An Empirical Evaluation of the Diagnostic Criteria for Premenstrual Dysphoric Disorder: Problems with Sex Specificity and Validity

Premenstrual dysphoric disorder is a psychiatric disorder that reportedly affects between 3 to 8% of women. Although not an official diagnosis in the current Diagnostic and Statistical Manual of Mental Disorders, premenstrual dysphoric disorder has received increasing attention in the clinical literature, and considerable debate exists regarding the validity of this proposed condition. This study examined the prevalence of premenstrual dysphoric disorder in a sample of women and men and assessed the construct validity of the disorder. Twenty percent of women met the criteria for provisional diagnosis of premenstrual dysphoric disorder using Diagnostic and Statistical Manual criteria. In addition, 4% of men met these criteria when given sex-neutral assessment forms. Self-reported psychological distress and impaired interpersonal functioning did not predict women's likelihood of meeting the criteria for premenstrual dysphoric disorder. Results cast doubt on the sex-specificity of the diagnostic criteria of premenstrual dysphoric disorder and the construct validity of the disorder. Limitations of this study are discussed.     

'You get used to it': Working with trauma in a burns unit of a South African children's hospital

I report here on the first stages of my work as a consultant clinical psychologist in a burns unit of a South African children's hospital. I show how the enormous trauma of the work leads inevitably to the adoption of defences on the part of staff against the pain and load of their work. I use the writing of Menzies Lyth and other authors as a basis for understanding staff defences in their daily work. I then describe the process whereby it has become possible to institute a form of group support for the staff. It has been important to think not only of the maladaptive but also of the helpful function of defences, and to recognize the staff's need for continuity and acceptance on the part of the consultant.     

Transfer of newly acquired stimulus valence between identities in dissociative identity disorder (DID)

Patients with Dissociative Identity Disorder (DID) frequently report episodes of interidentity amnesia, that is amnesia for events experienced by other identities. The goal of the present experiment was to test the implicit transfer of trauma-related information between identities in DID. We hypothesized that whereas declarative information may transfer from one identity to another, the emotional connotation of the memory may be dissociated, especially in the case of negative, trauma-related emotional valence. An evaluative conditioning procedure was combined with an affective priming procedure, both performed by different identities. In the evaluative conditioning procedure, previously neutral stimuli come to refer to a negative or positive connotation. The affective priming procedure was used to test the transfer of this acquired valence to an identity reporting interidentity amnesia. Results indicated activation of stimulus valence in the affective priming task, that is transfer of emotional material between identities.     

A Preventive Coping Perspective of Individual Response to Terrorism in Canada

A plethora of studies on terrorism underscores the challenges of managing the psychological and behavioural impacts of terrorist events. This literature also emphasizes the idea that the global pending threat of terrorism, prior to the occurrence of any event, may also give rise to significant reactions among members of the public. Drawing from the literature on proactive coping, the current study presents the results of factor analyses performed on sections of a national survey that assessed appraisals of as well as actual responses to the threat of terrorism in Canada (N = 1,502). Findings revealed that items assessing individual response to terrorism were represented by three factors in this context: Individual Preparedness, Information Seeking, and Avoidance Behaviour. Further analyses demonstrated a tendency for actual preparedness behaviours to be associated with decreased psychological stress, and actual avoidance behaviours to be associated with heightened psychological stress. Furthermore, the divergent patterns of relationships of terrorism response appraisals and corresponding actual responses with psychological stress emphasized the need to distinguish different stages in the process of preventive coping with terrorism. Theoretical and practical implications of findings for individual preparedness in Canada are discussed.

Anger-associated panic attacks in Cambodian refugees with PTSD; a multiple baseline examination of clinical data

Despite the increasing recognition of the importance of anger as a key aspect of post-traumatic stress disorder (PTSD), the presence of anger-induced panic attacks has been understudied in traumatized groups. The present investigation determines the prevalence of anger-associated panic attacks among Cambodian refugees suffering from PTSD. Specific characteristics of these episodes that were examined included frequency, symptoms, and cognitions (in particular, fear of death from bodily dysfunction). In a survey of 100 Khmer patients suffering PTSD, 58% reported anger-associated panic attacks in the last month. These attacks occurred at a mean rate of 6.2 attacks a month and were characterized by extreme arousal and in 81% of these cases, fears of death due to bodily dysfunction during the anger-induced panic. Mechanisms for this high rate of fear of death during anger arousal are discussed with a focus on culture-specific catastrophic cognitions.     

La psychothérapie assistée par la MDMA dans la prise en charge du syndrome de stress post-traumatique

Posttraumatic stress disorder (PTSD) is estimated to remain chronic and severe for 25–50% of patients despite psychotherapeutic treatment. Part of the reasons is that patients with PTSD can have difficulties in establishing a good therapeutical alliance with the therapist. Moreover, they often fail to re-think the content of the trauma without being overwhelmed by negative emotions and tend to rely on avoidance strategies and/or to abandon the therapy. MDMA (“ecstasy”) is a drug classified as an entactogen (en “within”, tactus “touch”, and gen “produce”), an amphetamine with psychedelic properties that possesses psychopharmacological properties to overcome these issues. Indeed, MDMA triggers the release of oxytocin, which favors the establishment of interpersonal relationship based on kindness and trust. Moreover, MDMA diminishes the activity of the amygdale, allowing patients to work on challenging memories with less fear and anxiety. Finally, MDMA may also provide access to meaningful spiritual experiences, release of tensions and a sense of healing on a non-verbal level that are not completely understood. But are viewed as important by patients. Today, there is no evidence that the use of MDMA in a clinical setting has bad neurologic, psychological or cognitive consequences. Results of phase II trials in the United States and Europe confirm that MDMA favors psychotherapy's outcome without severe adverse effects. Phase III trials are underway. The Multidisciplinary Association for Psychedelic Studies (MAPS) has published online a method proposal and trains therapists in MDMA-assisted psychotherapy.ConclusionFood and Drug Administration (FDA) and European Medicines Agency (EMA) could approve this therapeutic tool in the coming years.     

Parenting and Family Stress Treatment Outcomes in Attention Deficit Hyperactivity Disorder (ADHD): An Empirical Analysis in the MTA Study

Parenting and family stress treatment outcomes in the MTA study were examined. Male and female (579), 7–9-year-old children with combined type Attention Deficit Hyperactivity Disorder (ADHD), were recruited at six sites around the United States and Canada, and randomly assigned to one of four groups: intensive, multi-faceted behavior therapy program alone (Beh); carefully titrated and monitored medication management strategy alone (MedMgt); a well-integrated combination of the two (Comb); or a community comparison group (CC). Treatment occurred over 14 months, and assessments were taken at baseline, 3, 9, and 14 months. Parenting behavior and family stress were assessed using parent-report and child-report inventories. Results showed that Beh alone, MedMgt alone, and Comb produced significantly greater decreases in a parent-rated measure of negative parenting, Negative/Ineffective Discipline, than did standard community treatment. The three MTA treatments did not differ significantly from each other on this domain. No differences were noted among the four groups on positive parenting or on family stress variables. Results are discussed in terms of the theoretical and empirically documented importance of negative parenting in the symptoms, comorbidities and long-term outcomes of ADHD.     

An abbreviated PTSD checklist for use as a screening instrument in primary care

Although the importance of recognizing posttraumatic stress disorder (PTSD) in primary care has been well-established, routine screening for PTSD remains unfeasible for many primary care clinics because of the length of the available screening instruments. Thus, the purpose of this work was to develop and validate a brief screening tool for PTSD. In Study 1, four short forms of the PTSD Checklist-civilian version were identified that captured a majority of the variance in the measure. In Study 2, the performance of these short forms was evaluated in a separate sample of primary care patients. We found that both two-item and six-item versions have adequate psychometric properties for screening purposes and suggest that the selection of one version over the other depends on the specific needs of each primary care clinic.     

Symmetry, ordering and arranging compulsive behaviour

Compulsive ordering and arranging, and a preoccupation with symmetry are features of obsessive-compulsive disorder (OCD) that have not been examined experimentally. Three connected studies were conducted to examine this phenomenon: a self-report measure of this behaviour was developed and validated, participants were asked to engage in tasks designed to assess preferences for order, and to assess the interference of disorderly surroundings in the completion of a stressful activity. The self-report measure has sound psychometric properties and validity. Participants with a strong preference for order were made more anxious by having to complete a difficult task in a disorganized environment. Participants without this preference did not show this effect. The results are discussed in terms of the phenomenology of compulsive ordering and arranging, and its relationships with both OCD and normal human behaviour. It is suggested that compulsive ordering and a drive for symmetry are extreme manifestations of the common preference for order and symmetry.     

Stress priming in picture naming: an SOA study

This study investigates whether or not the representation of lexical stress information can be primed during speech production. In four experiments, we attempted to prime the stress position of bisyllabic target nouns (picture names) having initial and final stress with auditory prime words having either the same or different stress as the target (e.g., WORtel-MOtor vs. koSTUUM-MOtor; capital letters indicate stressed syllables in prime-target pairs). Furthermore, half of the prime words were semantically related, the other half unrelated. Overall, picture names were not produced faster when the prime word had the same stress as the target than when the prime had different stress, i.e., there was no stress-priming effect in any experiment. This result would not be expected if stress were stored in the lexicon. However, targets with initial stress were responded to faster than final-stress targets. The reason for this effect was neither the quality of the pictures nor frequency of occurrence or voice-key characteristics. We hypothesize here that this stress effect is a genuine encoding effect, i.e., words with stress on the second syllable take longer to be encoded because their stress pattern is irregular with respect to the lexical distribution of bisyllabic stress patterns, even though it can be regular with respect to metrical stress rules in Dutch. The results of the experiments are discussed in the framework of models of phonological encoding.