The purpose of this study was to eramine the course of comorbid posttraumatic stress disorder (PT... more The purpose of this study was to eramine the course of comorbid posttraumatic stress disorder (PTSD) in 54 patients with another anxiety disorder: Using a prospective longrtudinal design, the present study found that during the first 5 years of follow-up the probability of full remission from a chronic episode of PTSD was .18. Findings from this and other research confirm clinical impressions that a substantial number of people never fulb remit from their PTSD even after many years. Variables associated with a longer time to remit from an episode of chronic PTSD were a history of alcohol abuse and a history of childhood trauma.
This study compared the personality traits of subjects with bipolar I disorder in remission to th... more This study compared the personality traits of subjects with bipolar I disorder in remission to the personality traits of subjects with no history of any mental illness. Subjects were assessed as part of a prospective, multicenter, naturalistic study of mood disorders. Diagnoses were rendered according to Research Diagnostic Criteria, through use of the Schedule for Affective Disorders and Schizophrenia-Lifetime Version. A total of 30 euthymic bipolar I subjects were compared to 974 never-ill subjects on 17 personality scales selected for their relevance to mood disorders. The subjects with bipolar I disorder in remission had more aberrant scores on 6 of the 17 personality measures, including Emotional Stability, Objectivity, Neuroticism, Ego Resiliency, Ego Control, and Hysterical Factor. These findings indicate that patients with bipolar I disorder in remission have personality traits that differ from those of normal controls.
Background To examine prospectively the natural course of major depressive disorder (MDD) and to ... more Background To examine prospectively the natural course of major depressive disorder (MDD) and to test the effects of personality disorders (PDs) on remission and relapse over six- year follow-up. Methods Subjects were 302 patients (196 women, 106 men) with current MDD at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS), a NIMH-funded multi-site study (Yale, Brown, Columbia, Harvard). MDD and psychiatric disorders were assessed with the Structured Clinical Interview for DSM-IV and PDs with the DIPD-IV. The course of MDD was assessed with the Longitudinal Interval Follow-up Evaluation and the course of PDs with the Follow-Along version of the DIPD-IV at 6- and 12-months and then yearly for 6 years. Good inter-rater and test-retest reliabilities were established. Results Lifetable survival analyses revealed an overall 24-month remission rate of 74% for MDD that differed little by gender but was significantly lower among patients with PDs (range 52% to 81%) than without PDs (89%). Cox proportional hazards regression analyses revealed that MDD patients with co-existing PDs had significantly longer time to remission than did MDD patients without any PD even when controlling for other negative prognostic predictors (psychiatric co-morbidity, dysthymia, gender, ethnicity, early-onset and recurrent MDD, and treatment). Among patients who achieved remission from MDD, the probability of relapse was significantly greater and time to relapse was significantly shorter in patients with PD than without PD. Conclusions PDs are a robust predictor of slowed remission and accelerated relapse in MDD.
We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and c... more We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and cognitive behavior therapy, for the treatment of outpatients with major depression disorder diagnosed by Research Diagnostic Criteria. Two hundred fifty patients were randomly assigned to one of four 16-week treatment conditions: interpersonal psychotherapy, cognitive behavior therapy, imipramine hydrochloride plus clinical management (as a standard reference treatment), and placebo plus clinical management. Patients in all treatments showed significant reduction in depressive symptoms and improvement in functioning over the course of treatment. There was a consistent ordering of treatments at termination, with imipramine plus clinical management generally doing best, placebo plus clinical management worst, and the two psychotherapies in between but generally closer to imipramine plus clinical management. In analyses carried out on the total samples without regard to initial severity of illness (the primary analyses), there was no evidence of greater effectiveness of one of the psychotherapies as compared with the other and no evidence that either of the psychotherapies was significantly less effective than the standard reference treatment, imipramine plus clinical management. Comparing each of the psychotherapies with the placebo plus clinical management condition, there was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy. Superior recovery rates were found for both interpersonal psychotherapy and imipramine plus clinical management, as compared with placebo plus clinical management. On mean scores, however, there were few significant differences in effectiveness among the four treatments in the primary analyses. Secondary analyses, in which patients were dichotomized on initial level of severity of depressive symptoms and impairment of functioning, helped to explain the relative lack of significant findings in the primary analyses. Significant differences among treatments were present only for the subgroup of patients who were more severely depressed and functionally impaired; here, there was some evidence of the effectiveness of interpersonal psychotherapy with these patients and strong evidence of the effectiveness of imipramine plus clinical management. In contrast, there were no significant differences among treatments, including placebo plus clinical management, for the less severely depressed and functionally impaired patients.
This article describes issues in the design of an ongoing multisite randomized clinical trial of ... more This article describes issues in the design of an ongoing multisite randomized clinical trial of psychotherapy for treating posttraumatic stress disorder (PTSD) in female veterans and active duty personnel. Research aimed at testing treatments for PTSD in women who have served in the military is especially important due to the high prevalence of PTSD in this population. VA Cooperative Study 494 was designed to enroll 384 participants across 12 sites. Participants are randomly assigned to receive 10 weekly sessions of individual psychotherapy: Prolonged Exposure, a specific cognitive-behavioral therapy protocol for PTSD, or present-centered therapy, a comparison treatment that addresses current interpersonal problems but avoids a trauma focus. PTSD is the primary outcome. Additional outcomes are comorbid problems such as depression and anxiety; psychosocial function and quality of life; physical health status; satisfaction with treatment; and service utilization. Follow-up assessments are conducted at the end of treatment and then 3 and 6 months after treatment. Both treatments are delivered according to a manual. Videotapes of therapy sessions are viewed by experts who provide feedback to therapists throughout the trial to ensure adherence to the treatment manual. Discussion includes issues encountered in multisite psychotherapy trials along with the rationale for our decisions about how we addressed these issues in CSP #494. D Exposure to events such as sexual assault, combat, and accidents can have profound effects on a person's wellbeing. One of the most significant consequences is the development of posttraumatic stress disorder (PTSD). The lifetime prevalence of PTSD among adults in the US is 5% in men and 10% in women . Evidence from large 1551-7144/$ -see front matter D
In recent years there has been a renewed interest in the integration of descriptive and interpers... more In recent years there has been a renewed interest in the integration of descriptive and interpersonal approaches to mental illness. Much of the impetus for this stems from the introduction in 1980 of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) (American Psychiatric Association 1980), with subsequent research and clinical reports documenting important interactions between Axis I syndromes and Axis II personality trait factors. While many research efforts have described comorbidity in affective and anxiety disorders, less attention has been directed toward clarifying the relationships between stable and enduring character traits and Axis I symptoms in schizophrenia. In this paper we propose that schizophrenic patients display both adaptive and pathological personality traits throughout the illness, and that clinical and research efforts to address the interactions between syndromic and personality factors ("trait-state" interactions) will further our understanding of patterns of symptom presentation and treatment response in these patients.
Recent developments in individual psychotherapy for patients with borderline personality disorder... more Recent developments in individual psychotherapy for patients with borderline personality disorder indude psychodynamic, interpersonal, behavioral, and cognitive treatments. The author provides an overview ofstandardized treatment approaches-that is, modes of treatment that have a ckar theoretical rationak and specific strategies and techniques-for borderline personality disorder. Evaluations of the efficacy of these approaches are discussed. Although there is little empirically based knowledge about the effectiveness of these treatments, their adaptationfor the speafic treatment of borderline personality disorder represents an important step for treatment and research in this area. For patients with borderline personality disorder, individual psychotherapy is probably the most frequently used treatment modality. Early treatment approaches were primarily derivatives on modifications ofpsychoanalysis or psychoanalytically oriented psychotherapy. In recent years, alternative approaches, including behavioral and cognitive treatments, have been developed.
The goal of the study was to describe the naturalistic course of unipolar major depression in sub... more The goal of the study was to describe the naturalistic course of unipolar major depression in subjects not receiving somatic therapy for their depressive illness. Affectively i11 individuals were recruited into the Collaborative Depression Shrdy and followed prospectively for up to i5 years. One hundled thirry subjects who recovered frorn their intake episode of major depression subsequently experrenced a recurrence that went untreated for at least 4 weeks following onset of the recurrence. The duration of the recurrent episode was examined using survival analytic techniques. Of the i30 subjects, 46 obtained somatic therapy at some time during the course of their depressive illness, while 84 subjects received no somatic therapy throughout their entire depressive episode. Survival analysis, which accounts for these 46 individuals by censoring their episodes at the time treatment was obtained, yielded a median time to recovery of 23 weeks. In the subsarnple of 84 subjects whose depressive illness went untreated from its inception tlrough its resolution, the median time to recovery was 13 weeks. These results suggest that there is a high rate ofrecovery in individuals not receiving somatic treatment of their depressive illness, particularly in the first 3 months of an episode. Because treatment-seeking behavior is known to be associated with a worse prognosis, 23 weeks probably' represents a lower-limit approximation of the median duration of an untreated depressive episode.
Journal of Consulting and Clinical Psychology, 1998
The role of gender was examined in the process and outcome of therapy in the treatment of depress... more The role of gender was examined in the process and outcome of therapy in the treatment of depressed outpatients seen in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Patients received either interpersonal therapy, cognitive-behavioral therapy, imipramine plus clinical management, or placebo plus clinical management. None of the therapist-patient by gender groupings (i.e., therapist gender, therapist-patient gender matching vs. mismatching, or patients' beliefs about whether a male or female therapist would be more helpful) were significantly related to measures of treatment process and outcome, controlling for type of treatment and severity of pretreatment depressive symptoms. Findings were duplicated when examining the effects of gender within only the psychotherapeutic modes of treatment for the groupings of therapist gender and therapist-patient gender matching versus mismatching.
This paper describes the aims, background, design, and methods used in a collaborative longitudin... more This paper describes the aims, background, design, and methods used in a collaborative longitudinal study of Axis II personality disorders (PDs). This study examines the putative stability of selected PD diag noses and criteria, what factors affect their course, and whether thenstability and course distinguishes them from a representative Axis I dis order. This article also describes the acquisition and demographics of the sample on whom the study is being done. A prospective, repeated measures investigation of the stability of PDs is now underway at multiple clinical settings in four collaborating urban sites in Boston, New Haven, New York, and Providence. Diagnos tic assignments are based on semistructured interview assessments (by clinically trained raters) and confirmed by at least one additional con trasting diagnostic method. The sample consists of 668 treatment seeking and reliably diag nosed adults recruited from a broad range of clinical sites. By design, patients in the sample met standards for one of five diagnostic sub groups: (a) schizotypal [N = 86); (b) borderline (IV = 175); (c) avoidant [N = 157); (d) obsessive-compulsive (N = 153) personality disorders or a con trol group having (e) major depressive disorder without personality dis order (IV = 97).
The aims of the present investigation were (a) to examine associations between posttraumatic stre... more The aims of the present investigation were (a) to examine associations between posttraumatic stress disorder (PTSD; diagnosis and symptoms) and different aspects of functioning, severity, and subjective distress among Operation Iraqi Freedom and Operation Enduring Freedom National Guard and Reserve veterans, and (b) to examine the unique contribution of PTSD symptom clusters to different aspects of functioning and distress. Participants were 124 veterans who had returned from war-zone deployment. A PTSD diagnosis and PTSD symptoms were significantly associated with nearly all of the psychosocial functioning and distress measures, controlling for Axis I disorders and other covariates. Of the PTSD symptom clusters, numbing/avoidance symptoms were the strongest predictors of interpersonal and social functioning, and hyperarousal symptoms were the strongest predictors of overall severity and distress. In addition to death and physical injury, the cost of war includes a large mental health and public health burden. Comprehensive research on Vietnam veterans has found that psychiatric disorders, including posttraumatic stress disorder (PTSD), are frequent consequences of war-zone exposure (e.g., Kulka et al., 1990). Research on Vietnam veterans has also documented significant functional impairment among those with PTSD. Findings from the National Vietnam Veterans' Readjustment Study (Kulka et al., 1990) showed that Vietnam veterans with PTSD had greater work impairment and unemployment, higher rates of marital problems and divorce, poorer physical health, greater physical limitations, greater rates of violence perpetration, and more medical utilization than those without PTSD (Kulka et al., 1990; Zatzick et al., 1997). In addition to PTSD diagnosis, continuously assessed symptoms of PTSD (i.e., higher total PTSD symptom scores) have also been associated with poorer functioning in veteran samples (Magruder et al.
Individuals with a history ofdepression are characterized by high levels of certain personality t... more Individuals with a history ofdepression are characterized by high levels of certain personality traits, particularly neuroticism, introversion, and interpersonal dependency. The authors examined the "scar hypothesis, " i. e. , the possibility that episodes of niajor depression result in lasting personality changes that persist beyond recovery from the depression. Method: A large sample offirst-degree relatives, spouses, and comparison subjects ascertained in connection with the proband sample from the National Institute ofMental Health Collaborative Program oiz the Psychobiology ofDepression were assessed at two points in time sepa
This article considers the relationship between chronic mood disorders and depressive personality... more This article considers the relationship between chronic mood disorders and depressive personality from several perspectives. A historical overview of various theoretical, descriptive, and empirically based typologies is provided as well as a review of the relevant classifications from the psychiatric nomenclatures. The defining features of the different conceptions of chronic depression and depressive personality then are considered within the framework of dimensional models of personality, including the dimensions of positive and negative affectivity, and the five-factor model. It is proposed that these dimensional models may provide a useful integrating framework for future work in this area.
The concept of dependency has its roots in psychoanalytic theory, social psychological theory, an... more The concept of dependency has its roots in psychoanalytic theory, social psychological theory, and ethologic theory (Hirschfeld, Klerman, Chodoff, Korchin, 6k Barrett, 1976). Psychoanalytic theory emphasizes the attain ment of instinctual aims through interaction with social objects, such as the mother, as the source of dependency. Social learning theories consider dependency to be a learned behavior, that is, one acquired in experience rather than being instinctual in the organism. More specifically, de pendency refers to a class of behaviors stemming from the infant's initial reliance on the mother: subsequently these learned behaviors generalize to interpersonal relations in general. In ethological theory the concept of attachment has been proposed to refer to the affectional bond that one person forms to another specific individual. This bond is manifested by behaviors fostering proximity to and contact with the love object and by behavioral disruptions if separation occurs.
The purpose of this study was to eramine the course of comorbid posttraumatic stress disorder (PT... more The purpose of this study was to eramine the course of comorbid posttraumatic stress disorder (PTSD) in 54 patients with another anxiety disorder: Using a prospective longrtudinal design, the present study found that during the first 5 years of follow-up the probability of full remission from a chronic episode of PTSD was .18. Findings from this and other research confirm clinical impressions that a substantial number of people never fulb remit from their PTSD even after many years. Variables associated with a longer time to remit from an episode of chronic PTSD were a history of alcohol abuse and a history of childhood trauma.
This study compared the personality traits of subjects with bipolar I disorder in remission to th... more This study compared the personality traits of subjects with bipolar I disorder in remission to the personality traits of subjects with no history of any mental illness. Subjects were assessed as part of a prospective, multicenter, naturalistic study of mood disorders. Diagnoses were rendered according to Research Diagnostic Criteria, through use of the Schedule for Affective Disorders and Schizophrenia-Lifetime Version. A total of 30 euthymic bipolar I subjects were compared to 974 never-ill subjects on 17 personality scales selected for their relevance to mood disorders. The subjects with bipolar I disorder in remission had more aberrant scores on 6 of the 17 personality measures, including Emotional Stability, Objectivity, Neuroticism, Ego Resiliency, Ego Control, and Hysterical Factor. These findings indicate that patients with bipolar I disorder in remission have personality traits that differ from those of normal controls.
Background To examine prospectively the natural course of major depressive disorder (MDD) and to ... more Background To examine prospectively the natural course of major depressive disorder (MDD) and to test the effects of personality disorders (PDs) on remission and relapse over six- year follow-up. Methods Subjects were 302 patients (196 women, 106 men) with current MDD at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS), a NIMH-funded multi-site study (Yale, Brown, Columbia, Harvard). MDD and psychiatric disorders were assessed with the Structured Clinical Interview for DSM-IV and PDs with the DIPD-IV. The course of MDD was assessed with the Longitudinal Interval Follow-up Evaluation and the course of PDs with the Follow-Along version of the DIPD-IV at 6- and 12-months and then yearly for 6 years. Good inter-rater and test-retest reliabilities were established. Results Lifetable survival analyses revealed an overall 24-month remission rate of 74% for MDD that differed little by gender but was significantly lower among patients with PDs (range 52% to 81%) than without PDs (89%). Cox proportional hazards regression analyses revealed that MDD patients with co-existing PDs had significantly longer time to remission than did MDD patients without any PD even when controlling for other negative prognostic predictors (psychiatric co-morbidity, dysthymia, gender, ethnicity, early-onset and recurrent MDD, and treatment). Among patients who achieved remission from MDD, the probability of relapse was significantly greater and time to relapse was significantly shorter in patients with PD than without PD. Conclusions PDs are a robust predictor of slowed remission and accelerated relapse in MDD.
We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and c... more We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and cognitive behavior therapy, for the treatment of outpatients with major depression disorder diagnosed by Research Diagnostic Criteria. Two hundred fifty patients were randomly assigned to one of four 16-week treatment conditions: interpersonal psychotherapy, cognitive behavior therapy, imipramine hydrochloride plus clinical management (as a standard reference treatment), and placebo plus clinical management. Patients in all treatments showed significant reduction in depressive symptoms and improvement in functioning over the course of treatment. There was a consistent ordering of treatments at termination, with imipramine plus clinical management generally doing best, placebo plus clinical management worst, and the two psychotherapies in between but generally closer to imipramine plus clinical management. In analyses carried out on the total samples without regard to initial severity of illness (the primary analyses), there was no evidence of greater effectiveness of one of the psychotherapies as compared with the other and no evidence that either of the psychotherapies was significantly less effective than the standard reference treatment, imipramine plus clinical management. Comparing each of the psychotherapies with the placebo plus clinical management condition, there was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy. Superior recovery rates were found for both interpersonal psychotherapy and imipramine plus clinical management, as compared with placebo plus clinical management. On mean scores, however, there were few significant differences in effectiveness among the four treatments in the primary analyses. Secondary analyses, in which patients were dichotomized on initial level of severity of depressive symptoms and impairment of functioning, helped to explain the relative lack of significant findings in the primary analyses. Significant differences among treatments were present only for the subgroup of patients who were more severely depressed and functionally impaired; here, there was some evidence of the effectiveness of interpersonal psychotherapy with these patients and strong evidence of the effectiveness of imipramine plus clinical management. In contrast, there were no significant differences among treatments, including placebo plus clinical management, for the less severely depressed and functionally impaired patients.
This article describes issues in the design of an ongoing multisite randomized clinical trial of ... more This article describes issues in the design of an ongoing multisite randomized clinical trial of psychotherapy for treating posttraumatic stress disorder (PTSD) in female veterans and active duty personnel. Research aimed at testing treatments for PTSD in women who have served in the military is especially important due to the high prevalence of PTSD in this population. VA Cooperative Study 494 was designed to enroll 384 participants across 12 sites. Participants are randomly assigned to receive 10 weekly sessions of individual psychotherapy: Prolonged Exposure, a specific cognitive-behavioral therapy protocol for PTSD, or present-centered therapy, a comparison treatment that addresses current interpersonal problems but avoids a trauma focus. PTSD is the primary outcome. Additional outcomes are comorbid problems such as depression and anxiety; psychosocial function and quality of life; physical health status; satisfaction with treatment; and service utilization. Follow-up assessments are conducted at the end of treatment and then 3 and 6 months after treatment. Both treatments are delivered according to a manual. Videotapes of therapy sessions are viewed by experts who provide feedback to therapists throughout the trial to ensure adherence to the treatment manual. Discussion includes issues encountered in multisite psychotherapy trials along with the rationale for our decisions about how we addressed these issues in CSP #494. D Exposure to events such as sexual assault, combat, and accidents can have profound effects on a person's wellbeing. One of the most significant consequences is the development of posttraumatic stress disorder (PTSD). The lifetime prevalence of PTSD among adults in the US is 5% in men and 10% in women . Evidence from large 1551-7144/$ -see front matter D
In recent years there has been a renewed interest in the integration of descriptive and interpers... more In recent years there has been a renewed interest in the integration of descriptive and interpersonal approaches to mental illness. Much of the impetus for this stems from the introduction in 1980 of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) (American Psychiatric Association 1980), with subsequent research and clinical reports documenting important interactions between Axis I syndromes and Axis II personality trait factors. While many research efforts have described comorbidity in affective and anxiety disorders, less attention has been directed toward clarifying the relationships between stable and enduring character traits and Axis I symptoms in schizophrenia. In this paper we propose that schizophrenic patients display both adaptive and pathological personality traits throughout the illness, and that clinical and research efforts to address the interactions between syndromic and personality factors ("trait-state" interactions) will further our understanding of patterns of symptom presentation and treatment response in these patients.
Recent developments in individual psychotherapy for patients with borderline personality disorder... more Recent developments in individual psychotherapy for patients with borderline personality disorder indude psychodynamic, interpersonal, behavioral, and cognitive treatments. The author provides an overview ofstandardized treatment approaches-that is, modes of treatment that have a ckar theoretical rationak and specific strategies and techniques-for borderline personality disorder. Evaluations of the efficacy of these approaches are discussed. Although there is little empirically based knowledge about the effectiveness of these treatments, their adaptationfor the speafic treatment of borderline personality disorder represents an important step for treatment and research in this area. For patients with borderline personality disorder, individual psychotherapy is probably the most frequently used treatment modality. Early treatment approaches were primarily derivatives on modifications ofpsychoanalysis or psychoanalytically oriented psychotherapy. In recent years, alternative approaches, including behavioral and cognitive treatments, have been developed.
The goal of the study was to describe the naturalistic course of unipolar major depression in sub... more The goal of the study was to describe the naturalistic course of unipolar major depression in subjects not receiving somatic therapy for their depressive illness. Affectively i11 individuals were recruited into the Collaborative Depression Shrdy and followed prospectively for up to i5 years. One hundled thirry subjects who recovered frorn their intake episode of major depression subsequently experrenced a recurrence that went untreated for at least 4 weeks following onset of the recurrence. The duration of the recurrent episode was examined using survival analytic techniques. Of the i30 subjects, 46 obtained somatic therapy at some time during the course of their depressive illness, while 84 subjects received no somatic therapy throughout their entire depressive episode. Survival analysis, which accounts for these 46 individuals by censoring their episodes at the time treatment was obtained, yielded a median time to recovery of 23 weeks. In the subsarnple of 84 subjects whose depressive illness went untreated from its inception tlrough its resolution, the median time to recovery was 13 weeks. These results suggest that there is a high rate ofrecovery in individuals not receiving somatic treatment of their depressive illness, particularly in the first 3 months of an episode. Because treatment-seeking behavior is known to be associated with a worse prognosis, 23 weeks probably' represents a lower-limit approximation of the median duration of an untreated depressive episode.
Journal of Consulting and Clinical Psychology, 1998
The role of gender was examined in the process and outcome of therapy in the treatment of depress... more The role of gender was examined in the process and outcome of therapy in the treatment of depressed outpatients seen in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Patients received either interpersonal therapy, cognitive-behavioral therapy, imipramine plus clinical management, or placebo plus clinical management. None of the therapist-patient by gender groupings (i.e., therapist gender, therapist-patient gender matching vs. mismatching, or patients' beliefs about whether a male or female therapist would be more helpful) were significantly related to measures of treatment process and outcome, controlling for type of treatment and severity of pretreatment depressive symptoms. Findings were duplicated when examining the effects of gender within only the psychotherapeutic modes of treatment for the groupings of therapist gender and therapist-patient gender matching versus mismatching.
This paper describes the aims, background, design, and methods used in a collaborative longitudin... more This paper describes the aims, background, design, and methods used in a collaborative longitudinal study of Axis II personality disorders (PDs). This study examines the putative stability of selected PD diag noses and criteria, what factors affect their course, and whether thenstability and course distinguishes them from a representative Axis I dis order. This article also describes the acquisition and demographics of the sample on whom the study is being done. A prospective, repeated measures investigation of the stability of PDs is now underway at multiple clinical settings in four collaborating urban sites in Boston, New Haven, New York, and Providence. Diagnos tic assignments are based on semistructured interview assessments (by clinically trained raters) and confirmed by at least one additional con trasting diagnostic method. The sample consists of 668 treatment seeking and reliably diag nosed adults recruited from a broad range of clinical sites. By design, patients in the sample met standards for one of five diagnostic sub groups: (a) schizotypal [N = 86); (b) borderline (IV = 175); (c) avoidant [N = 157); (d) obsessive-compulsive (N = 153) personality disorders or a con trol group having (e) major depressive disorder without personality dis order (IV = 97).
The aims of the present investigation were (a) to examine associations between posttraumatic stre... more The aims of the present investigation were (a) to examine associations between posttraumatic stress disorder (PTSD; diagnosis and symptoms) and different aspects of functioning, severity, and subjective distress among Operation Iraqi Freedom and Operation Enduring Freedom National Guard and Reserve veterans, and (b) to examine the unique contribution of PTSD symptom clusters to different aspects of functioning and distress. Participants were 124 veterans who had returned from war-zone deployment. A PTSD diagnosis and PTSD symptoms were significantly associated with nearly all of the psychosocial functioning and distress measures, controlling for Axis I disorders and other covariates. Of the PTSD symptom clusters, numbing/avoidance symptoms were the strongest predictors of interpersonal and social functioning, and hyperarousal symptoms were the strongest predictors of overall severity and distress. In addition to death and physical injury, the cost of war includes a large mental health and public health burden. Comprehensive research on Vietnam veterans has found that psychiatric disorders, including posttraumatic stress disorder (PTSD), are frequent consequences of war-zone exposure (e.g., Kulka et al., 1990). Research on Vietnam veterans has also documented significant functional impairment among those with PTSD. Findings from the National Vietnam Veterans' Readjustment Study (Kulka et al., 1990) showed that Vietnam veterans with PTSD had greater work impairment and unemployment, higher rates of marital problems and divorce, poorer physical health, greater physical limitations, greater rates of violence perpetration, and more medical utilization than those without PTSD (Kulka et al., 1990; Zatzick et al., 1997). In addition to PTSD diagnosis, continuously assessed symptoms of PTSD (i.e., higher total PTSD symptom scores) have also been associated with poorer functioning in veteran samples (Magruder et al.
Individuals with a history ofdepression are characterized by high levels of certain personality t... more Individuals with a history ofdepression are characterized by high levels of certain personality traits, particularly neuroticism, introversion, and interpersonal dependency. The authors examined the "scar hypothesis, " i. e. , the possibility that episodes of niajor depression result in lasting personality changes that persist beyond recovery from the depression. Method: A large sample offirst-degree relatives, spouses, and comparison subjects ascertained in connection with the proband sample from the National Institute ofMental Health Collaborative Program oiz the Psychobiology ofDepression were assessed at two points in time sepa
This article considers the relationship between chronic mood disorders and depressive personality... more This article considers the relationship between chronic mood disorders and depressive personality from several perspectives. A historical overview of various theoretical, descriptive, and empirically based typologies is provided as well as a review of the relevant classifications from the psychiatric nomenclatures. The defining features of the different conceptions of chronic depression and depressive personality then are considered within the framework of dimensional models of personality, including the dimensions of positive and negative affectivity, and the five-factor model. It is proposed that these dimensional models may provide a useful integrating framework for future work in this area.
The concept of dependency has its roots in psychoanalytic theory, social psychological theory, an... more The concept of dependency has its roots in psychoanalytic theory, social psychological theory, and ethologic theory (Hirschfeld, Klerman, Chodoff, Korchin, 6k Barrett, 1976). Psychoanalytic theory emphasizes the attain ment of instinctual aims through interaction with social objects, such as the mother, as the source of dependency. Social learning theories consider dependency to be a learned behavior, that is, one acquired in experience rather than being instinctual in the organism. More specifically, de pendency refers to a class of behaviors stemming from the infant's initial reliance on the mother: subsequently these learned behaviors generalize to interpersonal relations in general. In ethological theory the concept of attachment has been proposed to refer to the affectional bond that one person forms to another specific individual. This bond is manifested by behaviors fostering proximity to and contact with the love object and by behavioral disruptions if separation occurs.
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Papers by M. Shea