The psychological challenge of genital injury.

INTRODUCTION: Injuries sustained from Improvised Explosive Devices (IEDs) can have a devastating impact on bodily integrity; physical injuries can be severe and include traumatic amputation of limbs, pelvic fracture, abdominal trauma, extremity fragmentation wounds and genital trauma. Soldiers suffering from genital trauma can experience overwhelming emotions and adjusting to their injuries is a process that occurs over time, that some find easier than others. This paper explores current practice and identifies guidelines for psychological interventions within this arena. METHODS: Relevant associated literature has been reviewed to identify the long-term consequences of genital trauma and to ascertain best practice in supporting this patient population. Current practices within the Royal Centre for Defence Medicine (RCDM) and the Defence Medical Rehabilitation Centre (DMRC) Headley Court have been explored. RESULTS: There is little published literature in this area. Therefore, in respect of guiding treatment of this patient population, related research on the psychological consequences of prostate and penile cancer, limb amputation, acquired infertility and acquired disability has been used as a base to inform interventions. Current practices at RCDM and DMRC have been found to support interventions within related areas. CONCLUSIONS: There is no published evidence base to guide psychological interventions for genital trauma. Professional multidisciplinary intervention will potentially be beneficial in establishing the long-term needs of this patient population, together with qualitative research exploring the experience of soldiers suffering genital trauma.

A clinical follow-up study of reserve forces personnel treated for mental health problems following demobilisation.

BACKGROUND: The Reserves Mental Health Programme (RMHP) provides a clinical service for members of the United Kingdom's Reserve Forces deployed to combat operations since 2003. AIM: To assess whether mental health and occupational functioning changed after treatment. METHODS: We examined a treatment group with operationally attributable mental health problems and a non-intervention group with non-operationally attributable problems. A self-report, repeat measures study design examined post traumatic stress disorder (PTSD), common mental disorders, alcohol use and occupational functioning at follow up delivered by either telephone or post. RESULTS: One hundred three reservists were offered an initial assessment. Adjusted response rates were 66.7% (n=16) for the no treatment group and 62.7% (n=37) for the treatment group. The treatment group were more likely to be cases at baseline on all mental health outcome measures other than PTSD, but at follow up, they were no more likely to be so. A one-way ANCOVA was conducted to evaluate treatment outcome. This was not significant for all measures except for PTSD. On completion of treatment, three quarters of serving personnel returned to full occupational fitness. CONCLUSION: The RMHP appears to offer a clinically and occupationally effective intervention to recently de-mobilised reservists with operationally attributable mental health problems.

Psychological predictors of good health in three longitudinal samples of educated midlife women.

Concurrent and longitudinal associations between cognitive and affective personality variables--intellectual efficiency (IE), anxiety, and hostility--and observer ratings of physical health were examined in 3 longitudinal samples of women: Mills Longitudinal Study (n = 101); Radcliffe Study (RS, n = 118); and University of California, San Francisco Study (n = 44). Observer ratings of health were based on participants' reports of health problems. The California Psychological Inventory (H. G. Gough, 1996) IE, Hostility, and Anxiety Scales were used in all studies at Times 1 and 2, except in RS, when at Time 1 the Zung Anxiety (W. K. Zung, 1971) and the Profile of Mood States (D. M. McNair, M. Lorr, & L. F. Droppleman, 1971) Hostility Scales were used. In the majority of analyses, IE was positively associated with good health, and Anxiety and Hostility were negatively associated with health. IE was the strongest independent predictor of health, indicating that cognitive characteristics may have an important role in health and should be examined further.

Two faces of narcissism.

The present study examines the lack of strong correlations among existing self-report measures of narcissism. A principal-components analysis of 6 MMPI narcissism scales resulted in 2 orthogonal factors, 1 implying Vulnerability-Sensitivity and the other Grandiosity-Exhibitionism. Although unrelated to each other, these 2 factors were associated with such core features of narcissism as conceit, self-indulgence, and disregard of others. Despite this common core, however, Vulnerability-Sensitivity was associated with introversion, defensiveness, anxiety, and vulnerability to life's traumas, whereas Grandiosity-Exhibitionism was related to extraversion, self-assurance, exhibitionism, and aggression. Three alternative interpretations of these results are considered, and an argument for the distinction between covert and overt narcissism is made.

Personality change in women and their partners.

Adjective Check List (ACL) data from 82 female participants in a longitudinal study and their male partners were used to investigate personality change between the early parental and postparental periods. In the early parental period, men were more competent, whereas women were more emotionally dependent and more facilitative in their interpersonal relations. In the postparental period, primarily because of the greater breadth and sharper gradient of ACL changes in women, these differences were attenuated or even reversed. The influence of the mother role, women's status level in work, whether partners were the same or different, and personality differences between the women's mothers and fathers were considered.

Two conceptions of maturity examined in the findings of a longitudinal study.

The third vector score (competence) of the revised California Psychological Inventory (CPI) and ego level as assessed by the Loevinger Sentence Completion Test (SCT) are measures of alternative ways of conceptualizing maturity: as the ability of the individual to function effectively in society or as the degree of intrapsychic differentiation and autonomy. A longitudinal study of women (for the CPI, N = 107; for the SCT, N = 90) provides these two measures of maturity at age 43. Competence and ego level were correlated with antecedent and concurrent measures selected from inventories and life history material concerning work, marriage, relations with parents, and so forth, to assess aspects of maturity adapted from Allport: self-extension in significant endeavors, reality orientation in perception of self and others and in the conduct of one's activities, capacity for intimacy, emotional security, and individuality of personal integration. Results from the age-21 data indicate that competence and ego level are enduring trait complexes. Despite considerable overlap, they differ conspicuously in the greater emphasis of competence on emotional security and of ego level on individuality of personal integration. Analysis of the patterning of competence and ego level in the whole sample and in homogeneous groups high on one or both measures suggests psychological reasons why the two types of maturity diverge and why the relation of ego level to adjustment seems to be curvilinear.

Personality change in women from the early 40s to the early 50s.

Between their early 40s and early 50s, 101 alumnae in the Mills longitudinal study decreased in dependence and self-criticism and increased in confidence and decisiveness. They also increased in comfort and stability attained through adherence to personal and social standards, and they scored higher on measures of coping through intellectuality, logical analysis, tolerance of ambiguity, and substitution. Normative personality change on the California Psychological Inventory was not associated with menopausal status, empty nest status, or involvement in care for parents. Feelings about life corresponded to descriptions of middle age by stage and period theorists, including the idea of turmoil around age 40. Findings support the view that personality changes across middle age in normative ways. Change seems to be attributable to long-term trends or period effects rather than to discrete life events.

Self- and object-directedness in adult women.

Separate factor analyses of items anchoring the opposite ends of a narcissism prototype derived from the California Q-set resulted in three narcissism or self-directed factors: Hypersensitivity, Willfulness, and Autonomy; and two factors hypothesized to represent the object-directed line of development: Straightforwardness and Givingness. These five factors were scored in Q-sort descriptions of 103 adult women. Correlates of the factors with the California Psychological Inventory, Adjective Check List, Sentence Completion Test, and life measures supported the usefulness of the distinction between self- and object-directedness. Whereas the narcissistic trajectory related to creativity, norm questioning, undercontrol of impulses, independence, and work orientation, the object-directed line of development was associated with prosocial inclinations, suppressive ego control, readiness to accept life demands, and stress on interpersonal relations.

Transition from the early 40s to the early 50s in self-directed women.

How does personality type moderate personality change in middle age? Answers to this question were sought with three observer-based measures of self-directedness (autonomy, hypersensitivity, and willfulness) scored from the California Q-set when the participants in the Mills longitudinal study were age 43. From their early 40s to early 50s, high scorers on autonomy (healthy self-directedness) increased on California Psychological Inventory measures of impulse control and agency, and continued their involvement in high-status occupational careers. Despite increases in impulse control, the hypersensitive women had not increased in agency and expressed boredom in major social roles. In their early 50s, high scorers on willfulness increased in agency but not impulse control. In social roles, they perceived themselves as stimulating and creative.

Three narcissism scales for the California Q-set.

Three observer-based narcissism scales were developed from factor scores based on a California Q-set (CAQ) narcissism prototype. Each of the three scales--Willfulness, Hypersensitivity, and Autonomy--correlated with observer and self-report narcissism measures in the derivation sample of 105 women and a cross-validation sample of 175 men and 175 women. California Psychological Inventory (CPI), Adjective Check List (ACL), and Minnesota Multiphasic Personality Inventory (MMPI) correlates and partner ACL ratings suggested that the Willfulness scale represents self-assuredness, rebelliousness, and exhibitionism characteristic of overt or phallic narcissism. The correlates of the Hypersensitivity scale included depression and introversion along with rebelliousness and hostility, indicative of covert narcissism. The Autonomy scale was correlated positively with creativity, empathy, achievement-orientation, and individualism, and thus assesses a healthy variant of narcissism.

Three types of narcissism in women from college to mid-life.

This article examines personality change in three types of narcissists (hypersensitive, willful, and autonomous), who were members of a longitudinal sample of women. Measures of narcissism were derived from the age-43 California Q-set ratings. Women who had high scores on hypersensitivity at age 43 were characterized by decline in personal resources, as assessed by the California Psychological Inventory (CPI), relative to their early 20s, and by lack of success either in career or as a homemaker. Women who were high scorers on willfulness at age 43 showed little change from college days, but there was evidence they had grown during their 20s. The autonomous women, following conflict in their 20s, experienced personality growth evident by their early 40s. Hypersensitivity and willfulness, but not autonomy, were associated with evidence of troubled childhood relations with parents, particularly the mother. Willfulness was associated with early identification with a willful father. These findings demonstrate the usefulness of the construct of narcissism for the study of adult development and document the close relation between personality and social roles in the life of an individual over time.

Psychological implications of the Psychopathy Q-sort.

The construct validity of the Psychopathy Q-sort (PQS; Reise & Oliver, 1994) was investigated by correlating it with an array of observer-based and self-report personality measures in a sample of 350 men and women assessed at the Institute of Personality Assessment and Research (IPAR). High discriminant validity of the PQS was indicated by a pattern of significant correlations with self-report measures of the Cluster B personality disorder scales of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1980) and the absence of correlations with scales belonging to Clusters A and C of the manual. The PQS also correlated positively with the California Psychological Inventory measures of social poise and assurance and correlated negatively with measures of normative control of impulse. Gender differences in psychopathy were explored using Adjective Check List (Gough & Heilbrun, 1983) ratings provided by IPAR staff observers and by 76 pairs of spouses.

New narcissism scales for the California Psychological Inventory and MMPI.

New Narcissism scales for the California Psychological Inventory (CPI) and the Minnesota Multiphasic Personality Inventory (MMPI) were developed on the basis of DSM-III criteria and the writings of Akhtar and Thomson (1982), Kernberg (1975) and Kohut (1971, 1977). Self-report protocols from 152 adults and 198 college students were utilized. Rationally selected preliminary items were retained or discarded according to their alignment with the total score on these items. The resulting 49-item CPI and 39-item MMPI scales correlated .81 with each other, and significantly so at p less than .01 with ratings of narcissism, the Raskin-Hall Narcissistic Personality Inventory (NPI) and the MMPI Narcissism scale of Morey, Waugh, and Blashfield. Personological implications of the two new scales were examined in relation to other measures and to observers' adjectival and Q-sort descriptions. Intrascale factor analyses identified five common themes: Cathexis of Power, Risk-Seeking Propensity, Need for Attention, Disesteem for Others, and Impatient Willfulness.

What leads to good health in midlife women physicians? Some clues from a longitudinal study.

Data from a longitudinal study of women physicians is used to study psychosocial and current implications of good health in midlife. The women comprise the classes 1964 to 1967 of the University of California School of Medicine at San Francisco. The subjects were interviewed and tested using the California Psychological Inventory while they were still in medical school (Time 1, average age 24 years) and at midlife (Time 2, average age 46 years). The women in good health at midlife, in contrast to their peers, were characterized by certain personality traits, including a higher degree of intellectual efficiency and empathy and relatively less hostility. Early antecedents of good health included having better educated parents. Good physical health at Time 2 was also predicted by Time 1 personality traits reflecting planful, logical, and efficacious use of intellectual resources and having optimistic, trusting relationships with others.

Patterns of outpatient consultation: a survey of outpatients attending a metropolitan psychiatric hospital.

A survey of all outpatients (n = 1135) attending a regional psychiatric hospital during a 3-month period. Psychoses constituted 72% and non-psychotic disorders 25%. Psychoses had a greater proportion of long-term attenders while non-psychotic disorders, though frequent (43%) among recent attenders, showed a high attrition rate. Demographic characteristics, patterns of attendance, selected clinical features, level of functioning and difficulties of management of the different diagnostic groups are presented and discussed. Reasons are adduced to explain why patients who were deemed suitable for transfer to other care had not been discharged from hospital. Steps taken to reduce the patient load and increase the efficiency of the services are described.