Muscle dysmorphia: Current research and potential classification as a disorder

ObjectiveTo review the literature for scientific evidence in support of inclusion of Muscle Dysmorphia (MD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).DesignThe criteria proposed by Blashfield, Sprock, and Fuller (1990) were used for determining whether scientific evidence supports the introduction of MD as a new disorder into a disease classification system.MethodPeer-reviewed journal articles were identified by searching databases for articles published (in print and electronically) from 2001 to 2011.ResultsThe search identified 59 journal articles that specifically focused on MD, of which 39 were empirical journal articles. There is ample literature on MD, including a common set of diagnostic criteria and assessment instruments to measure MD. However, questions remain about the diagnostic reliability and validity, including inter-rater reliability, and whether MD represents a disorder that consists of symptoms that frequently co-occur. Also, evidence of syndrome differentiation is lacking. Only two of the five criteria proposed by Blashfield et al. have been met.ConclusionLiterature suggests that MD is associated with several indicators of clinical significance and distinctiveness. However the current review has found significant limitations and gaps in the scientific literature on MD. Possible options regarding the status of MD in the DSM-5 are proposed, including introducing MD as an example of an eating disorder not otherwise specified, retaining MD as a body dysmorphic disorder, introducing MD as a new disorder, or introducing MD as a provisional diagnosis in need of further study.     

肌肉上瘾综合征:一种新型的心理障碍?

肌肉上瘾综合征是指个体对于缺乏大块肌肉的错误认知的先占观念,是近二十年来西方学者的研究热点之一。已有研究从肌肉上瘾的诊断和测量,与体象障碍等心理障碍和行为异常的关系,以及形成机制等方面进行了深入的研究。然而,目前关于其临床诊断、产生机制等方面还存在争议。肌肉上瘾综合征在我国,甚至是亚洲尚缺乏足够的关注度。肌肉上瘾综合征的诊断依据、病征的文化差异、共患疾病、形成机制等将成为今后研究的焦点问题。     

Eating Disorders—The Regulation of Positive as well as Negative Emotion Experience

Disordered eating behaviors are often conceptualized as maladaptive emotion regulation strategies. The present study investigated links between emotional experience, schematic belief systems, and psychological themes associated with eating disorders. In contrast to the majority of studies, which focus on just one or two emotions and use nonclinical samples, this study compared the full range of emotional experience in women with eating disorders to a control group. Measures used include the Differential Emotional Scale-IV, Youngs Early Maladaptive Schema Questionnaire, and Eating Disorder Inventory-2. The study provides the first empirical evidence that women diagnosed with eating disorders report experiencing pleasant as well as unpleasant emotions more frequently than do controls. A surprising finding was that pleasant emotions (joy, interest, surprise) correlated with eating disorder themes (EDI-2 subscales) more consistently than unpleasant emotions in the eating disorder group, while the reverse was true of the control group. Also of note, eating-disordered women reported significantly less anger and similar levels of fear vs. controls. While eating-disordered women scored more highly than do controls on all maladaptive schema (suggesting high levels of distress in women with eating disorders), the pattern of correlations between schema and emotion experience was distinctly different for each group and counterintuitive for the eating disorder group. In particular, pleasant emotion was highly correlated with maladaptive schema in the eating-disordered group but not in the control group. These marked group differences in the pattern of relationships between emotion experience, eating disorder themes, and belief systems suggest that it is not valid to draw conclusions about eating disorders from research that employs only nonclinical samples. The authors discuss these findings, and suggest that women with eating disorders are proficient at using disordered eating behaviors to manipulate their experience of both positive and negative emotional states, and that this dynamic should be recognized as an important maintenance factor.     

Models of the Mind (Book)

In this study, we investigated evidence for reliability and validity of the Perceptual Thinking Index (PTI; Exner, 2000a, 2000b) among an adult inpatient population. We conducted reliability and validity analyses on 107 patients who met the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; American Psychiatric Association, 2000) criteria for a schizophrenia-spectrum disorder (SSD) or mood disorder with no psychotic features (MD). Results provided support for interrater reliability as well as internal consistency of the PTI. Furthermore, the PTI was an effective index in differentiating SSD patients from patients diagnosed with an MD. Finally, the PTI demonstrated adequate diagnostic statistics that can be useful in the classification of patients diagnosed with SSD and MD. We discuss methodological issues, implications for assessment practice, and directions for future research.     

A psychometric evaluation of the Rorschach comprehensive system's perceptual thinking index

In this study, we investigated evidence for reliability and validity of the Perceptual Thinking Index (PTI; Exner, 2000a, 2000b) among an adult inpatient population. We conducted reliability and validity analyses on 107 patients who met the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; American Psychiatric Association, 2000) criteria for a schizophrenia-spectrum disorder (SSD) or mood disorder with no psychotic features (MD). Results provided support for interrater reliability as well as internal consistency of the PTI. Furthermore, the PTI was an effective index in differentiating SSD patients from patients diagnosed with an MD. Finally, the PTI demonstrated adequate diagnostic statistics that can be useful in the classification of patients diagnosed with SSD and MD. We discuss methodological issues, implications for assessment practice, and directions for future research.     

Cognitive Analysis of Children's Mathematics Difficulties

The aim of the study is to investigate the informal and formal mathematical knowledge of children suffering from "mathematics difficulty" (MD). The research involves comparisons among three groups: fourth-grade children performing poorly in mathematics but normal in intelligence; fourth-grade peers matched for intelligence but experiencing no apparent difficulties in mathematics; and a randomly selected group of third graders. These children were individually presented with a large number of tasks designed to measure key mathematical concepts and skills. The findings suggest that: (1) MD children are not seriously deficient in key informal mathematical concepts and skills; (2) MD children seem to have elementary concepts of base ten notation but experience difficulty in related enumeration skills, particularly when large numbers are involved; (3) MD children's calculational errors often result from common error strategies; (4) MD children display severe difficulty in recalling common addition facts; and (5) in the area of problem solving, MD children are capable of "insightful" solutions and can solve simple forms of word problems, but experience difficulty with complex word problems. MD children are in many respects similar to normal, younger peers; an hypothesis of "essential cognitive normality" is advanced. The only and dramatic exception occurs in the area of number facts. While clinical experience corroborates this finding, its explanation is not evident.     

Predictors of first onset and recurrence of major depression in young women during the 5 years following high school graduation

Although most depressive episodes in adulthood are recurrences of the disorder, lifetime history of major depression (MD) is often neglected in predictive models. On the basis of research and theory suggesting differential prediction of MD across the course of the disorder, the authors explored whether factors that predict a first MD onset would not predict MD recurrence. Predictors of MD were examined longitudinally in a sample of 128 young women followed for 5 years. Controlling for lifetime MD history, 5-year MD was predicted by the presence before study entry of 3 variables: having witnessed family violence before age 16, having a parent with a psychiatric disorder, and having a nonmood Axis I disorder. During the follow-up period, chronic and episodic stress predicted MD. Prior lifetime MD interacted with both chronic stress and parental psychopathology to predict MD, such that first onsets, but not recurrences, were predicted by these risk variables.     

The Experience of Prisoners’ Parents: A Meta‐Synthesis of Qualitative Studies

The parents of prisoners have long drawn the attention of researchers, due to their role in the etiology of criminality as well as the importance of their support of their offspring during and after incarceration. However, although studies have shown that the parents of prisoners experience high levels of distress, burden, and social stigma, research into their experience is only now beginning to emerge. This metasynthesis examined the limited body of qualitative research on the experience of prisoners’ parents, as an exploratory step toward advancing the understanding of their experience. Relevant terms were used to systematically search key databases. Ten small‐scale studies, which varied in focus, location, and disciplinary orientation, met the inclusion criteria. The synthesis produced four core themes, reflecting findings regarding parents’ (primarily mothers’) experience of their offspring's incarceration: parenting from a distance; the burden of care; troubled parental identity; and social reaction. Furthermore, the findings suggested a number of possible mediating factors of this experience, such as parents’ social capital and their cognitive appraisal of their offspring's criminality. These themes imply a possible experience of “imprisonment by association” among the parents of inmates and illuminate features that may be unique to them. Given the inherent limitations regarding generalizability of a metasynthesis and the heterogeneity of the experiences of the parents represented by the articles reviewed, the findings call for future large‐scale quantitative studies to explore the challenges and therapeutic needs of parents of prisoners regarding the themes identified.     

Propranolol and the Prevention of Post-Traumatic Stress Disorder: Is it Wrong to Erase the “Sting” of Bad Memories?

The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias put forth by the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry.     

What’s in a name? A psychoanalytic exploration of self and identity in transgender individuals who were assigned female at birth

This study explores the development of self and gender identity within the lived experience of transgender individuals who were assigned female at birth and now identify as male or male spectrum. A psychoanalytically informed interview technique was employed here, involving six participants, aged 20–37 for 3–4 one-hour interviews. Alongside close attention to the content and the manner of representation of self and other across interviews, the analysis was also informed by counter-transference processes. Three core themes emerged from the data: ‘What’s in a Name?’; ‘Rejected, Bullied, Ignored and Forgotten’; and ‘I’m a Boy (not a Girl)’. Recollections of traumatic experiences and the use of laughter were other notable details that appeared across participants. Links are made between the emerging themes and concepts of incongruent mirroring and the development of a false self. Directions for further research and clinical implications for working with transgender clients in a psychotherapeutic context are also outlined.     

Preimplantation Genetic Diagnosis: Understanding What Parents Plan to Tell Their Children About Their Conception

Over 10,000 babies have been born by PGD and PGS worldwide (Simpson, Prenatal Diagnosis 30(7): 682–695 2010). The experience of parents who have undergone this procedure and their children’s well-being are documented, but no research to date has explored whether parents intend to tell their children how they were conceived and whether this raises special issues for them. PGD practitioners recommend research in this area as parents of children born by PGD increasingly ask questions pertaining to disclosure. We conducted 30 in-depth interviews with couples who have had a baby conceived by PGD. We explored what couples plan to tell their children about how they were conceived, when they plan to do this, and issues they anticipate may arise. The couples had a family history of a monogenic disorder or chromosome rearrangement. Six themes emerged which highlight key issues: (1) To tell or not to tell? (2) Primary reason for undergoing PGD, (3) The ideal time to tell, (4) Situations which may warrant earlier disclosure, (5) Words which parents might choose, and (6) Issues which parents anticipate may arise. We conclude that parents are likely to inform their children about PGD because there is an affected sibling or relative about whom they ask questions, and/or their children are carriers of a condition their parents feel obliged to tell them about. Parents felt they would benefit from access to a genetic counsellor at the time of disclosure and are optimistic about the future of reproductive technology for their children.     

Cognitive and behavioral attention in children with math difficulties

Cognitive assessments and behavioral ratings of attention were used to examine the relation of inattention to math performance in children. Third grade students with math difficulties (MD; n?=?17) and math and reading difficulties (MDRD; n?=?35) were administered the Attentional Network Test (ANT), as well as achievement and intelligence measures. Strengths and Weaknesses of ADHD-Symptoms and Normal-Behavior-IV (SWAN-IV) Inattention ratings were collected from teachers. Two comparison groups were also recruited: a typically achieving group (n?=?23) and a group that responded to a math-tutoring intervention (responders; n?=?54). On the ANT, children with MD and MDRD did not perform significantly different than typically achieving children or responders on measures of alerting and orienting attention and executive control. All subgroups did demonstrate performance patterns that were expected on the ANT. However, performance across blocks of the task was inconsistent, suggesting poor reliability. There were no relations between ANT performance and SWAN-IV behavioral inattention scores, though behavioral ratings of inattention correlated significantly with math performance. Children with MD and MDRD may have more difficulty with distraction and attention to detail in contextual situations, as opposed to impulsive responding in these settings. The lack of relation between cognitive attention and math performance may suggest that either the ANT does not assess the relevant attention constructs associated with math difficulties or may parallel studies of attention deficit/hyperactivity disorder (ADHD) in which cognitive and behavioral assessments are weakly related.     

Are community studies of psychological trauma's impact accurate? A study among Jews and Palestinians

We evaluated the accuracy of posttraumatic stress disorder (PTSD) and major depression (MD) diagnoses using brief assessment instruments conducted by phone. PTSD and MD were assessed by telephone interview in a randomly selected sample of Jewish and Palestinian residents of Jerusalem (N = 150) during a period of marked threat of terrorism and war. We utilized the PTSD Symptom Scale Interview Format (Foa, Riggs, Dancu, & Rothbaum, 1993) and the Patient Health Questionnaire-9 (PHQ-9; Kroenke, Spitzer, & Williams, 2001). We then conducted in-depth, in-person interviews within 2 weeks, assessing PTSD and MD using the Composite International Diagnostic Interview (CIDI; Kessler et al., 2004). The prevalence of PTSD and MD diagnosis ascertained by the 2 assessment modalities was similar. Indices of classification accuracy for the phone interview, using the in-person interview as the standard, ranged from modest to high. Brief phone and in-depth in-person measures of PTSD and MD also correlated similarly with other demographic, stress, and coping factors, suggesting convergent validity. Brief phone interviews appear useful for estimating the prevalence of psychological disorders in mass casualty contexts and may have a critical role in both epidemiologic work and guiding public health interventions.     

Everyday Strivings in War Veterans With Posttraumatic Stress Disorder: Suffering From a Hyper-Focus on Avoidance and Emotion Regulation

This research investigated whether combat veterans' daily strivings are related to the presence of post-traumatic stress disorder (PTSD) and well-being. Veterans created a list of their most important strivings, which were content-analyzed for emotion regulation and approach or avoidance themes. It was hypothesized that veterans pursuing strivings with themes of emotion regulation or avoidance experience deleterious consequences compared with other veterans. For all veterans, devoting finite time and energy in daily life to regulating emotions was associated with less purpose, meaning, and joy compared with other strivings. Veterans with PTSD endorsed more strivings related to emotion regulation and devoted considerable effort to emotion regulation and avoidance strivings. Yet, these efforts failed to translate into any discernible benefits; veterans without PTSD derived greater joy and meaning from strivings focusing on approac- oriented behavior and themes other than emotion regulation. The presence of PTSD and a high rate of emotion regulation strivings led to the lowest global well-being and daily self-esteem during a 14-day assessment period. The presence of PTSD and a high rate of avoidance strivings also led to lower emotional well-being. Results indicate that strivings devoted to regulating emotions or avoidance efforts influence the mental health of veterans with and without PTSD. Studying personality at different levels of analysis—traits, strivings, and life narratives—allows for a fine-grained understanding of emotional disorders.     

Self-help conferences for people who stutter: a qualitative investigation

Self-help activities for people who stutter (PWS) have been gaining in popularity; however, there is a scarcity of evidence to support their utility in stuttering management. The purpose of this investigation was to understand the lived experience of individuals who attended a self-help conference(s) for PWS from the perspective of a PWS to learn its potential utility in stuttering management. The investigator used Interpretive Phenomenological Analysis (IPA) to systematically collect authentic data of this social phenomenon. Twelve participants were recruited from a self-help conference and the self-help community of PWS. Semi-structured interviews were conducted 4–18 months after each participant's last conference. Interviews were transcribed and analyzed. Themes were explained in investigator narratives and illustrated through participants’ quotes. Interpreted themes of the experience of having attended a self-help conference(s) for PWS included: socializing opportunities with other PWS, affiliation, redefining oneself and post-conference disclosures. A conclusion of the study was that the experience of having attended a self-help conference(s) for PWS helped to minimize negative impact that stuttering can have on daily functioning. It appears that self-help conferences were perceived as a safer or “stutter-friendly” environment and promoted social interaction, relationship building, and community building through planned and unplanned activities. Another conclusion was that the experience of having attended self-help conferences for PWS helped participants to communicate more easily. Reported increases in social activity and an “openness” about stuttering, suggest self-help conferences’ utility in stuttering management. These findings are supported by other studies about successful stuttering management and self-help activities for PWS. They have helped attendees who stutter to communicate more easily and suggest a reduction in the negative impact that stuttering has on their lives.Educational objectives: The reader will be able to: (1) describe recurring themes associated with the lived experience having attended a self-help conference(s) for people who stutter (PWS) from the perspective of a group of adults who stutter, and (2) describe the potential benefits of attending self-help conferences for PWS in order to make appropriate evidence-based referrals to self-help conferences for PWS.     

A Phenomenological Study of Identifying as Lesbian,Gay and Bisexual in an Islamic Country

Ten adult Kuwaitis (four women and six men) who self-identified as being gay, lesbian, or bisexual (GLB) participated in in-depth semi-structured interviews examining their experience of being a sexual minority and living in a socially conservative Islamic country. The data were analyzed using interpretive phenomenology and yielded four primary themes including the role of religion and culture, risks, coping, and influential political factors. These themes help understand the ways in which LGB individuals in Kuwait integrate their sexual identity with religious and cultural factors and navigate a socially conservative society. The results of the study have implications for political and social policies in Kuwait, and for more culturally-sensitive models of sexual identity development among Arab populations.     

"Motherhood starts in prison": the experience of motherhood among women in prison

This study aims to explore the way in which women prisoners in Israel experience motherhood in prison and construct their motherhood after being released. In-depth interviews were conducted with 9 women, and the data were analyzed according to the phenomenological approach. The qualitative methodology generated 5 main themes: (a) motherhood in prison as a motive for survival; (b) the sense of failure experienced by mothers in prison; (c) coping versus avoidance in the mother-child relationship during imprisonment; (d) motherhood in prison as a motive for change; and (e) the transition from questioning the right to be a mother to redeeming motherhood. The 5 themes were organized into a model that depicts the process of becoming a mother in prison and the move toward mending the experience of motherhood. The findings indicate that side by side with the traumatic experiences of prison are other aspects that allow for growth and rehabilitation. The discussion focuses on 2 main issues that evolved from the findings: the reasons for the change in motherhood that occurs during imprisonment and the aspects of prison that enable this change.     

Associations between Thematic Content and Memory Detail in Trauma Narratives

This study examined whether thematic content (e.g., fear, anger, alienation, self‐blame, and spirituality) in trauma narratives predicted memory detail. Trauma‐specific memory models suggest that trauma narrative themes are associated with much sensory detail; general autobiographical memory models suggest that themes are associated with little context detail. Seventy‐one narratives from a diverse community sample exposed to a variety of traumatic events (e.g., sexual assault, natural disasters) were coded for themes and detail. Analyses controlled for narrative length, childhood or adulthood occurrence, self‐reported post‐traumatic stress disorder, depression and dissociation symptoms. Fear themes were associated with greater sensory detail; anger and spirituality themes were associated with less context detail. Findings support a link between thematic content and detail, and may partially explain why details in memory for traumatic events sometimes appear better and other times worse than memory for other events. Memory models may benefit from specification based on themes in trauma narratives. Copyright © 2013 John Wiley & Sons, Ltd.     

Leading and Learning in the Psychotherapy Supervision Seminar: Some Thoughts on the Beginnings of Supervisor Development

Supervisor development theories typically give focus to growth of the supervisor via practice. But in what ways does the foundational psychotherapy supervision seminar stimulate and first set in motion the supervisor development process? That question is subsequently considered. Based on personal experience in training supervisors via seminars and ongoing reflection about that learning process, five seminar-induced themes that potentially reflect beginning tensions of supervisor development are proposed, and their seeming evolution over the course of the supervision seminar is considered. Points that are raised include the following: (a) the supervision seminar is the first, primary stimulus of supervisor development and sets the stage for later growth via practice; (b) early themes that are identified in supervisor development theories also make appearance in the supervision seminar experience; (c) to best understand the full arc of supervisor development, the seminar as both developmental initiator and intervention preparedness foundation merits more careful scrutiny; and (d) through more completely understanding the seminar as instigator of supervisor development, supervisor educators might be better positioned to develop seminars that most constructively affect the very beginnings of the supervisor development process.