Reed LI, Meyer AK, Okun SJ, Best CK, Hooley JM. In smiles we trust? Smiling in the context of antisocial and borderline personality pathology Didden R. PLOS ONE. 2020;15 (6) :e0234574. Publisher's VersionAbstract
Research suggests that people behave more cooperatively towards those who smile and less cooperatively towards those with personality pathology. Here, we integrated these two lines of research to model the combined effects of smiles and personality pathology on trust. In two experiments, participants read vignettes portraying a person with either borderline personality disorder, antisocial personality disorder, or no personality pathology. These portrayals were paired with a brief video clip that showed a person with either a neutral expression or a smile. Participants then played a Trust game with the “person” presented using each vignette and video clip combination. In Experiment 1, rates of trust were lower in response to the borderline and antisocial personality disorder vignettes compared with the control vignette. Interestingly, the effect of smiles was dependent upon personality. Although participants were more trusting of smiling confederates portrayed as having borderline personality disorder or no pathology, they were less trusting of confederates portrayed as having antisocial personality disorder if they smiled. In Experiment 2, run with a second set of personality vignettes, rates of trust were lower in response to both personality disorder vignettes and higher in response to smiles with no significant interaction. Together, these results suggest that information regarding both the current emotional state as well as the personality traits of a partner are important for creating trust.
Hooley JM, Fox KR, Boccagno C. Nonsuicidal Self-Injury: Diagnostic Challenges And Current Perspectives. Neuropsychiatric Disease and Treatment. 2020;16 :101 - 112. Publisher's VersionAbstract
Nonsuicidal self-injury (NSSI) involves deliberate and intentional injury to body tissue that occurs in the absence of suicidal intent. Typical examples here might include self-cutting, burning, or self-hitting. Behavior of this kind is fundamentally unsettling as well as perplexing. It is also the case that self-harming behavior of any kind runs counter to a fundamental survival instinct. In the past, behaviors such as these were viewed as self-mutilation and considered to be a form of attenuated suicide. Much has changed over time, culminating in the entry of NSSI Disorder into DSM-5 as a condition in need of further study. In this review we describe the evolution of the NSSI construct and consider current issues in its diagnosis and assessment.
Hooley JM, Dahlgren MK, Best SG, Gonenc A, Gruber SA. Decreased Amygdalar Activation to NSSI-Stimuli in People Who Engage in NSSI: A Neuroimaging Pilot Study. Frontiers in Psychiatry. 2020;11 :238. Publisher's Version pdf
Hooley JM. Borderline Personality Disorder, Borderline Traits, and Brain Structure. Biological psychiatry. Cognitive neuroscience and neuroimaging. 2020;5 (7) :638 - 639. Publisher's Version
Rosenthal SA, Hooley JM, Montoya RM, van der Linden SL, Steshenko Y. The Narcissistic Grandiosity Scale: A Measure to Distinguish Narcissistic Grandiosity From High Self-Esteem. Assessment. 2020;27 (3) :487 - 507. Publisher's VersionAbstract
Measures of self-esteem frequently conflate two independent constructs: high self-esteem (a normative positive sense of self) and narcissistic grandiosity (a nonnormative sense of superiority). Confusion stems from the inability of self-report self-esteem scales to adequately distinguish between high self-esteem and narcissistic grandiosity. The Narcissistic Grandiosity Scale (NGS) was developed to clarify this distinction by providing a measure of narcissistic grandiosity. In this research, we refined the NGS and demonstrated that NGS scores exhibit good convergent, discriminant, and concurrent validity relative to scores on theoretically relevant measures. NGS scores, when used as simultaneous predictors with scores on a self-esteem measure, related more strongly to phenomena linked to narcissistic grandiosity (e.g., competitiveness, overestimating one’s attractiveness, lack of shame), whereas self-esteem scores related more strongly to phenomena crucial to individuals’ well-being (e.g., higher levels of optimism and satisfaction with life, and lower levels of depression, worthlessness, and hostility). The NGS provides researchers with a measure to help clarify the distinctions between narcissistic grandiosity and high self-esteem, as well as other facets of narcissism, both in theory and as predictors of important real-life characteristics.
Fox KR, Wang SB, Boccagno C, Haynos AF, Kleiman E, Hooley JM. Comparing self-harming intentions underlying eating disordered behaviors and NSSI: Evidence that distinctions are less clear than assumed. The International journal of eating disorders. 2019;52 (5) :564 - 575. Publisher's VersionAbstract
Objective:Eating disordered (ED) behaviors (i.e., binge eating, compensatory behaviors, restrictive eating) and nonsuicidal self-injury (NSSI; intentional and nonsuicidal self-harm) are highly comorbid and share several similarities, including consequent pain and physical damage. However, whereas NSSI is considered direct self-harm, ED behaviors are considered indirect self-harm. These distinctions stem from theoretical understanding that NSSI is enacted to cause physical harm in the moment, whereas ED behaviors are enacted for other reasons, with consequent physical harm occurring downstream of the behaviors. We sought to build on these theoretically informed classifications by assessing a range of self-harming intentions across NSSI and ED behaviors. Method: Study recruitment was conducted via online forums. After screening for inclusion criteria, 151 adults reported on their intent to and knowledge of causing physical harm in the short- and long-term and suicide and death related cognitions and intentions when engaging in NSSI and specific ED behaviors. Results: Participants reported engaging in ED and NSSI behaviors with intent to hurt themselves physically in the moment and long-term, alongside thoughts of suicide, and with some hope and knowledge of dying sooner due to these behaviors. Distinctions across behaviors also emerged. Participants reported greater intent to cause physical harm in the moment via NSSI and in the long-run via restrictive eating. NSSI and restrictive eating were associated with stronger endorsement of most suicide and death-related intentions than binge eating or compensatory behaviors. Conclusions: Findings shed light on classification of self-harming behaviors, casting doubt that firm boundaries differentiate direct and indirectly self-harming behaviors.
Hooley JM, Fox KR, Wang SB, Kwashie AND. Novel online daily diary interventions for nonsuicidal self-injury: a randomized controlled trial. BMC Psychiatry. 2018;18 (1) :264. Publisher's VersionAbstract
Background: Nonsuicidal self-injury (NSSI), which involves self-damaging behavior (e.g., cutting) causes tissue damage and places people at elevated risk for future suicidal behaviors. Yet few specific treatments for NSSI currently exist. Extreme self-criticism is implicated in the development and maintenance of NSSI. We conducted a randomized controlled trial to evaluate Autobiographical Self-Enhancement Training (ASET), a novel, cognitive intervention for NSSI focused on reducing self-criticism and enhancing positive self-worth. We also examined whether Expressive Writing (EW) was a helpful treatment for NSSI.Method: Participants (N = 144) who had engaged in NSSI at least twice in the past month were recruited online and then randomly assigned via Qualtrics to receive the ASET intervention (N = 49), the EW intervention (N = 49), or Daily Journaling [JNL; N = 46]), an active comparison condition. Treatments were designed as month-long daily diaries. Participants in ASET wrote about something that made them feel good about themselves that day, participants in EW described something that had been on their mind that day, and participants in JNL reported on the events of the day in a factually descriptive manner without emotional content. Results: Intent-to-treat analyses revealed that, regardless of treatment group, participants showed significant reductions in self-criticism, NSSI episodes, depression, and suicide ideation from baseline to the end of active treatment. Relative to the JNL group, the ASET group reported significantly less self-criticism at post-treatment; this was not maintained at follow-up. There was also a trend toward ASET being associated with less suicide ideation at the end of treatment compared to EW. This difference was significant at the 3-month follow-up. Unexpectedly, the JNL group reported significantly less suicide ideation than the EW group at post-treatment; this was maintained at 3-month follow-up. No significant treatment effects were detected for suicide plans, suicidal behaviors, desire to discontinue NSSI, or likelihood of future NSSI. Conclusion: Self-criticism is an important treatment target in NSSI, but changing self-criticism in people with an established history of NSSI presents challenges. Nonetheless, all approaches provided benefits. This study also established the feasibility of inexpensive and easily disseminated treatments for NSSI. Trial registration number: ISRCTN12276176 (retrospectively registered, March 13, 2018).
Allen KJD, Jill Miranda Hooley DP. Negative Emotional Response Inhibition: Support for a cognitive mechanism underlying negative urgency in nonsuicidal self-injury. 2018. Publisher's VersionAbstract
Negative urgency, the self-reported tendency to act impulsively when distressed, increases risk for nonsuicidal self-injury (NSSI). Prior research also suggests that NSSI is associated with impaired negative emotional response inhibition (NERI), a cognitive process theoretically related to negative urgency. Specifically, individuals with a history of NSSI had difficulty inhibiting behavioral responses to negative affective images in an Emotional Stop-Signal Task, but not to those depicting positive or neutral content. The present study sought to replicate this finding, determine whether this deficit extends to an earlier stage of NERI, and explore whether impairment in these two stages of emotional inhibitory control helps explain the relationship between negative urgency and NSSI. To address these aims, 88 adults with NSSI histories (n = 45) and healthy control participants (n = 43) without NSSI history or psychopathology completed a clinical interview, symptom inventories, an impulsivity questionnaire, and behavioral impulsivity tasks measuring early and late emotional response inhibition. The NSSI group had worse late NERI than the control group on the Emotional Stop-Signal Task, but no group differences were observed in early NERI on an Emotional Go/no-go task. However, both early and late stages of NERI accounted for independent variance in negative urgency. We additionally found that late NERI explained variance in the association between negative urgency and NSSI. These results suggest that impulsive behavior in NSSI may involve specifically impaired inhibitory control over negative emotional impulses during late response inhibition, and that this cognitive deficit might reflect one mechanism or pathway to elevated negative urgency among people who self-injure.
Hooley JM, Miklowitz DJ. Perceived Criticism in the Treatment of a High-Risk Adolescent: Perceived Criticism. Journal of Clinical Psychology. 2017;73 (5) :570 - 578. Publisher's VersionAbstract
Perceived criticism (PC) is a construct that plays a key role in family relationships of persons with psychiatric disorders. It can be assessed in a brief and simple way using the Perceived Criticism Measure. PC ratings made by patients about their caregivers predict adverse clinical outcomes including increases in symptoms and relapse across a broad range of psychiatric diagnoses. Although research supports the concurrent and predictive validity of PC, the measure is not widely used in clinical practice. Here, we describe the construct of PC and review evidence supporting its clinical utility. We then illustrate how criticism and perceptions of criticism can be addressed in a clinical context, describing a family focused treatment approach used with a depressed adolescent at high risk for bipolar disorder.
Fox KR, Toole KE, Franklin JC, Hooley JM. Why Does Nonsuicidal Self-Injury Improve Mood? A Preliminary Test of Three Hypotheses. Clinical Psychological Science. 2017;5 (1) :111 - 121. Publisher's VersionAbstract
People who engage in nonsuicidal self-injury (NSSI) often state that it helps them feel better. We tested three hypotheses through which this mood modification might occur. Following a negative mood induction, adults reporting past year NSSI were randomized into a control (i.e., sitting alone quietly), mild distraction, or pain condition. All participants completed mood ratings at regular intervals. No mood repair occurred in the control condition. However, distraction improved mood both during and after the activity. Participants who self-administered pain reported no overall mood change, suggesting that contrary to popular NSSI theories, pain likely does not improve mood via distraction. However, as predicted, level of self-criticism moderated mood change during pain. Participants high on self-criticism felt significantly better during pain and participants low on self-criticism felt significantly worse during pain. Findings shed light on how NSSI improves mood by clarifying the circumstances under which different affect regulation processes may operate.
Weintraub MJ, Hall DL, Carbonella JY, Weisman de Mamani A, Hooley JM. Integrity of Literature on Expressed Emotion and Relapse in Patients with Schizophrenia Verified by a p -Curve Analysis. Family Process. 2017;56 (2) :436 - 444. Publisher's VersionAbstract
There is growing concern that much published research may have questionable validity due to phenomena such as publication bias and p-hacking. Within the psychiatric literature, the construct of expressed emotion (EE) is widely assumed to be a reliable predictor of relapse across a range of mental illnesses. EE is an index of the family climate, measuring how critical, hostile, and overinvolved a family member is toward a mentally ill patient. No study to date has examined the evidential value of this body of research as a whole. That is to say, although many studies have shown a link between EE and symptom relapse, the integrity of the literature from which this claim is derived has not been tested. In an effort to confirm the integrity of the literature of EE predicting psychiatric relapse in patients with schizophrenia, we conducted a p-curve analysis on all known studies examining EE (using the Camberwell Family Interview) to predict psychiatric relapse over a 9- to 12-month follow-up period. Results suggest that the body of literature on EE is unbiased and has integrity, as there was a significant right skew of p-values, a nonsignificant left skew of p-values, and a nonsignificant test of flatness. We conclude that EE is a robust and valuable predictor of symptom relapse in schizophrenia.
Hooley JM, Masland SR. Borderline personality disorder. In: Craighead WE, Miklowitz DJ, Craighead LW Psychopathology: History, Theory and Diagnosis. 3rd ed. New York: John Wiley and Sons ; 2017.
Hooley JM, Masland SR. Expressed emotion. In: Wenzel AE Sage Encyclopedia of Abnormal and Clinical Psychology. Thousand Oaks, CA: Sage Publications, Inc ; 2017.
Silk JS, Lee KH, Elliott RD, Hooley JM, Dahl RE, Barber A, Siegle GJ. “Mom -- I don’t want to hear it”: Brain responses to maternal praise and criticism in adolescents with major depressive disorder. Social Cognitive and Affective Neuroscience. 2017;12 (5) :729-738.
Weintraub MJ, Hall DL, Carbonella JY, Weisman de Mamani A, Hooley JM. Integrity of literature on expressed emotion and relapse in schizophrenia verified by a p-curve analysis. Family Process. 2017;56 (436-444).
Hooley JM, Miklowitz DJ. Perceived criticism in the treatment of a high risk adolescent. . Journal of Clinical Psychology. 2017;73 (5) :570-578.
Allen KJD, Hooley JM. Negative mood and interference control in non-suicidal self- injury. Comprehensive Psychiatry. 2017;73 :35-42.
Hooley JM, Butcher J, Nock MK, Mineka, S M. Abnormal Psychology . 17th ed. Boston: Pearson; 2017.