Major depressive disorder (MDD) (also known as clinical depression, major depression, unipolar depression, unipolar disorder or recurrent depression in the case of repeated episodes) is a mental disorder characterized by episodes of all-encompassing low mood accompanied by low self-esteem and loss of interest or pleasure in normally enjoyable activities. This cluster of symptoms (syndrome) was named, described and classified as one of the mood disorders in the 1980 edition of the American Psychiatric Association's diagnostic manual. The term "depression" is ambiguous. It is often used to denote this syndrome but may refer to other mood disorders or to lower mood states lacking clinical significance. Major depressive disorder is a disabling condition that adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, around 3.4% of people with major depression commit suicide, and up to 60% of people who commit suicide had depression or another mood disorder.
The diagnosis of major depressive disorder is based on the patient's self-reported experiences, behavior reported by relatives or friends, and a mental status examination. There is no laboratory test for major depression, although physicians generally request tests for physical conditions that may cause similar symptoms. The most common time of onset is between the ages of 20 and 30 years, with a later peak between 30 and 40 years.
Typically, patients are treated with antidepressant medication and, in many cases, also receive psychotherapy or counseling, although the effectiveness of medication for mild or moderate cases is questionable. Hospitalization may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. A minority are treated with electroconvulsive therapy (ECT). The course of the disorder varies widely, from one episode lasting weeks to a lifelong disorder with recurrent major depressive episodes. Depressed individuals have shorter life expectancies than those without depression, in part because of greater susceptibility to medical illnesses and suicide. It is unclear whether or not medications affect the risk of suicide. Current and former patients may be stigmatized.
The understanding of the nature and causes of depression has evolved over the centuries, though this understanding is incomplete and has left many aspects of depression as the subject of discussion and research. Proposed causes include psychological, psycho-social, hereditary, evolutionary and biological factors. Long-term use and misuse of certain drugs/substances are known to cause and worsen depressive symptoms. Psychological treatments are based on theories of personality, interpersonal communication, and learning. Most biological theories focus on the monoamine chemicals serotonin, norepinephrine and dopamine, which are naturally present in the brain and assist communication between nerve cells.
People's conceptualizations of depression vary widely, both within and among cultures. "Because of the lack of scientific certainty," one commentator has observed, "the debate over depression turns on questions of language. What we call it—'disease,' 'disorder,' 'state of mind'—affects how we view, diagnose, and treat it." There are cultural differences in the extent to which serious depression is considered an illness requiring personal professional treatment, or is an indicator of something else, such as the need to address social or moral problems, the result of biological imbalances, or a reflection of individual differences in the understanding of distress that may reinforce feelings of powerlessness, and emotional struggle.
The diagnosis is less common in some countries, such as China. It has been argued that the Chinese traditionally deny or somatizeemotional depression (although since the early 1980s, the Chinese denial of depression may have modified drastically). Alternatively, it may be that Western cultures reframe and elevate some expressions of human distress to disorder status. Australian professor Gordon Parker and others have argued that the Western concept of depression "medicalizes" sadness or misery. Similarly, Hungarian-American psychiatrist Thomas Szasz and others argue that depression is a metaphorical illness that is inappropriately regarded as an actual disease. There has also been concern that the DSM, as well as the field of descriptive psychiatry that employs it, tends to reify abstract phenomena such as depression, which may in fact be social constructs. American archetypal psychologist James Hillman writes that depression can be healthy for the soul, insofar as "it brings refuge, limitation, focus, gravity, weight, and humble powerlessness." Hillman argues that therapeutic attempts to eliminate depression echo the Christian theme of resurrection, but have the unfortunate effect of demonizing a soulful state of being.
Historical figures were often reluctant to discuss or seek treatment for depression due to social stigma about the condition, or due to ignorance of diagnosis or treatments. Nevertheless, analysis or interpretation of letters, journals, artwork, writings or statements of family and friends of some historical personalities has led to the presumption that they may have had some form of depression. People who may have had depression include English author Mary Shelley, American-British writer Henry James, and American president Abraham Lincoln. Some well-known contemporary people with possible depression include Canadian songwriter Leonard Cohen and American playwright and novelist Tennessee Williams. Some pioneering psychologists, such as Americans William James and John B. Watson, dealt with their own depression
There has been a continuing discussion of whether neurological disorders and mood disorders may be linked to creativity, a discussion that goes back to Aristotelian times. British literature gives many examples of reflections on depression. English philosopher John Stuart Mill experienced a several-months-long period of what he called "a dull state of nerves", when one is "unsusceptible to enjoyment or pleasurable excitement; one of those moods when what is pleasure at other times, becomes insipid or indifferent". He quoted English poet Samuel Taylor Coleridge's "Dejection" as a perfect description of his case: "A grief without a pang, void, dark and drear, / A drowsy, stifled, unimpassioned grief, / Which finds no natural outlet or relief / In word, or sigh, or tear." English writer Samuel Johnson used the term "the black dog" in the 1780s to describe his own depression, was subsequently popularized by depression sufferer former British Prime Minister Sir Winston Churchill.
Social stigma of major depression is widespread, and contact with mental health services reduces this only slightly. Public opinions on treatment differ markedly to those of health professionals; alternative treatments are held to be more helpful than pharmacological ones, which are viewed poorly. In the UK, the Royal College of Psychiatrists and the Royal College of General Practitioners conducted a joint Five-year Defeat Depression campaign to educate and reduce stigma from 1992 to 1996; a MORI study conducted afterwards showed a small positive change in public attitudes to depression and treatment.
Friday, 25 January 2013
Thursday, 24 January 2013
Research on Dissociative Identity Disorder
Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD),[1] is a mental disorder characterized by at least two distinct and relatively enduring identities or dissociated personality states that alternately control a person's behavior, and is accompanied by memory impairment for important information not explained by ordinary forgetfulness. These symptoms are not accounted for by substance abuse, seizures, other medical conditions or imaginative play in children.[2] Diagnosis is often difficult as there is considerable comorbidity with other mental disorders. Malingering should be considered if there is possible financial or forensic gain, as well as factitious disorder if help-seeking behavior is prominent.[2]
DID is one of the most controversial psychiatric disorders with no clear consensus regarding its diagnosis or treatment.[3] Research on treatment effectiveness still focuses mainly on clinical approaches and case studies. Dissociative symptoms range from common lapses in attention, becoming distracted by something else, and daydreaming, to pathological dissociative disorders.[4] No systematic, empirically-supported definition of "dissociation" exists.[5][6]
Although neither epidemiological surveys nor longitudinal studies have been done, it is thought DID rarely resolves spontaneously. Symptoms are said to vary over time.[4] In general, the prognosis is poor, especially for those with co-morbid disorders. There is little systematic data on the prevalence of DID.[7] The International Society for the Study of Trauma and Dissociation states that the prevalence is between 1 and 3% in the general population, and between 1 and 5% in inpatient groups in Europe and North America.[8][dead link] DID is diagnosed more frequently in North America than in the rest of the world, and is three to nine times more common in females than in males.[5][7][9] The prevalence of DID increased greatly in the latter half of the 20th century, along with the number of identities (often referred to as "alters") claimed by patients (increasing from an average of two or three to approximately 16).[5]
Dissociative disorders including DID have been attributed to disruptions in memory caused by trauma and other forms of stress, but research on this hypothesis has been characterized by poor methodology. So far, scientific studies, usually focusing on memory, have been few and the results have been inconclusive.[10] An alternative hypothesis for the etiology of DID is as a product of techniques employed by some therapists, especially those using hypnosis, and disagreement between the two positions is characterized by intense debate.[3][11] DID became a popular diagnosis in the 1970s, 80s and 90s but it is unclear if the actual incidence of the disorder increased, if it was more recognized by clinicians, or if sociocultural factors caused an increase in iatrogenic presentations. The unusual number of diagnoses after 1980, clustered around a small number of clinicians and the suggestibility characteristic of those with DID, support the hypothesis that DID is therapist-induced.[12] The unusual clustering of diagnoses has also been explained as due to a lack of awareness and training among clinicians to recognize cases of DID.[13]
DID is among the most controversial of the dissociative disorders, and among the most controversial disorders found in the DSM-IV-TR.[5] The primary dispute is between those who believe DID is caused by traumatic stresses forcing the mind to split into multiple identities, each with a separate set of memories,[10][14] and the belief that the symptoms of DID are produced artificially by certain psychotherapeutic practices or patients playing a role they believe appropriate for a patient suffering from DID.[11][13][33][35][36][48] The debate between the two positions is characterized by intense disagreement.[3][11][12][13][33][36]
Psychiatrists August Piper and Harold Merskey have challenged the trauma hypothesis, arguing that correlation does not imply causation - the fact that people with DID report childhood trauma does not mean trauma causes DID — and point to the rareness of the diagnosis before 1980 as well as a failure to find DID as an outcome in longitudinal studies of traumatized children. They assert that DID cannot be accurately diagnosed because of vague and unclear diagnostic criteria in the DSM and undefined concepts such as "personality state" and "identities", and question the evidence for childhood abuse beyond self-reports, the lack of definition of what would indicate a threshold of abuse sufficient to induce DID and the extremely small number of cases of children diagnosed with DID despite an average age of appearance of the first alter of three years.[12] Psychiatrist Colin Ross disagrees with Piper and Merskey's conclusion that DID cannot be accurately diagnosed, pointing to internal consistency between different structured dissociative disorder interviews (including the Dissociative Experiences Scale, Dissociative Disorders Interview Schedule and Structured Clinical Interview for Dissociative Disorders)[14] that are in the internal validity range of widely accepted mental illnesses such as schizophrenia and major depressive disorder. In his opinion, Piper and Merskey are setting the standard of proof higher than they are for other diagnoses. He also asserts that Piper and Merskey have cherry-picked data and not incorporated all relevant scientific literature available, such as independent corroborating evidence of trauma.[49]
Richard J. McNally has explained in his 2005 book how he sees child abuse being politicized.[34]#
The cause of DID is controversial, with debate occurring between supporters of different hypotheses: that DID is a reaction to trauma; that DID is produced iatrogenically by inappropriate psychotherapeutic techniques that cause a patient to enact the role of a patient with DID; and newer hypotheses involving memory processing that allows for the possibility that trauma-causing dissociation can occur after childhood in DID, as it does in PTSD. It has been suggested that all the trauma-based and stress-related disorders be placed in one category that would include both DID and PTSD.[25] Disturbed and altered sleep has also been suggested as having a role in dissociative disorders in general and specifically in DID.[26]
Research is needed to determine the prevalence of the disorder in those who have never been in therapy, and the prevalence rates across cultures. These central issues relating to the epidemiology of DID remain largely unaddressed despite several decades of research.[27] The debates over the causes of DID also extend to disagreements over how the disorder is assessed and treated.[5]
Delinking early trauma from the etiology of dissociation has been explicitly rejected by those supporting the early trauma model. However, a 2012 review article supports the hypothesis that current or recent trauma may affect an individual's assessment of the more distant past, changing the experience of the past and resulting in dissociative states.[31] Giesbrecht et al. have suggested there is no actual empirical evidence linking early trauma to dissociation, and instead suggest that problems with neuropsychological functioning, such as increased distractibility in response to certain emotions and contexts, account for dissociative features.[32] A middle position hypothesizes that trauma, in some situations, alters neuronal mechanisms related to memory. Evidence is increasing that dissociative disorders are related both to a trauma history and to "specific neural mechanisms".[19] It has also been suggested that there may be a genuine but more modest link between trauma and DID, with early trauma causing increased fantasy-proneness, which may in turn render individuals more vulnerable to socio-cognitive influences surrounding the development of DID.[6]
Proponents of the SCM note that the bizarre dissociative symptoms are rarely present before intensive therapy by specialists in the treatment of DID who, through the process of eliciting, conversing with and identifying alters, shape, or possibly create the diagnosis. While proponents note that DID is accompanied by genuine suffering and the distressing symptoms, and can be diagnosed reliably using the DSM criteria, they are skeptical of the traumatic etiology suggested by proponents.[34] The characteristics of people diagnosed with DID (hypnotizability, suggestibility, frequent fantasization and mental absorption) contributed to these concerns and those regarding the validity of recovered memories of trauma.[35] Skeptics note that a small subset of doctors are responsible for diagnosing the majority of individuals with DID.[11][12] Psychologist Nicholas Spanos Others have suggested that in addition to iatrogenesis, DID may be the result of role-playing rather than alternative identities, though others disagree, pointing to a lack of incentive to manufacture or maintain separate identities and point to the claimed histories of abuse.[36] Other arguments for the iatrogenic position, include the lack of children diagnosed with DID, the sudden spike in incidence after 1980 (although DID was not a diagnosis until DSM-IV, published in 1994), the absence of evidence of increased rates of child abuse, the appearance of the disorder almost exclusively in individuals undergoing psychotherapy, particularly involving hypnosis, the presences of bizarre alternate identities (such as those claiming to be animals or mythological creatures) and an increase in the number of alternate identities over time[6][12] (as well as an initial increase in their number as psychotherapy begins in DID-oriented therapy.[6]) These various cultural and therapeutic causes occur within a context of pre-existing psychopathology, notably borderline personality disorder, which is commonly co-morbid with DID.[6] In addition, presentations can vary across cultures, such as Indian patients who only switch alters after a period of sleep — which is commonly how DID is presented by the media within that country.[6]
The iatrogenic position is strongly linked to the false memory syndrome, coined by the False Memory Syndrome Foundation in reaction to memories recovered by a range of controversial therapies whose effectiveness is unproven. Such a memory could be used to make a false allegation of child sexual abuse. There is little consensus between the iatrogenic and traumagenic positions regarding DID.[3] Proponents of the iatrogenic position suggest a small number of clinicians diagnosing a disproportionate number of cases would provide evidence for their position[27] though it has also been claimed that higher rates of diagnosis in specific countries like the United States, may be due to greater awareness of DID. Lower rates in other countries may be due to an artificially low recognition of the diagnosis.[13]
The initial theoretical description of DID was that dissociative symptoms were a means of coping with extreme stress (particularly childhood sexual and physical abuse), but this belief has been challenged by the data of multiple research studies.[6] Proponents of the traumagenic hypothesis claim the high correlation of child sexual and physical abuse reported by adults with DID corroborates the link between trauma and DID.[5][6] However, the DID-maltreatment link has been questioned for several reasons. The studies reporting the links often rely on self-report rather than independent corroborations, and these results may be worsened by selection and referral bias.[5][6] Most studies of trauma and dissociation are cross-sectional rather than longitudinal, which means researchers can not attribute causation, and studies avoiding recall bias have failed to corroborate such a causal link.[5][6] In addition, studies rarely control for the many disorders comorbid with DID, or family maladjustment (which is itself highly correlated with DID).[5][6] The popular association of DID with childhood abuse is relatively recent, occurring only after the publication of Sybil in 1973. Most previous examples of "multiples" such as Chris Costner Sizemore, whose life was depicted in the book and film The Three Faces of Eve, disclosed no history of child abuse.[34]
DID is one of the most controversial psychiatric disorders with no clear consensus regarding its diagnosis or treatment.[3] Research on treatment effectiveness still focuses mainly on clinical approaches and case studies. Dissociative symptoms range from common lapses in attention, becoming distracted by something else, and daydreaming, to pathological dissociative disorders.[4] No systematic, empirically-supported definition of "dissociation" exists.[5][6]
Although neither epidemiological surveys nor longitudinal studies have been done, it is thought DID rarely resolves spontaneously. Symptoms are said to vary over time.[4] In general, the prognosis is poor, especially for those with co-morbid disorders. There is little systematic data on the prevalence of DID.[7] The International Society for the Study of Trauma and Dissociation states that the prevalence is between 1 and 3% in the general population, and between 1 and 5% in inpatient groups in Europe and North America.[8][dead link] DID is diagnosed more frequently in North America than in the rest of the world, and is three to nine times more common in females than in males.[5][7][9] The prevalence of DID increased greatly in the latter half of the 20th century, along with the number of identities (often referred to as "alters") claimed by patients (increasing from an average of two or three to approximately 16).[5]
Dissociative disorders including DID have been attributed to disruptions in memory caused by trauma and other forms of stress, but research on this hypothesis has been characterized by poor methodology. So far, scientific studies, usually focusing on memory, have been few and the results have been inconclusive.[10] An alternative hypothesis for the etiology of DID is as a product of techniques employed by some therapists, especially those using hypnosis, and disagreement between the two positions is characterized by intense debate.[3][11] DID became a popular diagnosis in the 1970s, 80s and 90s but it is unclear if the actual incidence of the disorder increased, if it was more recognized by clinicians, or if sociocultural factors caused an increase in iatrogenic presentations. The unusual number of diagnoses after 1980, clustered around a small number of clinicians and the suggestibility characteristic of those with DID, support the hypothesis that DID is therapist-induced.[12] The unusual clustering of diagnoses has also been explained as due to a lack of awareness and training among clinicians to recognize cases of DID.[13]
DID is among the most controversial of the dissociative disorders, and among the most controversial disorders found in the DSM-IV-TR.[5] The primary dispute is between those who believe DID is caused by traumatic stresses forcing the mind to split into multiple identities, each with a separate set of memories,[10][14] and the belief that the symptoms of DID are produced artificially by certain psychotherapeutic practices or patients playing a role they believe appropriate for a patient suffering from DID.[11][13][33][35][36][48] The debate between the two positions is characterized by intense disagreement.[3][11][12][13][33][36]
Psychiatrists August Piper and Harold Merskey have challenged the trauma hypothesis, arguing that correlation does not imply causation - the fact that people with DID report childhood trauma does not mean trauma causes DID — and point to the rareness of the diagnosis before 1980 as well as a failure to find DID as an outcome in longitudinal studies of traumatized children. They assert that DID cannot be accurately diagnosed because of vague and unclear diagnostic criteria in the DSM and undefined concepts such as "personality state" and "identities", and question the evidence for childhood abuse beyond self-reports, the lack of definition of what would indicate a threshold of abuse sufficient to induce DID and the extremely small number of cases of children diagnosed with DID despite an average age of appearance of the first alter of three years.[12] Psychiatrist Colin Ross disagrees with Piper and Merskey's conclusion that DID cannot be accurately diagnosed, pointing to internal consistency between different structured dissociative disorder interviews (including the Dissociative Experiences Scale, Dissociative Disorders Interview Schedule and Structured Clinical Interview for Dissociative Disorders)[14] that are in the internal validity range of widely accepted mental illnesses such as schizophrenia and major depressive disorder. In his opinion, Piper and Merskey are setting the standard of proof higher than they are for other diagnoses. He also asserts that Piper and Merskey have cherry-picked data and not incorporated all relevant scientific literature available, such as independent corroborating evidence of trauma.[49]
Richard J. McNally has explained in his 2005 book how he sees child abuse being politicized.[34]#
The cause of DID is controversial, with debate occurring between supporters of different hypotheses: that DID is a reaction to trauma; that DID is produced iatrogenically by inappropriate psychotherapeutic techniques that cause a patient to enact the role of a patient with DID; and newer hypotheses involving memory processing that allows for the possibility that trauma-causing dissociation can occur after childhood in DID, as it does in PTSD. It has been suggested that all the trauma-based and stress-related disorders be placed in one category that would include both DID and PTSD.[25] Disturbed and altered sleep has also been suggested as having a role in dissociative disorders in general and specifically in DID.[26]
Research is needed to determine the prevalence of the disorder in those who have never been in therapy, and the prevalence rates across cultures. These central issues relating to the epidemiology of DID remain largely unaddressed despite several decades of research.[27] The debates over the causes of DID also extend to disagreements over how the disorder is assessed and treated.[5]
Developmental trauma
Main article: Trauma model of mental disorders
People diagnosed with DID often report that they have experienced severe physical and sexual abuse, especially during early to mid-childhood,[28] (although the accuracy of these reports has been disputed[2]) and others report an early loss, serious medical illness or other traumatic event.[18] They also report more historical psychological trauma than those diagnosed with any other mental illness.[not in citation given][29] Severe sexual, physical, or psychological trauma in childhood has been proposed as an explanation for its development; awareness, memories and emotions of harmful actions or events caused by the trauma are removed from consciousness, and alternate personalities or subpersonalities form with differing memories, emotions and behavior.[30] DID is attributed to extremes of stress or disorders of attachment. What may be expressed as post-traumatic stress disorder in adults may become DID when occurring in children, possibly due to their greater use of imagination as a form of coping.[16][19] Possibly due to developmental changes and a more coherent sense of self past the age of six, the experience of extreme trauma may result in different, though also complex, dissociative symptoms and identity disturbances.[19] A specific relationship between childhood abuse, disorganized attachment, and lack of social support are thought to be a necessary component of DID.[16] Other suggested explanations include insufficient childhood nurturing combined with the innate ability of children in general to dissociate memories or experiences from consciousness.[18]Delinking early trauma from the etiology of dissociation has been explicitly rejected by those supporting the early trauma model. However, a 2012 review article supports the hypothesis that current or recent trauma may affect an individual's assessment of the more distant past, changing the experience of the past and resulting in dissociative states.[31] Giesbrecht et al. have suggested there is no actual empirical evidence linking early trauma to dissociation, and instead suggest that problems with neuropsychological functioning, such as increased distractibility in response to certain emotions and contexts, account for dissociative features.[32] A middle position hypothesizes that trauma, in some situations, alters neuronal mechanisms related to memory. Evidence is increasing that dissociative disorders are related both to a trauma history and to "specific neural mechanisms".[19] It has also been suggested that there may be a genuine but more modest link between trauma and DID, with early trauma causing increased fantasy-proneness, which may in turn render individuals more vulnerable to socio-cognitive influences surrounding the development of DID.[6]
Therapist induced
The prevailing post-traumatic model of dissociation and dissociative disorders is contested.[6] It has been hypothesized that symptoms of DID may be created by therapists using techniques to "recover" memories (such as the use of hypnosis to "access" alter identities, facilitate age regression or retrieve memories) on suggestible individuals.[11][12][13][27][33] Referred to as the "sociocognitive model" (SCM), it proposes that DID is due to a person consciously or unconsciously behaving in certain ways promoted by cultural stereotypes,[27] with unwitting therapists providing cues through improper therapeutic techniques. This behavior is enhanced by media portrayals of DID.[6]Proponents of the SCM note that the bizarre dissociative symptoms are rarely present before intensive therapy by specialists in the treatment of DID who, through the process of eliciting, conversing with and identifying alters, shape, or possibly create the diagnosis. While proponents note that DID is accompanied by genuine suffering and the distressing symptoms, and can be diagnosed reliably using the DSM criteria, they are skeptical of the traumatic etiology suggested by proponents.[34] The characteristics of people diagnosed with DID (hypnotizability, suggestibility, frequent fantasization and mental absorption) contributed to these concerns and those regarding the validity of recovered memories of trauma.[35] Skeptics note that a small subset of doctors are responsible for diagnosing the majority of individuals with DID.[11][12] Psychologist Nicholas Spanos Others have suggested that in addition to iatrogenesis, DID may be the result of role-playing rather than alternative identities, though others disagree, pointing to a lack of incentive to manufacture or maintain separate identities and point to the claimed histories of abuse.[36] Other arguments for the iatrogenic position, include the lack of children diagnosed with DID, the sudden spike in incidence after 1980 (although DID was not a diagnosis until DSM-IV, published in 1994), the absence of evidence of increased rates of child abuse, the appearance of the disorder almost exclusively in individuals undergoing psychotherapy, particularly involving hypnosis, the presences of bizarre alternate identities (such as those claiming to be animals or mythological creatures) and an increase in the number of alternate identities over time[6][12] (as well as an initial increase in their number as psychotherapy begins in DID-oriented therapy.[6]) These various cultural and therapeutic causes occur within a context of pre-existing psychopathology, notably borderline personality disorder, which is commonly co-morbid with DID.[6] In addition, presentations can vary across cultures, such as Indian patients who only switch alters after a period of sleep — which is commonly how DID is presented by the media within that country.[6]
The iatrogenic position is strongly linked to the false memory syndrome, coined by the False Memory Syndrome Foundation in reaction to memories recovered by a range of controversial therapies whose effectiveness is unproven. Such a memory could be used to make a false allegation of child sexual abuse. There is little consensus between the iatrogenic and traumagenic positions regarding DID.[3] Proponents of the iatrogenic position suggest a small number of clinicians diagnosing a disproportionate number of cases would provide evidence for their position[27] though it has also been claimed that higher rates of diagnosis in specific countries like the United States, may be due to greater awareness of DID. Lower rates in other countries may be due to an artificially low recognition of the diagnosis.[13]
In children
DID is rarely diagnosed in children, despite the average age of appearance of the first alter being three years.[12] This fact is cited as a reason to doubt the validity of DID,[12][27] and proponents of both etiologies believe that the discovery of DID in a child that had never undergone treatment would critically undermine the SCM. Conversely, if children are found to only develop DID after undergoing treatment it would challenge the traumagenic model.[27] As of 2011[update] approximately 250 cases of DID in children have been identified, though the data does not offer unequivocal support for either theory. While children have been diagnosed with DID before therapy, several were presented to clinicians by parents who were themselves diagnosed with DID; others were influenced by the appearance of DID in popular culture or due to a diagnosis of psychosis due to hearing voices — a symptom also found in DID. No studies have looked for children with DID in the general population, and the single study that attempted to look for children with DID not already in therapy did so by examining siblings of those already in therapy for DID. An analysis of diagnosis of children reported in scientific publications, 44 case studies of single patients were found to be evenly distributed (i.e. each case study was reported by a different author) but in articles regarding groups of patients, four researchers were responsible for the majority of the reports.[27]The initial theoretical description of DID was that dissociative symptoms were a means of coping with extreme stress (particularly childhood sexual and physical abuse), but this belief has been challenged by the data of multiple research studies.[6] Proponents of the traumagenic hypothesis claim the high correlation of child sexual and physical abuse reported by adults with DID corroborates the link between trauma and DID.[5][6] However, the DID-maltreatment link has been questioned for several reasons. The studies reporting the links often rely on self-report rather than independent corroborations, and these results may be worsened by selection and referral bias.[5][6] Most studies of trauma and dissociation are cross-sectional rather than longitudinal, which means researchers can not attribute causation, and studies avoiding recall bias have failed to corroborate such a causal link.[5][6] In addition, studies rarely control for the many disorders comorbid with DID, or family maladjustment (which is itself highly correlated with DID).[5][6] The popular association of DID with childhood abuse is relatively recent, occurring only after the publication of Sybil in 1973. Most previous examples of "multiples" such as Chris Costner Sizemore, whose life was depicted in the book and film The Three Faces of Eve, disclosed no history of child abuse.[34]
Research into Anorexia Nervosa
Anorexia nervosa is an eating disorder characterized by immoderate food restriction and irrational fear of gaining weight, as well as a distorted body self-perception. It typically involves excessive weight loss and is usually found more in females than in males. Because of the fear of gaining weight, people with this disorder restrict the amount of food they consume. This restriction of food intake causes metabolic and hormonal disorders. Outside of medical literature, the terms anorexia nervosa and anorexia are often used interchangeably; however, anorexia is simply a medical term for lack of appetite, and people with anorexia nervosa do not in fact, lose their appetites. Patients suffering from anorexia nervosa may experience dizziness, headaches, drowsiness and a lack of energy.
Anorexia nervosa is characterized by low body weight, inappropriate eating habits, obsession with having a thin figure, and the fear of gaining weight. It is often coupled with a distorted self image which may be maintained by various cognitive biases that alter how the affected individual evaluates and thinks about her or his body, food and eating. Those suffering from anorexia often view themselves as "too fat" even if they are already underweight. They may practice repetitive weighing, measuring, and mirror gazing, alongside other obsessive actions to make sure they are still thin, a common practice known as "body checking".
Anorexia nervosa most often has its onset in adolescence and is more prevalent among adolescent females than adolescent males. However, more recent studies show the onset age has decreased from an average of 13 to 17 years of age to 9 to 12. While it can affect men and women of any age, race, and socioeconomic and cultural background, anorexia nervosa occurs in ten times more females than males.
People with anorexia nervosa continue to feel hunger, but they deny themselves all but very small quantities of food. The average caloric intake of a person with anorexia nervosa is 600–800 calories per day, but extreme cases of complete self-starvation are known. It is a serious mental illness with a high incidence of comorbidity and similarly high mortality rates to serious psychiatric disorders. People suffering from anorexia have extremely high levels of ghrelin (the hunger hormone that signals a physiological desire for food) in their blood. The high levels of ghrelin suggests that their bodies are trying to desperately switch the hunger aspect on; however, that hunger call is being suppressed, ignored, or overridden. Nevertheless, one small single-blind study found that intravenous administration of ghrelin to anorexia nervosa patients increased food intake by 12–36% over the trial period.
The term anorexia nervosa was established in 1873 by Sir William Gull, one of Queen Victoria's personal physicians. The term is of Greek origin: an- (ἀν-, prefix denoting negation) and orexis (ὄρεξις, "appetite"), thus meaning a lack of desire to eat. However, while the term "anorexia nervosa" literally means "neurotic loss of appetite", the literal meaning of the term is somewhat misleading. Many anorexics do enjoy eating and have certainly not lost their appetites as the term "loss of appetite" is normally understood; it is better to regard anorexia nervosa as a self-punitive addiction to fasting, rather than a literal loss of appetite.
Media are among the principal social agents in many societies around the world. Television, magazines, newspapers, radio, cinema, advertising, the Internet, and other so-called "new media" or "new technologies" are the principal factors behind body dissatisfaction, concerns about weight, and disordered eating behaviour. Mass media interventions frequently offer a distorted vision of the world, and it may be difficult for children and adolescents to distinguish whether what they see is real or not, so that they are more vulnerable to the messages transmitted. Field, Cheung, et al.'s survey of 548 preadolescent and adolescent girls found that 69% acknowledged that images in magazines had influenced their conception of the ideal body, while 47% reported that they wanted to lose weight after seeing such images. There was also the survey by Utter et al. who studied 4,746 adolescent boys and girls demonstrating the tendency of magazine articles and advertisements to activate weight concerns and weight management behaviour. He discovered that girls who frequently read fashion and glamour magazines and girls who frequently read articles about diets and issues related to weight loss were seven times more likely to practice a range of unhealthy weight control behaviours and six times more likely to engage in extremely unhealthy weight control behaviours (e.g., taking diet pills, vomiting, using laxatives, and using diuretics) from magazines, websites that stress the message of thinness as the ideal have surfaced the internet and has managed to embed itself as an increasing source of influence. The possibility that pro-anorexia websites may reinforce restrictive eating and exercise behaviours is an area of concern. Pro-anorexia websites contain images and writing that support the pursuit of an ideal thin body image. Research has shown that these websites stress thinness as the ideal choice for women and in some websites ideal images of muscularity and thinness for men It has also been shown that women who had viewed these websites at least once had a decrease in self-esteem and reports also show an increased likelihood of future engagement in many negative behaviours related to food, exercise, and weight. Evidence of the value of thinness in majority U.S culture is found in Hollywood's elite and the media promotion of waif models in fashion and celebrity circles (e.g. Nicole Richie, Mary Kate Olsen, Kate Moss, and Lady Gaga).
Not only does starvation result in physical complications, but mental complications as well. It has been shown that eating disorders such as anorexia nervosa are reinforced by reward and attention. P. Sodersten and colleagues suggest that effective treatment of this disorder depends on re-establishing reinforcement for normal eating behaviours instead of unhealthy weight loss.
Anorexia nervosa is classified as an Axis I disorder in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV), published by the American Psychiatric Association. The DSM-IV should not be used by laypersons to diagnose themselves.
Webliography:
http://en.wikipedia.org/wiki/Anorexia_nervosa
Anorexia nervosa is characterized by low body weight, inappropriate eating habits, obsession with having a thin figure, and the fear of gaining weight. It is often coupled with a distorted self image which may be maintained by various cognitive biases that alter how the affected individual evaluates and thinks about her or his body, food and eating. Those suffering from anorexia often view themselves as "too fat" even if they are already underweight. They may practice repetitive weighing, measuring, and mirror gazing, alongside other obsessive actions to make sure they are still thin, a common practice known as "body checking".
Anorexia nervosa most often has its onset in adolescence and is more prevalent among adolescent females than adolescent males. However, more recent studies show the onset age has decreased from an average of 13 to 17 years of age to 9 to 12. While it can affect men and women of any age, race, and socioeconomic and cultural background, anorexia nervosa occurs in ten times more females than males.
People with anorexia nervosa continue to feel hunger, but they deny themselves all but very small quantities of food. The average caloric intake of a person with anorexia nervosa is 600–800 calories per day, but extreme cases of complete self-starvation are known. It is a serious mental illness with a high incidence of comorbidity and similarly high mortality rates to serious psychiatric disorders. People suffering from anorexia have extremely high levels of ghrelin (the hunger hormone that signals a physiological desire for food) in their blood. The high levels of ghrelin suggests that their bodies are trying to desperately switch the hunger aspect on; however, that hunger call is being suppressed, ignored, or overridden. Nevertheless, one small single-blind study found that intravenous administration of ghrelin to anorexia nervosa patients increased food intake by 12–36% over the trial period.
The term anorexia nervosa was established in 1873 by Sir William Gull, one of Queen Victoria's personal physicians. The term is of Greek origin: an- (ἀν-, prefix denoting negation) and orexis (ὄρεξις, "appetite"), thus meaning a lack of desire to eat. However, while the term "anorexia nervosa" literally means "neurotic loss of appetite", the literal meaning of the term is somewhat misleading. Many anorexics do enjoy eating and have certainly not lost their appetites as the term "loss of appetite" is normally understood; it is better to regard anorexia nervosa as a self-punitive addiction to fasting, rather than a literal loss of appetite.
Media are among the principal social agents in many societies around the world. Television, magazines, newspapers, radio, cinema, advertising, the Internet, and other so-called "new media" or "new technologies" are the principal factors behind body dissatisfaction, concerns about weight, and disordered eating behaviour. Mass media interventions frequently offer a distorted vision of the world, and it may be difficult for children and adolescents to distinguish whether what they see is real or not, so that they are more vulnerable to the messages transmitted. Field, Cheung, et al.'s survey of 548 preadolescent and adolescent girls found that 69% acknowledged that images in magazines had influenced their conception of the ideal body, while 47% reported that they wanted to lose weight after seeing such images. There was also the survey by Utter et al. who studied 4,746 adolescent boys and girls demonstrating the tendency of magazine articles and advertisements to activate weight concerns and weight management behaviour. He discovered that girls who frequently read fashion and glamour magazines and girls who frequently read articles about diets and issues related to weight loss were seven times more likely to practice a range of unhealthy weight control behaviours and six times more likely to engage in extremely unhealthy weight control behaviours (e.g., taking diet pills, vomiting, using laxatives, and using diuretics) from magazines, websites that stress the message of thinness as the ideal have surfaced the internet and has managed to embed itself as an increasing source of influence. The possibility that pro-anorexia websites may reinforce restrictive eating and exercise behaviours is an area of concern. Pro-anorexia websites contain images and writing that support the pursuit of an ideal thin body image. Research has shown that these websites stress thinness as the ideal choice for women and in some websites ideal images of muscularity and thinness for men It has also been shown that women who had viewed these websites at least once had a decrease in self-esteem and reports also show an increased likelihood of future engagement in many negative behaviours related to food, exercise, and weight. Evidence of the value of thinness in majority U.S culture is found in Hollywood's elite and the media promotion of waif models in fashion and celebrity circles (e.g. Nicole Richie, Mary Kate Olsen, Kate Moss, and Lady Gaga).
Not only does starvation result in physical complications, but mental complications as well. It has been shown that eating disorders such as anorexia nervosa are reinforced by reward and attention. P. Sodersten and colleagues suggest that effective treatment of this disorder depends on re-establishing reinforcement for normal eating behaviours instead of unhealthy weight loss.
Anorexia nervosa is classified as an Axis I disorder in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV), published by the American Psychiatric Association. The DSM-IV should not be used by laypersons to diagnose themselves.
- DSM-IV-TR: diagnostic criteria for AN includes intense fear of gaining weight, a refusal to maintain body weight above 85% of the expected weight for a given age and height, and three consecutive missed periods and either refusal to admit the seriousness of the weight loss, or undue influence of shape or weight on one's self-image, or a disturbed experience in one's shape or weight. There are two types: the binge-eating/purging type is characterized by overeating or purging, and the restricting type is not.
- Criticism of DSM-IV There has been criticisms over various aspects of the diagnostic criteria utilized for anorexia nervosa in the DSM-IV. Including the requirement of maintaining a body weight below 85% of the expected weight and the requirement of amenorrhea for diagnosis; some women have all the symptoms of AN and continue to menstruate. Those who do not meet these criteria are usually classified as eating disorder not otherwise specified; this may affect treatment options and insurance reimbursments. The validity of the AN subtype classification has also been questioned because of the considerable diagnostic overlap between the binge-eating/purging type and the restricting type and the propensity of the patient to switch between the two.
Webliography:
http://en.wikipedia.org/wiki/Anorexia_nervosa
Friday, 11 January 2013
Further changes
Since my last post, I have now decided to show three different mental disorder in three acts. I decided to do this because it would challenge me to make three different, distinct short pieces to effectively show how a person suffers with mental disorders.
Monday, 7 January 2013
Time Management
By the end of January I want to have successfully shot the acts on Depression and Dissociative Identity Disorder and begun editing.
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