The "Truman Show" delusion: psychosis in the global village.

INTRODUCTION: We report a novel delusion, primarily persecutory in form, in which the patient believes that he is being filmed, and that the films are being broadcast for the entertainment of others. METHODS: We describe a series of patients who presented with a delusional system according to which they were the subjects of something akin to a reality television show that was broadcasting their daily life for the entertainment of others. We then address three questions, the first concerning how to characterise the delusion, the second concerning the role of culture in delusion, and the third concerning the implications of cultural studies of delusion for the cognitive theory of delusion. RESULTS: Delusions are both variable and stable: Particular delusional ideas are sensitive to culture, but the broad categories of delusion are stable both across time and culture. This stability has implications for the form a cognitive theory of delusion can take. CONCLUSIONS: Cultural studies of delusion have important contributions to make to the cognitive theory of delusion.

Psychiatry and terrorism.

Terrorism has dominated the domestic and international landscape since 9/11. Like other fields, psychiatry was not well prepared. With the 10th anniversary of the 9/11 attack approaching, it is timely to consider what can be done to prepare before the next event. Much has been learned to provide knowledge and resources. The roles of psychiatrists are challenged by what is known of the causes of, consequences of, and responses to terrorism. Reflecting on knowledge from before and since 9/11 introduces concepts, how individuals become terrorists, how to evaluate the psychiatric and behavioral effects of terrorism, and how to expand treatments, behavioral health interventions, public policy initiatives, and other responses for its victims. New research, clinical approaches, and policy perspectives inform strategies to reduce fear and cope with the aftermath. This article identifies the psychiatric training, skills and services, and ethical considerations necessary to prevent or reduce terrorism and its tragic consequences and to enhance resilience.

Competitive personality attitudes and forgiveness of others.

The authors conducted a survey to determine whether competitive attitudes are differentially associated with forgiveness or lack of forgiveness of others. The results showed that hypercompetitiveness was associated with a lack of forgiveness, whereas personal development competitiveness was associated positively with forgiveness. Discussion centers on the need to discourage socialization practices that foster the adoption of a self-contained individualism that is associated with a maladaptive hypercompetitiveness. Instead, parents should promote an ensembled individualism that is associated with a psychologically healthy personal development competitive orientation.

Value priorities and intention to register for posthumous organ donation in Dutch adolescents.

The authors conducted a survey to identify knowledge level about organ donation and the kinds of personal values associated with intent to register as an organ donor. Participants' levels of knowledge were modest but associated positively with intent to register. Knowledge deficiencies about organ donation suggest the need for education-based programs designed to overcome these limitations. Also, students who scored higher in social conformity but lower in hedonism values expressed a greater intent to register, which indicated that personal values could play a role in future health education campaigns designed to increase the supply of donor organs available for transplantation. Furthermore, appeals could be tailored to the primary values of adolescents at particular stages of ego development to facilitate their willingness to register as donors.

Assessing competition avoidance as a basic personality dimension.

The lack of an adequate psychometric instrument has impeded personality theory testing in the area of competition avoidance. The authors conducted 6 studies in an attempt to remedy this deficiency by constructing an individual-difference measure of competition avoidance. In line with K. Horney's (1937) interpersonal theory of neurosis, participants who were higher in competition avoidance showed higher levels of neuroticism, greater fears of both success and failure, a lower desire to prove themselves in competitive situations, higher levels of self-handicapping, and more maladaptiveness than those participants who were lower in competition avoidance. Also, they were more modest and willing to conform to group standards than were those lower in competition avoidance. The authors discuss the measure's potential usefulness as a diagnostic and assessment tool in academic, athletic, and clinical settings.

Psychological sequelae of the September 11 terrorist attacks in New York City.

BACKGROUND: The scope of the terrorist attacks of September 11, 2001, was unprecedented in the United States. We assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and depression among residents of Manhattan five to eight weeks after the attacks. METHODS: We used random-digit dialing to contact a representative sample of adults living south of 110th Street in Manhattan. Participants were asked about demographic characteristics, exposure to the events of September 11, and psychological symptoms after the attacks. RESULTS: Among 1008 adults interviewed, 7.5 percent reported symptoms consistent with a diagnosis of current PTSD related to the attacks, and 9.7 percent reported symptoms consistent with current depression (with "current" defined as occurring within the previous 30 days). Among respondents who lived south of Canal Street (i.e., near the World Trade Center), the prevalence of PTSD was 20.0 percent. Predictors of PTSD in a multivariate model were Hispanic ethnicity, two or more prior stressors, a panic attack during or shortly after the events, residence south of Canal Street, and loss of possessions due to the events. Predictors of depression were Hispanic ethnicity, two or more prior stressors, a panic attack, a low level of social support, the death of a friend or relative during the attacks, and loss of a job due to the attacks. CONCLUSIONS: There was a substantial burden of acute PTSD and depression in Manhattan after the September 11 attacks. Experiences involving exposure to the attacks were predictors of current PTSD, and losses as a result of the events were predictors of current depression. In the aftermath of terrorist attacks, there may be substantial psychological morbidity in the population.

What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder?

Participants included 165 children with attention-deficit/hyperactivity disorder (ADHD; 130 boys, 35 girls) and their 1,298 same-sex classmates (1,026 boys, 272 girls) who served as raters. For each child with ADHD, a child of the same sex was randomly selected from the same classroom to serve as a comparison child, which yielded 165 dyads. Consistent with predictions, contrasted with the comparison children, those with ADHD were lower on social preference, higher on social impact, less well liked, and more often in the rejected social status category; they also had fewer dyadic friends. When liking ratings that children made versus received were examined, children with ADHD had less positive imbalance and greater negative imbalance relative to comparison children. Analyses that considered the types of peers who chose children with ADHD as friends or nonfriends demonstrated that children with ADHD were nominated as nonfriends by children of higher social preference and who were better liked by others.

An investigation of the psychological effects of the September 11, 2001, attacks on New York City: developing and implementing research in the acute postdisaster period.

The September 11, 2001, attack on New York City was the largest human-made disaster in United States history. In the first few days after the attack, it became clear that the scope of the attacks (including loss of life, property damage, and financial strain) was unprecedented and that the attacks could result in substantial psychological sequelae in the city population. Researchers at the Center for Urban Epidemiologic Studies at the New York Academy of Medicine designed and implemented an assessment of the mental health of New Yorkers 5-8 weeks after the attacks. To implement this research in the immediate postdisaster period, researchers at the center had to develop, in a compressed time interval, new academic collaborations, links with potential funders, and unique safeguards for study respondents who may have been suffering from acute psychological distress. Results of the assessment contributed to a New York state mental health needs assessment that secured Federal Emergency Management Agency funding for mental health programs in New York City. This experience suggests that mechanisms should be in place for rapid implementation of mental health assessments after disasters.

Opposites do not attract: social status and behavioral-style concordances and discordances among children and the peers who like or dislike them.

Homophily, a term used to describe the tendency to associate with similar others, serves as a basis for attraction among children. The converse may also be true. Dissimilarity appears to contribute to dislike. In one of the only published studies to examine homophily and its converse, D. W. Nangle, C. A. Erdley, and J. A. Gold (1996) found that children were liked by peers who were similar to them in social status and behavioral style and disliked by peers who were dissimilar to them in social status and behavioral style. Examining gender influences, we were only able to partially replicate their findings in the present study. That is, evidence of homophily was found only for girls. In contrast, dissimilarity contributed to dislike for both genders, but was especially evident for boys. With respect to age, prosocial behavior appeared to have a more positive valence among younger girls. whereas aggressive behavior appeared to have a more negative valence among older boys. Attempts to reconcile these findings with those of the Nangle et al. (1996) investigation and the implications for understanding peer processes, gender influences, and behavior problems are discussed.

Television images and psychological symptoms after the September 11 terrorist attacks.

Exposure to graphic television images may exacerbate psychological symptoms in disaster situations. We tested the hypotheses that (1) more frequent viewing of television images of the September 11 terrorist attacks was associated with posttraumatic stress disorder (PTSD) and depression, and that (2) direct exposure to disaster events had an interactive effect with media viewing. We recruited 1,008 adult residents of the borough of Manhattan in New York City through a random-digit-dial telephone survey conducted between October 16 and November 15, 2001. Respondents who repeatedly saw "people falling or jumping from the towers of the World Trade Center" had higher prevalence of PTSD (17.4%) and depression (14.7%) than those who did not (6.2% and 5.3%, respectively). Among respondents who were directly affected by the attacks (e.g., had a friend killed), those who watched this television image frequently were more likely to have PTSD and depression than those who did not. Among respondents not directly affected by the attacks, prevalence of PTSD and depression was not associated with frequency of television image viewing. Specific disaster-related television images were associated with PTSD and depression among persons who were directly exposed to a disaster. Future research should address causal directionality of this association.

Participant reactions to survey research in the general population after terrorist attacks.

There remains concern that survey research after a disaster can precipitate or exacerbate distress among study participants. The authors surveyed 5,774 persons in three random-digit-dial telephone surveys of the general population of New York City conducted 1-2 months, 4-5 months, and 6-9 months after the terrorist attack on September 11, 2001. Overall, 746 (12.9%) people who finished the surveys said that the survey questions were upsetting but only 57 (1.0% overall) were still upset at the end of the interview, and 19 (0.3%) wanted assistance from a counselor. Ten persons who did not finish the survey also received counselor assistance. Persons with mental health symptoms were more likely to find the survey questions emotionally upsetting as were participants who lacked salutary resources, including health insurance and a regular health care provider. Although relatively few of those interviewed found the survey assessment disturbing, the presence of a small number of respondents who wanted mental health assistance suggests the need for a mental health backup system for research conducted soon after exposure to large-scale traumatic events.

Peer-assessed outcomes in the multimodal treatment study of children with attention deficit hyperactivity disorder.

Peer-assessed outcomes were examined at the end of treatment (14 months after study entry) for 285 children (226 boys, 59 girls) with attention deficit hyperactivity disorder (ADHD) who were rated by their classmates (2,232 classmates total) using peer sociometric procedures. All children with ADHD were participants in the Multimodal Treatment Study of Children with ADHD (MTA). Treatment groups were compared using the orthogonal treatment contrasts that accounted for the largest amount of variance in prior MTA outcome analyses: Medication Management + Combined Treatment versus Behavior Therapy + Community Care; Medication Management versus Combined Treatment; Behavior Therapy versus Community Care. There was little evidence of superiority of any of the treatments for the peer-assessed outcomes studied, although the limited evidence that emerged favored treatments involving medication management. Post hoc analyses were used to examine whether any of the four treatment groups yielded normalized peer relationships relative to randomly selected-classmates. Results indicated that children from all groups remained significantly impaired in their peer relationships.

Attitudes and Values: A Further Test of the Semantic Memory Model.

A hierarchical model for the storage of attitudes and values, for which evidence was presented by Gold and Russ, was studied with the use of a choice reaction time paradigm. Twenty three male and female university students responded with evaluative judgments (good-bad, etc.) by pressing one of two telegraph keys to a series of stimuli consisting of 10 of Rokeach's terminal values, 10 values designed by the authors to be the opposites of these terminal values, and 42 attitude items. Items preceded by values to which they were related, as determined through a previously administered paper and pencil measure, were responded to faster than items preceded by unrelated values. The value RT's did not vary as a function of their relatedness to the preceding attitude items. Positively held values were responded to faster than negatively held values. No RT effects were found for matching or mismatching in the evaluative sign of the attitude item-value or value-attitude item pairs. The results were interpreted as supporting a hierarchical storage model of attitudes and values.

A Measure of Clustering in Free Recall Utilizing the Parameters of the Original Stimulus List.

A measure of clustering in free recall based upon the parameters of the original stimulus list (R/Opt. R) was proposed and compared with five other measures for eight recall protocols. The R/Opt. R measure was shown to be relatively independent of the length of the recall protocol, but yielded higher scores where fewer categories were utilized. Optimum clustering was defined not simply in terms of perfect ordering of elements within the protocol but also in terms of the number of categories and items within those categories in the original stimulus list.

Semantics and Structure: A Comparison between Monolingual and Bilingual Subjects.

Twenty English-speaking monolinguals and 20 French-American bilinguals were given 11 words to encode in order to obtain certain measures of codability: latency, reaction time, number of words, number of syllables, and interpersonal agreement. In addition, the semantic differential was administered in order to obtain an indication of meaning intensity. Although the classical coding measures correlated with each other in expected directions for both groups, intensity of meaning was inversely correlated with the coding measures only for the monolingual group. For the bilinguals, intensity was directly related to the coding measures. The results imply that although coding measures do hold up between groups, they may mean different things. Words that have intense meaning for bilinguals may be those that elicit a host of associations; while for monolinguals, the most semantically intense words elicit few associations.

Infatuation and Attraction to a Dissimilar Other: Why is Love Blind?

The present experiment attempted to increase understanding of the "love is blind" phenomenon. White male American undergraduates exposed to an infatuation induction with an attitudinally dissimilar female confederate showed greater attraction to her than unexposed control subjects. The use of a misattribution-of-arousal manipulation eliminated this difference in attraction between the infatuation induction and control groups, thereby providing support for the role of positive emotional arousal in creating attraction toward the dissimilar other in the infatuation condition. Evidence was also found that suggested that attraction toward the dissimilar other was based not on a distortion by the subjects of her dissimilar attitudes, but rather on a more favorable evaluation of these attitudes.

Increased use of cigarettes, alcohol, and marijuana among Manhattan, New York, residents after the September 11th terrorist attacks.

The September 11, 2001, terrorist attacks were the largest human-made disaster in the United States since the Civil War. Studies after earlier disasters have reported rates of psychological disorders in the acute postdisaster period. However, data on postdisaster increases in substance use are sparse. A random digit dial telephone survey was conducted to estimate the prevalence of increased cigarette smoking, alcohol consumption, and marijuana use among residents of Manhattan, New York City, 5-8 weeks after the attacks. Among 988 persons included, 28.8% reported an increase in use of any of these three substances, 9.7% reported an increase in smoking, 24.6% reported an increase in alcohol consumption, and 3.2% reported an increase in marijuana use. Persons who increased smoking of cigarettes and marijuana were more likely to experience posttraumatic stress disorder than were those who did not (24.2% vs. 5.6% posttraumatic stress disorder for cigarettes; 36.0% vs. 6.6% for marijuana). Depression was more common among those who increased than for those who did not increase cigarette smoking (22.1 vs. 8.2%), alcohol consumption (15.5 vs. 8.3%), and marijuana smoking (22.3 vs. 9.4%). The results of this study suggest a substantial increase in substance use in the acute postdisaster period after the September 11th attacks. Increase in use of different substances may be associated with the presence of different comorbid psychiatric conditions.

Consumption of cigarettes, alcohol, and marijuana among New York City residents six months after the September 11 terrorist attacks.

Early analyses following the September 11 terrorist attacks on New York City showed an increase in cigarette, alcohol, and marijuana use, but it was unknown whether these increases would persist. A random-digit dial phone survey was conducted to estimate the prevalence of increased substance use among residents of New York City six to nine months after the attacks. Among 1570 adults, 9.9% reported an increase in smoking, 17.5% an increase in alcohol use, and 2.7% an increase in marijuana use compared to the month before September 11. These increases were comparable to increases reported in the first one to two months after September 11. Persons who increased use of cigarettes were more likely than those who did not to report symptoms consistent with posttraumatic stress disorder (PTSD) in the past month (4.3% and 1.2% respectively). Depression was more common among those who increased use of cigarettes (14.6% and 5.2% respectively), alcohol (11.8% vs. 5.2%), and marijuana (34.1% vs. 5.3%). Among residents living in Manhattan below One Hundred Tenth Street, the prevalence of PTSD and depression declined by more than half in the first six months after September 11, while the increase in substance use did not decline substantially. These results suggest that the increase in substance use after a disaster may be a cause for public health concern in the long-term.

Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks.

The authors investigated trends in probable post-traumatic stress disorder (PTSD) prevalence in the general population of New York City in the first 6 months after the September 11 terrorist attacks. Three random digit dialing telephone surveys of adults in progressively larger portions of the New York City metropolitan area were conducted 1 month, 4 months, and 6 months after September 11, 2001. A total of 1,008, 2,001, and 2,752 demographically representative adults were recruited in the three surveys, respectively. The current prevalence of probable PTSD related to the September 11 attacks in Manhattan declined from 7.5% (95% confidence interval: 5.7, 9.3) 1 month after September 11 to 0.6% (95% confidence interval: 0.3, 0.9) 6 months after September 11. Although the prevalence of PTSD symptoms was consistently higher among persons who were more directly affected by the attacks, a substantial number of persons who were not directly affected by the attacks also met criteria for probable PTSD. These data suggest a rapid resolution of most of the probable PTSD symptoms in the general population of New York City in the first 6 months after the attacks. The psychological consequences of a large-scale disaster in a densely populated urban area may extend beyond persons directly affected by the disaster to persons in the general population.