A Visit To Cadabams

Introduction to Cadabams

The center is dedicated to the memory of  the late Amita M. Cadabam , daughter of Smt and Sri. C. A. Mannar Krishna Shetty .

The place is located on the southern outer fringes  of  Bangalore city at the address –

Cadabam’s Home for Mentally Disabled Trust ( Regd.)

Gulkamale Village , Near Kaggalipura ,

Post : Taralu , 17th Mile , Kanakapura Road , Bangalore – 560062 , INDIA.

Phone : 080 – 28432841 / 843 / 844/ 867 / 985 / 986.

Fax: 080 – 2843 2840 E-mail : cadabams@bgl.vsnl.net.in

Vision

To set up a “Home Away from Home” offering solace to the suffering individual and family alike, where the atmosphere would be of a large extended family in which the residents would get the comfort, security, love and kindness of the family, with psychosocial Rehabilitation Programmes and medical care administered by experts in respective areas.

Not content with the achievements, Cadabam’S vision is to renew the hopes of its residents, and their family members, re-kindle their life, and bring back its residents to social mainstream and integration with their families, “Towards Excellence” being its motto.

Mission

“To respond to the needs of families requiring long or Short term Residential Care and Psycho social Rehabilitation Service for their wards suffering from mental disability of varying degrees and Types.”

Services provided

• Dignified community living in a well designed and equipped campus
• Regular Psychiatric and general medical intervention
• Counselling and Psychosocial rehabilitation activities

Charitable Trust

CADABAM’S charitable trust was established in the year 2003 to make psychosocial rehabilitation affordable and accessible. It has conceived health care, education and community service as its 3 main focus areas for functioning. in its many endeavours ARPITHA stands out stretching hands of help to those needy people who would require quality mental health care that is affordable and reliable.

Experience has shown that even by keeping CADABAM’S AMITHA affordable to middle class it had become unaffordable for some sections. Responding to their needs CADABAMS’ started ARPITHA a 70 bedded rehabilitation centre in which 24 beds has been set apart for providing free treatment and rehabilitation to really poor and destitute for one year under certain conditions.

Administration

Psycho social rehabilitation at CADABAM’S group of centres has range of multi component programmes like Pharmacological management, living and social skill training, psychological support to resident and his carers (family), vocational guidance, recreational activities and Supported education.

Patients on admission are evaluated by a psychiatrist and a counsellor (professional with psychology back ground) considering various factors like the illness expected recovery and expectation of the family therapeutic interventions are planned. Counsellors regularly interact with residents (patients) and a psychiatrist evaluates at regular intervals.

The general health of the resident is also given due importance. CADABAM’S has a full time doctor managing and co-coordinating the clinical services with visiting professor of medicine for quality physical healthcare. The team of nurses will ensure that the residents get the prescribed medication, also nurse will attend to the resident in case of simple illnesses at CADABAM’S. The Centre also has an Ambulance to commute and transport patients to hospitals where the need for either specialist consultation or for admission arises.

Investigations advised and those required to be done on regular basis are carried out with local laboratories and diagnostic centres. CADABAM’S also has understanding with hospitals and tertiary care centre to ensure emergency medical help in case of emergency.

Admission Procedure

The patients are accepted for short/long term residential care and rehabilitation/de addiction based on the recommendations of the psychiatrist, who has been treating him/her, with the consent of the family and the person needing such care. Request for admission should be made by the parents / guardian / person concerned in the prescribed application form, obtainable from the office of the Administrator. On receipt of completed application from, the Admission committee will review the request. On approval of the committee the patient will be admitted as short or long term resident as the case may be, after fulfilling the other terms and conditions stipulated by the CADABAM’S. A thorough psychological and physical check-up of the patient is done at the time of admission.

Mental Health Scenario

Mental illnesses are the most devastating and disabling of the diseases, affecting the mankind, giving it’s victims and their families a life of suffering, trauma and travail. They totally destroy the victims personally, sap his capacity to lead a normal family and social life, and drive him to a life of isolation from the family and society.

Nearly one percent of Humanity is suffering from this malady, of which nearly 20% would become chronic. In the context of our country it means nearly one crore of our people are victims of different forms of Mental illness and of whom 20 Lakhs are likely to become chronic. For this formidably stupendous number the facility available for their treatment and rehabilitation is deplorably poor and does not touch even the fringe of the problem.

Often the victims’ entire personality becomes shattered due to dysfunctioning of their mental faculty. They drift from social mainstream, remain castigated from immediate neighbourhood, as well as the society at large. What they need is not just medical intervention but a multiple therapeutic approach to bring them back even to a semblance of normal functionality. They require along with psychiatric treatment a scientifically planned and organized counselling and Rehabilitation Programme,

While the illness affects the individual, the families, who are the chief caregivers, suffer equally because of lack of skills to handle critical situations, inadequate knowledge of the nature of illness, dismally poor facilities to treat the illness. Particularly in mofussil centres and villages, and also unfortunately the social stigma attached to the illness.

DSM IV Criteria for Panic Schizophrenia

Diagnostic Criteria for Schizophrenia

A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

• delusions
• hallucinations
• disorganized speech (e.g., frequent derailment or incoherence)
• grossly disorganized or catatonic behavior
• negative symptoms, i.e., affective flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.

B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive Episode, Manic Episode, or Mixed Episode have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

Subtypes

1. Paranoid Type

A type of Schizophrenia in which the following criteria are met:

• Preoccupation with one or more delusions or frequent auditory hallucinations.
• None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.

2. Catatonic Type

A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:

• motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
• excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
• extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
• peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures),
• stereotyped movements, prominent mannerisms, or prominent grimacing
• echolalia or echopraxia

3. Disorganized Type: A type of Schizophrenia in which the following criteria are met:

* All of the following are prominent:

• disorganized speech
• disorganized behavior
• flat or inappropriate affect
• The criteria are not met for Catatonic Type.

4. Undifferentiated Type

A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.

5. Residual Type

A type of Schizophrenia in which the following criteria are met:

• Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.
• There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Associated features

• Learning Problem
• Hypoactivity
• Psychosis
• Euphoric Mood
• Depressed Mood
• Somatic or Sexual Dysfunction
• Hyperactivity
• Guilt or Obsession
• Sexually Deviant Behavior
• Odd/Eccentric or Suspicious Personality
• Anxious or Fearful or Dependent Personality
• Dramatic or Erratic or Antisocial Personality

MSE –Mental Status Examination

Patient’ s Name : “ANONYMOUS SUBJECT”

A Gujarati Muslim, aged 50, “ANONYMOUS SUBJECT” seemed cold and distant at first when we met her. She told us to go away, but later, when we didn’t leave, she opened up and began to talk to us.

Physical Appearance: “ANONYMOUS SUBJECT” was interested in her appearance, though the nurses told us she had poor personal hygiene. She wore bangles and anklets, and told us where she had got them from, or who had given it. She also commented on my personal appearance. Her hair was grey, she seemed quite old, and said she was tired. The entire time we talked to her, she lay in a horizontal position on her bed.

Speech: “ANONYMOUS SUBJECT” took time to answer questions, and her answers were sometimes slurred. She spoke slowly, but speech as a whole was normal.

Thought Process: She took some time to answer the questions, and her thoughts were random, and didn’t connect to what she was saying before.

Perception: “ANONYMOUS SUBJECT” had some distortions in thinking. Every family member held some unusual and unbelievable posts. He father was a teacher in a school for all subjects, husband owned a pen business, her mother a chemical company, one son was a beautician, the other an engineer and doctor. She had various degrees, in MBA and Science. It was clear she was either making it up, or thought so actually.

Insight : On asking “ANONYMOUS SUBJECT” why she was here, she was silent for a long time, so we continued to ask her random questions. We the repeated the first question, to which she said that heR son had left for UK, and left her here. She clearly did not have knowledge of her condition. She probably thought Cadabams was an old age home.

Bibliography

http://www.cadabams.org/index.html

http://counsellingresource.com/distress/schizophrenia/dsm/schizophrenia.html

SELF-MUTILATION

Introduction to Self Injury

DEFINITION OF SELF-MUTILATION
Several definitions of this phenomenon exist. In fact, researchers and mental health
professionals have not agreed upon one term to identify the behavior. Self-harm,
self-injury, and self-mutilation are often used interchangeably.

Some researchers have categorized self-mutilation as a form of self-injury. Self-injury is
characterized as any sort of self-harm that involves inflicting injury or pain on one’s own
body. In addition to self-mutilation, examples of self-injury include: hair pulling, picking
the skin, excessive or dangerous use of mind-altering substances such as alcohol, and
eating disorders. Favazza and Rosenthal (1993) identify pathological self-mutilation as the deliberate alteration or destruction of body tissue without conscious suicidal intent.
Self-mutilating behavior does exist within a variety of populations. For the purpose of
accurate identification, three different types of self-mutilation have been identified:
1) superficial or moderate; 2) stereotypic; and 3) major. Superficial or moderate
self-mutilation is seen in individuals diagnosed with personality disorders (i.e. borderline
personality disorder).
Additionally, self-injurious behavior may be divided into two dimensions: nondissociative
and dissociative. Self-mutilative behavior often stems from events that occur in the first six years of a child’s development.

Nondissociative self-mutilators usually experience a childhood in which they are
required to provide nurturing and support for parents or caretakers. If a child
experiences this reversal of dependence during formative years, that child perceives
that she can only feel anger toward self, but never toward others. This child experiences
rage, but cannot express that rage toward anyone but him or herself. Consequently,
self-mutilation will later be used as a means to express anger.

Dissociative self-mutilation occurs when a child feels a lack of warmth or caring, or
cruelty by parents or caretakers. A child in this situation feels disconnected in his/her
relationships with parents and significant others. Disconnection leads to a sense of
“mental disintegration.” In this case, self-mutilative behavior serves to center the person
(Levenkron, 1998, p. 48).

REASONS FOR SELF-MUTILATING BEHAVIOR
Individuals who self-injure often have suffered sexual, emotional, or physical abuse from
someone with whom a significant connection has been established such as a parent or
sibling. This often results in the literal or symbolic loss or disruption of the relationship.
The behavior of superficial self-mutilation has been described as an attempt to escape
from intolerable or painful feelings relating to the trauma of abuse.
The person who self-harms often has difficulty experiencing feelings of anxiety, anger,
or sadness. Consequently, cutting or disfiguring the skin serves as a coping
mechanism. The injury is intended to assist the individual in dissociating from immediate
tension (Stanley, Gameroff, Michaelson & Mann, 2001).

CHARACTERISTICS OF INDIVIDUALS WHO SELF-MUTILATE
Self-mutilating behavior has been studied in a variety of racial, chronological, ethnic,
gender, and socioeconomic populations. However, the phenomenon appears most
commonly associated with middle to upper class adolescent girls or young women.
People who participate in self-injurious behavior are usually likeable, intelligent, and
functional. At times of high stress, these individuals often report an inability to think, the
presence of unexpressable rage, and a sense of powerlessness. An additional
characteristic identified by researchers and therapists is the inability to verbally express
feelings.

COMMON MISCONCEPTIONS OF
SELF-MUTILATION

Suicide
Stanley et al., (2001) report that approximately 55%-85% of self-mutilators have made
at least one attempt at suicide. Although suicide and self-mutilation appear to possess
the same intended goal of pain relief, the respective desired outcomes of each of these
behaviors is not entirely similar.
Attention-seeking behavior
Levenkron (1998) reports that individuals who self-mutilate are often accused of “trying
to gain attention.” Although self-mutilation may be considered a means of
communicating feelings, cutting and other self-harming behavior tends to be committed
in privacy.
Dangerousness to others
Another reported misconception is that those individuals who commit self-harm are a
danger to others. Although self-mutilation has been identified as a characteristic of
individuals suffering from a variety of diagnosed pathology, most of these individuals are
functional and pose no threat to the safety of other persons.
TREATMENT OF THE INDIVIDUAL WHO SELF-MUTILATES
Methods employed to treat those persons who self-mutilate range on a continuum from
successful to ineffective. Those treatment methods that have shown effectiveness in
working with this population include: art therapy, activity therapy, individual counseling,
and support groups. An important skill of the professional working with a self-harming
individual is the ability to look at wounds without grimacing or passing judgment
(Levenkron, 1998). A setting that promotes the healthy expression of emotions, and
counselor patience and willingness to examine wounds is the common bond among
these progressive interventions (Levenkron, 1998; Zila & Kiselica, 2001).

CONCLUSION
Research shows that self-mutilation has been in existence far longer than the
understanding and accurate conceptualization of the phenomenon. Therapeutic
interventions have improved substantially over the past two decades. However, further
study is imperative to insure that those who practice the behavior continue to receive
effective care.

Article Summary
Self-mutilation is common in borderline personality disorder, but this pattern of behavior does not usually carry suicidal intent. Instead, it serves other functions, including regulation of dysphoric affect, communication of distress, expression of emotions, and coping with dissociative states. Multiple causal factors, including biological, psychological, and social risks, influence thresholds for self-mutilation. Management of this behavior can be informed by understanding its psychological functions. This review made use of both MEDLINE and PsycINFO databases, identifying all English articles between 1980 and 2004. This review will focus on the pattern seen in BPD: repetitive, nonlethal self-injury without intent to die.
Self-mutilation began to be discussed in the psychiatric literature only several decades ago, in a series of clinical reports and reviews 8–13 that described patients who repeatedly, but superficially, cut their wrists.it occurs in serious psychopathology, most particularly mental retardation, schizophrenia, and personality disorders,14–16 and it is especially common in BPD.1
Although self-injury often lacks suicidal intent, it can perform other psychological functions, several of which have been suggested in the BPD literature. The first (and most often discussed) is that self-injury can provide relief  from negative mood states. Since self-mutilation tends to reduce dysphoria resulting from stressful life events, it can become a habitual method of dealing with psychological distress, reduce distress , communicate distress and obtain care . express emotions in a symbolic fashion. derives from its connection with dissociative phenomena.

FUNCTIONS OF SELF-MUTILATION IN BPD
Descriptor  for self-mutilation. Provides psychological functions provide relief from negative mood states. Since self-mutilation tends to reduce dysphoria resulting from stressful life events, it can become a habitual method of dealing with psychological distress in such cases the behavior comes to function like an addiction; distraction is another mechanism by which self mutilation can reduce distress in BPD physical injury tends to refocus the patient’s attention away from mental pain to physical pain. used to communicate distress and obtain care from other people—significant others as well as therapists, express emotions in a symbolic fashion, describe cutting as a self-punishment related to guilty feelings or as a way of expressing anger that cannot be communicate, it derives from its connectionwith dissociative phenomena. BPD patients may experience dissociation as dysphoric or may be in a dissociated state when they cut. BPD has been shown to have a strong associationwith multiple comorbidities, affective instability and impulsivity
Self-mutilation in BPD is associated with a history of abuse in childhood, could be due to social environment—in particular, from learning (through imitation) of behaviors observed in other patients or in the media
If one of the primary functions of self-injury is to reduce dysphoria, then therapy needs to identify the causes of that dysphoria and to help patients find better ways of dealing with emotions
TREATMENT :
Linehan’s dialectical behavior therapy (DBT), which is specifically designed to target parasuicidal behaviors by improving emotion regulation, Controlled trials in several settings have shown that self-mutilation in BPD can be reduced by DBT within a year of treatment, yielding results significantly better than treatment as usual. While other forms of cognitive-behavioral therapy (CBT) have been proposed for BPD, they have not yet been subjected to empirical testing. In a randomized controlled trial psychodynamically oriented outpatient therapy other methods used are “mentalization-based treatment” (MBT), designed to reduce impulsive behaviors in BPD by increasing self-observation, have been encouraging.selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, and naltrexone

Abstracts

Title: Reported childhood onset of self-mutilation among borderline patients.
Authors: Zanarini MC; Frankenburg FR; Ridolfi ME; Jager-Hyman S; Hennen J; Gunderson JG
Abstract: The purpose of this study was to determine the percentage of borderline patients who first engaged in self-mutilation as children and to compare the parameters of their self-harm to those of borderline patients who first harmed themselves at an older age. Two hundred and ninety inpatients meeting both Revised Diagnostic Interview for Borderlines (DIB-R; Zanarini, Gunderson, Frankenburg, & Chauncey, 1989) and Diagnostic and Statistical Manual of Mental Disorders (3rd ed. ref.) (DSM-III-R; APA, 1987) criteria for borderline personality disorder were interviewed about their history of self-mutilation. Of the 91% with a history of self mutilation, 32.8% reported first harming themselves as children (12 years of age or younger), 30.2% as adolescents (13-17 years of age), and 37% as adults (18 or older). Using logistic regression analyses and controlling for baseline age, it was found that those with a childhood onset reported more episodes of self-harm, a longer duration of self-harm, and a greater number of methods of self-harm than either those with an adolescent or adult onset to their self-mutilation. The results of this study suggest that a sizable minority of borderline patients first engage in self-harm as children and that the course of their self-mutilation may be particularly malignant.

Title: Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder.
Author(s): Chengappa KN; Ebeling T; Kang JS; Levine J; Parepally HAbstract:
Abstract:  The  seven subjects, all white women with a mean age of 37 years were selected for careful chart audits. All subjects carried DSM-III-R or DSM-IV borderline personality disorder diagnoses and an Axis I disorder diagnosis. These subjects had been admitted to 2 state psychiatric hospitals owing to severe self-mutilation and/or violence and subsequently treated with clozapine. After clozapine treatment, there were statistically significant reductions in incidents of self-mutilation (restraint), seclusion, the use of p.r.n. antianxiety medications, and injuries to staff and peers. It is thus concluded that clozapine deserves careful consideration for a controlled study in patients with borderline personality disorder and psychoses, especially if the clinical issues include severe self-mutilation, aggression, and violence.

Title: Clinical correlates of self-mutilation in borderline personality disorder.
Author(s): Dulit RA; Fyer MR; Leon AC; Brodsky BS; Frances AJ
Abstract: Among 124 consecutively admitted inpatients with borderline personality disorder, there were 62 who did not mutilate themselves, 23 who mutilated themselves infrequently (fewer than five lifetime events), and 39 who mutilated themselves frequently (five or more lifetime events); each received ratings on numerous measures of psychopathology.
The results found that compared to nonmutilators, frequent mutilators were significantly more likely to be in outpatient treatment at the time of admission and had more weeks of prior outpatient and inpatient treatment; they were also more likely to receive comorbid diagnoses of current major depression, anorexia nervosa, and bulimia nervosa. Frequent mutilators had significantly higher group means on the Beck Scale for Suicidal Ideation, were more likely to have attempted suicide, and were more likely to have attempted suicide more often than both infrequent mutilators and nonmutilators. The adjusted odds ratios from logistic regression analyses demonstrated that major depression, bulimia nervosa, number of prior suicide attempts, and acute suicidal ideation were each associated with greater risk of frequent mutilation. CONCLUSIONS: Borderline patients who frequently mutilate themselves may represent a subgroup of especially high utilizers of psychiatric treatment who are at particularly high risk for suicidal behavior and for comorbid major depression and eating disorders. Clinicians should consider aggressive treatment of comorbid axis I disorders and careful assessment of suicide risk in these patients.

Title: Professional attitudes towards deliberate self-harm in patients with borderline personality disorder.
Author(s): Commons Treloar AJ; Lewis AJ
Abstract: The aim of the present study was to assess the attitudes of mental health and emergency medicine clinicians towards patients diagnosed with borderline personality disorder. A purpose-designed questionnaire and an assessment tool to quantify attitudinal levels were used to collect demographic information and assess the attitudes of 140 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service. Statistically and clinically significant differences were found between emergency medical staff and mental health clinicians in their attitudes towards working with borderline personality disorder. The strongest predictor of attitudes was whether the clinician worked in emergency medicine or mental health. This was followed by years of experience and specific training in personality disorders as significant predictors of attitudes to self-harm. The implications of these findings for the professional training of clinicians in the management and treatment of borderline personality disorder patients are discussed.

References

Introduction
Simpson, Chris  (2001-12-00). Self-Mutilation. ERIC/CASS Digest. 1-4, ERIC Digests, http://www.eric.ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/1a/26/aa.pdf ERIC

Articles
Paris J (2005). Understanding self-mutilation in borderline personality disorder. Harvard Review Of Psychiatry [Harv Rev Psychiatry] 2005 May-Jun; Vol. 13 (3), pp. 179-85. 16020029, http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=16020029&site=ehost-live                                                                                                                 MEDLINE

Abstracts
[Zanarini MC; Frankenburg FR; Ridolfi ME; Jager-Hyman S; Hennen J; Gunderson JG (2006) Reported childhood onset of self-mutilation among borderline patients. [Journal of Personality Disorders (J PERS DISORD), 2006 Feb; 20(1): 9-15 (26 ref) 2009285665. http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2009285665&site=ehost-live, CINAHL with Full Text
Chengappa KN; Ebeling T; Kang JS; Levine J; Parepally H (1999), Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder. The Journal Of Clinical Psychiatry [J Clin Psychiatry] 1999 Jul; Vol. 60 (7), pp. 477-84. 10453803Database: http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=10453803&site=ehost-live, MEDLINE

Dulit RA; Fyer MR; Leon AC; Brodsky BS; Frances (1994) Clinical correlates of self-mutilation in borderline personality disorder.The American Journal Of Psychiatry [Am J Psychiatry] 1994 Sep; Vol. 151 (9), pp. 1305-11.8067485 http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=8067485&site=ehost-live, MEDLINE

Commons Treloar AJ; Lewis AJ (2008) Professional attitudes towards deliberate self-harm in patients with borderline personality disorder. The Australian And New Zealand Journal Of Psychiatry [Aust N Z J Psychiatry] 2008 Jul; Vol. 42 (7), pp. 578-84. 18612861 http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=18612861&site=ehost-live, MEDLINE

16 Personality Factor Questionnaire (16PF)

Consistency of the Test

The Consistency of the Test can be defined as “the reliability or agreement of factor scores overtime.” reliability is based on two factors. a) Dependability, which measures the test’s reliability over a short period of time. and b) stability which measures the test’s reliability over a long period of time Several tests were conducted over several samples of population to verify the credibility of the 16 PF Scale. these tests, ranging from a two week period, to a 4 year period, noted the coefficient correlation between the subject’s initial scores and scores after a given time period. the correlation coefficient was seen to be high in most cases, showing that the test had a good consistency.

Validity of the test

The validity of a test is generally defined as its capacity to measure what it claims to measure. since the 16 PF Scale was designed to measure personality, the evidence of the validity of the test lies in the fact that the individual’s score on all 16 factors truly reflects the individual’s personality. The validity of the scale lies in 10 successive factor analysis on different samples, verifying the existence and natural structure of the 16 personality factors and has been cross validated based on different samples of the adult population. The questions asked in the test have been found to be appropriate to measure personality factors, as these factors represent research analysis. However, we can always question how valid a test that measures personality can be. the test is one easy to administer and score, which measures the complicated concept of personality. personality is measured in the test by a wide range of personality factors or traits, broadly classified. The M.D. or Motivational Distortion score acts like a lie detector, which identifies whether the subject is consciously or unconsciously distorting his or her answers. The test could be wrapped up with the following lines. “at the end of the day, the test does not give a concrete view on the personality of the subject, as the experimenter and subject are as confused about the subject’s personality, as they were before its administration and the only realizable information received through he test is the tendency of the subject to distort his results through the M.D. Scale”

Summary – Is the term “Pain” Disorder a Valid Diagnosis?

The essay essentially talks about the controversy—should ‘pain’ be considered as a symptom or as a disorder? Pain; in General Medicine usually indicates that a disease is present, but what is happening is, when there is an no organic disease found in the patient, they are diagnosed with ‘pain disorder’ or ‘somatoform disorder’. The article argues that the diagnosis for pain disorder is unsupportive and deceptive because it misleads the patient into thinking that the reason for pain is understood even though it’s not the case. Just like we consider headaches, or diarrhoea as symptoms to an illness, even pain is a symptom and not a diagnosis. The author states that pain can be caused due to psychological factors and that there is a strong relationship between psychological events and physical symptoms, like sometimes unhappiness causes a headache. The author repeatedly states that pain is not always cause by physical disease and can be caused by inner emotional conflict. He also talks about the disadvantages of a broadened knowledge of Medicine being increase number of possible causes for a symptom and the inability to quantify psychological influences as we do for organic causes.

The debate continues as to whether pain originates from purely physical factors(as believed by the psychodynamic perspective) or if it can stem from psychological causes, as well.

With regard to treatment of pain disorder, a lot has been tried and tested, with little success. Cognitive behavioral therapy, relaxation technique, anti depressants, acupuncture and multidisciplinary pain centers have been suggested, but none of these have lead to a remarkable cure. Three separate studies were conducted on immigrants in different countries to check the validity of cognitive behavioural therapy, which reinforced the strength of the psychodynamic theory, as well as the psychological theory, as immigrants, who were subjected to many hardships, learnt to cope better. Studies regarding relaxation techniques and acupuncture have shown a positive effect, but with insufficient evidence. Antidepressants were found to have no effect. Multidisciplinary pain centers are said to be the most cost effective treatment, which focuses on improving functioning rather than cure of the disorder.

Recent literature shows that no defined etiology or pathology for chronic pain has been found, nor any specific treatment, there is little difference in experience of pain between those patients who have an organic disease and those who don’t, and many persons who develop chronic pain have personality disorders.

The DSM VI criteria measures pain disorder in 5 criteria- intensity, hindrance in normal functioning, psychological reasons, ‘real’ pain and causes not attributed to mood, anxiety or psychotic disorders. Its major shortcomings are that pain is subjective, expressed differently and can’t be measured scientifically. Tucker criticizes the DSM VI criteria, as it “treats the disorder, and not the patient.” This article supports this view, as, once given the label of a disease, patients would think of the disorder in physical terms, thus doing away with the psychological aspect, which, if used in early stages can greatly benefit the patient, thus lessening the unnecessary use of health care services, generally used excessively by these patients. Furthermore, clinical observations have found that the symptoms are exaggerated, making them undeserving of medical compensation, causing jealousy and resentment in the society (especially among coworkers) and a drain on the economy. Lastly, as it has no cure, it is extremely frustrating to the patients and physicians, lowering their moral. Therefore, this article suggests that pain disorder is a socially accepted way of getting out of work, and should not be compensated.

Rorschach Inkblot Test

To determine cultural validity, especially in the Indian Context

An assignment which evaluates the Rorschach Inkblot Test
as a Projective Tests, gives general information about
the test and evaluates its use in the indian context.

ACKNOWLEDGEMENT

I would like to extend this sincere and enthusiastic acknowledgement to Father Viju Painadath for giving me the wonderful opportunity to accomplish this project and for giving me the freedom to select the topic of my choice. I would also like to thank the other people involved – whether directly or indirectly, who have made this project a possiblity.

Poonam Vaidya,

07D2345

CONTENTS

1. Introduction………………………..4

1. Theoretical Framework…………… 5

1. Review of Literature……………… 7

1. Conclusion…………………………11

1. Bibliography…………………….…12

INTRODUCTION

Most personality tests are based on the occurrence of projection, a mental process described by Sigmund Freud as the tendency to point to others way of thinking or personality that are difficult to accept. Because projective techniques are relatively formless and suggest only a few indications to help in defining responses, they tend to bring out concerns that are extremely private and important. The best-known projective tests are the Rorschach test, popularly known as the inkblot test, and the Thematic Apperception Test; others include word-association techniques, sentence-completion tests, and various drawing procedures. The psychologist’s past experience gives the structure for analyzing individual responses. Although the subjective nature of interpretation makes these tests principally susceptible to criticism, in clinical settings they are part of the standard battery of psychological tests.

Projective tests, with their complicated scoring methods and own share of controversies, have always been a subject of great interest for me. Rorschach Inkblot Test, being one of the many fascinating tests, is the second most commonly used projective test after the Minnesota Multipurpose Personality Inventory (MMPI). With its colourful, black and white inkblots, complicated scoring and analysis procedure, along with the evident controversy of the test’s validity made it a remarkably good challenge to undertake.

THEORETICAL FRAMEWORK

Personality tests “are instruments for the measurement of emotional, motivational, interpersonal, and attitudinal characteristics, as distinguished from abilities.” Some types of personality tests are called “projective techniques.”

Probably the best-known and most idolized of the projective techniques is the Rorschach inkblot test. Swiss psychiatrist Hermann Rorschach developed this test, which has been used for more than 80 years. The test consists of 10 cards. Each card has a bilaterally even inkblot on it. Five cards are black and white and the other five are colored. An examiner shows the cards to the individual and asks him to describe what he sees. The examiner then evaluates the person’s responses according to specified guidelines.

A subject’s interpretations of ten standard abstract designs are analyzed as a measure of to determine emotional and intellectual functioning (diagnosing underlying thought disorder) and integration, and differentiating psychotic from non-psychotic thinking in cases where the patient is reluctant to openly admit to psychotic thinking. The test is considered “projective” because the patient is supposed to project his or her real personality into the inkblot via the interpretation. The inkblots are purportedly ambiguous, structureless tests which are to be given a in clear sequence by the interpreter. Those who believe in the effectiveness of such tests think that they are a way of getting into the deepest recesses of the patient’s psyche or subconscious mind.

Using the scores for these categories, the examiner then performs a series of calculations producing a structural summary of the test data. The results of the structural summary are interpreted using existing research data on personality characteristics that have been demonstrated to be associated with different kinds of responses.

A common misconception of the Rorschach test is that its interpretation is based primarily on the contents of the response – what the examinee sees in the inkblot. In fact, the contents of the response are only a comparatively small part of a broader group of variables that are used to interpret the Rorschach data.

Critics of the test have raised questions about the extraction of objective meaning from responses to inkblots; the objectivity of psychologists administrating the test (to be truly projective the inkblots must be considered ambiguous and without structure by the therapist.); inter-rater reliability; the verifiability and general validity of the test; bias of the test’s pathology scales towards greater numbers of responses; the limited number of psychological conditions which it accurately diagnoses; the inability to replicate the test’s norms; its use in court-ordered evaluations; and the proliferation of the ten inkblot images, potentially invalidating the test for those who have been exposed to them.

Hence, the therapist must not make reference to the inkblot in interpreting the patient’s responses or else the therapist’s projection would have to be taken into account by an independent party. Then the third person would have to be interpreted by a fourth ad infinitum. Thus, the therapist must interpret the patient’s interpretation without reference to what is being interpreted.

Every culture is distinctively unique, and people brought up an socialized through a culture are evidently going to have differences in thinking, learning, perspective on social situations, religion and a whole array of unique differences in selection, background and culture. Projective tests like the Rorschach are supposed to overcome many of these difficulties, this is an attempt to verify the objectivity of the Rorschach Inkblot Test in the context of different culture, especially in the case of India. Indians have a different perspective than people of the West, whom this test is supposed to cater to. Will the Rorschach Inkblot Test be valid in the context of Indian culture and other cultures that are significantly different from that of the West?

REVIEW OF LITERATURE

Review of Literature -1

Title: PSYCHOPATHOLOGY AND MENTAL RETARDATION: A STUDY USING THE RORSCHACH INKBLOT TEST.

Authors:

di Nuovo, Santo F.

Buono, Serafino

Colucci, Gerardo

Pellicciotta, Anna

Source: Psychological Reports; Jun2004 Part 2, Vol. 94 Issue 3, p1313-1321, 9p

Document Type: Article

Abstract:

The aim of this research was to study the psychological effects of disorders such as schizophrenia and depression associated with mental retardation. The Rorschach Inkblot Test and the Wechsler Adult Intelligence Scale were administered to a group of 97 subjects (52 women and 45 men) ages 15:10 yr. to 36:6 yr. (M=21:5, SD =5:3). The subjects were divided into four subgroups according to the presence or absence of mental retardation and psychiatric diagnosis (schizophrenia versus depression). The quality of the perception in Rorschach responses and the Eriebnis Typus scores differentiated psychotic and depressed subjects well. These disorders, when associated with mental retardation, make impairment of perceptual performance worse. The interaction between Axis I mental disorders (according to DSM-IV diagnosis) and mental retardation, an Axis II disorder, is discussed. [ABSTRACT FROM AUTHOR]

Review of Literature -2

Title: PREDICTING SUICIDE USING THE RORSCHACH INKBLOT TEST.

Authors: Kendra, John M.

Source: Journal of Personality Assessment; Oct79, Vol. 43 Issue 5, p452, 5p

Document Type: Article

Subject Terms:

*SUICIDE

*RORSCHACH Test

*PROJECTIVE techniques

Abstract:

Three hundred and seventy-five Rorschach protocols were scored blind and then divided into three groups: psychiatric controls, suicide, attempts, and suicide effectors. Using the stepwise procedure of multiple discriminant analysis a trio of formulas, composed of six weighted variables each, and a constant, were constructed to apply to each of the three groups based on a test sample of 100 subjects in each group Cross validation results on a new sample of 25 subjects in each group predicted classification with 52% overall accuracy at step six (chance .33). Internal reliability tests showed all values significant beyond .001. Discussion integrates the test data into the literature on suicide, and attends to the problem of overlap of predictability which occurs with most prediction scales. [ABSTRACT FROM AUTHOR]

Review of Literature -3

Title: HOMOSEXUAL SIGNS AND HETEROSEXUAL SILENCES: Rorschach Research on           Male Homosexuality form 1921 to 1969.

Authors: Hegarty, Peter1

Source: Journal of the History of Sexuality; Jul2003, Vol. 12 Issue 3, p400-423, 24p

Document Type: Article

Subject Terms:

*RORSCHACH Test

*HOMOSEXUALITY

*MALE homosexuality

*RESEARCH

People: RORSCHACH, Hermann

Abstract:

The article details research on male homosexuality using Rorschach inkblot test from 1921 to 1969. The lifelong research of the Swiss psychiatrist Hermann Rorschach was published in 1921 in a volume entitled Psychodiagnostik. In this volume, Rorschach presented his conclusions about the inkblot test of personality he had developed. Most of Rorschach’s work involved clinical patients and psychiatric diagnoses, but some included social research. In the decade after Rorschach’s death, his test inspired little active research. However, by the mid-1930s researchers in the U.S. had begun to re-examine the test and form a network of practice around its usage. Psychologist Bruno Klopfer conceived of the test subject in phenomenological and holistic terms. The nascent Rorschach network developed further when it became implicated in military work during World War II. Homosexuality became grounds for psychiatric exclusion from the military for the first time during World War II. In the 1930s psychoanalysts had developed accounts of male sexuality as both a transitory neurosis and a deep-rooted permanent psychosis. At least three research teams tried to develop the Rorschach as a means of detecting homosexual men among the troops. Rorschach researchers insisted that the test could clearly discern a pattern of responses among genuine chronic cases that was not shown by simulators. After the war Rorschach research speeded up enormously. The publication of William Marshall Wheeler’s Ph.D. dissertation in 1949 enhanced the legitimacy of using the Rorschach as way to detect homosexuality in the postwar context.

Author Affiliations:

1Yale University

ISSN:

10434070

Accession Number:

12514131

Review of Literature -4

Title: Norms of the Rorschach Test for Indian Subjects

Authors: Lt Col S Chaudhury (Retd)*, Lt Col M Augustine (Retd)+, Col D Saldanha#, Mrs K Srivastava**,Mrs SM Kundeyawala++, Surg Capt AA Pawar##, Surg Capt VSSR Ryali***

Subject Terms: Rorschach test; norms; schizophrenia; neurosis

Abstract:

Background : The clinical utility of the Rorschach test in Indians is hampered by the absence of reliable normative data.

Method : The Rorschach by Dlopfer’s method was administrated to 1256 subjects consisting of 300 normal army personnel, 300 normal civilians, 250 schizophrenics, 300 neurotics and 106 patients with organic disorders.

Results : The Rorschach protocols of normal Indian army personnel and normal civilians showed significant differences from one another and also from the western norms. These differences are culturally determined and are not indicative of low intelligence or psychopathology. Patients with schizophrenia, neurosis, head injury and epilepsy show significant differences from the records of normal subjects. The protocols of army schizophrenics show significant deviations from those of normal army personnel and these changes revert to normal with clinical recovery.

Conclusion : The Rorschach test is not a culture free test as claimed earlier. In view of the differences from Western norms,Rorschach protocols of Indians should be interpreted using the norms for Indians. In the case of army personnel the norms for army personnel should be used. While the use of the Rorschach to study the personality patterns of normal individuals and as an aid to clinical diagnosis was strongly supported, the findings of the study indicate that the test can also be employed to assess therapeutic response of patients with schizophrenia.

CONCLUSION

The Rorschach Inkblot Test is according to me, a very good way to find out abnormalities in personality of individuals, although it might me a little towards the subjective side in its method of analyzing, it still takes into consideration the emotional characteristics of an individual, and gives them complete freedom to decide their answers, rather than be forced to select one out of a predetermined set of answers. Projective tests have also been used successfully on children, the CAT, or Children’s Apperception Test and Group Zulliger Inkblot Test, are examples of this, though it is still uncertain whether the Rorschach Inkblot Test may be administer on children and yield the same results.

The main objectives of the Rorschach Inkblot Test are to determine emotional and intellectual functioning (diagnosing underlying thought disorder) and integration, and differentiating psychotic from non-psychotic thinking. Through the innovative method of inkblots, it reveals concerns that are extremely private and important for the psychiatrist and researcher alike, paving the way for a solution to the problems that are extracted. The subject unknowingly admits the various biases and fears he hides from society and sometimes, even themselves.

In order to use the Rorschach properly, professionals need an authoritative source of advice and guidance on how to administer, score, and interpret it. Available evidence indicates that the Rorschach Inkblot Test is a psychometrically sound measuring instrument that provides valid assessments of personality characteristics and can facilitate differential diagnosis and treatment planning and evaluation. The Rorschach Inkblot Test continues as in the past to be widely used by both clinicians and researchers. However, the esteem in which it is held by practitioners, who are generally agreed that clinical psychologists should be competent in Rorschach assessment, is not universally shared by academicians, many of whom presently question the future place of Rorschach training in graduate education.

Most psychological tests are said to have limited value because they depend on the subject’ selection, background and culture. Projective tests like the Rorschach attempt to overcome many of these difficulties. But recent research has revealed that norms cannot be used from one country to another and differences within the same cultural group are also to be found. The Rorschach norms established by researchers in India differ considerably. Faced with the lack of reliable norms, mental health professionals in India are left with no alternative but to interpret Rorschach on the basis of own experience, which results in subjective bias.

Therefore, it can be concluded (with the help of the Review of Literature, part 4) that the Rorschach Inkblot Test, though a projective test, is still not as culturally free as we hoped. In view of the differences from Western norms, Rorschach protocols of Indians should be interpreted using the norms for Indians, which should be developed based Indian sensibilities by a reliable group of scientists, rather than various individual researchers giving their own bias interpretations as norms, which would render the test unreliable, unscientific and invalid in India.

BIBLIOGRAPHY

1. Introduction

Projective techniques http://encarta.msn.com/encyclopedia_761564236_3____10/Psychological_Testing.html#s10

16th July 2009

1. Theoretical Framework

http://www.psychoheresy-aware.org/inkblot95.html

http://www.skepdic.com/inkblot.html

http://www.absoluteastronomy.com/topics/Rorschach_inkblot_test#encyclopedia

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1. Review of Literature

Part 1

http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=14234145&site=ehost-live

Part 2

http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=6383307&site=ehost-live

Part 3

http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=12514131&site=ehost-live

Part 4

http://medind.nic.in/maa/t06/i2/maat06i2p153.pdf

16th July 2009