Self‐liking and self‐competence: relationship to symptoms of anorexia nervosa

Self‐esteem has been hypothesised to play a pivotal role in the development and treatment, and outcome of anorexia nervosa (AN). Though this relationship is typically investigated by considering self‐esteem as a unitary construct, research suggests that this comprises of two related but distinct components of self‐liking and self‐competence. This study investigates the association between self‐liking, self‐competence, and symptomatology of AN through the course of a defined treatment episode in 77 women. Self‐liking was significantly associated with laxative abuse. Self‐competence was significantly associated with elevated ineffectiveness, perfectionism and interpersonal distrust. Although self‐competence and eating disturbance severity significantly improved over the treatment episode, one in three participants reported a reduced self‐like or self‐competence. Changes in both self‐competence and self‐liking at the end of treatment was associated with changes in drive for thinness. Such findings have implications for treatment models concerned with improving self‐esteem. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.     

Self‐care versus self‐harm: piercing,tattooing, and self‐injuring in eating disorders

Eating disordered patients seem to have a love–hate relationship with their bodies. Why do some decorate their bodies by means of tattooing and piercing, while others deliberately injure themselves and make parts of their body unattractive? We have explored this question in 101 eating‐disordered patients by means of self‐reporting questionnaires about the presence and characteristics of tattooing, piercing and self‐injuring as well as the underlying motives. Furthermore, we studied the co‐occurrence of impulsive behaviours as well as personality traits. In our patient sample, 11.9 per cent had one or more tattoos, 25.7 per cent a piercing and 64.9 per cent showed some form of self‐injurious behaviour (SIB). Tattooing and piercing are clearly driven by esthetical reasons, whereas SIB can have various explanations. All three behaviours were significantly more often linked to substance (ab)use. With respect to personality traits, piercing was positively linked to extraversion (positive affectivity) and openness, and negatively to conscientiousness. SIB, on the contrary, was positively linked to neuroticism (negative affectivity) and conscientiousness, and negatively to extraversion and openness. Tattooing did not show significant correlations with particular personality traits (probably due to the small number of tattooed patients). In summary, piercing and tattooing seem to reflect more self‐care, and might protect some patients against more self‐harm. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Participation in patient self‐management programs

Objective

Participation in evidenced‐based arthritis self‐management programs (SMPs) has not been well documented. The purpose of this study was to investigate the participation rate and participant characteristics in a closed cohort of subjects in a geographic region where arthritis SMPs have been offered multiple times and continuously for 2 decades.

Methods

Data were from osteoarthritis (OA) and rheumatoid arthritis subjects participating in the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) who resided in the San Francisco (SF) Bay area who had responded to questions about ever participating in an SMP. Differences between participants and nonparticipants were examined by t‐tests and chi‐square tests.

Results

Questions added to the Health Assessment Questionnaire were returned by 1,176 patients; 618 resided in the SF Bay area. Of the SF Bay area sample, 41.9% had participated in an SMP. Small group SMPs, which had been offered multiple times, in diverse settings, continuously over the past 2 decades, were attended by the highest proportion (28%) of participants. Characteristics of participants and nonparticipants in the SF Bay area were similar (～70 years old, 15 years of education, and the majority had OA [～72%]). However, a higher proportion of participants were white (88% versus 82%; P = 0.046) and female (82% versus 73%; P < 0.05).

Conclusion

When arthritis SMPs were offered multiple times in diverse settings and continuously over many years, >40% of the cohort was reached. More research is needed with larger samples and different geographic regions to identify participation rates in more diverse populations.     

Patient–provider perceptions of diabetes and its impact on self‐management: a comparison of African‐American and White patients

Aims To compare patient–provider differences in diabetes‐related perceptions between African‐American and White patients and to examine its association with self‐care behaviours. Methods One hundred and thirty patient–provider pairs were recruited from the greater Detroit area. Patients and providers completed a survey assessing perceptions about diabetes‐related concepts and demographic background. The Diabetes Semantic Differential Scale was used to measure diabetes‐related perceptions. Patients also reported the frequency of performing self‐care behaviours, including following a healthy eating plan, engaging in physical activity, blood glucose monitoring, and taking medication and/or insulin. Results There were a greater number of patient–provider differences in diabetes‐related perceptions for the African‐American patients (nine of 18 concepts) compared with the White patients (four of 18 concepts). Stepwise regression analyses found patients’ semantic differential scores to be significantly associated with five self‐care behaviours for African‐American patients and two self‐care behaviours for White patients. Providers’ semantic differential scores emerged as predictors of self‐care behaviours for African‐American patients, but not for White patients. Conclusions Our findings suggest that compared with White patients, African‐Americans differ in a greater number of diabetes‐related perceptions than their providers. Patients’ and providers’ perceptions of diabetes care concepts have a significant impact on a greater number of self‐care behaviours for African‐American patients than White patients.     

Accuracy of self‐reported hypertension: Effect of age,gender, and history of alcohol dependence

Patient awareness of medical conditions may influence treatment seeking and monitoring of these conditions. Accurate awareness of hypertension reported to clinicians evaluating patients for whom clinical history is limited, such as in emergency care, can aid in diagnosis by revealing whether measured hypertension is typical or atypical. Measurement of blood pressure in a laboratory study was assessed at rest, immediately before phlebotomy, and within 10 minutes after. The resting measure was used to determine the accuracy of self‐reported hypertension in 283 adults. Parametric analyses were conducted to identify potential variables influencing accuracy of self‐reported hypertension. Sensitivity, specificity, and the kappa coefficient of agreement were calculated to determine the influence of alcohol dependence (AD), sex, age, and cigarette smoking on hypertension awareness. Self‐report was mildly sensitive, correctly identifying individuals with hypertension in approximately 37% of the cases, but was highly specific (95%) in identifying individuals without hypertension. Similar sensitivities were found in analyses separated by sex. Sensitivity was greater in those over age 55 (53%) in comparison with those <54, as well as in those who were not smoking. Comparison of those with and without a history of AD revealed that both groups show similar accuracy in reporting hypertension. Absence of hypertension can be accurately determined with self‐report data in those without hypertension. A significant proportion of those with measured hypertension report an absence of hypertension.     

Enhancing self‐care strategies in heart failure through patient‐reported outcome measures

Heart failure (HF) is a major cause of morbidity and mortality, requiring collaborative patient‐centred care. Patient engagement is fundamental to long‐term management; patient‐reported outcome measures are an increasingly recognised method of assessing medical interventions. A qualitative study of 31 patients with HF found they were twice as likely to use their own management strategies including electronic platforms rather than existing resources. Barriers to self‐care included patient education, timely recognition of signs and symptoms of HF with an appropriate escalation plan, non‐adherence and polypharmacy.     

Human sex differences in d‐amphetamine self‐administration

Women and men may respond differently to the effects of stimulants such as amphetamine and cocaine. Aim In order to assess potential sex differences in the reinforcing effects of d‐amphetamine, a retrospective‐analysis was conducted on data collected from three studies that employed similar d‐amphetamine self‐administration procedures and used identical subject‐rated drug‐effect measures. Methods Data from 10 women and 15 men were included in the analysis. In all studies, participants sampled placebo, low (8–10 mg) or high (16–20 mg) dose oral d‐amphetamine. Following sampling sessions, participants worked for capsules containing one eighth of the previously sampled dose on a modified progressive‐ratio schedule of reinforcement. We hypothesized that women and men would be differentially sensitive to the reinforcing effects of d‐amphetamine. A two‐way mixed‐model analysis of variance (sex and dose) and planned comparisons were used in the statistical analyses. Results The low dose of d‐amphetamine functioned as a reinforcer in women, but not men, whereas the high dose of d‐amphetamine functioned as a reinforcer in men, but not women. Men self‐administered significantly more capsules under the high dose condition than women. Conclusion The results of this study suggest that men are more sensitive to the reinforcing effects of a high dose of d‐amphetamine than women. Future research is needed that determines prospectively the reinforcing effects of weight‐adjusted doses of d‐amphetamine in women and men while controlling for menstrual cycle phase.