CIC, CLPS, and MSAD

The purpose of this article is to provide a commentary on the reports of the findings from the longitudinal Children in the Community (CIC) study by Cohen, Crawford, Johnson, and Kasen (this issue), Collaborative Longitudinal Personality Disorders Study (CLPS) by Skodol et al. (this issue), and McLean Study of Adult Development (MSAD) by Zanarini, Frankenburg, Hennen, Reich, and Silk (this issue). This article focuses in particular on the implications of their longitudinal findings with regard to a fundamental component of personality disorder: temporal stability. Also discussed are their findings with regard to an integration of general personality structure with personality disorder.     

Emotional, behavioral, and cognitive factors that differentiate obsessive-compulsive disorder and other anxiety disorders in youth

Abstract The current study examined specific emotional, behavioral, and cognitive variables that may distinguish obsessive-compulsive disorder (OCD) from generalized anxiety disorder (GAD), social phobia (SoP), and separation anxiety disorder (SAD) in youth. Youth with OCD (n=26) and other anxiety disorders (ADs; n=31), aged 7-12 years (56.1% males), and their parents participated. The study compared the two anxious groups on levels of emotional, behavioral, and cognitive functioning, as well as impairment associated with the disorder. Results indicated that in comparison to youth with GAD, SoP, or SAD, youth with OCD were found to have poorer emotion regulation skills, as well as greater oppositionality, cognitive problems/inattention, and parent impairment associated with the disorder. The findings suggest that there are unique characteristics of OCD that may differentiate this disorder from other ADs in youth. Potential clinical implications and directions for future research are discussed.     

Neighborhood and Housing Disorder,Parenting, and Youth Adjustment in Low-Income Urban Families

Using two waves of data, this study examined relations among neighborhood and housing disorder, parents’ psychological distress, parenting behaviors, and subsequent youth adjustment in a low‐income, multiethnic sample of families with children aged 6–16. Results supported the hypothesized indirect relation between disorder and youth outcomes via parenting processes. Higher levels of neighborhood and housing disorder were associated with higher levels of parents’ psychological distress, which was in turn related to more frequent use of harsh and inconsistent discipline strategies and lower parental warmth. More frequent use of harsh and inconsistent discipline was associated with higher levels of youth internalizing and externalizing behaviors 3 years later. Housing disorder contributed more strongly to parents’ psychological distress than neighborhood disorder, whereas neighborhood disorder contributed more strongly to youth externalizing behaviors compared to housing disorder. Multiple‐group analyses showed that the patterns of relations were similar for younger and older children, and for girls and boys.     

Current status of the scientific study of the personality disorders: an overview of epidemiological, longitudinal, experimental psychopathology, and neurobehavioral perspectives

Research on the nature and development of personality disorders has grown immensely over the past thirty years. A selective summary overview is given of the current status of the scientific study of the personality disorders from several perspectives, including the epidemiological, longitudinal, experimental psychopathology, and neurobehavioral perspectives. From this research, we now know that approximately 10 percent of the general population suffer from a diagnosable personality disorder. Moreover, contrary to nearly a century of theory and clinical pedagogy, modern longitudinal studies clearly suggest that personality disorders decrease in severity over time. The mechanisms by which this change occurs are not understood at present, though it is not likely that change in underlying normal personality systems drives the change in personality disorder. The methods of the experimental psychopathology laboratory, including neuroimaging approaches, are being brought to bear on the nature of personality disorders in efforts to relate neurobiological and neurocognitive functions to personality disorder symptomatology. A model that links personality disorder feature development to underlying, interacting brain-based neurobehavioral systems is reviewed in brief. Current issues and findings illustrative of these developments are given using borderline personality disorder as an exemplar. Finally, areas of intersection between psychoanalytic treatment approaches and the growing science of personality disorder are highlighted.     

The cycle of schizoaffective disorder, cognitive ability, alcoholism, and suicidality

In this study we investigated the putative role of cognitive dysfunction, diagnosis (schizoaffective versus schizophrenia disorder), and alcoholism as risk factors for suicidal behavior among individuals with DSM-TV schizophrenia or schizoaffective disorders. Subjects received cognitive tests and medical records were reviewed for evidence of a history of suicide attempts or suicidal ideation. Discriminant analysis was used to identify cognitive test performance measures that distinguished those with versus those without suicidal behavior. None of the cognitive measures discriminated between the two groups. The rates of suicidal behavior (suicidal ideation and suicide attempts) did not differ between participants with versus those without comorbid alcohol use. An association was found between suicidal behavior and the diagnosis of schizoaffective disorder. It was concluded that the history of prominent mood syndromes characteristic of schizoaffective disorder contributes to increased risk of suicidal behaviors. Cognitive dysfunction and/or alcoholism did not contribute additionally to risk in this study.     

Hoarding Disorder: Diagnosis,Assessment, and Treatment

Hoarding disorder (HD) is a newly added mental disorder in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). In this article, the symptoms, characteristics, and features of HD are described, along with diagnosis and assessment strategies. The most efficacious treatments for counseling clients diagnosed with HD are also discussed.     

Emotional,behavioral, and cognitive factors that differentiate obsessive-compulsive disorder and other anxiety disorders in youth

Abstract

The current study examined specific emotional, behavioral, and cognitive variables that may distinguish obsessive-compulsive disorder (OCD) from generalized anxiety disorder (GAD), social phobia (SoP), and separation anxiety disorder (SAD) in youth. Youth with OCD (n=26) and other anxiety disorders (ADs; n=31), aged 7–12 years (56.1% males), and their parents participated. The study compared the two anxious groups on levels of emotional, behavioral, and cognitive functioning, as well as impairment associated with the disorder. Results indicated that in comparison to youth with GAD, SoP, or SAD, youth with OCD were found to have poorer emotion regulation skills, as well as greater oppositionality, cognitive problems/inattention, and parent impairment associated with the disorder. The findings suggest that there are unique characteristics of OCD that may differentiate this disorder from other ADs in youth. Potential clinical implications and directions for future research are discussed.     

Voluntariness, intention, and the defence of mental disorder: toward a rational approach

This article addresses how mental disorder may be used in common law countries to negate the requirements of voluntariness and intention in serious criminal offences as well as to provide the basis for current versions of the insanity defence. The notion that mental disorder can cause conduct to become completely involuntary or unintentional is questionable, given current thinking in the behavioral sciences. This article argues that different forms of mental disorder should be subsumed within a separate defence of mental disorder. Providing that a range of dispositional options is available, the law in this complex area would be simplified and brought into line with current psychological notions of goal-directed behavior.     

Sociodemographic, clinical and outcome differences among anxiety disorders

The aims of this paper are to analyze differences in sociodemographic and clinical characteristics among the various anxiety disorders treated in a Psychology Clinic, and the results of treatment in each anxiety disorder. Data from 282 patients of University Psychology Clinic at the Complutense University of Madrid, who had at least one diagnosis of anxiety according to DMS-IV-TR criteria, were analyzed. The most frequent anxiety disorders were nonspecific anxiety disorder (19.1%) and social phobia (18.8%). Significant differences were observed according to sex (in all disorders, the percentage of women was significantly higher than that of men, except for obsessive-compulsive disorder). Unspecific anxiety disorder required a smaller number of assessment and treatment sessions, whereas obsessive-compulsive disorder required a greater number of sessions. There were no significant differences between the percentage of patients who completed treatment and dropout rates in specific phobia, general anxiety disorder and obsessive-compulsive disorder. Differences between epidemiological and clinical data are discussed.     

Diffuse Lewy Body Disease: Clinical,Pathological, and Neuropsychological Review

The pathophysiological etiologies and clinical presentations of neurodegenerative dementias have been found to be complex and heterogeneous. Recently, Lewy body inclusions have been identified as an etiological factor in 20–34% of autopsied dementia cases. The term diffuse Lewy body disease (DLBD) is generally accepted as the diagnostic term representative of this currently under-reported and under-recognized disease. This article reviews the literature on the clinical, pathological, and neuropsychological features of this disorder. Differential diagnostic issues are discussed as well as current pharmacological treatment. Nine confirmed cases of DLBD are presented to demonstrate the various features of this disorder. The diagnostic implications of neuropsychological examination results are discussed in relation to other common dementing neurologic diseases.     

Mismanagement of Panic Disorder in Emergency Departments: Contributors, Costs, and Implications for Integrated Models of Care

Panic disorder (PD) is associated with the rapid onset of fear-related symptomatology, often somatic in nature. As a result, individuals with the disorder often fear that they are experiencing a life-threatening emergency and present in hospital emergency departments (EDs). As the operating heuristics of EDs are geared toward identifying organic causes and allow only brief physician–patient contact, the diagnosis of PD is more often than not overlooked. Those with the disorder go on to incur enormous costs as they seek out an explanation for their symptoms. Efforts to alleviate this problem, including increased physician education and the development of screening instruments, have been largely unsuccessful. The continued misidentification and mismanagement of this disorder argues for greater incorporation of mental health professionals into the ED, allowing collaborative efforts that recognize the relationship between physiological and psychological aspects of panic.     

A psychobiographical analysis of Brian Douglas Wilson: Creativity, drugs, and models of schizophrenic and affective disorders

The suggestion of a relationship between creativity and mental disorder has existed for centuries, and has been advocated by many psychological researchers. The present analysis offers a consideration of the nature of mental disorder present in Brian Wilson, an individual recognised as one of the most creative figures in 20th century popular music. Using converging biographical evidence, and the diagnostic program Opcrit, Wilson’s diagnosis is concluded to be schizoaffective. Employing details of his drug abuse, various models of schizoaffective spectra are examined, in particular a reconsideration of the LSD model of schizophrenia. The model is shown to be useful for positive schizophrenic symptoms including overinclusion, a potentially key element of creativity. In doing so, this psychobiographical analysis allows examination of potential relationships between mental disorder and creativity, the effects of various narcotics on creativity and various elements of mental disorder, the efficacy of various drug models of psychotic disorders, and the overlap between psychotic and affective disorders.     

The CBCL Bipolar Profile and Attention,Mood, and Behavior Dysregulation

Biederman and colleagues reported that a CBCL profile identified youngsters who were diagnosed with bipolar disorder. Some studies found that this CBCL profile does not reliably identify children who present with bipolar disorder, but nonetheless this CBCL does identify youngsters with severe dysfunction. However, the nature of the impairment of youngsters who fit this profile is unclear. The goal of this study was to describe the clinical characteristics of youngsters who fit this CBCL profile. The sample included 310 youngsters referred to an outpatient psychopharmacology clinic. There were 55 youngsters who fit the CBCL profile. These youngsters were compared to 255 youngsters who did not fit the CBCL profile. Measures included the CBCL, standardized measures of aggression and ADHD symptoms, youngsters’ self-reported depression, DSM-IV diagnoses, and child and adolescent psychiatrists’ ratings of impairment and functioning. Compared to youngsters who did not fit the CBCL bipolar disorder profile, youngsters who fit the profile had significantly higher scores on all but one CBCL scale and significantly higher levels of aggression. Youngsters who fit the CBCL profile also had greater psychosocial impairment and more DSM-IV diagnoses than youngsters who did not fit the profile. Youngsters who fit the CBCL profile exhibit severe dysregulation across multiple domains of functioning including attention, affective, and behavioral dysregulation that are not easily nor efficiently captured by extant DSM-IV diagnoses. These youngsters are not uncommon and comprise slightly less than 1 in 5 referrals to a child psychiatry clinic.     

Order,disorder, and the absolute: An experiment in dialogue

The first section of this dialogue is excerpted from an edited conversation between Sean Kelly and the late David Bohm, and focuses on the concepts of order, disorder, and the Absolute. The second section explores these concepts in greater depth, with Bohm maintaining the impossibility of absolute knowledge and the fundamental unintelligibility of the concept of disorder, preferring instead to speak of “orders of infinite degree” which emerge out of an “unknown ground.” Kelly responds by proposing the concept of “absolute knowing” as the cognitive process within which the concepts of order and disorder, the known and the Unknown are seen as dialectically related moments of the Absolute as complex whole. The third section is Edgar Morin's response to the preceding dialogue. He begins by outlining his views on the nature and limits of rationality, maintaining, with Bohm, the superiority of the “negative modality” of speaking about “being” or “reality.” In the second part, however, he proposes the notion of nature as “chaosmos,” which he understands as a creative “dialogic” of order, disorder, and organization.     

Traumatic Events,Psychiatric Disorders,and Pathways of Risk and Resilience During the Transition to Adulthood

The goal in this study was to investigate the occurrence, frequency, and consequences of traumatic events during the first 2 decades of life. The sample omprised 524 Euro-American young adults from the rural Midwest who are part of an ongoing longitudinal study (see Conger & Conger, 2002). We found that psychiatric disorders were associated with traumatic events and particularly strongly associated with experiences of childhood maltreatment. Maltreated children were 5.64 times more likely to develop a disorder than individuals who xperienced no trauma. These odds varied, depending on the disorder, from more than 3 for alcohol dependence to more than 18 for drug dependence. We found that social support acted to reduce risk for emotional disorder and buffered effects of traumatic events under some circumstances, especially in cases of childhood trauma.     

Post-Traumatic Stress Disorder,Sensory Integration,and Aquatic Therapy: A Scoping Review

The prevalence of post-traumatic stress disorder (PTSD) continues to increase. Symptomology of PTSD include sensory deficits much like those displayed in children with sensory integration (SI) disorder. The aim of this scoping review is to review symptoms of PTSD and SI, and make a case of how aquatic therapy may be an effective modality in treating clients with PTSD. Eighteen articles were selected for review. From this review, it is suggested that aquatic therapy can be an effective modality in reducing symptoms of PTSD; however, future research is essential in determining its effectiveness.     

Perfectionistic self-presentation, body image, and eating disorder symptoms

A specific model for eating disorder symptoms involving perfectionistic self-presentation and two different moderators (i.e., body image evaluation and body image investment) was tested. Participants completed measures of perfectionistic self-presentation, body image dysfunction, and eating disorder symptoms. Findings indicated that all three dimensions of perfectionistic self-presentation were associated with eating disorder symptoms. Results also showed that perfectionistic self-presentation predicted eating disorder symptoms in women who were dissatisfied with their bodies, but that it did not predict eating problems in women who liked their bodies and felt there was little or no discrepancy between their actual and ideal appearances. Body image investment did not moderate the relationship between perfectionistic self-presentation and eating disorder symptoms, suggesting that ego-involvement alone is insufficient to promote eating disturbance in the context of perfectionism. The importance of self-presentation components of perfectionism and specific body image difficulties in predicting eating disorder symptoms are discussed.     

Cognitive impairments and disordered speech in schizophrenia: thought disorder, disorganization, and communication failure perspectives

This article posits that basic cognitive impairments in schizophrenia are more highly related to speech disorder measured as communication failures than speech disorder measured as thought disorder or disorganization. The author tested 47 schizophrenia patients and 36 control participants for sustained attention, sequencing, and conceptual sequencing ability. Their speech was also rated for communication failures, thought disorder, and conceptual disorganization. Attention and sequencing impairments, examined hierarchically, explained a substantial 38% of the variance in the communication measure of speech disorder but little of the variance in formal thought disorder or conceptual disorganization. The author concludes that (a) impairments in attention and sequencing abilities contribute substantially to schizophrenic communication failures, and (b) it is important to consider lower level cognitive "3rd variables" when examining higher level cognitive associates of speech disorder.     

Antisocial personality disorder, affect dysregulation and childhood abuse among incarcerated women

The aim of this study was to examine the role of affect dysregulation and childhood abuse in antisocial personality disorder (ASPD), using a sample of incarcerated women. Subjects for this study were 85 incarcerated women who were administered structured interviews to assess for ASPD, borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), childhood trauma, and affect dysregulation. Using a series of logistic regressions, this study found that a greater degree of affect dysregulation--in particular, poor anger modulation--was significantly related to ASPD, controlling for BPD and PTSD in women prisoners. After controlling for BPD, recent self mutilation was not significantly related to ASPD. Likewise, a history of childhood abuse was not significantly associated with ASPD.     

Cognitive-behavioral therapy for panic disorder: a review of treatment elements,strategies, and outcomes

This article provides an overview of cognitive-behavioral therapy (CBT) for panic disorder. CBT is currently considered a first-line treatment for panic disorder. It offers benefit after short-term intervention, typically consisting of 12-15 sessions conducted in either an individual or a group format. The treatment focuses on the elimination of the patterns that underlie and perpetuate the disorder. Through CBT, patients learn about the nature of the disorder and acquire a set of strategies that counter the fears of panic attacks themselves, and break the recurring cycle of anticipatory anxiety, panic, and agoraphobic avoidance. The collaborative format of treatment, and a focus on elimination of core fears may be factors in enhancing longer-term outcome. In this article, we review the efficacy of CBT as a first-line treatment, a strategy for medication nonresponders, a replacement strategy for patients who wish to discontinue pharmacotherapy, and a potential preventive strategy for at-risk individuals. We also discuss some of the complex issues involved with combination-treatment strategies.