What You Are Hiding Could Be Hurting You: Autistic Masking in Relation to Mental Health, Interpersonal Trauma, Authenticity, and Self-Esteem.

Background: Autistic masking refers to some autistic individuals' tendency to hide, suppress, or camouflage their autistic traits, autistic identity, or autism diagnosis. Autistic masking also may include unconscious or conscious attempts to mimic the behavioral, cognitive, or sensory styles of nonautistic neurotypical people and to suppress natural forms of autistic behavior, cognition, and reactions to sensory experiences. Since autistic people are a stigmatized minority in many neurotypical dominated societies, passing as nonautistic through autistic masking may be an attempt to avoid autism stigma and a reaction to previous interpersonal trauma. Increased autistic masking behaviors are associated with reports of increased depression, anxiety, burnout, and exhaustion in autistic people, and thus, exploring the roots and impact of autistic masking is an important mental health topic. Methods: This study investigated the relationships between autistic masking and depression, anxiety, gender identity, sexual orientation, interpersonal trauma, self-esteem, authenticity, and autistic community involvement. Participants were autistic adults (n = 342) recruited through autistic social media groups. Results: This study found that higher self-reported autistic masking behaviors were associated with higher reports of past interpersonal trauma, greater anxiety and depression symptoms, lower self-esteem, lower authenticity, and lower participation within the autistic community. Autistic masking was not associated with gender identity or sexual orientation. Conclusions: The results of this study highlight the relationship between autistic masking and past interpersonal trauma, finding that autistic masking behavior is associated with mental health, self-esteem, and authenticity risks for autistic adults. We call into question the teaching of autistic masking strategies in therapies and education programs for autistic people based on the negative associations with autistic masking presented in this study and other research in this field.

Why is this an important issue? Autistic masking refers to autistic people suppressing their natural autistic traits, responses, and behaviors, in an attempt, consciously or unconsciously, to hide or reduce the visibility of their autistic traits, autistic identity, or autism diagnosis. High levels of autistic masking are associated with negative mental health, authenticity challenges, and burnout for autistic people. Interpersonal pressuring, past traumatic social experiences, and autism stigma potentially fuel autistic masking. What is the purpose of this study? This study aimed to investigate relationship between autistic masking and depression, anxiety, interpersonal trauma, self-esteem, authenticity, autistic community involvement, gender identity, and sexual orientation. What did the researchers do? We recruited 342 autistic adult participants through autistic social media groups on Facebook to complete a 30-minute anonymous survey online comprising validated scales to measure autistic masking, depression, anxiety, interpersonal trauma, self-esteem, and authenticity. Additional questions were asked about demographic factors, such as gender identity and sexual orientation, and we asked open-ended questions about past social trauma and intersectional issues. What were the results of the study? We found that higher self-reported autistic masking behaviors were associated with higher reports of past interpersonal trauma, specifically being shamed and teased about autistic traits, and broader experiences of emotional and physical abuse. Masking was also associated with greater anxiety and more depression symptoms, lower self-esteem, lower authentic living, greater accepting of external influence, higher self-alienation, and lower participation within the autistic community. Autistic masking was not found to be associated with gender identity or sexual orientation. Participants who reported involvement in previous applied behavior analysis therapy reported higher past interpersonal trauma than participants involved in some other forms of therapy such as cognitive behavior therapy. What do the findings add to what was already known? This study supports previous research associating autistic masking with depression and anxiety symptoms, and lower reported authenticity, such as autistic people feeling they were not being true to themselves, or revealing their genuine selves to others. This study is the first to quantitatively investigate relationships between autistic masking and past interpersonal traumas, self-esteem, authenticity, and autistic community involvement. What are potential weaknesses in the study? Our sample is not representative of the U.S. population when it comes to race, educational level, gender, and sexual orientation. It was very White, highly educated, had few cisgender men, and sixty three percent were members of sexual minority groups. The majority of participants reported late diagnosis of autism. This sample potentially contained an overrepresentation of people with high levels of autistic masking or who more recently realized they were autistic masking in comparison with the general autistic population. We did not analyze differences between early-diagnosed and late-diagnosed cohorts. How will these findings help autistic adults now or in the future? This research calls into question the teaching of autistic masking strategies in parenting, education, and therapy programs for autistic people based on the negative associations of autistic masking. Our findings should be utilized as a strong call to action to push back against practices that encourage autistic masking and autistic trait shaming. Instead we advocate for promoting forms of parenting, education, and therapy that respect autistic people's traits, communication styles, sensory needs, and autistic identity.

Nature, urban, or treadmill: How walking environment impacts state body satisfaction and appreciation and the role of body sanctification.

This study examined the effects of walking environments on state body satisfaction and state body appreciation and the potential moderating role of body sanctification. Participants included 189 undergraduates from a private Christian University in the Southwestern US, randomly assigned to walk for 20-minutes in a natural, outdoors built, or indoors built environment. Participants completed measures of state body satisfaction and state body appreciation prior to and immediately following the walk. Those who walked in nature experienced increased state body satisfaction but not state body appreciation compared to those who walked in an indoor built environment. Theistic sanctification of the body was associated with greater state body appreciation and moderated the relationship between walking location and body appreciation. Participants who sanctified their bodies to a greater extent experienced increases in body appreciation when walking in a natural environment compared to an indoor built environment relative to those who were lower in body sanctification. Nontheistic sanctification of the body was associated with higher state body satisfaction and state body appreciation but did not moderate links between walking location and these outcomes. Overall, walking in nature is beneficial to body satisfaction and theistic sanctification of the body may bolster these effects.

Considerations in geriatric dermatopathology.

This review provides an overview of considerations in geriatric dermatopathology. The nuances of specimen collection and reporting in this population, including the importance of obtaining adequate tissue, providing detailed clinical information and ethical considerations surrounding specimen collection will be discussed. The histopathologic changes associated with aging and the morphologic features of common lesions related to photoaging are outlined followed by a discussion of common interpretation pitfalls, specifically entities at risk of overinterpretation and those related to hyper- and hypopigmentation. Finally, the recent literature is reviewed regarding special cases and what this implies for future research both in dermatology and dermatopathology.

Walking in nature may improve affect but not cognition.

Beneficial effects of natural environments on affect have been consistently reported, but effects on cognition have been less consistent. We examined affect and cognitive performance in the domains of attention, working memory, executive function, and recall and recognition memory in a sample of 188 undergraduate participants who completed a walk in one of three environments: an outdoor nature environment, an outdoor urban environment, or an indoor (treadmill) environment. Supporting the hypotheses, the outdoor nature environment resulted in the greatest increase in positive affect and decrease in negative affect from pre-to post-walk. However, there were no effects of location on any cognitive measure. These results suggest that cognitive effects do not always occur in tandem with affective benefits. Possible explanations, including prior frequent exposure to nature in our participants and extremity of the natural environment, are discussed.

A Preliminary Validation of the Polish Version of the Comprehensive Intellectual Humility Scale (CIHS).

Background: In the last few years, empirical research on intellectual humility has grown notably, involving the elaboration of promising measures that provide a different outlook on the construct. Although all of them offer valid, theoretically sound, and meaningful contributions, we selected the 22-item Comprehensive Intellectual Humility Scale (CIHS) by Krumrei-Mancuso and Rouse for validation. The rationale for choosing this questionnaire for Polish validation stands in its multidimensional nature, which enables the study of various nuances of this psychological concept. Methods: The research was carried out with the participation of 260 adults (Study 1) and 210 adults (Study 2). The respondents completed a Polish translation of the original version of the CIHS, the Gratitude Questionnaire-Six Item Form (GQ-6), the General Self-Efficacy Scale (GSES), and the Positive Orientation Scale (P-Scale). Results: The findings obtained in both studies support the four-factor model of the CIHS with the higher order factor. The good fit indices of the CFA and MGCFA show the psychometric solidity of the 22-item structure of the Polish version of the CIHS. With respect to convergent validity, the validation study (Study 2) confirmed that gratitude, self-efficacy, and positive orientation are significant correlates of the CIHS. Conclusion: Since intellectual humility is still a little-known psychological construct, both as a concept and as a possible antecedent or consequence, it would be worth examining it in the future with other variables of an intraindividual and interindividual nature.

Renal Involvement and Its Treatment in Pediatric Patients With Proteinase-3 Anti-Neutrophil Cytoplasmic Antibody Positive Granulomatosis With Polyangiitis: A Case Series.

We describe three pediatric patients between the ages of 10 and 14 years old who were diagnosed with granulomatosis with polyangiitis (GPA) between 2014 and 2019. Each case involves variations in presentation, symptomatology, diagnostics, and induction and maintenance therapy regimens. Patient 1 presented with significant renal involvement, hypertensive emergency, and focal alveolar hemorrhage, a rare presentation of GPA that causes up to 60% mortality.Patient 2 presented with minimal renal involvement and a diffuse petechial rash, which is the most common cutaneous presentation of GPA. Finally, patient 3 presented with significant renal involvement and later on with symptoms of idiopathic intracranial hypertension (IIH), a unique and rare presentation associated with GPA. Despite the heterogeneity of these cases, the similar therapy regimens used in each case successfully achieved induction and maintenance of disease remission, providing an evidentiary basis for these treatment regimens even in severe and unusual pediatric GPA cases.

The effects of fitspiration and self-compassion Instagram posts on body image and self-compassion in men and women.

Research has demonstrated links between viewing idealized images on social media and body dissatisfaction, but more work is needed to understand how exposure to appearance-related content influences body image. The current research evaluated the effects of viewing fitspiration images and images of self-compassion quotes on Instagram on men and women's body image and self-compassion. This topic was examined in two separate investigations in the U.S.; a sample of undergraduate students (N = 180, 62 men and 118 women) and a community sample recruited through Amazon Mechanical Turk (N = 296; 173 men and 123 women). In both studies, participants viewed either same-gender images of fitspiration, self-compassion quotes, a combination of fitspiration images and self-compassion quotes, or neutral images (control). Overall, the findings suggest that viewing fitspiration images only promotes lower body satisfaction and appreciation, whereas viewing self-compassion images only leads to improved body satisfaction and appreciation. There was, however, little support for the buffering effects of self-compassion in the combined condition. Our results demonstrate the detrimental effects of exposure to fitspiration content and the positive effects of exposure to self-compassion content on social media for men and women as well as the need for future research in this area.

Characterization of the Neuroinflammatory Response to Thiol-ene Shape Memory Polymer Coated Intracortical Microelectrodes.

Thiol-ene based shape memory polymers (SMPs) have been developed for use as intracortical microelectrode substrates. The unique chemistry provides precise control over the mechanical and thermal glass-transition properties. As a result, SMP substrates are stiff at room temperature, allowing for insertion into the brain without buckling and subsequently soften in response to body temperatures, reducing the mechanical mismatch between device and tissue. Since the surface chemistry of the materials can contribute significantly to the ultimate biocompatibility, as a first step in the characterization of our SMPs, we sought to isolate the biological response to the implanted material surface without regards to the softening mechanics. To accomplish this, we tightly controlled for bulk stiffness by comparing bare silicon 'dummy' devices to thickness-matched silicon devices dip-coated with SMP. The neuroinflammatory response was evaluated after devices were implanted in the rat cortex for 2 or 16 weeks. We observed no differences in the markers tested at either time point, except that astrocytic scarring was significantly reduced for the dip-coated implants at 16 weeks. The surface properties of non-softening thiol-ene SMP substrates appeared to be equally-tolerated and just as suitable as silicon for neural implant substrates for applications such as intracortical microelectrodes, laying the groundwork for future softer devices to improve upon the prototype device performance presented here.

Sex Work and Mental Health: A Study of Women in the Netherlands.

This study examined how characteristics of prostitution and quality-of-life factors related to symptoms of depression and post-traumatic stress among 88 women engaged in prostitution in the Netherlands. Numerous factors were associated with elevated mental health concerns, including the experience of violence in prostitution, engaging in street prostitution, being motivated to engage in prostitution for financial reasons, having less confidence in one's ability to find alternative work, desiring to leave prostitution, and sense of self-transcendence. In contrast, focusing on achievement, having a sense of fair treatment from others and society, and self-acceptance were associated with better mental health outcomes. Finally, mediation analyses indicated that post-traumatic stress associated with engaging in prostitution against one's deeper desire to exit prostitution was, in part, the result of a lack of self-acceptance. The analyses controlled for relevant demographic factors, including age and level of education. The effect sizes for each of the findings ranged from medium to large. Implications for mental health care and public policy are included.

The Development and Validation of the Comprehensive Intellectual Humility Scale.

A series of studies was conducted to create the 22-item Comprehensive Intellectual Humility Scale on the basis of theoretical descriptions of intellectual humility, expert reviews, pilot studies, and exploratory and confirmatory factor analyses. The scale measures 4 distinct but intercorrelated aspects of intellectual humility, including independence of intellect and ego, openness to revising one's viewpoint, respect for others' viewpoints, and lack of intellectual overconfidence. Internal consistency and test-retest analyses provided reliable scale and subscale scores within numerous independent samples. Validation data were obtained from multiple, independent samples, supporting appropriate levels of convergent, discriminant, and predictive validity. The analyses suggest that the scale has utility as a self-report measure for future research.

Validation of the University of São Paulo's Sensory Phenomena Scale -- English version.

INTRODUCTION: Sensory phenomena (SP) are disturbing sensations, feelings or urges. Although such feelings are often found in obsessive-compulsive disorder (OCD) and Tourette's Syndrome (TS) patients, sensory phenomena are usually not addressed in assessment measures. The University of São Paulo's Sensory Phenomena Scale (USP-SPS) was designed to measure sensory phenomena among all ages of patients with OCD and TS, and it was validated in Portuguese. OBJECTIVES: The aim of this study is to validate the English version of the USP-SPS and to examine its psychometric properties. MATERIAL AND METHODS: Sixty subjects, between the ages of 7 and 60 years, completed the USP-SPS, Y-BOCS or CY-BOCS and YGTSS. An expert clinician also performed a Clinical Inquiry about SP. Inter-rater reliability, sensitivity, specificity, convergent and divergent validity were evaluated. RESULTS: The USP-SPS symptom checklist showed good sensitivity in all ages, however its severity scale did not show good validity results for the pediatric population.

Traumatic events and obsessive compulsive disorder in children and adolescents: is there a link?

BACKGROUND: The extant literature supports an association between psychological trauma and development of OCD in adults, and this link is a plausible mediator for environment-gene interactions leading to phenotypic expression of OCD. OBJECTIVE: To explore the relationship between OCD and traumatic life events in children and adolescents. METHODS: We examined the prevalence of traumatic life events and PTSD in a large sample of systematically assessed children with OCD. OCD symptoms and severity were assessed using the Children's Yale Brown Obsessive Compulsive Scale (CY-BOCS) in those with and without concurrent PTSD. RESULTS: Rate of PTSD and trauma exposure was higher in children with OCD than in a comparable control group of non-OCD youth matched for age, gender and SES. Children with concurrent PTSD had more intrusive fears and distress and less control over their rituals than children with OCD but without PTSD. Total CY-BOCS scores were higher in those with concurrent PTSD. Specific type of OCD symptoms was not altered by a PTSD diagnosis. CONCLUSIONS: A history of psychologically traumatic events may be over-represented in children with OCD. Given the need to search for non-genetic factors that may lead to onset of OCD, better and more systematic methods to obtain and quantify psychologically traumatic life events are needed in clinical populations.

Treatment of pediatric obsessive-compulsive disorder: a review.

Recently, research in pediatric obsessive-compulsive disorder (OCD) has expanded to include large family genetic studies, elaboration of phenotypic dimensions, description of co-morbid disorders and their moderating effects on treatment response and outcome, research on immune-based neuropsychiatric causes, randomized controlled trials of selective serotonin reuptake inhibitors (SSRIs), randomized controlled trials of cognitive behavioral therapy (CBT), comparative treatment trials; new approaches in behavior therapy, and increased awareness of newer approaches to treatment. The purpose of this article is to review assessment and treatment strategies to include current advances in research.

Atomoxetine for the treatment of attention-deficit/hyperactivity disorder in children and adolescents: a review.

OBJECTIVE: This review examines and summarizes the pharmacodynamic and pharmacokinetic properties, short- and longer-term efficacy, the moderating effect of comorbid disorders, as well as short- and long-term safety and tolerability of atomoxetine for the treatment of pediatric attention-deficit/hyperactivity disorder (ADHD). METHODS: A systematic literature search was performed to review the extant literature on articles pertaining to the pharmacological treatment with atomoxetine in pediatric and/or adolescent ADHD. RESULTS: There is an extensive literature on atomoxetine; over 4000 children have participated in clinical trials of atomoxetine, demonstrating its short- and longer-term efficacy. In addition, studies have examined the moderating effect of comorbid disorders on atomoxetine response, as well as atomoxetine's therapeutic potential for other psychiatric conditions. Short- and longer-term safety and tolerability continue to be reported. CONCLUSIONS: Atomoxetine is indicated for both acute and maintenance/extended treatment of pediatric ADHD. Clinicians and families must be familiar with atomoxetine's evidence base, including its profile of clinical response and its possible effectiveness in the presence of comorbidity.