The sociocognitive model of dissociative identity disorder: a reexamination of the evidence.

According to the sociocognitive model of dissociative identity disorder (DID; formerly, multiple personality disorder), DID is not a valid psychiatric disorder of posttraumatic origin; rather, it is a creation of psychotherapy and the media. Support for the model was recently presented by N.P. Spanos (1994). In this article, the author reexamines the evidence for the model and concludes that it is based on numerous false assumptions about the psychopathology, assessment, and treatment of DID. Most recent research on the dissociative disorders does not support (and in fact disconfirms) the sociocognitive model, and many inferences drawn from previous research appear unwarranted. No reason exists to doubt the connection between DID and childhood trauma. Treatment recommendations that follow from the sociocognitive model may be harmful because they involve ignoring the posttraumatic symptomatology of persons with DID.

The effects of child sexual abuse: Comment on Rind, Tromovitch, and Bauserman (1998).

B. Rind, P. Tromovitch, and R. Bauserman (1998) examined the long-term effects of childhood sexual abuse (CSA) by meta-analyzing studies of college students. The authors reported that effects "were neither pervasive nor typically intense" and that "men reacted much less negatively than women" (p. 22) and recommended value-neutral reconceptualization of the CSA construct. The current analysis revealed numerous problems in that study that minimized CSA-adjustment relations, including use of a healthy sample, an inclusive definition of CSA, failure to correct for statistical attenuation, and misreporting of original data. Rind et al.'s study's main conclusions were not supported by the original data. As such, attempts to use their study to argue that an individual has not been harmed by sexual abuse constitute a serious misapplication of its findings.

Correlates of dissociative symptoms among women with eating disorders.

We examined the relationship between dissociative symptoms and other Axis I and Axis II symptoms among a sample of 53 women diagnosed as having anorexia nervosa (n = 18), bulimia nervosa (n = 27), or eating disorder NOS (n = 8). Dissociative symptoms were measured by the Dissociative Experiences Scale and the dissociation scale from the Trauma Symptom Checklist 40. Severity of dissociative symptoms was generally unrelated to severity of bulimic or anorexic symptomatology but was significantly associated with severity of anxiety and depression. In terms of Axis II symptoms, dissociative symptoms were most highly correlated with schizotypal symptomatology (r = .59), uncorrelated with borderline or antisocial symptomatology, and slightly negatively correlated with histrionic symptomatology.

Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies.

Increased interest in body dysmorphic disorder (BDD) has generated a wealth of recent research. This paper reviews the current literature regarding conceptualizations of the disorder, the development of assessment tools, and treatment outcome. Although BDD has been viewed as a variant of an eating disorder, obsessive compulsive disorder, or a somatoform disorder, it appears best conceptualized as a body image disorder with social, psychological, and possibly biological influences. Assessment instruments with acceptable psychometric properies have been developed to specifically assess BDD (e.g., the Body Dysmorphic Disorder Examination and the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder). Examination and the initial results from uncontrolled and controlled treatment research suggest that cognitive behavioral treatments for BDD may be as effective as those for possibly related disorders such as obsessive compulsive disorder and bulimia nervosa.

An examination of the diagnostic validity of dissociative identity disorder.

We review the empirical evidence for the validity of the Dissociative Identity Disorder (DID) diagnosis, the vast majority of which has come from research conducted within the last 10 years. After reviewing three different guidelines to establish diagnostic validity, we conclude that considerable converging evidence supports the inclusion of DID in the current Diagnostic and Statistical Manual for Mental Disorders. For instance, DID appears to meet all of the guidelines for inclusion and none of the exclusion guidelines; proposed by Blashfield et al. [Comprehensive Psychiatry 31 (1990) 15-19], and it is one of the few disorders currently supported by taxometric research. However, we also discuss possible problems with the current diagnostic criteria and offer recommendations, based on recent research, for possible revisions to these criteria.

Confirmatory factor analysis of a multidimensional model of bulimia nervosa.

In a recent investigation of the psychopathology of bulimia nervosa by Tobin, Johnson, Steinberg, Staats, and Dennis (1991), a multidimensional model for bulimia nervosa was presented, based on the results of an exploratory factor analysis. In the present investigation, these results and the multidimensional model were tested by means of confirmatory factor analysis with 100 women diagnosed as having bulimia nervosa. The results not only support the multidimensional model with the higher order dimensions Affective and Personality Disorder, Bulimic Behaviors, and Restricting Behaviors, but also demonstrate the importance of body dissatisfaction as a significant, and possibly independent, component of bulimia nervosa.

Equivalence of body image disturbances in anorexia and bulimia nervosa.

A silhouette method, the Body Image Assessment, was used to measure self-evaluation of current and ideal body size in three groups: Ss with with anorexia nervosa (n = 37), Ss with bulimia nervosa (n = 59), and normal control Ss (n = 95). Current and ideal body size measures were contrasted across the three groups using body mass index as a covariate to control for the Ss actual body size. Both eating disorder groups judged current body size to be larger and ideal body size to be thinner relative to control Ss. When actual body size was not statistically controlled, Ss with anorexia nervosa judged current body size to be thinner than did control Ss and Ss with bulimia nervosa. These data illustrate the importance of controlling for actual body size when investigating the self-evaluation of body size.

On the relation of dieting and bingeing in bulimia nervosa.

The continuum model of bulimia nervosa suggests that dieting plays a major role in the etiology and maintenance of bulimia. However, a previous study (M. R. Lowe et al., 1996) recently found no relationship between dieting intensity and binge eating problems in nonclinical participants differing widely in eating and weight concerns. The present study extended these findings by examining the relationship between dieting and bingeing among individuals with bulimia. Three samples of individuals diagnosed with bulimia were divided into frequent and infrequent weight-loss dieters and were compared on multiple measures of binge eating. No diet-binge relationship was found in 1 sample, whereas in the other 2 samples frequent dieters binged less than infrequent dieters. These results raise new questions about the continuum model of bulimia and suggest that weight-loss dieting may not play as prominent a role in the maintenance of bulimia as it does in its initiation.

Continuity and discontinuity models of bulimia nervosa: a taxometric investigation.

Past research evaluating the continuity and discontinuity models of bulimia has produced inconclusive results. In the current study, we performed a taxometric analysis of bulimia nervosa using means above minus below a sliding cut and maximum covariance analysis with a sample of women diagnosed with bulimia nervosa (n = 201) or women college students (n = 412). Indicators were derived from the Bulimia Test--Revised and the Eating Attitudes Test--26, and both a mixed sample and the nonclinical sample were analyzed. With both taxometric methods and both mixed and nonclinical samples, results were consistently suggestive of a latent taxon for bulimia. These results challenge a dimensional model of bulimia nervosa.

Restraint, dieting, and the continuum model of bulimia nervosa.

The authors evaluated the continuity model of bulimia nervosa, which suggests that bulimia results from extreme weight concern and dieting practices. Individuals with bulimia, current dieters, restrained nondieters, and unrestrained nondieters were compared on measures of general psychopathology, eating-disorder-specific psychopathology, and overeating. Multiple methods, including questionnaires, clinical interviews, and food records, were used to collect data. The continuity and discontinuity models were tested with trend and regression analyses. The results of most analyses were consistent with the continuity perspective. However, binge eating behaviour exhibited a clear nonlinear trend, which occurred because binge eating was common in bulimic individuals but virtually non-existent in the other 3 groups. Current dieters scored higher than restrained nondieters on restraint/ weight concern, but not on psychopathology or binge eating. Overall, the results suggest that "normal" dieting is associated with psychological, but not consummatory, symptoms of bulimia.

"Remembering" words not presented in lists: relevance to the current recovered/false memory controversy.

H.L. Roediger and K.B. McDermott (1995) found that when participants studied a list of words with a common but not presented associate, participants frequently falsely reported remembering the never presented associated word as part of the list. Roediger and McDermott suggest that this finding is generalizable to the current controversy surrounding contested memories of child abuse. The present authors urge caution in making such a generalization, arguing that there are critical differences between Roediger and McDermott's findings and contested memories of abuse.

The development and validation of Spanish versions of the State and Trait Food Cravings Questionnaires.

OBJECTIVE: We developed and tested the psychometric properties of Spanish versions of the Trait and State Food Cravings Questionnaires (FCQ-T and FCQ-S respectively). METHOD: The instruments were translated and adapted to Spanish and administered to undergraduate students from a Southern university in Spain (N = 271). The data were analyzed using confirmatory factor analysis to compare the factor structure of the English and Spanish versions of both questionnaires. RESULTS: The factors structure of both questionnaires obtained excellent fit indices across their Spanish versions with the one exception that some factors of the FCQ-S were more highly intercorrelated among the Spanish sample than the American. DISCUSSION: This study supports the conceptualization of food cravings as universal multidimensional motivational states that can be reliably measured and supports the use of the Spanish versions of the FCQ.

Body image, body dysphoria, and dietary restraint: factor structure in nonclinical subjects.

The principal aim of this study was to examine the factor structure of several assessment methods used to measure dietary restraint, body dissatisfaction, and body image. Factor analysis was employed to identify and confirm the primary constructs measured by these assessment methods. A total of 206 undergraduate women were recruited as subjects. This sample was divided into two subsets of 100 and 106 subjects. On the first subset, principle components analysis identified three factors: body dysphoria, dietary restraint, and body image. With the second subset of subjects, confirmatory factor analysis cross-validated this factor structure. A two factor solution, body dysphoria and dietary restraint, was identified and confirmed when the body image measure was converted to a self-minus-ideal discrepancy score. These findings are discussed in relation to the definition of control groups to be used in studies of anorexia and bulimia nervosa. Guidelines for the selection of measures for each of the three factors also are presented.

Low-level lead exposure and intelligence in children.

Numerous prospective and cross-sectional studies of the relation between low-level lead exposure and cognitive functioning in children have suggested that intellectual and academic performance declines as lead burdens increase. Kaufman [Arch. Clin. Neuropsychol. (2001)] raises questions regarding interpretive issues along these lines, and therein challenges the wisdom of using the available lead/IQ data complex as an essential element of the decision-making process that leads to policy statements. In this article, we address some of the concerns expressed by Kaufman, and conclude that each of his five points are logically or statistically flawed, as is his overall strategy of critiquing individual studies after methodologically sound meta-analyses have been performed. Kaufman is perhaps correct that the findings from correlational research on low lead levels and IQ loss should be interpreted with caution, but the caution extends equally if not more greatly in the direction of previous research having underestimated the relationship between the two variables in question.

Additive effects of mood and eating forbidden foods upon the perceptions of overeating and binging in bulimia nervosa.

We examined the relationship between actual caloric intake and subjective perceptions of amount eaten using self-monitoring data. Forty subjects participated in the study: 20 bulimia nervosa patients and 20 normal controls. All subjects monitored their eating for a 2-week period and rated each eating episode on a Likert-type scale ranging from an undereat to a binge. Estimates of actual caloric intake were compared with these subjective ratings. Bulimics were found to overrate the amount consumed, relative to controls. The effect increased as caloric intake increased. Bulimics' ratings of amount eaten and binging were found to be predicted by the estimate of the actual amount eaten, the type of foods eaten, and the subjects' mood prior to eating, while nonbulimics' ratings were predicted only by the estimated actual amount. Subjective ratings of amount were found to be the best predictor of purgative activity. The results are discussed in terms of a perceptual bias theory, treatment implications, and possible revisions to the current DSM criteria for bulimia nervosa.

Cross-ethnic equivalence of the Hopkins Symptom Checklist-21 in European American, African American, and Latino college students.

To determine if the Hopkins Symptom Checklist-21 demonstrates equivalent validity across different ethnic groups, the authors tested the factor structure of the instrument with a sample of European American (n = 514), African American (n = 154), and Latino (n = 229) college students using confirmatory factor analysis with tests of invariance across groups. For the most part, a 3-factor model with Performance, General, and Somatic factors fit equally well for all 3 racial/ethnic groups. Differences involved only a few items in terms of either the strength of a factor loading or an error term. The results generally support the validity of the use of the instrument for measurement of distress in these different racial/ethnic groups.

The reliability and validity of a group-administered version of the body image assessment.

The Body Image Assessment (BIA) is a simple measure of body image disturbance. However, it has currently only been used with an individual administration format and only to assess ratings of current body size, ideal body size, and body dissatisfaction. It has also only been validated for use with women. In the current two studies, the reliability and validity of a group-administered version of the BIA procedure for both men and women that also assessed ratings of the ideal opposite sex and predictions about what the opposite sex would prefer as most attractive was examined. In the first study, results indicated good test-retest reliability for the group version for current and ideal body size and good concurrent validity with the individual administration format of the BIA. The results of the second study supported the construct and predictive validity of the group administered BIA, suggesting that it is a time-efficient alternative to the original, individually administered assessment.

Development and validation of a multifactorial treatment outcome measure for eating disorders.

The purpose of this investigation was to develop a brief self-report inventory which could be used to evaluate treatment outcome for anorexia and bulimia nervosa. The Multifactorial Assessment of Eating Disorders Symptoms (MAEDS) was constructed to measure six symptom clusters which have been found to be central to the eating disorders: depression, binge eating, purgative behavior, fear of fatness, restrictive eating, and avoidance of forbidden foods. The factor structure of the MAEDS was found to be stable and it was found to have satisfactory reliability and validity. Normative data were collected so that raw scores could be converted to standardized scores. While still in the experimental stages, the MAEDS shows promise as a valid and economical measure of treatment interventions for anorexia and bulimia nervosa.

Recent reformulations of Freud's development and abandonment of his seduction theory: historical/scientific clarification or a continued assault on truth?

It is well known that, as part of Freud's early work with "hysteria," he reported making discoveries of sexual abuse that he interpreted first as genuine but subsequently as fantasy. Several writers now argue that Freud never made such discoveries; rather that he lied about them, only inferred abuse from his patients' symptoms, or suggested false memories to his clients. The present authors evaluate Freud's original work and these recent claims and conclude that (a) they are not new and are similar to the original reaction that Freud received; (b) the assertion that Freud did not make discoveries of abuse is unwarranted; and (c) these recent writers frequently have supported their positions by misrepresenting what Freud actually wrote, ignoring evidence that contradicted their position, failing to consider obvious and more plausible explanations for Freud's behavior, and going beyond the available data and stating with certainty what cannot be determined.

Wethinks the author doth protest too much: a reply to Esterson (2002).

A Esterson (2002) responded to the authors' analysis of recent reformulations of Freud's seduction theory and alleged sexual abuse discoveries. Esterson gave several additional examples of the same type of problematic writing the authors discussed in their original article. His commentary is largely a repetition of several already-published arguments, and his numerous criticisms of the article are, in the authors' opinion, without merit. The authors address confusion over inferring abuse from symptoms, treatment of symptoms versus resolution of cases, and fathers as perpetrators of abuse. It is clear that, as long as the topic of child sexual abuse elicits heated debate, so will Freud's seduction theory, but there may be times when one needs to step back to allow a debate to move forward.