Psychopathology

Conduct disorder is a maladjusted behaviour characterized by a consistent pattern of harming others or breaking accepted rules. This study examined the prevalence of conduct disorder among purposefully selected 90 adolescents in two correctional centres in Lagos, Nigeria. Descriptive survey design was employed for the study because it guaranteed an accurate account of the sample for the study. Gilliam Conduct Disorder Scale was used, the items in the scale depict the specific diagnostic behaviours that are characteristic of persons with Conduct (...) Disorder. The reliability coefficient for the scale is 0.96. Two research questions and one research hypothesis were raised, descriptive statistics and analysis of variance were employed for data analysis. Results of data analysis showed that in order of prominence female participants exhibited more deceitfulness and theft than the male participants. Similarly, unlike their male counterpart more females reported moderate and severe cases of conduct disorder. There was no significant difference in the order of prominence of conduct disorder. The existence of conduct disorder in Correctional Centres is not an imagination but a reality. Consequently, efforts should be geared towards the development and implementation of preventive and premeditative techniques by psychologists, counsellors, and other professionals in allied fields. (shrink)

Chapter 9 describes and evaluates the relatively recent mental health models of the impact of trauma, and discusses the ways that traumatic events affect people, the political and cultural effects of understanding these consequences as ‘disorder’, particularly as Post-traumatic Stress Disorder (PTSD), and concludes by looking at the relevance of the concept of PTSD to forensic populations.

The paper describes the refusal of the liberal community to assert the right of persons accused of mental illness to be free of coercive psychiatric intrusion. It suggests that the penchant for benevolent governmental intrusion into other social problems may be at fault and recommends that intervention be abandoned in favor of a return to human autonomy as a basis of the concept of freedom.

In this commentary, we critique the appropriate behavioural features for evolutionary genetic analysis, the role of the environment, and the viability of a general evolutionary genetic model for all common mental disorders. In light of these issues, we suggest that the authors may have prematurely discounted the role of some of the mechanisms they review, particularly balancing selection. (Published Online November 9 2006).

This short contribution questions the ethics of basing the way we think and act in relation to mental disorder on beliefs and assumptions that are in the view of the author at best, unhelpful and at worst, simply incorrect.

Grouping severe mental disorders into a global category is likely to lead to a “theory of everything” which forcefully explains everything and nothing. Speculation even at the phenotypic level of the single disorder cannot be fruitful, unless specific and testable models are proposed. Inclusive fitness must be incorporated in such models. (Published Online November 9 2006).

This chapter suggests that, when considering the philosophical problem of other minds, we distinguish between "thick" and "thin" versions of it. While traditional approaches take the problem to be a thick one, more recent work can be seen as addressing only a thin variant. Dretske, while acknowledging the thick problem, proposes a perceptual model of our knowledge of other minds which addresses only the thin version. The chapter proposes that, in the place of the thick problem, we consider the quality (...) of our interactions with others. Following Wittgenstein, it suggests that where individuals share a nature their interactions exhibit a quality that it calls "depth." Where that nature is not, or is only partially, shared, there one might expect to find the quality of the interaction between persons disturbed. The chapter suggests that this disturbance might explain the impaired quality of interaction between autistic and non-autistic individuals. (shrink)

Mentalizing - the ability to understand oneself and others by inferring the mental states that lie behind overt behavior - develops during childhood within the context of a secure attachment relationship. It is crucial to self-regulation and constructive, intimate relationships. Failure to retain mentalizing, particularly in the midst of emotional interactions, is a core problem in borderline personality disorder and results in severe emotional fluctuations, impulsivity, and vulnerability to interpersonal and social interactions. Mentalization-based treatment for borderline personality disorder is a (...) 'How to Do It' book outlining a clinically proven treatment for Borderline Personality Disorder. Containing illustrative clinical examples, it details precisely how to develop and implement treatment and is a companion to the highly successful book Psychotherapy for Borderline Personality Disorder - mentalization based treatment. This practical guide explains how to treat borderline patients by helping them develop a more robust mentalizing capacity within the context of an attachment relationship. It provides the practitioner with everything they need to know about how to practise mentalizing treatment in day patient and out-patient settings. Enough theory is provided to orientate the clinician and there is step-by-step practical advice on the assessment of mentalizing and interpersonal relationships, how to structure treatment, the use of basic mentalizing interventions and how to apply them, as well as information on what not to do. In addition, it includes a check list to be used in the assessment of mentalizing and a self-rating exercise for practitioners to evaluate their adherence to mentalizing. (shrink)

Borderline Personality disorder is a severe personality dysfunction characterized by behavioural features such as impulsivity, identity disturbance, suicidal behaviour, emptiness, and intense and unstable relationships. Approximately 2% of the population are thought to meet the criteria for BPD. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment to BPD known as mentalization treatment. With randomised controlled trials having shown this method to be effective, this book presents the first account of mentalization (...) treatment for BPD. The first section gives an overview of BPD, including discussion of nosology, epidemiology, natural history, and psychosocial aetiology. It additionally summarises the present state of our research knowledge about effective psychotherapeutic treatments and use of medication. The second section outlines the authors' theoretical approach and contrasts it with other well known methods, including DBT, CAT, and CBT. In the extensive final section, the authors outline their clinical approach starting with how treatment is organised. A detailed account of the transferable features of the model is provided along with the main strategies and techniques of treatment. Numerous clinical examples are given to illustrate the core techniques and detailed information provided about how to apply aspects of the mentalization based treatment approach in everyday practice. Aimed at mental health professionals, along with counsellors, psychotherapists, and psychoanalysts, the book will be a valuable tool, providing an effective means of treating those suffering from Borderline Personality Disorder. (shrink)

In Italy, a judge reduced the sentence of a defendant by 1 year in response to evidence for a genetic predisposition to violence. The best characterized of these genetic differences, those in the monoamine oxidase A (MAOA), were cited as especially relevant. Several months previously in the USA, MAOA data contributed to a jury reducing charges from 1st degree murder (a capital offence) to voluntary manslaughter. Is there a rational basis for this type of use of MAOA evidence in criminal (...) court? This paper will review in context recent work on the MAOA gene–environment interaction in predisposing individuals to violence and address the relevance of such findings to murder trials. Interestingly, the MAOA genetic variants impact future violence and aggression only when combined with the adverse environmental stimuli of childhood maltreatment. Thus nature and nurture interact to determine the individual’s risk. Based on current evidence, I argue there is a weak case for mitigation. But should future experiments confirm the hypothesis that individual differences in impulse control and response to provocation found in MAOA-L men (without abuse) are significantly magnified when combined with childhood maltreatment, the case could turn into a stronger one. (shrink)

A review of cultural and historical accounts of anorexia nervosa indicates that this disorder is found primarily in Westernized societies during periods of relative affluence and greater social opportunities for women. Some hypotheses regarding the vulnerability to eating disorders are proposed to the basis of these data.

Patients suffering from the Cotard syndrome can deny being alive, having guts, thinking or even existing. They can also complain that the world or time have ceased to exist. In this article, I argue that even though the leading neurocognitive accounts have difficulties meeting that task, we should, and we can, make sense of these bizarre delusions. To that effect, I draw on the close connection between the Cotard syndrome and a more common condition known as depersonalisation. Even though they (...) are not delusional, depersonalised patients seem to have experiences that are quite similar to those of Cotard patients. I argue that these experiences are essentially characterised by a lack of subjective character and of two other structural features of experience, which I call ‘the present character’ and ‘the actual character’. Cotard's nihilistic delusions simply consist in taking these anomalous experiences at face value. (shrink)

Extensive and diverse conceptual work towards developing a definition of ‘mental disorder’ was motivated by the declassification of homosexuality from the Diagnostic and Statistical Manual in 1973. This highly politicised event was understood as a call for psychiatry to provide assurances against further misclassification on the basis of discrimination or socio-political deviance. Today, if a definition of mental disorder fails to exclude homosexuality, then it fails to provide this safeguard against potential abuses and therefore fails to do an important part (...) of the work it was intended to do. We argue that fact-based definitions of mental disorder, relying on scientific theory, fail to offer a robust definition of mental disorder that excludes homosexuality. Definitions of mental disorder based on values do not fare better: these definitions are silent on questions about the diagnostic status of individuals in oppressive societies and over-inclusive of mental or behavioural states that happen to be negatively valued in the individual's social context. We consider the latest definition proposed for the Diagnostic and Statistical Manual-5 in light of these observations. We argue that definition fails to improve on these earlier deficiencies. Its inclusion in the manual may offer false reassurance against repetition of past misclassifications. We conclude with a provocation that if candidate definitions of mental disorder are unable to exclude homosexuality, it might perhaps be preferable not to attempt a definition at all. (shrink)

The stated purpose of the Diagnostic and Statistical Manual of Mental Disorders is to classify mental disorders. However, no tenable operational definition of mental disorder is offered in the manual. This leaves the possibility open that the behaviors labeled as disordered in the DSM are not members of a valid category. Attempts to define mental illness fall into the category of essentialist or relativist based, respectively, on the acceptance or denial of the existence of a defining biological attribute that all (...) mental disorders possess. However, the disorders in the DSM cannot be accounted for by either of these approaches making it unlikely that they represent a single valid concept. Simultaneous inclusion of brain illnesses and normal behaviors in the DSM are a likely explanation for the disparate nature of DSM disorders. (shrink)