A brief overview of safety planning in interpersonal reconstructive therapy.

Most research to date with Interpersonal Reconstructive Therapy (IRT: Benjamin, 2006) involves application with patients who qualify for the acronym "CORDS": Comorbid, Often Rehospitalized, Dysfunctional, and Suicidal. A case formulation (CF) based on interpersonal copy process theory defines links between presenting symptoms and patterns of affect, cognition, and behavior that invoke safety or threat and were learned and internalized in close relationships. The "gift of love" (GOL) hypothesis is that the wish to receive love and acceptance from specific internalized attachment figures organizes and propels problem patterns and their associated symptoms. Through a series of steps, IRT seeks to help patients become aware of and learn about their copied patterns, including where they were learned, the role they play in maintaining connection with internalized attachment figures, and their functions in the present. The goal is to help a patient differentiate from their "family in the head" and pursue healthy behaviors and self-concepts. With awareness and differentiation comes the possibility of letting go of problematic quests for love and acceptance from the internalized attachments and to choose healthy alternatives instead. As an integrative method, safety planning in IRT shares much with other approaches. What is unique is how therapists utilize the CF to guard against unsafe behavior as an ongoing part of the treatment process with patients with suicidality. This article provides an overview and illustration emphasizing these unique aspects of the IRT approach to safety planning in the context of individual psychotherapy with adults. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Affiliative interpersonal behaviors during stress are associated with sleep quality and presleep arousal in young, healthy adults.

OBJECTIVES: This study examined the association between stress-related interpersonal behaviors, presleep arousal (PSA), and sleep quality. METHODS: Sixty-four participants (53% female) described a recent stressful interpersonal event that was coded for overall degree of affiliation (warmth vs hostility) and autonomy (independence vs interdependence). Cognitive and somatic PSA and sleep quality were examined using regression with affiliation and autonomy scores as predictors. Specific interpersonal behaviors that comprise overall affiliation were also examined. RESULTS: More affiliation (warmth) was associated with lower cognitive PSA (ß=-.32) and better sleep quality (ß=-.28). Autonomy was not associated with sleep quality or PSA. The specific behavior trust in others was associated with better sleep quality (rs=-.25). CONCLUSIONS: Behaviors during stress reflect underlying dimensions of interpersonal security. Findings underscore importance of interpersonal frameworks for understanding associations between stress and sleep, and provide support for the anthropological theory that interpersonal security is necessary for healthy sleep.

Assessing Sexual Interest in Adolescents Who Have Sexually Offended.

Adolescents who have sexually offended have unique treatment needs. For mental health professionals to adequately address these unique needs, further research is necessary. To that end, we explored the assessment of sexual interest (which may play an integral role in understanding potential for sexual reoffending) in a sample of 103 male adolescents who have sexually offended. We compared results from a physiological assessment (MONARCH 21 penile plethysmography [PPG]) and an actuarial assessment (Screening Scale for Pedophilic Interest [SSPI]), plus data from an unobstrusive assessment (Affinity, a viewing time measure) in a smaller subsample of 16 male adolescents. One finding that has particular relevance for clinical assessment is that the SSPI may have limited utility with adolescents. We also found evidence for some overlap between data from PPG and viewing time assessments, although whether or not PPG data are ipsatized may affect relationships with other assessment modalities.

Beholder and Beheld: A Multilevel Model of Perceived Sexual Appeal.

When individuals (observers) assess how appealing they find sexual stimuli (targets), which factors matter and to whom? The present study examined how observer and target characteristics interact and impact perceived sexual appeal. Participants were 302 men (206 heterosexual, 96 gay) and 289 women (196 heterosexual, 93 lesbian) between the ages of 18 and 67 years, who viewed 34 photographs of targets of their preferred gender and rated each target for sexual appeal, masculinity-femininity, and estimated age. Participants also rated their own masculinity-femininity. A baseline model indicated that roughly 30 % of the variance in sexual appeal ratings was at the observer level (between observers) and 70 % of the variance was at the target level (within observers). In the final model, five characteristics of the participant observers (gender, sexual orientation, age, race/ethnicity, and self-described masculinity-femininity) and six characteristics of the target photographs (gender, whether the photographs were taken from heterosexual versus gay/lesbian media, race/ethnicity, perceived masculinity-femininity, and estimated age) were independently and interactively related to observer ratings of target sexual appeal. Observers displayed preferences for similar targets in terms of race/ethnicity and masculinity-femininity, while also displaying a general preference for target youth. Variation in the strength of these preferences occurred according to observers' own gender, race/ethnicity, masculinity-femininity, and sexual orientation.

Ethnic Differences in Personality Disorder Patterns among Women Veterans Diagnosed with PTSD.

Personality Disorders (PDs) impair the ability to function socially and occupationally. PD prevalence rates among veterans who have also been diagnosed with posttraumatic stress disorder (PTSD) range from 45%-79%. This study examined ethnic differences in PDs assessed with the Millon Clinical Multiaxial Inventory-III in 260 non-Hispanic white (64%), Hispanic (27%), and African American (9%), mostly single, women veterans in treatment for PTSD. After adjusting for covariates including number and sexual-nature of trauma, findings revealed the adjusted odds ratio of having a cluster A PD was almost three times higher for African Americans (p = 0.046) then the other two ethnic groups, which may be driven by the paranoid PD scale and potentially reflects an adaptive response to racial discrimination. In cluster designation analysis, the odds were twice as high of having a cluster B PD with childhood trauma (p = 0.046), and a cluster C PD with sexual trauma (p = 0.004), demonstrating the significance of childhood and sexual trauma on long-term chronic personality patterns in women veterans. These results highlight the importance of using instruments with demonstrated diagnostic validity for minority populations.

The impact of parenting on gay male couples' relationships, sexuality, and HIV risk.

Parenthood changes couples' relationships across multiple domains, generally decreasing relationship quality, sexual satisfaction, and sexual frequency. Emerging research suggests that gay couples who are parenting might experience similar challenges. However, such changes might have even more profound implications for gay couples' health, and in particular their HIV risk, given the somewhat different ways in which they negotiate and tolerate sexual behaviors with outside partners. We aimed to examine these issues in a qualitative analysis of interviews from 48 gay male couples who were actively parenting children. Findings suggest that parenthood increases men's commitment to their primary relationship while simultaneously decreasing time and energy for relationship maintenance, and generally decreasing sexual satisfaction. These challenges alone did not generally result in greater infidelity or HIV risk, as most men reported successfully coping with such changes through a combination of acceptance and revaluing what is important in their relationships. Additionally, couples reported negotiating agreements regarding sex with outside partners that closely resemble those documented in studies of gay couples who are not parents. Men reported that parenthood typically decreased their opportunities to engage in sex with outside partners, but also posed barriers to talking about these behaviors with their partners and healthcare providers. HIV-related sexual risk behavior was relatively rare, but nevertheless present in some men. Providers should assess sexual function as a regular part of their work with gay couples who parent, and facilitate opportunities for men to discuss their sexual agreements both with their primary partners and with relevant healthcare providers.

The latent structure of Multiphasic Sex Inventory-assessed pedophilic interest.

The Multiphasic Sex Inventory (MSI; Nichols & Molinder, 1984) is a self-report measure frequently used in the assessment of sex offenders. Scores on the MSI are often used to assess levels of pedophilic interest. However, the question of whether men with pedophilia represent a unique group distinguished by their sexual interests, or whether they are high-scorers on a continuum of sexual interest in children among men who sexually offend against children remains unanswered. Because no existing evidence points conclusively to pedophilia having either a categorical or continuous latent structure, it is unresolved whether MSI scores should be treated as a continuous measure of severity or whether a cut score should be used to categorize individuals as members of a pedophilic taxon. In the present study, the authors used 3 taxometric procedures to analyze the latent structure of pedophilic interest in a sample of 371 convicted child sex offenders. The results converged to indicate that pedophilic interest (as measured by the MSI) is dimensional. The implications of these findings for the assessment of pedophilic interest are discussed.

Echocardiographic findings in the PANDAS subgroup.

BACKGROUND: Sydenham's chorea is the neurologic manifestation of rheumatic fever and is a diagnosis of exclusion requiring only the presence of frank chorea in the absence of another neurologic disorder. Two thirds of children with Sydenham's chorea also have rheumatic carditis (pathologic mitral valve regurgitation). Although there are similar neuropsychiatric symptoms and preceding group A beta-hemolytic streptococcal infection associated with both Sydenham's chorea and the PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) subgroup, it is unknown whether patients in the PANDAS subgroup have any cardiac involvement. METHODS: Sixty children meeting the criteria for PANDAS were entered into protocols at National Institute of Mental Health between 1993 and 2002. Doppler and 2-dimensional echocardiograms were performed on these subjects to assess valvular heart disease. RESULTS: Of these 60 children, no echocardiographic evidence of significant mitral or aortic valve regurgitation was found. One patient was found to have mild mitral regurgitation, and all patients had normal left atrial size and normal left ventricular size and function. Follow-up echocardiograms on 20 children showed no significant valvular regurgitation. CONCLUSION: The evidence of a clear lack of rheumatic carditis in these children supports the hypothesis that PANDAS is a distinct neuropsychiatric diagnosis separate from Sydenham's chorea.