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Clinical Psychology

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2022

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Full-Text Articles in Social and Behavioral Sciences

A Qualitative Study Into Modern Psychoanalytic Joining And Mirroring Through Psychotherapeutic Exchanges, Tricia Shihui Wang Dec 2022

A Qualitative Study Into Modern Psychoanalytic Joining And Mirroring Through Psychotherapeutic Exchanges, Tricia Shihui Wang

Electronic Theses and Dissertations

This dissertation intends to address current deficits in knowledge regarding the modern psychoanalytic interventions of joining and mirroring, including substantial definition issues in the literature and the absence of current writings on the psychotherapeutic interventions of joining and mirroring in practice. The focus of the study was on the ever-dynamic landscape between modern analytically-informed practitioners and their clients in psychotherapeutic exchange(s) that the practitioners believed encompassed joining and/or mirroring interventions. Participants were six experienced practitioners who described their clinical work as being informed by modern psychoanalysis and who have engaged or were currently engaging in individual psychotherapy with a client. …


African American Female Identified Therapists' Experiences Working Culturally Similar And Dissimilar Populations, Kimiko J. May Dec 2022

African American Female Identified Therapists' Experiences Working Culturally Similar And Dissimilar Populations, Kimiko J. May

Doctoral Dissertations

African-American female-identified individuals continue to be one of the smallest subgroups of licensed therapists. However, this group continues to grow steadily and offer services to a broad array of clientele. While the aims of literature have grown to include populations that have been historically marginalized, the research surrounding African-American female-identified therapists is scarce. Deep understanding of their lived experiences while navigating the multifaceted nature of clinical work has been grossly overlooked. This study aimed to qualitatively analyze the lived experiences of African-American female-identified therapists who work with diverse populations using interpretative phenomenological analysis. Since the nature of clinical work is …


Developing Queer Faith: Exploring Experiences Of Cognitive Dissonance And Identity Integration For Lgbq Catholics Individuals, Kendal M. Vaarwerk Dec 2022

Developing Queer Faith: Exploring Experiences Of Cognitive Dissonance And Identity Integration For Lgbq Catholics Individuals, Kendal M. Vaarwerk

Doctoral Dissertations

While religion may be meeting existential needs, it may, at the same time, be asking the LGBQ youth to be someone different than who they are (Longo et al., 2018). LGBQ individuals experience severe cognitive and emotional consequences because of oppressive religious doctrine, including guilt, shame, self-loathing, and suicidal ideation (Schuck & Liddle, 2001). When LGBQ individuals are involved with religious belief systems that cast rejecting or disapproving messages about LGBQ individuals, these individuals often experience more internalized negative self-messages, as well as more significant challenges in developing and accepting one’s sexual identity (Page et al., 2013). Therefore, this very …


Interpersonal Emotion Regulation In Current And Remitted Major Depressive Disorder: An Experience Sampling Study, Yunjing Liu Dec 2022

Interpersonal Emotion Regulation In Current And Remitted Major Depressive Disorder: An Experience Sampling Study, Yunjing Liu

Arts & Sciences Electronic Theses and Dissertations

Individuals with major depressive disorder (MDD) have difficulties regulating emotion on their own. As people also turn to others for help with emotion regulation (i.e., interpersonal emotion regulation [IER]), we examined whether these difficulties extend to IER in current and remitted MDD. We generally expected individuals with current MDD (and remitted MDD to a lesser extent) to utilize IER in distinct ways compared to those with no history of psychiatric disorders (i.e., controls) due to differences in emotional, cognitive, and interpersonal functioning. Using experience sampling, adults with current MDD (n=48), remitted MDD (n=80), and controls (n=87) reported on how frequently …


An Online Vignette Study To Examine The Outcomes Of A Preclinical Alzheimer Disease Diagnosis, Matthew John Wynn Dec 2022

An Online Vignette Study To Examine The Outcomes Of A Preclinical Alzheimer Disease Diagnosis, Matthew John Wynn

Arts & Sciences Electronic Theses and Dissertations

As Alzheimer disease research forges ahead, and new potential treatments are developed, a conceptualization is emerging of a presymptomatic disease stage. This stage, known as preclinical Alzheimer disease, is characterized by the buildup of amyloid beta and tau proteins in the brain to abnormal levels in a cognitively normal person. There are unknown potential risks and benefits of communicating biological marker risk information for Alzheimer disease using the preclinical Alzheimer disease diagnostic label. The current study uses a vignette methodology to measure older adults’ understanding of risk information when presented with information regarding their risk for developing Alzheimer dementia. Participants …


Exploring The Role Of Dieting Style In Nutritional And Psychological Health Among College Women, Hayley L. Vanderjagt Dec 2022

Exploring The Role Of Dieting Style In Nutritional And Psychological Health Among College Women, Hayley L. Vanderjagt

Psychology ETDs

The current study aimed to profile styles of eating among dieting and non-dieting college-aged women, and to explore the extent to which dieting attitudes were associated with both nutritionally healthy eating and psychological well-being. A latent profile analysis was conducted using indicators of self-reported intuitive eating, binge eating, and two psychometric measures of dietary restraint; various measures of eating restraint were utilized to potentially capture distinct characteristics of dieting, such as self-discipline and disinhibition (Polivy et al., 2020; Stice et al., 2010). Four distinct probabilistic profiles emerged, indicating that individuals within the study population could be meaningfully categorized as Intuitive …


2 Years On: Loss And Grief Amidst The Covid-19 Pandemic, Eman H. Nabulsi Dec 2022

2 Years On: Loss And Grief Amidst The Covid-19 Pandemic, Eman H. Nabulsi

Psychology and Counseling Theses

This study sought to examine the variability and impact of different kinds of losses experienced during COVID-19 and how people reacted to and coped with those losses. The most common loss reported by individuals was the loss of social connection, while death-related losses were identified as the most impactful loss experienced. Results suggest that people responded in a myriad of ways, including increased cautiousness for health safety, refocusing their attention on important life matters, and finding alternative ways to connect with others. Furthermore, this study found that individual factors such as intolerance of uncertainty and perceived social support may play …


A Novel Test Of Emotion Recognition Bias Using Dynamic Facial Morphing, Michael R. Gallagher Dec 2022

A Novel Test Of Emotion Recognition Bias Using Dynamic Facial Morphing, Michael R. Gallagher

Theses and Dissertations

Depressed persons have demonstrated emotion based cognitive biases, specifically surrounding vigilance of negative information and avoidance of positivity. These biases are sometimes operationalized through emotion recognition tasks. However, previous emotion recognition tasks lack in their ability to accurately measure and decompose positivity avoidance with enhanced negativity, while accounting for basic cognitive processes that can drive the results. Therefore, we developed a novel emotion recognition task that examines emotional intensity thresholds, while accounting for general response bias. Linear mixed effects modeling revealed substantial individual differences on all conditions in the task, using both frequentist and Bayesian approaches. Additionally, the findings suggest …


Latent Profiles Of Psychopathic Traits Among Emerging Adult College Students: Functional And Dysfunctional Psychopathy And Related Outcomes, Lydia J. Stanhope Dec 2022

Latent Profiles Of Psychopathic Traits Among Emerging Adult College Students: Functional And Dysfunctional Psychopathy And Related Outcomes, Lydia J. Stanhope

Theses and Dissertations

Psychopathy research continues to study the adaptability of psychopathic characteristics and differentiate between functional and dysfunctional features. The current study identified latent profiles in emerging adults and compared them across behavioral/cognitive correlates, functional outcomes, aggression types, and also examined gender differences. Results demonstrated that men scored higher across cold-heartedness and fearless dominance profiles, but not self-centered impulsivity. The low psychopathy group had lower proactive aggression than the high psychopathy group; no other differences were observed. Additionally, men and women in the high psychopathy group did not significantly differ regarding experienced outcomes. Lastly, higher psychopathy was not associated with higher proactive …


Examining The Malleability And Influence Of Attributions On Discipline Responses To Child Misbehavior, Jenna E. Russo Dec 2022

Examining The Malleability And Influence Of Attributions On Discipline Responses To Child Misbehavior, Jenna E. Russo

Theses and Dissertations

Attributions of child behavior have been shown to influence discipline responses and ultimately, child developmental trajectories. Research highlights various social-psychological factors in the formation of attributions, largely characterized as stable. However, research also demonstrates the efficacy of attribution retraining (AR) programs in restructuring individuals’ explanations for various outcomes. This study examined a trauma-informed training intervention with an AR component designed to evoke balanced and contextual attributions of child behavior among child-serving professionals. Of particular interest was the malleability and stability of attributions, and their influence on discipline responses. From pre- to post-training, there was a significant decrease in hostile attributions …


Interprofessional Practice And Handling The First Break: A Case Study, Jalen D. Clemmons Dec 2022

Interprofessional Practice And Handling The First Break: A Case Study, Jalen D. Clemmons

Social Work Masters Capstone Projects

Handling the first psychotic break can be a delicate process. In order to do so effectively, it is important to utilize the perspectives and disciplines offered within an inter-professional team. This paper is a case study revolving around the work done by an inter-professional treatment team at Eastern State Hospital.


Coping Styles As Potential Mediators In The Relationships Between Morally Injurious Events, Moral Injury, And Meaning-Making, Marjorie A. Perkins Dec 2022

Coping Styles As Potential Mediators In The Relationships Between Morally Injurious Events, Moral Injury, And Meaning-Making, Marjorie A. Perkins

Doctoral Dissertations

Exposure to morally injurious events has consistently been correlated with negative mental health outcomes for military servicemembers and veterans (Bryan et al., 2014; Currier et al., 2015a; Currier et al., 2015b; Currier et al., 2017; Dennis et al., 2017; Jordan et al., 2017; Maguen et al., 2009, 2010; Maguen, Vogt et al., 2011; Nash et al., 2013). However, some servicemembers and veterans may experience a deeper sense of understanding of the event and/or growth after a potentially morally injurious experience through a process called meaning-making (Park, 2013). The present study seeks to examine the relationship between individual coping styles and …


Acceptability And Feasibility Of Telehealth Delivered Written Exposure Therapy With College Students, Maya Anais Krek Dec 2022

Acceptability And Feasibility Of Telehealth Delivered Written Exposure Therapy With College Students, Maya Anais Krek

Theses and Dissertations

Full and subthreshold presentations of posttraumatic stress disorder (PTSD) are both functionally impairing and chronic. Therefore, development of feasible and acceptable treatments for both is imperative. Written Exposure Therapy (WET), a brief five-session in-person PTSD treatment, has the potential to be successfully administered accessibly via a telehealth format due to minimal therapist contact and short duration of treatment. This study explored the feasibility and acceptability of WET delivered via a telehealth format to college students experiencing posttraumatic stress symptoms.

Participants (N = 4) were college students who were impacted by at least one traumatic event and had associated posttraumatic stress …


The Development Of A Trauma-Informed Care Measure: Can Universal Precautions Address The Complexity Of Trauma?, Jennifer A. Castaneda Dec 2022

The Development Of A Trauma-Informed Care Measure: Can Universal Precautions Address The Complexity Of Trauma?, Jennifer A. Castaneda

Open Access Theses & Dissertations

A system that is trauma-informed, recognizes how interpersonal, community, and organizational systems contribute to health outcomes. Currently, research on TIC has been unable to translate basic scientific findings of trauma to research studies that evaluate the implementation of TIC. As such, the field is unable to offer valuable recommendations to implement TIC in different settings. The present study aimed to develop a measure of TIC to be used in medical settings. The resulting measure was revised through qualitative feedback from individuals who have experienced trauma and tested with an online convenient sample. The measure was re-evaluated with a second sample …


The Real Face Of Borderline Personality Organization Within Intimate Partner Violence, Adriana Isabel Patino Dec 2022

The Real Face Of Borderline Personality Organization Within Intimate Partner Violence, Adriana Isabel Patino

Open Access Theses & Dissertations

This study tests the relationship between IPV perpetration and victimization with BPO. Results indicate that, as predicted, BPO is positively associated with both IPV perpetration and victimization and is more prevalent in female perpetrators and victims than in male perpetrators and victims. However, contrary to what previous literature says, self-control does not show enough significance to state that it is one of the leading causes of IPV perpetrated by those who present traits of BPO. In addition, results also indicate that having suffered from physical abuse during childhood diminishes the probability of perpetrating IPV. To fully understand these results, future …


The Influence Of Beliefs About Emotion On Avoidance Behaviors, Elise Warner Dec 2022

The Influence Of Beliefs About Emotion On Avoidance Behaviors, Elise Warner

Graduate Theses and Dissertations

The beliefs individuals hold about emotions have been shown to influence their tendencies to avoid distressing situations. While much of the work to-date has been on beliefs about whether emotions can be changed (i.e., malleability beliefs), there is research suggesting that the belief that emotions last for long periods of time (i.e., longevity beliefs) have important implications for emotion regulation (Veilleux et al., 2020). Thus, our aim was to examine the relationship between longevity beliefs and experiential avoidance. We predicted that greater longevity beliefs would be associated with greater avoidance tendencies, and that stronger beliefs in the moment would also …


Female Adults’ Experiences Of Sexual Harassment And Assault In The Presence Of Others: A Qualitative Analysis Of The Effectiveness And Consequences Of Bystander Intervention Strategies, Kayla Ford Dec 2022

Female Adults’ Experiences Of Sexual Harassment And Assault In The Presence Of Others: A Qualitative Analysis Of The Effectiveness And Consequences Of Bystander Intervention Strategies, Kayla Ford

Graduate Theses and Dissertations

Bystander intervention programs aim to reduce the acceptance of violence against women by fostering prosocial behavior from community members, and often provide knowledge on behaviors associated with sexual risk and ways a bystander can intervene. However, there is limited knowledge on which intervention strategies are used, and how these interventions impact perpetrator behavior and incidence of verbal and physical harm to those involved. There is even less research on these phenomena from the perspective of the victim. To address these gaps, the current study utilized a qualitative approach to (1) identify bystander intervention strategies employed; (2) discuss trends of the …


Examination Of The Relationship Between Loneliness And Binge Eating Symptoms, Kimberly Stevens Dec 2022

Examination Of The Relationship Between Loneliness And Binge Eating Symptoms, Kimberly Stevens

UNLV Theses, Dissertations, Professional Papers, and Capstones

Loneliness is implicated in several mental health conditions and may also be linked to eating pathology, like binge eating symptoms (e.g., loss-of-control eating). However, the pathways by which loneliness might be associated with binge eating symptoms are less well understood. Preliminary evidence suggests perceived stress may be a key explanatory pathway. Specifically, perceived stress mediates the impact of loneliness on other mental health outcomes and is associated with increased risk of binge eating symptoms. This study investigated relationships between loneliness, perceived stress, and binge eating symptoms and tested whether heightened levels of binge eating was accounted for by increases in …


Validating An Internet Gaming Disorder Measure During Covid-19: Video Game Use, Distance Learning, And Impacts Of Covid-19 On Gaming Behavior, Christin Collie Dec 2022

Validating An Internet Gaming Disorder Measure During Covid-19: Video Game Use, Distance Learning, And Impacts Of Covid-19 On Gaming Behavior, Christin Collie

Electronic Theses and Dissertations

For most students, playing video games is a popular, enjoyable activity to do in their leisure time. While many people play video games for fun, some do develop problems associated with their play. Excessive engagement in video game play can lead to significant impairment and clinically significant levels of harm. However, there are several important gaps in the research literature which limit understanding of potential harm. First, little is known about the gaming behavior of students, ranging from middle-school to graduate school, specifically as it relates to their reasons for playing video games and their time spent playing. Second, concerns …


Borderline Personality Disorder And Violent Crime: The Moderating Role Of Sex And Race, Genevieve Allison Dec 2022

Borderline Personality Disorder And Violent Crime: The Moderating Role Of Sex And Race, Genevieve Allison

Electronic Theses and Dissertations

People receiving treatment for substance use disorders (SUD) are at risk of justice involvement. Although it is well-established that borderline personality disorder (BPD) increases risk for criminal involvement, it is unclear whether this relationship exists among people with SUDs. Furthermore, prior research has found sex and race differences in the relationships between BPD and justice involvement as well as violence, but these moderators have not been explored within a substance using sample. The current study utilized a sample receiving SUD treatment to examine whether BPD is associated with prior violent charges and, if race and sex moderated this relationship. Results …


The Impact Of Video-Taped Social Modeling On Alcohol Outcome Expectancies Of Young Adults And The Role Of Social Anxiety, Kyle Kevin Jackson Dec 2022

The Impact Of Video-Taped Social Modeling On Alcohol Outcome Expectancies Of Young Adults And The Role Of Social Anxiety, Kyle Kevin Jackson

Graduate Theses and Dissertations

Alcohol outcome expectancies (AOEs) represent people’s ideas about the effects of alcohol (Fromme, 1993). Positive AOEs particularly have been identified as a potential risk factor for hazardous drinking (e.g., Brown et al., 1985). The exact mechanisms that modify AOEs are not fully understood. Further, people higher in social anxiety may be especially receptive to social modeling due to attentional bias shift towards others in social contexts (Rapee & Heimberg, 1997). The current study examined how social anxiety and social modeling associate with AOEs. It was hypothesized that 1) those in the social modeling treatment condition would have higher social anxiety-adjacent …


Therapists’ Demonstrated Multicultural Competence In Treating Latinx Immigrants, Dulce Diaz Benitez Dec 2022

Therapists’ Demonstrated Multicultural Competence In Treating Latinx Immigrants, Dulce Diaz Benitez

Graduate Theses and Dissertations

Studies suggest that health disparities occur when people from marginalized communities receive care that is inadequate based on their cultural needs (USDHHS, 2011). Multicultural competence (MCC) models have been proposed to provide a framework of the competencies that therapists should develop to work with multicultural populations (Sue et al., 1992). Researchers have questioned the validity of measures, which are mostly based on therapist self-report (Cartwright, 2008). The multicultural case conceptualization ability task has been used in previous studies as a measure of demonstrated cultural competence using a vignette to assess case conceptualization abilities (Ladany et al., 1997). However, it has …


The Effects Of Neuroticism And Treatment Delivery Modality On Therapeutic Outcomes In A Community Mental Health Training Clinic, Michelle Elizabeth Sibol Dec 2022

The Effects Of Neuroticism And Treatment Delivery Modality On Therapeutic Outcomes In A Community Mental Health Training Clinic, Michelle Elizabeth Sibol

Theses and Dissertations

The onset of the novel Coronavirus Disease 2019 (COVID-19) two and a half years prior to this writing resulted in shifts in everyday life, as individuals worldwide were required to shelter-in-place and abide by social distancing guidelines to slow the spread of the disease. This resulted in a marked increase in the utilization of virtual platforms (“teletherapy”) by mental health care providers, including training clinics, to continue providing therapy services to the community at large. Although the pandemic restrictions have lifted, adaptations made during shelter-in-place mandates remain, including provision of services via teletherapy platforms. The pandemic shed light on the …


Headache Disorders And Neurocognitive Performance Pre- And Post-Concussive Injury, Kaci Gorres Dec 2022

Headache Disorders And Neurocognitive Performance Pre- And Post-Concussive Injury, Kaci Gorres

Theses and Dissertations

Objective: The aim of this study is to examine the relationship between pre-existing headache disorders, such as headache or migraine, and neurocognitive testing obtained before and after college-athletes sustain a concussion. Method: A total of 1129 NCAA Division II college athletes from Florida Tech were included in the present study. Participants were included in this study if they completed baseline and/or post-trauma neuropsychological evaluations that included the Sports Concussion Assessment Tool – Fifth Edition (SCAT-5) and Immediate Post-Concussion Assessment and Cognitive Tool (ImPACT). Athletes’ headache and/or migraine history was self-reported at baseline and indicated their position in headache history or …


How Well Do Your Family Members Know You? The Relationship Between Informant Report And Cognitive Performance Of Older Adults, Mairy Yousif Dec 2022

How Well Do Your Family Members Know You? The Relationship Between Informant Report And Cognitive Performance Of Older Adults, Mairy Yousif

Theses and Dissertations

Introduction: Given the clear impact and prevalence of dementia on the aging population, there is a need for greater research and understanding in this area. As the dementia progresses, medical providers rely heavily on caregiver and family member reports of the patient’s functioning and other aspects of their care. Therefore, it is important to know how accurate caregivers and family members are in judging their loved ones’ cognitive and physical strengths and weaknesses. This study aims to expand upon these previous studies by comparing caregiver/collateral reports of cognitive and functional status on the DSRS to neuropsychological tests and an objective …


Disentangling Instrumental And Reactive Aggression In The Competitive Reaction Time Task And Their Associations With Factors Of Meanness In Psychopathy, Ashley Michelle Poston Dec 2022

Disentangling Instrumental And Reactive Aggression In The Competitive Reaction Time Task And Their Associations With Factors Of Meanness In Psychopathy, Ashley Michelle Poston

UNLV Theses, Dissertations, Professional Papers, and Capstones

Aggression is often subtyped into reactive and instrumental aggression. Reactive aggression occurs in response to some form of provocation and is often accompanied by anger. Instrumental aggression is not provoked and is relatively unemotional. Existing aggression paradigms primarily measure reactive aggression, and the laboratory measurement of instrumental aggression has proved challenging. This study modified the competitive reaction time task to include an entire block of instrumental aggression trials, in addition to the standard block of reactive trials, in effort to create a single paradigm within which both reactive and instrumental aggression can be measured in the laboratory. Psychopathy is a …


Mindfulness And Avoidant Coping: Examining The Behavioral Correlates Of Suicidal Ideation Among Sexual Minority College Students, Matt Siroty Dec 2022

Mindfulness And Avoidant Coping: Examining The Behavioral Correlates Of Suicidal Ideation Among Sexual Minority College Students, Matt Siroty

Undergraduate Honors Theses

Lesbian, gay, and bisexual (LGB) individuals are at higher risk for mental health problems including suicidal ideation (SI). Previous research has indicated that coping strategies and mindfulness may explain disparities in SI among LGB individuals. The aim of the present study was to examine how coping strategies (self-sufficient, avoidant, socially-supported) and trait mindfulness facets (observing, describing, acting with awareness, non-judging, non-reactivity) contribute to these differences. The sample consisted of 927 college students, 124 of whom identified as LGB. Within the analytic sample, a majority identified as women (n = 639, 68.9%), 18 or 19 years of age (n …


Coping Strategies And Self-Compassion As Protective Factors In The Infant And Early Childhood Mental Health Workforce, Megan Wolff Dec 2022

Coping Strategies And Self-Compassion As Protective Factors In The Infant And Early Childhood Mental Health Workforce, Megan Wolff

Electronic Theses and Dissertations

The mental health field experiences high levels of stress, resulting in a greater risk of poor professional quality of life, likely exacerbated by the additional stress associated with COVID-19. The present study examined the effect COVID-19 stress had on the professional quality of life of the infant and early childhood mental health (IECMH) workforce and whether coping strategies and self-compassion acted as protective factors. Results indicated that higher COVID-19 stress was associated with higher burnout and secondary traumatic stress (STS) and lower compassion satisfaction (CS). The results also showed that the pathway from COVID-19 stress to burnout was moderated by …


The Relationship Between Hallucinations And Visuospatial Impairment Among Individuals With Dementia, Ruta Sohoni Dec 2022

The Relationship Between Hallucinations And Visuospatial Impairment Among Individuals With Dementia, Ruta Sohoni

Theses and Dissertations

Objective: This study examines the neuropsychological functioning, specifically using the Hooper Visual Organization Test (VOT), to understand the impact of hallucinations on the level of impairment in the visuospatial domain.

Method: Archival data obtained over three years from a total of 73 patients from the Health First Memory Disorder Clinic was used in this study. Participants were included in the study if they endorsed experiencing hallucinations, were given the VOT during their brief neuropsychological evaluation, and were diagnosed with dementia or unspecified neurocognitive disorder. The patient’s electronic medical record was used to retrospectively gather additional details regarding their hallucinations and …


The Mediating Role Of Gun Attitudes In The Association Between Dsm-5 Posttraumatic Stress Disorder Symptom Clusters, And Gun Ownership In Young Hispanic Adults With Exposure To Interpersonal Trauma, Vanessa Gonzalez Dec 2022

The Mediating Role Of Gun Attitudes In The Association Between Dsm-5 Posttraumatic Stress Disorder Symptom Clusters, And Gun Ownership In Young Hispanic Adults With Exposure To Interpersonal Trauma, Vanessa Gonzalez

Theses and Dissertations

Despite growing interest in gun attitudes and gun ownership among United States citizens, the current body of literature is limited and tends to focus on white non-Hispanic individuals. The present study examined the effect of interpersonal trauma-related PTSD symptoms on gun attitudes and protective gun ownership. The associations between experiencing PTSD symptoms, gun attitudes, and protective gun ownership were examined in a sample of 176 young Hispanic adults (n = 127 women, n = 49 men) with exposure to interpersonal trauma. Specifically, the mediating role of positive attitudes towards guns in the associations between the four clusters of DSM-5 …