves superior to everyone else, they usually become depressed when confronted with objective evidence of failure or inadequacy too profound to ignore. Their usually puffed-up self-esteem deflates, leaving feelings of depression in its wake. In contrast, dependent personalities seek powerful others to take care of them, instrumental surrogates who confront a cruel world. Here, depression usually follows the loss of a significant caretaker. The point of the multiaxial model is that each patient is more than the sum of his or her diagnoses Both are depressed, but for very different reasons. In each case, what differentiates them is not their surface symptoms, but rather the meaning of their symptoms in the context of their underlying personalities. By considering symptoms in relation to deeper characteristics, an understanding of the person is gained that transcends either symptoms or traits considered separately. To say that someone is a...

Narcissistic Personality Disorder

The narcissistic personality is characterized by an exaggerated or grandiose sense of self-importance and an illusion of being unique or special that lead to feelings of entitlement. Such persons overestimate their abilities, popularity, and power, frequently coming across as self-centered, conceited, and boastful. They are typically preoccupied with themselves and their self-affirming fantasies of unlimited success, fame, intellectual sophistication, power, and beauty. Sadly, their excessive self-regard is equaled only by their cavernous misperception they think and expect that others should recognize their superiority, special talents, and uniqueness. Underneath, it is presumed that the narcissist feels inadequate and dependent, with fragile self-esteem (Kernberg, 1975). The narcissistic type often responds to negative feedback with intense rage and attempts to degrade those who were critical, presumably in an attempt to bolster fragile self-esteem.

Intentionality development and content

It is also relatively easy to see ways in which the function of anxiety is elaborated in phylogenesis and ontogenesis. Danger comes to include not only assaults on physical integrity and deprivation of biological necessities, but also, e.g. in social beings, threat to status in the group, and in human beings, threat to various aspects of'self-esteem'. Development also elaborates the response side of anxiety. Increased cognitive resources create more possibilities of problem-solving. Specifically, the behavioural coping skills of avoidance and attack find mental analogues (analogues in mental representations) in living beings with the requisite cognitive capacity. This means, roughly, that some possible dangers need not be thought about at all, or if at all, that they can be disqualified in the imagination. There are also problem-solving analogues within the realm of mental representations, which involve making plans as to how to cope with the difficult situation if and when it arises.

The cognitive model of depression and case conceptualization Enduring cognitive vulnerability to depression

Basis for an individualized conceptualization, developed and shared with the patient, which informs and guides therapy. It suggests that, on the basis of experience (loss, events with lasting implications for self-worth), people arrive at fundamental conclusions about themselves, others, and the world ('basic' or 'core' beliefs, or

Looking at Significant Stressors What Else Can Account for Somatic Symptomatology

Most patients who require psychological testing present with one or more Axis I disorders. Traits refer to long-standing personality characteristics that endure over time and situations. In contrast, states refer to potentially short-lived conditions, usually emotional in nature. Anxiety, depression, and loss of reality contact can all affect the results of personality testing. J. Reich, Noyes, Coryell, and Gorman (1986), for example, obtained personality profiles on a group of persons with panic disorder and agoraphobia. Those judged improved six weeks later showed significantly increased emotional strength and extroversion and significantly decreased interpersonal dependence. Some disorders also have a motivational or cognitive dimension that can affect the validity of test results. Depressed individuals report increased feelings of worthlessness and shame, which can lead to overendorsement of items intended to assess low self-esteem as a personality trait, for example. Research on...

Therapeutic Strategies and Techniques

With this foundation, the therapist can help the subject test reality in areas where di-chotomous thinking dominates. For example, the individual can be asked to define the elements that go into being trustworthy and untrustworthy. Once an adequately complex definition is achieved, actual persons in the subject's life can be evaluated and shown to occupy a position somewhere between these polar opposites. With practice, borderlines can learn to identify automatic thoughts that caricature the interpersonal world, thus paving the way toward a new and more realistic way of experiencing others Not everyone will criticize, hurt, or abandon you. If successful, existing relationships should settle down somewhat, and new relationships get a more realistic beginning. The same holds for the borderline's self-image. By refuting dichotomous images of themselves,

The Biological Perspective

The emotional vista of the avoidant personality is one of constant and confusing undercurrents of anxiety, sadness, and anger. Anguished by most all actions and events, they vacillate between unrequited desires for affection and pervasive fears of rebuff and embarrassment. The confusion and emotional irresolution they experience frequently lead to a general state of numbness. As noted, avoidant personalities have a deep mistrust of others and a marked deflated image of their own self-worth. They have learned to believe, through painful experiences, that the world is unfriendly, cold, and humiliating, As the child matures, feelings of shame expressed by parents in response to lack of achievement are likely to instill a sense of defectiveness or incompetence, even when the child performs above the norm. An athletic father who becomes frustrated and disappointed with his lanky and uncoordinated son, for example, implicitly communicates the idea that love and acceptance are contingent on...

The Case ofThelma Histrionic Personality Disorder

None were serious, but collectively they served to reestablish Thelma's confidence in her ability to attract the attention of men and to heal her wounded self-esteem. When her husband suffered a second heart attack, which he did not survive, Thelma found herself a grieving wife and an available widow. She sold the family home in the suburbs and bought a small condo in the city. She sold the small condo in Florida and bought a larger unit in the same community. At this point, she began to live in Florida for 9 months of the year, and in the city for 3 months, using it also for occasional weekends to visit her daughter, now married and the mother of two children. Thelma did not envision herself as a grandmother, but frequently sent the children gifts and cute cards signed, With love from Thelma. The therapist would serve as a reliable presence for comfort and support, and to diminish her sense of helplessness. This would enable Thelma to restore her...

Subsequent social impairment

There are a number of reasons for thinking that early-onset depression might not only predict further depression, but also could be associated with effects on social and cognitive functioning. Thus, depression in young people is frequently accompanied by social withdrawal and irritability, and so depressed youngsters may find it more difficult to establish and maintain social relationships. In addition, symptoms such as loss of concentration and psychomotor retardation may interfere with the process of learning. This, in turn, might lead to low self-esteem and so on to further academic failure. Kovacs and Goldston (1991) pointed out that young people suffering from major depression are impaired for a significant proportion of the lifespan, and they are handicapped at a time when learning takes place rapidly. Perhaps, then, they will eventually show cognitive as well as social delays.

Maximizing Supervision Finding the Most Suitable Therapeutic Approach

Having learned much from her first supervisor, a psychodynamic sage, Jenna was eager to begin studying with her second supervisor, known for his knowledge of cognitive techniques. When her first client, a depressed male graduate student, scored in the narcissistic range on the MCMI-III, her new supervisor recommended that she educate the client in the principles of cognitive therapy, focusing particularly on the discovery of automatic thoughts and their connection with his self-image, which featured quickly vacillating appraisals of his ability, ranging from godlike to pathetically inadequate. After the first two sessions, however, she noticed that the client seemed increasingly condescending, apparently chaffed by her attempts. Realizing that the personality disorder was the most important factor driving his depression, Jenna suggested to her new supervisor that perhaps the automatic thoughts underlying the transference itself could be discussed as a means of synergizing the...

Timed Voiding and Fluid Management

The three components of timed voiding are education regarding continence and incontinence mechanisms scheduled voiding with systemic delay of voiding by implementing distraction and relaxation techniques and positive reinforcement provided by a caregiver. The specific goals of bladder training include correcting inappropriate habits of frequent urination, improving control of bladder urgency, extending intervals between voids, increasing bladder capacity, reducing incontinence episodes, and building patient self-confidence in bladder control. There is very little understanding of how bladder retraining works. Several hypotheses exist, including improved cortical suppression of sensory stimuli from an uninhibited bladder, improved cortical inhibition of an overactive detrusor muscle, maintenance of bladder pressures lower than the urethral closure pressure during stress, increasing bladder reserve volume, and altered patient behavior to avoid incontinence triggers and to gain awareness...

Differential diagnosis and ascertainment difficulties Depression

The three key features of lowered self-esteem, increased self-criticism, and acknowledgment of a depressed mood distinguish depression phenomenologically from states such as grief or bereavement where there is a distinct sense of 'loss', but no primary 'loss' of self-esteem. They also assist phenomenological differentiation from anxiety, where the individual is more likely to report a sense of insecurity, fear, apprehension, worry, panic, or of 'going mad'. In practice, such features, together with less specific concomitants such as crying, non-reactive mood, and anhedonia, assist in making a diagnosis of depression in the majority of instances.

Dependent Personality Disorder

(4) has difficulty initiating projects or doing things on his or her own (because of lack of self-confidence in judgment or abilities rather than a lack of motivation or energy) illness is present. Older persons with cognitive impairment may show deficits in their abilities to make reasonable decisions for themselves, display previously held good judgment, and initiate constructive behaviors (lack of initiation is a classic sign of frontal lobe impairment). In these cases, it would be incorrect to conclude that the person has met the threshold for Criterion 1 (has difficulty making everyday decisions without an excessive amount of advice and reassurance from others) and Criterion 4 (has difficulty initiating projects or doing things on his or her own because of lack of self-confidence in judgment or abilities rather than a lack of motivation or energy ), especially if these behaviors are not lifelong traits or can be accounted for by organic changes in the brain.

The school is an arena for mental health promotion

Given that it can be shown that both the social processes which take place in schools affect behavioural development, preventive intervention in schools is therefore logical. Schools can, through indirect processes, promote self-esteem and self-effectiveness. The qualities of so-called effective schools can be identified but their effects are largely beyond the scope of this review.

Variations of the Paranoid Personality

The fanatic paranoid pattern often resembles its less troubled cousin, the narcissistic personality, as this variant is an interweaving of both paranoid and narcissistic traits. Like the narcissist, the fanatic variant of the paranoid pattern comes across as arrogant, pretentious, and expansive and maintains an air of contempt toward others. A major difference is that narcissists often achieve some success, whereas fanatic paranoids have run hard into reality, their narcissism profoundly wounded. Thus fallen from grace, their self-image of perfection shattered, fanatic paranoids seek to reestablish lost pride through extravagant claims and intricate fantasies. By endowing themselves with illusory powers, they become superheroes or demigods, ready to prevail against an evil universe. Eventually, delusions of grandeur become their primary coping mechanism. By assuming a grandiose identity, fanatic paranoids offset the collapse of self-esteem produced by objective reality. They may...