Low Self-esteem (low + self-esteem)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Patient reported and anatomical outcomes after surgery for pelvic organ prolapse,,

Ahmed S. El-Azab
Abstract Aim Primary aim was to modify Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) to assess pelvic organ prolapse (POP) in Arabic Muslim women. Secondary aim was to compare functional and anatomical outcomes of POP repair. Methods Questionnaire. A characteristic (prayer) was added to PFIQ. Linguistic validation of questionnaires was then done. Twenty cases were enrolled in a pilot study to test internal consistency and reliability. Subsequent study. Prospective study included women with symptomatic POP,,,stage II. History, examination by POP-Q, and administration of PFDI and PFIQ, were done before and 6 months after surgery. Results Questionnaire. Internal consistency of added question was good (Cronbach ,,=,0.78). Test,retest reliability of individual PFIQ items was variable. Subsequent Study. Between September 2004 and February 2007, 78 consecutive women were included. Cystocele, rectocele, and no site predominated in 74.4%, 17.9% and 7.7% of cases, respectively. Preoperatively 19.2%, 15.4% and 47.4% reported stress, urge, and mixed incontinence, respectively. Overall and individual urinary symptoms scores improved significantly after surgery. There were significant improvements in individual symptoms of constipation, splint to defecate and losing not well formed stools. Low self-esteem was most negative impact of prolapse on quality of life (QoL) followed by prayer. After surgery 90% of subjects had anatomical cure. After surgery, QoL issues are significantly related to anatomic location of prolapse as determined by POP-Q. Conclusions Modified PFIQ and PFDI are suitable to assess POP among Muslim women. Postoperatively, many prolapse-related symptoms and QoL significantly improve after surgery on the short term with an anatomic cure rate of 90%. Neurourol. Urodynam. 28:219,224, 2009. © 2008 Wiley-Liss, Inc. [source]

Incidence of social phobia and identification of its risk indicators: a model for prevention

C. Acarturk
Objective:, This study seeks to examine the incidence of social phobia in the general population and to establish a number of risk indicators. Method:, Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) which is a population based prospective study (n = 7076). A sample of adults aged 18,64 years (n = 5618) were re-interviewed 1 year later using Composite International Diagnostic Interview (CIDI). Results:, The 12-month incidence of DSM-III-R social phobia was 1.0%. Low education, low mastery, low self-esteem, emotional neglect in childhood and ongoing difficulties were found to be risk indicators. After including other mental disorders as risk indicators in the model, the incidence was found to be more common among those with low mastery, major depression, subthreshold social phobia, emotional neglect, negative life events, and low education. Conclusion:, The incidence of social phobia can be predicted relatively well with psychosocial variables and comorbidity. [source]

Victimization: a newly recognized outcome of prematurity

Line Nadeau PhD
Victimization by peers affects 10 to 20% of school children under the age of 12 years. Physical, verbal, and psychological victimization (being pushed, hit, called names, teased, being the target of rumours, theft, extortion) is associated with short- and long-term adjustment problems, such as peer rejection, social withdrawal, low self-esteem, anxiety, loneliness, and depression, as well as academic problems and school drop-out. Research on populations of school children (primary and secondary) has associated victimization with personal risk factors (the victim's characteristics and behaviour) and interpersonal risk factors (social relationships between peers). Studies on the social adjustment of preterm children at school age show that, even in the absence of a major motor or cognitive disability, this population has several personal risk factors associated with victimization. The objective of this study was to compare the level of victimization experienced by a group of 96 seven-year-old children born extremely preterm (EP, <29 weeks of gestation; 49 females) against that experienced by a group of 63 term children (34 females) matched for age and sex, maternal level of education, and family socioeconomic status. The children born EP had a mean gestational age of 27.3 weeks (SD 1.2) and a mean birthweight of 1001.1g (SD 223) and normal birth weight children had a mean gestational age of 39.5 weeks (SD 1.5) and a mean birthweight of 3468.7g (SD 431). Physical and verbal victimization were assessed in a school setting by peers with individual sociometric interviews (Modified Peer Nomination Inventory). After controlling for physical growth (height and weight) at the age of 7 years, the data indicate two independent effects: males were more victimized than females, and children born preterm experienced more verbal victimization by their peers than their term classmates, even when participants with a visible motor, intellectual, or sensory disability were excluded. Several hypotheses are presented to account for the higher incidence of verbal victimization of preterm children. [source]

Self-esteem and suicide rates in 55 Nations

Armand Chatard
Abstract Using recent data from the International Sexuality Description Project (ISDP), we examined whether national differences in self-esteem across 55 nations are reflected in suicide rates. Results indicate that suicide is especially common in nations with relatively low levels of self-esteem. This relation is consistent across sex lines, age of suicide and independent from several other relevant factors such as economic affluence, transition, individualism, subjective well-being, and neuroticism. These findings provide support for the predictive validity of self-esteem scores as assessed in the ISDP survey. They also contribute to a growing body of research documenting negative consequences associated with low self-esteem. Possible implications for suicide prevention strategies are discussed. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Dissonance thin-ideal and didactic healthy behavior eating disorder prevention programs: Results from a controlled trial

Jill Anne Matusek
Abstract Objective Negative body image, a common problem among college-age women in the United States, strongly correlates with low self-esteem, disturbed eating behavior, and eating disorders. Psychoeducational programs have inconsistently shown improvement in body image, thin-ideal internalization, eating behaviors, psychosocial functioning, and self-esteem. Method In the current study, college women with body image concerns (N = 84) were randomly assigned to a cognitive dissonance-based, thin-ideal internalization, single-session workshop (DTI; n = 26); a psychoeducational, healthy behavior, single-session workshop (HB; n = 24); or a wait-list control (WL; n = 34). Results Comparing baseline data with 4-week follow-up data, results indicated that both DTI and HB participants reported improvement in body image, thin-ideal internalization, and eating behaviors. Discussion Results provide evidence that both interventions effectively reduce risk factors for eating pathology. © 2004 by Wiley Periodicals, Inc. Int J Eat Disord 36: 376,388, 2004. [source]

Self-reported health, self-esteem and social support among young unemployed people: a population-based study

Lars Axelsson
A population-based study was performed in southern Sweden in the autumn of 1998. The aim was to study connections between self-reported health, self-esteem and social support among unemployed (, three months) young people. The sample consisted of 264 unemployed individuals aged 20,25 years, and 528 individuals of the same age, randomly selected from the population register and not registered as unemployed. The response rate was 72%. Defined by means of factor analysis, mental health consisted of the symptoms tearfulness, dysphoria, sleeping disturbance, restlessness, general fatigue and irritability. The unemployed had more mental health problems than young people who were working or studying. Restlessness and dysphoria were significantly over-represented in the unemployed among both sexes. However, good social support seemed to predict mental health. Support from parents was most important, particularly in males. Those with low self-esteem and poor parental support were especially vulnerable. [source]

Evaluating a Survivors Group Pilot for Women with Significant Intellectual Disabilities who have been Sexually Abused

Nicholas Guy Peckham
Background, Sexual abuse has been associated with trauma, low self-esteem, anger, depression and challenging behaviours. This pilot study builds on a small published literature by evaluating a survivors group (SG) for women with an intellectual disability and an educational support group (ESG) for their carers. Method, The SG was delivered weekly over 5 months for 20 sessions and the ESG ran concurrently for their seven carers in a separate room within the same community-based building. Participants were helped to build trust and rapport, provided with education about sexual abuse designed for their level of ability, and helped to reprocess the trauma of their sexual abuse. Results, Both the SG and the ESG were evaluated using a repeated-measures design (double baseline, mid-treatment, post-treatment and follow up), to see whether there was any improvement in relevant clinical dependent variables associated with the consequences of sexual abuse (i.e. trauma, self-esteem, anger, depression and challenging behaviour). Improvements occurred in sexual knowledge, trauma and depression. Neither self-esteem nor anger improved for most of the SG and challenging behaviour worsened at first before improving. Conclusions, The SG seemed to be successful in improving sexual knowledge and in reducing trauma and depression, although challenging behaviours worsened at first before improving. There is a need for more sexual abuse/sexual education groups for men and women with intellectual disabilities. [source]

The Psychological Impact of Domestic Violence on Spanish Women,

M. Pilar Matud
This study examined the psychological impact of partner violence on 240 Spanish women who were identified as abused, comparing them to a control group of 240 non-abused women. The abused women suffered more long-lasting anxiety and insomnia, severe depression, and somatic symptomatology, and also had lower self-esteem than did the non-abused women. The severity of the psychological abuse was correlated positively with the severity of the physical abuse, while the number of years of abuse endured correlated with the women's age and number of children. The most relevant variable for predicting severe depression, social dysfunction, anxiety and insomnia, and somatic symptoms was low self-esteem. [source]

Psychological aspects of hair disease

Ramon Grimalt
Summary Balding men are viewed as less desirable in a physical, personal, and social sense. Given the stereotype, it is not surprising that some men with androgenetic alopecia (AGA) appear to have a lower self-image, depression resulting in increased introversion, and increased feelings of unattractiveness. Ours is a culture that places a premium on physical appearance. In this context, appearance-altering conditions can be psychosocially insidious, especially conditions such as AGA with an uncertain course and a negative social meaning. To date, little or no data have been available regarding the psychosocial and quality-of-life aspects of AGA in a representative sample of community men. It is unknown whether AGA is a causal factor in the development of low self-esteem, depression, introversion, and feeling of unattractiveness, or whether there are underlying problems in certain patients prior to hair loss. Longitudinal studies will be important to investigate the temporal relationships between the degree of hair loss and psychosocial variables associated with AGA. A patient with male pattern baldness will be better treated and consequently more satisfied (better quality of life) if he receives effective anti-alopecia agents and simultaneously is evaluated and treated, if needed, for his psychological disorder. [source]

Obesity and obesity-related secondary conditions in adolescents with intellectual/developmental disabilities

J. H. Rimmer
Abstract Background To explore the prevalence of obesity and related secondary conditions associated with obesity in adolescents with intellectual/developmental disabilities (IDD). Methods In total, 461 parents of adolescents with IDD (M = 14.9 year, SD = 1.9) across 49 US states completed a web-based survey containing questions related to their child's health status, including body weight and existing health conditions. Results were compared with published data for youth without disabilities. Results Adolescents with autism and Down syndrome were two to three times more likely to be obese than adolescents in the general population. Secondary health conditions were higher in obese adolescents with IDD compared with healthy weight adolescents with IDD including high blood pressure, high blood cholesterol, diabetes, depression, fatigue, liver or gallbladder problems, low self-esteem, preoccupation with weight, early maturation and pressure sores. Conclusion Obesity is as much of a health problem in youth with IDD as it is among youth without disabilities and, in certain disability groups, is a significantly greater health problem. Obese youth with IDD have a high number of obesity-related secondary conditions predisposing them to greater health problems as they transition into adulthood. Federal and local initiatives to reduce obesity among youth in the general population must recognise the need for interventions that are also relevant (i.e. accessible and effective) for youth with IDD. [source]

Students' Perceptions of Prosthodontics in a PBL Hybrid Curriculum

Cortino Sukotjo DDS
Abstract Purpose: A survey was distributed to the Harvard School of Dental Medicine (HSDM) predoctoral student classes of 2005 and 2006 to assess their perceptions regarding preclinical prosthodontics laboratory exercises. Prosthodontics curriculum clock hours, prosthodontics teaching participation, and plans for specialization were also analyzed. We hypothesized that reduced hours and perceived stress in the prosthodontics curriculum might impact students' choice of specialty at HSDM Materials and Methods: HSDM preclinical prosthodontics clock hours were compared with national means from published data. A survey was distributed to the HSDM classes of 2005 and 2006 (n = 70) at the end of their preclinical prosthodontics laboratory exercises, prior to students seeing their first patient in the clinics. Results: A 100% response rate was achieved. Results from this study show that HSDM preclinical prosthodontics clock hours are on average shorter than other schools. The majority of the students felt stressed during the laboratory exercises, and they felt they did not gain adequate knowledge from the lectures, resulting in low self-esteem (confidence) in treating patients in the clinic. Despite this perception, HSDM students do just as well, if not better, than other students, as judged by external and internal outcome measures. Graduate prosthodontics specialization is still a specialty of choice among the graduates when compared to national data. Conclusions: The shortened preclinical didactic and laboratory exercises in prosthodontics at HSDM affect student anxiety, but not their didactic and clinical performances or their decisions in choosing their graduate program. Problem-based learning (PBL) tutorials help the students to integrate preclinical and clinical knowledge and skills in prosthodontics. [source]

Social comparison as a coping strategy among caregivers of eating disorder patients

Accessible summary ,,The paper describes social comparisons among caregivers of eating disorder patients as a coping strategy. ,,Different social comparison strategies were assessed in a sample of 96 caregivers as well as their self-esteem, characteristics of personality and perceived quality of life. ,,The use of unfavourable strategies was correlated to neuroticism and low self-esteem. ,,Women adopted worse strategies and the fact that having obtained different subgroups regarding the use of those strategies could have prognostic repercussions. Abstract The aim of the study was to determine any gender differences in the social comparisons made by caregivers of eating disorder patients and to analyse the relationship between social comparison and personality, age of caregivers, self-esteem, duration of illness, duration of treatment and perceived health and quality of life. We also explored the possibility of classifying caregivers according to these variables. Comparison strategies were analysed in a sample of 96 caregivers of eating disorder patients. The social comparison during illness scale, visual analogue scales of health and quality of life, self-esteem scale of Rosenberg and Eysenck Personality Questionnaire were used. In order to explore possible groupings a cluster analysis was performed. A significant correlation between the use of more unfavourable strategies, neuroticism and low self-esteem was found. Women adopted worse strategies and the cluster analysis revealed two sub-groups with respect to comparisons, personality, self-esteem, self-perceived health status and quality of life. The finding of subgroups associated with worse comparison strategies, higher neuroticism, lower self-esteem and a poorer self-perception of health and quality of life could have repercussions as regards the prognosis of eating disorders and, at all events, should be taken into account during therapeutic work with families. [source]

Self-esteem in community mental health nurses: findings from the all-Wales stress study

A. Fothergill ph dbsc(hons)pgce rmn rgn
The authors conducted an all-Wales survey of community mental health nurses (CMHNs) to determine their levels of stress, coping and burnout. A total of 301 CMHNs were surveyed in 10 NHS Trusts in Wales. A range of measures were used. These included the General Health Questionnaire (GHQ-12), Maslach Burnout Inventory (MBI), Rosenberg Self-Esteem Scale (SES), Community Psychiatric Nursing (CPN) Stress Questionnaire, and PsychNurse Methods of Coping Questionnaire. The findings from the Rosenberg SES are reported here. Community mental health nurses in Wales scored as having average self-esteem. When the data were divided into high and low self-esteem, a large group of CMHNs (40%) were found to have low self-esteem. Factors that are associated with low and high self-esteem were identified. Alcohol consumption and being on lower nursing grades (D, E, F) were associated with low self-esteem, whilst amount of experience working as a CMHN was associated with high self-esteem. [source]

Psychological well-being in rheumatoid arthritis: a review of the literature

Lynda Gettings BSc (Hons)
Abstract The psychological well-being of patients with rheumatoid arthritis (RA) is an important issue, and the advent of measurement tools has led to a better understanding of the mental aspects associated with this chronic illness. Patients with RA are more likely to suffer from anxiety, depression and low self-esteem, with high levels of associated mortality and suicide. The loss of the ability to carry out daily functions owing to RA is also associated with the onset of depressive symptoms. Furthermore, the psychological effects of RA can extend to the partners, families and carers of sufferers. Conventional treatment has focused on treating the symptoms of RA and containment of disease progression, but may not necessarily address the psychological issues associated with the condition. Furthermore, patient perception of RA and of the support offered to them can cause further unnecessary psychological distress. Access to psychological support for RA patients has been shown to be inconsistent and haphazard. It is now being recognized that what is needed is a multidisciplinary team approach to treat psychological distress in RA alongside conventional treatment, involving alternative therapies tailored to the psychological needs of the patient. The benefits of treatments such as cognitive behavioural therapy, meditation and exercise are clear and these treatments should be actively encouraged, thereby enabling patients with RA to better manage the psychological burden associated with this chronic condition. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Pediatric cardiothoracic domino transplantation: The psychological costs and benefits

Jo Wray
Abstract:, The first domino transplants were carried out in the UK in 1987, since which time 52 such procedures have been carried out involving patients within the paediatric cardiothoracic transplant programmes of Harefield and Great Ormond Street Hospitals. Although there are medical advantages in using domino organs , such as the ability for preoperative cross-matching, the heart not being subjected to the biochemical changes of brain death and less post-transplant coronary artery disease in the recipients of domino hearts compared with the recipients of hearts from cadaveric donors , the psychological sequelae for both donor and recipient have not been previously studied. The objective of this study was to identify the main psychological themes for patients involved in the domino programmes at the two hospitals, focusing on those situations where both patients were cared for in the same tertiary centre. Patients and their families were interviewed during routine outpatient clinic visits. Negative themes identified by patients included anxiety, guilt, resentment and anger if either patient had a poor outcome or suffered significant complications, disappointment and low self-esteem for potential donors whose heart was not used and recipient awareness of donor characteristics. Positive themes included gratefulness, comfort for the recipient that someone had not had to die for them directly and the benefit to the donor of giving their heart to another patient. In conclusion, domino transplantation has many medical advantages but there are significant negative psychological concomitants which need to be addressed within the multi-disciplinary management of these patients. [source]

Job stress and depressive symptoms among Japanese fire fighters

Yasuaki Saijo MD
Abstract Background Associations between job stresses, as assessed by theoretical job stress model and depressive symptoms among fire fighters have not been fully investigated. The purpose of this study is to clarify the factors of job stress that influence the depressive symptoms in Japanese fire fighters. Methods The subjects involved 1,672 fire fighters from a local government. The questionnaire comprised age, gender, job type, job class, martial status, smoking, and drinking habit, the Center for Epidemiologic Studies Depression Scale (CES-D), and The National Institute for Occupational Safety and Health (NIOSH) generic job questionnaire. Results A group showing depressive symptoms (CES-D,,,16) included 373 subjects (22.3%). In a multivariate logistic regression analysis, high variance in workload, high intergroup conflict, high role conflict, and low self-esteem had significantly higher odds ratio for depressive symptoms. Conclusions High variance in workload, high intergroup conflict, high role conflict, and low self-esteem were significantly related to depressive symptoms among Japanese fire fighters. Further prospective studies are needed to clarify the influence of these stress factors on other health outcomes, and to elucidate whether alleviation of these stress factors improve the mental health among fire fighters. Am. J. Ind. Med. 50:470,480, 2007. © 2007 Wiley-Liss, Inc. [source]

Proceedings of the 20th Annual Conference of the Japanese Association for Adolescent Psychotherapy, 16 November 2002, Tokyo, Japan

Article first published online: 28 AUG 200
Inpatient treatment of obsessive,compulsive disorder in a child and adolescent psychiatry ward M. USAMI National Center of Neurology and Psychiatry, Kohnodai Hospital, Chiba, Japan This is a case report of a 13-year-old-boy (2nd grade in junior high school). His father had poor communication; his mother was a very fragile woman. The boy had been overprotected by his parents, as long as he responded to their expectations. He did not have any other siblings. He played well with his friends since he was young, and did not have problems until the 1st term (from April to July) of 1st grade in junior high school. However, in September he started to have difficulties going well with his friends, and going to school. He spent most of his time in his room, and began to repeat checking and hand-washing frequently. Even at midnight, he forced his mother to touch the shutter from outside of the house for many times. He also ritually repeated to touch his mother's body, after he licked his hands, for over an hour. He became violent, when his parents tried to stop him. In April, year X, his parents visited our hospital for the first time. From then, his mother could not tolerate her son's coerciveness any longer. His father explained to the boy that ,your mother has been hospitalized', and she started to live in the next room to the boy's without making any noise. After 3 months he noticed that his mother was not hospitalized, and he got very excited. He was admitted to our hospital with his family and relatives, in October, year X. At the initial stage of hospitalization he showed distrust and doubt towards the therapist and hospital. He had little communication with other boys and did not express his feelings. Therefore, there was a period of time where he seemed to wonder whether he could trust the treatment staff or not. During his interviews with his therapist he repeated only ,I'm okay' and did not show much emotional communication. For the boy, exposing himself was equivalent to showing his vulnerability and incompleteness. Therefore, the therapist considered that he was trying to denying his feelings to avoid this. The therapist set goals for considering his own feelings positively and expressing them appropriately. Also, the therapist carried out behavioral restrictions towards him. He hardly had any emotional communication with the staff, and his peer relationship in the ward was superficial. Therefore, he gradually had difficulty spending his time at the end of December On the following day in which he and the therapist decided to return to his house for the first time, he went out of the ward a few days before without permission. From thereon it was possible for him to share feelings such as hostility and aggression, dependence and kindness with the therapist. The therapist changed his role from an invasive one to a more protective one. Then, his unsociability gradually faded. He also developed good peer relationships with other boys in the ward and began to express himself feeling appropriately. He was also able to establish appropriate relations with his parents at home, and friends of his neighborhood began to have normal peer relationships again. During childhood and adolescence, boys with obsessive,compulsive disorder are known to have features such as poor insight and often involving their mothers. We would like to present this case, through our understanding of dynamic psychiatry throughout his hospitalization, and also on the other therapies that were performed. Psychotherapy with a graduate student that discontinued after only three sessions: Was it enough for this client? N. KATSUKI Sophia University, Tokyo, Japan Introduction: Before and after the psychotherapy, SWT was administrated in this case. Comparing these two drawings, the therapist was provided with some ideas of what kind of internal change had taken place inside this client. Referring to the changes observed, we would like to review the purposes and the ways of the psychotherapy, as well as the adequacy of the limited number of the sessions (vis-a-vis result attained.) Also we will discuss later if any other effective ways could be available within the capacities of the consulting system/the clinic in the university. Case: Ms. S Age 24 years. Problems/appeal: (i) awkwardness in the relationship with the laboratory colleagues; (ii) symptoms of sweating, vomiting and quivering; and (iii) anxiety regarding continuing study and job hunting. Diagnosis: > c/o PTSD. Psychotherapeutic setting: At the therapy room in the clinic, placed at the university, 50 min-session; once a week; paralleled with the medical treatment. Process: (1) Since she was expelled from the study team in the previous year, it has become extremely difficult for her to attend the laboratory (lab) due to the aforementioned symptoms. She had a feeling of being neglected by the others. When the therapist suggested that she compose her mental confusions in the past by attending the therapy room, she seemed to be looking forward to it, although she said that she could remember only a few. (2) She reported that she overdosed on sedatives, as she could not stop irritating. She was getting tough with her family, also she slashed the mattress of her bed with a knife for many times. She complained that people neither understood nor appreciated her properly. and she said that she wanted revenge on the leader of the lab by punishing him one way or other. (3) Looking back the previous session, she said ,I had been mentally mixed up at that time, but I feel that now I can handle myself, as I stopped the medication after consulting the psychiatrist. According to what she said, when she disclosed the occurrences in the lab to her mother, she felt to be understood properly by her mother and felt so relieved. and she also reported that she had been sewing up the mattress which she slashed before, without any reason. She added, " although I don't even know what it means, I feel that this work is so meaningful to me, somehow". Finally, she told that she had already made her mind to cope with the situation by herself from now on, although it might result in a flinch from the real solution. Situations being the above, the session was closed. Swt: By the remarkable changes observed between the two drawings, the meanings of this psychotherapy and its closure to the client would be contemplated. Question of how school counselors should deal with separation attendant on students' graduation: On a case in which the separation was not worked through C. ASAHARA Sophia University, Tokyo, Japan Although time limited relationship is one of the important characteristics in school counseling, the question of separation attendant on it has not been much discussed based on specific cases. This study focuses on the question of separation through looking at a particular case, in which the separation was not worked through, and halfway relationship continued even after the student's graduation and the counselor's resignation. I was a part time school counselor at a junior high school in Tokyo. The client was a 14-year-old female student, who could not go to her classroom, and spent a few hours in a sick bay when she came to school. She was in the final grade and there was only half a year left before graduation when we first met, and we started to see each other within a very loose structure. As her personality was hyper-vigilant and defensive, it took almost 2 months before I could feel that she was nearer. Her graduation was the first occasion of separation. On that occasion, I found that there had been a discrepancy between our expectations; while I took it for granted that our relationship would end with the graduation, she expected to see me even after she graduated, and she actually came up to see me once in a while during the next year. A year later, we faced another occasion of separation, that was my resignation. Although I worried about her, all I have done for her was to hand a leaflet of a counseling office, where I work as a part time counselor. Again I could not refer to her feelings or show any concrete directions such as making a fixed arrangement. After an occasional correspondence for the next 10 months (about 2 years after her graduation), she contacted me at the counseling office asking for a constant counseling. Why could I not deal with both occasions? and how did that affect the client thereafter? There were two occasions of separation. At the time of the client's graduation, I seemed to be enmeshed in the way of separation that is peculiar to the school setting. In general in therapeutic relationship, mourning work between counselor and client is regarded as being quite important. At school, however, separation attendant on graduation is usually taken for granted and mourning work for any personal relationship tends to be neglected. Graduation ceremony is a big event but it is not about mourning over one's personal relationships but separation from school. That may be why I did not appreciate how the client counted on our relationship. At the time of my resignation I was too worried about working through a change from very loose structure which is peculiar to the school setting to a usual therapeutic structure (fees are charged, and time, place are fixed). That is why I did nothing but give her a leaflet. In this way, we never talked about her complex feelings such as sadness or loneliness, which she was supposed to experience on separation. Looking at the aforementioned process from the client's viewpoint, it can be easily imagined that she could not accept the fact of separation just because she graduated. and later, she was forced to be in double-bind situation, in which she was accepted superficially (handed a leaflet), while no concrete possibility was proposed concerning our relationship (she could never see me unless she tries to contact me.) As a result, she was left alone and at a loss whether she could count on me or not. The halfway situation or her suspense was reflected in her letter, in which she appeared to be just chatting at first sight, but between the lines there was something more implying her sufferings. Above discussion suggests that in some case, we should not neglect the mourning work even in a school setting. To whom or how it is done is the next theme we should explore and discuss in the future. For now, we should at least be conscious about the question of separation in school setting. Study of the process of psychotherapy with intervals for months M. TERASHIMA Bunkyo Gakuin University, Tokyo, Japan This is a report on the process of psychotherapy of an adolescent girl who showed manic and depressive state. At the time of a depressed state, she could not go to a college and withdrew into home, and the severe regressive situation was shown. Her therapy began at the age of 20 and she wanted to know what her problem was. The process of treatment went on for 4 years but she stopped coming to sessions for several months because of failure of the therapist. She repeated the same thing twice. After going through these intervals the client began to remember and started to talk about her childhood , suffering abusive force from her father, with vivid impressions. They once were hard for her to accept, but she began to establish the consistent figure of herself from past to present. In this case, it could be thought that the intervals of the sessions had a certain role, with which the client controlled the structure of treatment, instead of an attack against the therapist. Her object relation, which is going to control an object offensively, was reflected in these phenomena. That is, it can be said that the ambivalence about dependency , difficult to depend but desirous of the object , was expressed. Discontinuation of the sessions was the product of the compromise formation brought about the ambivalence of the client, and while continuing to receive this ambivalence in the treatment, the client started to realize discontinuance of her memories and then advanced integration of her self-image. For the young client with conflict to dependence such as her, an interval does not destroy the process of treatment but in some cases it could be considered as a therapeutic element. In the intervals the client could assimilate the matter by herself, that acquired by the sessions. Psychotherapy for a schizoid woman who presented eccentric speech and behaviour M. OGASAWARA Osaka University Graduate School of Medicine, Osaka, Japan Case presentation: A case of a 27-year-old woman at the beginning of therapy. Life history: She had been having a wish for death since she was in kindergarten and she had been feeling strong resistance to do the same as others after school attendance. She had a history of ablutomania from the age of 10,15, but the symptom disappeared naturally. and she said that she had been eliminated from groups that she tried to enter. After graduating a junior college, she changed jobs several times without getting a full-time position. Present history: Scolded by her boy friend for her coming home too late one day, she showed confusion such as excitement, self-injury or terror. She consulted a psychiatrist in a certain general hospital, but she presented there eccentric behaviours such as tense facial expression, stiffness of her whole body, or involuntary movement of limbs. and because she felt on bad terms with the psychiatrist and she had come to cause convulsion attacks in the examination room, she was introduced to our hospital. Every session of this psychotherapy was held once a week and for approximately 60 min at a time. Treatment process: She sometimes presented various eccentric attitudes, for example overturning to the floor with screaming (1), going down on her knees when entrance at the door (5), entering with a knife in her mouth and hitting the wall suddenly (7), stiffening herself just outside the door without entering the examination room (9), taking out a knife abruptly and putting it on her neck (40), exclaiming with convulsion responding to every talk from the therapist (41), or stiffening her face and biting herself in the right forearm suddenly (52). She also repeated self-injuries or convulsion attacks outside of the examination room in the early period of the therapy. Throughout the therapy she showed hypersensitivity for interpersonal relations, anxiety about dependence, terror for self-assertion, and avoidance for confrontation to her emotional problems. Two years and 6 months have passed since the beginning of this therapy. She ceased self-injury approximately 1 year and 6 months before and her sense of obscure terror has been gradually reduced to some extent. Discussion: Her non-verbal wariness and aggression to the therapist made the sessions full of tension and the therapist felt a sense of heaviness every time. In contrast, she could not express aggression verbally to the therapist, and when the therapist tried to identify her aggression she denied it. Her anxiety, that she will be thoroughly counterattacked to self-disintegration if she shows aggression to other persons, seems to be so immeasurably strong that she is compelled to deny her own aggression. Interpretations and confrontations by the therapist make her protective, and occasionally she shows stronger resistance in the shape of denial of her problems or conversion symptoms (astasia, aphonia, or involuntary movements) but she never expresses verbal aggression to the therapist. and the therapist feels much difficulty to share sympathy with her, and she expresses distrust against sympathetic approach of the therapist. However, her obvious disturbance that she expresses when she feels the therapist is not sympathetic shows her desire for sympathy. Thus, because she has both strong distrust and desire for sympathy, she is in a porcupine dilemma, which is characteristic of schizoid patients as to whether to lengthen or to shorten the distance between herself and the therapist. This attitude seems to have been derived from experience she might have had during her babyhood and childhood that she felt terror to be counterattacked and deserted when she showed irritation to her mother. In fact, existence of severe problems of the relationship between herself and her mother in her babyhood and childhood can be guessed from her statement. Although she has been repeating experiences to be excluded from other people, she shows no attitude to construct interpersonal relationship actively. On the contrary, by regarding herself to be a victim or devaluating other persons she externalizes responsibility that she herself should assume essentially. The reason must be that her disintegration anxiety is evoked if she recognizes that she herself has problems; that is, that negative things exist inside of her. Therefore, she seems to be inhibited to get depressive position and obliged to remain mainly in a paranoid,schizoid position. As for the pathological level, she seems to have borderline personality organization because of frequent use of mechanisms to externalize fantastically her inner responsibility. For her high ability to avoid confronting her emotional problems making the most of her verbal ability, every intervention of the therapist is invalidated. So, it seems very difficult for her to recognize her own problems through verbal interpretations or confrontation by the therapist, for the present. In general, it is impossible to confront self problems without containing negative emotions inside of the self, but her ability seemed to be insufficient. So, to point out her problems is considered to be very likely to result in her confusion caused by persecution anxiety. Although the therapy may attain the stage on which verbal interpretation and confrontation work better some day, the therapist is compelled to aim at promoting her ability to hold negative emotion inside of herself for the time being. For the purpose, the therapist is required to endure the situation in which she brings emotion that makes the therapist feel negative counter-transference and her process to experience that the therapeutic relation itself would not collapse by holding negative emotion. On supportive psychotherapy with a male adolescent Y. TERASHIMA Kitasato University Health Care Center, Kanagawa, Japan Adolescent cases sometimes show dramatic improvements as a consequence of psychotherapy. The author describes how psychotherapy can support an adolescent and how theraputic achievements can be made. Two and a half years of treatment sessions with a male adolescent patient are presented. The patient was a 19-year-old man, living with his family. He had 5 years of experience living abroad with his family and he was a preparatory school student when he came to a mental clinic for help. He was suffering from not being able to sleep well, from difficulties concerning keeping his attention on one thing, and from fear of going to distant places. He could barely leave his room, and imagined the consequence of overdosing or jumping out of a window. He claimed that his life was doomed because his family moved from a town that was familiar to him. At the first phase of psychotherapy that lasted for approximately 1 year, the patient seldom responded to the therapist. The patient was basically silent. He told the therapist that the town he lives in now feels cold or that he wants to become a writer. However, these comments were made without any kind of explanation and the therapist felt it very difficult to understand what the patient was trying to say. The sessions continued on a regular basis. However, the therapist felt very useless and fatigued. Problems with the patient and his family were also present at this phase of psychotherapy. He felt unpleasant at home and felt it was useless to expect anything from his parents. These feelings were naturally transferred to the therapist and were interpreted. However, interpretation seemed to make no changes in the forms of the patient's transference. The second phase of psychotherapy began suddenly. The patient kept saying that he did not know what to talk about. However, after a brief comment made by the therapist on the author of the book he was reading, the patient told the therapist that it was unexpected that the therapist knew anything of his favorite writer. After this almost first interaction between the patient and the therapist, the patient started to show dramatic changes. The patient started to bring his favorite rock CDs to sessions where they were played and the patient and the therapist both made comments on how they felt about the music. He also started asking questions concerning the therapist. It seemed that the patient finally started to want to know the therapist. He started communicating. The patient was sometimes silent but that did not last long. The therapist no longer felt so useless and emotional interaction, which never took place in the first phase, now became dominant. The third phase happened rapidly and lasted for approximately 10 months. Conversations on music, art, literature and movies were made possible and the therapist seldom felt difficulties on following the patient's line of thought. He started to go to schools and it was difficult at first but he started adjusting to the environment of his new part-time jobs. By the end of the school year, he was qualified for the entrance to a prestigious university. The patient's problems had vanished except for some sleeping difficulties, and he did not wish to continue the psychotherapy sessions. The therapist's departure from the clinic added to this and the therapy was terminated. The patient at first reminded the therapist of severe psychological disturbances but the patient showed remarkable progress. Three points can be considered to have played important roles in the therapy presented. The first and the most important is the interpretation by behavior. The patient showed strong parental transference to the therapist and this led the therapist to feel useless and to feel fatigue. Content analysis and here-and-now analysis seemed to have played only a small part in the therapy. However, the therapist tried to keep in contact with the patient, although not so elegant, but tried to show that the therapist may not be useless. This was done by maintaining the framework of the therapy and by consulting the parents when it was considered necessary. Second point is the role that the therapist intentionally took as a model or target of introjection. With the help of behavioral interpretation that showed the therapist and others that it may not be useless, the patient started to introject what seemed to be useful to his well being. It can be considered that this role took some part in the patient going out and to adjust to the new environment. Last, fortune of mach must be considered. The patient and the therapist had much in common. It was very fortunate that the therapist knew anything about the patient's favorite writer. The therapist had some experience abroad when he was young. Although it is a matter of luck that the two had things in common, it can be said that the congeniality between the patient and the therapist played an important role in the successful termination of the therapy. From the physical complaint to the verbal appeal of A's recovery process to regain her self-confidence C. ITOKAWA and S. KAZUKAWA Toyama Mental Health Center, Toyama, Japan This is one of the cases at Toyama Mental Health Center about a client here, we will henceforth refer to her simply as ,A'. A was a second grade high school student. We worked with her until her high school graduation using our center's full functions; counseling, medical examination and the course for autogenic training (AT). She started her counseling by telling us that the reason for her frequent absences from school began because of stomach pains when she was under a lot of stress for 2 years of junior high school, from 2nd grade to 3rd grade. Due to a lack of self confidence and a constant fear of the people around her, she was unable to use the transportation. She would spend a large amount of time at the school infirmary because she suffered from self-diagnosed hypochondriac symptoms such as nausea, diarrhea and a palpitation. She continued that she might not be able to have the self-confidence to sit still to consult me on her feelings in one of our sessions. A therapist advised her to take the psychiatric examination and the use of AT and she actually saw the medical doctor. In counseling (sessions), she eventually started to talk about the abuse that started just after her entering of junior high school; she approached the school nurse but was unable to tell her own parents because she did not trust them. In doing so, she lost the rest of her confidence, affecting the way she looked at herself and thought of how others did. At school she behaved cheerfully and teachers often accused her of idleness as they regarded this girl's absences along with her brightly dyed hair and heavy make-up as her negligent laziness. I, as her therapist, contacted some of the school's staff and let them know of her situation in detail. As the scolding from the teachers decreased, we recognized the improvement of her situation. In order to recover from the missed academic exposure due to her long absence, she started to study by herself. In a couple of months her physical condition improved gradually, saying ,These days I have been doing well by myself, haven't I?' and one year later, her improved mental condition enabled her to go up to Tokyo for a concert and furthermore even to enjoy a short part-time job. She continued the session and the medical examination dually (in tangent) including the consultation about disbelief to the teachers, grade promotion, relationships between friends and physical conditions. Her story concentrated on the fact that she had not grown up with sufficiently warm and compassionate treatment and she could not gain any mental refuge in neither her family nor her school, or even her friends. Her prospects for the future had changed from the short-ranged one with no difficulty to the ambitious challenge: she aimed to try for her favorite major and hoped to go out of her prefecture. But she almost had to give up her own plan because the school forced her to change her course as they recommended. (because of the school's opposition with her own choice). So without the trust of the teachers combined with her low self-esteem she almost gave up her hopes and with them her forward momentum. In this situation as the therapist, I showed her great compassion and discussed the anger towards the school authorities, while encouraging this girl by persuading her that she should have enough self-confidence by herself. Through such sessions, she was sure that if she continued studying to improve her own academic ability by herself she could recognize the true meaning of striving forward. and eventually, she received her parents' support who had seemed to be indifferent to her. At last she could pass the university's entrance exams for the school that she had yearned to attend. That girl ,A' visited our center 1 month later to show us her vivid face. I saw a bright smile on her face. It was shining so brightly. [source]

Physical and emotional development, appetite and body image in adolescents who failed to thrive as infants

R.F. Drewett
Background:, Previous studies suggest that failure to thrive in infancy may be associated with adverse sequelae in childhood. Although cognitive abilities have been extensively investigated, little systematic research is available on other aspects of development. Methods:, Eighty-nine children who failed to thrive as infants and 91 controls were followed up when twelve years old and examined using anthropometric measurement, self-ratings of appetite and body image, the Dutch Eating Behaviour Questionnaire, the Self-perception Profile for Children, The Revised Children's Manifest Anxiety Scale, the parent and child form of the Mood and Feelings Questionnaire and the parent and teacher's form of the Child Behavior Checklist. Results:, The children who failed to thrive were significantly shorter and lighter at twelve and had significantly lower BMIs, but they did not go into puberty any later. They were more likely to rate their appetite as lower than their best friend's, were generally more satisfied with their body shape, and had significantly lower restraint score on the Dutch Eating Behaviour Questionnaire. They were not significantly different from controls on any of the measures reflecting anxiety, depression or low self-esteem. Conclusions:, Failure to thrive in infancy is not associated with adverse emotional development in childhood. [source]

Associations among adolescent risk behaviours and self-esteem in six domains

Lauren G. Wild
Background:, This study investigated associations among adolescents' self-esteem in 6 domains (peers, school, family, sports/athletics, body image and global self-worth) and risk behaviours related to substance use, bullying, suicidality and sexuality. Method:, A multistage stratified sampling strategy was used to select a representative sample of 939 English-, Afrikaans- and Xhosa-speaking students in Grades 8 and 11 at public high schools in Cape Town, South Africa. Participants completed the multidimensional Self-Esteem Questionnaire (SEQ; DuBois, Felner, Brand, Phillips, & Lease, 1996) and a self-report questionnaire containing items about demographic characteristics and participation in a range of risk behaviours. It included questions about their use of tobacco, alcohol, cannabis, solvents and other substances, bullying, suicidal ideation and attempts, and risky sexual behaviour. Data was analysed using a series of logistic regression models, with the estimation of model parameters being done through generalised estimation equations. Results:, Scores on each self-esteem scale were significantly associated with at least one risk behaviour in male and female adolescents after controlling for the sampling strategy, grade and race. However, specific self-esteem domains were differentially related to particular risk behaviours. After taking the correlations between the self-esteem scales into account, low self-esteem in the family and school contexts and high self-esteem in the peer domain were significantly independently associated with multiple risk behaviours in adolescents of both sexes. Low body-image self-esteem and global self-worth were also uniquely associated with risk behaviours in girls, but not in boys. Conclusions:, Overall, the findings suggest that interventions that aim to protect adolescents from engaging in risk behaviours by increasing their self-esteem are likely to be most effective and cost-efficient if they are aimed at the family and school domains. [source]

Is self-esteem a universal need?

Evidence from The People's Republic of China
In a provocative article, Heine et al. concluded that self-esteem needs are less important in collectivistic, East Asian countries than in individualistic, Western ones. Their conclusion was based, in part, on evidence that: (i) self-esteem scores are less positively biased in Japan than in Western countries; and that (ii) low self-esteem is less predictive of psychological distress in Japan than in Western countries. The present research examined whether these cultural differences occur in another collectivistic culture: The People's Republic of China. Two meta-analyses were conducted. Study 1 found that, for young and old alike, self-esteem was positively biased, with most participants reporting high levels of self-esteem. Study 2 found that low self-esteem in China is associated with three indicators of psychological distress: depression, anxiety and low subjective well-being. These findings are consistent with results in Western samples and suggest that high self-esteem may indeed be a universal psychological imperative. [source]

The enigma of the welfare state: excellent child health prerequisites , poor subjective health

C Lindgren
Abstract The rate of subjective health complaints among Swedish children is increasing by age and over time, and more so than among children in other Scandinavian countries. In contrast, the somatic health and prerequisites for wellbeing are excellent. This paradoxical situation, The Enigma of the Welfare State, is the focus of this viewpoint. We argue that one important background factor may be late adverse effects of the welfare society itself and some of its inherent values. We have identified several possible pathways. We have given them names of diseases , on the society level , like health obsession, stress panic, welfare apathy and hyper-individualism. Together with other factors such as a dysfunctional school and an unsatisfactory labour market for youth, these diseases are involved in an interplay that is constantly inducing anxiety and low self-esteem. Conclusion:, The gradually deteriorating self-reported health among Swedish youth may, to some degree, be explained as a late adverse effect of the welfare society itself and its inherent values. [source]

Personality style, psychological adaptation and expectations of trainee clinical psychologists

Jeni Brooks
The literature suggests that personality affects how individuals experience stress, cope, utilize social support and psychologically adapt. This study examined the personality style, psychological adaptation and expectations of 364 UK trainee clinical psychologists. Personality traits characterizing the sample were: enhancing, modifying, extraversing, outgoing, and agreeing. Mean overall personality adjustment was significantly better than the normal population. The sample scored significantly poorer on self-esteem, anxiety and depression, but well outside the defined range for poor adaptation. A small percentage (8%, n = 31) had ,poor' personality adjustment scores, scored worse on indicators of psychological adaptation and reported greater shortfall of course aspects compared with expectations. However, 41% scored as having a significant problem on one or more of: anxiety, depression, low self-esteem and work adjustment. About one-third had a probable substance use problem. In regression analyses, poor personality adjustment, and different areas of expectation-shortfall, especially impact of training on life variously predicted anxiety, depression, and poor work adjustment. Satisfaction with social support was not predictive of adaptation after personality adjustment was accounted for. Implications for clinical psychology training include the need for enhanced expectation-management through pre-course marketing, and better attention to trainees' personal and professional development throughout training. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Elucidating the Relationship Between Obesity and Depression: Recommendations for Future Research

Joshua I. Hrabosky
The obese population is heterogeneous in its experiences of psychosocial disturbances, yet many obese individuals do experience such problems as body image disturbance, low self-esteem, diminished self-efficacy, and binge eating. Furthermore, recent research has repeatedly found obesity to correlate with negative affect, depressed mood, and clinical depression. In their comprehensive review, Markowitz, Friedman, and Arent (2008) identify numerous psychosocial and biological processes that they hypothesize to act as mediating factors in the relationship between obesity and depression. This commentary extends Markowitz and colleagues' review and proposed causal pathway model by (a) evaluating the specificity of the relationship between obesity and depression, and (b) providing recommendations for the empirical evaluation of causal hypotheses. [source]