Although tension reduction is a key principle in drive theory, there are clear dynamic aspects of libido expression aimed at increased tension levels. In a paradigmatic shift from the Freudian conflict model, tension reduction and tension enhancement dynamics are re-conceptualized as valences toward the processes of tension reduction and tension enhancement, rather than toward the respective states of reduced tension or enhanced tension. We posit a unitary direction-independent foundational id drive toward tension level change which incorporates tension reduction and enhancement. As the primary drive circumscribed to manipulations of id tension level, the dynamics of Delta are distinguished from those of Eros and Thanatos whose purviews are in the domain of drive purpose/function (or evolutionary design) and also differentiated from the subjective phenomenological experience of drive expression which varies among people. Theoretical and clinical issues in sexuality and aggression are critically analyzed as entailing libidinal elements of tension enhancement and reduction. Key points are annotated with illustrative clinical vignettes. The intersections between Delta dynamics, ego psychology, and object relations are explored. Possible elaborations of sub-drive development entailing functional autonomy are outlined.

Childhood trauma is theorized to be the source of adult sexual violence. The psychological repercussions of such trauma and the ego options in dealing with its effects-ranging from the adaptive to the pathological-are outlined. Key concepts in attachment theory and drive theory are utilized to arrive at a coherent understanding of the unconscious dynamics of sexual violence. Critically evaluating relevant literature, we frame our clinical experience within the rubrics of trauma and defense mechanism theory to evaluate predispositional antecedents and to elucidate the key determinants of sexual violence.

We are delighted that practitioners, theorists, and researchers have been following the clinical and diagnostic endeavors in psychopathology of our team at NYU. In a recent set of publications delineating specific aspects of character disorders (Juni 2009, 2009a, 2010, 2014), a comprehensive psychodynamic model of psychopathy has been emerging as clinical findings led us to reconceptualize symptom clusters. I have been asked by the editor of this journal to share a unified model of psychopathy and antisocial behavior which incorporates our findings and conceptualizations. This paper is descriptive, intended to present an abridged summary of our conceptual system as it has evolved to date. The theoretical development and clinical rationales of the elements in this model are detailed in our previous papers. Grounded in our publications to date, the model is made more robust by incorporating the Oppositional Defiant factor and fine-tuning the other categories based on more recent clinical insights. Culling the conclusions from our clinical research studies, we annotate and outline the key elements of recent diagnostic and theoretical expositions of psychopathy, while elaborating and refining constructs of personality and behavioral disorders. The model is offered as a uniform classification strategy to systematize and reconcile disparate clinical and research data in the fields of neuropsychiatry, neuropsychology, personality, forensics, and social psychology.

Drawing from trauma theory, psychodynamic conceptualization, developmental psychology, clinical data, and personal experience, this article portrays a life haunted by tragedy predating its victims. Healthy child development is outlined, with particular attention to socialization and theological perspectives. Key characteristics of trauma are delineated, highlighting the nuances of trauma that are most harmful. As is the case with general trauma, Holocaust survivors are described as evincing survivor's guilt and paranoia in response to their experiences. Divergent disorders resulting from the Holocaust are described for 1st-generation and 2nd-generation survivors, respectively. Primary trauma responses and pervasive attitudes of survivors are shown to have harmful ramifications on their children's personality and worldview as well as on their interpersonal and theistic object relations. These limitations translate into problems in the adult lives of second generation survivors.

Coining the term theistic dissonance to capture conflicted attitudes and feelings toward God, this article examines faith-based reactions to the Holocaust. The theological weltanschauung of religious Jewish Holocaust survivors is analyzed, with a particular focus on their attempts to reconcile the notion of a benevolent and caring God with their harrowing experience. Basic religious sources and contemporary literature are presented to elucidate the realm of resolutions of theistic dissonance. It is suggested that elements of defense mechanisms are adapted from the emotional into the cognitive realm, and are used by survivors to facilitate respective interpretations of God's role during the Holocaust. Dissonance resolution is seen as being informed theologically and experientially for these victims who confronted stark challenges to their religious integrity.

Survivor guilt is a construct which is ill defined in the literature. Disparate overlapping and inconsistent formulations are outlined and critiqued from the orientation of reactions of Jewish Holocaust victims. Utilizing the perspective of Defense Mechanism Theory, guilt is explored as an adaptive construct of mastery and survival in extreme conditions. Aspects of culpability in guilt are examined. Brief quotes from survivor narratives are presented to elaborate nuances of guilt experiences. Defensive strategies which coincide with exposure to violence and suffering of others and where there is no overt personal threat experienced by the 'survivor' are highlighted. A framework is proposed synthesizing the various motifs, bridging emotions ranging from self-recrimination to traumatic anxiety. The assumptions that survivor guilt is engendered by survival and that it entails feelings of guilt are both challenged.

Healthy child development is outlined, with particular attention to its crucial element of identity formation. Second-generation Holocaust survivors are saddled with a mission of "carrying the torch" which is inconsistent with normal identity formation. Over and above the normative milestones in acquiring personal identity, children of this generation had particular difficulties establishing a sense of self distinct from family and religious identity. This threatened ego integrity portends potential identity dissonance, disruption of the developmental process, and problems in the adult lives of second-generation survivors. The author's personal narrative is featured to highlight identity challenges inherent in the life of a "memorial candle."

For those who believe in God, tragedy and misfortune often raise internal emotional and religious dissonance. Regardless of one's theological stance, emotional reactions to the Holocaust can be expected to elicit negative feelings towards God, resembling the reactions one would experience towards parents or caretakers who perpetrate or facilitate aggression. Coining the term "theistic object relations" to reflect the maturity level of relationship with God, it is posited that it is predicated on a safe and nurturing environment - paralleling the maturational development of healthy interpersonal interactions. In this context, survivors' reactions are elaborated using the lens of parental abuse and neglect. Individual beliefs about God's role, while affecting the options for cognitive rationalisations among victims, are posited to have only minimal relevance to the expected negative emotionality. Variations in such reactions are explored from a psychoanalytic perspective within the intersectional context of trauma, divine providence, object relations development, and defence mechanism theory. Unresolved questions about the developmental hallmarks of theistic object relations are outlined insofar as they are relevant to our population.

Purpose– Psychopathy and antisocial personality are controversial disorders with alternate behavioral and dynamic formulations. As such, diagnostic approaches are often fragmentary and inconsistent. The purpose of this paper is to delineate the various conceptual parameters and to propose a comprehensive diagnostic approach.Design/methodology/approach– A model is presented based on the congruence and differences among various categories of psychopathic and antisocial personality disorders and their clinical manifestations. Diagnostic approaches are critiqued and evaluated. Specific assessment tools and measures are recommended based on referrals and symptomatology.Findings– Key factors of low frustration tolerance, poor social intelligence, aggression-driven psychopathy, sadism, and superego impairment are shown as central in the differential diagnostics of antisocial individuals.Originality/value– The model enables the differentiation of problematic behaviors which may appear similar but require different forensic, legal, diagnostic, and intervention strategies.

Drawing from analytic theory and clinical conceptualization, three major types of psychopathy are detailed: Superego deficit, aggression driven, and sadism. The types of psychopathy are discussed in terms of their overlap with personality disorders. The range of sadism is charted from the enjoyment of inflicting pleasure to the borderline manifestations in compulsive reenactments in psychopathic patients. Two categories of antisocial behavior— low social intelligence and poor impulse control—are elaborated clinically as inconsistent with the psychodynamic formulation of characterological psychopathy. The divergence between psychodynamic and behavioral approaches to antisocial behavior is discussed, and unresolved enigmas in the formulation of psychopathy are outlined.

The sexual components of sadism are conceptualized within the contexts of different forms of sadism. In aggression-drive sadism, sexuality is seen as a generalization of instinctual reactivity. Parallels are presented of such spillover between aggression and anxiety and even between aggression and oral impulses, with the notion that any areas of excitation or partial impulses can be energized by the acute release of energy in another domain. Another dynamic is presented for re-enactment sadists, in which the sexuality has a relational meaning. In such cases, sexuality is intertwined with the aggression, as the sadistic ritual actually re-evokes an original trauma that features these elements. It is further agued that the sexuality in these two sadistic modes is not consistent. The instinctual spillover that occurs in hostile psychopathy is psychosexually rooted in phallic functioning, in which relational implications are absent, while the sexuality in re-enacted sadism is genitally based, and is intrinsically linked to an imagined emotional relationship with the victim that is intended to ameliorate and undo past trauma that haunt the perpetrator.

The analysis of response inconsistency is a crucial aspect of intellectual and clinical psychological assessment. Erratic patterns of failures and successes across and within particular domains qualify the measurement of intellectual potential and functioning. Although the interpretation of intertest scatter (inconsistencies between subtest scores) on intellectual tests has been elaborated on in the literature, intratest scatter (inconsistencies within specific subtests) is an underresearched area. Some approaches towards establishing a quantitative measure of intrasubtest scatter (ISS) have been developed, but most have proved clinically impractical or have produced inconsistent results. This article proposes a methodology of codifying ISS on the Wechsler Intelligence Scales to provide a measurement of inefficiency within subtests for individual subjects. In addition to systematizing and standardizing scatter measurement in clinical assessment, such codification will be useful in future research directed at discriminating groups based on inefficient performance across particular subtests. Applications and limitations in ISS interpretation for the various Wechsler instruments are annotated and discussed.

A distinct formulation of hostile psychopathy is presented, based on analytic clinical experience with psychopathic youth and adults. Two psychodynamic conceptualizations of aggression are presented - one connoting a basic destructive drive, the other portraying aggression as a means of ensuring gratification and countering frustration. Following Meloy's (1988) analysis of psychopathy as a combination of a deficient object relational capacity to bond and high levels of instinctual aggression, hostile psychopathy in general, and sadism specifically, are conceptualized from these two perspectives. Sadism, which features re-enacted events of violence, is posited as a distinct manifestation of hostile psychopathy with ritualized features attributable to object relations disturbances. Other variants of hostile psychopathy are analyzed as derivatives of more direct aggressive instinctual expressions that are not relational in their intent or function, in which destructiveness is an end in itself. Hostile psychopathy is presented as entailing elements of an instinctual propensity toward aggressive discharge. In addition, a more elaborate motif is posited in which the pain and suffering of others is the key factor in sadism. In the latter facet, there is an actual enjoyment of the others' suffering, and unresolved relationships are re-enacted with a reparative intent. A psychosexual developmental hypothesis is suggested, in which drive-based aggressive discharge is linked to the oral sadistic stage, while sadistic relational dynamics are posited to reflect the power-control battles of the anal sadistic stage. As a limitation, it is noted that the sociopolitical aspects of psychopathy are not addressed in this clinical analysis. Moreover, since the data presented are oriented toward the intrapsychic (in contrast to social) aspects of psychopathy, the countertransference aspects of relationships that psychopaths tend to engender are not addressed specifically.

The aim of this study was to explore the latent affective and persuasive meaning attributed to text when appearing in two commonly used fonts. Two satirical readings were selected from the New York Times. These readings (one addressing government issues, the other education policy) were each printed in Times New Roman and Arial fonts of the same size and presented in randomized order to 102 university students, who ranked the readings on a number of adjective descriptors. Analysis showed that satirical readings in Times New Roman were perceived as more funny and angry than those in Arial, the combination of emotional perception which is congruent with the definition of satire. This apparent interaction of font type with emotional qualities of text has implications for marketing, advertising, and the persuasive literature.

This study examined relationships between academic cheating behaviors by using self-reports of past cheating behavior, providing a situational experiment with the opportunity to cheat, and evaluating defense mechanisms and object relations as measured by the Defense Mechanisms Inventory. Subjects included 75 female and 8 male university students ranging in age from 18 to 51 years (M=25.5, SD=6.9). Analysis showed variations in students' self-reported cheating history relative to their measured object relations status and type of defense mechanisms. Actual cheating in the experimental setting was not significantly related to any of these variables. Findings are discussed based on a critique of heterogeneity of the cheating construct.

The reliabilities of Helms' People of Color Racial Identity Attitude Scale and White Racial Identity Attitude Scale when used with a sample of master's counseling students were explored for modified versions. Reliabilities were assessed using Cronbach alpha as a measure of internal consistency, and temporal stabilities were measured. Results were consistent with previous findings, with coefficients alpha ranging from .67 to .77 for the modified People of Color Racial Identity Attitude Scale, and from .36 to .84 for the modified White Racial Identity Attitude Scale. Analyses also identified items that may suppress internal consistencies in responding by this sample.

Our purpose in this study is to view theories of psychotherapy from a general social-political context, especially insofar as they pertain to values. Beginning with Weisskopf-Joelson's (1980) thesis that theories of psychotherapy may be "perceptual houses" with their own unique value structures, we studied the values of psychoanalytic psychotherapists within the framework of Rokeach's (1968) system. Through the Rokeach Value Survey, we examined the values held by a group of psychoanalytic trainees in 1979 and those held by a group of practicing psychoanalysts in 1993. Because neither group of subjects can be regarded as randomly representative of the universe of psychoanalysts, we regard the resultant data as evocative and informative rather than definitive. Nonetheless, we examined the extent to which value profiles for the psychoanalytic trainees of 1979 were similar or dissimilar to those of practicing psychoanalysts in 1993. Such comparisons at the least provide some general indication as to whether values have shifted in the universe within this time period. Findings are presented about specific patterns of values, and implications are discussed. There appears to be more consistency than difference in values among the psychoanalytically-oriented psychotherapists we studied, lending support to this discipline's designation of a "perceptual house" insofar as its values are concerned.

Objective To report a case of atrial fibrillation (AF) due to oral methylprednisolone. Case Summary A 45-year-old white man with chronic intermittent paroxysmal supraventricular tachycardia (PSVT) reacted to oral methylprednisolone by developing a PSVT episode that elicited an 18-hour episode of AF. AF was resolved by discontinuing methylprednisolone and administering oral nadolol, and no recurrence was reported for 6 years. Discussion This appears to be the first published report linking AF to oral methylprednisolone. Based on an analysis of the literature, it is suggested that AF may be triggered by any autonomic paroxysmal event in some individuals. Accepting the clinical evidence linking methylprednisolone to PSVT, the case is elaborated as having involved an initial atrial paroxysmal reaction to the drug, which then triggered AF. Conclusions Clinicians may wish to consider history of arrhythmias, and to monitor them, when prescribing oral methylprednisololne.