The ups and downs of self-criticism and disordered eating: Complementing Paranjothy and Wade's (2024) analysis by considering both trait and state perspectives.

Paranjothy and Wade's (2024) meta-review reveals that individuals higher in the personality trait of self-criticism consistently experience more disordered eating than those lower in the trait. The clinical implications of this meta-review are important in that they suggest current theoretical models and clinical practices in the field of eating disorders should incorporate a greater focus on self-criticism. Building on this exciting contribution, we highlight conceptual, practical, and empirical reasons why the field would benefit from supplementing this research on trait self-criticism with investigations of state self-criticism. We review research showing that self-criticism levels vary not only between individuals, with some people chronically more self-critical than others, but also within a person, with a given individual enacting relatively more self-criticism during some moments and days than others. We then present emerging research showing that these periods of higher-than-usual self-criticism are associated with more disordered eating. Thus, we emphasize the need to explore the factors that give rise to self-critical states in daily life, and review preliminary findings on this topic. We highlight the ways in which research on within-person variations in self-criticism can complement research on trait self-criticism to advance case formulation, prevention, and treatment in the field of eating disorders.

Self-compassion promotes positive mental health in women with anorexia nervosa: A two-week daily diary study.

Despite the importance of positive mental health, little is known about its facilitators in people with eating disorders (EDs). Drawing on past research, we hypothesized that self-compassion might be a contributing factor to positive mental health in individuals with EDs. In a two-week daily diary study of women (N = 32) with anorexia nervosa, we investigated whether self-compassion levels-on average, on a given day, and from one day to the next-predicted social safeness (i.e. a sense of social connection and warmth) and positive affect, both indicators of positive mental health. Multilevel modeling revealed that, controlling for ED symptoms, (1) higher daily self-compassion, (2) increases in self-compassion from the previous day, and (3) higher trait self-compassion, were associated with greater positive affect and social safeness. Findings suggest that in addition to reducing ED symptoms in people with EDs, as documented by prior research, the cultivation of self-compassion might facilitate improved emotional and social well-being in this population.

The whole is more than the sum of its parts: A qualitative investigation of body-dissatisfied college women's experiences of relational body image.

Research on relational body image suggests that women's body image changes across their important relationships, with women most at risk for maladaptive body image reporting the most extreme changes. To enrich our understanding of relational body image beyond that offered by prior psychologically-based quantitative research, the present study integrated critical-feminist approaches. Eighteen female-identified university students participated in a one-on-one semi-structured interview. Each participant first completed ratings of her body image across seven important relationships, which the interviewer used to create a graph depicting her relational body image. The interviewer shared the graph with the participant to prompt reflection on her subjective experiences of relational body image and asked her a series of questions. Reflexive thematic analysis, informed by a critical-realist framework, was used to identify themes. One overarching theme, "The Whole Is More than The Sum of Its Parts," demonstrated how relational body image may be understood as a unique configuration of interconnected factors within a specific relationship. Three subthemes then highlighted how interpersonal, idiographic, and systemic factors come together to influence subjective experiences of relational body image. The present results suggest that personalized treatment targets within specific relationships may be a worthwhile focus for future body image interventions.

Collaborative care in eating disorders treatment: exploring the role of clinician distress, self-compassion, and compassion for others.

BACKGROUND: Collaborative care is described as showing curiosity and concern for patient experiences, providing choices, and supporting patient autonomy. In contrast, in directive care, the clinician has authority and the patient is expected to adhere to a treatment plan over which they have limited influence. In the treatment of eating disorders, collaborative care has been shown to be more acceptable and produce better outcomes than directive care. Despite widespread patient and clinician preference for collaborative care, it is common for clinicians to be directive in practice, resulting in negative patient attitudes toward treatment and poor adherence. There is a need to understand factors which contribute to its use. PURPOSE: This study examined the contribution of clinicians' experience of distress and how they relate to themselves and others in times of difficulty (self-compassion and compassion for others), to their use of collaborative support. METHOD: Clinicians working with individuals with eating disorders from diverse professional backgrounds (N = 123) completed an online survey. RESULTS: Whereas clinician distress was not associated with use of collaborative or directive support behaviours, self-compassion and compassion for others were. Regression analyses indicated that compassion for others was the most important determinant of collaborative care. DISCUSSION: Relating to their own and others' distress with compassion was most important in determining clinicians' use of collaborative support. Understanding how to cultivate conditions that foster compassion in clinical environments could promote the delivery of collaborative care.

A daily diary study of self-compassion and adaptive coping behaviours in women with symptoms of bulimia nervosa.

BACKGROUND: Mental health is more than the absence of illness and includes the ability to cope adaptively with stress. To shed light on the factors that promote mental health in people with eating disorders, this daily diary study examined whether daily and trait levels of self-compassion predict adaptive coping behaviours in women with symptoms of bulimia nervosa (BN). METHODS: Women (N = 124) who met the DSM-5 criteria for BN completed 2 weeks of nightly measures assessing their daily level of self-compassion and their daily adaptive coping behaviours, namely, their use of problem-solving strategies, seeking and receiving of instrumental social support, and seeking and receiving of emotional social support. RESULTS: Multilevel modelling revealed that on days when self-compassion levels were higher than their personal mean level or than the preceding day's level, participants reported greater use of problem-solving strategies, greater seeking and receiving of instrumental social support, and greater receiving of emotional social support. Daily levels of self-compassion, but not increased self-compassion from the preceding day, were associated with emotional support sought. Further, higher trait self-compassion, as measured by participants' mean level of self-compassion over the 2 weeks, was associated with increased seeking and receiving of instrumental and emotional social support but not with problem-solving strategies. All models controlled for participants' daily and mean eating pathology over the 2 weeks, highlighting the unique contribution of self-compassion to adaptive coping behaviours. CONCLUSIONS: Results suggest that self-compassion may help individuals with symptoms of BN cope with challenges in their daily life more adaptively, an integral component of positive mental health. The present study is among the first to suggest that the benefits of self-compassion for individuals with eating disorder symptoms may lie not only in facilitating reduced eating pathology, as evidenced by prior research, but also in promoting positive mental health. More broadly, findings underscore the potential value of interventions designed to build self-compassion in individuals with eating disorder symptoms.

There is a call in the eating disorder field to identify factors that not only reduce eating disorder symptoms, but also promote positive mental health. Yet, the factors that interventions might target to accomplish both of these goals remain relatively unknown. Self-compassion, which is a way of responding to personal distress with care and understanding, has been linked to fewer eating disorder symptoms. In non-eating disorder populations, self-compassion also promotes adaptive coping behaviours, including problem-solving and calling on others for support, key aspects of mental health. To test whether these benefits of self-compassion extend to people with eating disorders, we had women with symptoms of bulimia nervosa complete questionnaires about their daily level of self-compassion and their daily adaptive coping behaviours every night for 2 weeks. We found that on days when women were more self-compassionate than usual or more self-compassionate than the day before, they reported using more adaptive coping strategies. Further, individuals who were generally more self-compassionate than others over the 2 weeks reported receiving more social support from others. Our results are the first to suggest that, by treating themselves with compassion, individuals with eating disorder symptoms may cope more effectively with challenges in daily life.

Improvements in Compassion and Fears of Compassion throughout the COVID-19 Pandemic: A Multinational Study.

During large-scale disasters, social support, caring behaviours, and compassion are shown to protect against poor mental health outcomes. This multi-national study aimed to assess the fluctuations in compassion over time during the COVID-19 pandemic. Respondents (Time 1 n = 4156, Time 2 n = 980, Time 3 n = 825) from 23 countries completed online self-report questionnaires measuring the flows of compassion (i.e., Compassionate Engagement and Action Scales) and fears of compassion toward self and others and from others (i.e., Fears of Compassion Scales) and mental health at three time-points during a 10-month period. The results for the flows of compassion showed that self-compassion increased at Time 3. Compassion for others increased at Time 2 and 3 for the general population, but in contrast, it decreased in health professionals, possibly linked to burnout. Compassion from others did not change in Time 2, but it did increase significantly in Time 3. For fears of compassion, fears of self-compassion reduced over time, fears of compassion for others showed more variation, reducing for the general public but increasing for health professionals, whilst fears of compassion from others did not change over time. Health professionals, those with compassion training, older adults, and women showed greater flows of compassion and lower fears of compassion compared with the general population, those without compassion training, younger adults, and men. These findings highlight that, in a period of shared suffering, people from multiple countries and nationalities show a cumulative improvement in compassion and reduction in fears of compassion, suggesting that, when there is intense suffering, people become more compassionate to self and others and less afraid of, and resistant to, compassion.

An Implementation Roadmap for Establishing Remote Infectious Disease Specialist Support for Consultation and Antibiotic Stewardship in Resource-Limited Settings.

Infectious Disease (ID)-trained specialists, defined as ID pharmacists and ID physicians, improve hospital care by providing consultations to patients with complicated infections and by leading programs that monitor and improve antibiotic prescribing. However, many hospitals and nursing homes lack access to ID specialists. Telehealth is an effective tool to deliver ID specialist expertise to resource-limited settings. Telehealth services are most useful when they are adapted to meet the needs and resources of the local setting. In this step-by-step guide, we describe how a tailored telehealth program can be implemented to provide remote ID specialist support for direct patient consultation and to support local antibiotic stewardship activities. We outline 3 major phases of putting a telehealth program into effect: pre-implementation, implementation, and sustainment. To increase the likelihood of success, we recommend actively involving local leadership and other stakeholders in all aspects of developing, implementing, measuring, and refining programmatic activities.

Alkaline State of the Domain-Swapped Dimer of Human Cytochrome c: A Conformational Switch for Apoptotic Peroxidase Activity.

A 2.08 Å structure of an alkaline conformer of the domain-swapped dimer of K72A human cytochrome c (Cytc) crystallized at pH 9.9 is presented. In the structure, Lys79 is ligated to the heme. All other domain-swapped dimer structures of Cytc have water bound to this coordination site. Part of Ω-loop D (residues 70-85) forms a flexible linker between the subunits in other Cytc domain-swapped dimer structures but instead converts to a helix in the alkaline conformer of the dimer combining with the C-terminal helix to form two 26-residue helices that bracket both sides of the dimer. The alkaline transition of the K72A human dimer monitored at both 625 nm (high spin heme) and 695 nm (Met80 ligation) yields midpoint pH values of 6.6 and 7.6, respectively, showing that the Met80 → Lys79 and high spin to low spin transitions are distinct. The dimer peroxidase activity increases rapidly below pH 7, suggesting that population of the high spin form of the heme is what promotes peroxidase activity. Comparison of the structures of the alkaline dimer and the neutral pH dimer shows that the neutral pH conformer has a better electrostatic surface for binding to a cardiolipin-containing membrane and provides better access for small molecules to the heme iron. Given that the pH of mitochondrial cristae ranges from 6.9 to 7.2, the alkaline transition of the Cytc dimer could provide a conformational switch to tune the peroxidase activity of Cytc that oxygenates cardiolipin in the early stages of apoptosis.

In silico analysis of soil, sediment and groundwater microbial communities to predict biodegradation potential.

This study examined soil, sediment and groundwater microbial communities for a set of key functional genes important for contaminant biodegradation. This involved PICRUSt2 (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States) predictions based on 16S rRNA gene amplicon datasets from three separate studies with different inocula and incubation conditions, as follows: aerobic soils, oxygen-limited microcosms containing sediments and groundwater, as well as methanogenic microcosms with different inocula. PICRUSt2 predicts functional profiles of microbial communities based on marker gene (16S rRNA gene) data. The relative abundances of genera previously associated with the biodegradation of chlorinated solvents/metabolites and/or 1,4-dioxane were also determined. Predicted values for each functional gene varied between the three datasets. In all, values were high for propane monooxygenase and low for soluble methane monooxygenase. Common phylotypes associated with propane monooxygenase in two of the three datasets included Mycobacterium, Rhodococcus and Pseudonocardia. Toluene monooxygenase predicted values were greater in the oxygen-limited microcosms compared to the other two datasets. The methanogenic microcosms exhibited the highest predicted values for particulate methane/ammonia monooxygenase. The most common genera detected, previously reported as chlorinated solvents/metabolites and/or 1,4-dioxane degraders, included Pseudomonas, Sphingomonas, Rhodococcus and Rhodanobacter. Eighteen of the queried genera were not detected. As expected, more potential anaerobic degrading genera were found in the oxygen-limited and methanogenic microcosms compared to the aerobic soils. The results provide key insights as to which genes and genera may be important for biodegradation over a range of inocula and redox conditions.

Individual differences in relational body image: Within-person variability predicts maladaptive trait body image.

Findings have been mixed as to whether individual differences in within-person variability in body image predict maladaptive body image and eating behaviors. The current study aimed to resolve this ambiguity by addressing limitations of past research. First, we measured within-person variability in body image across the context-sensitive domain of relationships. Second, we incorporated the latest statistical methods to increase the robustness of the results. Online, 189 female-identified undergraduates completed seven baseline measures of trait body image. At least three days later, in-lab, participants were guided to generate a list of the most important people in their lives (i.e., friends, family members, close others) using egocentric network methods. Participants then completed a set of three relationship-specific measures in which they reported on their typical body image with 10 people from their list, one by one. Multiverse analysis tested the hypothesis that, across combinations of measures, within-person variability in relational body image would positively predict indicators of maladaptive body image. In 84 regression analyses, permutation testing supported our overall hypothesis (p = .006); however, results varied across different model specifications. Results provide further evidence for the predictive power of within-person variability in body image and yield valuable methodological and statistical recommendations.

Self-compassion and its barriers: predicting outcomes from inpatient and residential eating disorders treatment.

BACKGROUND: Individuals with eating disorders (EDs) experience barriers to self-compassion, with two recently identified in this population: Meeting Standards, or concerns that self-compassion would result in showing flaws or lead to loss of achievements or relationships, and Emotional Vulnerability, or concerns that self-compassion would elicit difficult emotions such as grief or anger. This exploratory study examined the utility of self-compassion and two barriers to self-compassion in predicting clinical outcomes in intensive ED treatments. METHOD: Individuals in inpatient (n = 87) and residential (n = 68) treatment completed measures of self-compassion and fears of self-compassion, and ten clinical outcome variables at pre- and post-treatment. RESULTS: Pre-treatment self-compassion was generally not associated with outcomes, whereas pre-treatment self-compassion barriers generally were. In both treatment settings, fewer Emotional Vulnerability barriers were associated with improved interpersonal/affective functioning and quality of life, and fewer Meeting Standards barriers were associated with improved readiness and motivation. Interestingly, whereas Meeting Standards barriers were associated with less ED symptom improvement in inpatient treatment, Emotional Vulnerability barriers were associated with less ED symptom improvement in residential treatment. CONCLUSIONS: Given that few longitudinal predictors of outcome have been established, the finding that pre-treatment barriers to self-compassion predict outcomes in both inpatient and residential settings is noteworthy. Targeting self-compassion barriers early in treatment may be helpful in facilitating ED recovery.

Self-compassion is associated with a number of positive health indicators and has been shown to support recovery from an eating disorder. This exploratory study examined whether self-compassion and barriers to self-compassion predict clinical outcomes in inpatient and residential eating disorders treatment settings. Whereas self-compassion was rarely associated with outcome, self-compassion barriers were associated with the majority of variables investigated. Given that few longitudinal predictors have been established in this field, the relation between barriers to self-compassion and outcome in both inpatient and residential settings is noteworthy. Targeting self-compassion barriers early in treatment may be helpful in facilitating eating disorder recovery.

Adaptive body image can be contagious: An examination of college women facing situational body image threats.

The present research examined whether and which adaptive body image displays in peers can promote more adaptive body image in self. In two studies, female-identified undergraduates recalled a personally distressing body image event. In Study 1, participants (N = 158) then heard an alleged female-identified peer responding to her own distressing body image event with either self-compassion, self-esteem enhancement, or distraction. Participants across conditions reported increased body acceptance and body image-related self-compassion, and decreased body image distress, but changes did not vary by condition. Study 2 sought to determine which component(s) common to Study 1's conditions explained the benefits participants experienced. Participants (N = 207) listened to an alleged peer: describe body image distress with which she coped adaptively; express body image distress but no adaptive coping; or deny body image distress and relate positively to her body. Hearing a peer cope adaptively with body image distress yielded the greatest body image benefits, whereas hearing a peer deny body image distress was generally least helpful. Results suggest that learning how a peer copes adaptively with body image distress may be most helpful in the face of personal body image distress, and support the overarching theory that adaptive body image may be socially transmissible.

Compassion Protects Mental Health and Social Safeness During the COVID-19 Pandemic Across 21 Countries.

Objectives: The COVID-19 pandemic is having an unprecedented detrimental impact on mental health in people around the world. It is important therefore to explore factors that may buffer or accentuate the risk of mental health problems in this context. Given that compassion has numerous benefits for mental health, emotion regulation, and social relationships, this study examines the buffering effects of different flows of compassion (for self, for others, from others) against the impact of perceived threat of COVID-19 on depression, anxiety, and stress, and social safeness. Methods: The study was conducted in a sample of 4057 adult participants from the general community population, collected across 21 countries from Europe, Middle East, North America, South America, Asia, and Oceania. Participants completed self-report measures of perceived threat of COVID-19, compassion (for self, for others, from others), depression, anxiety, stress, and social safeness. Results: Perceived threat of COVID-19 was associated with higher scores in depression, anxiety, and stress, and lower scores in social safeness. Self-compassion and compassion from others were associated with lower psychological distress and higher social safeness. Compassion for others was associated with lower depressive symptoms. Self-compassion moderated the relationship between perceived threat of COVID-19 on depression, anxiety, and stress, whereas compassion from others moderated the effects of fears of contracting COVID-19 on social safeness. These effects were consistent across all countries. Conclusions: Our findings highlight the universal protective role of compassion, in particular self-compassion and compassion from others, in promoting resilience by buffering against the harmful effects of the COVID-19 pandemic on mental health and social safeness. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-021-01822-2.

The role of social connection on the experience of COVID-19 related post-traumatic growth and stress.

BACKGROUND: Historically social connection has been an important way through which humans have coped with large-scale threatening events. In the context of the COVID-19 pandemic, lockdowns have deprived people of major sources of social support and coping, with others representing threats. Hence, a major stressor during the pandemic has been a sense of social disconnection and loneliness. This study explores how people's experience of compassion and feeling socially safe and connected, in contrast to feeling socially disconnected, lonely and fearful of compassion, effects the impact of perceived threat of COVID-19 on post-traumatic growth and post-traumatic stress. METHODS: Adult participants from the general population (N = 4057) across 21 countries worldwide, completed self-report measures of social connection (compassion for self, from others, for others; social safeness), social disconnection (fears of compassion for self, from others, for others; loneliness), perceived threat of COVID-19, post-traumatic growth and traumatic stress. RESULTS: Perceived threat of COVID-19 predicted increased post-traumatic growth and traumatic stress. Social connection (compassion and social safeness) predicted higher post-traumatic growth and traumatic stress, whereas social disconnection (fears of compassion and loneliness) predicted increased traumatic symptoms only. Social connection heightened the impact of perceived threat of COVID-19 on post-traumatic growth, while social disconnection weakened this impact. Social disconnection magnified the impact of the perceived threat of COVID-19 on traumatic stress. These effects were consistent across all countries. CONCLUSIONS: Social connection is key to how people adapt and cope with the worldwide COVID-19 crisis and may facilitate post-traumatic growth in the context of the threat experienced during the pandemic. In contrast, social disconnection increases vulnerability to develop post-traumatic stress in this threatening context. Public health and Government organizations could implement interventions to foster compassion and feelings of social safeness and reduce experiences of social disconnection, thus promoting growth, resilience and mental wellbeing during and following the pandemic.

A two-week daily diary study examining the association between daily self-compassion and symptoms of bulimia nervosa.

OBJECTIVES: Individuals with symptoms of bulimia nervosa (BN) are more likely to binge and purge on days of greater negative affect. Given that self-compassion helps individuals cope more adaptively with distress, the present study examined the contribution of daily fluctuations in self-compassion to eating disorder symptoms in women who endorse symptoms of BN. The directionality of these associations was also examined. METHOD: For 2 weeks, 124 women who met the DSM-5 criteria for BN completed nightly measures of their daily eating pathology and self-compassion. RESULTS: Self-compassion levels varied almost as much within a person from day-to-day as between-persons (i.e., from one person to the next). Multilevel modeling revealed that within persons, higher daily levels of self-compassion were associated with a reduced probability of both binge eating and inappropriate compensation, and lower levels of dietary restraint and clinical impairment. Secondary analyses revealed that these variables mutually influenced one another within but not across days. Between persons, higher mean levels of self-compassion over the 2 weeks were associated with less dietary restraint and clinical impairment but were unrelated to binge eating and compensatory behaviors. DISCUSSION: For women who report symptoms consistent with BN, responding to daily distress with greater self-compassion than usual may attenuate the psychosocial and behavioral symptoms of their eating disorder. Similarly, days of reduced eating pathology may facilitate self-compassion. Future research using experimental paradigms and ecological momentary assessments may shed further light on the ways in which self-compassion and eating pathology relate to one another in this population.

Fears of compassion magnify the harmful effects of threat of COVID-19 on mental health and social safeness across 21 countries.

BACKGROUND: The COVID-19 pandemic is a massive global health crisis with damaging consequences to mental health and social relationships. Exploring factors that may heighten or buffer the risk of mental health problems in this context is thus critical. Whilst compassion may be a protective factor, in contrast fears of compassion increase vulnerability to psychosocial distress and may amplify the impact of the pandemic on mental health. This study explores the magnifying effects of fears of compassion on the impact of perceived threat of COVID-19 on depression, anxiety and stress, and social safeness. METHODS: Adult participants from the general population (N = 4057) were recruited across 21 countries worldwide, and completed self-report measures of perceived threat of COVID-19, fears of compassion (for self, from others, for others), depression, anxiety, stress and social safeness. RESULTS: Perceived threat of COVID-19 predicted increased depression, anxiety and stress. The three flows of fears of compassion predicted higher levels of depression, anxiety and stress and lower social safeness. All fears of compassion moderated (heightened) the impact of perceived threat of COVID-19 on psychological distress. Only fears of compassion from others moderated the effects of likelihood of contracting COVID-19 on social safeness. These effects were consistent across all countries. CONCLUSIONS: Fears of compassion have a universal magnifying effect on the damaging impact of the COVID-19 pandemic on mental health and social safeness. Compassion focused interventions and communications could be implemented to reduce resistances to compassion and promote mental wellbeing during and following the pandemic.

Why would I want to be more self-compassionate? A qualitative study of the pros and cons to cultivating self-compassion in individuals with anorexia nervosa.

OBJECTIVE: Although self-compassion facilitates eating disorder symptom remission, individuals with eating disorders are fearful of developing it and higher fears of self-compassion are associated with poorer treatment outcomes. In-depth exploration of individuals' pros and cons of behaviour change is generally helpful at resolving ambivalence; however, no research has examined the pros and cons individuals with eating disorders perceive to be associated with developing self-compassion, limiting our understanding of their personal experiences when confronted with self-compassion. Given the research suggesting higher resistance to self-compassion development in individuals with anorexia nervosa (AN), the present study used qualitative methods to gain a deeper understanding of their perceived pros and cons to self-compassion. METHODS: Thirty-seven women with typical (64%) and atypical (36%) AN signed up for a study on self-help strategies for daily distress. Upon learning that the intervention would entail cultivating self-compassion, they identified their perceived pros and cons of developing self-compassion by typing them out. RESULTS: Thematic analysis was used to extract themes. Three superordinate cons and four superordinate pros of self-compassion emerged. Perceived cons were as follows: self-compassion leading to personal shortcomings; apprehension and doubt about the efficacy of self-compassion; and emotional challenges associated with developing self-compassion. Perceived pros were as follows: improved health; personal development (e.g., growth, coping); improved outlook; and enhanced social relationships. CONCLUSIONS: These findings reveal the various advantages and disadvantages that women with AN perceive to be associated with developing self-compassion. Results may help clinicians work more sensitively and effectively when trying to cultivate self-compassion in patients who have AN. PRACTITIONER POINTS: This research suggests that patients with anorexia nervosa (AN) perceive various disadvantages to cultivating self-compassion, but also certain advantages. By familiarizing themselves with the pros and cons to self-compassion identified by individuals with AN, clinicians may be able to more effectively listen to and communicate with their patients about ambivalence about self-compassion development. Clinicians may want to listen for and explore concerns in their AN patients that self-compassion will lead to personal shortcomings, fail to be beneficial, and be emotionally challenging. Clinicians may want to listen for and help patients elaborate upon their beliefs about how self-compassion might benefit their outlook, health, personal development, and relationships.

The sociocultural and behavioural characteristics that patients want in psychiatrists: cross-sectional survey of patients' views.

AIMS AND METHOD: There appears to be no research to date investigating patients' preferences for sociocultural characteristics or behavioural qualities of psychiatrists. We aimed to assess which are most important to patients. Patients (132) in community mental health teams across two sites (East Cornwall, East London) completed a questionnaire ranking the importance of different sociocultural characteristics and behaviours of psychiatrists. RESULTS: Patients cared more about age and gender than other characteristics. Four preferences (from a choice of ten) regarding behavioural qualities were clearly identified as important: explaining things clearly, dedication to personal treatment, being friendly and polite, and being up to date with medical knowledge. CLINICAL IMPLICATIONS: Patients are fairly unconcerned about the age, gender, religion and social background of psychiatrists. Characteristics they care about most include communication skills, competence, dedication to personal treatment and friendliness. Explaining things clearly is particularly important. This indicates specific areas of improvement for training and further research.