A review of the literature from 2001 to 2011 on child abuse, neglect, and psychiatric disorders finds that early life stress subtypes can predict the development of psychopathology subtypes in adults. Physical & sexual abuse and unspecified neglect were associated with mood & anxiety disorders. Emotional abuse was associated with personality disorders and schizophrenia, and physical neglect with personality disorders. The research appears in the December issue of the Journal of Nervous and Mental Disease.
This blog was prompted by an invitation to do a guest post on the site of one of my favorite bloggers, 1 Boring Old Man. This is my response to the notion that there are certain conditions – Schizophrenia among them – that correspond more directly to biomedical conditions Full Article →
I think it is time to reclaim the word disability. Disability needs to be appreciated. To the extent we value community over isolation, anything anyone cannot do, or needs help with, builds community. There are infinite examples in every career and walk of life of how necessary “disability” (since we’re calling it that) is for connection, service and meaning in life. Without it we’d have absolutely no need for each other. And the fastest way to despair is to feel unnecessary. Full Article →
A prospective study in the American Journal of Psychiatry compares Dialectical Behavior Therapy (DBT) with psychiatric management for borderline personality disorder, founding that outcomes after two years were equivalent for both groups. Both groups exhibited poor functional outcome after 36 months (53% neither employed or in school, 39% receiving disability). However, an editorial in the same issue reports that clinicians over-react to the immediate clinical presentations of borderline, but that the long-term outcomes are positive nonetheless.
“Mixed anxiety-depressive disorder,” “attenuated psychosis syndrome,” “obsessive-compulsive personality disorder,” “antisocial personality disorder,” and “nonsuicidal self-injury” were among diagnoses that met with disappointing results in field trials for the new DSM-5. Either low interrater reliability (a lack of sufficient agreement between clinicians), or a lack of sufficient examples of people with a proposed diagnosis in the real world meant that these diagnoses could not be included in this round of the APA’s official list of disorders. One architect of the trials said that a goal of the DSM-5 was to test diagnoses “with real clinicians and real patients,” a goal that may explain why even “major depressive disorder” was found to be surprisingly unreliable, possibly because the previous version of the DSM excluded patients with complicated “psychiatric comorbidities.”
Researchers from Australia and the UK found that people with a schizophrenia diagnosis almost four times more likely than controls to have a history of childhood adversity. The quality of the evidence in this meta-analysis of the currently available data was found to be very strong (p<0.00001). No difference in rates of childhood adversity were found between schizophrenia and affective psychosis, depression, and personality disorders. Rates of childhood adversity is slightly higher in dissociative disorders and PTSD. Results will appear in Psychological Medicine.
Researchers in Australia investigate the growing evidence that childhood trauma predisposes individuals to both bipolar and borderline syndromes, with the intention of examining areas of discrimination between the diagnoses. “No studies have examined the neurobiological underpinnings of both in the same design,” they say, and research comparing bipolar and borderline patients’ self-reports is limited. This paper provides an overview of emotional dysregulation, impulsivity, childhood environment and neurobiology in the context of bipolar and borderline diagnoses. The authors conclude with the question of whether the two belong to the same spectrum. The paper will appear in Australian and New Zealand Journal of Psychiatry.
Although research supports the stigma and labeling perspective, empirical evidence also indicates that a social safety net remains intact for those with mental illness, recalling the classic “sick role” concept. Here, insights from social networks theory are offered as explanation for these discrepant findings. Using data from individuals experiencing their first contact with the mental health treatment system, the effects of diagnosis and symptoms on social networks and stigma experiences are examined. The findings suggest that relative to those with less severe affective disorders, individuals with severe diagnoses and more visible symptoms of mental illness have larger, more broadly functional networks, as well as more supporters who are aware of and sympathetic toward the illness situation. However, those with more severe diagnoses are also vulnerable to rejection and discrimination by acquaintances and strangers. These findings suggest that being formally labeled with a mental illness may present a paradox, simultaneously initiating beneficial social processes within core networks and detrimental ones among peripheral ties.
Multimillionaire U.K. psychiatrist Dr. George Hibbert is being investigated – potentially by Parliament - for deliberately misdiagnosing hundreds of parents with ‘personality disorders’ in order to fit the view of the social service agency for whom he worked that their children should be taken away. The lawyer for one of the parents said “we believe this may be the tip of a very big iceberg.”