Why Psychiatrists Can’t Predict Mass Murderers

Psycholog

A complex network perspective on clinical science

Contemporary classification systems for mental disorders assume that abnormal behaviors are expressions of latent disease entities. An alternative to the latent disease model is the complex network approach. Instead of assuming that symptoms arise from an underlying disease entity, the complex network approach holds that disorders exist as systems of interrelated elements of a network. This approach also provides a framework for the understanding of therapeutic change. Depending on the structure of the network, change can occur abruptly once the network reaches a critical threshold (the tipping point). Homogeneous and highly connected networks often recover more slowly from local perturbations when the network approaches the tipping point, potentially making it possible to predict treatment change, relapse, and recovery. In this article, we discuss the complex network approach as an alternative to the latent disease model and its implications for classification, therapy, relapse, and recovery.R34 MH086668 - NIMH NIH HHS; R01 AT007257 - NCCIH NIH HHS; R21 MH101567 - NIMH NIH HHS; R34 MH099311 - NIMH NIH HHS; R21 MH102646 - NIMH NIH HHS; K23 MH100259 - NIMH NIH HHS; R01 MH099021 - NIMH NIH HH

Risk Factors and Posttraumatic Stress Disorder: Are They Especially Predictive Following Exposure to Less Severe Stressors?

Background: The diagnosis of posttraumatic stress disorder (PTSD) requires exposure to a traumatic stressor, as defined by Criterion A in the DSM criteria for PTSD. Yet, over the course of successive revisions of the diagnostic manual, the range of qualifying stressors has expanded considerably (e.g., watching terrorist attacks on television). Moreover, stressors that fall short of qualifying for even an expanded Criterion A can produce apparent PTSD. Taken together, these findings imply that people who do satisfy symptomatic criteria for PTSD following exposure to less severe stressors carry a heavy burden of risk factors. Method: To test this hypothesis, we examined whether the association between the risk factor of lower intelligence and more severe PTSD and depression symptoms would be greater among women reporting less severe CSA (n = 15) relative to women who reported moderate (n = 54) or high (n = 31) severity CSA. Results: The evidence was consistent with this hypothesis for subjects in the low and moderate severity groups, but less so for those in the high severity group. Conclusions: Lower intelligence was a more potent risk factor for posttraumatic distress among people exposed to less severe relative to moderately severe stressors.Psycholog

Trauma Centrality and PTSD Symptom Severity in Adult Survivors of Childhood Sexual Abuse

Theorists have posited that regarding a trauma as central to one's identity leads to greater posttraumatic stress disorder (PTSD) symptom severity. To test this hypothesis, we administered the Centrality of Events Scale (CES) to women reporting a history of childhood sexual abuse (N = 102). The CES scores were correlated with PTSD symptom severity, depression severity, and self-esteem. In addition, we conducted a principal component analysis (PCA) to evaluate factors underlying the CES. The PCA yielded 3 factors reflecting (a) the centrality and integration of the trauma, (b) whether the event is regarded as a turning point in one's life story, and (c) whether the event is a reference point for expectations about the future. Each factor was associated with PTSD symptom severity.Psycholog

Inter-Identity Autobiographical Amnesia in Patients with Dissociative Identity Disorder

Background: A major symptom of Dissociative Identity Disorder (DID; formerly Multiple Personality Disorder) is dissociative amnesia, the inability to recall important personal information. Only two case studies have directly addressed autobiographical memory in DID. Both provided evidence suggestive of dissociative amnesia. The aim of the current study was to objectively assess transfer of autobiographical information between identities in a larger sample of DID patients. Methods: Using a concealed information task, we assessed recognition of autobiographical details in an amnesic identity. Eleven DID patients, 27 normal controls, and 23 controls simulating DID participated. Controls and simulators were matched to patients on age, education level, and type of autobiographical memory tested. Findings: Although patients subjectively reported amnesia for the autobiographical details included in the task, the results indicated transfer of information between identities. Conclusion: The results call for a revision of the DID definition. The amnesia criterion should be modified to emphasize its subjective nature.Psycholog

Explaining "Memories" of Space Alien Abduction and Past Lives: An Experimental Psychopathology Approach

In this article, I describe how my colleagues, students, and I have used the methods of experimental psychopathology to explain why seemingly sincere, nonpsychotic people claim to have memories of being abducted by space aliens or memories from past lives. Our group has used experimental methods from cognitive psychology and psychophysiology, supplementing them with clinical interviews and psychometric tests, to elucidate the psychology of these two groups. Our data point to quasi-spiritual motivations for why some people embrace the identity of alien abductee or past lifer.Psycholog

Reflections on Mentoring

Psycholog

Nuevos desarrollos en el tratamiento del trastorno de pánico

El objetivo de este artículo consiste en proporcionar una revisión sobre los desarrollos recientes producidos en la investigación del tratamiento del trastorno de pánico. Aunque los estudios controlados apenas han comenzado a iniciarse en el momento presente, los defensores del uso de fármacos han apoyado de forma abrumadora la utilización de los inhibidores selectivos de recaptación de serotonina (selective serotonin reuptake inhibitors, SSRIs) como el fármaco apropiado para el tratamiento del pánico. Los terapeutas cognitivo-conductuales han documentado más a fondo la efectividad de sus aproximaciones, a la vez que han ocurrido desarrollos sorprendentes. Algunos datos sugieren que la exposición no necesita estar incluida para que ciertos tratamientos psicosociales sean efectivos, mientras que otros estudios han demostrado que los elementos cognitivos añaden poco más a la terapia de exposición. Otros desarrollos adicionales se han referido tanto al establecimiento de criterios estandarizados para evaluar el trastorno de pánico cuando se aplican indistintamente fármacos y tratamiento psicológico, como a la clarificación de métodos apropiados para planificar e interpretar intervenciones controladas

Are We Winning the War against Posttraumatic Stress Disorder?

The most methodologically rigorous epidemiological study on American military personnel deployed to Iraq and Afghanistan found that 4.3% of troops developed posttraumatic stress disorder (PTSD). Among deployed combatants, 7.6% developed PTSD, whereas 1.4% of deployed noncombatants did so. The U.S. Department of Veterans Affairs has launched a program ensuring that all veterans with PTSD will receive evidence-based cognitive-behavioral therapy, and the Army has developed Battlemind postdeployment early interventions that reduce risk for the disorder.Psycholog

Attention Training Toward and Away from Threat in Social Phobia: Effects on Subjective, Behavioral, and Physiological Measures of Anxiety

Social Phobics exhibit an attentional bias for threat in probe detection and probe discrimination paradigms. Attention training programs, whereby probes always replace nonthreat cues, reduce attentional bias for threat and self-reported anxiety. However, it remains unclear whether the therapeutic benefits of attention training result from people learning to disengage attention from threat cues or acquiring greater control over their attention by learning to deploy it flexibly. Moreover, researchers have seldom taken behavioral measures, and have never taken physiological measures of fear reduction. Investigating these questions, we found that training to disengage attention from threat is more effective than training to deploy it flexibly in social phobia. Indeed, the former condition reduced self-report, behavioral and physiological measures of anxiety.Psycholog