Factor structure invariance of the Defense Style Questionnaire-60 in outpatients

This study examined the content validity and consumer satisfaction of a newly developed forensic Measurement invariance across important subgroups such as gender and language has not yet been corroborated for Defense Style Questionnaire (DSQ). We examined the structure of the DSQ-60 (N= 509) using Exploratory Structural Equation Modelling with target rotation to the three factor-structure (Image distorting, Affect regulating and Adaptive style). We did find good fit to this 3-factor model for the data of the total group of outpatients. Next, we explored measurement invariance for both gender and language (French and Dutch). We did find configural invariance (i.e. pattern invariance) across gender and language. However, metric invariance (i.e. equal factor loadings) was not supported for gender and language. Moreover, the highest scale loadings were not always on the factor that would be expected based on three-factor solutions found earlier with different DSQ versions (i.e. an adaptive, image distorting style, and affect regulating style). We did find an adaptive and an image distorting factor. The third factor did not clearly represent the affect regulating style. We conclude that, although the widespread use of the DSQ, researchers must be careful in their use and interpretation of the DSQ-scales across important subgroups such as gender and language. Yet the DSQ is still a good screening measure for immature defenses and can give an indication of the presence of relatively more mature versus more immature defenses in an individual (AU)

Patients are changing - The ripple effects of changing the law and creating new forensic beds in Belgium.

Clinical impressions suggest that forensic patients in Belgium have more complex needs regarding care and risk in recent years than before. In this article, we analyzed psychometric data regarding patients' symptoms, risk estimates, antisocial personality traits, and functional capabilities over a 10-year span in a medium-security unit for rehabilitation of forensic patients. Data from a total of 129 patients with a main diagnosis of psychosis were analyzed. Results confirmed that patients had higher risk assessment estimates, more psychopathic/antisocial personality traits, and lower cognitive and functional capabilities. The average psychotic symptom levels and protective factors did not statistically change over the ten-year period. The changes are thought to be due to a new forensic law and the creation of new high- and medium-risk beds.

Associations between supernormality ('faking good'), narcissism and depression: An exploratory study in a clinical sample.

We explored underreporting of mental health symptoms and its correlates in adults receiving psychological treatment. We administered the Supernormality Scale (SS), the Minnesota Multiple Personality Inventory-2 (Restructured Form, MMPI-2-RF), the Narcissistic Personality Inventory (NPI) and the Beck Depression Inventory-II (BDI-2) to 147 patients at the start of their treatment. Supernormality (i.e., denial of common symptoms) was positively associated with MMPI-2(-RF) faking good parameters supporting the construct validity of the SS. Narcissism was negatively related to self-reported depression symptoms, but this association failed to reach significance (r = -.15, p = .07). This suggests that patients high on grandiose/overt narcissism might tend to deny common symptoms. The link between supernormality and depression symptoms as measured by the BDI-2 was substantial and negative (r = -.72). Our data suggest that supernormality is associated with constricted self-reports of depression. Given the clinical relevance of symptom underreporting, our preliminary findings require a large-scale replication.

Countertransference in Forensic Inpatient Settings: An Empirical Examination of Therapist Responses to Patients With Psychotic Disorders.

OBJECTIVE: Countertransference in forensic inpatient settings has received little empirical attention despite frequent emotional reactions in staff members, such as anger, disgust, or fear. In this exploratory study, we investigated countertransference in two forensic medium-secure units for patients with psychotic disorders. METHOD: We measured countertransference using the Therapist Response Questionnaire and measured staff personality using the Ten-Item Personality Inventory. Our design allowed all staff members to participate anonymously. RESULTS: One hundred thirty-four Therapist Response Questionnaire forms, along with data on patient and staff characteristics, were collected. Staff characteristics such as profession, experience, and personality were associated with different countertransference reactions. Psychologists and psychiatrists tended to report more countertransference feelings than nursing staff. Patient and staff variables (such as patient having committed violent offenses or a diagnosis of personality disorder and staff experience or gender) were associated with more negative countertransference feelings and subscale scores as well as less positive countertransference feelings such as parental, protective, and satisfying countertransference feelings. Some patient and staff variables (such as patient cooperativeness, staff personality trait agreeableness) had the inverse effect on countertransference feelings. CONCLUSION: We discussed several conceptual problems inherent to measuring countertransference (in forensic inpatient settings) and the clinical implications of our findings.

Differentiation between defensive personality functioning and psychopathology as measured by the DSQ-42 and MMPI-2-RF

Defensive functioning is considered one of the core aspects of personality functioning and its maturity level is regarded an important predictor of psychopathology and more specific personality pathology. The current investigation assesses the relation between overall defensive functioning, as measured by the Defense Style Questionnaire-42 (DSQ-42), and higher order models of psychopathology as measured by the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). The DSQ-42 and MMPI-2-RF was completed by 383 patients. We analysed the MMPI-2-RF personality and psychopathology as measured with the Restructured Clinical scales and the Personality Psychopathology Five-revised scales using Goldberg’s Bass Ackwards Method. Higher order dimensions of personality and psychopathology in the current investigation demonstrated structural similarity with previously reported higher order models. Next we examined the optimal level of differentiation of defensive functioning, as measured by the DSQ-42 Total and Overall Defensive Functioning scores, to personality and psychopathology at each succeeding level of the hierarchical factor structures. Results indicated that immature defense mechanisms exemplify strong correlations with internalizing pathology (i.e., Demoralisation and Introversion), but not with externalizing pathology and thought disorder. The differentiation of defensive functioning from higher order models of psychopathology and maladaptive personality traits seems to be limited, based on the current results. The DSQ-42 appeared to have a large overlap and correlations with internalizing pathology, which appeared to be due to its item content: mostly intrapsychic and immature defenses. Theoretical and clinical implications considering the use of the DSQ are discussed

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Heboidophrenia and Pseudo-Psychopathic Schizophrenia: Current Knowledge and Critical Perspective.

In this article, based on literature review, we present an integrated description of heboidophrenia and pseudo-psychopathic schizophrenia. Both diagnostic constructs describe latent psychotic processes inextricably bound with psychopathic features. Although both have been described in different eras and research threads, they are that similar that we could not find divergences. We formulated operational criteria for clinical and research purpose. The recognition of this syndrome improves risk management, treatment, and legal decisions.

Assessing psychopathy in forensic schizophrenia spectrum disorders: Validating the Comprehensive Assessment of the Psychopathic Personality-Institutional Rating Scale (CAPP-IRS).

The assessment of psychopathy in (forensic) schizophrenia spectrum disorders is long-standing debate. In the present study, we investigated the psychometric properties of the Comprehensive Assessment of Psychopathic Personality-Institutional Rating Scale (CAPP-IRS) in a sample of 72 male forensic patients with a primary diagnosis of schizophrenia spectrum disorders. We compared the CAPP-IRS' psychometric properties to those of the Psychopathy Checklist-Revised (PCL-R). The CAPP-IRS showed good interrater reliability and internal consistency except for the CAPP-IRS Cognition and Emotional Domains. There appears to be a larger but intelligible overlap between the CAPP-IRS and schizophrenia symptoms than between the PCL-R and schizophrenia symptoms. Inversely, the PCL-R showed overall stronger associations with risk assessment measures. We conclude that, in (forensic) schizophrenia disorder spectrum patients, the CAPP-IRS has closer associations with clinical features, while the PCL-R is better a predicting risk and life-time dimensions.

Relationship Between Subjective Experience of Individuals, Practitioner Seniority, Cavitation Occurrence, and 3-Dimensional Kinematics During Cervical Spine Manipulation.

OBJECTIVE: The purpose of this study was to assess individual subjective experience (ISE) of the recipients of a cervical manipulation and to analyze the influence of kinematics, cavitation occurrence, and practitioner seniority on individual experience. METHODS: Practitioners with different seniority (years of experience) manipulated 20 asymptomatic volunteers at C3 and C5 on both sides. Kinematics were recorded using a 3-dimensional electrogoniometer, and ISE data were gathered through a questionnaire to explore the subjects' experiences of manipulation in terms of tactile sensations, relaxation, perception of the task, and therapist handling. Kinematics, occurrence of cavitation, practitioner's seniority, and ISE data were analyzed concurrently. RESULTS: Motion parameters obtained during manipulation were found to be influenced by cavitation occurrence and differences between practitioners. Data analysis indicated that ISE could be grouped into 2 factors. The first revolved around grip firmness and range and speed of practitioner's gesture. The second factor represented patient's relaxation and the precision of handling. Also, most ISE data correlated with kinematics, although a subjective measurement did not always correlate the highest with its objective counterpart. When cavitation occurred, ISE ratings were higher, suggesting that participants may associate cavitation with the success of manipulations. Higher practitioner seniority (more years of experience) induced feelings of higher speed, amplitude, firmness, and precision. CONCLUSIONS: Recipients of cervical manipulation experienced different subjective feelings that can be expressed in 2 dimensions. These feelings are influenced by cavitation occurrence and practitioner's seniority. A better understanding of an individual's subjective experience related to cervical manipulation could increase confidence and improve the patient-therapist relationship, and it may provide further therapeutic perspectives for the practitioners.

Psychogenic Foreign Accent Syndrome: A New Case.

This paper presents the case of a 33-year-old, right-handed, French-speaking Belgian lady who was involved in a car accident as a pedestrian. Six months after the incident she developed a German/Flemish-like accent. The patient's medical history, the onset of the FAS and the possible psychological causes of the accent change are analyzed. Relevant neuropsychological, neurolinguistic, and psychodiagnostic test results are presented and discussed. The psychodiagnostic interview and testing will receive special attention, because these have been underreported in previous FAS case reports. Furthermore, an accent rating experiment was carried out in order to assess the foreign quality of the patient's speech. Pre- and post-morbid spontaneous speech samples were analyzed phonetically to identify the pronunciation characteristics associated with this type of FAS. Several findings were considered essential in the diagnosis of psychogenic FAS: the psychological assessments as well as the clinical interview confirmed the presence of psychological problems, while neurological damage was excluded by means of repeated neuroimaging and neurological examinations. The type and nature of the speech symptoms and the accent fluctuations associated with the patient's psychological state cannot be explained by a neurological disorder. Moreover, the indifference of the patient toward her condition may also suggest a psychogenic etiology, as the opposite is usually observed in neurogenic FAS patients.

Foreign Accent Syndrome As a Psychogenic Disorder: A Review.

In the majority of cases published between 1907 and 2014, FAS is due to a neurogenic etiology. Only a few reports about FAS with an assumed psychogenic origin have been published. The present article discusses the findings of a careful database search on psychogenic FAS. This review may be particularly relevant as it is the first to analyze the salient features of psychogenic FAS cases to date. This article hopes to pave the way for the view that psychogenic FAS is a cognate of neurogenic FAS. It is felt that this variant of FAS may have been underreported, as most of the psychogenic cases have been published after the turn of the century. This review may improve the diagnosis of the syndrome in clinical practice and highlights the importance of recognizing psychogenic FAS as an independent taxonomic entity.