A new diagnosis of complex Post-traumatic Stress Disorder,PTSD – a window of opportunity for the treatment of patients in the NHS?

The concept of complex trauma has been around for a long time and in 2018, it’s expected to become a new diagnosis in the International Classification of Diseases eleventh revision, ICD-11, the World Health Organisation, WHO, manual used formally in the NHS. Psychiatric diagnosis often does not sit well with psychoanalysis, which is at least as interested in unconscious phantasy as it is in symptoms. But as psychodynamically-trained practitioners in the NHS we need to engage with ICD-11 and apply our own understanding to service design so that patients have access to treatment which works for them. The service where I work (a secondary mental health team in the London borough of Lewisham) has already been receiving referrals for ‘complex trauma’ for some time, despite its not being formally classified. Patients so described are most often those with a history of childhood sexual abuse, and refugees with a history of brutality and torture. Differential diagnosis includes personality disorder since many have difficulties with interpersonal issues. In this paper I want to discuss how we might understand the new diagnosis of complex Post-traumatic Stress Disorder, PTSD, and its implications for treatment in the NHS.     

Against Perceptual Conceptualism

This paper is concerned with the question of whether mature human experience is thoroughly conceptual, or whether it involves non-conceptual elements or layers. It has two central goals. The first goal is methodological. It aims to establish that that question is, to a large extent, an empirical question. The question cannot be answered by appealing to purely a priori and transcendental considerations. The second goal is to argue, inter alia by relying on empirical findings, that the view known as ‘state-conceptualism’ is false. We will argue that our experiences do involve non-conceptual elements. That is, a subject may enjoy an experience with a particular phenomenal aspect, without possessing the concept needed for the specification of the content of that aspect, and moreover, without being able to acquire that concept upon having that experience.     

Parents’ Experiences of Receiving the Initial Positive Newborn Screening (NBS) Result for Cystic Fibrosis and Sickle Cell Disease

The clinical advantages of the newborn screening programme (NBS) in the UK are well described in the literature. However, there has been little exploration of the psychosocial impact on the family. This study followed the principles of grounded theory to explore parents’ experiences of receiving the initial positive NBS result for their child with cystic fibrosis (CF) or sickle cell disease (SCD). Semi-structured, qualitative interviews were conducted with 22 parents (12 mothers and 10 fathers) whose children had been diagnosed with CF or SCD via NBS and were under the age of 1 year at the time of interview. The main themes that arose from the data were; parents previous knowledge of the condition and the NBS programme, the method of delivery and parental reactions to the result, sharing the results with others, the impact on parental relationships and support strategies. Study conclusions indicate that most parents thought initial positive NBS results should be delivered by a health professional with condition specific knowledge, preferably with both parents present. Genetic counselling needs to include a focus on the impact of NBS results on parental relationships. Careful consideration needs to be given to strategies to support parents of babies who have positive NBS results both in terms of the psychological health and to assist them in sharing the diagnosis.     

Mental Health Diagnostic Considerations in Racial/Ethnic Minority Youth

Misdiagnoses of racial/ethnic minority youth’s mental health problems can potentially contribute to inappropriate mental health care. Therefore, we conducted a systematic review that focuses on current theory and empirical research in an attempt to answer the following two questions: (1) What evidence exists that supports or contradicts the idea that racial/ethnic minority youth’s mental health problems are misdiagnosed? (2) What are the sources of misdiagnoses? Articles were reviewed from 1967 to 2014 using PsychINFO, PubMed, and GoogleScholar. Search terms included “race”, “ethnicity”, “minority”, “culture”, “children”, “youth”, “adolescents”, “mental health”, “psychopathology”, “diagnosis”, “misdiagnosis”, “miscategorization”, “underdiagnosis”, and “overdiagnosis”. Seventy-two articles and book chapters met criteria and were included in this review. Overall, evidence was found that supports the possibility of misdiagnosis of ethnic minority youth’s emotional and behavioral problems. However, the evidence is limited such that it cannot be determined whether racial/ethnic differences are due to differences in psychopathology, mental health biases, and/or inaccurate diagnoses. Cultural and contextual factors that may influence misdiagnosis as well as recommendations for research and practice are discussed.     

The left digit effect in a complex judgment task: Evaluating hypothetical college applicants

A left digit effect has been broadly observed across judgment and decision-making contexts ranging from product evaluation to medical treatment decisions to number line estimation. For example, $3.00 is judged to be a much greater cost than $2.99, and “801” is estimated strikingly too far to the right of “798” on a number line. Although the consequences of the effects for judgment and decision behavior have been documented, the sources of the effects are not well established. The goal of the current work is to extend investigations of the left digit effect to a new complex judgment activity and to assess whether the magnitude of the effect at the individual level can be predicted from performance on a simpler number skills task on which the left digit effect has also recently been observed. In three experiments (N = 434), adults completed a judgment task in which they rated the strength of hypothetical applicants for college admission and a self-paced number line estimation task. In all experiments, a small or medium left digit effect was found in the college admissions task, and a large effect was found in number line estimation. Individual-level variation was observed, but there was no relationship between the magnitudes of the effects in the two tasks. These findings provide evidence of a left digit effect in a novel multiattribute judgment task but offer no evidence that such performance can be predicted from a simple number skills task such as number line estimation.     

Childhood abuse and neglect and cognitive flexibility in adolescents

Childhood maltreatment (CM) has been associated with diminished executive functioning in children and adults; however, there is a relative paucity of study of executive function in adolescents exposed to CM. Yet, executive dysfunction in adolescence may have important adverse consequences including increased vulnerability to risky behaviors and impaired school functioning. This study investigates the relationship between self-reported CM and an executive function, cognitive flexibility, in adolescents without identified psychiatric disorders. Effects of physical and emotional, abuse and neglect, maltreatment subtypes were explored. Thirty adolescents ages 12-17 years, 50% females, completed the retrospective self-report Childhood Trauma Questionnaire (CTQ) and were administered the Wisconsin Card Sorting Test (WCST). Correlational analyses assessed the relationship between WCST perseverative error scores norm-referenced for age and education with CTQ total scores. The relationship with nonperseverative errors, as well as with physical and emotional abuse and neglect CM subscores, were explored. Total CTQ scores showed significant associations with perseverative errors on the WCST, but not with nonperseverative errors. Significant associations with perseverative errors were seen for physical abuse and physical neglect among the CTQ subscales. The results suggest both physical abuse and physical neglect are associated with diminished cognitive flexibility in adolescents. These effects were detected in adolescents without identified psychiatric diagnoses suggesting the importance of considering executive dysfunction in adolescents exposed to CM who may not meet diagnostic criteria for an Axis I disorder and that tests of perseverative errors, such as those of the WCST, may be sensitive indicators of this dysfunction.     

Executive function on the Psychology Experiment Building Language tests

The measurement of executive function has a long history in clinical and experimental neuropsychology. The goal of the present report was to determine the profile of behavior across the lifespan on four computerized measures of executive function contained in the recently developed Psychology Experiment Building Language (PEBL) test battery and evaluate whether this pattern is comparable to data previously obtained with the non-PEBL versions of these tests. Participants (N = 1,223; ages, 5–89 years) completed the PEBL Trail Making Test (pTMT), the Wisconsin Card Sort Test (pWCST; Berg, Journal of General Psychology, 39, 15–22, 1948; Grant & Berg, Journal of Experimental Psychology, 38, 404–411, 1948), the Tower of London (pToL), or a time estimation task (Time-Wall). Age-related effects were found over all four tests, especially as age increased from young childhood through adulthood. For several tests and measures (including pToL and pTMT), age-related slowing was found as age increased in adulthood. Together, these findings indicate that the PEBL tests provide valid and versatile new research tools for measuring executive functions.     

The relationships between fat talk, body dissatisfaction, and drive for thinness: perceived stress as a moderator

Although body dissatisfaction and drive for thinness are commonplace in college-aged women, their relationships with fat talk and stress are understudied. This study examined (a) whether fat talk predicts body dissatisfaction and drive for thinness and (b) whether stress moderates these relationships. Results from self-report questionnaires completed by 121 female college students revealed that fat talk and perceived stress were significantly positively correlated with body dissatisfaction and drive for thinness. Although fat talk was a significant independent predictor of body dissatisfaction and drive for thinness, stress moderated these relationships such that they were stronger at lower stress levels. Although contrary to predictions, these results are logical when means are considered. Results suggest that fat talk positively predicts body dissatisfaction and drive for thinness in students with relatively lower stress levels, but does not for students under high stress because mean levels of these constructs are all already high.