Diferencias en el estilo atribucional y de la autoestima en una muestra de pacientes delirantes / Comparative analysis of attributional and self-esteem in a sample of patients with delusions and control subjets

ABSTRACT

Introduction The attributional along with the self-esteem (that plays a central role in the development and maintenance of the pathological state) is a very important mediating element in the delusion, so we find the necessity to realise basic studies of these processes. In the field of psychology, and mainly in the personality area, the atributional has a great relevance, when understanding the causal attributions like mechanisms of facing that guide the conduct of the subject. In this way, we see the importance that supposes the study of the dysfunctional attribution to be able to replace it on the other adaptive, mainly in the pathologies where delusions beliefs exist. In the present investigation the influence has been analyzed that carries out the variable attributional and the self-esteem in the delusional ideas (defined by the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] as <belief based on the realization of incorrect inferences about external reality, beliefs that are held firmly believe despite of almost everyone else, and despite of constitutes an obvious proof or evidence otherwise indisputable>>) in a sample of delusional patients in comparison with a group control. Most of the research, focus on the dimension of <research), is to examine attributional biases in the reasoning of delirious patients. Therefore, the departure hypotheses are the following a) the delusional patients, more than the normal subjects, will realise in their social reasoning more external attributions for the negative events that stop the positives; b) the delusional patients, like the control group, tend to realise global and excessively stable attributions, as much for positive events as for negative events; and c) the delusional patients in comparison with the control group will indicate a high self-esteem. Patients and methods To carry out this research both self-esteem and attributional have been tested in a sample of 20 delusional in-patients (85% are men and 15% women of average age of 36.20 years) entered the unit of Rehabilitation of a Psychiatric Hospital of Santiago de Compostela (Spain) and have been compared to 40 normal control subject in age and sex with the experimental group that do not own psychiatric history, no upheaval that requires treatment. The criteria of inclusion have been the following a) all of the patients were entered the unit of Rehabilitation, b) the patients had delusional ideas at the moment of the tests, c) their diagnosis fulfilled the criteria according to DSM-IV for paranoid schizophrenia (16 patients) and delusions upheaval (paranoid) (4 patients), d) the ages of the patients had to be included between 20 and 50 years, e) none of the patients had a history of drug use, f) patient did not show evidence of organic brain disorders, g) all of them had a score in items 1 (delusion), 5 (magnitude), and 6 (mistrust/damage) in the positive scale of PANSS (PANSS-P) of more than 3, and h) all the patients had more than 5 years of disease. One is comparative, observational, and cross-sectional and homodemic a study according to the propose classification by Feinstein and with a design of cases and controls. The instruments applied in the study were a) Rosenberg Self-esteem Scale (EA), is an instrument for assessing the patient's global self-esteem; b) Attributional Questionnaire (ASQ), which is a self-administered questionnaire consisting of twelve situations, six positive (success) and six negative (failure), against which the subject must indicate the causes they attribute its occurrence; and c) Positive and Negative Syndrome Scale for Schizophrenia (PANSS), suitable for evaluation of positive and negative symptoms in schizophrenia. Of the thirty items included in the PANSS, seven are positive scale (PANSS-P), seven the negative scale (PANSS-N), and the sixteen remaining general psychopathology scale (PANSS-PG). All the instruments used for the study, count on their corresponding data of reliability and validity. In this investigation a descriptive analysis of the object of study has been carried out variable, which provided us the frequency allocation, percentage, averages, medians and standard deviations for each of them. Results The results of this investigation show that the delusional patients realised more external attributions for the negative events that the group normal control, and more internal for the positives. The delusional patients realised a causal attribution in stability and globality for the negative events similar to the one of the normal ones. Nevertheless, before positive events have been significant differences between both groups in relation to the stability, not thus for the globality. Also the delusional patients, like the group normal control, indicated a high self-esteem. In the statistic analysis has not been significant differences in self-esteem between the delusional group and the group control that the hypothesis supports that the delusional ones have a high self-esteem with respect to the normal ones. Conclusion The hypothesis raised by Bentall has not been able to state in this investigation, since when analyzing the variable self-esteem we observed that their scores are similar to the group control of normal. According to the atribucional , one concludes that the delusional subjects tend to blame their failures and errors to the other people or other circumstances. On the other hand, when they are successful in some situation, they consider that it must to them themselves, attributing the favourable events to internal level. The conclusions of the analysis of the globality dimension, which determines the temporary generalization of the expectation, do not fulfil the hypothesis in which it affirmed that the delusional subjects, like the normal ones, excessively realised global attributions as much for positive facts as for negative, but do not indicate an exaggerated slant towards the excessive globality. The hypothesis raised by Bentall that the delusion reflect a defensive atribucional , which protects the individual against feelings of low self-esteem, has not been possible to state in this investigation, since when analyzing the variable self-esteem we observed that significant differences in the delusional patients do not exist, since their scores are similar to the group control, showing a both high self-esteem. By all this, it is possible to be concluded that it enters the delusional patients and the group control only exists significant differences taking care of the atribucional of each group. However, such studies contribute along with other made in the understanding of these disorders and consequently to the development of effective psychological program with the aim of improving the symptoms of these patients and even in other pathologies.

RESUMEN

Introducción El estilo atribucional y la autoestima (que cumple un papel central en el desarrollo y mantenimiento del estado patológico) son elementos mediadores muy importantes en el delirio. De ahí la necesidad de realizar estudios básicos de dichos procesos. En el campo de la psicología, y en concreto en el área de personalidad, el estilo atribucional es de gran relevancia al entender las atribuciones causales como mecanismos de afrontamiento que guían la conducta del sujeto. Por ello, la importancia que supone el estudio de la atribución disfuncional para poder sustituirla por otra adaptativa, sobre todo en las patologías donde existen creencias delirantes. En la presente investigación se ha analizado el papel que desempeñan la variable estilo atribucional y la autoestima en las ideas del irantes en una muestra de pacientes delirantes en comparación con un grupo control. Pacientes y métodos En esta investigación se ha examinado la autoestima y los sesgos atribucionales en una muestra de 20 pacientes delirantes (85% son hombres y 15% mujeres de edad media de 36.20 años) ingresados en la unidad de Rehabilitación de un Hospital Psiquiátrico de Santiago de Compostela (España) y se ha comparado con 40 sujetos control normales igualados en edad y sexo con el grupo experimental que no poseen historia psiquiátrica, ni ningún trastorno que requiera tratamiento. Se trata de un estudio comparativo, observacional, transversal y homodémico según la clasificación propuesta por Feinstein y con un diseño de casos y controles. Los instrumentos aplicados en el estudio fueron a) la Escala de Autoestima de Rosenberg (Rosenberg Self-esteem Scale, EA), b) el Cuestionario de Estilo Atribucional (Attributional Questionnaire, ASQ) y c) la Escala de Síndrome Positivo y Negativo en la Esquizofrenia (Positive and Negative Syndrome Scale for Schizophrenia, PANSS). Todos los instrumentos empleados para el estudio cuentan con sus correspondientes datos de fiabilidad y validez. Resultados Los resultados de esta investigación muestran que los pacientes delirantes realizaron atribuciones más externas para los eventos negativos que el grupo control normal, y más internas para los positivos. Los pacientes delirantes realizaron una atribución causal en estabilidad y globalidad para los sucesos negativos similar a la de los normales. Sin embargo, ante eventos positivos se han encontrado diferencias significativas entre ambos grupos en relación con la estabilidad, no así para la globalidad. Asimismo, los pacientes delirantes, al igual que el grupo control normal, manifestaron una alta autoestima. Conclusión La hipótesis planteada por Bentall no se ha podido constatar en esta investigación, ya que al analizar la variable autoestima observamos que sus puntuaciones son similares al grupo control de sujetos normales. Según el estilo atribucional, se concluye que los sujetos delirantes tienden a culpar por sus fallos y errores a las demás personas o a otras circunstancias. Por el contrario, cuando ellos tienen éxito en alguna situación, consideran que se debe a ellos mismos, y atribuyen los eventos favorables a nivel interno. Las conclusiones del análisis de la dimensión globalidad, la cual determina la generalización temporal de la expectativa, no cumplen la hipótesis en la cual se afirmaba que los sujetos delirantes, al igual que los normales, realizaban atribuciones excesivamente globales tanto para hechos positivos como para negativos, pero no manifiestan un sesgo exagerado hacia la excesiva globalidad.