Dominance Hierarchy and Clinical Course of Psychiatrically Hospitalized Boys

Patient contact rank order, quantitatively defined, reflects the dominance hierarchy in a psychiatric treatment cottage. The patient's position in this hierarchy was correlated with staff impressions of his behavior and with clinical variables. Diagnosis correlates with contact rank order: children with primary behavior disorders rank highest; brain-damaged children rank lowest. Children in the upper half of the rank order appear to have a better prognosis than those in the lower half, both in incidence of discharge and in average time spent in the hospital. A high contact rank-order position is positively related to ward privileges and to school social adjustment. Clinically relevant insight, obtained from geographic mapping and from the patient's rank order in his peer group, may be used to test treatment hypotheses, especially attempts at resocialization.