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What is the Bulimia Test-Revised?

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Introduction

The Bulimia Test-Revised (BULIT-R) is a 36 item self-report questionnaire to assess the presence of bulimic symptoms.

Background

The Bulimia Test (BULIT) was devised by Smith and Thelen in 1984. It was a self-reported questionnaire measure of bulimia that was based on the Diagnostic and Statistical Manual of Mental Disorders III (DSM III) criteria for bulimia (Smiht & Thelen, 1984).

It was then revised (Bulimia Test-Revised, BULIT-R) in 1991 to accommodate the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria of bulimia nervosa, using a 28-item, self-report, multiple-choice scale was developed by comparing responses of clinically identified female bulimics with those of female college students (Thelen et al., 1991).

The results of retesting and diagnostic judgements based on interviews showed that the BULIT-R was a reliable and valid predictor of bulimia nervosa in a nonclinical population.

The test has been validated for use in both males and females.

Scoring

The BULIT-R contains 36 multiple choice questions with five possible responses, 28 of which factor into the total score, questions 6,11, 19, 20, 27, 29, 31 and 36 are not scored.

Items 2,5,7,8,10, 12, 13, 14, 15, 16, 17, 21, 23, 26, 28, 30, 32, 35 are reversed scored. Scores range from 29-140 with those greater than 104 being indicative of bulimia nervosa.

References

Smith, M.C. & Thelen, M.H. (1984) Development and Validation of a Test for Bulimia. Journal of Consulting and Clinical Psychology. 52, pp.863-872

Thelen, M.H., Farmer, J., Wonderlich, S. & Smith, M. (1991) A Revision of the Bulimia Test: The BULIT-R. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 3(1), pp.119-124. https://doi.org/10.1037/1040-3590.3.1.119

What is Associationism?

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Introduction

Associationism is the idea that mental processes operate by the association of one mental state with its successor states.

It holds that all mental processes are made up of discrete psychological elements and their combinations, which are believed to be made up of sensations or simple feelings. In philosophy, this idea is viewed as the outcome of empiricism and sensationism. The concept encompasses a psychological theory as well as comprehensive philosophical foundation and scientific methodology.

Brief History

Early History

The idea is first recorded in Plato and Aristotle, especially with regard to the succession of memories. Particularly, the model is traced back to the Aristotelian notion that human memory encompasses all mental phenomena. The model was discussed in detail in the philosopher’s work, Memory and Reminiscence. This view was widely embraced until the emergence of British associationism, which began with Thomas Hobbes.

Associationist School

Members of the Associationist School, including John Locke, David Hume, David Hartley, Joseph Priestley, James Mill, John Stuart Mill, Alexander Bain, and Ivan Pavlov, asserted that the principle applied to all or most mental processes.

John Locke

The phrase association of ideas was first used by John Locke. In Chapter 33 of An Essay Concerning Human Understanding entitled “Of the Association of Ideas″, he describes the ways that ideas can be connected to each other. He writes “Some of our ideas have a natural correspondence and connexion with one another”. Although he believed that some associations were natural and justified, he believed that others were illogical, causing errors in judgment. He also explains that one can associate some ideas together based on their education and culture, saying, “there is another connection of ideas wholly owing to chance or custom”. The term associationism later became more prominent in psychology and the psychologists that subscribed to the idea became known as the associationists. Locke’s view that the mind and body are two aspects of the same unified phenomenon can be traced back to Aristotle’s ideas on the subject.

David Hume

In his book Treatise on Human Nature David Hume outlines three principles for ideas to be connected to each other: resemblance, continuity in time or place, and cause or effect. He argues that the mind uses these principles, rather than reason, to traverse from idea to idea. He writes “When the mind, therefore, passes from the idea or impression of one object to the idea or belief of another, it is not determined by reason, but by certain principles, which associate together the ideas of these objects, and unite them in the imagination.” These connections are formed in the mind by observation and experience. Hume does not believe that any of these associations are “necessary’ in a sense that ideas or object are truly connected, instead he sees them as mental tools used for creating a useful mental representation of the world.

Later Members

Later members of the school developed very specific principles elaborating how associations worked and even a physiological mechanism bearing no resemblance to modern neurophysiology.

Applications

Associationism is often concerned with middle-level to higher-level mental processes such as learning. For instance, the thesis, antithesis, and synthesis are linked in one’s mind through repetition so that they become inextricably associated with one another. Among the earliest experiments that tested the applications of associationism, involve Hermann Ebbinghaus’ work. He was considered the first experimenter to apply the associationist principles systematically, and used himself as subject to study and quantify the relationship between rehearsal and recollection of material.

Some of the ideas of the Associationist School also anticipated the principles of conditioning and its use in behavioural psychology. Both classical conditioning and operant conditioning use positive and negative associations as means of conditioning.

Karatani’s Theory

Kojin Karatani, a Japanese philosopher, refers to Hannah Arendt’s remark about council communism (Soviet or Räte) that it does not emerge as a result of tradition or theory of revolutions, but “entirely spontaneously, each time as if it had never existed before”, and that such a social construct is the same as what has been called socialism, communism, anarchism, etc., but because these names are cloying and misleading, he calls it X or associationism in his book.

What is Gray’s Biopsychological Theory of Personality?

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Introduction

The biopsychological theory of personality is a model of the general biological processes relevant for human psychology, behaviour, and personality. The model, proposed by research psychologist Jeffrey Alan Gray in 1970, is well-supported by subsequent research and has general acceptance among professionals.

Gray hypothesized the existence of two brain-based systems for controlling a person’s interactions with their environment: the behavioural inhibition system (BIS) and the behavioural activation system (BAS). BIS is related to sensitivity to punishment and avoidance motivation. BAS is associated with sensitivity to reward and approach motivation. Psychological scales have been designed to measure these hypothesized systems and study individual differences in personality. Neuroticism, a widely studied personality dimension related to emotional functioning, is positively correlated with BIS scales and negatively correlated with BAS scales.

Brief History

The biopsychological theory of personality is similar to another one of Gray’s theories, reinforcement sensitivity theory. The Biopsychological Theory of Personality was created after Gray disagreed with Hans Eysenck’s arousal theory that dealt with biological personality traits. Eysenck looked at the ascending reticular activating system (ARAS) for answering questions about personality. The ARAS is part of the brain structure and has been proposed to deal with cortical arousal, hence the term arousal theory. Eysenck compared levels of arousal to a scale of introversion versus extraversion. The comparison of these two scales was then used to describe individual personalities and their corresponding behavioural patterns. Gray disagreed with Eysenck’s theory because Gray believed that things such as personality traits could not be explained by just classical conditioning. Instead, Gray developed his theory which is based more heavily on physiological responses than Eysenck’s theory.

Gray had a lot of support for his theories and experimented with animals to test his hypotheses. Using animal subjects allows researchers to test whether different areas of the brain are responsible for different learning mechanisms. Specifically, Gray’s theory concentrated on understanding how reward or punishment related to anxiety and impulsivity measures. His research and further studies have found that reward and punishment are under the control of separate systems and as a result people can have different sensitivities to such rewarding or punishing stimuli.

Behavioural Inhibition System

The behavioural inhibition system (BIS), as proposed by Gray, is a neuropsychological system that predicts an individual’s response to anxiety-relevant cues in a given environment. This system is activated in times of punishment, boring things, or negative events. By responding to cues such as negative stimuli or events that involve punishment or frustration, this system ultimately results in avoidance of such negative and unpleasant events. According to Gray’s Theory, the BIS is related to sensitivity to punishment as well as avoidance motivation. It has also been proposed that the BIS is the causal basis of anxiety. High activity of the BIS means a heightened sensitivity to non-reward, punishment, and novel experience. This higher level of sensitivity to these cues results in a natural avoidance of such environments in order to prevent negative experiences such as fear, anxiety, frustration, and sadness. People who are highly sensitive to punishment perceive punishments as more aversive and are more likely to be distracted by punishments.

The physiological mechanism behind the BIS is believed to be the septohippocampal system and its monoaminergic afferents from the brainstem. Using a voxel-based morphometry analysis, the volume of the regions mentioned was assessed to view individual differences. Findings may suggest a correlation between the volume and anxiety-related personality traits. Results were found in the orbitofrontal cortex, the precuneus, the amygdala, and the prefrontal cortex.

Behavioural Activation System

The behavioural activation system (BAS), in contrast to the BIS, is based on a model of appetitive motivation – in this case, an individual’s disposition to pursue and achieve goals. The BAS is aroused when it receives cues corresponding to rewards and controls actions that are not related to punishment, rather actions regulating approachment type behaviours. This system has an association with hope. According to Gray’s theory, the BAS is sensitive to conditioned appealing stimuli, and is associated with impulsivity. It is also thought to be related to sensitivity to reward as well as approach motivation. The BAS is sensitive to non-punishment and reward. Individuals with a highly active BAS show higher levels of positive emotions such as elation, happiness, and hope in response to environmental cues consistent with non-punishment and reward, along with goal-achievement. In terms of personality, these individuals are also more likely to engage in goal-directed efforts and experience these positive emotions when exposed to impending reward. The physiological mechanism for BAS is not known as well as BIS, but is believed to be related to catecholaminergic and dopaminergic pathways in the brain. Dopamine is a neurotransmitter commonly linked with positive emotions, which could explain the susceptibility to elation and happiness upon achieving goals which has been observed. People with a highly active BAS have been shown to learn better by reward than by punishment, inverse to BIS as mentioned above. BAS is considered to include trait impulsivity that is also related to psychopathological disorders such as ADHD, substance use disorder, and alcohol use disorder. The higher the BAS score, or the higher the impulsive, the more it is likely to be related to psycho-pathological or dis-inhibitory disorders. Certain aspects of the dopaminergic reward system activate when reward cues and reinforcers are presented, including biological rewards such as food and sex. These brain areas, which were highlighted during multiple fMRI studies, are the same areas associated with BAS.

Compare and Contrast

Together, the two systems work in an inverse relationship. In other words, when a specific situation occurs, an organism can approach the situation with one of the two systems. The systems will not be stimulated at the same time and which system is dominant depends on the situation in terms of punishment versus reward. This phenomenon of the differentiation between the two systems is thought to occur because of the distinct areas in the brain that becomes activated in response to different stimuli. This difference was noted years ago through electrical stimulation of the brain.

The behavioural activation system and behavioural inhibition system differ in their physiological pathways in the brain. The inhibition system has been shown to be linked to the septo-hippocampal system which appears to have a close correlation to a serotonergic pathway, with similarities in their innervations and stress responses. On the other hand, the activation, or reward system, is thought to be associated more with a mesolimbic dopaminergic system as opposed to the serotonergic system.

The two systems proposed by Gray differ in their motivations and physiological responses. Gray also proposed that individuals can vary widely in their responsiveness of the behavioural inhibition system and the behavioural activation system. It has been found that someone who is sensitive to their BIS will be more receptive to the negative cues as compared to someone who is sensitive to their BAS and therefore responds more to cues in the environment that relate to that system, specifically positive or rewarding cues. Researchers besides Gray have shown interest in this theory and have created questionnaires that measure BIS and BAS sensitivity. Carver and White have been the primary researchers responsible for the questionnaire. Carver and White created a scale that has been shown to validly measure levels of individual scores of BIS and BAS. This measure focuses on the differences in incentive motivations and aversive motivations. As previously mentioned these motivations correlate to impulsivity and anxiety respectively.

Applications

Since the development of the BAS and BIS, tests have been created to see how individuals rate in each area. The questionnaire is called the Behavioural Inhibition System and Behavioural Activation System Questionnaire.

People can be tested based on their activation of either systems by using an EEG. These tests will conclude whether a person has a more active BIS or BAS. The two systems are independent of each other.

These tests can determine different things about a person’s personality. They can determine if a person has more positive or negative moods. Using psychological test scales designed to correlate with the attributes of these hypothesized systems, neuroticism has been found to be positively correlated with the BIS scale, and negatively correlated with the BAS scale.

According to Richard Depue’s BAS dysregulation theory of bipolar disorders, now doctors and other professionals can determine if a person with bipolar disorder is on the brink of a manic or depressive episode based on how they rate on a scale of BAS and BIS sensitivity. Essentially, this dysregulation theory proposes that people with BAS dysregulation have an extraordinarily sensitive behavioural activation system and their BAS is hyper-responsive to behavioural approach system cues. If a person with bipolar disorder self-reports high sensitivity to BAS, it means that a manic episode could occur faster. Also, if a person with bipolar disorder reports high sensitivity to BIS it could indicate a depressive phase. A better understanding of BAS dysregulation theory can inform psychosocial intervention (e.g. cognitive behavioural therapy, psychoeducation, interpersonal and social rhythm therapy, etc.).

The BAS/BIS Questionnaire can also be used in the cases of criminal profiling. Previous research as reported by researchers MacAndrew and Steele in 1991 compared two groups on opposite spectrum levels of fear and the response of a variety of questions. The two groups in the study varied on levels of BIS, either high or low, and were selected by the researchers. One group was composed of women who had experienced anxiety attacks and together made up the high BIS group. The low BIS group was composed of convicted prostitutes who had been found to take part in illegal behaviour. Main findings showed that the responses to the questionnaires were distinctly different between the high BIS group and the low BIS group, with the convicted women scoring lower. Results from this study demonstrate that questionnaires can be used as a valid measurement to show differences in the behavioural inhibition systems of different types of people. Gray also introduced his SPSRQ questionnaire to measure sensitivity to reward (SR) and sensitivity to punishment (SP) in anxiety (2012). It is a specifically designed questionnaire linking to Gray’s theory referencing the SR to the BAS and the SP to the BIS.

Future Research or Implications

As mentioned previously, psychological disorders have been analysed in terms of the behavioural inhibition and activation systems. Understanding the differences between the systems may relate to an understanding of different types of disorders that involve anxiety and impulsivity. To date, there are many types of anxiety disorders that deal with avoidance theories and future research could show that the behavioural activation system plays a large role in such disorders and may have future implications for treatment of patients.

What is Conduct Disorder?

Published on by Andrew Marshall3 Comments

Introduction

Conduct disorder (CD) is a mental disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behaviour that includes theft, lies, physical violence that may lead to destruction and wanton breaking of rules, in which the basic rights of others or major age-appropriate norms are violated.

These behaviours are often referred to as “antisocial behaviours.” It is often seen as the precursor to antisocial personality disorder, which is per definition not diagnosed until the individual is 18 years old. Conduct disorder may result from parental rejection and neglect and can be treated with family therapy, as well as behavioural modifications and pharmacotherapy. Conduct disorder is estimated to affect 51.1 million people globally as of 2013.

Signs and Symptoms

One of the symptoms of conduct disorder is a lower level of fear. Research performed on the impact of toddlers exposed to fear and distress shows that negative emotionality (fear) predicts toddlers’ empathy-related response to distress. The findings support that if a caregiver is able to respond to infant cues, the toddler has a better ability to respond to fear and distress. If a child does not learn how to handle fear or distress the child will be more likely to lash out at other children. If the caregiver is able to provide therapeutic intervention teaching children at risk better empathy skills, the child will have a lower incident level of conduct disorder.

Increased instances of violent and antisocial behaviour are also associated with the condition; examples may range from pushing, hitting and biting when the child is young, progressing towards beating and inflicted cruelty as the child becomes older.

Conduct disorder can present with limited prosocial emotions, lack of remorse or guilt, lack of empathy, lack of concern for performance, and shallow or deficient affect. Symptoms vary by individual, but the four main groups of symptoms are described below.

Aggression to People and Animals

  • Often bullies, threatens or intimidates others.
  • Often initiates physical fights.
  • Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
  • Has been physically cruel to people.
  • Has been physically cruel to animals.
  • Has stolen while confronting a victim (e.g. mugging, purse snatching, extortion, armed robbery).
  • Has forced someone into sexual activity (rape or molestation).
  • Feels no remorse or empathy towards the harm, fear, or pain they may have inflicted on others.

Destruction of Property

  • Has deliberately engaged in fire setting with the intention of causing serious damage.
  • Has deliberately destroyed others’ property (other than by fire setting).

Deceitfulness or Theft

  • Has broken into someone else’s house, building, or car.
  • Often lies to obtain goods or favours or to avoid obligations (i.e. “cons” others).
  • Has stolen items of nontrivial value without confronting a victim (e.g. shoplifting, but without breaking and entering; forgery).

Serious Violations of Rules

  • Often stays out at night despite parental prohibitions, beginning before age 13 years.
  • Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period).
  • Is often truant from school, beginning before age 13 years.

The lack of empathy these individuals have and the aggression that accompanies this carelessness for the consequences is dangerous – not only for the individual but for those around them.

Developmental Course

Currently, two possible developmental courses are thought to lead to conduct disorder. The first is known as the “childhood-onset type” and occurs when conduct disorder symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviours. Specifically, children in this group have greater levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction and higher likelihood of aggression and violence.

There is debate among professionals regarding the validity and appropriateness of diagnosing young children with conduct disorder. The characteristics of the diagnosis are commonly seen in young children who are referred to mental health professionals. A premature diagnosis made in young children, and thus labelling and stigmatising an individual, may be inappropriate. It is also argued that some children may not in fact have conduct disorder, but are engaging in developmentally appropriate disruptive behaviour.

The second developmental course is known as the “adolescent-onset type” and occurs when conduct disorder symptoms are present after the age of 10 years. Individuals with adolescent-onset conduct disorder exhibit less impairment than those with the childhood-onset type and are not characterised by similar psychopathology. At times, these individuals will remit in their deviant patterns before adulthood. Research has shown that there is a greater number of children with adolescent-onset conduct disorder than those with childhood-onset, suggesting that adolescent-onset conduct disorder is an exaggeration of developmental behaviours that are typically seen in adolescence, such as rebellion against authority figures and rejection of conventional values. However, this argument is not established and empirical research suggests that these subgroups are not as valid as once thought.

In addition to these two courses that are recognised by the DSM, there appears to be a relationship among oppositional defiant disorder, conduct disorder, and antisocial personality disorder. Specifically, research has demonstrated continuity in the disorders such that conduct disorder is often diagnosed in children who have been previously diagnosed with oppositional defiant disorder, and most adults with antisocial personality disorder were previously diagnosed with conduct disorder. For example, some research has shown that 90% of children diagnosed with conduct disorder had a previous diagnosis of oppositional defiant disorder. Moreover, both disorders share relevant risk factors and disruptive behaviours, suggesting that oppositional defiant disorder (ODD) is a developmental precursor and milder variant of conduct disorder. However, this is not to say that this trajectory occurs in all individuals. In fact, only about 25% of children with oppositional defiant disorder will receive a later diagnosis of conduct disorder. Correspondingly, there is an established link between conduct disorder and the diagnosis of antisocial personality disorder as an adult. In fact, the current diagnostic criteria for antisocial personality disorder require a conduct disorder diagnosis before the age of 15. However, again, only 25-40% of youths with conduct disorder will develop an antisocial personality disorder. Nonetheless, many of the individuals who do not meet full criteria for antisocial personality disorder still exhibit a pattern of social and personal impairments or antisocial behaviours. These developmental trajectories suggest the existence of antisocial pathways in certain individuals, which have important implications for both research and treatment.

Associated Conditions

Children with conduct disorder have a high risk of developing other adjustment problems. Specifically, risk factors associated with conduct disorder and the effects of conduct disorder symptomatology on a child’s psychosocial context have been linked to overlapping with other psychological disorders. In this way, there seems to be reciprocal effects of comorbidity with certain disorders, leading to increased overall risk for these youth.

Attention Deficit Hyperactivity Disorder

ADHD is the condition most commonly associated with conduct disorders, with approximately 25-30% of boys and 50-55% of girls with conduct disorder having a comorbid ADHD diagnosis. While it is unlikely that ADHD alone is a risk factor for developing conduct disorder, children who exhibit hyperactivity and impulsivity along with aggression is associated with the early onset of conduct problems. Moreover, children with comorbid conduct disorder and ADHD show more severe aggression.

Substance Use Disorders

Conduct disorder is also highly associated with both substance use and abuse. Children with conduct disorder have an earlier onset of substance use, as compared to their peers, and also tend to use multiple substances. However, substance use disorders themselves can directly or indirectly cause conduct disorder like traits in about half of adolescents who have a substance use disorder. As mentioned above, it seems that there is a transactional relationship between substance use and conduct problems, such that aggressive behaviours increase substance use, which leads to increased aggressive behaviour.

Substance use in conduct disorder can lead to antisocial behaviour in adulthood.

Schizophrenia

Conduct disorder is a precursor to schizophrenia in a minority of cases, with about 40% of men and 31% of women with schizophrenia meeting criteria for childhood conduct disorder.

Cause

While the cause of conduct disorder is complicated by an intricate interplay of biological and environmental factors, identifying underlying mechanisms is crucial for obtaining accurate assessment and implementing effective treatment. These mechanisms serve as the fundamental building blocks on which evidence-based treatments are developed. Despite the complexities, several domains have been implicated in the development of conduct disorder including cognitive variables, neurological factors, intraindividual factors, familial and peer influences, and wider contextual factors. These factors may also vary based on the age of onset, with different variables related to early (e.g. neurodevelopmental basis) and adolescent (e.g. social/peer relationships) onset.

Risks

The development of conduct disorder is not immutable or predetermined. A number of interactive risk and protective factors exist that can influence and change outcomes, and in most cases conduct disorder develops due to an interaction and gradual accumulation of risk factors. In addition to the risk factors identified under cause, several other variables place youth at increased risk for developing the disorder, including child physical abuse, in-utero alcohol exposure, and maternal smoking during pregnancy. Protective factors have also been identified, and most notably include high IQ, being female, positive social orientations, good coping skills, and supportive family and community relationships.

However, a correlation between a particular risk factor and a later developmental outcome (such as conduct disorder) cannot be taken as definitive evidence for a causal link. Co-variation between two variables can arise, for instance, if they represent age-specific expressions of similar underlying genetic factors. For example, the tendency to smoke during pregnancy (SDP) is subject to substantial genetic influence, as is conduct disorder. Thus, the genes that dispose the mother to SDP may also dispose the child to CD following mitotic transmission. Indeed, Rice et al. (2009) found that in mother-fetus pairs that were not genetically related (by virtue of in-vitro fertilisation), no link between SDP and later conduct problems arose. Thus, the distinction between causality and correlation is an important consideration.

Learning Disabilities

While language impairments are most common, approximately 20-25% of youth with conduct disorder have some type of learning disability. Although the relationship between the disorders is complex, it seems as if learning disabilities result from a combination of ADHD, a history of academic difficulty and failure, and long-standing socialisation difficulties with family and peers. However, confounding variables, such as language deficits, SES disadvantage, or neurodevelopmental delay also need to be considered in this relationship, as they could help explain some of the association between conduct disorder and learning problems.

Cognitive Factors

In terms of cognitive function, intelligence and cognitive deficits are common amongst youths with conduct disorder, particularly those with early-onset and have intelligence quotients (IQ) one standard deviation below the mean and severe deficits in verbal reasoning and executive function. Executive function difficulties may manifest in terms of one’s ability to shift between tasks, plan as well as organise, and also inhibit a prepotent response. These findings hold true even after taking into account other variables such as socioeconomic status (SES), and education. However, IQ and executive function deficits are only one piece of the puzzle, and the magnitude of their influence is increased during transactional processes with environmental factors.

Brain Differences

Beyond difficulties in executive function, neurological research on youth with conduct disorder also demonstrate differences in brain anatomy and function that reflect the behaviours and mental anomalies associated in conduct disorder. Compared to normal controls, youths with early and adolescent onset of conduct disorder displayed reduced responses in brain regions associated with social behaviour (i.e. amygdala, ventromedial prefrontal cortex, insula, and orbitofrontal cortex). In addition, youths with conduct disorder also demonstrated less responsiveness in the orbitofrontal regions of the brain during a stimulus-reinforcement and reward task. This provides a neural explanation for why youths with conduct disorder may be more likely to repeat poor decision making patterns. Lastly, youths with conduct disorder display a reduction in grey matter volume in the amygdala, which may account for the fear conditioning deficits. This reduction has been linked to difficulty processing social emotional stimuli, regardless of the age of onset. Aside from the differences in neuroanatomy and activation patterns between youth with conduct disorder and controls, neurochemical profiles also vary between groups. Individuals with conduct disorder are characterised as having reduced serotonin and cortisol levels (e.g. reduced hypothalamic-pituitary-adrenal (HPA) axis), as well as reduced autonomic nervous system (ANS) functioning. These reductions are associated with the inability to regulate mood and impulsive behaviours, weakened signals of anxiety and fear, and decreased self-esteem. Taken together, these findings may account for some of the variance in the psychological and behavioural patterns of youth with conduct disorder.

Intra-Individual Factors

Aside from findings related to neurological and neurochemical profiles of youth with conduct disorder, intraindividual factors such as genetics may also be relevant. Having a sibling or parent with conduct disorder increases the likelihood of having the disorder, with a heritability rate of .53. There also tends to be a stronger genetic link for individuals with childhood-onset compared to adolescent onset. In addition, youth with conduct disorder also exhibit polymorphism in the monoamine oxidase A gene, low resting heart rates, and increased testosterone.

Family and Peer Influences

Elements of the family and social environment may also play a role in the development and maintenance of conduct disorder. For instance, antisocial behaviour suggestive of conduct disorder is associated with single parent status, parental divorce, large family size, and the young age of mothers. However, these factors are difficult to tease apart from other demographic variables that are known to be linked with conduct disorder, including poverty and low socioeconomic status. Family functioning and parent-child interactions also play a substantial role in childhood aggression and conduct disorder, with low levels of parental involvement, inadequate supervision, and unpredictable discipline practices reinforcing youth’s defiant behaviours. Peer influences have also been related to the development of antisocial behaviour in youth, particularly peer rejection in childhood and association with deviant peers. Peer rejection is not only a marker of a number of externalizing disorders, but also a contributing factor for the continuity of the disorders over time. Hinshaw and Lee (2003) also explain that association with deviant peers has been thought to influence the development of conduct disorder in two ways: 1) a “selection” process whereby youth with aggressive characteristics choose deviant friends, and 2) a “facilitation” process whereby deviant peer networks bolster patterns of antisocial behaviour. In a separate study by Bonin and colleagues, parenting programmes were shown to positively affect child behaviour and reduce costs to the public sector.

Wider Contextual Factors

In addition to the individual and social factors associated with conduct disorder, research has highlighted the importance of environment and context in youth with antisocial behaviour. However, it is important to note that these are not static factors, but rather transactional in nature (e.g. individuals are influenced by and also influence their environment). For instance, neighbourhood safety and exposure to violence have been studied in conjunction with conduct disorder, but it is not simply the case that youth with aggressive tendencies reside in violent neighbourhoods. Transactional models propose that youth may resort to violence more often as a result of exposure to community violence, but their predisposition towards violence also contributes to neighbourhood climate.

Diagnosis

Conduct disorder is classified in the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM). It is diagnosed based on a prolonged pattern of antisocial behaviour such as serious violation of laws and social norms and rules in people younger than the age of 18. Similar criteria are used in those over the age of 18 for the diagnosis of antisocial personality disorder. No proposed revisions for the main criteria of conduct disorder exist in the DSM-5; there is a recommendation by the work group to add an additional specifier for callous and unemotional traits. According to DSM-5 criteria for conduct disorder, there are four categories that could be present in the child’s behaviour: aggression to people and animals, destruction of property, deceitfulness or theft, and serious violation of rules.

Almost all adolescents who have a substance use disorder have conduct disorder-like traits, but after successful treatment of the substance use disorder, about half of these adolescents no longer display conduct disorder-like symptoms. Therefore, it is important to exclude a substance-induced cause and instead address the substance use disorder prior to making a psychiatric diagnosis of conduct disorder.

Treatment

First-line treatment is psychotherapy based on behaviour modification and problem-solving skills. This treatment seeks to integrate individual, school, and family settings. Parent-management training can also be helpful. No medications have been FDA approved for Conduct Disorder, but Risperidone (a second-generation antipsychotic) has the most evidence to support its use for aggression in children who have not responded to behavioural and psychosocial interventions. Selective Serotonin Reuptake Inhibitors (SSRIs) are also sometimes used to treat irritability in these patients.

Prognosis

About 25-40% of youths diagnosed with conduct disorder qualify for a diagnosis of antisocial personality disorder when they reach adulthood. For those that do not develop ASPD, most still exhibit social dysfunction in adult life.

Epidemiology

Conduct disorder is estimated to affect 51.1 million people globally as of 2013. The percentage of children affected by conduct disorder is estimated to range from 1-10%. However, among incarcerated youth or youth in juvenile detention facilities, rates of conduct disorder are between 23% and 87%.

Sex Differences

The majority of research on conduct disorder suggests that there are a significantly greater number of males than females with the diagnosis, with some reports demonstrating a threefold to fourfold difference in prevalence. However, this difference may be somewhat biased by the diagnostic criteria which focus on more overt behaviours, such as aggression and fighting, which are more often exhibited by males. Females are more likely to be characterised by covert behaviours, such as stealing or running away. Moreover, conduct disorder in females is linked to several negative outcomes, such as antisocial personality disorder and early pregnancy, suggesting that sex differences in disruptive behaviours need to be more fully understood.

Females are more responsive to peer pressure including feelings of guilt than males.

Racial Differences

Research on racial or cultural differences on the prevalence or presentation of conduct disorder is limited. However, according to studies on American youth, it appears that African-American youth are more often diagnosed with conduct disorder, while Asian-American youth are about one-third as likely to develop conduct disorder when compared to White American youth. It has been widely theorised for decades that this disparity is due to unconscious bias in those who give the diagnosis.

What is Oppositional Defiant Disorder?

Published on by Andrew Marshall6 Comments

Introduction

Oppositional defiant disorder (ODD) is listed in the DSM-5 under Disruptive, impulse-control, and conduct disorders and defined as “a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness” in children and adolescents.

This behaviour is usually targeted toward peers, parents, teachers, and other authority figures. Unlike children with conduct disorder (CD), children with oppositional defiant disorder are not aggressive towards people or animals, do not destroy property, and do not show a pattern of theft or deceit. It has certain links to Attention Deficit Hyperactivity Disorder (ADHD) and as much as one half of children with ODD will also diagnose as having ADHD as well.

Brief History

Oppositional defiant disorder was first defined in the DSM-III (1980). Since the introduction of ODD as an independent disorder, the field trials to inform the definition of this disorder have included predominantly male subjects. Some clinicians have debated whether the diagnostic criteria presented above would be clinically relevant for use with females. Furthermore, some have questioned whether gender-specific criteria and thresholds should be included. Additionally, some clinicians have questioned the preclusion of ODD when conduct disorder is present. According to Dickstein, the DSM-5 attempts to:

“redefine ODD by emphasizing a ‘persistent pattern of angry and irritable mood along with vindictive behavior,’ rather than DSM-IV’s focus exclusively on negativistic, hostile, and defiant behavior.’ Although DSM-IV implied, but did not mention, irritability, DSM-5 now includes three symptom clusters, one of which is ‘angry/irritable mood’—defined as ‘loses temper, is touchy/easily annoyed by others, and is angry/resentful.’ This suggests that the process of clinically relevant research driving nosology, and vice versa, has ensured that the future will bring greater understanding of ODD”.

Epidemiology

ODD, is a pattern of negativistic, defiant, disobedient and hostile behaviour, and is one of the most prevalent disorders from preschool age to adulthood. ODD is marked by defiant and disobedient behaviour towards authority figures. This can include: frequent temper tantrums, excessive arguing with adults, refusing to follow rules, acting in a way to purposely upset others, getting easily irked, having an angry attitude, and acting vindictive. Children with ODD usually begin showing symptoms around 6 to 8, although the disorder can emerge in younger children, too. Symptoms can last throughout the teen years. The pooled prevalence is approximately 3.6% up to age 18. There has been research to support that ODD is more common in boys than girls with a 2:1 ratio.

ODD has a prevalence of 1% to 11%. The average prevalence is approximately 3.3%. Gender and age play an important role in the rate of the disorder. In fact, ODD gradually develops and becomes apparent in preschool years; often before the age of eight years old. However, it is very unlikely to emerge following early adolescence. There is difference in prevalence between boys and girls. The ratio of this prevalence is 1.4 to 1 with it being more prevalent in boys than in girls, before adolescence. On the other hand, girls’ prevalence tends to increase after puberty. When researchers observed the general prevalence of oppositional defiant disorder throughout cultures, they noticed that it remained constant. However, the sex difference in ODD prevalence is only significant in Western cultures. There are two possible explanations for this difference which are that in non-Western cultures there is a decreased prevalence of ODD in boys or an increased prevalence of ODD in girls. Other factors can influence the prevalence of the disorder. One of these factors is the socioeconomic status. Youths living in families of low socioeconomic status have a higher prevalence. Another factor is based on the criteria used to diagnose an individual. When the disorder was first included in the DSM-III, the prevalence was 25% higher than when the DSM-IV revised the criteria of diagnosis. The DSM-V made more changes to the criteria grouping certain characteristics together in order to demonstrate that ODD display both emotional and behavioural symptomatology. In addition, criteria were added to help guide clinicians in diagnosis because of the difficulty found in identifying whether the behaviours or symptoms are directly related to the disorder or simply a phase in a child’s life. Consequently, future studies may obtain results indicating a decline in prevalence between the DSM-IV and the DSM-V due to these changes.

Signs and Symptoms

DSM-IV-TR) (now replaced by DSM-5) stated that a child must exhibit four out of the eight signs and symptoms to meet the diagnostic threshold for oppositional defiant disorder. These symptoms include:

  1. Often loses temper.
  2. Is often touchy or easily annoyed.
  3. Is often angry and resentful.
  4. Often argues with authority figures or for children and adolescents, with adults.
  5. Often actively defies or refuses to comply with requests from authority figures or with rules.
  6. Often deliberately annoys others.
  7. Often blames others for his or her mistakes or misbehaviour.
  8. Has been spiteful or vindictive at least twice within the past 6 months.

These behaviours are mostly directed towards an authority figure such as a teacher or a parent. Although these behaviours can be typical among siblings, they must be observed with individuals other than siblings for an ODD diagnosis. Children with ODD can be verbally aggressive. However, they do not display physical aggressiveness, a behaviour observed in conduct disorder. Furthermore, they must be perpetuated for longer than six months and must be considered beyond a normal child’s age, gender and culture to fit the diagnosis. For children under 5 years of age, they occur on most days over a period of 6 months. For children over 5 years of age they occur at least once a week for at least 6 months. It is possible to observe these symptoms in only one setting, most commonly home. Thus the severity would be mild. If it is observed in two settings then it would be characterised as moderate and if the symptoms are observed in 3 or more settings then it would be considered severe.

These patterns of behaviour result in impairment at school and/or other social venues.

Aetiology

There is no specific element that has yet been identified as directly causing ODD. Researchers looking precisely at the etiological factors linked with ODD are limited. The literature often examines common risk factors linked with all disruptive behaviours, rather than specifically about ODD. Symptoms of ODD are also often believed to be the same as CD even though the disorders have their own respective set of symptoms. When looking at disruptive behaviours such as ODD, research has shown that the causes of behaviours are multifactorial. However, disruptive behaviours have been identified as being mostly due either to biological or environmental factors.

Genetic Influences

Research indicates that parents pass on a tendency for externalising disorders to their children that may be displayed in multiple ways, such as inattention, hyperactivity, or oppositional and conduct problems. Research has also shown that there is a genetic overlap between ODD and other externalising disorders. Heritability can vary by age, age of onset, and other factors. Adoption and twin studies indicate that 50% or more of the variance causing antisocial behaviour is attributable to heredity for both males and females. ODD also tends to occur in families with a history of ADHD, substance use disorders, or mood disorders, suggesting that a vulnerability to develop ODD may be inherited. A difficult temperament, impulsivity, and a tendency to seek rewards can also increase the risk of developing ODD. New studies into gene variants have also identified possible gene-environment (G x E) interactions, specifically in the development of conduct problems. A variant of the gene that encodes the neurotransmitter metabolising enzyme monoamine oxidase-A (MAOA), which relates to neural systems involved in aggression, plays a key role in regulating behaviour following threatening events. Brain imaging studies show patterns of arousal in areas of the brain that are associated with aggression in response to emotion-provoking stimuli.

Prenatal Factors and Birth Complications

Many pregnancy and birth problems are related to the development of conduct problems. Malnutrition, specifically protein deficiency, lead poisoning or exposure to lead, and mother’s use of alcohol or other substances during pregnancy may increase the risk of developing ODD. In numerous research, substance use prior to birth has also been associated with developing disruptive behaviours such as ODD. Although pregnancy and birth factors are correlated with ODD, strong evidence of direct biological causation is lacking.

Neurobiological Factors

Deficits and injuries to certain areas of the brain can lead to serious behavioural problems in children. Brain imaging studies have suggested that children with ODD may have hypofunction in the part of the brain responsible for reasoning, judgment, and impulse control. Children with ODD are thought to have an overactive behavioural activation system (BAS) and an underactive behavioural inhibition system (BIS) (both discussed here). The BAS stimulates behaviour in response to signals of reward or non-punishment. The BIS produces anxiety and inhibits ongoing behaviour in the presence of novel events, innate fear stimuli, and signals of non-reward or punishment. Neuroimaging studies have also identified structural and functional brain abnormalities in several brain regions in youths with conduct disorders. These brain regions are the amygdala, prefrontal cortex, anterior cingulate, and insula, as well as interconnected regions.

Social-Cognitive Factors

As many as 40% of boys and 25% of girls with persistent conduct problems display significant social-cognitive impairments. Some of these deficits include immature forms of thinking (such as egocentrism), failure to use verbal mediators to regulate his or her behaviour, and cognitive distortions, such as interpreting a neutral event as an intentional hostile act. Children with ODD have difficulty controlling their emotions or behaviours. In fact, students with ODD have limited social knowledge that is based only on individual experiences, which shapes how they process information and solve problems cognitively. This information can be linked with the social information processing model (SIP) that describes how children process information to respond appropriately or inappropriately in social settings. This model explains that children will go through five stages before displaying behaviours: encoding, mental representations, response accessing, evaluation, and enactment. However, children with ODD have cognitive distortions and impaired cognitive processes. This will therefore directly impact their interactions and relationship negatively. It has been shown that social and cognitive impairments result in negative peer relationships, loss of friendship, and an interruption in socially engaging in activities. Children learn through observational learning and social learning. Therefore, observations of models have a direct impact and greatly influence children’s behaviours and decision-making processes. Children often learn through modelling behaviour. Modelling can act as a powerful tool to modify children’s cognition and behaviours.

Environmental Factors

Negative parenting practices and parent-child conflict may lead to antisocial behaviour, but they may also be a reaction to the oppositional and aggressive behaviours of children. Factors such as a family history of mental illnesses and/or substance use disorders as well as a dysfunctional family and inconsistent discipline by a parent or guardian can lead to the development of behaviour disorders. Parenting practices not providing adequate or appropriate adjustment to situations as well as a high ratio of conflicting events within a family are causal factors of risk for developing ODD.

Insecure parent-child attachments can also contribute to ODD. Often little internalisation of parent and societal standards exists in children with conduct problems. These weak bonds with their parents may lead children to associate with delinquency and substance use. Family instability and stress can also contribute to the development of ODD. Although the association between family factors and conduct problems is well established, the nature of this association and the possible causal role of family factors continues to be debated.

In a number of studies, low socioeconomic status has also been associated with disruptive behaviors such as ODD.

Other social factors such as neglect, abuse, parents that are not involved, and lack of supervision can also contribute to ODD.

Externalising problems are reported to be more frequent among minority-status youth, a finding that is likely related to economic hardship, limited employment opportunities, and living in high-risk urban neighbourhoods. Studies have also found that the state of being exposed to violence was also a contribution factor for externalizing behaviours to occur.

Diagnosis

For a child or adolescent to qualify for a diagnosis of ODD, behaviours must cause considerable distress for the family or interfere significantly with academic or social functioning. Interference might take the form of preventing the child or adolescent from learning at school or making friends or placing him or her in harmful situations. These behaviours must also persist for at least six months. Effects of ODD can be greatly amplified by other disorders in comorbidity such as ADHD. Other common comorbid disorders include depression and substance use disorders.

Management

Approaches to the treatment of ODD include parent management training, individual psychotherapy, family therapy, cognitive behavioural therapy, and social skills training. According to the American Academy of Child and Adolescent Psychiatry, treatments for ODD are tailored specifically to the individual child, and different treatment techniques are applied for pre-schoolers and adolescents.

Children with oppositional defiant disorder tend to exhibit problematic behaviour that can be very difficult to control. An occupational therapist can recommend family based education referred to as Parent Management Training (PMT) in order to encourage positive parents and child relationships and reduce the child’s tantrums and other disruptive behaviours. Since ODD is a neurological disorder that has biological correlates, an occupational therapist can also provide problem solving training to encourage positive coping skills when difficult situations arise, as well as offer cognitive behavioural therapy (CBT).

Psychopharmacological Treatment

Psychopharmacological treatment is the use of prescribed medication in managing oppositional defiant disorder. Prescribed medications to control ODD include mood stabilisers, anti-psychotics, and stimulants. In two controlled randomised trials, it was found that between administered lithium and the placebo group, administering lithium decreased aggression in children with conduct disorder in a safe manner. However, a third study found the treatment of lithium over a period of two weeks invalid. Other drugs seen in studies include haloperidol, thioridazine, and methylphenidate which also is effective in treating ADHD, as it is a common comorbidity.

The effectiveness of drug and medication treatment is not well established. Effects that can result in taking these medications include hypotension, extrapyramidal symptoms, tardive dyskinesia, obesity, and increase in weight. Psychopharmacological treatment is found to be most effective when paired with another treatment plan, such as individual intervention or multimodal intervention.

In one case, a 16-year-old boy was given oestrogen at an L.A. juvenile jail due to allegedly having ODD due to somewhat elevated testosterone levels, developing gynecomastia and requiring breast reduction surgery as a result.

Individual Interventions

Individual interventions are focused on child-specific individualised plans. These interventions include anger control/stress inoculation, assertiveness training, and child-focused problem-solving skills training programme, and self-monitoring skills.

Anger control and stress inoculation help prepare the child for possible upsetting situations or events that may cause anger and stress. It includes a process of steps they may go through.

Assertiveness training educates individuals in keeping a balance between passivity and aggression. It is about creating a response that is controlled, and fair.

A child-focused problem-solving skills training programme aims to teach the child new skills and cognitive processes that teach how to deal with negative thoughts, feelings, and actions.

Parent and Family Treatment

According to randomised trials evidence shows that parent management training is most effective. It has strong influences over a longer period of time and in various environments.

Parent-child interaction training is intended to coach the parents while involving the child. This training has two phases. The first phase being child-directed interaction, whereby it is focused on teaching the child non-directive play skills. The second phase is parent-directed interaction, where the parents are coached on aspects including clear instruction, praise for compliance, and time-out for noncompliance. The parent-child interaction training is best suited for elementary-aged children.

Parent and family treatment has a low financial cost, which can yield an increase in beneficial results.

Multimodal Intervention

Multimodal intervention is an effective treatment that looks at different levels including family, peers, school, and neighbourhood. It is an intervention that concentrates on multiple risk factors. The focus is on parent training, classroom social skills, and playground behaviour programmes. The intervention is intensive and addresses barriers to individuals’ improvement such as parental substance use or parental marital conflict.

An impediment to treatment includes the nature of the disorder itself, whereby treatment is often not complied with and is not continued or stuck with for adequate periods of time.

Comorbidity

ODD can be described as a term or disorder with a variety of pathways in regard to comorbidity. High importance must be given to the representation of ODD as a distinct psychiatric disorder independent of conduct disorder.

In the context of oppositional defiant disorder and comorbidity with other disorders, researchers often conclude that ODD co-occurs with an ADHD, anxiety disorders, emotional disorders as well as mood disorders. Those mood disorders can be linked to major depression or bipolar disorder. Indirect consequences of ODD can also be related or associated with a later mental disorder. For instance, conduct disorder is often studied in connection with ODD. Strong comorbidity can be observed within those two disorders, but an even higher connection with ADHD in relation to ODD can be seen. For instance, children or adolescents who have ODD with coexisting ADHD will usually be more aggressive, will have more of the negative behavioural symptoms of ODD and thus, inhibit them from having a successful academic life. This will be reflected in their academic path as students.

Other conditions that can be predicted in children or people with ODD are learning disorders in which the person has significant impairments with academics and language disorders in which problems can be observed related to language production and/or comprehension.

On This Day … 28 June

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People (Births)

  • 1948 – Daniel Wegner, Canadian-American psychologist and academic (d. 2013).

People (Deaths)

  • 2012 – Richard Isay, American psychiatrist and author (b. 1934).

Daniel Wegner

Daniel Merton Wegner (28 June 1948 to 05 July 2013) was an American social psychologist. He was a professor of psychology at Harvard University and a fellow of both the American Association for the Advancement of Science and the American Academy of Arts and Sciences. He was known for applying experimental psychology to the topics of mental control (for example ironic process theory) and conscious will, and for originating the study of transactive memory and action identification. In The Illusion of Conscious Will and other works, he argued that the human sense of free will is an illusion.

After gaining his doctorate in 1974, he spent sixteen years teaching at Trinity University, becoming a full Professor in 1985. From 1990 to 2000, he researched and taught at the University of Virginia, after which he joined the faculty at Harvard University.

Awards

In 2011, Wegner was awarded the William James Fellow Award by the Association for Psychological Science, the Distinguished Scientific Contribution Award by the American Psychological Association, and the Distinguished Scientist Award by the Society of Experimental Social Psychology. In 2012, he was awarded the Donald T. Campbell Award by the Society for Personality and Social Psychology (SPSP). Furthermore, shortly after Wegner’s death in 2013, SPSP announced that its annually awarded Theoretical Innovation Prize would henceforth be known as the Daniel M. Wegner Theoretical Innovation Prize to honour Wegner’s memory and his innovative work.

Richard Isay

Richard A. Isay (13 December 1934 to 28 June 2012) was an American psychiatrist, psychoanalyst, author and gay activist. He was a professor of psychiatry at Weill Cornell Medical College and a faculty member of the Columbia University Center for Psychoanalytic Training and Research. Isay is considered a pioneer who changed the way that psychoanalysts view homosexuality.

Richard Isay was born and raised in Pittsburgh, Pennsylvania. Isay graduated from Haverford College and the University of Rochester School of Medicine and Dentistry. Soon after completing his psychiatry residency at Yale University, he completed his training at the Western New England Psychoanalytic Institute. Throughout his career, Isay maintained a private practice of psychiatry and psychoanalysis and was an influential teacher and supervisor. He was the programme chairman of the American Psychoanalytic Association (APsaA), the American Program Chairman of the International Psychoanalytical Association and chairman of the Committee on Gay, Lesbian and Bisexual Issues of the American Psychiatric Association.

In 1983, as chair of the APsaA’s programme committee, Isay organised a panel called “New Perspectives on Homosexuality”. Isay argued that homosexuality is a normal variant of sexual identity, and that psychoanalysts should stop trying to change the sexual orientation of their patients, which he considered injurious, creating a firestorm of controversy. “Several analysts walked out”, Isay later recalled. Isay soon became the first openly gay member of the association.

Isay wrote widely on the subjects of psychoanalysis and homosexuality, including texts such as Being Homosexual: Gay Men and Their Development. Being Homosexual was one of the first books to argue that homosexuality is an inborn identity, and the first to describe a non-pathological developmental pathway that is specific to gay men. It is widely considered a breakthrough in psychoanalytic theory and an important, historical work.

In an autobiographical chapter of his book, Becoming Gay: The Journey to Self-Acceptance, Isay tells the story of how he spent ten years trying to change his homosexual orientation. During his analysis, he married. After completing his analysis, he realised that he was, in fact, gay. He was closeted in his professional life for several years, during which time he became a prominent member of the American Psychoanalytic Association. He began to write about homosexuality shortly after meeting his life partner and future husband, Gordon Harrell, in 1979.

In Becoming Gay, Isay recounts that with the help of the American Civil Liberties Union, he threatened to sue the APsaA, due to their discriminatory policies. As a result, on 09 May 1991, the APsaA adopted a non-discrimination policy for the training of analytic candidates and changed its position statement on homosexuality. 1991 was also the year that the APsaA agreed to allow gays and lesbians to become training analysts, and to promote gay and lesbian teachers and supervisors.

This fundamental change in position by the APsaA created a ripple effect that was felt throughout the profession. The ApsaA was and is the preeminent psychoanalytic organisation in the world. These changes of position and practice by the APsaA became a stimulus for reform. They were slowly copied by psychoanalytic, psychiatric, psychological and social work organisations internationally. A few years later, these changes were adopted by psychoanalytic groups in the UK.

What is National PTSD Awareness Day?

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Introduction

National PTSD Awareness Day is a day dedicated to creating awareness regarding PTSD (Post Traumatic Stress Disorder).

Background

It is acknowledged annually on the 27th of June. The US Senate officially designated this day in 2010. In 2014 the Senate designated the whole month of June as PTSD Awareness Month.

In the US, 6.8% of adults will experience PTSD in their lifetimes with women twice as likely as men to experience it (10.4% to 5%) frequently as a result of sexual trauma. Veterans are another group highly likely to experience PTSD during their lives, with Vietnam War veterans at 30%, Gulf War veterans at 10%, and Iraq War veterans at 14%.

On this day, organisations that work with employees, consumers, and patients at risk for the condition work to get information about symptoms and treatments for it out to the public in the hopes that when more people know about the disease more people who suffer from it will get treatment. The US Department of Defence is one of the major organisations involved as June is full of days relating to the military.

On This Day … 26 June

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People (Births)

Virginia Satir

Virginia Satir (26 June 1916 to 10 September 1988) was an influential American author and psychotherapist, recognised for her approach to family therapy. Her pioneering work in the field of family reconstruction therapy honoured her with the title. “Mother of Family Therapy” Her most well-known books are Conjoint Family Therapy, 1964, Peoplemaking, 1972, and The New Peoplemaking, 1988.

She is also known for creating the Virginia Satir Change Process Model, a psychological model developed through clinical studies. Change management and organisational gurus of the 1990s and 2000s embrace this model to define how change impacts organisations.

After graduating social work school, Satir began working in private practice. She met with her first family in 1951, and by 1955 was working with Illinois Psychiatric Institute, encouraging other therapists to focus on families instead of individual patients. By the end of the decade she had moved to California, where she cofounded the Mental Research Institute (MRI) in Palo Alto, California. MRI received a grant from NIMH in 1962, allowing them to begin the first formal family therapy training program ever offered; Satir was hired as its Training Director.[8]

Innovation

Satir’s skills and views about the important role the family has and its connection to an individual’s problems and/or healing process, led her into becoming a renowned therapist. One of Satir’s most novel ideas at the time, was that the “presenting issue” or “surface problem” itself was seldom the real problem; rather, how people coped with the issue created the problem.” Satir also offered insights into the particular problems that low self-esteem could cause in relationships. In addition to Satir’s influence in human sciences, she helped establish organizations with the purpose of educating therapist around the world and granting them with resources to help families and clients.

Long interested in the idea of networking, Satir founded two groups to help individuals find mental health workers or other people who were suffering from similar issues to their own. In 1970, she organised “Beautiful People,” which later became known as the “International Human Learning Resources Network.” In 1977 she founded the Avanta Network, which was renamed to the Virginia Satir Global Network in 2010.

Recognition

Two years later, Satir was appointed to the Steering Committee of the International Family Therapy Association and became a member of the Advisory Board for the National Council for Self-Esteem.

She has also been recognized with several honorary doctorates, including a 1978 doctorate in Social Sciences from the University of Wisconsin-Madison.

Honours and Awards Received

  • 1976 Awarded Gold Medal of “Outstanding and Consistent Service to Mankind” by the University of Chicago.
  • 1978 Awarded honorary doctorate in Social Sciences from the University of Wisconsin-Madison.
  • 1982 Selected by the West German Government as one of the twelve most influential leaders in the world today.
  • 1985 Time magazine quotes a colleague, “She can fill any auditorium in the country”, after her stellar contribution to the Evolution of Psychotherapy Conference in Phoenix, Arizona.
  • 1985 Selected by the prestigious National Academy of Practice as one of two members to advise on health concerns to the Congress of the United States.
  • 1986 Selected as member of the International Council of Elders, a society developed by the recipients of the Nobel Peace Prize.
  • 1987 Named Honourary Member of the Czechoslovakian Medical Society.
  • She was honoured in the California Social Work Hall of Distinction.
  • In two national surveys of Psychiatrists, Psychologists, Social Workers, and Marriage and Family Therapists, she was voted the most influential therapist.

What is Neurophenomenology?

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Introduction

Neurophenomenology refers to a scientific research program aimed to address the hard problem of consciousness in a pragmatic way.

It combines neuroscience with phenomenology in order to study experience, mind, and consciousness with an emphasis on the embodied condition of the human mind. The field is very much linked to fields such as neuropsychology, neuroanthropology and behavioural neuroscience (also known as biopsychology) and the study of phenomenology in psychology.

Overview

The label was coined by C. Laughlin, J. McManus and E. d’Aquili in 1990. However, the term was appropriated and given a distinctive understanding by the cognitive neuroscientist Francisco Varela in the mid-1990s, whose work has inspired many philosophers and neuroscientists to continue with this new direction of research.

Phenomenology is a philosophical method of inquiry of everyday experience. The focus in phenomenology is on the examination of different phenomena (from Greek, phainomenon, “that which shows itself”) as they appear to consciousness, i.e. in a first-person perspective. Thus, phenomenology is a discipline particularly useful to understand how is it that appearances present themselves to us, and how is it that we attribute meaning to them.

Neuroscience is the scientific study of the brain, and deals with the third-person aspects of consciousness. Some scientists studying consciousness believe that the exclusive utilisation of either first- or third-person methods will not provide answers to the difficult questions of consciousness.

Historically, Edmund Husserl is regarded as the philosopher whose work made phenomenology a coherent philosophical discipline with a concrete methodology in the study of consciousness, namely the epoche. Husserl, who was a former student of Franz Brentano, thought that in the study of mind it was extremely important to acknowledge that consciousness is characterised by intentionality, a concept often explained as “aboutness”; consciousness is always consciousness of something. A particular emphasis on the phenomenology of embodiment was developed by philosopher Maurice Merleau-Ponty in the mid-20th century.

Naturally, phenomenology and neuroscience find a convergence of common interests. However, primarily because of ontological disagreements between phenomenology and philosophy of mind, the dialogue between these two disciplines is still a very controversial subject. Husserl himself was very critical towards any attempt to “naturalizing” philosophy, and his phenomenology was founded upon a criticism of empiricism, “psychologism”, and “anthropologism” as contradictory standpoints in philosophy and logic. The influential critique of the ontological assumptions of computationalist and representationalist cognitive science, as well as artificial intelligence, made by philosopher Hubert Dreyfus has marked new directions for integration of neurosciences with an embodied ontology. The work of Dreyfus has influenced cognitive scientists and neuroscientists to study phenomenology and embodied cognitive science and/or enactivism. One such case is neuroscientist Walter Freeman, whose neurodynamical analysis has a marked Merleau-Pontyian approach.

What is Phenomenological Psychology?

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Introduction

Phenomenology within psychology (or phenomenological psychology) is the psychological study of subjective experience.

It is about explaining the experience from the point of view of the subject, by analysing the words that they have spoken or had written. It is an approach to psychological subject matter that has its roots in the phenomenological philosophical work of Edmund Husserl.

Refer to Neurophenomenology.

Brief History

Early phenomenologists such as Husserl, Jean-Paul Sartre, and Maurice Merleau-Ponty, conducted philosophical investigations of consciousness in the early 20th century. Their critiques of psychologism and positivism later influenced at least two main fields of contemporary psychology: the phenomenological psychological approach of the Duquesne School (the descriptive phenomenological method in psychology), including Amedeo Giorgi and Frederick Wertz; and the experimental approaches associated with Francisco Varela, Shaun Gallagher, Evan Thompson, and others (embodied mind thesis). Other names associated with the movement include Jonathan Smith (interpretative phenomenological analysis), Steinar Kvale, and Wolfgang Köhler. But “an even stronger influence on psychopathology came from Heidegger (1963), particularly through Kunz (1931), Blankenburg (1971), Tellenbach (1983), Binswanger (1994), and others.” Phenomenological psychologists have also figured prominently in the history of the humanistic psychology movement.

Phenomenological Experience

The experiencing subject can be considered to be the person or self, for purposes of convenience. In phenomenological philosophy (and in particular in the work of Husserl, Heidegger, and Merleau-Ponty), “experience” is a considerably more complex concept than it is usually taken to be in everyday use. Instead, experience (or being, or existence itself) is an “in-relation-to” phenomenon, and it is defined by qualities of directedness, embodiment, and worldliness, which are evoked by the term “Being-in-the-World”.

The quality or nature of a given experience is often referred to by the term qualia, whose archetypical exemplar is “redness”. For example, we might ask, “Is my experience of redness the same as yours?” While it is difficult to answer such a question in any concrete way, the concept of intersubjectivity is often used as a mechanism for understanding how it is that humans are able to empathize with one another’s experiences, and indeed to engage in meaningful communication about them. The phenomenological formulation of “Being-in-the-World”, where person and world are mutually constitutive, is central here.

The observer, or in some cases the interviewer, achieve this sense of understanding and feeling of relatedness to the subject’s experience, through subjective analysis of the experience, and the implied thoughts and emotions that they relay in their words.

Difficulties in Considering Subjective Phenomena

The philosophical psychology prevalent before the end of the 19th century relied heavily on introspection. The speculations concerning the mind based on those observations were criticised by the pioneering advocates of a more scientific and objective approach to psychology, such as William James and the behaviourists Edward Thorndike, Clark Hull, John B. Watson, and B.F. Skinner. However, not everyone agrees that introspection is intrinsically problematic, such as Francisco Varela, who has trained experimental participants in the structured “introspection” of phenomenological reduction.

In the early 1970s, Amedeo Giorgi applied phenomenological theory to his development of the Descriptive Phenomenological Method in Psychology. He sought to overcome certain problems he perceived from his work in psychophysics by approaching subjective phenomena from the traditional hypothetical-deductive framework of the natural sciences. Giorgi hoped to use what he had learned from his natural science background to develop a rigorous qualitative research method. His goal was to ensure that to phenomenological research was both reliable and valid and he did this by seeking to make its processes increasingly measurable.

Philosophers have long confronted the problem of “qualia”. Few philosophers believe that it is possible to be sure that one person’s experience of the “redness” of an object is the same as another person’s, even if both persons had effectively identical genetic and experiential histories. In principle, the same difficulty arises in feelings (the subjective experience of emotion), in the experience of effort, and especially in the “meaning” of concepts. As a result, many qualitative psychologists have claimed phenomenological inquiry to be essentially a matter of “meaning-making” and thus a question to be addressed by interpretive approaches.

Psychotherapy and the Phenomenology of Emotion

Carl Rogers’s person-centred psychotherapy theory is based directly on the “phenomenal field” personality theory of Combs and Snygg. That theory in turn was grounded in phenomenological thinking. Rogers attempts to put a therapist in closer contact with a person by listening to the person’s report of their recent subjective experiences, especially emotions of which the person is not fully aware. For example, in relationships the problem at hand is often not based around what actually happened but, instead, based around the perceptions and feelings of each individual in the relationship. The phenomenal field focuses on “how one feels right now”.