Maternal antenatal attachment style and potential fetal abuse.

OBJECTIVE: Maternal antenatal emotional attachment (MAEA) to the fetus has been proposed as an important factor for the emergence of harm to the unborn child. The present study investigated whether MAEA was associated with self-reported intent to harm the fetus. METHOD: Forty pregnant women, referred for psychological evaluation, completed a self-report measure of MAEA, the Millon Clinical Multiaxial Inventory-2 (MCMI-2) and confidential self-report questions on irritation with the fetus, urge to harm the fetus and predicted future loss of control with the child. Interview data was used to determine the mothers' adult attachment styles. RESULTS: (1) Negative preoccupied MAEA was associated with increased likelihood of reported irritation with the fetus, preoccupied adult attachment, borderline, histrionic, paranoid personality dimensions and symptoms of anxiety, mood disturbances and depression. (2) Negative disinterested MAEA was associated with a dismissing adult attachment, narcissistic, antisocial, aggressive-sadistic and passive-aggressive personality dimensions, alcohol dependence, but not self-report intention to harm the fetus. CONCLUSION: The findings are discussed in terms of their implications for understanding difficulties which may emerge in mother-fetus bonding and the identification of and interventions for mothers who report an intention to harm the fetus.

Feigned mental disorder in prisoners referred to forensic mental health services.

This paper describes a study that aimed to identify the extent to which feigning of mental illness represents a significant problem in prisoners referred to a medium secure unit. A clinical method was used to assess the prisoners, employing the Structured Interview of Reported Symptoms (SIRS) and selected Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity indices. Stringent criteria were used to classify 60 consecutive referrals to a secure unit as feigning mental disorder or not. In addition, the study examined characteristic differences, on a number of selected variables, between those prisoners who feign and those who respond honestly. The personality profiles of prisoners who feign were also investigated. Analysis of data showed that 32% of the sample (P < 0.01) could be classified as fabricating or exaggerating symptoms of mental illness. It is suggested that such presentations may be more prevalent than previously considered. Few differences were observed between the groups on selected variables, although prisoners who feigned mental illness demonstrated significantly higher dependent and anxious (avoidant) personality types. The implications of the findings are discussed in relation to available models of feigned presentations.

Clinical issues in the cognitive analytic therapy of sexually abused women who commit violent offences against their partners.

Clinical issues arising in the cognitive analytic therapy (CAT; Ryle, 1990) are described for seven sexually abused women who committed violent offences against their partners in intimate relationships. Two principal findings are reported; firstly, support is provided for the original hypothesis of Pollock & Kear-Colwell (1994) in that, following the offence, the women perceived themselves as 'guilty aggressors' and disavowed the role of their own victimization in the commission of the offence; secondly, psychometric data suggested that dissociative states were reported as common experiences for the women before, during and after the offence. The relationship between the abusing-victimized reciprocal role procedure, affective functioning, dissociative states and violent acts is discussed. Themes encountered in the application of CAT for these women are described and a case report is used to illustrate specific treatment issues.

The relationship between a medium secure environment and occupational stress in forensic psychiatric nurses.

The present study investigated occupational stress levels in forensic psychiatric nurses within a medium secure unit for mentally disordered offenders and examined the possible relationships between aspects of the ward environment and identified stress levels. Data were obtained through self-report measures and unit statistics using a sample of 38 nurses on two secure (high and medium) wards. No significant differences in levels of occupational stress or perception of ward environment were observed between nurses on the two wards. Global ward atmosphere scores were compared with those of a maximum secure facility in the USA, showing the unit to be highly therapeutic. Occupational stress scores for all nurses were compared with normative regional data and showed elevated scores on broad view of control, satisfaction and type A behaviour. No demographic or ward environment variables were found to be associated with these high scores. Interpretations and implications are discussed.

Women who stab: a personal construct analysis of sexual victimization and offending behaviour.

The personalities and perceptions of two women with a history of very significant sexual abuse who had committed serious violent offences against 'boy friends' are investigated using role construct repertory grid (Kelly) and hypotheses developed for treatment, in particular to prevent any reoffending. The most significant dimension that emerged was in general terms that of 'abuser-victim'. It was clear that there was significant confusion about their self-perceptions with regard to these roles. They perceived themselves as abusers despite their histories of victimization. There was a high level of guilt associated with the victim role in each woman and in previous therapy simply dealing with their victim role gave rise to very disturbed self-destructive behaviour and even more guilt. The grid results enabled the abuser self-perception to be identified and treatment programmes to be developed using Ryle's cognitive-analytic therapy. Following treatment further grids and clinical evidence suggested that there were significant changes in self-perception and in behaviour. The findings were discussed and the need for further investigations suggested.