Book: A Straight Talking Introduction to Psychiatric Diagnosis

Book Title:

A Straight Talking Introduction to Psychiatric Diagnosis.

Author(s): Lucy Johnstone.

Year: 2014.

Edition: First (1st).

Publisher: PCCS Books.

Type(s): Paperback and Kindle.

Synopsis:

Do you still need your psychiatric diagnosis? This book will help you to decide. A revolution is underway in mental health. If the authors of the diagnostic manuals are admitting that psychiatric diagnoses are not supported by evidence, then no one should be forced to accept them. If many mental health workers are openly questioning diagnosis and saying we need a different and better system, then service users and carers should be allowed to do so too. This book is about choice. It is about giving people the information to make up their own minds, and exploring alternatives for those who wish to do so.

What is Relational Disorder?

Introduction

According to Michael First of the Diagnostic and Statistical Manual of Mental Disorders Version 5 (DSM-5) working committee the focus of a relational disorder, in contrast to other DSM-IV disorders, “is on the relationship rather than on any one individual in the relationship”.

Relational disorders involve two or more individuals and a disordered “juncture”, whereas typical Axis I psychopathology describes a disorder at the individual level. An additional criterion for a relational disorder is that the disorder cannot be due solely to a problem in one member of the relationship, but requires pathological interaction from each of the individuals involved in the relationship.

For example, if a parent is withdrawn from one child but not another, the dysfunction could be attributed to a relational disorder. In contrast, if a parent is withdrawn from both children, the dysfunction may be more appropriately attributable to a disorder at the individual level.

First states that “relational disorders share many elements in common with other disorders: there are distinctive features for classification; they can cause clinically significant impairment; there are recognizable clinical courses and patterns of comorbidity; they respond to specific treatments; and they can be prevented with early interventions. Specific tasks in a proposed research agenda: develop assessment modules; determine the clinical utility of relational disorders; determine the role of relational disorders in the aetiology and maintenance of individual disorders; and consider aspects of relational disorders that might be modulated by individual disorders.”

The proposed new diagnosis defines a relational disorder as “persistent and painful patterns of feelings, behaviors, and perceptions” among two or more people in an important personal relationship, such a husband and wife, or a parent and children.

According to psychiatrist Darrel Regier, MD, some psychiatrists and other therapists involved in couples and marital counselling have recommended that the new diagnosis be considered for possible incorporation into the DSM IV.

Brief History

The idea of a psychology of relational disorders is far from new. According to Adam Blatner, MD, some of the early psychoanalysts alluded to it more or less directly, and the history of marital couple therapy began with a few pioneers in 1930s. J.L. Moreno, the inventor of psychodrama and a major pioneer of group psychotherapy and social psychology, noted the idea that relationships could be “sick” even if the people involved were otherwise “healthy,” and even vice versa: Otherwise “sick” people could find themselves in a mutually supportive and “healthy” relationship.

Moreno’s ideas may have influenced some of the pioneers of family therapy, but also there were developments in general science, namely, cybernetic theory, developed in the mid-1940s, and noting the nature of circularity and feedback in complex systems. By the 1950s, the idea that relationships themselves could be problematic became quite apparent. So, diagnostically, in the sense not of naming a disease or disorder, but just helping people think through what was really going on, the idea of relational disorder was nothing new.

Types

The majority of research on relational disorders concerns three relationship systems:

  • Adult children and their parents;
  • Minor children and their parents; and
  • The marital relationship.

There is also an increasing body of research on problems in dyadic gay relationships and on problematic sibling relationships.

Marital

Marital disorders are divided into “Marital Conflict Disorder Without Violence” and “Marital Abuse Disorder (Marital Conflict Disorder With Violence).” Couples with marital disorders sometimes come to clinical attention because the couple recognise long-standing dissatisfaction with their marriage and come to the clinician on their own initiative or are referred by a health care professional. Secondly, there is serious violence in the marriage which is “usually the husband battering the wife”. In these cases the emergency room or a legal authority often is the first to notify the clinician.

Most importantly, marital violence “is a major risk factor for serious injury and even death and women in violent marriages are at much greater risk of being seriously injured or killed” (National Advisory Council on Violence Against Women 2000). The authors of this study add that “There is current considerable controversy over whether male-to-female marital violence is best regarded as a reflection of male psychopathology and control or whether there is an empirical base and clinical utility for conceptualizing these patterns as relational.”

Recommendations for clinicians making a diagnosis of “Marital Relational Disorder” should include the assessment of actual or “potential” male violence as regularly as they assess the potential for suicide in depressed patients. Further, “clinicians should not relax their vigilance after a battered wife leaves her husband, because some data suggest that the period immediately following a marital separation is the period of greatest risk for the women.

Many men will stalk and batter their wives in an effort to get them to return or punish them for leaving. Initial assessments of the potential for violence in a marriage can be supplemented by standardised interviews and questionnaires, which have been reliable and valid aids in exploring marital violence more systematically.

The authors conclude with what they call “very recent information” on the course of violent marriages which suggests that “over time a husband’s battering may abate somewhat, but perhaps because he has successfully intimidated his wife.”

The risk of violence remains strong in a marriage in which it has been a feature in the past. Thus, treatment is essential here; the clinician cannot just wait and watch. The most urgent clinical priority is the protection of the wife because she is the one most frequently at risk, and clinicians must be aware that supporting assertiveness by a battered wife may lead to more beatings or even death.

In some cases, men are abuse victims of their wives; there is not exclusively male-on-female physical violence, although this is more common than female-on-male violence.

Parent-Child Abuse

Research on parent-child abuse bears similarities to that on marital violence, with the defining characteristic of the disorder being physical aggression by a parent toward a child. The disorder is frequently concealed by parent and child, but may come to the attention of the clinician in several ways, from emergency room medical staff to reports from child protection services.

Some features of abusive parent–child relationships that serve as a starting point for classification include:

  • The parent is physically aggressive with a child, often producing physical injury;
  • Parent-child interaction is coercive, and parents are quick to react to provocations with aggressive responses, and children often reciprocate aggression;
  • Parents do not respond effectively to positive or prosocial behaviour in the child;
  • Parents do not engage in discussion about emotions;
  • Parent engages in deficient play behaviour, ignores the child, rarely initiates play, and does little teaching;
  • Children are insecurely attached and, where mothers have a history of physical abuse, show distinctive patterns of disorganised attachment; and
  • Parents relationship shows coercive marital interaction patterns.

Defining the relational aspects of these disorders can have important consequences. For example, in the case of early appearing feeding disorders, attention to relational problems may help delineate different types of clinical problems within an otherwise broad category. In the case of conduct disorder, the relational problems may be so central to the maintenance, if not the aetiology, of the disorder that effective treatment may be impossible without recognising and delineating it.

On This Day … 22 May

People (Births)

  • 1932 – Robert Spitzer, American psychiatrist and academic (d. 2015).

Robert Spitzer

Robert Leopold Spitzer (22 May 1932 to 25 December 2015) was a psychiatrist and professor of psychiatry at Columbia University in New York City. He was a major force in the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Education

He received his bachelor’s degree in psychology from Cornell University in 1953 and his M.D. from New York University School of Medicine in 1957. He completed his psychiatric residency at New York State Psychiatric Institute in 1961 and graduated from Columbia University Centre for Psychoanalytic Training and Research in 1966.

Spitzer wrote an article on Wilhelm Reich’s theories in 1953 which the American Journal of Psychiatry declined to publish.

Career

Spitzer spent most of his career at Columbia University in New York City as a Professor of Psychiatry until he retired in 2003. He was on the research faculty of the Columbia University Centre for Psychoanalytic Training and Research where he retired after 49 years in December 2010. He has been called one of the most influential psychiatrists of the 20th century. The Lancet’s obituary described him as “Stubborn, sometimes abrasive, and always eager, Spitzer’s work was guided by a strong sense of ethical fairness”. A colleague at Columbia has described him as an “iconoclast” who “looked for injustice”.

Screening and Diagnostic Tools

Spitzer was a major architect of the modern classification of mental disorders. In 1968, he co-developed a computer program, Diagno I, based on a logical decision tree, that could derive a diagnosis from the scores on a Psychiatric Status Schedule which he co-published in 1970 and that the United States Steering Committee for the United States-United Kingdom Diagnostic Project used to check the consistency of its results.

Spitzer was a member on the four-person United States Steering Committee for the United States-United Kingdom Diagnostic Project, which published their results in 1972. They found the most important difference between countries was that the concept of schizophrenia used in New York was much broader than the one used in London, and included patients who would have been termed manic-depressive or bipolar.

He developed psychiatric methods that focused on asking specific interview questions to get at a diagnosis as opposed to the open-ended questioning of psychoanalysis, which was the predominant technique of mental health. He codeveloped the Mood Disorder Questionnaire (MDQ), a screening technique used for diagnosing bipolar disorder. He also co-developed the Patient Health Questionnaire (PRIME-MD) which can be self-administered to find out if one has a mental illness. The portions of PRIME-MD directed at depression (PHQ2 and PHQ9) have since become accepted in primary care medicine for screening and diagnosis of major depression as well as for monitoring response to treatment.

Position on the Diagnostic and Statistical Manual of Mental Disorders

In 1974, Spitzer became the chair of the American Psychiatric Association’s task force of the third edition of the Diagnostic and Statistical Manual of Mental Disorders the so-called, DSM-III which was released in 1980. Spitzer is a major architect of the modern classification of mental disorders which involves classifying mental disorders in discrete categories with specified diagnostic criteria but later criticised what he saw as errors and excesses in the DSM’s later versions, although he maintained his position that the DSM is still better than the alternatives.

In 2003, Spitzer co-authored a position paper with DSM-IV editor Michael First, stating that the “DSM is generally viewed as clinically useful” based on surveys from practicing professionals and feedback from medical students and residents, but that primary care physicians find the DSM too complicated for their use. The authors emphasized that given then-current limitations in understanding psychiatric disorders, a multitude of DSM codes/diagnoses might apply to some patients, but that it would be a “total speculation” to assign a single diagnosis to a patient. The authors rejected calls to adopt the ICD-9 because it lacked diagnostic criteria and would “[set] psychiatry back 30 years,” while the ICD-10, closely resembled the DSM-III-R classification.[14] In 2013, a definitive autobiography of Spitzer, The Making of DSM-III®: A Diagnostic Manual’s Conquest of American Psychiatry, was published by author and historian Hannah S. Decker.

Spitzer was briefly featured in the 2007 BBC TV series The Trap, in which he stated that the DSM, by operationalising the definitions of mental disorders while paying little attention to the context in which the symptoms occur, may have medicalised the normal human experiences of a significant number of people.

In 2008, Spitzer had criticised the revision process of the DSM-5 for lacking transparency. He has also criticised specific proposals, like the proposed introduction of the psychosis risk syndrome for people who have mild symptoms found in psychotic disorders.

On Homosexuality

Spitzer led a successful effort, in 1973, to stop treating homosexuality as a mental illness.

It was partly due to Spitzer’s efforts that homosexuality was “removed” (i.e. renamed as Sexual Orientation Disturbance) in 1974 DSM-II: “By withdrawing it from the manual, homosexuality was legitimized as a normal difference rather than a psychiatric behavior. This early powerful statement by institutional psychiatry that this is normal sped up the confidence of people in the movement.”

In 2001, Spitzer delivered a controversial paper, “Can Some Gay Men and Lesbians Change Their Sexual Orientation?” at the 2001 annual APA meeting; he argued that it is possible that some highly motivated individuals could successfully change their sexual orientation from homosexual to heterosexual.

Awards

Spitzer received the Thomas William Salmon Medal from the New York Academy of Medicine for his contributions to psychiatry.

On This Day … 07 April

People (Deaths)

  • 1999 – Heinz Lehmann, German-Canadian psychiatrist and academic (b. 1911).

Heinz Lehmann

Heinz Edgar Lehmann, OC FRSC (17 July 17 1911 to 07 April 1999) was a German-born Canadian psychiatrist best known for his use of chlorpromazine for the treatment of schizophrenia in 1950s and “truly the father of modern psychopharmacology.”

Early Life

Born in Berlin, Germany, he was educated at the University of Freiburg, the University of Marburg, the University of Vienna, and the University of Berlin. He emigrated to Canada in 1937.

Hospital Work in Canada

In 1947, he was appointed the clinical director of Montreal’s Douglas Hospital. From 1971 to 1975, he was the chair of the McGill University Department of Psychiatry. He was also a humane lecturer in psychiatry in 1952, and was able to give empathetic lectures on the plight of people suffering from anxiety, depression obsessions, paranoia etc. No one to that time had been able to understand or help schizophrenic patients, who filled mental hospitals around the world, so when chlorpromazine showed some promise he helped to promote it in North America and start the drug revolution. He was ahead of his time in that he supported research in the use of the active ingredient psilocybin to alleviate anxiety.

Le Dain Commission

From 1969 to 1972, he was one of the five members of the Le Dain Commission, a royal commission appointed in Canada to study the non-medical use of drugs. He was an advocate for decriminalisation of marijuana.

DSM Work

In 1973, he was a member of the Nomenclature Committee of the American Psychiatric Association that decided to drop homosexuality from the Diagnostic and Statistical Manual of Mental Disorders, i.e. to depathologise it.

Honours and Awards

In 1970 he was made a Fellow of the Royal Society of Canada and, in 1976, he was made an Officer of the Order of Canada. He was inducted into the Canadian Medical Hall of Fame in 1998.

Heinz Lehmann Award

In 1999, the Canadian College of Neuropsychopharmacology established the Heinz Lehmann Award in his honour, given in recognition of outstanding contributions to research in neuropsychopharmacology in Canada.

On This Day … 15 December

Events

  • 1973 – The American Psychiatric Association votes 13-0 to remove homosexuality from its official list of psychiatric disorders, the DSM-II.

People (Births)

  • 1911 – Nicholas P. Dallis, American psychiatrist and illustrator (d. 1991).

People (Deaths)

  • 2005 – Heinrich Gross, Austrian physician and psychiatrist (b. 1914).
  • 2010 – Eugene Victor Wolfenstein, American psychoanalyst and theorist (b. 1940).

Nicholas P. Dallis

Nicholas Peter Dallis (15 December 1911 to 06 July 1991), known as Nick Dallis, was an American psychiatrist turned comic strip writer, creator of the soap opera-style strips Rex Morgan MD, Judge Parker and Apartment 3-G. Separating his comics career from his medical practice, he wrote under pseudonyms, Dal Curtis for Rex Morgan MD, and Paul Nichols for Judge Parker.

Born in New York City, Nick Dallis grew up on Long Island. He graduated from Washington & Jefferson College in 1933 and from Temple University’s medical school in 1938 and married a nurse, Sarah Luddy. He decided to specialize in psychiatry, and after World War II, started a practice in Toledo, Ohio. Allen Saunders was chair at the time of the local mental hygiene centre that invited him there, and in his autobiography, he recalled that Dallis approached him, as a well-known comics writer (Steve Roper and Mike Nomad, Mary Worth), about “his desire to write a comic strip, one tracing the history of medicine. I told him that, commendable as his idea was, such a feature would not succeed. Readers want entertainment, not enlightenment. But a story about a handsome young doctor’s involvement with his patients might be a winner.”

Heinrich Gross

Heinrich Gross (14 November 1915 to 15 December 2005) was an Austrian psychiatrist, medical doctor and neurologist, a reputed expert as a leading court-appointed psychiatrist, ill-famed for his proven involvement in the killing of at least nine children with physical, mental and/or emotional/behavioural characteristics considered “unclean” by the Nazi regime, under its Euthanasia Programme. His role in hundreds of other cases of infanticide is unclear. Gross was head of the Spiegelgrund children’s psychiatric clinic for two years during World War II.

A significant element of the controversy surrounding Gross’ activities is that after the children had been murdered, parts of their bodies, particularly their brains, were preserved and retained for future study for decades after the murders. It was only on 28 April 2002 that the preserved remains of these murdered children were finally buried.

Pre-War Career

Heinrich Gross was born in Vienna on 14 November 1915. His parents, Karl and Petronella Gross, were in the wool and knitwear business. His father died before Heinrich was born and his mother placed him in a Catholic boarding school for his early education. He graduated from a public high school in 1934 and received a medical degree in 1939 from the University of Vienna.

In 1932 Gross became a member of the Hitler Youth and joined the Sturmabteilung in 1934. He remained a member throughout the period 1934 to 1938 when these organisations were outlawed in Austria. After Germany annexed Austria in 1938, Gross joined the Nazi Party.

Euthanasia Programme

Euthanasia was commonly practiced long before the infamous Nazi concentration camps. The euthanasia programme was introduced to the German people as an efficient manner to obtain a Master Race for the Nazi people and an economic relief to families. As Nazi popularity grew and the economy still struggling these options were widely accepted by the German people. Am Spiegelgrund was a youth care facility on the grounds of a mental institution. From the years of 1940 to 1945 it was used for mentally handicapped adults or children. During their stay they suffered numerous forms of torture and up to 800 people were murdered there. Gross began in pavilion 15 in November 1940. By 1942 he had killed more children than any other doctor in the hospital. He became the leading psychiatrist and began studying the neurology of mentally handicapped children. With the passing of Aktion T4 the killings increased and Gross began to harvest the brains of his victims for further study. In 1943 Gross was called for military service returning pretty regularly for research until his capture in 1945.

Post-war Career

In the same year of his overturned manslaughter case, Gross was allowed to resume his research at Rose Hill. In 1955, he completed his training as a specialist in nervous and mental diseases and became the head prison doctor or physician in the former Hospital and nursing home Am Steinhof. In 1957 he became the Chief court psychiatrist for men’s mental institutions. There he worked with the justice system in insanity cases and was the main decision maker in all sterilisation cases as well. He got promoted to the management of the “Ludwig Boltzmann Institute for the study of the abnormalities of the nervous system” created specially for him in 1968. Gross worked as a reviewer and for years was considered the most busy court expert in Austria. In 1975 the Republic of Austria awarded him the medal für Wissenschaft und Kunst 1, of which he was stripped of in 2003. In 1975 it was realised that he had been involved in illegal killings during the Nazi occupation of Austria. Gross was stripped of many awards but continued serving as a court expert until he came under investigation in 1997 for nine counts of murder.

Eugene Victor Wolfenstein

Eugene Victor Wolfenstein (09 July 1940 to 15 December 2010) was an American social theorist, practicing psychoanalyst, and a professor of political science at University of California, Los Angeles.

Career

Wolfenstein graduated with his Bachelor of Arts magna cum laude from Columbia College in 1962. He was a member of Phi Beta Kappa.

Wolfenstein received his Master of Arts in political science in 1964 and his PhD in political science in 1965 from Princeton University. Wolfenstein became a professor of political science at UCLA.

He also completed a PhD in psychoanalysis from the Southern California Psychoanalytic Institute in 1984. He was the member of the faculty of the institute from 1988 to 2004. Moreover, he was in private practice from the time he received his degree up to the time of his death.

Wolfenstein worked in the critical theory tradition, with a focus on African American culture and social movements. In his book The Victims of Democracy: Malcolm X and the Black Revolution, he used a theory of the interaction between social classes and psychological groups to analyse white racism and the black liberation struggle. He developed a more general version of this theory in Psychoanalytic-Marxism: Groundwork (1993) and refined it further through engagement with Nietzsche’s philosophy in Inside/Outside Nietzsche: Psychoanalytic Explorations (2000). These later works add a concern with gender identity to the earlier agenda. His research is in the area of African-American narrative. A Gift of the Spirit: Reading THE SOULS OF BLACK FOLK (2007) offered a sustained reconstruction of W.E.B. Du Bois’s canonical text. A further study entitled “Talking Books: Toni Morrison Among the Ancestors” was published right before his death.

He was a professor at UCLA. At the undergraduate level, he taught the lower division Introduction to Political Theory, along with Ancient Political Theory, African-American Freedom Narratives, Malcolm X and Black Liberation, Marxist Political Theory, and an occasional seminar on Platonic Dialectic and Spiritual Liberation. At the graduate level, he focused on major works of Du Bois, Foucault, Freud, Hegel, Marx, and Nietzsche, along with the related critical literatures.

His main interests were History of Political Theory, Psychoanalytic Theory and Practice, Critical Theory, Critical Race Theory and Feminist Theory.

Sleep-Wake Disorders & DSM-5

Research Paper Title

Sleep-wake disorders and DSM-5.

Background

Most individuals with mental disorders complain about the problems they experience with sleeping and waking. It is becoming evident that careful diagnosis of sleep-wake disorders is of great importance for the prevention and treatment of mental disorders. Since the introduction of the DSM-IV, clinical scientific research has provided important new insights in this field.

Therefore the aim of this research was to find out whether the new classification of sleep-wake disorders in DSM-5 is likely to improve the diagnosis of disorders of this type.

Method

The researchers discuss the main changes in the DSM-5 classification of sleep- wake disorders, comparing the new version with the version in DSM-IV.

Results

Because considerable attention is being given to the symptom-orientated and dimensional approach, the classification of sleep-wake disorders in the DSM-5 is closer to current psychiatric practice and it does justice to the current scientific insights into the dimensional nature of psychiatric disorders.

Conclusions

The DSM-5 classification takes recent scientific insights into account and might help to improve the diagnosis of sleep-wake disorders in psychiatry.

Reference

van Bemmel, A.L. & Kerkhof, G.A. (2020) Sleep-wake disorders and DSM-5. Tijdschrift voor Psychiatrie. 56(3), pp.192-195.

Book: Abnormal Psychology

Book Title:

Abnormal Psychology.

Author(s): Thomas F. Oltmanns and Robert E. Emery.

Year: 2019.

Edition: Ninth (9th).

Publisher: Pearson.

Type(s): Paperback.

Synopsis:

An overview of abnormal psychology that focuses not on “them,” but on all of us.

Abnormal Psychology brings both the science and personal aspects of the discipline to life with a focus on evidence-based practice and emerging research. Authors Thomas Oltmanns and Robert Emery cover methods and treatment in context in order to helps readers understand the biological, psychological, and social perspectives on abnormal psychology.

The 9th Edition has been updated to integrate coverage of the DSM-5, as well as the latest research and contemporary topics that will interest students.

Misophonia: Quirk of Human Behaviour or Mental Health Condition?

Introduction

By analogy with misogyny and misanthropy, misophonia ought to mean hatred of noise.

In fact, it is a recent coinage used to label the phenomenon of strong aversive reactions to sounds originating in other people’s oral or nasal cavities, such as chewing, sniffing, slurping, and lip smacking.

A report of a large series of cases seen in the Netherlands suggests that misophonia is well on its way to becoming a new psychiatric disorder (see below) (Jager et al., 2020).

Some commentators have expressed concern at the creeping medicalisation of quirks of human behaviour (BMJ, 2020).

What is Misophonia?

  • It is also known as Selective Sound Sensitivity Syndrome.
  • Misophonia is a disorder in which certain sounds trigger emotional or physiological responses that some might perceive as unreasonable given the circumstance.
  • Those who have misophonia might describe it as when a sound “drives you crazy.”
  • Their reactions can range from anger and annoyance to panic and the need to flee.

Research Paper Title

Misophonia: Phenomenology, comorbidity and demographics in a large sample.

Objective

Analyse a large sample with detailed clinical data of misophonia subjects in order to determine the psychiatric, somatic and psychological nature of the condition.

Methods

This observational study of 779 subjects with suspected misophonia was conducted from January 2013 to May 2017 at the outpatient-clinic of the Amsterdam University Medical Centres, location AMC, the Netherlands. The researchers examined DSM-IV diagnoses, results of somatic examination (general screening and hearing tests), and 17 psychological questionnaires (e.g. SCL-90-R, WHOQoL).

Results

The diagnosis of misophonia was confirmed in 575 of 779 referred subjects (74%). In the sample of misophonia subjects (mean age, 34.17 [SD = 12.22] years; 399 women [69%]), 148 (26%) subjects had comorbid traits of obsessive-compulsive personality disorder, 58 (10%) mood disorders, 31 (5%) attention-deficit (hyperactivity) disorder, and 14 (3%) autism spectrum conditions. 2% reported tinnitus and 1% hyperacusis. In a random subgroup of 109 subjects the researchers performed audiometry, and found unilateral hearing loss in 3 of them (3%). Clinical neurological examination and additional blood test showed no abnormalities. Psychological tests revealed perfectionism (97% CPQ>25) and neuroticism (stanine 7 NEO-PI-R). Quality of life was heavily impaired and associated with misophonia severity (rs (184) = -.34 p = < .001, p = < .001).

Limitations

This was a single site study, leading to possible selection–and confirmation bias, since AMC-criteria were used.

Conclusions

This study with 575 subjects is the largest misophonia sample ever described.

Based on these results the researchers propose a set of revised criteria useful to diagnose misophonia as a psychiatric disorder.

References

BMJ 2020;369:m1843.

Jager, I., de Koning, P., Bost, T., Denys, D. & Vulink, N. (2020) Misophonia: Phenomenology, comorbidity and demographics in a large sample. PloS One. https://doi.org/10.1371/journal.pone.0231390.

Misophonia: Quirk of Human Behaviour or Mental Health Condition?

Introduction

By analogy with misogyny and misanthropy, misophonia ought to mean hatred of noise.

In fact, it is a recent coinage used to label the phenomenon of strong aversive reactions to sounds originating in other people’s oral or nasal cavities, such as chewing, sniffing, slurping, and lip smacking.

A report of a large series of cases seen in the Netherlands suggests that misophonia is well on its way to becoming a new psychiatric disorder (see below) (Jager et al., 2020).

Some commentators have expressed concern at the creeping medicalisation of quirks of human behaviour (BMJ, 2020).

What is Misophonia?

  • It is also known as Selective Sound Sensitivity Syndrome.
  • Misophonia is a disorder in which certain sounds trigger emotional or physiological responses that some might perceive as unreasonable given the circumstance.
  • Those who have misophonia might describe it as when a sound “drives you crazy.”
  • Their reactions can range from anger and annoyance to panic and the need to flee.

Research Paper Title

Misophonia: Phenomenology, comorbidity and demographics in a large sample.

Objective

Analyse a large sample with detailed clinical data of misophonia subjects in order to determine the psychiatric, somatic and psychological nature of the condition.

Methods

This observational study of 779 subjects with suspected misophonia was conducted from January 2013 to May 2017 at the outpatient-clinic of the Amsterdam University Medical Centres, location AMC, the Netherlands. The researchers examined DSM-IV diagnoses, results of somatic examination (general screening and hearing tests), and 17 psychological questionnaires (e.g. SCL-90-R, WHOQoL).

Results

The diagnosis of misophonia was confirmed in 575 of 779 referred subjects (74%). In the sample of misophonia subjects (mean age, 34.17 [SD = 12.22] years; 399 women [69%]), 148 (26%) subjects had comorbid traits of obsessive-compulsive personality disorder, 58 (10%) mood disorders, 31 (5%) attention-deficit (hyperactivity) disorder, and 14 (3%) autism spectrum conditions. 2% reported tinnitus and 1% hyperacusis. In a random subgroup of 109 subjects the researchers performed audiometry, and found unilateral hearing loss in 3 of them (3%). Clinical neurological examination and additional blood test showed no abnormalities. Psychological tests revealed perfectionism (97% CPQ>25) and neuroticism (stanine 7 NEO-PI-R). Quality of life was heavily impaired and associated with misophonia severity (rs (184) = -.34 p = < .001, p = < .001).

Limitations

This was a single site study, leading to possible selection–and confirmation bias, since AMC-criteria were used.

Conclusions

This study with 575 subjects is the largest misophonia sample ever described.

Based on these results the researchers propose a set of revised criteria useful to diagnose misophonia as a psychiatric disorder.

References

BMJ 2020;369:m1843.

Jager, I., de Koning, P., Bost, T., Denys, D. & Vulink, N. (2020) Misophonia: Phenomenology, comorbidity and demographics in a large sample. PloS One. https://doi.org/10.1371/journal.pone.0231390.

Identifying Qualitatively Distinct PTSD Symptom Typologies

Research Paper Title

Identifying PTSD Symptom Typologies: A Latent Class Analysis.

Background

Posttraumatic stress disorder (PTSD) is characterised by re-experiencing, avoidance, negative alterations in cognition and mood, and arousal symptoms per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

While numerous symptom combinations are possible to meet diagnostic criteria, simplification of this heterogeneity of symptom presentations may have clinical utility.

Methods

In a nationally representative sample of American adults with lifetime DSM-5 PTSD diagnoses from the third wave of the National Epidemiologic Survey on Alcohol and Related Conditions (n = 2,365), the researchers used Latent Class Analysis (LCA) to identify qualitatively distinct PTSD symptom typologies.

Subsequently, they used linear and logistic regressions to identify demographic, trauma-related, and psychiatric characteristics associated with membership in each class.

Results

In contrast to prior LCAs with DSM-IV-TR diagnostic criteria, fit indices for the present analyses of DSM-5 PTSD revealed a four-class solution to the data:

  1. Dysphoric (23.8%);
  2. Threat-Reactivity (26.1%);
  3. High Symptom (33.7%); and
  4. Low Symptom (16.3%).

Exploratory analyses revealed distinctions between classes in socioeconomic impairment, trauma exposure, comorbid diagnoses, and demographic characteristics.

Conclusions

Although the study is limited by its cross-sectional design (preventing analysis of temporal associations or causal pathways between covariates and latent classes), findings may support efforts to develop personalised medicine approaches to PTSD diagnosis and treatment.

Reference

Campbell, S.B., Trachik, B., Goldberg, S. & Simpson, T.L. (2020) Identifying PTSD Symptom Typologies: A Latent Class Analysis. Psychiatry Research. 285:112779. doi: 10.1016/j.psychres.2020.112779. Epub 2020 Jan 23.