Measuring Change in Attachment Insecurity Using Short Forms of the ECR-R: Longitudinal Measurement Invariance and Sensitivity to Treatment.

Attachment insecurity is important for psychotherapy both as an aspect influencing the therapeutic process as well as potential outcome variable of a treatment. Two German short forms of the Experiences in Close Relationships - Revised (ECR-R) have been proposed to assess individual differences in attachment anxiety and avoidance. In this research, we examined whether these questionnaires are suitable for measuring change in attachment anxiety and avoidance by testing longitudinal measurement invariance in two independent clinical samples (N1 = 493, N2 = 273) using a pre-post design. Results indicated that strict longitudinal measurement invariance can be assumed for both measures. Thus, changes in scale scores before and after treatment can be interpreted as changes in the latent dimensions of attachment anxiety and avoidance. Both questionnaires were also sensitive to treatment in that attachment insecurity was overall reduced after therapy. Although both measures appear to be generally suitable for investigating treatment effects, they exhibited consistent problems with structural validity across samples that should be reexamined in future research.

[Assessing Relationship Satisfaction with Four Items? Psychometric Evaluation of the Ultra-short German Version of the Dyadic Adjustment Scale (DAS-4)]. / Erfassung der Partnerschaftszufriedenheit mit vier Items? Psychometrische Evaluation der deutschen Version einer Kurzform der Dyadic Adjustment Scale (DAS-4).

The quality of an individual's relationship plays a central role in their personal well-being as well as their mental and physical health. Despite its great importance, there are only a few ultra-short self-report measures for the assessment of relationship quality. An exception is the four-item version of the Dyadic Adjustment Scale (DAS-4), which is gaining increasing popularity internationally. In this study, the German version of the DAS-4 was evaluated for the first time with regard to its psychometric properties in a general population sample of individuals in a romantic relationship (N=1296). In addition to satisfactory item characteristics, the unidimensional measurement model showed sufficient goodness of fit and the internal consistency was satisfactory (ω=0.80). Measurement invariance was shown for men and women based on the latent construct of the DAS-4. In line with the hypothesis, associations of the DAS-4 with gender, general life satisfaction, psychopathology and attachment styles were found, which suggests construct validity. Despite the lack of application experiences and pending psychometric analyses of the DAS-4 in relevant target groups, such as individuals in couples counselling or therapy, the four-item version can be recommended for assessing relationship satisfaction.

[Validation of a German version of the self-rating Adult Disorganized Attachment scale (ADA-D)]. / Validierung der deutschsprachigen Version der Adult Disorganized Attachment Scale (ADA-D).

OBJECTIVE: Disorganized attachment represents the greatest risk factor for psychopathology compared to the "organized" insecure attachment dimensions in various meta-analyses. Recently, the Adult Disorganized Attachment Scale (ADA) was developed as a self-rating scale for measuring disorganized attachment in romantic partnerships. However, a translation and evaluation in German-speaking samples is not yet available. METHODS: A German Translation of the scale (ADA-D) comprising nine items was assessed in a general population sample (N=1101) and in a student sample (N=328). The factor structure, psychometric properties, and validity of the scale with respect to psychopathology and the Experiences in Close Relationships questionnaire (ECR-RD) were examined. The differential associations of ADA-D and ECR-RD with psychopathology were determined using linear regression models. RESULTS: The unidimensional factor structure of the original version could be confirmed for the ADA-D and the instrument exhibited high internal consistency (McDonalds ω=0.91 / 0.89). Compared to attachment anxiety and avoidance, ADA-D was the strongest predictor of dissociative symptoms (Sample 1: ß=0.48; p<0.001; Sample 2: ß=0.23; p<0.01) and, in Sample 1, additionally for physical aggression (ß=0.37; p<0.001). DISCUSSION: The ADA-D exhibits good psychometric properties that are comparable to the original version of the scale. The associations with aggressiveness and dissociation are in line with previous findings regarding the unresolved attachment status in the Adult Attachment Interview. CONCLUSION: The ADA-D can be recommended for further use in research as a screening instrument for disorganized attachment in adulthood. An application in psychotherapeutic diagnostics seems promising, however, evaluations in clinical samples are necessary beforehand.

[Parental Stress: Psychometric Evaluation of the German Version of the Parental Stress Scale in the General Population]. / Stress durch Elternschaft: Psychometrische Evaluation der deutschen Version der Parental Stress Scale in der Allgemeinbevölkerung.

Parental stress has negative impact on parents and their children. Parental stress may be of special interest for family and child well-being due to Covid-19 pandemic. A reliable and valid assessment of parental stress would be beneficial both in research and clinical practice. The Parental Stress Scale (PSS) is internationally well established as an economic and psychometric valid assessment. It consists of 18 items. The study evaluated the factor structure of the German version of the PSS in a general population (n=386 parents with children<16 years) for the first time. The sample was part of a representative sample (n=2519). The confirmatory factor analysis did not confirm internationally previously reported models. Eliminating one item, the explorative factor analysis suggested a two factor structure with the dimensions "lack of confident" and "worries and strain". Both subscales showed a good internal consistence (McDonalds ω≥0,87). We observed correlations of the PSS-17 items with family dysfunction and elevated scores for depressive or anxiety symptoms, but not with sociodemographic factors. One conclusion is that the multidimensional construct of parental stress maybe is not comprehensively represented by the PSS. For the use in clinical practice and research this has to be taken into account. Albeit, the German version of the PSS is an economic, reliable and valid assessment.

[Assessment of General Family Functioning: Psychometric Evaluation of the German Version of the Brief Assessment of Family Functioning Scale]. / Die Erfassung des allgemeinen familiären Funktionsniveaus: Psychometrische Evaluation der deutschen Version der Brief Assessment of Family Functioning Scale.

The functionality of the family system is not only a central theme in developmental psychology and family research, but also plays a key role in many physical illnesses and mental disorders. Despite its high relevance, there are only a very few brief and user-friendly self-report measures assessing general family functioning. This gap is closed by the Brief Assessment of Family Functioning Scale (BAFFS), which consists of three items of the General Functioning Scale of the internationally well-established Family Assessment Device. In this study, the German version (KSAFF) of the BAFFS was psychometrically evaluated for the first time in a large and representative general population sample (n=2463). Using multigroup confirmatory factor analyses, strong measurement invariance was shown for relevant subsamples (women vs. men; participants in partnerships with vs. without children) with good model fit. Although one of the three items, which is the only negatively formulated item, yielded insufficient psychometric item characteristics, the internal consistency was Cronbach's α=0.71. As an indication of adequate construct validity, associations of family functioning with socioeconomic status as well as with current depression and anxiety were found in accordance with the hypothesis. Although application experiences and psychometric analyses of the German version of the BAFFS in relevant clinical samples are pending, this three-item self-report measure can be recommended as an economic, user-friendly assessment device for general family functioning, particularly since it yielded satisfactory to good psychometric properties in the general population.

[Attachment predicts changes in the level of personality functioning after psychotherapeutic inpatient treatment]. / Bindung als Prädiktor von Strukturveränderungen im Verlauf von stationärer Psychotherapie.

Objectives: The relationship between patients' attachment strategies and the effectiveness of psychotherapy is empirically well established. However, studies on outcome measures other than symptomatic change are mostly lacking. The present study investigates if attachment anxiety and avoidance predict changes in personality functioning at the end of inpatient psychotherapy. Method: In two independent samples (the first sample consisting of N = 967 diagnostically heterogeneous patients, Fachklinikum Tiefenbrunn, and the second sample comprising N = 344 patients with personality impairments, Rehaklinik Bad Grönenbach), personality functioning was assessed by means of the short version of the OPD structure questionnaire OPD-SQS (OPD-Strukturfragebogen 12-Item-Screeningversion, OPD-SFK) at admission and discharge in a naturalistic study design. Data on the Brief Symptom Inventory (BSI) and the Inventory of Interpersonal Problems (IIP-32) were evaluated as additional outcome measures in the first sample. Patients' attachment strategies were assessed at admission using the German short version of the Experiences in Close Relationships (ECR-RD 12). Results: Attachment avoidance at baseline was inversely associated with improvements in personality functioning, psychopathology, and interpersonal problems. In the sample of patients diagnosed with personality disorders (sample 2), we found a negative association between attachment anxiety and improvements in the ability to make contact with others. Conclusions: Considering the limitations, our results underline the relevance of attachment for the treatment outcome of inpatient psychotherapy. The assessment of patient's attachment strategy as part of standardized diagnostics can be helpful in clinical practice regarding prognosis, therapy planning as well as the adjustment of the therapeutic relationship while treating patients suffering from impairments in personality functioning.

Childhood maltreatment and lung function: findings from the general population.

OBJECTIVE: Cumulative evidence indicates that childhood maltreatment is linked to self-reported asthma and COPD. However, the relationship between childhood maltreatment and objective measures of lung function as determined by spirometry has not yet been assessed. METHODS: Medical histories and spirometric lung function were taken in 1386 adults from the general population. Participants completed the Childhood Trauma Questionnaire for the assessment of emotional, physical and sexual abuse as well as emotional and physical neglect. RESULTS: 25.3% of the participants reported at least one type of childhood maltreatment. Among them, use of medication for obstructive airway diseases as well as typical signs and symptoms of airflow limitation were significantly more frequent than in the group without exposure to childhood maltreatment. Although participants with childhood maltreatment had numerically lower values for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow than those without, these differences were nonsignificant when accounting for relevant covariates such as age, sex, height and smoking. Likewise, there were no differences in the FEV1/FVC ratio nor in the frequency of airflow limitation regardless of its definition. No specific type of childhood maltreatment was related to spirometrically determined parameters of lung function. CONCLUSIONS: Our findings call into question the association of childhood maltreatment with obstructive lung diseases as indicated by prior research relying on self-reported diagnoses. We consider several explanations for these discrepancies.

Childhood Maltreatment and Subclinical Atherosclerosis: Findings From the General Population.

OBJECTIVE: Evidence suggests that childhood maltreatment (CM) is cross-sectionally and prospectively associated with cardiovascular disease. However, its association with proxy markers of atherosclerosis has hardly been investigated. Thus, in this general population study, we examined the association of CM with carotid plaque and intima-media thickness. METHODS: Adults from the general population free of any cardiovascular disease (n = 1909; mean [SD] age = 50.4 (13.6) years, 53.9% women) completed the self-report Childhood Trauma Questionnaire for the assessment of emotional, physical, and sexual abuse as well as emotional and physical neglect; in addition, an ultrasound of the carotid arteries was performed in each participant. RESULTS: At least one type of CM was reported by 25% of the participants. Carotid plaque was significantly more frequent in those with CM compared with those without (odds ratio = 1.47, 95% confidence interval = 1.19-1.81). Accounting for age and sex rendered it nonsignificant (odds ratio = 1.07, 95% confidence interval = 0.81-1.42). Emotional abuse and physical neglect were significantly associated with both carotid intima-media thickness and plaque occurrence, but these associations were fully explained by risk factors. Neither sexual nor physical abuse was related to proxy markers of atherosclerosis. CONCLUSIONS: Our findings suggest that the relationship between CM types and subclinical atherosclerosis as well as its clinical end points is complex and remains inconclusive, suggesting the need for further research.

[Measurement of Change with the Short Form of the OPD Structure Questionnaire (OPD-SQS)]. / Veränderungsmessung mit der Kurzform des OPD-Strukturfragebogens (OPD-SFK).

The transdiagnostic concept of personality structure plays a key role in psychodynamic nosology, since many mental and psychosocial disorders are considered mainfestations of structural vulnerabilities and deficits. Therefore, structural diagnostics is of particular importance, especially with respect to the planning of tailor-made psychotherapeutic interventions. Because changes in personality structure are increasingly being considered as a relevant therapeutic goal, any measures employed towards achieving this goal should be sensitive enough to capture these changes appropriately. Although the short form of the OPD Structure Questionnaire (OPD-SQS) can easily be administered and is therefore frequently used in clinical and research settings, its sensitivity to change has not yet been analyzed. Two large, independent and diagnostically heterogeneous samples of inpatient psychotherapy patients (n=1183 and n=967, respectively) completed the OPD-SQS both at admission and before discharge. Standardized Effect Size (SES), Standardized Response Mean (SRM) and Smallest Real Difference (SRD) were computed as indicators of the measure's ability to capture change. For the OPD-SQS and its subscales, low effect sizes were found in both samples (SES between 0.23 and 0.48; SRM between 0.27 and 0.53). Additionally, it was demonstrated that greater changes among patients with structural deficits were detectable with the OPD-SQS compared to those without structural deficits, and that these group differences were significant. By means of the SRD, we determined a proportion of about 22% of patients with significantly structurally improved changes in both samples. Despite some methodological issues, our findings suggest that the OPD-SQS is suitable for measuring changes in personality structure in inpatients between the beginning and the end of treatment. Since studies on the sensitivity to change of similar assessment tools are still pending, it is not yet possible to formulate any empirically validated recommendations as to which of the measure best captures therapeutically induced changes in personality structure.

[Psychometric evaluation of the Experiences in Close Relationships Revised German 12-item version (ECR-RD 12) in a sample of psychotherapeutic inpatients]. / Evaluation der deutschsprachigen Kurzform des Experiences in Close Relationships Questionnaire (ECR-RD 12) im stationären Psychotherapiesetting.

Psychometric evaluation of the Experiences in Close Relationships Revised German 12-item version (ECR-RD 12) in a sample of psychotherapeutic inpatients Objectives: The ECR-R assesses the self-description of adult attachment strategies in romantic relationships. The present study evaluates the psychometric properties of the German 12-item short version ECR-RD 12 in a large sample of patients in psychotherapeutic inpatient treatment. Method: Inpatients in psychotherapeutic treatment (N = 2231) were assessed using the ECR-RD 12 and other clinical questionnaires. Its psychometric properties and factor structure of were evaluated. Results: The psychometric properties of the short form measure were in line with the German full length version (ECR-RD). In contrast to theoretical assumptions, factor analysis suggested a three factor solution in the present sample. Discussion: The ECR-RD 12 can be recommended as a screening measure for assessing attachment styles in inpatient psychotherapeutic settings. Further studies are required to investigate the factor structure of the measure in clinical samples.

[Comparison of Self-Reported Childhood Maltreatment Between East and West Germany]. / Selbstberichtete Kindesmisshandlungen im Vergleich zwischen Ost- und Westdeutschland.

OBJECTIVE: The socioecological model emphasize the relevance of political, cultural and economic socialization effects for the prevalence of childhood maltreatment, which are analyzed by comparing child maltreatment between East and West German subjects who came of age before the fall of the Berlin Wall. METHODS: Using an online survey, a representative general population sample with respect to age, gender distribution and income was assessed regarding child maltreatment and current psychological distress using standardized self-report instruments. RESULTS: Of 507 study participants, 22,5% reported being born and socialized in East Germany. They reported significantly less emotional abuse than the 77,5% who grew up in the FRG. The East and West German subjects did not differ in any other form of abuse. CONCLUSION: Our findings underline the importance of socialization and enculturation effects on memory, which should be considered when interpreting the results.

Childhood maltreatment, traumatic experiences, and posttraumatic stress disorder in pathological skin picking: An online case-control study.

OBJECTIVE: Although traumatic stress including childhood maltreatment (CM) has a profound impact on mental health, its relation to pathological skin picking (PSP) has been understudied and results remain inconclusive. Likewise, posttraumatic stress disorder (PTSD) as the most typical sequelae of traumatic stress has hardly been investigated in those with PSP. The objective of our online case-control study was to shed further light on this issue. METHODS: Using an anonymous online survey, 325 adult participants with PSP defined by Skin Picking Scale-Revised (SPS-R) scores ≥ 7 as well as Skin Picking Impact Scale (SPIS) scores ≥ 7 were administered the Childhood Trauma Questionnaire (CTQ), the Short Screening Scale for DSM-IV PTSD (PTSD-7) including a list of traumatic events, and a brief measure of psychopathological distress. They were compared to an age-, sex-, and education-matched control group recruited online by means of analyses of variance (ANOVA). RESULTS: The PSP sample scored significantly higher on the CTQ dimensions of sexual and emotional abuse as well as emotional neglect with small to moderate effect sizes (d between 0.27 and 0.49). Accounting for psychological distress, the only significant difference related to emotional abuse with a small effect (d = 0.23). Participants with PSP reported significantly more traumatic experiences in adulthood than the control group (59.1% vs. 38.2%; χ2(1; N=638) = 28.02, p < .001). Among those with PSP, a probable diagnosis of PTSD was found in 44 (13.5%) compared to zero cases in the control group. CONCLUSIONS: Our findings indicate that emotional abuse in childhood may be of relevance in skin picking. Since exposure to traumatic events in adulthood as well as PTSD seem to be more frequent in those with PSP compared to a control group, it might be worthwhile to consider these factors in the assessment of patients with skin picking.

Prevalence of pathological skin-picking in dermatological patients.

OBJECTIVE: The prevalence of pathological skin-picking (PSP) has predominantly been studied in students and the community, but not yet in dermatological patients. However, those may be at increased risk of PSP because it is often triggered by the feel or look of the skin. Thus, its prevalence among patients with a physician-diagnosed dermatological disease remains to be determined. METHODS: A consecutive series of 460 adult patients attending a dermatological university outpatient clinic was administered the 8-item Skin Picking Scale-Revised (SPS-R). They also reported demographic data and rated the severity of their skin disease. The dermatologist evaluating the patient provided his/her diagnosis. RESULTS: PSP as defined by SPS-R scores ≥7 was reported by 121 participants (26.3%). It was significantly more frequent in patients with atopic dermatitis (AD, OR = 3.23; 95% CI: 1.95-5.68) and psoriasis (OR = 1.64; 95% CI: 1.00-2.67), but less frequent in those with malignant epithelial skin tumors (OR = 0.10; 95% CI: 0.02-0.43). PSP was not associated with female gender or younger age. CONCLUSIONS: Our findings indicate that PSP affects about one in four patients with skin disease. In particular, individuals suffering from atopic dermatitis may represent a high-risk population for PSP deserving early recognition and adequate treatment.

Association of traumatic stress and posttraumatic stress disorder with carotid atherosclerosis: findings from the general population.

Background: Cumulative evidence suggests that both traumatic stress and posttraumatic stress disorder (PTSD) are cross-sectionally and prospectively linked to cardiovascular disease (CVD). However, their association with proxy markers of atherosclerosis has hardly been investigated. Objective: The objective of this general population study was to relate traumatic stress and PTSD to carotid plaque and intima-media thickness (cIMT). Methods: 3119 adults from the general population were assessed regarding their traditional cardiovascular risk factors, and an ultrasound of the carotid arteries was performed in each participant. Based on a PTSD interview, every participant was assigned to one of three groups: no trauma; trauma, but no PTSD; and trauma with PTSD. The sample was stratified into five age groups. Results: Trauma exposure was reported by 54.5% of the sample and 2.0% had PTSD. Traumatized participants had increased odds of self-reported CVD events compared to those without trauma exposure, even when accounted for CVD risk factors and other covariates (odds ratio [OR] = 1.51; 95% confidence interval [CI]: 1.03-2.22). This association was driven by those aged 70 years or older. Only in those aged 40 to 49 years, there was an association between cIMT and PTSD. There were no further associations between carotid plaque or cIMT and traumatic stress or PTSD. Conclusions: Our findings in concert with prior research suggest that the association between traumatic stress, PTSD and atherosclerosis as well as its clinical endpoints is complex and remains inconclusive.

Antecedentes: La evidencia acumulada sugiere que tanto el estrés traumático como el trastorno de estrés postraumático (TEPT) están vinculados de manera transversal y prospectiva con la enfermedad cardiovascular (ECV). Sin embargo, apenas se ha investigado su asociación con marcadores indirectos de aterosclerosis.Objetivo: El objetivo de este estudio de población general fue relacionar el estrés traumático y el TEPT con la placa carotídea y el grosor de la íntima-media (GIMc).Métodos: Se evaluó a 3119 adultos de la población general respecto a factores de riesgo cardiovascular tradicionales y se realizó una ecografía de las arterias carótidas en cada participante. Basado en una entrevista de TEPT, cada participante fue asignado a uno de tres grupos: sin trauma; trauma, pero no TEPT; y trauma con TEPT. La muestra se estratificó en cinco grupos de edad.Resultados: El 54,5% de la muestra informó exposición al trauma y el 2,0% tenía TEPT. Los participantes traumatizados tenían mayores probabilidades de eventos de ECV auto-reportados en comparación con los sin exposición al trauma, incluso cuando se tienen en cuenta los factores de riesgo de ECV y otras covariables (razón de posibilidades [OR] = 1,51; intervalo de confianza [IC] del 95%: 1,03-2,22). Esta asociación fue mayormente determinada por personas de 70 años o más. Solo en los de 40 a 49 años, hubo una asociación entre cIMT y TEPT. No hubo más asociaciones entre la placa carotídea o el cIMT y el estrés traumático o el TEPT.Conclusiones: Nuestros hallazgos, en conjunto con investigaciones anteriores, sugieren que la asociación entre el estrés traumático, el TEPT y la aterosclerosis, así como sus criterios de valoración clínicos, es compleja y no es concluyente.