This document discusses conceptualizing mental health problems as complex systems rather than discrete syndromes or diagnoses. It argues that diagnostic classifications oversimplify complex biopsychosocial processes, and that studying individual elements in isolation through reductionism has limited progress. Taking a systems perspective recognizes that mental health states emerge from interactions among numerous risk factors and considers diagnoses as useful tools rather than definitive categories. This approach provides new ways to study mental illness and develop more effective treatments.
Chapter 1Mental Disorders as Discrete Clinical Conditions Dimen.docxketurahhazelhurst
Chapter 1
Mental Disorders as Discrete Clinical Conditions: Dimensional Versus Categorical Classification
Thomas A. Widiger and Cristina Crego
In DSM-IV, there [was] “no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder” (American Psychiatric Association [APA], APA, 2000, p. xxxi). This carefully worded disclaimer, however, was somewhat hollow, as it was the case that “DSM-IV [was] a categorical classification that divides mental disorders into types based on criterion sets with defining features” (APA, 2000, p. xxxi). The categorical model of classification is consistent with a medical tradition in which it is believed (and often confirmed in other areas of medicine) that disorders have specific etiologies, pathologies, and treatments (Guze, 1978; Guze & Helzer, 1987; Zachar & Kendler, 2007).
Clinicians, following this lead, diagnosed and conceptualized the conditions presented in DSM-IV-TR as disorders that are qualitatively distinct from normal functioning and from one another. DSM-IV-TR provided diagnostic criterion sets to help guide clinicians toward a purportedly correct diagnosis and an additional supplementary section devoted to differential diagnosis that indicated “how to differentiate [the] disorder from other disorders that have similar presenting characteristics” (APA, 2000, p. 10). The intention of the manual was to help the clinician determine which particular mental disorder provides the best explanation for the symptoms and problems facing the patient. Clinicians devote initial time with a new patient to identify, through differential diagnosis, which specific disorder best explains a patient's presenting complaints. The assumption is that the person is suffering from a single, distinct clinical condition, caused by a specific pathology for which there will be a specific treatment (Frances, First, & Pincus, 1995).
Authors of the diagnostic manual devote a considerable amount of time writing, revising, and researching diagnostic criteria to improve differential diagnosis. They buttress each disorder's criterion set, trying to shore up discriminant validity and distinctiveness, following the rubric of Robins and Guze (1970) that the validity of a diagnosis rests in large part on its “delimitation from other disorders” (p. 108). “These criteria should…permit exclusion of borderline cases and doubtful cases (an undiagnosed group) so that the index group may be as homogeneous as possible” (Robins & Guze, 1970, p. 108).
Scientists may devote their careers to attempting to identify the specific etiology, pathology, or treatment for a respective diagnostic category. Under the assumption that the diagnoses do in fact refer to qualitatively distinct conditions, it follows that there should be a specific etiology, pathology, and perhaps even a specific treatment for each respective disorder. The theories, hypothese ...
This document discusses a study on self-identification with major depressive disorder (MDD) among undergraduate college students. The study examined how exposure to diagnostic criteria and different patient accounts affected self-identification with MDD. Results showed those exposed to diagnostic criteria and an account of a clinically diagnosed patient were more likely to identify themselves as having MDD, compared to those exposed to other patient accounts or no additional information. The document provides background on rising internet use, depression prevalence among college students, and issues with primary care physicians prescribing antidepressants without oversight from mental health professionals. It argues proper diagnosis and long-term treatment are needed but often lacking.
Chapter 1Mental Disorders as Discrete Clinical Conditions Dimen.docxwalterl4
Chapter 1
Mental Disorders as Discrete Clinical Conditions: Dimensional Versus Categorical Classification
Thomas A. Widiger and Cristina Crego
In DSM-IV, there [was] “no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder” (American Psychiatric Association [APA], APA, 2000, p. xxxi). This carefully worded disclaimer, however, was somewhat hollow, as it was the case that “DSM-IV [was] a categorical classification that divides mental disorders into types based on criterion sets with defining features” (APA, 2000, p. xxxi). The categorical model of classification is consistent with a medical tradition in which it is believed (and often confirmed in other areas of medicine) that disorders have specific etiologies, pathologies, and treatments (Guze, 1978; Guze & Helzer, 1987; Zachar & Kendler, 2007).
Clinicians, following this lead, diagnosed and conceptualized the conditions presented in DSM-IV-TR as disorders that are qualitatively distinct from normal functioning and from one another. DSM-IV-TR provided diagnostic criterion sets to help guide clinicians toward a purportedly correct diagnosis and an additional supplementary section devoted to differential diagnosis that indicated “how to differentiate [the] disorder from other disorders that have similar presenting characteristics” (APA, 2000, p. 10). The intention of the manual was to help the clinician determine which particular mental disorder provides the best explanation for the symptoms and problems facing the patient. Clinicians devote initial time with a new patient to identify, through differential diagnosis, which specific disorder best explains a patient's presenting complaints. The assumption is that the person is suffering from a single, distinct clinical condition, caused by a specific pathology for which there will be a specific treatment (Frances, First, & Pincus, 1995).
Authors of the diagnostic manual devote a considerable amount of time writing, revising, and researching diagnostic criteria to improve differential diagnosis. They buttress each disorder's criterion set, trying to shore up discriminant validity and distinctiveness, following the rubric of Robins and Guze (1970) that the validity of a diagnosis rests in large part on its “delimitation from other disorders” (p. 108). “These criteria should…permit exclusion of borderline cases and doubtful cases (an undiagnosed group) so that the index group may be as homogeneous as possible” (Robins & Guze, 1970, p. 108).
Scientists may devote their careers to attempting to identify the specific etiology, pathology, or treatment for a respective diagnostic category. Under the assumption that the diagnoses do in fact refer to qualitatively distinct conditions, it follows that there should be a specific etiology, pathology, and perhaps even a specific treatment for each respective disorder. The theories, hypothese.
Research-Based Interventions: Dissociative Identity Disorder 1
THIS IS AN EXAMPLE PLEASE DO NO COPY DO NOT PLAGiarism
Research-Based Interventions: Dissociative Identity Disorder
“Dissociative identity disorder is characterized by the presence of two or more identities or personality states, each with its relatively enduring pattern of perceiving, relating to, and thinking about the environment and the self” (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). There are many characteristics used that accompany Dissociative Disorder (DID). One method to understanding would be to know how the disorders are classified and defined. DID may be conceptualized effectively using the diathesis-stress model. There are many different intervention strategies for this disorder as well. Over time researchers have discovered the most effective treatments and interventions that can be used regarding DID. When one dissociates, the person may not have conscious awareness of what is happening (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006).
Peer-reviewed Articles
One limitless, longitudinal, naturalistic, and prospective study investigated childhood maltreatment (CM) in adult intimate partner violence (IPV) victims among Dissociative Disorder (DD) patients with Dissociative Identity Disorder with CM rates of 80-95% and severe dissociative symptoms (Webermann, Brand, & Chasson, 2014). The methods of this study include 275 DD outpatient therapy patients who completed a self-reported measure of dissociation (Webermann, Brand, & Chasson, 2014). Analyses assessed associations between CM typologies, trait dissociation, and IPV (Webermann, Brand, & Chasson, 2014). The results of this study include emotional and physical child abuse associated with childhood witnessing of domestic violence, physical, and emotional IPV (Webermann, Brand, & Chasson, 2014) Two-tailed independent samples t -tests and z-tests were used in this study to represent data as well. “As an effect size, odds ratios (ORs) were calculated to predict the likelihood of a participant being in an abusive adult relationship if they experienced a particular type of CM” (Webermann, Brand, & Chasson, 2014, p. 5).
A double-blind study was conducted including 15 females with DID compared to 23 without psychopathology., chosen by self-disclosure results of a questionnaire along with a structured clinical interview by psychiatrists The objective was to examine the volumetric differences between amygdala and hippocampal volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). These researchers used MRI to measure volumes of the amygdala and hippocampus. The results included the volume of the hippocampus being 19.2 % smaller and the amygdala being 31.6% smaller in patients with DID when compared to the other subjects without psychopath ...
This document summarizes a meta-analysis that examined the associations between "Big" personality traits (from the Big Three and Big Five models) and specific anxiety, depressive, and substance use disorders. The meta-analysis included 175 studies published between 1980-2007, comprising 851 effect sizes. It found that neuroticism was strongly associated with all disorders, while low conscientiousness was also common across disorders. Many disorders also showed low extraversion. Disinhibition was specifically linked to substance use disorders. Agreeableness and openness showed few associations. Substance use disorders had a distinct profile of less neuroticism but more disinhibition and disagreeableness. The study provides evidence that common mental disorders are strongly linked
Asian Journal of Psychiatry 3 (2010) 96–98Special article.docxfestockton
Asian Journal of Psychiatry 3 (2010) 96–98
Special article
Depression vs. ‘‘understandable sadness’’: is the difference clear, and is it
relevant to treatment decisions?
Mario Maj
Department of Psychiatry, University of Naples, Naples, Italy
Contents lists available at ScienceDirect
Asian Journal of Psychiatry
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / a j p
A R T I C L E I N F O
Article history:
Received 2 July 2010
Accepted 8 July 2010
One of the items of the ‘‘neo-Kraepelinian credo’’, articulated in
the 1970s, was ‘‘there is a boundary between the normal and the
sick’’. In other terms, it was maintained that there is a clear,
qualitative distinction between persons who have a mental
disorder and persons who have not (Blashfield, 1984). A corollary
to this item was the statement that ‘‘depression, when carefully
defined as a clinical entity, is qualitatively different from the mild
episodes of sadness that everyone experiences at some point in his
or her life’’ (Blashfield, 1984). Apparently in line with this
statement was the observation that tricyclic antidepressants were
active only in people who were clinically depressed; when
administered to other people, they did not act as stimulant and
did not alter their mood.
Today, the picture appears much less clear, and this is certainly
in part a consequence of the evolution of psychiatric treatments.
Guidelines for treatment of major depression often contain
contradictory statements in this respect: on the one hand, the
assertion that it is important to clearly differentiate clinical
depression from normal adaptive responses to stress; on the other,
the warning that antidepressant medications are effective even in
the presence of significant life stress, and should not be withheld
solely because the condition is understandable. These statements
beget two questions: (a) Are we really able to distinguish between
a ‘‘dysfunctional’’ and an ‘‘adaptive’’ response to an adverse life
event? (b) Is this distinction clinically relevant, since treatment
decisions are expected not to be influenced by whether the
condition is understandable or not, but only by its clinical picture,
severity, duration and by the degree of impairment of social
functioning? These are questions with significant political, ethical,
scientific and clinical implications, which have become particu-
larly visible and pressing in the past few decades, in parallel to the
escalation of the prevalence rates of depression in community
E-mail address: [email protected]
1876-2018/$ – see front matter � 2010 Elsevier B.V. All rights reserved.
doi:10.1016/j.ajp.2010.07.004
studies, of the estimated social costs of depression, of the number
of patients in treatment for depression, and of the prescriptions of
antidepressant medications.
The National Comorbidity Survey, published in 1994, reported
that the 1-year prevalence of major depression in the US adult
community was about 10%, and the l ...
Behavioral avoidance mediates the relationship betweenanxi.docxikirkton
Behavioral avoidance mediates the relationship between
anxiety and depressive symptoms among social
anxiety disorder patients
§
Ethan Moitra, James D. Herbert *, Evan M. Forman
Department of Psychology, Drexel University, 245 N. 15th Street, MS 988, Philadelphia, PA, USA
Received 26 September 2007; received in revised form 20 December 2007; accepted 4 January 2008
Abstract
This study investigated the relationship between social anxiety, depressive symptoms, and behavioral avoidance among adult
patients with Social Anxiety Disorder (SAD). Epidemiological literature shows SAD is the most common comorbid disorder
associated with Major Depressive Disorder (MDD), though the relationship between these disorders has not been investigated. In
most cases, SAD onset precedes MDD, suggesting symptoms associated with SAD might lead to depression in some people. The
present study addressed this question by investigating the mediational role of behavioral avoidance in this clinical phenomenon,
using self-report data from treatment-seeking socially anxious adults. Mediational analyses were performed on a baseline sample of
190 individuals and on temporal data from a subset of this group. Results revealed behavioral avoidance mediated this relationship,
and supported the importance of addressing such avoidance in the therapeutic setting, via exposure and other methods, as a possible
means of preventing depressive symptom onset in socially anxious individuals.
# 2008 Elsevier Ltd. All rights reserved.
Journal of Anxiety Disorders 22 (2008) 1205–1213
Keywords: Social anxiety disorder; Depression; Behavioral avoidance
The lifetime prevalence of Social Anxiety Disorder
(SAD) in Western societies is quite high, ranging from
7% to 13% (Furmark, 2002). In fact, SAD is the most
common anxiety disorder in the U.S. and the third most
common psychiatric disorder, exceeded only by alcohol
dependence and Major Depressive Disorder (MDD;
Kessler et al., 1994). SAD is a disabling condition;
compared to people without psychiatric morbidity,
adults with SAD report lower employment rates, lower
§
Portions of this research were previously presented at the annual
meeting of the Anxiety Disorders Association of America in March
2006.
* Corresponding author. Tel.: +1 215 762 1692;
fax: +1 215 762 8706.
E-mail address: [email protected] (J.D. Herbert).
0887-6185/$ – see front matter # 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.janxdis.2008.01.002
income, and lower socio-economic status (Patel, Knapp,
Henderson, & Baldwin, 2002).
1. SAD and depression
SAD is also the most common comorbid anxiety
disorder with MDD, with estimates of SAD ranging
from 15% to 37% of depressed patients (Belzer &
Schneier, 2004; Fava et al., 2000; Kessler et al., 1994).
Comorbid SAD and MDD has been associated with an
earlier onset of MDD, more depressive episodes, longer
duration of episodes, a two-fold increased risk of
alcohol dependence, and an incr ...
This document discusses the importance of neurobehavioral assessment in forensic practice. It notes that many mental disorders previously seen as behavioral are now understood to have neurological roots. A neurobehavioral assessment evaluates cognitive functioning using expertise from multiple disciplines, including social work, psychology, and medicine. The assessment integrates information from social histories, testing, and medical evaluations to understand a subject's neurobehavioral capacity and how impairments shape their behaviors and functioning in real-world contexts. This holistic understanding is essential for accurate forensic evaluations.
Chapter 1Mental Disorders as Discrete Clinical Conditions Dimen.docxketurahhazelhurst
Chapter 1
Mental Disorders as Discrete Clinical Conditions: Dimensional Versus Categorical Classification
Thomas A. Widiger and Cristina Crego
In DSM-IV, there [was] “no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder” (American Psychiatric Association [APA], APA, 2000, p. xxxi). This carefully worded disclaimer, however, was somewhat hollow, as it was the case that “DSM-IV [was] a categorical classification that divides mental disorders into types based on criterion sets with defining features” (APA, 2000, p. xxxi). The categorical model of classification is consistent with a medical tradition in which it is believed (and often confirmed in other areas of medicine) that disorders have specific etiologies, pathologies, and treatments (Guze, 1978; Guze & Helzer, 1987; Zachar & Kendler, 2007).
Clinicians, following this lead, diagnosed and conceptualized the conditions presented in DSM-IV-TR as disorders that are qualitatively distinct from normal functioning and from one another. DSM-IV-TR provided diagnostic criterion sets to help guide clinicians toward a purportedly correct diagnosis and an additional supplementary section devoted to differential diagnosis that indicated “how to differentiate [the] disorder from other disorders that have similar presenting characteristics” (APA, 2000, p. 10). The intention of the manual was to help the clinician determine which particular mental disorder provides the best explanation for the symptoms and problems facing the patient. Clinicians devote initial time with a new patient to identify, through differential diagnosis, which specific disorder best explains a patient's presenting complaints. The assumption is that the person is suffering from a single, distinct clinical condition, caused by a specific pathology for which there will be a specific treatment (Frances, First, & Pincus, 1995).
Authors of the diagnostic manual devote a considerable amount of time writing, revising, and researching diagnostic criteria to improve differential diagnosis. They buttress each disorder's criterion set, trying to shore up discriminant validity and distinctiveness, following the rubric of Robins and Guze (1970) that the validity of a diagnosis rests in large part on its “delimitation from other disorders” (p. 108). “These criteria should…permit exclusion of borderline cases and doubtful cases (an undiagnosed group) so that the index group may be as homogeneous as possible” (Robins & Guze, 1970, p. 108).
Scientists may devote their careers to attempting to identify the specific etiology, pathology, or treatment for a respective diagnostic category. Under the assumption that the diagnoses do in fact refer to qualitatively distinct conditions, it follows that there should be a specific etiology, pathology, and perhaps even a specific treatment for each respective disorder. The theories, hypothese ...
This document discusses a study on self-identification with major depressive disorder (MDD) among undergraduate college students. The study examined how exposure to diagnostic criteria and different patient accounts affected self-identification with MDD. Results showed those exposed to diagnostic criteria and an account of a clinically diagnosed patient were more likely to identify themselves as having MDD, compared to those exposed to other patient accounts or no additional information. The document provides background on rising internet use, depression prevalence among college students, and issues with primary care physicians prescribing antidepressants without oversight from mental health professionals. It argues proper diagnosis and long-term treatment are needed but often lacking.
Chapter 1Mental Disorders as Discrete Clinical Conditions Dimen.docxwalterl4
Chapter 1
Mental Disorders as Discrete Clinical Conditions: Dimensional Versus Categorical Classification
Thomas A. Widiger and Cristina Crego
In DSM-IV, there [was] “no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder” (American Psychiatric Association [APA], APA, 2000, p. xxxi). This carefully worded disclaimer, however, was somewhat hollow, as it was the case that “DSM-IV [was] a categorical classification that divides mental disorders into types based on criterion sets with defining features” (APA, 2000, p. xxxi). The categorical model of classification is consistent with a medical tradition in which it is believed (and often confirmed in other areas of medicine) that disorders have specific etiologies, pathologies, and treatments (Guze, 1978; Guze & Helzer, 1987; Zachar & Kendler, 2007).
Clinicians, following this lead, diagnosed and conceptualized the conditions presented in DSM-IV-TR as disorders that are qualitatively distinct from normal functioning and from one another. DSM-IV-TR provided diagnostic criterion sets to help guide clinicians toward a purportedly correct diagnosis and an additional supplementary section devoted to differential diagnosis that indicated “how to differentiate [the] disorder from other disorders that have similar presenting characteristics” (APA, 2000, p. 10). The intention of the manual was to help the clinician determine which particular mental disorder provides the best explanation for the symptoms and problems facing the patient. Clinicians devote initial time with a new patient to identify, through differential diagnosis, which specific disorder best explains a patient's presenting complaints. The assumption is that the person is suffering from a single, distinct clinical condition, caused by a specific pathology for which there will be a specific treatment (Frances, First, & Pincus, 1995).
Authors of the diagnostic manual devote a considerable amount of time writing, revising, and researching diagnostic criteria to improve differential diagnosis. They buttress each disorder's criterion set, trying to shore up discriminant validity and distinctiveness, following the rubric of Robins and Guze (1970) that the validity of a diagnosis rests in large part on its “delimitation from other disorders” (p. 108). “These criteria should…permit exclusion of borderline cases and doubtful cases (an undiagnosed group) so that the index group may be as homogeneous as possible” (Robins & Guze, 1970, p. 108).
Scientists may devote their careers to attempting to identify the specific etiology, pathology, or treatment for a respective diagnostic category. Under the assumption that the diagnoses do in fact refer to qualitatively distinct conditions, it follows that there should be a specific etiology, pathology, and perhaps even a specific treatment for each respective disorder. The theories, hypothese.
Research-Based Interventions: Dissociative Identity Disorder 1
THIS IS AN EXAMPLE PLEASE DO NO COPY DO NOT PLAGiarism
Research-Based Interventions: Dissociative Identity Disorder
“Dissociative identity disorder is characterized by the presence of two or more identities or personality states, each with its relatively enduring pattern of perceiving, relating to, and thinking about the environment and the self” (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). There are many characteristics used that accompany Dissociative Disorder (DID). One method to understanding would be to know how the disorders are classified and defined. DID may be conceptualized effectively using the diathesis-stress model. There are many different intervention strategies for this disorder as well. Over time researchers have discovered the most effective treatments and interventions that can be used regarding DID. When one dissociates, the person may not have conscious awareness of what is happening (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006).
Peer-reviewed Articles
One limitless, longitudinal, naturalistic, and prospective study investigated childhood maltreatment (CM) in adult intimate partner violence (IPV) victims among Dissociative Disorder (DD) patients with Dissociative Identity Disorder with CM rates of 80-95% and severe dissociative symptoms (Webermann, Brand, & Chasson, 2014). The methods of this study include 275 DD outpatient therapy patients who completed a self-reported measure of dissociation (Webermann, Brand, & Chasson, 2014). Analyses assessed associations between CM typologies, trait dissociation, and IPV (Webermann, Brand, & Chasson, 2014). The results of this study include emotional and physical child abuse associated with childhood witnessing of domestic violence, physical, and emotional IPV (Webermann, Brand, & Chasson, 2014) Two-tailed independent samples t -tests and z-tests were used in this study to represent data as well. “As an effect size, odds ratios (ORs) were calculated to predict the likelihood of a participant being in an abusive adult relationship if they experienced a particular type of CM” (Webermann, Brand, & Chasson, 2014, p. 5).
A double-blind study was conducted including 15 females with DID compared to 23 without psychopathology., chosen by self-disclosure results of a questionnaire along with a structured clinical interview by psychiatrists The objective was to examine the volumetric differences between amygdala and hippocampal volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). These researchers used MRI to measure volumes of the amygdala and hippocampus. The results included the volume of the hippocampus being 19.2 % smaller and the amygdala being 31.6% smaller in patients with DID when compared to the other subjects without psychopath ...
This document summarizes a meta-analysis that examined the associations between "Big" personality traits (from the Big Three and Big Five models) and specific anxiety, depressive, and substance use disorders. The meta-analysis included 175 studies published between 1980-2007, comprising 851 effect sizes. It found that neuroticism was strongly associated with all disorders, while low conscientiousness was also common across disorders. Many disorders also showed low extraversion. Disinhibition was specifically linked to substance use disorders. Agreeableness and openness showed few associations. Substance use disorders had a distinct profile of less neuroticism but more disinhibition and disagreeableness. The study provides evidence that common mental disorders are strongly linked
Asian Journal of Psychiatry 3 (2010) 96–98Special article.docxfestockton
Asian Journal of Psychiatry 3 (2010) 96–98
Special article
Depression vs. ‘‘understandable sadness’’: is the difference clear, and is it
relevant to treatment decisions?
Mario Maj
Department of Psychiatry, University of Naples, Naples, Italy
Contents lists available at ScienceDirect
Asian Journal of Psychiatry
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / a j p
A R T I C L E I N F O
Article history:
Received 2 July 2010
Accepted 8 July 2010
One of the items of the ‘‘neo-Kraepelinian credo’’, articulated in
the 1970s, was ‘‘there is a boundary between the normal and the
sick’’. In other terms, it was maintained that there is a clear,
qualitative distinction between persons who have a mental
disorder and persons who have not (Blashfield, 1984). A corollary
to this item was the statement that ‘‘depression, when carefully
defined as a clinical entity, is qualitatively different from the mild
episodes of sadness that everyone experiences at some point in his
or her life’’ (Blashfield, 1984). Apparently in line with this
statement was the observation that tricyclic antidepressants were
active only in people who were clinically depressed; when
administered to other people, they did not act as stimulant and
did not alter their mood.
Today, the picture appears much less clear, and this is certainly
in part a consequence of the evolution of psychiatric treatments.
Guidelines for treatment of major depression often contain
contradictory statements in this respect: on the one hand, the
assertion that it is important to clearly differentiate clinical
depression from normal adaptive responses to stress; on the other,
the warning that antidepressant medications are effective even in
the presence of significant life stress, and should not be withheld
solely because the condition is understandable. These statements
beget two questions: (a) Are we really able to distinguish between
a ‘‘dysfunctional’’ and an ‘‘adaptive’’ response to an adverse life
event? (b) Is this distinction clinically relevant, since treatment
decisions are expected not to be influenced by whether the
condition is understandable or not, but only by its clinical picture,
severity, duration and by the degree of impairment of social
functioning? These are questions with significant political, ethical,
scientific and clinical implications, which have become particu-
larly visible and pressing in the past few decades, in parallel to the
escalation of the prevalence rates of depression in community
E-mail address: [email protected]
1876-2018/$ – see front matter � 2010 Elsevier B.V. All rights reserved.
doi:10.1016/j.ajp.2010.07.004
studies, of the estimated social costs of depression, of the number
of patients in treatment for depression, and of the prescriptions of
antidepressant medications.
The National Comorbidity Survey, published in 1994, reported
that the 1-year prevalence of major depression in the US adult
community was about 10%, and the l ...
Behavioral avoidance mediates the relationship betweenanxi.docxikirkton
Behavioral avoidance mediates the relationship between
anxiety and depressive symptoms among social
anxiety disorder patients
§
Ethan Moitra, James D. Herbert *, Evan M. Forman
Department of Psychology, Drexel University, 245 N. 15th Street, MS 988, Philadelphia, PA, USA
Received 26 September 2007; received in revised form 20 December 2007; accepted 4 January 2008
Abstract
This study investigated the relationship between social anxiety, depressive symptoms, and behavioral avoidance among adult
patients with Social Anxiety Disorder (SAD). Epidemiological literature shows SAD is the most common comorbid disorder
associated with Major Depressive Disorder (MDD), though the relationship between these disorders has not been investigated. In
most cases, SAD onset precedes MDD, suggesting symptoms associated with SAD might lead to depression in some people. The
present study addressed this question by investigating the mediational role of behavioral avoidance in this clinical phenomenon,
using self-report data from treatment-seeking socially anxious adults. Mediational analyses were performed on a baseline sample of
190 individuals and on temporal data from a subset of this group. Results revealed behavioral avoidance mediated this relationship,
and supported the importance of addressing such avoidance in the therapeutic setting, via exposure and other methods, as a possible
means of preventing depressive symptom onset in socially anxious individuals.
# 2008 Elsevier Ltd. All rights reserved.
Journal of Anxiety Disorders 22 (2008) 1205–1213
Keywords: Social anxiety disorder; Depression; Behavioral avoidance
The lifetime prevalence of Social Anxiety Disorder
(SAD) in Western societies is quite high, ranging from
7% to 13% (Furmark, 2002). In fact, SAD is the most
common anxiety disorder in the U.S. and the third most
common psychiatric disorder, exceeded only by alcohol
dependence and Major Depressive Disorder (MDD;
Kessler et al., 1994). SAD is a disabling condition;
compared to people without psychiatric morbidity,
adults with SAD report lower employment rates, lower
§
Portions of this research were previously presented at the annual
meeting of the Anxiety Disorders Association of America in March
2006.
* Corresponding author. Tel.: +1 215 762 1692;
fax: +1 215 762 8706.
E-mail address: [email protected] (J.D. Herbert).
0887-6185/$ – see front matter # 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.janxdis.2008.01.002
income, and lower socio-economic status (Patel, Knapp,
Henderson, & Baldwin, 2002).
1. SAD and depression
SAD is also the most common comorbid anxiety
disorder with MDD, with estimates of SAD ranging
from 15% to 37% of depressed patients (Belzer &
Schneier, 2004; Fava et al., 2000; Kessler et al., 1994).
Comorbid SAD and MDD has been associated with an
earlier onset of MDD, more depressive episodes, longer
duration of episodes, a two-fold increased risk of
alcohol dependence, and an incr ...
This document discusses the importance of neurobehavioral assessment in forensic practice. It notes that many mental disorders previously seen as behavioral are now understood to have neurological roots. A neurobehavioral assessment evaluates cognitive functioning using expertise from multiple disciplines, including social work, psychology, and medicine. The assessment integrates information from social histories, testing, and medical evaluations to understand a subject's neurobehavioral capacity and how impairments shape their behaviors and functioning in real-world contexts. This holistic understanding is essential for accurate forensic evaluations.
Psychosocial interventions may be a safer alternative to antidepressant medication for treating depression in older adults. A literature review found that psychosocial interventions can be effective in reducing depressive symptoms and increasing self-efficacy in elderly populations. The review categorized psychosocial interventions into four groups: self-help, technology-based, social/befriending, and clinical approaches. While more research is still needed, available evidence suggests psychosocial therapies show potential for improving depression outcomes for older adults.
Contents lists available at ScienceDirectPsychiatry ResearAlleneMcclendon878
Contents lists available at ScienceDirect
Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres
Factors associated with depression, anxiety, and PTSD symptomatology
during the COVID-19 pandemic: Clinical implications for U.S. young adult
mental health
Cindy H. Liu (PhD)a,c,d,⁎, Emily Zhang (MA)a,c, Ga Tin Fifi Wong (BA)a,c, Sunah Hyun (PhD)a,c,
Hyeouk “Chris” Hahm (PhD)b,c
a Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
b Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
c School of Social Work, Boston University, Boston, MA, USA
d Harvard Medical School
A R T I C L E I N F O
Keywords:
Psychological stress, Loneliness
University health services
Social support
Ethnicity
COVID-19
Depression
Anxiety
PTSD
A B S T R A C T
This study sought to identify factors associated with depression, anxiety, and PTSD symptomatology in U.S.
young adults (18-30 years) during the COVID-19 pandemic. This cross-sectional online study assessed 898
participants from April 13, 2020 to May 19, 2020, approximately one month after the U.S. declared a state of
emergency due to COVID-19 and prior to the initial lifting of restrictions across 50 U.S. states. Respondents
reported high levels of depression (43.3%, PHQ-8 scores ≥ 10), high anxiety scores (45.4%, GAD-7 scores ≥
10), and high levels of PTSD symptoms (31.8%, PCL-C scores ≥ 45). High levels of loneliness, high levels of
COVID-19-specific worry, and low distress tolerance were significantly associated with clinical levels of de-
pression, anxiety, and PTSD symptoms. Resilience was associated with low levels of depression and anxiety
symptoms but not PTSD. Most respondents had high levels of social support; social support from family, but not
from partner or peers, was associated with low levels of depression and PTSD. Compared to Whites, Asian
Americans were less likely to report high levels across mental health symptoms, and Hispanic/Latinos were less
likely to report high levels of anxiety. These factors provide initial guidance regarding the clinical management
for COVID-19-related mental health problems.
1. Introduction
The COVID-19 pandemic that has upended the lives of individuals
worldwide escalated in the U.S. beginning in March of 2020. Although
research on acute and widescale stressors (e.g., natural disasters), de-
monstrates severe implications for mental health (Kessler et al., 2008),
there is no precedent for understanding the mental health effects due to
COVID-19, as prospective studies investigating the effects of a pan-
demic are virtually non-existent. In particular, the identification of risk
factors associated with depression, anxiety, and post-traumatic stress
disorder (PTSD) among U.S. young adults (18-30 years) during the
pandemic is urgently needed. Comprising more than one-third of the
current U.S. workforce, young adults (often referred to as “Millennials”
and “Generation Z”) will be a dominant workforce grou ...
Classification systems aim to organize mental disorders into categories based on their similarities to aid diagnosis, treatment, and research. The two major systems are the ICD-10 produced by the WHO and the DSM-5 produced by the APA. These systems classify disorders into broad groups such as mood disorders, psychotic disorders, substance abuse disorders, and more. However, there is no single agreed upon definition of mental disorder due to cultural and social factors.
Dissociative Identity Disorder (DID) is a complex disorder resulting from severe childhood trauma. Recent neurobiological research has provided insights into the brain mechanisms underlying DID and has informed the development of new treatment approaches. Phase-oriented treatment aims to help patients overcome fears of dissociated personality parts and traumatic memories through gradual exposure, with the goal of full personality integration. Promising treatments incorporate elements shown to affect relevant brain regions, such as hypnotherapy, and have been shown to potentially reverse brain changes caused by early trauma. Further research integrating biological and clinical understanding holds hope for more successful treatment outcomes.
Respond to at least two colleagues by explaining how they could use .docxcarlstromcurtis
Respond to at least two colleagues by explaining how they could use strategies to advocate for a client with a somatic symptom disorder given the reasons for advocacy they described.
Colleague 1: Brooke
Somatic symptom disorders are mental disorders that manifest with physical symptoms that are not always clear to explain with medical diagnosis (APA, 2013). One specific example of such a disorder is the Illness Anxiety Disorder (F45.21). This disorder is diagnosed when there is a pervasive and impacting preoccupation with having a serious medical condition in circumstances when no predisposition or existing symptomatology indicate there should be medical concern (APA, 2013). The diagnosed individual will exhibit heightened anxiety regarding their perceived condition. Furthermore, the diagnosis is classified as either “care-seeking type,” whereby the individual frequently seeks out medical guidance from professionals or “care-avoidant type: whereby the individual avoids medical care despite their ongoing concerns (APA, 2013).
This can present a unique challenge for guiding professionals, as the client is potentially in need of both medical and mental health care. Therefore, a biopsychosocial assessment is recommended to gain the most thorough, comprehensive picture of the client and their current set of circumstances. This multi aspect evaluation serves to understand the biological, or physical, contributors to the individual’s somatic diagnosis, while also delving into their perceptions and beliefs (psychological) and their social environment and experiences. When this information is gathered from these varied perspectives, intervention can be designed to target specific areas of need, with the understanding that medical care may be required, concurrently, with mental health support (Dimsdale, Patel, Xin and Kleinman, 2007).
Because of the complexity of such diagnoses, a multidisciplinary approach is deemed most effective when working with such clients. Because of the psychological involvement in this disorder, psychotherapy aimed at modifying existing thought patterns would be considered sound practice (Kirmayer and Sartorius, 2007). To expand, cognitive behavioral therapy (CBT) can be applied, increasing the client's awareness of their current thought patterns, possible triggers and strategies to combat negative thinking. Additionally, the prescription of medication to address the co-occurring anxiety or other resulting physical symptoms would be provided by a medical professional, such as a psychiatrist. This approach, widely accepted, allows for the client’s case to be viewed through different lenses.
While there is certainly significant validity in approaching such cases through a multidisciplinary team, the professionals required to ensure this effective intervention all have to be “on board.” This may require advocacy on the part of a social worker to convey the importance of employing this approach. It can b ...
This document discusses a study that explores whether convenience may cause practitioners to more readily diagnose ADHD. The study primed 150 college students with different levels of convenience and had them respond to vignettes describing ADHD. The study found no statistically significant relationship between the type of priming and the likelihood of diagnosis. The document provides background on the debate around rising ADHD diagnoses and whether overdiagnosis is a problem. It notes concerns about potential misdiagnosis, medication side effects, and diversion of stimulant drugs.
This document summarizes the rationale for the new diagnosis of somatic symptom disorder (SSD) in the DSM-5. The authors explain that SSD represents a consolidation of several previously separate diagnoses from the DSM-IV. It aims to address numerous issues with the previous somatoform disorder categories, such as unclear terminology, overreliance on the concept of "medically unexplained symptoms," overlapping criteria between diagnoses, and low reliability and prevalence rates in clinical practice. The new SSD criteria emphasize persistent somatic symptoms along with disproportionate thoughts, feelings and behaviors related to the symptoms, rather than focusing only on a lack of medical explanation for symptoms.
Literature Review- Major Depressive DisorderCooper Feild
This document provides a literature review on current research and perspectives regarding major depressive disorder (MDD). It summarizes research on the epidemiology, etiology, symptoms, and treatment of MDD. Regarding etiology, the document reviews research on anatomical, physiological, and genetic factors but notes the etiology is complex with no single cause identified. Treatment research indicates cognitive behavioral therapy can reduce relapse while incomplete recovery from initial episodes predicts a more severe long-term course. The review emphasizes the importance of fully understanding each patient's individual experience of MDD.
A narrative approach to body dysmorphic disorderTeresa Levy
This article proposes using narrative therapy to treat body dysmorphic disorder (BDD). BDD causes people to obsess over a perceived flaw in their appearance and affects 2% of the US population. Narrative therapy could help clients replace negative self-narratives influenced by sociocultural pressures with more empowering stories. The article outlines BDD and its treatment, describes narrative therapy theory and practice, provides a case example, and discusses implications for using narrative therapy for BDD.
This document provides an introduction to a paper that will compare and evaluate the effectiveness of cognitive behavioral therapy (CBT) and group psychotherapy in treating antisocial personality disorder. It defines antisocial personality disorder and discusses its causes, symptoms, diagnosis, and challenges in treatment. The paper will investigate CBT and group psychotherapy theories, analyzing their effects on treating antisocial personality disorder and comparing their advantages and disadvantages.
This study examined risk factors for suicidal behavior in 46,745 individuals in Sweden who received disability pensions due to common mental disorders from 2005-2010. The researchers found that 1,046 (2.2%) individuals attempted suicide and 210 (0.4%) committed suicide during the follow-up period. Younger age, lower education, and living alone were associated with higher risks of suicide attempt and suicide. Having received inpatient mental health treatment or treatment for a prior suicide attempt from 2001-2005, as well as being prescribed both antidepressants and anxiolytics in 2005, were strongly linked to later suicide attempts and suicide. The researchers concluded that both socio-demographic characteristics and previous healthcare and medication history should be considered when
A critique of outcome research in psychotherapy, and a proposal that more weight should be put on the ability fo therapists and clients to continue in relationships for as long as therapy remains active and mutative
The document discusses several modern perspectives on mental disorders: biological, psychological, sociocultural, and the diathesis-stress model. The biological perspective emphasizes the role of the nervous system, brain malfunctions, neurotransmitter imbalances, and genetics. The psychological perspective focuses on basic psychological processes and unconscious conflicts. The sociocultural perspective highlights the influence of social factors like poverty and education. The diathesis-stress model suggests disorders result from a predisposition interacting with environmental stressors. Assessment and diagnosis involve gathering information and identifying problems using systems like the DSM-IV. National surveys found higher rates of mental disorders in young people, especially young women, and the most common disorders were anxiety and affective disorders.
Obsessive compulsive disorder in adults assignment to turn in for gradeCASCHU3937
This document discusses obsessive compulsive disorder (OCD) in adults. It provides an overview of OCD, including its neurological and biological underpinnings such as involvement of cortico-striatal pathways and neurotransmitters like serotonin. Treatment options for OCD discussed include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and emerging interventions like deep brain stimulation. The document concludes by discussing future directions for research on OCD including use of neuroimaging to predict treatment response and identify biological markers.
Mental Health Policy - Defining mental illness, epidemiology, service use, an...Dr. James Swartz
The document discusses the evolution of definitions and classifications of mental disorders from DSM-II to the current DSM-5. It notes that DSM-III represented a radical departure by focusing on defining disorders based on observable symptoms rather than etiology. This symptom-based model allowed for more standardized diagnosis and epidemiological research but was also influenced by various political and economic pressures from pharmaceutical companies, clinicians, and insurers. Subsequent DSM revisions have continued expanding diagnoses and faced criticism for potentially overmedicalizing human suffering.
Specificity of Treatment Effects Cognitive Therapy and Relaxa.docxrafbolet0
Specificity of Treatment Effects: Cognitive Therapy and Relaxation for
Generalized Anxiety and Panic Disorders
Jedidiah Siev and Dianne L. Chambless
University of Pennsylvania
The aim of this study was to address claims that among bona fide treatments no one is more efficacious
than another by comparing the relative efficacy of cognitive therapy (CT) and relaxation therapy (RT) in
the treatment of generalized anxiety disorder (GAD) and panic disorder without agoraphobia (PD). Two
fixed-effects meta-analyses were conducted, for GAD and PD separately, to review the treatment
outcome literature directly comparing CT with RT in the treatment of those disorders. For GAD, CT and
RT were equivalent. For PD, CT, which included interoceptive exposure, outperformed RT on all
panic-related measures, as well as on indices of clinically significant change. There is ample evidence
that both CT and RT qualify as bona fide treatments for GAD and PD, for which they are efficacious and
intended to be so. Therefore, the finding that CT and RT do not differ in the treatment of GAD, but do
for PD, is evidence for the specificity of treatment to disorder, even for 2 treatments within a CBT class,
and 2 disorders within an anxiety class.
Keywords: generalized anxiety disorder, panic disorder, cognitive therapy, relaxation therapy, treatment
specificity
There has been extensive debate and controversy in recent years
regarding the utility of examining active ingredients versus com-
mon factors in psychotherapy. Wampold and colleagues (e.g., Ahn
& Wampold, 2001; Wampold et al., 1997) and Luborsky and
colleagues (e.g., Luborsky et al., 2002) have claimed that all forms
of psychotherapy are equivalent; what matters are the quality of
the therapeutic alliance and other factors common to all treatments
such as the presentation of a treatment rationale. Their assertions
are based on meta-analyses that combine treatments of all types
and disorders of all types, largely for adult patients. Researchers
have challenged their conclusions on the grounds that the fact that
all treatments for all disorders when combined do not differ from
each other does not imply that a particular treatment for a partic-
ular disorder is not superior (Chambless, 2002). Proponents of a
common factors approach to psychotherapy limit their contentions
to bona fide treatments, defined as “those that were delivered by
trained therapists and were based on psychological principles,
were offered to the psychotherapy community as viable treatments
(e.g., through professional books or manuals), or contained spec-
ified components” (Wampold et al., 1997, p. 205). This reasoning,
however, presupposes that a treatment can be, in and of itself, bona
fide, with no clinical referent: for the treatment of what?
Ahn and Wampold (2001) noted that “a familiar criticism of
meta-analysis” is that “aggregating across diverse studies yields
spurious conclusions” (p. 254). Certainly in conducting a meta-
analysis, .
Clients Presentation Your client can make up whatever they want.WilheminaRossi174
Clients Presentation: Your client can make up whatever they want. They can be as dramatic as they want to be. Have fun with it!
Subjective Data (4 points): (Review History questions in power point and on page 534-535 of text.)
Objective Data (4 points):
Inspection: What is the shape and size of the abdomen? Any masses or pulsations upon inspection? Skin smooth? Striae, scars, lesions?
Auscultation: Bowel Sounds Present in all 4 quadrants? Hypoactive, Normoactive, etc. Any bruits upon auscultation?
Percussion: Tympany in all 4 quadrants?
Palpation: Abdomen soft, firm? Any enlarged organs? Masses? Tenderness?
Any other objective data you found important to document?
Describe 2 Actual/Potential Risk Factors (2 points):
CHAPTER 15
15.1 INTRODUCTION
Although in some cases behavioral and psychiatric/mental are grouped under the same broad
category, behavioral health problems are generally effectively treated on an outpatient basis with
combination psychotherapy and pharmacotherapy (medications). Behavioral health professionals
are licensed by the state in which they reside to practice, and they collaborate on the management
of clients’ behavioral problems. These professionals include psychiatrists, psychologists,
psychiatric nurse practitioners, social workers, family counselors, and drug/alcohol and mental
health counselors (Parker, 2002). Such chronic problems as dementia and mental retardation are
considered psychiatric/mental problems rather than behavioral.
There is a distinct interconnectedness between mental health and health in general. The WHO
defines health as, “a state of complete physical, mental, and social well-being, and not merely the
absence of disease and infirmity” (WHO, 2001b, p. 1). Mental health on the other hand is defined
as, “a state of well-being in which the individual realizes his or her own abilities, can cope with the
normal stress of life, can work productively and fruitfully, and is able to make a contribution to his
or her community … it is determined by socioeconomic and environmental factors and it is linked
to behavior” (WHO, 2001a, p. 1; WHO 2010, p. 1). For example, people are generally resilient
enough ...
This document summarizes a research study that surveyed 837 mental health professionals to determine their views on various models of mental illness. It found that professionals' endorsement of models differed depending on the specific illness. For schizophrenia, they most endorsed a biological model followed by cognitive and behavioral aspects. For depression, a social model was most endorsed followed by cognitive and behavioral aspects, with biological being least endorsed. For antisocial personality disorder, professionals most endorsed social constructionist and nihilist models, suggesting lack of interest in viewing it as a mental illness. The implications of professionals' endorsed models are discussed, such as impacts on treatment approaches, responsibility attribution, stigma, and access to social benefits.
A Theoretical Framework For Future ResearchKarin Faust
1) The paper discusses future directions for research on suicide, noting the need to distinguish between attempters and completers as they represent distinct populations.
2) A major risk factor for suicide is the presence of a major mental disorder like depression or bipolar disorder. Genetic vulnerability also contributes significantly to suicide risk.
3) Future research should use standardized epidemiological techniques to study samples beyond just clinical patients, and conduct intensive longitudinal studies to distinguish trait from state factors. Biomarkers like serotonin may differ in their association with suicide between diagnostic groups.
Speak to the idea of feminism from your perspective and.docxstirlingvwriters
The document asks students to discuss their perspectives on feminism by answering several questions: 1) What they were taught about feminism by family/culture, 2) If they identify as a feminist and how that label may change based on audience, 3) The most important issue regarding feminism/gender equality today, 4) Whether the quote about privilege and equality resonates regarding gender, and 5) What they wish another gender understood about their experiences. Students are asked to write a minimum 270-word initial post responding to the questions.
Demand/Supply Integration (DSI) aims to align demand signals with supply planning to achieve an ideal state where inventory levels and production schedules match customer demand. However, issues like data or system silos between functions can prevent the ideal DSI state. Warehouses and distribution centers create value in the supply chain by storing inventory in strategic locations to efficiently meet customer demand and support supply chain operations.
More Related Content
Similar to Studying Mental Health Problems as Not Syndromes.pdf
Psychosocial interventions may be a safer alternative to antidepressant medication for treating depression in older adults. A literature review found that psychosocial interventions can be effective in reducing depressive symptoms and increasing self-efficacy in elderly populations. The review categorized psychosocial interventions into four groups: self-help, technology-based, social/befriending, and clinical approaches. While more research is still needed, available evidence suggests psychosocial therapies show potential for improving depression outcomes for older adults.
Contents lists available at ScienceDirectPsychiatry ResearAlleneMcclendon878
Contents lists available at ScienceDirect
Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres
Factors associated with depression, anxiety, and PTSD symptomatology
during the COVID-19 pandemic: Clinical implications for U.S. young adult
mental health
Cindy H. Liu (PhD)a,c,d,⁎, Emily Zhang (MA)a,c, Ga Tin Fifi Wong (BA)a,c, Sunah Hyun (PhD)a,c,
Hyeouk “Chris” Hahm (PhD)b,c
a Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
b Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
c School of Social Work, Boston University, Boston, MA, USA
d Harvard Medical School
A R T I C L E I N F O
Keywords:
Psychological stress, Loneliness
University health services
Social support
Ethnicity
COVID-19
Depression
Anxiety
PTSD
A B S T R A C T
This study sought to identify factors associated with depression, anxiety, and PTSD symptomatology in U.S.
young adults (18-30 years) during the COVID-19 pandemic. This cross-sectional online study assessed 898
participants from April 13, 2020 to May 19, 2020, approximately one month after the U.S. declared a state of
emergency due to COVID-19 and prior to the initial lifting of restrictions across 50 U.S. states. Respondents
reported high levels of depression (43.3%, PHQ-8 scores ≥ 10), high anxiety scores (45.4%, GAD-7 scores ≥
10), and high levels of PTSD symptoms (31.8%, PCL-C scores ≥ 45). High levels of loneliness, high levels of
COVID-19-specific worry, and low distress tolerance were significantly associated with clinical levels of de-
pression, anxiety, and PTSD symptoms. Resilience was associated with low levels of depression and anxiety
symptoms but not PTSD. Most respondents had high levels of social support; social support from family, but not
from partner or peers, was associated with low levels of depression and PTSD. Compared to Whites, Asian
Americans were less likely to report high levels across mental health symptoms, and Hispanic/Latinos were less
likely to report high levels of anxiety. These factors provide initial guidance regarding the clinical management
for COVID-19-related mental health problems.
1. Introduction
The COVID-19 pandemic that has upended the lives of individuals
worldwide escalated in the U.S. beginning in March of 2020. Although
research on acute and widescale stressors (e.g., natural disasters), de-
monstrates severe implications for mental health (Kessler et al., 2008),
there is no precedent for understanding the mental health effects due to
COVID-19, as prospective studies investigating the effects of a pan-
demic are virtually non-existent. In particular, the identification of risk
factors associated with depression, anxiety, and post-traumatic stress
disorder (PTSD) among U.S. young adults (18-30 years) during the
pandemic is urgently needed. Comprising more than one-third of the
current U.S. workforce, young adults (often referred to as “Millennials”
and “Generation Z”) will be a dominant workforce grou ...
Classification systems aim to organize mental disorders into categories based on their similarities to aid diagnosis, treatment, and research. The two major systems are the ICD-10 produced by the WHO and the DSM-5 produced by the APA. These systems classify disorders into broad groups such as mood disorders, psychotic disorders, substance abuse disorders, and more. However, there is no single agreed upon definition of mental disorder due to cultural and social factors.
Dissociative Identity Disorder (DID) is a complex disorder resulting from severe childhood trauma. Recent neurobiological research has provided insights into the brain mechanisms underlying DID and has informed the development of new treatment approaches. Phase-oriented treatment aims to help patients overcome fears of dissociated personality parts and traumatic memories through gradual exposure, with the goal of full personality integration. Promising treatments incorporate elements shown to affect relevant brain regions, such as hypnotherapy, and have been shown to potentially reverse brain changes caused by early trauma. Further research integrating biological and clinical understanding holds hope for more successful treatment outcomes.
Respond to at least two colleagues by explaining how they could use .docxcarlstromcurtis
Respond to at least two colleagues by explaining how they could use strategies to advocate for a client with a somatic symptom disorder given the reasons for advocacy they described.
Colleague 1: Brooke
Somatic symptom disorders are mental disorders that manifest with physical symptoms that are not always clear to explain with medical diagnosis (APA, 2013). One specific example of such a disorder is the Illness Anxiety Disorder (F45.21). This disorder is diagnosed when there is a pervasive and impacting preoccupation with having a serious medical condition in circumstances when no predisposition or existing symptomatology indicate there should be medical concern (APA, 2013). The diagnosed individual will exhibit heightened anxiety regarding their perceived condition. Furthermore, the diagnosis is classified as either “care-seeking type,” whereby the individual frequently seeks out medical guidance from professionals or “care-avoidant type: whereby the individual avoids medical care despite their ongoing concerns (APA, 2013).
This can present a unique challenge for guiding professionals, as the client is potentially in need of both medical and mental health care. Therefore, a biopsychosocial assessment is recommended to gain the most thorough, comprehensive picture of the client and their current set of circumstances. This multi aspect evaluation serves to understand the biological, or physical, contributors to the individual’s somatic diagnosis, while also delving into their perceptions and beliefs (psychological) and their social environment and experiences. When this information is gathered from these varied perspectives, intervention can be designed to target specific areas of need, with the understanding that medical care may be required, concurrently, with mental health support (Dimsdale, Patel, Xin and Kleinman, 2007).
Because of the complexity of such diagnoses, a multidisciplinary approach is deemed most effective when working with such clients. Because of the psychological involvement in this disorder, psychotherapy aimed at modifying existing thought patterns would be considered sound practice (Kirmayer and Sartorius, 2007). To expand, cognitive behavioral therapy (CBT) can be applied, increasing the client's awareness of their current thought patterns, possible triggers and strategies to combat negative thinking. Additionally, the prescription of medication to address the co-occurring anxiety or other resulting physical symptoms would be provided by a medical professional, such as a psychiatrist. This approach, widely accepted, allows for the client’s case to be viewed through different lenses.
While there is certainly significant validity in approaching such cases through a multidisciplinary team, the professionals required to ensure this effective intervention all have to be “on board.” This may require advocacy on the part of a social worker to convey the importance of employing this approach. It can b ...
This document discusses a study that explores whether convenience may cause practitioners to more readily diagnose ADHD. The study primed 150 college students with different levels of convenience and had them respond to vignettes describing ADHD. The study found no statistically significant relationship between the type of priming and the likelihood of diagnosis. The document provides background on the debate around rising ADHD diagnoses and whether overdiagnosis is a problem. It notes concerns about potential misdiagnosis, medication side effects, and diversion of stimulant drugs.
This document summarizes the rationale for the new diagnosis of somatic symptom disorder (SSD) in the DSM-5. The authors explain that SSD represents a consolidation of several previously separate diagnoses from the DSM-IV. It aims to address numerous issues with the previous somatoform disorder categories, such as unclear terminology, overreliance on the concept of "medically unexplained symptoms," overlapping criteria between diagnoses, and low reliability and prevalence rates in clinical practice. The new SSD criteria emphasize persistent somatic symptoms along with disproportionate thoughts, feelings and behaviors related to the symptoms, rather than focusing only on a lack of medical explanation for symptoms.
Literature Review- Major Depressive DisorderCooper Feild
This document provides a literature review on current research and perspectives regarding major depressive disorder (MDD). It summarizes research on the epidemiology, etiology, symptoms, and treatment of MDD. Regarding etiology, the document reviews research on anatomical, physiological, and genetic factors but notes the etiology is complex with no single cause identified. Treatment research indicates cognitive behavioral therapy can reduce relapse while incomplete recovery from initial episodes predicts a more severe long-term course. The review emphasizes the importance of fully understanding each patient's individual experience of MDD.
A narrative approach to body dysmorphic disorderTeresa Levy
This article proposes using narrative therapy to treat body dysmorphic disorder (BDD). BDD causes people to obsess over a perceived flaw in their appearance and affects 2% of the US population. Narrative therapy could help clients replace negative self-narratives influenced by sociocultural pressures with more empowering stories. The article outlines BDD and its treatment, describes narrative therapy theory and practice, provides a case example, and discusses implications for using narrative therapy for BDD.
This document provides an introduction to a paper that will compare and evaluate the effectiveness of cognitive behavioral therapy (CBT) and group psychotherapy in treating antisocial personality disorder. It defines antisocial personality disorder and discusses its causes, symptoms, diagnosis, and challenges in treatment. The paper will investigate CBT and group psychotherapy theories, analyzing their effects on treating antisocial personality disorder and comparing their advantages and disadvantages.
This study examined risk factors for suicidal behavior in 46,745 individuals in Sweden who received disability pensions due to common mental disorders from 2005-2010. The researchers found that 1,046 (2.2%) individuals attempted suicide and 210 (0.4%) committed suicide during the follow-up period. Younger age, lower education, and living alone were associated with higher risks of suicide attempt and suicide. Having received inpatient mental health treatment or treatment for a prior suicide attempt from 2001-2005, as well as being prescribed both antidepressants and anxiolytics in 2005, were strongly linked to later suicide attempts and suicide. The researchers concluded that both socio-demographic characteristics and previous healthcare and medication history should be considered when
A critique of outcome research in psychotherapy, and a proposal that more weight should be put on the ability fo therapists and clients to continue in relationships for as long as therapy remains active and mutative
The document discusses several modern perspectives on mental disorders: biological, psychological, sociocultural, and the diathesis-stress model. The biological perspective emphasizes the role of the nervous system, brain malfunctions, neurotransmitter imbalances, and genetics. The psychological perspective focuses on basic psychological processes and unconscious conflicts. The sociocultural perspective highlights the influence of social factors like poverty and education. The diathesis-stress model suggests disorders result from a predisposition interacting with environmental stressors. Assessment and diagnosis involve gathering information and identifying problems using systems like the DSM-IV. National surveys found higher rates of mental disorders in young people, especially young women, and the most common disorders were anxiety and affective disorders.
Obsessive compulsive disorder in adults assignment to turn in for gradeCASCHU3937
This document discusses obsessive compulsive disorder (OCD) in adults. It provides an overview of OCD, including its neurological and biological underpinnings such as involvement of cortico-striatal pathways and neurotransmitters like serotonin. Treatment options for OCD discussed include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and emerging interventions like deep brain stimulation. The document concludes by discussing future directions for research on OCD including use of neuroimaging to predict treatment response and identify biological markers.
Mental Health Policy - Defining mental illness, epidemiology, service use, an...Dr. James Swartz
The document discusses the evolution of definitions and classifications of mental disorders from DSM-II to the current DSM-5. It notes that DSM-III represented a radical departure by focusing on defining disorders based on observable symptoms rather than etiology. This symptom-based model allowed for more standardized diagnosis and epidemiological research but was also influenced by various political and economic pressures from pharmaceutical companies, clinicians, and insurers. Subsequent DSM revisions have continued expanding diagnoses and faced criticism for potentially overmedicalizing human suffering.
Specificity of Treatment Effects Cognitive Therapy and Relaxa.docxrafbolet0
Specificity of Treatment Effects: Cognitive Therapy and Relaxation for
Generalized Anxiety and Panic Disorders
Jedidiah Siev and Dianne L. Chambless
University of Pennsylvania
The aim of this study was to address claims that among bona fide treatments no one is more efficacious
than another by comparing the relative efficacy of cognitive therapy (CT) and relaxation therapy (RT) in
the treatment of generalized anxiety disorder (GAD) and panic disorder without agoraphobia (PD). Two
fixed-effects meta-analyses were conducted, for GAD and PD separately, to review the treatment
outcome literature directly comparing CT with RT in the treatment of those disorders. For GAD, CT and
RT were equivalent. For PD, CT, which included interoceptive exposure, outperformed RT on all
panic-related measures, as well as on indices of clinically significant change. There is ample evidence
that both CT and RT qualify as bona fide treatments for GAD and PD, for which they are efficacious and
intended to be so. Therefore, the finding that CT and RT do not differ in the treatment of GAD, but do
for PD, is evidence for the specificity of treatment to disorder, even for 2 treatments within a CBT class,
and 2 disorders within an anxiety class.
Keywords: generalized anxiety disorder, panic disorder, cognitive therapy, relaxation therapy, treatment
specificity
There has been extensive debate and controversy in recent years
regarding the utility of examining active ingredients versus com-
mon factors in psychotherapy. Wampold and colleagues (e.g., Ahn
& Wampold, 2001; Wampold et al., 1997) and Luborsky and
colleagues (e.g., Luborsky et al., 2002) have claimed that all forms
of psychotherapy are equivalent; what matters are the quality of
the therapeutic alliance and other factors common to all treatments
such as the presentation of a treatment rationale. Their assertions
are based on meta-analyses that combine treatments of all types
and disorders of all types, largely for adult patients. Researchers
have challenged their conclusions on the grounds that the fact that
all treatments for all disorders when combined do not differ from
each other does not imply that a particular treatment for a partic-
ular disorder is not superior (Chambless, 2002). Proponents of a
common factors approach to psychotherapy limit their contentions
to bona fide treatments, defined as “those that were delivered by
trained therapists and were based on psychological principles,
were offered to the psychotherapy community as viable treatments
(e.g., through professional books or manuals), or contained spec-
ified components” (Wampold et al., 1997, p. 205). This reasoning,
however, presupposes that a treatment can be, in and of itself, bona
fide, with no clinical referent: for the treatment of what?
Ahn and Wampold (2001) noted that “a familiar criticism of
meta-analysis” is that “aggregating across diverse studies yields
spurious conclusions” (p. 254). Certainly in conducting a meta-
analysis, .
Clients Presentation Your client can make up whatever they want.WilheminaRossi174
Clients Presentation: Your client can make up whatever they want. They can be as dramatic as they want to be. Have fun with it!
Subjective Data (4 points): (Review History questions in power point and on page 534-535 of text.)
Objective Data (4 points):
Inspection: What is the shape and size of the abdomen? Any masses or pulsations upon inspection? Skin smooth? Striae, scars, lesions?
Auscultation: Bowel Sounds Present in all 4 quadrants? Hypoactive, Normoactive, etc. Any bruits upon auscultation?
Percussion: Tympany in all 4 quadrants?
Palpation: Abdomen soft, firm? Any enlarged organs? Masses? Tenderness?
Any other objective data you found important to document?
Describe 2 Actual/Potential Risk Factors (2 points):
CHAPTER 15
15.1 INTRODUCTION
Although in some cases behavioral and psychiatric/mental are grouped under the same broad
category, behavioral health problems are generally effectively treated on an outpatient basis with
combination psychotherapy and pharmacotherapy (medications). Behavioral health professionals
are licensed by the state in which they reside to practice, and they collaborate on the management
of clients’ behavioral problems. These professionals include psychiatrists, psychologists,
psychiatric nurse practitioners, social workers, family counselors, and drug/alcohol and mental
health counselors (Parker, 2002). Such chronic problems as dementia and mental retardation are
considered psychiatric/mental problems rather than behavioral.
There is a distinct interconnectedness between mental health and health in general. The WHO
defines health as, “a state of complete physical, mental, and social well-being, and not merely the
absence of disease and infirmity” (WHO, 2001b, p. 1). Mental health on the other hand is defined
as, “a state of well-being in which the individual realizes his or her own abilities, can cope with the
normal stress of life, can work productively and fruitfully, and is able to make a contribution to his
or her community … it is determined by socioeconomic and environmental factors and it is linked
to behavior” (WHO, 2001a, p. 1; WHO 2010, p. 1). For example, people are generally resilient
enough ...
This document summarizes a research study that surveyed 837 mental health professionals to determine their views on various models of mental illness. It found that professionals' endorsement of models differed depending on the specific illness. For schizophrenia, they most endorsed a biological model followed by cognitive and behavioral aspects. For depression, a social model was most endorsed followed by cognitive and behavioral aspects, with biological being least endorsed. For antisocial personality disorder, professionals most endorsed social constructionist and nihilist models, suggesting lack of interest in viewing it as a mental illness. The implications of professionals' endorsed models are discussed, such as impacts on treatment approaches, responsibility attribution, stigma, and access to social benefits.
A Theoretical Framework For Future ResearchKarin Faust
1) The paper discusses future directions for research on suicide, noting the need to distinguish between attempters and completers as they represent distinct populations.
2) A major risk factor for suicide is the presence of a major mental disorder like depression or bipolar disorder. Genetic vulnerability also contributes significantly to suicide risk.
3) Future research should use standardized epidemiological techniques to study samples beyond just clinical patients, and conduct intensive longitudinal studies to distinguish trait from state factors. Biomarkers like serotonin may differ in their association with suicide between diagnostic groups.
Similar to Studying Mental Health Problems as Not Syndromes.pdf (20)
Speak to the idea of feminism from your perspective and.docxstirlingvwriters
The document asks students to discuss their perspectives on feminism by answering several questions: 1) What they were taught about feminism by family/culture, 2) If they identify as a feminist and how that label may change based on audience, 3) The most important issue regarding feminism/gender equality today, 4) Whether the quote about privilege and equality resonates regarding gender, and 5) What they wish another gender understood about their experiences. Students are asked to write a minimum 270-word initial post responding to the questions.
Demand/Supply Integration (DSI) aims to align demand signals with supply planning to achieve an ideal state where inventory levels and production schedules match customer demand. However, issues like data or system silos between functions can prevent the ideal DSI state. Warehouses and distribution centers create value in the supply chain by storing inventory in strategic locations to efficiently meet customer demand and support supply chain operations.
Thinking about password identify two that you believe are.docxstirlingvwriters
Brute force and dictionary attacks are two of the most dangerous password attacks. Brute force attacks can reveal passwords by trying all possible combinations, while dictionary attacks use common words and personal information to crack passwords. Organizations can implement strong password policies, multi-factor authentication, and monitoring for brute force attempts to better protect against these attacks.
The student will demonstrate and articulate proficiency in.docxstirlingvwriters
The student will demonstrate their clinical reasoning and prioritizing skills by reviewing a client case study, gathering evaluation and test results, and using this data to develop both long term and short term goals for the client's plan of care. To complete this assignment, the student will be provided a case study involving various impairments and dysfunctions and will analyze the evaluation to determine and write appropriate long and short term goals.
To help lay the foundation for your study of postmodern.docxstirlingvwriters
This document provides guidance for studying postmodern models of marriage and family therapy. It lists topics for discussion with a professor including social constructionism versus systems theory, postmodern philosophy assumptions versus modernist therapists, components of the recovery model, and identifying a personal model of MFT. Students are asked to discuss one unclear concept with the professor to improve their understanding.
TITLE Digital marketing before and after pandemic Sections that.docxstirlingvwriters
This document outlines the required sections for a report on digital marketing before and after the pandemic. The report must include an Introduction section describing the topic, a Discussion section comparing digital marketing practices pre- and post-pandemic, and a Conclusion section. An additional section on changes in consumer habits during the pandemic is recommended. Each section should be briefly described and references included.
This assignment focuses on Marxist students will educate.docxstirlingvwriters
The document instructs students to analyze the 2014 Flint, Michigan lead water crisis from a Marxist class perspective. Students are asked to educate themselves on the crisis, present the demographics of Flint, and explain the issues. They should then apply Marxist's two-class analysis of bourgeoisie and proletariat, as well as two social concepts, relating these to the crisis. At least two peer-reviewed sources no older than five years should validate the arguments.
The document provides a prompt for a 2-page journal entry discussing the role of art in promoting social change in America, referring to at least three works read in class: Upton Sinclair's "The Jungle", W.E.B. Du Bois's "The Souls of Black Folk", and Richard Wright's "Native Son". The journal must specifically analyze how these three novels addressed and impacted social issues through literature, supported by references from the texts, and should reflect knowledge of the authors and themes without summarizing plot.
The document discusses cybersecurity topics including botnets, intrusion detection systems, international efforts to support Ukrainian cyber defense, and cyber threat intelligence analysis regarding video conferencing software vulnerabilities. Specifically, it asks the reader to:
1) Name 5 intrusion detection system alternatives to Snort.
2) Describe 3 international efforts that support Ukrainian cyber defense based on a provided table from a Carnegie Endowment website.
3) Compile lists of known vulnerabilities in Zoom, Cisco WebEx, and Microsoft Teams and recommend one based on security. It also asks the reader to identify resources with official patch notes for these tools and discuss the details and timings provided in the notes and whether they would change the initial recommendation.
There are many possible sources of literature for.docxstirlingvwriters
This document discusses sources for literature on a research topic, including West Coast University library databases like Medline, Cinahl, and PubMed. It asks the reader to identify specific scholarly articles used for their topic and why they were chosen. It also prompts sharing the chosen change project with peers, including clinical questions on the topic and subtopics to guide research. The reader is asked to explain why their preceptor decided this change was needed and how it will occur.
You enter your project team meeting with Mike and Tiffany.docxstirlingvwriters
Mike and Tiffany met to discuss tools for analyzing their industry and competitors to support an upcoming board decision. Tiffany was impressed by the many options, while Mike wanted to carefully consider what information was needed. Through research, Mike and Tiffany identified some useful tools for their analysis.
Write a minimum of 200 words response to each post.docxstirlingvwriters
SoftBank, a large Japanese investment company, lacks an effective succession plan for replacing its founder and CEO Masayoshi Son. As Son's health declines, SoftBank has struggled to identify potential successors within the company who have the necessary skills and experience. Past attempts to groom outside executives as successors have failed. Effective succession planning requires developing talent internally, understanding cultural factors, and job shadowing potential successors. SoftBank's lack of succession planning could disrupt the company's culture and strategy when new leadership eventually takes over.
The document discusses Rosa's Law, a video about laws relating to the treatment of the disabled. Early laws were permissive but now laws protecting disabled individuals are mandatory. The document asks the reader to discuss similarities and differences between recent disability laws and potential positive and negative ramifications of these laws becoming mandatory.
Your software has gone live and is in the production.docxstirlingvwriters
Your software has gone live in production and is now being supported by the IT team. User acceptance testing is important for getting user feedback on the software in a real-world environment before full release to catch any remaining bugs or usability issues. Supporting software after deployment can be challenging due to needing to quickly fix any issues users encounter while preventing disruptions.
This learning was a cornucopia of enrichment with regard.docxstirlingvwriters
This week's class taught the author new skills in utilizing collaboration tools, formatting, and translation features in Microsoft Word. The author was surprised by the translation tool's usefulness for sharing work internationally. Learning these new skills will enhance the author's research documents and ability to work with colleagues around the world.
This is a school community relations My chosen school.docxstirlingvwriters
This school community relations plan is for Iowa Colony High School in Texas. The author does not currently teach at this school due to being diagnosed with Lupus and chose it as a new school to focus on. Examples were shared with the class along with instructions, and the author requests help working with the materials as they do not feel well.
This 3 page double spaced document discusses issues at HCL Technologies and the management style of Vineet. It outlines problems at HCL such as not following market trends, low employee morale leading to a 30% attrition rate, and a lack of coordination between business units. The document instructs the writer to analyze whether Vineet was a good or bad leader and to refer to a provided PPT to discuss his management style using concepts from class. The writer is only allowed to use one source, which is provided by HCL Technologies.
Sociology researches social issues through the use of theoretical.docxstirlingvwriters
1. Sociology examines social issues through theoretical frameworks like conflict theory, functionalism, and symbolic interactionism. A sociologist might ask different questions about a news story on police brutality, poverty, or sexual assault depending on which framework they use. These differing approaches combined can build a deeper understanding of the issue.
2. For a personal problem like high tuition costs or unemployment, viewing it only as personal or as influenced by public issues would lead to different ways of making sense of and finding solutions to the problem.
3. Explanations for the high U.S. college dropout rate would differ depending on a micro, meso, or macro analysis. A study might focus on the micro level of individual experiences
This document provides instructions to listen to a podcast called "Trail of Tears" from This American Life and then answer two questions about it. The questions ask what part of the story struck the reader the most and why, and why the human aspect of the Trail of Tears is often ignored in favor of just presenting the facts.
You are the newly hired Director of Risk Management for.docxstirlingvwriters
You have been hired as the new Director of Risk Management for Westview Clinical Center. Westview is facing a crisis as a recent state audit found that 85% of readmissions were due to secondary infections acquired at the hospital. Most infections were bacterial. To remain open, Westview must determine how infections are spreading, provide additional staff training, and draft a risk management plan to prevent future infections. As the new Director of Risk Management, you have been tasked with solving this problem.
A Guide to a Winning Interview June 2024Bruce Bennett
This webinar is an in-depth review of the interview process. Preparation is a key element to acing an interview. Learn the best approaches from the initial phone screen to the face-to-face meeting with the hiring manager. You will hear great answers to several standard questions, including the dreaded “Tell Me About Yourself”.
Resumes, Cover Letters, and Applying OnlineBruce Bennett
This webinar showcases resume styles and the elements that go into building your resume. Every job application requires unique skills, and this session will show you how to improve your resume to match the jobs to which you are applying. Additionally, we will discuss cover letters and learn about ideas to include. Every job application requires unique skills so learn ways to give you the best chance of success when applying for a new position. Learn how to take advantage of all the features when uploading a job application to a company’s applicant tracking system.
Job Finding Apps Everything You Need to Know in 2024SnapJob
SnapJob is revolutionizing the way people connect with work opportunities and find talented professionals for their projects. Find your dream job with ease using the best job finding apps. Discover top-rated apps that connect you with employers, provide personalized job recommendations, and streamline the application process. Explore features, ratings, and reviews to find the app that suits your needs and helps you land your next opportunity.
Leadership Ambassador club Adventist modulekakomaeric00
Aims to equip people who aspire to become leaders with good qualities,and with Christian values and morals as per Biblical teachings.The you who aspire to be leaders should first read and understand what the ambassador module for leadership says about leadership and marry that to what the bible says.Christians sh
5 Common Mistakes to Avoid During the Job Application Process.pdfAlliance Jobs
The journey toward landing your dream job can be both exhilarating and nerve-wracking. As you navigate through the intricate web of job applications, interviews, and follow-ups, it’s crucial to steer clear of common pitfalls that could hinder your chances. Let’s delve into some of the most frequent mistakes applicants make during the job application process and explore how you can sidestep them. Plus, we’ll highlight how Alliance Job Search can enhance your local job hunt.
Jill Pizzola's Tenure as Senior Talent Acquisition Partner at THOMSON REUTERS...dsnow9802
Jill Pizzola's tenure as Senior Talent Acquisition Partner at THOMSON REUTERS in Marlton, New Jersey, from 2018 to 2023, was marked by innovation and excellence.
2. oversimplification of mental illness. The first is diagnostic literalism, mistaking mental
health problems (complex within-person processes) for the diagnoses by which they are
classified (clinically useful idealizations to facilitate treatment selection and prognosis). The
second is reductionism, the isolated study of individual elements of mental disorders. I
propose conceptualizing people’s mental health states as outcomes emerging from complex
systems of biological, psychological, and social elements and show that this systems
perspective explains many robust phenomena, including variability within diagnoses,
comorbidity among diagnoses, and transdiagnostic risk factors. It helps us understand
diagnoses and reductionism as useful epistemological tools for describing the world, rather
than ontological convictions about how the world is. It provides new lenses through which
to study mental illness (e.g., attractor states, phase transitions), and new levers to treat
them (e.g., early warning signals, novel treatment targets). Embracing the complexity of
mental health problems requires opening our ivory towers to theories and methods from
other fields with rich traditions, including network and systems
sciences.Keywordsbiological reductionism, complex systems, diagnostic literalism,
emergence, mental disorders, psychiatric nosology, reductionism
Current Directions in Psychological Science 31(6) 501Similar developments can be
observed for other diag-noses. Many of DSM’s iterations, such as DSM-5’s transi-tion from a
categorical to a dimensional model of personality disorders, were based on data. But psychi-
atric nosology is “a pragmatic compromise among mul-tiple competing demands and
constituencies” (Lilienfeld, 2014, p. 269) and has been driven by adherence to prec-edent,
patient advocacy, lobbying efforts, and goals to minimize stigma and avoid excessive
prevalence rates. These sociopolitical forces have shaped the DSM, as have historical forces
and path dependence (Lilienfeld, 2014; Scull, 2021). Feighner, for example, could have
relied on one of the many frameworks competing with Cassidy’s views, which would have
eventually led to a somewhat different DSM-5. And if Wernicke (an influential competi-tor
of one of the founding fathers of modern psychiatry, Kraepelin) had not died prematurely in
a bicycle acci-dent, psychiatric nosology as a whole might look some-what different today
(Kendler, 2016a).Diagnostic LiteralismMental health problems are complex,
biopsychosocial processes that unfold in individuals over time. In con-trast, diagnoses are
categorical idealizations designed as clinically useful tools to facilitate communication,
accurate prognosis, and treatment selection and plan-ning. Mental health problems can be
described as diag-noses, and such description can be immensely helpful for research and
clinical practice, but mental health problems and diagnoses are not the same kind of thing.
Conflating the two is called diagnostic literalism (also referred to as reification or
essentialism; Adriaens & De Block, 2013; Kendler, 2016b; Kendler et al., 2011; Zachar,
2014), that is, taking diagnoses for more than they are.The following eight observations
help clarify the difference between mental health problems and diag-noses and are
expected results from superimposing clinical idealizations on the complex landscape of
men-tal disorders (Hyman, 2021).1. For most diagnoses, DSM ignores causes and etiology.2.
Classification systems such as DSM and ICD dif-fer considerably in their conceptualization
of some diagnoses (e.g., PTSD), and there are doz-ens of different measurement tools to
diagnose the same disorder (e.g., MDD; Fried et al., 2022).3. Interrater reliability for some
3. common diagnoses is low (Regier et al., 2013).4. People with the same diagnosis often have
some similarities (e.g., in terms of etiology and symptoms).5. However, they also show
considerable differ-ences (e.g., Galatzer-Levy & Bryant, 2013).6. There is considerable
comorbidity between diag-noses, and many risk factors are transdiagnostic (i.e., shared
among diagnoses; Eaton et al., 2015; Kessler et al., 2005).7. Although diagnoses are
categorical, most mental health problems are best described as lying on a dimension of
severity from absent to very severe—and various thresholds where normal functioning
turns into mental illness have been proposed (Haslam et al., 2012; von Glischinski et al.,
2021).8. Finally, disease pathways can be characterized by equifinality (different starting
points may lead to the same diagnosis) and multifinality (similar start-ing points may lead
to different diagnoses).Diagnoses do not carve nature at her joints, but are pragmatic kinds:
things constructed (in part on the basis of evidence) to be useful for specific purposes
(Kendler et al., 2011). Elements listed in psychiatry’s DSM are different from elements listed
in chemistry’s equivalent of the DSM, the periodic table. Helium and magnesium are natural
kinds, unchanging entities with necessary and sufficient properties that clearly define them.
Every atom with two protons is helium, and heli-um’s internal structure, not expert
consensus, defines kind membership. Unlike MDD and schizophrenia, helium has only one
definition, can be diagnosed with perfect reliability, and can be clearly distinguished from
other kinds, such as magnesium.That does not mean that psychiatric diagnoses have no
utility. Similar to MDD and PTSD, long-term high blood pressure is associated with
numerous adverse outcomes. But because blood pressure lies on a con-tinuum, the
definition of “abnormal” blood pressure remains somewhat arbitrary and is the result of
expert consensus taking into account nonscientific factors (Unger et al., 2020), just as the
criteria for MDD and PTSD are. Even the decision of the International Astro-nomical Union
to remove Pluto from the list of planets was based in part on somewhat arbitrary definitions
of what a planet ought to be, influenced by nonscientific factors, and heavily opposed by
some astronomers (Zachar & Kendler, 2012).Unfortunately, clinical psychology and
psychiatry have devoted most of their resources to studying the diagnostic labels that
summarize the complex mental health states of people, rather than how biopsychosocial
processes give rise to mental health problems. The literature is dominated by case-control
studies, in which a healthy control group is compared with a group diagnosed with one
specific mental disorder; such studies have resulted
502 Friedin “risk factors for schizophrenia,” “genes for MDD,” and “symptoms of PTSD.” It is
unlikely that such designs are optimally positioned to inform research, because the
approach is flawed to the degree that mental health prob-lems are not the diagnostic
idealizations they are sum-marized as (Fig. 1a).ReductionismAnother roadblock to better
understanding, predicting, and treating mental health problems has been the iso-lated study
of particular parts of mental disorders. A bicycle is a simple mechanical system consisting of
parts that relate to each other: A pedal moves a cog-wheel, which moves a chain, which
moves another cogwheel, and so on (A → B → C → D). To fully understand how this system
functions at the macro level, it is sufficient to investigate its constituent com-ponents at the
micro level. This approach can be understood as reductionism: figuring out the properties
of the whole given the properties of its parts (Pessoa, 2022, Chapter 8). It works well in this
4. example because characteristics of bicycle parts remain unaltered when investigated in
isolation. Although reductionism has been astonishingly successful in science, its limits
became clear in the 20th century when scholars tried to understand increasingly complex
systems, such as the stock market, the weather, the Internet (Barabási, 2012; Von
Bertalanffy, 1972), or—as I argue here—mental disorders. This is because complex systems
contain interdependent elements whose properties depend on each other, and thus call for
the study of system parts and the relationships among those parts (Fried et al.,
2022).Further, the biopsychosocial nature of mental illness requires investigating parts and
relationships across lev-els. A particular barrier to progress has been biological or
explanatory reductionism—the idea that lower levels (i.e., biology) offer explanatory power
inherently supe-rior to that of higher levels (i.e., psychology, environ-ment). Explanatory
reductionism has dominated the research landscape since the 1980s and constrained
research funds, health-care policy, and delivery of clini-cal services (Borsboom et al., 2019;
Miller, 2010; Scull, 2021). Highly influential strategic directives from the National Institute
of Mental Health (NIMH) are good examples: They have stated that mental disorders are
“brain disorders” (Insel & Cuthbert, 2015, p. 499), “brain-circuit disorders” (Insel &
Cuthbert, 2015, p. 500), or “dysfunctions in neural circuits” (Insel et al., 2010, p. 749) that
can be “identified with tools of clinical neuroscience” (Insel et al., 2010, p. 749), treated by
“tuning these [neural] circuits” (Insel & Cuthbert, 2015, p. 500), and ultimately better
understood through “neuroscience-based psychiatric classification” (Insel et al., 2010, p.
750). This perspective moves every aspect of mental health—psychiatric nosology,
individual diag-nosis, dysfunction, and treatment—to the level of the brain and is apparent
in many of NIMH’s efforts, such as early work on the Research Domain Criteria (RDoC; Insel
et al., 2010).Explanatory reductionism faces a number of chal-lenges (Borsboom et al.,
2019; Eronen, 2021). First, lower levels are not by definition superior in explaining higher-
level processes: “No one would seek to under-stand the origin of hypertension at the level of
quarks” (Kendler, 2005, p. 1249). Instead, output from complex systems often requires
higher-level explanations. The human heartbeat, for example, results from feedback loops
among properties such as the joint activity of ion channels and cell potential, not from a
central control unit (Eronen, 2021). Second, one may find biomarkers for a mental health
problem, such as delusions, but the content of the delusions (e.g., bizarre vs. grandiose), not
their biological instantiation, drives feelings (e.g., fear vs. elation) and behaviors (e.g.,
fleeing vs. approaching). Third, complex phenotypes such as gran-diose delusions are likely
multiply realizable; that is, they likely differ in brain activation across (and perhaps within)
individuals.Biological psychiatry has led to considerable insights into human biology but
has told us relatively little about the biology of specific diagnoses. The American Psy-
chiatric Association recently concluded that “neuroim-aging has yet to have a significant
impact on the diagnosis or treatment of individual patients in clinical settings” (First et al.,
2018, p. 915), and genome-wide association studies have largely resulted in transdiag-
nostic (rather than diagnosis-specific) hits that explain negligible amounts of variance
(Scull, 2021). Even NIMH director (2002–2015) Insel, one of the most influ-ential voices for
studying the biology of mental illness, concluded that after13 years at NIMH really pushing
on the neurosci-ence and genetics of mental disorders, [although] I succeeded at getting lots
5. of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I
don’t think we moved the needle in reducing suicide, reducing hospitaliza-tions, improving
recovery for the tens of millions of people who have mental illness. (quoted in Rogers, 2017,
para. 6)This lack of progress is not due to the fact that biology is not crucially involved in
mental health states—it is due to our focus on studying the biology of particular DSM labels
that are likely the wrong targets, and due
Current Directions in Psychological Science 31(6) 503YStrongGroupDifferenceXZMost
Typical PersonPeopleDiagnosedWith PTSDPeopleDiagnosedWith MDDNo
GroupDifferenceModerateGroupDifferenceVariabilityaMost Typical PersonResilient
SystemVulnerable SystemAlternativeStable StateForce Required to Move Systems to an
Alternative Stable StateCurrentStable StateAlternativeStable State bFig. 1. Conceptualizing
mental health problems as systems. The schematic in (a) represents 20 hypothetical people
diagnosed with post-traumatic stress disorder (PTSD; red) and major depressive disorder
(MDD; blue). Their mental health states are characterized by three features, X, Y, and Z, as a
simplification of a much larger, n-dimensional feature space. The two groups differ
moderately on feature X, differ greatly on feature Y, and do not differ appreciably on feature
Z; within-group variability on feature Z is much greater for the people with MDD than for
those with PTSD. From a systems perspective, the mental health states of these people are
emergent properties arising out of interactions of numerous biopsychosocial features (e.g.,
risk factors, etiology, thoughts, biological predispositions, social environments). Mental
health states cluster to some degree because features stand in probabilistic relations to each
other (e.g., severe trauma often leads to nightmares). Superimposing diagnoses on this
complex landscape leads to one person per group who is most typical of the diagnosis
(black circles), but also ignores meaningful interindividual differences. The diagram in (b)
uses two copies of the same playing card, held between two fingers, as a model for
vulnerable and resilient mental health states. The left card is in a vulnerable state and can
be moved with little energy to an alternative state. The right card is in a resilient state, and
forcing a phase transition to an alternative state requires considerable energy.
504 Friedto studying biology in isolation (Cai et al., 2020; Eronen, 2021; Hitchcock et al.,
2022).Diagnostic literalism and explanatory reductionism have formed a vicious cycle of
reification. We study the genomes of millions of participants diagnosed via DSM-5 when it is
unclear why these phenotypes would be well suited for genetic discovery in the first place
(Cai et al., 2020; Hitchcock et al., 2022). After identify-ing weak correlates, we further reify
diagnoses by talk-ing about “genes for major depression” or “brain biomarkers for PTSD.”
Our natural tendency to essen-tialize mental disorders (Adriaens & De Block, 2013) and
flawed inferences from measurement (“we have a commonly used measure for diagnosis X;
hence X exists”; cf. McPherson & Armstrong, 2021) and external validation (“diagnosis X
correlates with external con-structs; hence diagnosis X exists”) provide fertile ground for
this vicious cycle of reification.Mental Disorders as Complex SystemsIn the summer of 2019,
a scholar I greatly admire was kind enough to lend me his bicycle for a few months, granted
I take good care of it. When the bicycle broke down after 3 weeks, I was terribly worried,
but reduc-tionism came to the rescue: Bikes can be decomposed into their constituent parts,
and fixing all parts at the micro level will restore function at the macro level. But mental
6. disorders are not like bicycles—they are like many other complex systems in nature.
Whether a lake is clean or turbid results from interactions of interde-pendent elements,
such as oxygen levels, sunlight exposure, fish, pollution, and so on. Whether my mood while
writing this manuscript is anxious or cheerful is the outcome of causal relations among
elements of my mood system, including my personality and disposition; the previous night’s
sleep; my caffeine consumption; and external influences such as my email inbox. The same
applies to mental health states. From a systems perspective (see Fig. 1a), such states result
from interac-tions of numerous biological, psychological, and social features, including
specific risk and protective factors, moods, thoughts, behaviors, biological predispositions,
and social environments (Borsboom, 2017; Fried et al., 2022; Kendler et al., 2011; Olthof
et al., 2021; Robinaugh et al., 2020).This framework helps to explain the eight observa-tions
I described above. Some simply follow from acknowledging that diagnoses are
superimposed on a complex landscape of mental health states: They may ignore important
features such as etiology (Observation 1) and summarize dimensional processes as
categorical (Observation 7); multiple potentially equally valid sum-maries and measures
can coexist (Observation 2); and interrater reliability will necessarily be limited for some
diagnoses (Observation 3).This systems perspective also explains why mental health states
are somewhat clustered in nature (Obser-vation 4) rather than completely randomly
distributed: Some states are much more likely than others because features are linked in
probabilistic ways. For example, severe traumatic experiences often lead to nightmares,
which lead to further sleep problems and then interfere with daily activities. If trauma is
severe enough, most people show some level of impairment, in the same way that very few
lakes with severe pollution show healthy fish populations. In other words, feature inter-
dependence constrains the states systems can be in. Some people in the feature space will
be more typical of a given diagnosis than others are. These people can be thought to be in
the most likely mental health state, given that they reflect the average result of all proba-
bilistic feature relations. Probabilistic feature relations allow for considerable
interindividual differences within a given DSM diagnosis (Observation 5), as well as equi-
finality and multifinality (Observation 8).This framework can also accommodate two
diagno-ses being both similar and different (Observations 4 and 5). In Figure 1a, PTSD
shows much less variability than MDD on feature Z (e.g., the amount of adverse life events
experienced in the last year). The degree of similarity and difference between diagnoses can
vary across features: In the figure, PTSD and MDD differ strongly on feature Y (e.g.,
flashbacks are much more common in PTSD), moderately on feature X (e.g., MDD has
somewhat higher comorbidity rates with general-ized anxiety disorder), and not at all on
feature Z. If one were to plot the mental health state of millions of people and superimpose
the most prevalent DSM diag-noses, some point clouds would overlap substantially because
of shared risk factors, symptoms, or patho-physiology, whereas others would be somewhat
sepa-rated. This explains comorbidities and shared risk factors among DSM diagnoses
(Observation 6). Splitting or lumping such diagnoses is a pragmatic decision guided by
clinical utility, and I understand DSM and ICD, as well as recent frameworks, such as the
Hierarchical Taxon-omy of Psychopathology (HiTOP; a hierarchical, dimen-sional
taxonomy), as competing attempts to adequately summarize this space.From this
7. perspective, it is unsurprising that common one-size-fits-all treatments that target
diagnoses (e.g., antidepressants for MDD) have shown limited efficacy, and equally
unsurprising that biological psychiatry has been largely unsuccessful in identifying specific
markers for specific diagnoses. Further, symptoms lose their privileged epistemological
status as the criteria for studying mental disorders, given that many other
Current Directions in Psychological Science 31(6) 505features are also probabilistically
associated with diag-noses. In other words, symptoms are not inherently superior features
compared with etiology, personality, and other factors.A Systems Perspective Offers New
Lenses and LeversA systems perspective provides new lenses through which we can study
mental health problems: by using theories and methods from other fields with rich tradi-
tions, including network and systems sciences (Barabási, 2012; Von Bertalanffy, 1972). I
introduce a few concepts below that may help to advance understanding of men-tal health
problems.In complex systems, order can emerge at the macro level as a result of local
interdependence among features at the micro level. Flocking of birds is an exam-ple of an
emergent phenomenon arising from self- organization (Olthof et al., 2021). Such emergent
prop-erties cannot be fully understood by studying isolated elements of a system. Bird
flocking cannot be identified at the level of individual birds, in the same way that fluidity of
water is not a property of its constituent ele-ments, hydrogen and oxygen. Even systems
following very simple rules, such as prey and predator populations that simultaneously
depend on each other (A ⟷ B), can show emergence (Pessoa, 2022, Chapter 8). Ignoring the
interdependence of features at the micro level, such as the well-established feedback loop
between fear and avoidance relevant to many anxiety disorders, under-mines our ability to
understand, predict, and treat men-tal health problems that arise from interactions among
features (Robinaugh et al., 2020).Complex systems can have two (or more) attractor states
in which they can settle (Scheffer et al., 2018; van de Leemput et al., 2014). Figure 1b shows
two systems, each consisting of a playing card held between two fingers: One system is
vulnerable (i.e., prone to a phase transition into an alternative attractor state), whereas the
other is resilient, as indicated by the dif-ferent lengths of the horizontal black arrows. Lake
states (clean, turbid) and mental health states (healthy, depressed) work in similar ways.
These systems experi-ence random perturbations, such as a very hot week or a negative life
event. As a result of these perturba-tions, a system state may move around slightly, but as
long as it does not leave the safe operating space—which is much smaller for vulnerable
than for resilient systems—the system stays in the current attractor state. If perturbations
are severe enough to push a system out of its safe operating space, the system may transi-
tion into the alternative state via phase transition. Removing the force that caused a phase
transition does not always return the system to the prior state—a phe-nomenon known as
the hysteresis effect (Cramer et al., 2016). For example, pollution can cause a lake to tip into
a turbid state, but removing the pollution will not necessarily return the lake to a healthy
state, in the same way that the playing cards in Figure 1b will not return to their previous
states after the forces that pushed them are removed.A systems perspective also offers new
levers. When a system become less resilient over time, this can be measured by how long it
takes the system to recover from random perturbations. If we pushed against the playing
cards in Figure 1b and took a slow-motion video, we would see that the card in the
8. vulnerable system would “snap back” more slowly, because there is less “grip” on the card
to keep it in its current state compared with the card in the resilient system. When systems
snap back more slowly because they become more vulnera-ble, this is called critical slowing
down, and it is one of many early warning signals that may foreshadow upcom-ing
transitions into mental disorders (Olthof et al., 2020; van de Leemput et al., 2014; Wichers
et al., 2016). Such signals may facilitate timely prevention and intervention. A systems view
also allows researchers to utilize frame-works such as control theory (Henry et al., 2022) to
simulate interventions, much as meteorologists simulate what would happen to Earth’s
climate under potential interventions, such as reduced CO2 emissions. Such simulations
may reveal more optimal intervention strate-gies or completely novel intervention targets,
or they may showcase what interventions are most effective in what kind of systems (Henry
et al., 2022).The idea of mental health states as complex systems aligns closely with how
many clinicians think about and treat mental illness (Schiepek, 2009). Functional analysis is
commonly employed in psychotherapy to map out causal relations of a person’s system, and
clini-cal psychologists have long made use of the concept of network destabilization.
Suppose the resilient system in Figure 1b is in a psychopathological attractor state such as
PTSD: Destabilizing the attractor state (i.e., softening the grip on the playing card) will make
it much easier to help the system reorganize into a healthy state (Fried et al., 2022; Hayes
et al., 2015; Olthof et al., 2021). A large-scale consortium in The Netherlands is currently
investigating the efficacy of such system-based interventions (Roefs et al.,
2022).ConclusionsA systems view casts diagnoses and reductionism as useful
epistemological tools for describing the world, rather than as ontological convictions about
how the world is. It challenges the view of different diagnoses
506 Friedas clearly separable entities with single-cause etiologies (Kendler, 2012).Many
promising efforts toward embracing the com-plexity of mental health problems are on the
way. For example, although NIMH’s RDoC initiative started as a poster child of explanatory
reductionism (Insel et al., 2010), it has quickly matured into a truly integrative framework
focused on neurobiological, psychological, developmental, and environmental elements of
mental health systems. RDoC and other recent initiatives (e.g., Robinaugh et al., 2020; Roefs
et al., 2022) bring into sharper focus open questions. What are the right levels to study in
mental health systems, what are the right elements of these respective levels, and how do
ele-ments of different levels interact with each other (Eronen, 2021)? And if we accept that
diagnoses are pragmatic summaries, what validators of clinical utility should be used in
future classification efforts? Answering these and other questions will require building
interdis-ciplinary bridges and opening the ivory towers of clini-cal psychology and
psychiatry to theories and methods from fields with rich traditions, such as network and
systems sciences (Barabási, 2012; Von Bertalanffy, 1972).Recommended ReadingBarabási,
A.-L. (2012). (See References). A primer on the importance of studying systems.Eronen, M. I.
(2021). (See References). A primer on problems of explanatory reductionism and how
levels in psycho-pathology relate to each other.Henry, T. R., Robinaugh, D. J., & Fried, E. I.
(2022). (See References). An introduction to psychological networks and control theory,
aiming to combine these frameworks to test interventions via simulations and potentially
uncover novel treatment targets.Kendler, K. S. (2016a). (See References). An article
9. challeng-ing the idea that diagnoses carve nature at her joints and introducing the
distinction between different kinds (socially constructed, natural, pragmatic) used to
describe mental disorders.van de Leemput, I. A., Wichers, M., Cramer, A. O. J., Borsboom, D.,
Tuerlinckx, F., Kuppens, P., van Nes, E. H., Viechtbauer, W., Giltay, E. J., Aggen, S. H., Derom,
C., Jacobs, N., Kendler, K. S., van der Maas, H. L. J., Neale, M. C., Peeters, F., Thiery, E., Zachar,
P., & Scheffer, M. (2014). (See References). An introduction to utilizing time series data to
identify early warning signals, with the goal of forecasting transitions into mental disorders
such as depression.TransparencyAction Editor: Robert L. GoldstoneEditor: Robert L.
GoldstoneDeclaration of Conflicting InterestsThe author(s) declared that there were no
conflicts of interest with respect to the authorship or the publication of this
article.FundingE. I. Fried is supported by funding from the European Research Council
under the European Union’s Horizon 2020 research and innovation program, Grant
949059.ORCID iDEiko I. Fried https://orcid.org/0000-0001-7469-594XAcknowledgmentsI
thank Rany Abend and Diane O’Leary for comments on prior versions of this
manuscript.ReferencesAdriaens, P. R., & De Block, A. (2013). Why we essentialize mental
disorders. The Journal of Medicine and Philosophy, 38(2), 107–127.
https://doi.org/10.1093/jmp/jht008American Psychiatric Association. (2013). Diagnostic
and sta-tistical manual of mental disorders (5th ed.).Barabási, A.-L. (2012). The network
takeover. Nature Physics, 8(1), 14–16. https://doi.org/10.1038/nphys2188Borsboom, D.
(2017). A network theory of mental disorders. World Psychiatry, 16(1), 5–13.
https://doi.org/10.1002/wps.20375Borsboom, D., Cramer, A. O. J., & Kalis, A. (2019). Brain
dis-orders? Not really: Why network structures block reduc-tionism in psychopathology
research. Behavioral and Brain Sciences, 42, Article e2.
https://doi.org/10.1017/S0140525X17002266Cai, N., Choi, K. W., & Fried, E. (2020).
Reviewing the genetics of heterogeneity in depression: Operationalizations, man-ifestations,
and etiologies. Human Molecular Genetics, 29(R1), R10–R18.
https://doi.org/10.1093/hmg/ddaa115Cassidy, W. L., Flanagan, N. B., Spellman, M., &
Cohen, M. E. (1957). Clinical observations in manic-depressive disease: A quantitative study
of one hundred manic-depressive patients and fifty medically sick controls. Journal of the
American Medical Association, 164(14), 1535–1546.
https://doi.org/10.1001/jama.1957.02980140011003Cramer, A. O. J., van Borkulo, C. D.,
Giltay, E. J., van der Maas, H. L. J., Kendler, K. S., Scheffer, M., & Borsboom, D. (2016). Major
depression as a complex dynamic system. PLOS ONE, 11(12), Article e0167490.
https://doi.org/ 10.1371/journal.pone.0167490Eaton, N. R., Rodriguez-Seijas, C., Carragher,
N., & Krueger, R. F. (2015). Transdiagnostic factors of psychopathology and substance use
disorders: A review. Social Psychiatry and Psychiatric Epidemiology, 50(2), 171–182.
https://doi.org/10.1007/s00127-014-1001-2Eronen, M. I. (2021). The levels problem in
psychopathol-ogy. Psychological Medicine, 51(6), 927–933. https://doi
.org/10.1017/s0033291719002514Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Jr.,
Winokur, G., & Munoz, R. (1972). Diagnostic crite-ria for use in psychiatric research.
Archives of General Psychiatry, 26(1), 67–63. https://doi.org/10.1001/archpsyc
.1972.01750190059011First, M. B., Drevets, W. C., Carter, C., Dickstein, D. P., Kasoff, L., Kim,
K. L., McConathy, J., Rauch, S., Saad, Z. S., Savitz, J.,
10. Current Directions in Psychological Science 31(6) 507Seymour, K. E., Sheline, Y. I., &
Zubieta, J. K. (2018). Clinical applications of neuroimaging in psychiatric dis-orders.
American Journal of Psychiatry, 175(9), 915–916.
https://doi.org/10.1176/appi.ajp.2018.1750701Fried, E. I., Flake, J. K., & Robinaugh, D. J.
(2022). Revisiting the theoretical and methodological foundations of depres-sion
measurement. Nature Reviews Psychology,1(6), 358–368.
https://doi.org/10.1038/s44159-022-00050-2Galatzer-Levy, I. R., & Bryant, R. A. (2013).
636,120 ways to have posttraumatic stress disorder. Perspectives on Psychological Science,
8(6), 651–662. https://doi.org/10 .1177/1745691613504115Haslam, N., Holland, E., &
Kuppens, P. (2012). Categories versus dimensions in personality and psychopathology: A
quantitative review of taxometric research. Psychological Medicine, 42(5), 903–920.
https://doi.org/10.1017/S0033291711001966Hayes, A. M., Yasinski, C., Barnes, J. B., &
Bockting, C. L. H. (2015). Network destabilization and transition in depres-sion: New
methods for studying the dynamics of thera-peutic change. Clinical Psychology Review, 41,
27–39. https://doi.org/10.1016/j.cpr.2015.06.007Henry, T. R., Robinaugh, D. J., & Fried, E. I.
(2022). On the control of psychological networks. Psychometrika, 87(1), 188–213.
https://doi.org/10.1007/s11336-021-09796-9Hitchcock, P. F., Fried, E. I., & Frank, M. J.
(2022). Com-putational psychiatry needs time and context. Annual Review of Psychology,
73, 243–270. https://doi.org/ 10.1146/annurev-psych-021621-124910Hyman, S. E. (2021).
Psychiatric disorders: Grounded in human biology but not natural kinds. Perspectives in
Biology and Medicine, 64(1), 6–28. http://doi.org/10.1353/pbm.2021.0002Insel, T.,
Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., Sanislow, C., & Wang, P. (2010).
Research Domain Criteria (RDoC): Toward a new classifica-tion framework for research on
mental disorders. The American Journal of Psychiatry, 167(7), 748–751.
https://doi.org/10.1176/appi.ajp.2010.09091379Insel, T. R., & Cuthbert, B. N. (2015). Brain
disorders? Precisely. Science, 348(6234), 499–500. https://doi.org/10.1126/
science.aab2358Kendler, K. S. (2005). “A gene for...”: The nature of gene action in
psychiatric disorders. The American Journal of Psychiatry, 162(7), 1243–1252.
https://doi.org/10.1176/appi.ajp.162.7.1243Kendler, K. S. (2012). The dappled nature of
causes of psychiatric illness: Replacing the organic-functional/hardware-software
dichotomy with empirically based pluralism. Molecular Psychiatry, 17(4), 377–388.
https://doi.org/10.1038/mp.2011.182Kendler, K. S. (2016a). The nature of psychiatric
disorders. World Psychiatry, 15(1), 5–12. https://doi.org/10.1002/wps.20292Kendler, K. S.
(2016b). The phenomenology of major depres-sion and the representativeness and nature
of DSM crite-ria. The American Journal of Psychiatry, 173(8), 771–780.
https://doi.org/10.1176/appi.ajp.2016.15121509Kendler, K. S., Munõz, R. A., & Murphy, G.
(2010). The devel-opment of the Feighner criteria: A historical perspective. The American
Journal of Psychiatry, 167(2), 134–142.
https://doi.org/10.1176/appi.ajp.2009.09081155Kendler, K. S., Zachar, P., & Craver, C.
(2011). What kinds of things are psychiatric disorders? Psychological Medi-cine, 41(6),
1143–1150. https://doi.org/10.1017/S00332917 10001844Kessler, R. C., Chiu, W. T.,
Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-
IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry,
11. 62(6), 617–627. https://doi.org/10.1001/archpsyc.62.6.617Lilienfeld, S. O. (2014). DSM-5:
Centripetal scientific and cen-trifugal antiscientific forces. Clinical Psychology: Science and
Practice, 21(3), 269–279. https://doi.org/10.1111/cpsp.12075McPherson, S., & Armstrong,
D. (2021). Psychometric origins of depression. History of the Human Sciences. Advance
online publication. https://doi.org/10.1177/09526951211009085Miller, G. A. (2010).
Mistreating psychology in the Decades of the Brain. Perspectives on Psychological Science,
5(6), 716–743. https://doi.org/10.1177/1745691610388774Olthof, M., Hasselman, F.,
Maatman, F. O., Bosman, A. M. T., & Lichtwarck-Aschoff, A. (2021). Complexity theory of
psychopathology. PsyArXiv. https://doi.org/10.31234/osf .io/f68ejOlthof, M., Hasselman, F.,
Strunk, G., van Rooij, M., Aas, B., Helmich, M. A, Schiepek, G., & Lichtwarck-Aschoff, A. (2020).
Critical fluctuations as an early-warning signal for sudden gains and losses in patients
receiving psy-chotherapy for mood disorders. Clinical Psychological Science, 8(1), 25–35.
https://doi.org/10.1177/2167702619 865969Pessoa, L. (2022). The entangled brain: How
perception, cogni-tion, and emotion are woven together. MIT Press.Regier, D. A., Narrow, W.
E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 field
trials in the United States and Canada, Part II: Test-retest reliability of selected categorical
diagnoses. The American Journal of Psychiatry, 170(1), 59–70.
https://doi.org/10.1176/appi.ajp.2012.12070999Robinaugh, D. J., Haslbeck, J. M. B.,
Waldorp, L. J., Kossakowski, J. J., Fried, E. I., Millner, A. J., McNally, R. J., van Nes, E. H.,
Scheffer, M., Kendler, K. S., & Borsboom, D. (2020). Advancing the network theory of mental
disor-ders: A computational model of panic disorder. PsyArXiv.
https://doi.org/10.31234/osf.io/km37wRoefs, A., Fried, E. I., Kindt, M., Martijn, C., Elzinga,
B., Evers, A. W. M., Wiers, R. W., Borsboom, D., & Jansen, A. (2022). A new science of mental
disorders: Using person-alised, transdiagnostic, dynamical systems to understand, model,
diagnose and treat psychopathology. Behaviour Research and Therapy, 153, Article 104096.
https://doi .org/10.1016/j.brat.2022.104096Rogers, A. (2017, May 11). Star neuroscientist
Tom Insel leaves the Google-spawned Verily for . . . A startup? WIRED.
https://www.wired.com/2017/05/star-neuroscientist-tom-insel-leaves-google-spawned-
verily-startup/
508 FriedScheffer, M., Bolhuis, J. E., Borsboom, D., Buchman, T. G., Gijzel, S. M. W., Goulson,
D., Kammenga, J. E., Kemp, B., van de Leemput, I. A., Levin, S., Martin, C. M., Melis, R. J. F., van
Nes, E. H., Romero, L. M., & Olde Rikkert, M. G. M. (2018). Quantifying resilience of humans
and other animals. Proceed-ings of the National Academy of Sciences, USA, 115(47), 11883–
11890. https://doi.org/10.1073/pnas.1810630115Schiepek, G. (2009). Complexity and
nonlinear dynamics in psychotherapy. European Review, 17(2), 331–356.
https://doi.org/10.1017/S1062798709000763Scull, A. (2021). American psychiatry in the
new millennium: A critical appraisal. Psychological Medicine, 51(16), 2762–2770.
https://doi.org/10.1017/S0033291721001975Unger, T., Borghi, C., Charchar, F., Khan, N.
A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M.,
Wainford, R. D., Williams, B., & Schutte, A. E. (2020). 2020 International Society of
Hypertension Global Hypertension Practice Guidelines. Hypertension, 75(6), 1334–1357.
https://doi.org/10.1161/HYPERTENSIONAHA.120.15026van de Leemput, I. A., Wichers, M.,
Cramer, A. O. J., Borsboom, D., Tuerlinckx, F., Kuppens, P., van Nes, E. H., Viechtbauer, W.,
12. Giltay, E. J., Aggen, S. H., Derom, C., Jacobs, N., Kendler, K. S., van der Maas, H. L. J., Neale, M.
C., Peeters, F., Thiery, E., Zachar, P., & Scheffer, M. (2014). Critical slowing down as early
warning for the onset and termination of depression. Proceedings of the National Academy
of Sciences, USA, 111(1), 87–92. https://doi.org/10.1073/pnas.1312114110Von
Bertalanffy, L. (1972). The history and status of general systems theory. Academy of
Management Journal, 15(4), 407–426. https://doi.org/10.2307/255139von Glischinski, M.,
von Brachel, R., Thiele, C., & Hirschfeld, G. (2021). Not sad enough for a depression trial? A
system-atic review of depression measures and cut points in clinical trial registrations.
Journal of Affective Disorders, 292, 36–44.
https://doi.org/10.1016/j.jad.2021.05.041Wichers, M., Groot, P. C., Psychosystems, ESM
Group, & EWS Group. (2016). Critical slowing down as a personal-ized early warning signal
for depression. Psychotherapy and Psychosomatics, 85(2), 114–116. https://doi.org/
10.1159/000441458World Health Organization. (2019). International statistical
classification of diseases and related health problems (11th ed.).
https://icd.who.int/Zachar, P. (2014). A metaphysics of psychopathology. MIT Press.Zachar,
P., & Kendler, K. S. (2012). The removal of Pluto from the class of planets and homosexuality
from the class of psychiatric disorders: A comparison. Philosophy, Ethics, and Humanities in
Medicine, 7, Article 4. https://doi.org/ 10.1186/1747-5341-7-4