Podcasts about dsm iv

Owen Flanagan's newest book details his 20-year dependence on alcohol and pills — and outlines his research on what addiction can tell us about the nature of consciousness. SOURCES:Owen Flanagan, philosopher, neurobiologist, and professor emeritus at Duke University. RESOURCES:What Is It Like to Be an Addict?: Understanding Substance Abuse, by Owen Flanagan (2025).Consciousness Reconsidered, by Owen Flanagan (1993).Against Happiness, by Owen Flanagan, Joseph E. LeDoux, Bobby Bingle, Daniel M. Haybron, Batja Mesquita, Michele Moody-Adams, Songyao Ren, Anna Sun, and Yolonda Y. Wilson. (2023).The Bodhisattva's Brain: Buddhism Naturalized, by Owen Flanagan (2013).The Really Hard Problem: Meaning in a Material World, by Owen Flanagan (2009).Big Book, by Alcoholics Anonymous."Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health," by Cristie Glasheen, Kathryn Batts, Rhonda Karg, Jonaki Bose, Sarra Hedden, and Kathryn Piscopo (Substance Abuse and Mental Health Services Administration, 2016). EXTRAS:"Professor Carl Hart Argues All Drugs Should Be Legal — Can He Convince Steve?" by People I (Mostly) Admire (2021).Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear, by Carl Hart (2021).

Send Us a Message (include your contact info if you'd like a reply)At DCA, we share a vision that couples would have the ability to rearrange and restructure their relationships and their families in a way that leads to wholeness and happiness. Divorce is often seen as an end—an ending to a marriage, an ending to a chapter of life. But what if it didn't have to be a painful, adversarial process? What if divorce could be approached with intention, healing, and collaboration, with the goal of not just separating, but rebuilding lives in a healthy, sustainable way?In today's episode, we explore the idea of restorative divorce—an approach that focuses on healing, mutual respect, and long-term well-being for both partners. We'll dive into how this process works, how it differs from adversarial divorce, and why we believe it's a better way forward.We wrestle with the concept that divorce creates a broken home, discuss the recent addition of CAPRD (Child Affected by Parental Relationship Disorder) to the DSM IV, and outline the six elements of a restorative divorce process. As opposed to traditional divorce that focuses on winning, a restorative divorce process is an alternative that can reduce harm, encourage positive outcomes, and support healthier post-divorce relationships for everyone involved. Learn more about DCA® or any of the classes or events mentioned in this episode at the links below:Website: www.divorcecoachesacademy.comInstagram: @divorcecoachesacademyLinkedIn: divorce-coaches-academyEmail: DCA@divorcecoachesacademy.com

Episode 175: Alcohol Use Disorder Basics   Future Dr. Sangha explains the clinical presentation, diagnosis, and fundamentals of the treatment of alcohol use disorder (AUD). Dr. Arreaza offers insights about the human aspect of the treatment of AUD.    Written by Darshpreet Sangha, MS4, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is Alcohol Use Disorder?AUD is characterized as the inability to stop or control alcohol use despite adverse physical, social and occupational consequences. According to DSM-5, it is a pattern of alcohol use that, over 12 months, results in at least two of the following symptoms, indicating clinically substantial impairment or distress: Alcohol is frequently used in higher quantities or for longer periods than planned.There is a persistent desire or unsuccessful attempt to reduce or manage alcohol use.Activities that are required to get alcohol, consume alcohol, or recuperate from its effects take up a lot of time.A strong need or desire to consume alcohol—a craving.A pattern of drinking alcohol that prevents one from carrying out important responsibilities at work, school, or home.Sustained alcohol consumption despite ongoing or recurring interpersonal or social issues brought on by or made worse by alcohol's effects.Alcohol usage results in the reduction or cessation of important social, professional, or leisure activities.Frequent consumption of alcohol under risky physical circumstances.Continuing to drink even when one is aware of a chronic or recurrent health or psychological issue that may have been brought on by or made worse by alcoholTolerance: requiring significantly higher alcohol intake to produce the same intended effect. Withdrawal: Characterized by the typical withdrawal symptoms or a noticing relief after taking alcohol or a closely related substance, such as benzodiazepine.How can we determine the severity of AUD? Mild: 2–3 symptomsModerate: 4–5 symptomsSevere: >/= 6 symptomsWho is at risk for AUD?Note: Ancestry offers a DNA analysis to find out about your heritage. You can also send that DNA to a third party to learn about your risks for diseases and conditions (for example, Prometheus.) Anyone can find out about their risk for alcoholism by doing a DNA test. The risk factors for AUD are: Male genderAges 18-29Native American and White ethnicitiesHaving Significant disabilityHaving other substance use disorderMood disorder (MDD, Bipolar)Personality disorder (borderline, antisocial personality)What is heavy drinking?According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), heavy alcohol use is characterized as: Males who drink > 4 drinks daily or > 14 drinks per week Females who drink > 3 drinks on any given day or > 7 drinks per weekPathophysiology of AUD.The pathogenesis of AUD is not well understood, but factors that may play a role are genetics, environmental influences, personality traits, and cognitive functioning. Also, genetic factors may decrease the risk of AUD, i.e., the flushing reaction, seen in individuals who are homozygous for the gene that encodes for aldehyde dehydrogenase, which breaks down acetaldehyde. Who should be screened?A person with AUD may not be easy to diagnose in a simple office visit, but some clues may point you in that direction. First of all, patients with AUD may present to you during their sober state, that´s why ALL adults (including pregnant patients) must be screened for AUD in primary care )Grade B recommendation). The frequency has not been determined but as a general rule, at least in Clinica Sierra Vista, we screen once a year. The USPSTF has concluded that there is insufficient evidence to recommend screening adolescents between 12-17 years old. What are the clinical manifestations of AUD?Some symptoms may be subtle, including sleep disturbance, GERD, HTN, but some may be obvious, such as signs of advanced liver disease (ascites, jaundice, bleeding disorders, etc.)If you draw routine labs, you may find abnormal LFTs (AST:ALT ratio >2:1), macrocytic anemia (MCV >100 fL), and elevated Gamma-glutamyl transferase (GGT). All these findings are highly suggestive of AUD. Patients with AUD may present in either an intoxication or withdrawal state. Signs and symptoms of acute intoxication may include “slurred speech, nystagmus, disinhibited behavior, incoordination, unsteady gait, hypotension, tachycardia, memory impairment, stupor, or coma.” Signs and symptoms of withdrawal range from tremulousness to hallucinations, seizures, and death. They are seen between 4 and 72 hours after the last drink, peaking at 48 hours, and can last up to 5 days. Alcohol withdrawal is one of the few fatal withdrawal syndromes that we know in medicine, and the symptoms can be assessed using a CIWA assessment. Treatment of AUD.There are factors to consider before starting treatment: Evaluating the severity of AUD Establishing clear treatment goals is associated with better treatment outcomesAssessing readiness to change: It can be done by motivational interviewing and using the stages of change model, which are, Pre-contemplation, contemplation, preparation, action, maintenance, and relapse.Discussing treatment of withdrawal.Treatment may be done as outpatient or it may require hospitalization. Dr. Beare sent an email with this information: “The approach to treating patients with AUD can be broken into two parts - the first is withdrawal management and the second is the long-term maintenance part. You MUST have a good plan for withdrawal treatment as it can be fatal if it's not addressed properly.” “Patients with any history of seizures due to withdrawal or a history of delirium tremens need inpatient management. If their withdrawal symptoms are typically mild (agitation, tremors, sleeplessness, anxiety) then outpatient management may be appropriate, typically with a long-acting benzodiazepine such as Librium or Ativan.”According to Dr. Beare, “the human aspect isa key element in treating alcohol use disorder. These patients arrive with tremendous amounts of suffering, shame, guilt, and fear. The relationship between the patient and provider needs to be built with compassion and understanding that this disease is horrible from the patient's perspective and using an algorithmic and calculated approach can cause significant harm to the rapport-building process, leading to lower success rates.”Treatment requires a lot of motivation and willpower. Hopefully, we can use some tools to assist our patients to be successful.-For mild disorder, Psychosocial interventions like motivational interviewing and mutual help groups like AA meetings may be enough to help our patient quit drinking.-For moderate or severe disorder: 1st line treatment is Meditation and structured, evidence-based psychosocial interventions (CBT, 12-step facilitation); which leads to better outcomesFor patients who lack motivation, motivational interviewing can be a useful initial interventionFor motivated patients: medical management, combined behavioral intervention, or a combination of both can be utilizedFor patients with limited cognitive abilities, 12-step facilitation, or contingency management can be helpful For patients who have an involved partner: Behavioral couples therapy can be utilizedMedications for AUD.The first-line pharmacological treatment is Naltrexone. It is given as a daily single dose and can be started while the patient is still actively drinking. There is a monthly dose of long-acting injectable naltrexone as well. Naltrexone is contraindicated in individuals taking opioids, and patients with acute hepatitis or hepatic failure. Alternative 1st line treatment is Acamprosate which can be used in people with contraindications to Naltrexone.AUD is a chronic problem and requires a close follow-up to evaluate response to treatment and complications. Medications need to be used along with psychotherapy and support, and medications may need to be changed or adjusted depending on the patient. It is an individualized therapy that requires full engagement of the doctor, the patient, and their families or social support. In conclusion, I would just like to add that, be compassionate because AUD is not a choice. AUD is a chronic problem like diabetes and HTN and may require a long road to recovery. Treatment includes psychotherapy, medications, and regular follow-up.Thank you for listening!Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Risky drinking and alcohol use disorder: Epidemiology, clinical features, adverse consequences, screening, and assessment, https://www.uptodate.com/contents/risky-drinking-and-alcohol-use-disorder-epidemiology-clinical-features-adverse-consequences-screening-and-assessment, accessed on August 18, 2024.Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry, Accessed on August 18, 2024.Alcohol use disorder: Treatment overview, https://www.uptodate.com/contents/alcohol-use-disorder-treatment-overview, assessed on August 18, 2024. Royalty-free music used for this episode, Grande Hip-Hop by Gushito, downloaded on Nov 06, 2023, from https://www.videvo.net

Der Begriff Dissoziation beschreibt laut Definition des DSM-IV die Unterbrechung der normalerweise integrativen Funktionen des Bewusstseins, des Gedächtnisses, der Identität oder der Wahrnehmung der Umwelt. Dissoziation im psychiatrischen und/oder psychotherapeutischen Sinne kann als ein Defekt der mentalen Integration verstanden werden, bei der eine oder mehrere Bereiche mentaler Prozesse vom Bewusstsein getrennt werden und unabhängig voneinander ablaufen (Abspaltung von Bewusstsein). Demgegenüber umfasst Konversion somatische, also sensorische und motorische Phänomene. Der französische Psychiater Pierre Janet verwendete als erster den Begriff Dissoziation, um psychische Prozesse zu beschreiben, die mit einem Auseinanderdriften und sich Trennen von Bewusstseinsinhalten einhergehen. (Stangl, 2024). Verwendete Literatur Stangl, W. (2024, 19. April). Dissoziation. Online Lexikon für Psychologie & Pädagogik. https://lexikon.stangl.eu/872/dissoziation. Merkmale der Dissoziation: Verlust der Erinnerung an bestimmte Ereignisse oder Zeiträume. Gefühl, als ob man außerhalb des eigenen Körpers steht oder die Umgebung unrealistisch erscheint. Wahrnehmung der eigenen Handlungen oder Gedanken als fremdartig oder nicht kontrolliert. Empfindung von Taubheit oder einem Gefühl der Entfremdung von den eigenen Emotionen. Abspaltung oder Fragmentierung des Selbst, möglicherweise mit dem Auftreten unterschiedlicher Persönlichkeitszustände. Schwierigkeiten, Ereignisse oder Erfahrungen als zusammenhängend und real zu erleben. Neigung zur Tagträumerei oder zum Abschweifen der Gedanken, um sich von unangenehmen Realitäten zu distanzieren. Häufige Konzentrationsschwierigkeiten oder Gedächtnislücken. Wiederholte Phasen der Desorientierung oder Desrealisation, bei denen die Umgebung als unwirklich erscheint. Gefühl, als ob die Zeit entweder beschleunigt oder verlangsamt wird, was zu einem verzerrten Zeitgefühl führt. Werde Mitglied in der Schmerzfreie Liebe Community Jetzt Platz sichern Vielleicht hast du gelernt, dass Liebe mit Schmerz verbunden ist oder du ziehst unbewusst Partner an, die dir ähnliche Verletzungen zufügen wie in deiner Kindheit. Diese Muster können dein Glück und deine Zufriedenheit sabotieren. Links: Instagram | YouTube | 1:1 Beratung | GRATIS-Audiokurs: "Finde heraus welches Bindungsmuster du hast"|

Do you wonder what causes chronic depression? Perhaps, you yourself are diagnosed with clinical depression or you know someone who has depression, but you aren't sure why they suffer from depression? Depression is an extremely complex mental health problem ranging from combination of genetic to environmental causes. Even professionals are not 100% certain of what causes depression and furthermore, depression varies by individual cases and history. It this video, we do our best to cover three possible causes of depression: NEGATIVE ATTRIBUTIONAL STYLES and causes, & having a NEGATIVE SELF IMAGE. Hopefully, you find this video helpful in shedding some light on the topic of depression. If you would like a video on other possible signs or causes of depression, be sure to turn on the notification bell. We will make a follow up video. #psych2go #depression #lecture101series Also, please welcome a new member to our team, Amine Bouzaher. He is currently a UBC student and helping us with script writing, research and voice over. If you yourself are interested in being a part of the team, do reach out :) Animated by: Ben Carswell Check out his animation work here: https://www.youtube.com/Twisted4kStudiosBen's goal is to one day work as a director for animation. Credits: Script Writer: Amine Bouzaher Script Editor: Amine Bouzaher VO: Amine Bouzaher Animator: Ben Carswell YouTube Manager: Cindy Cheong For Business Inquiries - editorial@psych2go.net For further readings (important): Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005;62:593–602.doi:10.1001/archpsyc.62.6.593. [PubMed] World Health Organization . The global burden of disease: 2004 update. WHO Press; Geneva: 2008. Rose DT, Abramson LY. Developmental predictors of depressive cognitive style: Research and theory. In: Cicchetti D, Toth S, editors. Rochester Symposium of Developmental Psychopathology.Vol. 4. University of Rochester Press; Rochester, NY: 1992. pp. 323–349. Metalsky GI, Joiner TE., Jr Vulnerability to depressive symptomatology: A prospective test of the diathesis-stress and causal mediation components of the hopelessness theory of depression. Journal of Personality and Social Psychology. 1992;63:667–675. [PubMed] [Google Scholar] Please share and like our videos if they've helped you out! Want to support our mission, consider becoming a channel member of Psych2Go. We will send you exclusive perks.

Multicultural competence in psychiatry is more than just a buzzword; it is a crucial aspect of patient care that acknowledges the diverse tapestry of human experiences. On this episode of The Menninger Clinic's Mind Dive Podcast, Dr. Francis Lu shares an enlightening perspective on the intricacies of cultural considerations in psychiatric diagnosis and treatment as well as the five-part framework of Cultural Formulation from the DSM-IV and its refined application in the DSM-V, which now includes social determinants of mental health and the concept of 'structural competency'. The discussion isn't just theoretical; Dr. Lu's experiences allow for a practical look into the challenges and advancements in weaving these critical elements into the fabric of psychiatric care.  Dr. Lu, often considered a pioneer in cultural psychiatry, speaks with hosts Dr. Kerry Horrell and Dr. Bob Boland about his 36-year journey through the nexus of mental health care, community engagement, and spirituality, offering a treasure trove of insights into culturally competent care. The conversation covers the evolution of psychiatric training and the robust legacy Dr. Lu leaves behind, impacting both the care of patients and the education of mental health professionals. Dr. Lu's pioneering work in establishing ethnically focused inpatient psychiatric programs is a testament to the need for sensitivity towards a patient's cultural background. His initiatives at San Francisco General Hospital not only enhanced patient care but also set a new standard for inclusivity within psychiatric practice. The in-depth look of the psychiatric profession over the last four decades allows for a more personal discussion for Dr. Lu and our hosts about their personal journeys andcareers in mental health. Sharing stories and experiences about the lesser-known toll of being mental health clinicians and navigating a profession that is as diverse as the patients. Tune into Mind Dive for a comprehensive understanding of cultural psychiatry and the continuous quest to improve mental health care for all communities. Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform! Visit The Menninger Clinic website to learn more about The Menninger Clinic's research and leadership role in mental health.

Dr. Alycia Halladay joins we to discuss the topic of Profound Autism. If you're not familiar with Alycia's work, she is the Chief Science Officer for The Autism Science Foundation, and host of the excellent show, The ASF Weekly Science Podcast.  In this episode, we discuss the changes in Autism diagnosis from the DSM IV to V, the Lancet Commission paper on Profound Autism, why there is a need for this distinction in the Autism spectrum, the conditions under which an individual would be classified as having Profound Autism, the estimated proportion of Autistics who have Profound Autism, the differences in the distribution of sex-based differences in Profound and Non-profound populations, person vs. identity-first language, the importance of reducing stigma for everyone with Autism, criticisms of the proposal of this category, and responses to those criticisms. Even though we packed a lot into this interview, there is way more to this conversation than we had time for, so I'd like to revisit this again sometime in the future. In the meantime, if  you're in the New England area, consider attending The Profound Autism Summit, which is taking place on April 5th, 2024 in Burlington, Massachusetts. Alycia will be speaking at that event, and will go into even more detail than we did in this podcast. It's a multi track conference that, according to the PAS site, aims to "bring together leaders from the areas of research, medicine, treatment, advocacy, education, and human services to discuss the needs of those with Profound Autism across disciplines and throughout the lifespan." Even though the Profound Autism Summit features talks from notable Behavior Analysts like Drs. Greg Hanley, Shanna Bahry, Peter Gerhardt, Jessica Slaton and others, it's not just an ABA conference. There will be speakers and panelists representing advocacy groups, emergency services personnel, service providers, and more (check out the entire speakers roster here).  The PAS is right around the corner and is almost sold out, so if you're on the fence and are looking for some motivation, here it is (register your spot here!). If you can't make it, consider signing up for their mailing list, as I believe they'll be making the talks available  asynchronously some time down the road.  Did you know that if you use Apple Podcasts as your player, you can get transcripts to this show? See this for a tutorial. Register for the Profound Autism Summit! Hop on their 100% non-spammy email list for updates on Profound Autism. Session 248: A review of Autism diagnostic practices. Lord et al. (2021). The Lancet Commission on the future of care and clinical research in autism. ASF's post on the Lancet Commission paper.  ASF Weekly Science Podcast homepage.  ASF Weekly Science Podcast recommendation 1: Nobody ever talks about catatonia. ASF Weekly Science Podcast recommendation 2: "Emergent and Transactional," with Dr. Andrew Whitehouse.  This podcast is brought to you by: ACE Approved CEUs from .... Behavioral Observations. That's right, get your CEUs while driving, walking your dog, doing the dishes, or whatever else you might have going on, all while learning from your favorite podcast guests! The University of Cincinnati Online. UC Online designed a Master of Education in Behavior Analysis program that is 100% online and asynchronous, meaning you log on when it works for you. Want to learn more? Go to online.uc.edu and click the “request info” button. Behavior University. Their mission is to provide university quality professional development for the busy Behavior Analyst. Learn about their CEU offerings, including their brand new 8-hour Supervision Course, as well as their RBT offerings over at behavioruniversity.com/observations.

Being sad or feeling hopeless is a normal part of human existence appearing and disappearing and reappearing with the ebbs and flows of life. But when symptoms of a depressive episode last for more than two weeks, and begin to get in the way of one's day-to-day life, that's when a person meets the criteria for Major Depressive Disorder, or MDD, which is one type of the DSM-IV's depressive diagnoses and one of many different mood disorders. The prevalence of MDD in Canada is higher than other mood disorders such as bipolar disorder and anxiety disorders (discussed in our next episode!) like generalized anxiety disorder and social phobia. Because of its prevalence, many areas of treatment are available to those who are struggling with clinical depression, including talk therapy, changing diet and exercise, medication, and brain stimulation therapies.This episode's guest, Tammy, shares with us that she began experiencing symptoms of MDD when she was in grade school. While depressive disorders tend to begin later in life and global data suggests that the median age for the onset of symptoms is 26 years old, a study from the United States showed that depression can be diagnosed as young as three years of age. Interestingly, a study from Korea showed that the age at which a person experiences their first major depressive episode may be correlated to a variety of different clinical indicators, like the frequency in which MDD episodes recur, that play a key role in one's clinical prognosis of MDD and its outcomes. In this episode, we learn about a few of Tammy's family members, one of whom also struggles with their mental health. Given the hereditary, or genetic, predisposition to mental disorders, it is common for some mental illnesses, like bipolar disorder, schizophrenia and depression, to run in the family. But when discussing the “nature” side of things, we mustn't forget about the “nurture”. We've also seen that the environmental factors like one's family structure, exposure to traumatic events, and much more can increase rates of mental health problems. Fast FactsGlobally, depression is estimated to occur among 1.1% of adolescents aged 10 to14 years, and 2.8% of 15- to 19-year-olds. More than a quarter of a million Canadian youth, representing 6.5% of people between the ages of 15 and 24, experience major depression each year.Depression can go unnoticed in children. Some may not talk about their helpless and hopeless thoughts and may not appear sad. Depression might also cause a child to make trouble or act unmotivated causing others to incorrectly label the child as a troublemaker or lazy.In Canada, once depression is recognized, intervention and treatment can make a difference for 80% of people who are affected, which allows them to get back to their regular activities.Learn More about This Episode's Cool ResearchIn this episode, we spoke to Dr. Valerie Taylor, Head of Psychiatry at the University of Calgary, and the namesake for the Taylor Lab. Their main area of research is how the gut influences brain health, known in the literature as the gut-brain barrier. Scientists have already shown a potential for the influence of gut microbiota in diseases like asthma and type I and type II diabetes, to name a few. When it comes to the bidirectional relationship between the brain, gut and microbiome there is a growing amount of evidence that this is a valuable area of research that may have implications on new therapeutic avenues. For example, studies aiming to elucidate the relationship between depression and the microbiome have shown a link between MDD and an imbalance of the gut microbiota's bacterial composition. Some of these studies even reported seeing modest improvements in depressive symptoms following interventions targeting the gut microbiome. Dr. Taylor and her team are interested in whether or not microbiomes from the gut of healthy people can be used as a treatment for those suffering with ailments, and in their case specifically, people struggling with treatment-resistant MDD. In order to get those healthy microbiomes transferred, the Taylor Lab is experimenting with Fecal Matter Transplant, or FMT for short. For their research, the process involves retrieving fecal samples from healthy screened donors, converting those samples into capsules (also known as “poop pills”),and orally administering the capsules to patients. There is a fair amount of evidence to back up the efficacy of FMT in treating disease, in fact, the practice has been reported in literature dating 2,000 years ago. The efficacy of FMT for patients with treatment-resistant MDD, however, continues to be a question the Taylor Lab is working hard to answer. Through this work, Dr. Taylor remains hopeful. In an interview with Mike Fisher for the University of Calgary, Dr. Taylor discusses her team's research. “...[T]he jury is still out on whether we can actually leverage what seems to be a gut-brain connection into the next generation of therapies. There is reason to be excited and to pursue this work and that's what fuels us — the possibility. [...] There has been research that shows if you take bacteria from depressed mice and put it into non-depressed mice, they become depressed. Microbiota are not benign, and we want to ensure people are aware of that. [...] Patients are desperate for new treatments, sometimes the current treatments don't work for everyone or have side effects that are not tolerable. So, people are looking for anything that will help them.”SupportIf you're struggling with your mental health, you're not alone.If you are in immediate danger of harming yourself or others, call 9-1-1, or head to your nearest emergency room. You can also call or text 9-8-8 to reach the Suicide Crisis Helpline. Support is available 24 hours a day, 7 days a week.Young people can chat anytime with Kids Help Phone by calling 1-800-668-6868. Services are available in English and French.Wellness Together Canada provides one-on-one counselling, self-guided courses and programs, and peer support and coaching. Youth can contact this service by calling 1-888-668-6810 or texting WELLNESS to 686868. Adults can contact this service by calling 1-866-585-0445 or texting WELLNESS to 741741. You can also find credible articles and information on their website. The Canadian Mental Health Association can help you find resources, programs, or support for yourself or others. Find a CMHA branch in your area here. The Centre for Addiction and Mental Health provides Mental Health 101 tutorials and online courses on their website. The Canadian Network for Mood and Anxiety Treatment has a list of resources for those dealing with mood disorders, such as depression and bipolar disorder, and anxiety disorders. Depression Hurts is a website developed by the Mood Disorders Society of Canada that includes a symptom checklist and doctor discussion guide for patients.

Antisocial personality disorder is a mental condition in which a person has a lasting pattern of manipulating, exploiting or violating the rights of others without any remorse and it is linked to sociopathy. While only 3% of men and 1% of women suffer from this disorder in the US according to PsychologyToday, it is important for us to discuss it. In our previous video, we talked about what Antisocial Personality Disorder really is, so today, we want to look deeper into the signs of antisocial personality disorder. If you're wondering about the antisocial personality video we posted a while back, here's the link: https://youtu.be/bW2IjDNBI1c Disclaimer: We would like to remind you that this video is only meant for educational purposes, we strongly advise any diagnoses be performed by a professional. Writer: Vincent Wilts Script Editor: Morgan Franz Script Manager: Kelly Soong VO: Lily Hu Animator: Riva Ceres Laoreno YouTube Manager: Cindy Cheong De Brito, S. A., & Hodgins, S. H. E. I. L. A. G. H. (2009). Antisocial personality disorder. Personality, personality disorder and violence, 42, 133-153. Hare, R. D. (1983). Diagnosis of antisocial personality disorder in two prison populations. The American Journal of Psychiatry. Hart, S. D., & Hare, R. D. (1996). Psychopathy and antisocial personality disorder. Current opinion in Psychiatry, 9(2), 129-132. Luntz, B. K., & Widom, C. S. (1994). Antisocial personality disorder in abused and neglected children grown up. The American journal of psychiatry. Meloy, J. R., & Yakeley, A. J. (2011). Antisocial personality disorder. A. A, 301(2). Widiger, T. A., Cadoret, R., Hare, R., Robins, L., Rutherford, M., Zanarini, M., … & Hart, S. (1996). DSM—IV antisocial personality disorder field trial. Journal of Abnormal Psychology, 105(1), 3. Antisocial Personality. (2019, November 21). Retrieved from https://www.goodtherapy.org/learn-about-therapy/issues/antisocial-personality Mayo Clinic Staff. (2019, December 10). Antisocial personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/symptoms-causes/syc-20353928 Skodal, A. (2020, January). Antisocial Personality Disorder. Retrieved from https://www.merckmanuals.com/home/mental-health-disorders/personality-disorders/antisocial-personality-disorder If you have any topic requests or stories to share with us, feel free to email us at editorial@psych2go.net

Episode 17: Worst Fears This episode was recorded on December 7, 2023 and posted on January 13, 2024. Content Warning: Light vulgarity, mentions of suicide & sexual violence.  Introduction Welcome to No Bodies Episode 17 Introductions to your Ghosts Hosts with the Most - Lonely of Lonely Horror Club and Projectile Varmint aka Suzie Introductions to our guests Will/Armored Foe of Shapes & Shadows Podcast & Billy D of Halloween Babies Podcast Today's Topic: Worst Fears Discussion on Fear What is fear? Where does it come from? Phobias vs. Fear This Week's Coroner's Report What is your worst fear? What films capture that fear? Film Discussion Will's Watchlist | Fear: Water & Loss of Control Open Water (2003), The Strangers (2008), The Descent (2005) Billy D's Watchlist | Fear: Cleithrophobia - the fear of being trapped The Descent (2005), Buried (2010), Blind Beast (1969) Suzie's Watchlist | Fear: Harm coming to her children The Hallow (2015), Jaws (1975), Silent Hill (2006) Lonely's Watchlist | Fear: Men Don't Breathe (2016), Maniac (1980), Men (2022) Rapid Fire Recommendations Will's Recommendations For Billy D: Right at Your Door (2006) For Suzie: We Need to Talk About Kevin (2011) For Lonely: Berlin Syndrome (2017) Billy D's Recommendations For Will: Butt Boy (2019) For Suzie: Antlers (2021), The Boy Behind the Door (2020), Howard's Mill (2021) For Lonely: Hounds of Love (2016) Suzie's Recommendations  For Billy D: Oxygen (2021), The Lodge (2019) For Will: Funny Games (2007) For Lonely: Run Sweetheart Run (2020) Lonely's Recommendations For Billy D: The Snare (2017) For Will: The Deep House (2021) For Suzie: The Hollow Child (2017) Thank you to our guests!  Keep up with Will's art & film musings @armoredfoe on Instagram and be sure to check out his solocast Shapes & Shadows.  Check out Billy D's solocast Halloween Babies.  Next Week's Coroner's Report What is the scariest thing about having children? Keep Up with Your Hosts Check out our instagram antics and drop a follow @nobodieshorrorpodcast.  Take part in our new audience engagement challenge - The Coroner's Report! Comment, share, or interact with any Coroner's Report post on our socials to be featured in an upcoming episode.  Projectile Varmint - keep up with Suzie's film musings on Instagram @projectile__varmint Lonely - read more from Lonely and keep up with her filmstagram chaos @lonelyhorrorclub on Instagram and www.lonelyhorrorclub.com. Original No Bodies Theme music by Jacob Pini. Need music? Find Jacob on Instagram at @jacob.pini for rates and tell him No Bodies sent you!  Leave us a message at (617) 431-4322‬ and we just might answer you on the show! Sources Adolphs, R. (2013, January 21). The Biology of Fear. Current biology : CB. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595162/ Johns Hopkins Medicine. (n.d.). Phobias. https://www.hopkinsmedicine.org/health/conditions-and-diseases/phobias Office of Communications, SAMHSA, HHS. (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t11/ Paul Ekman Group. (2021, November 13). Fear. https://www.paulekman.com/universal-emotions/what-is-fear/

Dr. Lois Choi-Kain, Director of the Gunderson Personality Disorders Institute at McLean Hospital and Associate Professor of Psychiatry at Harvard Medical School, introduces us to borderline personality disorder (BPD). We discuss the prevalence, naturalistic course, and treatments for BPD. We explore BPD using the “Good Psychiatric Management” (GPM) model, which is intended to empower clinicians of all disciplines to manage patients with BPD effectively. We discuss the principles of GPM and walk through some examples of how it might be used in the clinical setting.  Book: Applications of Good Psychiatric Management for Borderline Personality Disorder: A Practical Guide (Check your academic library!)  References:  (11:30) Grant BF, Chou SP, Goldstein RB, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533-545.  (12:30) Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ. Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord. 2010;24(4):412-426.  (15:00) Gregory R, Sperry SD, Williamson D, Kuch-Cecconi R, Spink GL Jr. High Prevalence of Borderline Personality Disorder Among Psychiatric Inpatients Admitted for Suicidality. J Pers Disord. 2021;35(5):776-787.  (20:45) Kernberg O. Borderline personality organization. J Am Psychoanal Assoc. 1967;15(3):641-685.  (29:30) Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What Works in the Treatment of Borderline Personality Disorder. Curr Behav Neurosci Rep. 2017;4(1):21-30.  (33:00) Skodol AE, Gunderson JG, Shea MT, et al. The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications. J Pers Disord. 2005;19(5):487-504. (33:00) Temes CM, Zanarini MC. The Longitudinal Course of Borderline Personality Disorder. Psychiatr Clin North Am. 2018;41(4):685-694.   

Narcisme is misschien wel de meest intrigerende karaktereigenschap of stoornis die er is voor velen. Thijs en Lennard bespreken welke vormen van narcisme er zijn, wat het verschil is tussen 'normaal' narcisme en een narcistische persoonlijkheidsstoornis, hoe vaak het (bij je exen) voorkomt en wat je kunt doen als je het bij jezelf of een ander herkent. Adverteren in deze podcast? Podcasts@astrolads.com Bronnen en ander lees- en luister- en kijkvoer: - Bekijk de TEDx-talk van Martin Appelo, een zelf erkende narcist over narcisme: https://www.youtube.com/watch?v=RSd317TLlbc&pp=ygUNbWFydGluIGFwcGVsbw%3D%3D - Ook zijn de boeken van Martin Appelo interessant, zoals: Een spiegel voor narcisten: https://www.martinappelo.nl/project/spiegel-voor-narcisten/ - Deze psycholoog, Dr. Ramani is expert op het gebied van narcisme en heeft een YouTube kanaal met een hele hoop video's erover, waaronder uitleg over wat het met je doet als je opgegroeid bent rondom een narcist: https://www.youtube.com/@DoctorRamani - Check natuurlijk ook de wiki: https://en.wikipedia.org/wiki/Narcissism - Uitleg op PsyNed is ook interessant: https://www.psyned.nl/narcisme/ - En lees het boek The Narcissism Epidemic van Jean Twenge: https://www.bol.com/nl/nl/f/the-narcissism-epidemic/36548373/ Nerd-literatuur: - Schoenewolf G (2013). Psychoanalytic Centrism: Collected Papers of a Neoclassical Psychoanalyst. Living Center Press. ISBN 978-1-4811-5541-0. - Widman, L., & McNulty, J. K. (2010). Sexual narcissism and the perpetration of sexual aggression. Archives of Sexual Behavior, 39, 926-939. - Ribeiro, P., Moreira, D., Teixeira, A., Pereira, A., Almeida, F., & Vale, I. (2023). Narcissism and Masculinity/Feminity. International Journal of Biomedical Investigation, 6(1), 1-14. - Hurlbert DF, Apt C, Gasar S, Wilson NE, Murphy Y (1994). "Sexual narcissism: a validation study". Journal of Sex & Marital Therapy. 20 (1): 24–34. - Grijalva, E., Newman, D. A., Tay, L., Donnellan, M. B., Harms, P. D., Robins, R. W., & Yan, T. (2015). Gender differences in narcissism: a meta-analytic review. Psychological bulletin, 141(2), 261. - Stinson, F. S., Dawson, D. A., Goldstein, R. B., Chou, S. P., Huang, B., Smith, S. M., ... & Grant, B. F. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 69(7), 1033-1045. - Miller, J. D., Lynam, D. R., Hyatt, C. S., & Campbell, W. K. (2017). Controversies in narcissism. Annual review of clinical psychology, 13, 291-315. - Miller, J. D., Back, M. D., Lynam, D. R., & Wright, A. G. (2021). Narcissism today: What we know and what we need to learn. Current Directions in Psychological Science, 30(6), 519-525. - Emmons, R. A. (1987). Narcissism: theory and measurement. Journal of personality and social psychology, 52(1), 11. - Lasch, C. (2019). The culture of narcissism. In American Social Character (pp. 241-267). Routledge.

Join Dr. Holmes and Dr. Whitney as they discuss key moments from his keynote presentation: Short and Long-term consequences of COVID-19 on individuals with ASD and his workshop presentation on changes in criteria from DSM IV to DSM 5. Many topics are discussed on life transition and changes needed to understand better and accommodate those on the spectrum.About Dr. Whitney:Dr. Whitney received his Psy.D. in Clinical Psychology in 2001 from the Forest Institute of Professional Psychology (FIPP). He interned at St. Charles Hospital and Rehabilitation Center (SUNY-Stony Brook Health Sciences System) in Port Jefferson, New York (Long Island). Dr.Whitney has conducted outcome research and published on ways families can help their children cope with medical and developmental differences. He has 21 years of clinical experience working with children and adolescents with emotional and behavioral disorders,and 17 years of experience working with families and children with autism and other developmental disabilities.Disclaimer:When we have guests on the ASR podcast, they are recognized for their expertise on autism as an advocate, self-advocates, clinicians, parents, or other professionals in the field. They may or may not be part of the faith community; having a guest on the broader topic of autism does not reflect complete agreement with the guest, just as many guests may not agree with our faith perspective. Guests are chosen by topic for the chosen podcast discussion and are not necessarily in full agreement with all beliefs of the chosen guest(s).

Gliederung was ist ADHS? (mit Fallbeispiel) Konsequenzen für die Partnerschaft Tipps für eure Beziehung Studien und Quellen zum Thema: 1) Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics. 2012 Jul;9(3):490-9. doi: 10.1007/s13311-012-0135-8. • 2) Ayano G, Yohannes K, Abraha M. Epidemiology of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents in Africa: a systematic review and meta-analysis. Ann Gen Psychiatry. 2020 Mar 13;19:21. doi: 10.1186/s12991-020-00271-w. • 3) European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry. 2010 Sep 3;10:67. doi: 10.1186/1471-244X-10-67. • 4) Wilens TE, Morrison NR. The intersection of attention-deficit/hyperactivity disorder and substance abuse. Curr Opin Psychiatry. 2011 Jul;24(4):280-5. doi: 10.1097/YCO.0b013e328345c956. • 5) Balazs J, Kereszteny A. Attention-deficit/hyperactivity disorder and suicide: A systematic review. World J Psychiatry. 2017 Mar 22;7(1):44-59. doi: 10.5498/wjp.v7.i1.44. • 6) Coleman WL. Social competence and friendship formation in adolescents with attention-deficit/hyperactivity disorder. Adolesc Med State Art Rev. 2008 Aug;19(2):278-99, • 7) ADHD in Adults: What the Science Says byRussell A. Barkley, Kevin R. Murphy and Mariellen Fischer, The Guilford Press, 2008, pp. 380-384. • 8) The ADHD Effect on Marriage, Melissa Orlov • 9) Barkley, R. A. (2017). When an adult you love has ADHD: Professional advice for parents, partners, and siblings. American Psychological Association. https://doi.org/10.1037/15963-000Wenn du mich und den Podcast unterstützen möchtest, dann bewerte den Podcast gerne und schicke ihn an jemanden weiter, der sich auch dafür interessieren würde.  Jede Woche neue Tipps, Übungen und Hintergrundinformationen aus meiner paartherapeutischen Praxis. Melde dich hier für den Newsletter an.  Du hast Feedback oder Fragen? Dann schreib mir auf Instagram. Du möchtest eine persönliche (Online)Beratung oder Paartherapie mit mir? Dann schreib mir eine Mail an: kontakt@paartherapiebonn.com. Mehr zu mir und meiner Arbeit findest du ⁠hier⁠. Disclaimer: Es handelt sich bei dem Fallbeispiel, um ein fiktives Beispiel und nicht um eine echte Person. Die Inhalte ergeben sich aus verschiedenen Geschichten und KlientInnen, die ich in einem Beispiel zusammengefasst habe.  --- Send in a voice message: https://podcasters.spotify.com/pod/show/anouk-algermissen/message

Dr Allen Frances was chair of the task force writing the DSM-IV, but subsequently became an outspoken critic of the rapid expansion of mental health diagnoses in DSM-5, and what he sees as the over medicalisation of behaviours that fall into the normal range of human life. Dr Frances offers a US perspective on issues such as treating ADHD and Autism, the pros and cons of early diagnosis, the appropriate role of drugs in mental health, and strategies to bring public mental health care to the greatest numbers of people.

To access the full episode and our conference library of 200+ fascinating psychology talks and interviews (with certification), please visit: https://twumembers.com In this interview, I'm joined by Dr David Spiegel. Dr. Spiegel is an author, psychiatrist and professor at Stanford University, and one of the world's leading experts into the clinical applications of hypnosis. He has published thirteen books, over 400 scientific articles, and 170 chapters on hypnosis, stress physiology, trauma, and psychotherapy. In this conversation, we discuss: — Dr Spiegel's groundbreaking research into how hypnosis can be applied in a clinical setting to improve client outcomes — What's happening in the brain during hypnotic states of mind — A simple test for identifying if you are hypnotisable or not — Why hypnosis can be a powerful treatment for trauma And more. You can learn more about Dr Spiegel's Self Hypnosis Reveri App by going to www.reveri.com. --- This session was recorded as part of our Holistic Psychotherapy Summit in January 2023. To access the full conference package, as well as supporting materials, quizzes, and certification, please visit: https://holisticpsychotherapysummit.com. --- Dr. David Spiegel is Willson Professor and Associate Chair of Psychiatry & Behavioral Sciences, Director of the Center on Stress and Health, and Medical Director of the Center for Integrative Medicine at Stanford University School of Medicine, where he has been a member of the academic faculty since 1975, and was Chair of the Stanford University Faculty Senate from 2010-2011. He has published thirteen books, over 400 scientific journal articles, and 170 chapters on hypnosis, psychosocial oncology, stress physiology, trauma, and psychotherapy. His research has been supported by the National Institute of Mental Health, the National Cancer Institute, the National Institute on Aging, the National Center for Complementary and Integrative Health, the John D. and Catherine T. MacArthur Foundation, the Fetzer Institute, the Dana Foundation for Brain Sciences, and the Nathan S. Cummings Foundation. He was a member of the work groups on stressor and trauma-related disorders for the DSM-IV and DSM-5 editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. He is Past President of the American College of Psychiatrists and the Society for Clinical and Experimental Hypnosis, and is a Member of the National Academy of Medicine. In 2018, Dr Spiegel was invited to speak on hypnosis at the World Economic Forum in Davos in 2018. --- Interview Links: — www.reveri.com — Trance and Treatment: Clinical Uses of Hypnosis - Herbert Spiegel and David Spiegel https://amzn.to/3yKxA4K --- 3 Books Dr Spiegel Recommends Every Therapist Should Read: — Wherever You Go, There You Are - Jon Kabat Zinn - https://amzn.to/3P8rQa9 — Studies on Hysteria - Sigmund Freud - https://amzn.to/3ORL8B6 — When Nietzsche Wept - Irvin Yalom - https://amzn.to/3al0JKt

Geestelijke gezondheid is een veelbesproken onderwerp op het moment, reikend van de zorgen over de gevolgen van lockdown op het mentale welzijn, de toenemende zichtbaarheid van neurodivergentie en de overvraagde psychologische zorg. Anders dan bij lichamelijke gezondheid wordt mentale gezondheid vaak gezien als subjectief en is daarom de gemeenschappelijke norm van wat “gezond” is extra dwingend, maar ook grotendeels impliciet. De grootste authoriteit op het gebied van geestelijke gezondheid is de Diagnostic and Statistical Manual of Mental Disorders gemaakt door de American Psychological Association, die ook in Nederland is de geestelijke gezondheidszorg wordt gebruikt. Als alternatief is er ook nog de International Statistical Classification of Diseases and Related Health Problems (ICD) van de Wereldgezondheidsorganisatie. Er is echter veel kritiek op deze beide handleidingen, zowel van buiten de medische zorg als binnenuit. Een voorbeeld is dat Alles Frances, nota bene een schrijver van de DSM-IV, zegt dat vrijwel normaal gedrag steeds meer een label opgeplakt krijgen en vaker met medicijnen wordt behandeld. Prof. dr. Jim van Os, psychiater, zegt: “We zijn een beetje doorgeslagen in osn enthousiasme om iemand een label te geven zodra die zich anders gedraagd. Dit heeft een keerzijde. Door die sticker op iemand te plakken, duw je iemand in een hokje (…) - het bepaalt hoe de samenleving tegen je aankijkt en je wordt opeens in de richting van een specifieke behandeling geduwd omdat die in de behandelrichtlijn van dat specifieke hokje staat.” Hij zegt ook: “Je kunt zo'n diagnose niet objectief vaststellen in het lijf van iemand. Het is niet zoals een gebroken arm die je op een röntgenfoto kunt zien.” Naast de kritiek op specifieke authoriteit is er ook brede kritiek op het bestellen van gezonde geesten en ongezonden geesten, bijvoorbeeld invloedrijk verwoord door Michel Foucault in boeken als Folie et Déraison: Histoire de la folie à l'âge classique. Foucault stelt dat waar voor de Renaissance waanzin werd gezien als een apart soort inzich in de werkelijkheid, vaak ingegeven door goddelijke of bovennatuurlijke krachten, werd waanzin daarna steeds meer gezien als een ziekte, iets om mensen voor te behoeden. Hierdoor werden geesteszieken apart gehouden, onderdrukt en behandeld. Deze kritiek bestaat nog steeds: geestesziekte kan leiden tot gedwongen behandelingen, opname en stereotypering, terwijl mensen die als geestesziek worden bestempeld niet serieus worden genomen in hun kritiek op behandelingen. Waar we in aflevering zes over het gezonde lichaam bespraken hoe cultuur en samenleving gezondheid van het lijf vormen en de grens tussen ziek, gezond en wenselijk bepalen, willen we in deze aflevering onderzoeken hoe dit gebeurt met de gezonde geest. De centrale vraag is: wie bepaalt wie geestelijk gezond is? Te gast is Heleen, die tijdens haar studie Health Humanities onder andere onderzoek deed naar “normality” en “abnormality”. Nu werkt ze in het gezondheidsveld. Verwijzingen Intro DSM-5: bijvoorbeeld hier te vinden: https://drive.google.com/file/d/10r_oUv_fZXQ4jUVXQC-4UnMdaneR3TD5/view ICD-11: https://icd.who.int/en Allen Frances. Terug naar normaal. 2013. Nieuwezijds B.V. Michel Foucault. Folie et Déraison: Histoire de la folie à l'âge classique. 1961. Merel Lewis Carroll. Alice in Wonderland. 1865. Kasey Deems (2017) "“We're All Mad Here”: Mental Illness as Social Disruption in Alice's Adventures in Wonderland," SUURJ: Seattle University Undergraduate Research Journal: Vol. 1 , Article 13. https://scholarworks.seattleu.edu/cgi/viewcontent.cgi?article=1006&context=suurj Edgar Allan Poe. “The Tell-Tale Heart.” 1843. Meesterlijk voorgelezen door Christopher Lee: https://www.youtube.com/watch?v=Z_utA6j3Oc8 Heleen Mike Boddé. De Pil. 2010. Libris. Wessel Wouter Kusters. Filosofie van de Waanzin. 2014. Lemniscaat. Alex Avila.

No episódio 248 do PQU Podcast falamos sobre o Eixo IV do DSM-III – Problemas psicossociais e ambientais, no qual se deveria estimar a quanto estresse o paciente estava submetido. Ele continha dois itens: uma lista dos eventos estressantes que pudessem ter contribuído para o desenvolvimento ou exacerbação do episódio atual do transtorno e uma classificação do nível de estresse desses eventos sobre o indivíduo. Ambos foram expandidos e refinados no DSM-III-R e no DSM-IV. Hoje o eixo IV ficou na história, não mais faz parte da nova edição do DSM. Cremos que, com isso, algo se perdeu, mas esperamos que seja resgatado de alguma forma na sua prática clínica, pois levar em conta eventos de vida aumenta seu entendimento da situação do paciente. Não deixe de escutar.

SOCIAL MEDIA INFLUENCERS HOUSTONS Laura, Roberta Lee and Brian Charles were out in full mediocrity and DSM IV criteria following THE VERDICT. suddenly the legal system is the bees' knees. And the judge is honorable and they care about victims. Super cute if it weren't too little, too late. Come read along and follow the bouncing ball of snake oil selling and hypocrisy. Let's talk! Hosted on Acast. See acast.com/privacy for more information.

Gretchen LeFever Watson, Ph.D., is a clinical psychologist whose research and intervention projects have received international scholarly and media attention, including appearances on TV and radio programs. Dr. Watson was among the first to document drug overtreatment for ADHD in the U.S. and to demonstrate that disruptive conduct can be successfully reduced through school wide behavioral interventions. In her paper, she chronicles the personal and professional attacks she experienced as a result of challenging industry interests. This serves as a testament to the potential hindrance of pioneering research and the adverse effects it can have.MUST READ: Shooting the Messenger: The Case of ADHD | SpringerLinkDr Gretchen WatsonIf you are in a crisis or think you have an emergency, call your doctor or 911. If you're considering suicide, call 1-800-273-TALK to speak with a skilled trained counselor.RADICALLY GENUINE PODCASTDr. Roger McFillin / Radically Genuine WebsiteYouTube @RadicallyGenuineTwitter: Roger K. McFillin, Psy.D., ABPPSubstack | Radically Genuine | Dr. Roger McFillinInstagram @radicallygenuineContact Radically Genuine—-----------FREE DOWNLOAD! DISTRESS TOLERANCE SKILLS—----------ADDITIONAL RESOURCES12:00 - Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison - DSM-5 Changes - NCBI Bookshelf15:00 - Larry Silver, M.D.24:00 - ADHD Experts Conflicts of Interest25:00 - Russell A. Barkley, Ph.D. - Google Scholar27:00 - John Grisham29:00 - Harvard Physicians Sanctioned for Failing to File Proper Disclosure – Policy & Medicine52:00 - How to Rewire Your Brain: 6 Neuroplasticity Exercises1:08:00 - Over 25% of People Click the First Google Search Result1:10:00 - PharmedOut1:13:00 - Change.org Petition: Protect Children: Stop Overuse of Psychoactive Drugs1:16:00 - Warfighter Advance

According to the latest data from the CDC, one in 36 children is diagnosed with autism in the United States each day. Worldwide, one in 100 is diagnosed. In the late 90s, the numbers were more around one in 1,000, and people weren't quite sure what autism was. To put it simply, autism is a different way of thinking and viewing the world. We've encountered some amazing people with autism throughout the years and many have incredible strengths. Here, we dive into the technical definition of autism as stated in the DSM-V. Today's definition of autism differs from what was originally listed in the DSM-IV. It's currently outlined as one big spectrum with three levels of severity. We discuss each level and the criteria for a diagnosis, including behavioral patterns and aspects, and how to classify autism in terms of behavioral excesses and behavioral deficits. Our conversation also includes discussion about repetitive behavior and how the approach to treatment and goal setting is as unique as the individual client.What's Inside:An explanation of the three levels of autism according to the DSM-V.How to classify autism based on behavioral excesses and deficits.How treatment plans and goals help autistic clients become their best.Mentioned In This Episode:HowToABA.com/joinHow to ABA on YouTubeFind us on FacebookFollow us on InstagramHowToABA.com/shopEpisode 093: Thriving with Autism – ABA Success Story!

Join Dr. Holmes and Dr. Whitney as they discuss key moments from his keynote presentation :Short and Long term consequences of COVID-19 on individuals with ASD and his workshop presentation on changes in criteria from DSM IV to DSM 5. Many topics are discussed on life transition and changes needed to better understand and accommodate those on the spectrum.Dr. Whitney received his Psy.D. in Clinical Psychology in 2001 from Forest Institute of Professional Psychology (FIPP). He interned at St. Charles Hospital and Rehabilitation Center(SUNY-Stony Brook Health Sciences System) in Port Jefferson, New York (Long Island). Dr.Whitney has conducted outcome research and published on ways families can help their children cope with medical and developmental differences. He has 21 years of clinical experience working with children and adolescents with emotional and behavioral disorders,and 17 years experience working with families and children with autism and other developmental disabilities.

Co to jest osobowość borderline (Borderline Personality Disorder, skrót BPD, z ang. pograniczny)? Czy możemy te osoby określić jako chwiejne emocjonalnie? Jakie czynniki mogą wywołać pojawienie się tego zaburzenia? Czy osób z takim zaburzeniem jest dużo? W jakim wieku? Jak się je diagnozuje? Cechy osobowości chwiejnej emocjonalnie / borderline według najpopularniejszych klasyfikacji psychiatrycznych: ICD-10 i DSM-IV. Czy są jeszcze inne klasyfikacje? Na te i wiele innych pytań odpowiada nasz gość, a jest nim dr Paweł Brudkiewicz – specjalista psychiatra, psychoterapeuta, lekarz z kilkunastoletnim doświadczeniem zawodowym (w tym w zakresie medycyny somatycznej).

In this episode I go over the DSM IV criteria for autism. I explain in easier to understand terms what each criteria is looking for and give everyday examples to better understand it. --- Support this podcast: https://podcasters.spotify.com/pod/show/mich-mosh/support

In this episode I explain what autism is and go over the DSM IV criteria for it. I explain in easier to understand terms what each criteria is looking for and give everyday examples to better understand it. --- Support this podcast: https://podcasters.spotify.com/pod/show/mich-mosh/support

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.03.27.534351v1?rss=1 Authors: Savage, H. S., Mulders, P. C. R., van Eijndhoven, P. F. P., van Oort, J., Tendolkar, I., Vrijsen, J. N., Beckmann, C. F., Marquand, A. F. Abstract: In this study we dissect the heterogeneity that underlies traditional group-level analyses, and determine how individualised patterns of predicted activation relate to age, sex, and variations in acquisition parameters and task design choices. To this end we take advantage of six large open-access/shared datasets and collate a large representative sample of over 7500 participants from which we build a normative of task-evoked activation during a widely used emotional reactivity task, the Emotional Face Matching Task. This enables us to bind heterogeneous datasets to a common reference model and enables meaningful comparisons between them. We then apply this model to the naturalistic and clinically realistic MIND-Set cohort, which is a heterogeneous and highly comorbid sample containing individuals with one or more current diagnosis (affective and anxiety disorders, autism spectrum disorders and/or attention deficit hyperactivity disorder). This enables us to determine whether, and if so how, participants with mental illness and/or neurodivergence differ from the reference cohort, both at the group level and at the level of the individual and in terms of cross-diagnostic symptom domains in addition to diagnosis. We show that patients have, on average, a higher frequency of extreme deviations, and have unique spatial distributions depending on the DSM-IV diagnosis and the number of co-occurring diagnoses when models are constructed using the face greater than shapes task contrast. Models built using the face greater than baseline task contrast, have, by comparison, greater predictive value for individuals' functioning across four transdiagnostic domains. We demonstrate the application of the normative modelling framework to task-based functional neuroimaging data, discuss its potential to further our understanding of individual differences in brain function within reference populations, and further validate the clinical relevance of these models. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

In deze podcast kijken we naar de relatie tussen eetbuien en depressie (of depressieve gevoelens). Wil je meedoen aan de gratis eetbuien masterclass op 28 maart? Ga naar https://blijdieetvrij.nl/masterclass-eetbuien/ Blij Dieetvrij vind je ook op Instagram: https://www.instagram.com/blijdieetvrij/    Benieuwd naar de wetenschappelijke artikelen? Puccio, F., Fuller‐Tyszkiewicz, M., Ong, D., & Krug, I. (2016). A systematic review and meta‐analysis on the longitudinal relationship between eating pathology and depression. International Journal of Eating Disorders, 49, 439–454. Haedt-Matt, A. A., & Keel, P. K. (2011). Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment. Psychological Bulletin, 137, 660-681. Grilo, C. M., White, M. A., & Masheb, R. M. (2009). DSM‐IV psychiatric disorder comorbidity and its correlates in binge eating disorder. International Journal of Eating Disorders, 42(3), 228-234 Hilbert, A., Petroff, D., Herpertz, S., Pietrowsky, R., Tuschen-Caffier, B., Vocks, S., & Schmidt, R. (2019). Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder. Journal of consulting and clinical psychology, 87(1), 91

Today my guest is the esteemed Dr. David Spiegel. I'm going to read you his bio from the Standford University of Medicine website, but as a side note, this is NOT the David Spiegel from the Amber Heard trial.   Dr Spiegel is a Willson Professor and Associate Chair of Psychiatry & Behavioral Sciences, Director of the Center on Stress and Health, and Medical Director of the Center for Integrative Medicine at Stanford University School of Medicine. Dr. Spiegel has more than 40 years of clinical and research experience studying psycho-oncology, stress and health, pain control, psychoneuroendocrinology, sleep, hypnosis, and conducting randomized clinical trials involving psychotherapy for cancer patients. He has published thirteen books, 480 scientific journal articles, and 170 book chapters on hypnosis, psychosocial oncology, stress physiology, trauma, and psychotherapy. He was a member of the work groups on stressor and trauma-related disorders for the DSM-IV and DSM-5 editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.    In my estimation, Dr Spiegel is largely responsible for legitimizing modern hypnosis and making it widely accessible through the Reveri app. He was recently on The Huberman Lab podcast where they went deep into the neuroscience and brain mechanics of hypnosis, so I highly recommend you check that out too, but today, I directed him to speak primarily on the use of hypnosis to treat addiction, trauma, and chronic pain management for those who don't want to become dependent on drugs.   The topics we cover include: What is hypnosis Guided Meditation vs Hypnosis Hypnosis for healing shame based self identity Why Guilt is often the response to sexual abuse and trauma How to use hypnosis to break self-sabotaging behaviors We talk about Reveri - Low cost app for learning self-hypnosis   ….and much more.   It was such an honor to have him on, I learned so much from him and I know you will too!   So without further delay, please enjoy this episode, with Dr. David Spiegel   Connect with Dr David Spiegel! Visit Website: https://www.reveri.com/   Watch on YouTube: ​​https://www.youtube.com/channel/UCNuRolkOZ7X8fCEFCDYd5tg   Subscribe So You Don't Miss New Episodes!   Listen On:   https://apple.co/30g6ALF   https://odaatchat.libsyn.com/spotify   https://bit.ly/3n0taNQ     Watch Full Episodes!   https://bit.ly/2UpR5Lo  

“Personality Disorder: Personality—the fundamental characteristics of a person that influence thoughts and behaviors across situations and time—may be considered disordered if judged to be abnormally rigid and maladaptive. Although treated separately by some, the commonly used categorical schemes include them as mental disorders, albeit on a separate axis II in the case of the DSM-IV. A number of different personality disorders are listed, including those sometimes classed as eccentric, such as paranoid, schizoid and schizotypal personality disorders; types that have described as dramatic or emotional, such as antisocial, borderline, histrionic or narcissistic personality disorders; and those sometimes classed as fear-related, such as anxious-avoidant, dependent, or obsessive–compulsive personality disorders. Personality disorders, in general, are defined as emerging in childhood, or at least by adolescence or early adulthood. The ICD also has a category for enduring personality change after a catastrophic experience or psychiatric illness. If an inability to sufficiently adjust to life circumstances begins within three months of a particular event or situation, and ends within six months after the stressor stops or is eliminated, it may instead be classed as an adjustment disorder. There is an emerging consensus that personality disorders, similar to personality traits in general, incorporate a mixture of acute dysfunctional behaviors that may resolve in short periods, and maladaptive temperamental traits that are more enduring.[42] Furthermore, there are also non-categorical schemes that rate all individuals via a profile of different dimensions of personality without a symptom-based cutoff from normal personality variation, for example through schemes based on dimensional models.[43]” I saw people getting arrested, shoved into police vehicles, riding in law enforcement vehicles, raided, police raids, the batter ram raids of drug houses and brothels, indictments, prosecutions, thrown in prison, law enforcement gunning folks down, standoffs between criminals and law enforcement, sex scandals (some included pulpiteers), sex work scandals (some included pulpiteers),and police brutality. Disability hate crimes in words and actions, LGBTQIA+ hate crimes in words and actions, elderly hate crimes in words and actions, children hate crimes in words and actions, female (women and girls) hate crimes in words and actions, BIPOC (black, indigenous, people of color) hate crimes in words and actions, those in poverty hate crimes in words and actions, and abuse survivor hate crimes in words and actions do exist in organized crime. Frenemies exist in organized crime just like Pilate and Herod, and Pharisees and Sadducees. --- Send in a voice message: https://anchor.fm/antonio-myers4/message Support this podcast: https://anchor.fm/antonio-myers4/support

”Partialism is sexual fetish with an exclusive focus on a specific part of the body other than genitals.[1][2][3] Partialism is categorized as a fetishistic disorder in the DSM-5 of the American Psychiatric Association only if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life. In the DSM-IV, it was considered a separate paraphilia (not otherwise specified), but was merged into fetishistic disorder by the DSM-5.[1] Individuals who exhibit partialism sometimes describe the anatomy of interest to them as having equal or greater erotic attraction for them as do the genitals.[4]” --- Send in a voice message: https://anchor.fm/antonio-myers4/message Support this podcast: https://anchor.fm/antonio-myers4/support

Do you have a loved one who is always the life of the party, everyone's best friend, and a "drama queen"? If so, they may have a touch of histrionic personality disorder! In this episode, we describe what histrionic personality disorder is and how it could be difficult for loved ones. Then, Kibby has a crushing realization about her own history with histrionic personality disorder and loses track of everything after that. Read more about HPD here: ​Pfohl, B. (1991). Histrionic personality disorder: A review of available data and recommendations for DSM-IV. Journal of Personality Disorders, 5(2), 150-166.and here: French, J. H., & Shrestha, S. (2021). Histrionic personality disorder. In StatPearls [Internet]. StatPearls Publishing.For more info, check out: www.alittlehelpforourfriends.comFollow us on Instagram: @ALittleHelpForOurFriends

Do you think you might be struggling with Binge Eating? Is it Binge Eating? Which is just the one disordered eating habit? Or do you might think it might be Binge Eating Disorder which is a collection of disordered eating habits? In this episode, I will discuss the criteria of what is officially classified as a Binge Eating Episode (which is a disordered eating habit) and I have linked below the criteria for Binge Eating Disorder based on the DSM-V (The Diagnostic and Statistical Manual of Mental Disorders) and several resources to bring to your health provider to start discussions and possible points for treatment. BEAT Eating Disorders: Treatment for Binge Eating Disorder Guide: https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/binge-eating-disorder/treatment/ Official BEAT Eating Disorders Leaflet to Bring to Your GP Appointment to Start Discussions About Binge Eating Disorder: https://www.beateatingdisorders.org.uk/resource-index-page/binge-eating-disorder-leaflet/ DSM-IV and DSM-5 diagnostic criteria for binge-eating disorder: https://www.ncbi.nlm.nih.gov/books/NBK338301/table/introduction.t1/ How I can help you end binge eating: ⭐ Click here to find my online course, contact, resources, and my 1:1 coaching Disclaimer: This podcast is for education and informational purposes only, it should not be used as a form of individualised medical advice or replace your current medical treatment.

During this, the longest summer in the history of the world, we await the denouement of this great American experiment in Democracy. Also, on this episode, we answer the VERY impordant question, who the eff shot JR, anyway? JR Ewing, by-the-by, suffered from “Narcissistic Personality Disorder,” an incurable disease articulated in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Our host has it on good authority that the DSM IV was secretly authored by Kelly Ann Conway's soon to be former x- husband, George Conway. George also diagnosed Trumpie with the same disease, years ago! Can you believe it?  Also covered in this episode, Trumpie's abnormal chode and “yeti pubes,” per the author of that incredible piece of American literature, “Full Disclosure,” Stormy Daniels. And, FUPA's and gunts. (we blame @JoJoFromJerz for the FUPA reference!) On this episode, Midge celebrates (and we poke) her fellow deplorables: Jim Jordan, Madison Cawthorn, Lindsey Graham, Mitch McConnell,  Donald J. Trump, Marjorie Taylor Greene, MAGA's (in general), GOP, Kevin McCarthy,  THORN IN THE USA is brought to you by a group of bleeding-heart liberal scoundrels who can see that the former king is totally naked, but cannot understand why people like Lindsey Graham, Mitch McConnell, and house minority leader Kevin McCarthy continue to INSIST he's is fully clothed and decent. If you enjoyed this episode, please send your support behind Marcus Flowersfor Congress in the great state of Georgia! Engineering and Sound Design by the infinitely talented @DJBrianVasquezPodArt by the ENDLESSLY talented Jennifer Dahbura

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. In this episode, we present a broad overview of antisocial personality disorder and psychopathy with our guest expert - Dr. Donald Lynam. Dr. Lynam is a clinical psychologist by training, and professor at Purdue university, where he heads the Purdue's Developmental Psychopathology, Psychopathy and Personality Lab. While there may be some disagreement in the field, Dr. Lynam and I discuss how ASPD and psychopathy are two diagnostic constructs that are attempting to outline the same psychopathology, with the main difference being the degree of severity - for this reason, we use the terms antisocial and psychopathic interchangeably.    While not necessary, it may be of benefit for listeners to familiarize themselves with the DSM-V criteria for antisocial personality disorder, the psychopathy checklist (PCL), as well as the 5-factor model of personality. References for each are listed below in the references section, however, for a brief overview, one could do a quick google image search for each term (Wikipedia also has a succinct overview of the psychopathy checklist).   The learning objectives for this episode are as follows:   Develop a basic understanding of what is meant by antisocial personality and psychopathy Be aware of some of the classic traits and characteristics of antisocial/psychopathic personalities, and the general functions of these behaviors  Describe the theoretical basis for the development of antisocial personalities    Guest Expert: Dr. Donald Lynam - Clinical psychologist, Investigator at Purdue University, Indiana Produced and hosted by: Dr. Chase Thompson (PGY5 in Psychiatry) Episode guidance and feedback: Dr. Gaurav Sharma (PGY4 in Psychiatry)   Interview Content:   0:50 - Learning objectives 1:40 - Dr. Lynam discusses his path to his current research interests 3:40 - Defining the terms antisocial personality disorder, sociopathy, psychopathy 8:30 - Discussing the possibility of antisocial behaviors without an antisocial personality 12:07 - Laying out the core features of antisocial individuals  18:20 - Antisocial personality from the perspective of the Big 5 personality model 22:00 - Discussion of the high-functioning psychopathy  25:06 - Prevalence of psychopathy 30:10 - Factors relevant to the development of psychopathy 39:30 - Prognosis and clinical trajectory  44:30 - Comorbid psychopathology  46:30 - Functions of antagonism or antisocial behaviours  49:30 - Treatment    References   American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013. Broidy LM, Nagin DS, Tremblay RE, Bates JE, Brame B, Dodge KA, Fergusson D, Horwood JL, Loeber R, Laird R, Lynam DR. Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: a six-site, cross-national study. Developmental psychology. 2003 Mar;39(2):222. Babiak P, Hare RD, McLaren T. Snakes in suits: When psychopaths go to work. New York: Harper; 2007 May 8. Hare RD. The psychopathy checklist–Revised. Toronto, ON. 2003;412. Hare RD, Harpur TJ, Hakstian AR, Forth AE, Hart SD, Newman JP. The revised psychopathy checklist: reliability and factor structure. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1990 Sep;2(3):338. Hare RD, Hart SD, Harpur TJ. Psychopathy and the DSM-IV criteria for antisocial personality disorder. Journal of abnormal psychology. 1991 Aug;100(3):391. Jones SE, Miller JD, Lynam DR. Personality, antisocial behavior, and aggression: A meta-analytic review. Journal of Criminal Justice. 2011 Jul 1;39(4):329-37. Lynam DR. Early identification of chronic offenders: Who is the fledgling psychopath?. Psychological bulletin. 1996 Sep;120(2):209. Miller JD, Lynam DR. Psychopathy and the five-factor model of personality: A replication and extension. Journal of personality assessment. 2003 Oct 1;81(2):168-78.   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Nancy McWilliams, PhD, is a pioneer in the field of psychoanalytic/psychodynamics. Her genuine curiosity for trying to understand and help people has led to a rich, 50-year career. In this conversation, Nancy shares learnings from her research in the field of complex trauma and profound lessons from clients who have opened up their worlds to her.  Reflecting on the changing landscape of psychotherapeutic approaches, and her objections to the “so-called evidence-based treatments”, she highlights the humanity in the psychotherapeutic relationship: meeting the clients where they are. “You have to tolerate uncertainty and not knowing – a kind of moral equality with the patient, where we're figuring it out together. I have to learn from you; I'm not here to apply something to you.” About Nancy McWilliams: Nancy McWilliams, PhD, is a renowned psychoanalytic psychotherapist, professor, and author. Nancy teaches psychoanalytic theory and therapy at the Graduate School of Applied and Professional Psychology at Rutgers--The State University of New Jersey. She is also a senior analyst with the Institute for Psychoanalysis and Psychotherapy of New Jersey and the National Psychological Association for Psychoanalysis. Nacy's influential book, Psychoanalytic Diagnosis, is a response to the significant change of direction of the DSM IV and has become a standard text in many training programs for psychotherapists in the United States and abroad.  Learn More: Nancy McWilliams, PhD, ABPP  Psychoanalytic Diagnosis Text To read the full show notes and discover more resources visit https://www.narmtraining.com/podcast *** NARM Training Institute https://www.NARMtraining.com View upcoming trainings: https://narmtraining.com/schedule Join the Inner Circle: https://narmtraining.com/online-learning/inner-circle *** The NARM Training Institute provides tools for transforming complex trauma through: in-person and online trainings for mental health care professionals; in-person and online workshops on complex trauma and how it interplays with areas like addiction, parenting, and cultural trauma; an online self-paced learning program, the NARM Inner Circle; and other trauma-informed learning resources.   We want to connect with you! Facebook @NARMtraining YouTube Instagram @thenarmtraininginstitute

Comparative Effectiveness Associated With Buprenorphine and Naltrexone in Opioid Use Disorder and Cooccurring Polysubstance Use 

What is narcissism and how do we know if someone is a narcissist?  Alyssa teams up with returning podcast guest, Rebecca Christianson, LCSW as they tackle this very important topic.  Learn more about Rebecca Christianson, LCSW   Check out the Light After Trauma website for transcripts, other episodes, Alyssa's guest appearances, and more at: www.lightaftertrauma.com Want to get more great content and interact with the show? Check us out on Instagram: @lightaftertrauma We need your help! We want to continue to make great content that can help countless trauma warriors on their journey to recovery. So, please help us in supporting the podcast by becoming a recurring patron of the show via Patreon: https://www.patreon.com/lightaftertrauma   Transcript   Alyssa Scolari [00:23]: Hello, beautiful people. Welcome back to another episode of The Light After Trauma podcast. I'm your host, Alyssa Scolari. This is a two part, well, really a two part series. This is going to be two episodes today, and it is a guest episode. It has been a while since we've had a guest episode. I know that we he had talked about me sort of reeling back on guest episodes and being much more particular with who's coming on the show, just because I know that you all are really interested and have really, really liked the solo episodes that I've done. Alyssa Scolari [00:57]: But you all also love today's guest, who is a friend of the family, friend of the podcast, it's Rebecca Christianson. Duh, would it be anyone else? We love Rebecca. She has been on this podcast to talk about grief. She's been on the podcast to talk about guilt and shame, and she's incredible. Alyssa Scolari [01:19]: Today she's on the podcast to talk about narcissism. And I know this one's going to be a really big hit for you all because narcissism is honestly a very hot term right now. It is a really hot topic. It is all over TikTok, all over social media. But before we dive right into narcissism, I just want to take a minute to let you know who Rebecca is. Alyssa Scolari [01:41]: If you are a new listener, Rebecca really started out as a mentor for me and became, honestly, one of my closest friends. She's absolutely a soulmate of mine. We were absolutely meant to know each other in this life and every other life after that. And she really is the reason why I am the therapist that I am today. Alyssa Scolari [02:05]: So Rebecca is the founder of a group practice called Rebellious Wellness Counseling in the state of New Jersey in the United States. And I will, of course, link her group practice. She works with a bunch of wonderful people. She does amazing work. She is, especially you do a lot of grief, right? Like that's like you special when I think of you, I think like you do grief, but you also do couples, right? Rebecca Christianson [02:33]: Yes. Alyssa Scolari [02:34]: Yeah. Rebecca Christianson [02:34]: Yes. Alyssa Scolari [02:35]: Rebecca does two of the hardest things that I think any therapist can do. So I will absolutely link her group practice in the show notes for today. So let's just hand it over to Rebecca. Welcome. Rebecca Christianson [02:51]: Thank you. Thanks for having me. You always say the nicest things. You are the therapist that you are because you are extremely talented and work really hard, but thank you for giving me credit for that. Alyssa Scolari [03:04]: All shucks. Thank you. Rebecca Christianson [03:05]: Yeah. So I am always honored to be on the podcast. I love, obviously, I love talking to you. I love tackling some of these topics that I think are complex topics that everybody has to handle, but don't always understand exactly how to handle it or how it affects their lives. So I'm happy to be on it. Alyssa Scolari [03:27]: Yeah, exactly, exactly. And we make a really good team, which is why I feel like tackling narcissism today is like, you and I are really, really well suited to do this together because it's a really heavy topic, right? Rebecca Christianson [03:42]: Yep. Mm-hmm [affirmative]. Alyssa Scolari [03:43]: And it's something that I think gets talked about a lot, but also often very misused and overused. And so I think here's an interesting fact for y'all, right? So the word narcissism in itself is at actually derived from the Greek mythological figure, Narcissus. And basically the story of Narcissus is that he fell in love with his own reflection. And what narcissism is at its core is really just self-absorption but pathological self absorption. Alyssa Scolari [04:21]: So that's where the name comes from. And I think when it comes to narcissism, there's one way that therapists diagnose it. But then there's an entirely different way that I think you guys can understand it and recognize it in others. And that's kind of a little bit more important. Alyssa Scolari [04:48]: So the way that therapists diagnose it is, obviously, you all have heard of the DSM. I've talked about it on this podcast before. It's like the holy grail for mental health diagnoses. It's what therapists turn to in order to diagnose somebody. And there is a personality disorder in there called Narcissistic Personality Disorder. And this is how therapists would really diagnose somebody. And really what it is it's this pattern of grandiosity. Alyssa Scolari [05:23]: They just, people, who think that they just have this huge amount of self importance. They often exaggerate their achievements and their talents. They are preoccupied with fantasies of unlimited success, power, brilliance, or ideal love. They believe that they are super special and unique and that they are very high status and everyone else is below them. They require excessive admiration. They constantly need other people to be doting on them and thinking that they are just the bees knees. Alyssa Scolari [06:01]: They have an extreme sense of self entitlement, very unreasonable expectations, and they always think that they should be favored above everyone else. They exploit people, especially those who are closest to them. In other words, they try to take advantage of the people around them to meet their own needs. And they lack empathy. They cannot identify with feelings or needs of others and they often can seem very arrogant, right? Alyssa Scolari [06:33]: So that's a very brief run through of what those symptoms look like in the book that therapists use to diagnose. But it's a little bit different when we're just in our day to day life. So Rebecca, can you actually talk about, I don't know. I feel like what I just said was a very hoity-toity way of describing narcissism. Can you break this down? What does that actually look like day to day? Rebecca Christianson [07:02]: Yes, absolutely. I think that one of the things that's important to remember about narcissist is that underneath it all, it's a very, very fragile ego and that extremely, extremely fragile ego, came from somewhere, right? Oftentimes it comes from childhood trauma. Oftentimes it comes from neglect or abuse where a child doesn't get their needs met. So they have to manipulate to get their own needs met and they build this wall or protection around that very fragile ego. And no one can see the fragile ego at any cost. So they will always externally get their needs met instead of getting their needs met from within. Rebecca Christianson [07:55]: That would be... The only thing that was really healing for them is to go in and process through the things that made that ego so fragile. But they, at a very young age, protect that fragile ego at all costs. At all costs. At the cost to anyone else their needs will always come first and that the hallmark of a narcissist. Rebecca Christianson [08:14]: So I'm going to quote Shahida Arabi who wrote, Becoming the Narcissist Nightmare, because this is my favorite quote about narcissist. It says, "The first thing you must know about a narcissist is that you will never truly know anything about the narcissist." Alyssa Scolari [08:30]: Ugh. Yes, yes. That's it, case closed. End of episode. Rebecca Christianson [08:37]: Closed, there you go. You'll never really know. And I really believe that because they don't know. They've created such a false self that they don't even remember why they became a narcissist. One of the questions I get all the time is like, "Can a narcissist heal? Can they get better?" And the answer to that's, yes. Rarely do they do the work that's required to get better, but they can. But that would be going back to the childhood trauma, whatever happened that made them realize that they felt they needed to manipulate their environment to get their needs met, that they were not lovable enough to get their needs met just by being who they were. Rebecca Christianson [09:29]: And that's so painful. Usually by the time they show up in our office, that's so painful that they rarely do that. But the times that I've seen narcissists actually do that work is either they have a terminal illness, and because they have never truly been able to connect authentically with anyone, they don't have very many people who are going to take care of them. Or they've had such a traumatic loss in their life that it's shocked them to their core. And they don't want to continue to live that way. Rebecca Christianson [10:03]: So, those are the times. But I think how it would show up, you said a lot of the things, I think that when you notice somebody has the inability to empathize with you or with other people at all, like if you have a friend that's a narcissist and you tell them they have the inability to empathize, but they understand people, so they can fake empathy. They can... Alyssa Scolari [10:30]: Yes. They're typically very, very charming. Rebecca Christianson [10:34]: Mm-hmm [affirmative]. Alyssa Scolari [10:34]: But when it comes to empathy, it could look like you confide in a friend about something and or you tell a friend something, right? And if that friend goes, "Oh, well they deserved it. They deserved it. They had that coming." Right? Or it could be, this person responds in a way that's like completely ignores what you're talking about and shifts the focus onto them. "Oh, well, when I was that age, it was even harder for me. Babababa." Rebecca Christianson [11:07]: Mm-hmm [affirmative]. Alyssa Scolari [11:07]: Yeah. Rebecca Christianson [11:07]: Yep. Or they will fake empathy if they think that's going to get them something. So they'll be like, "Oh, that was a hard day at work." And like this, whatever it is, because they think that they're going to get something out of that. So sometimes they'll fake empathy to get their own need met at the end of the day. And then if that doesn't happen, they get angry. So the inability to authentically apologize, see hallmark up. You notice that somebody cannot take accountability. They will skirt accountability for something that they have done that has hurt the other person or isn't right or whatever. They cannot authentically apologize. Rebecca Christianson [11:47]: You said this before, but it will always be somebody else's fault. There will always be a reason why they cannot take accountability and authentically apologize. Also hallmark of when you notice that with someone that you're around or involved with, that's definitely a hallmark sign. And then if you confront them, they become extremely angry. Rebecca Christianson [12:11]: In fact, there's a term called Narcissistic Rage. And that's if they perceive their ego as being challenged, some people have narcissistic rage. And then you did a podcast earlier that I listened to about gaslighting. This is where gaslighting comes in. They're unable to take accountability. So they will gaslight at all costs. And it becomes, because they're usually extremely bright and charming, it can become almost impossible to pick up on the gaslighting. Rebecca Christianson [12:47]: Some people are so good at that, that your head is spinning and you don't even understand what just happened. It's not until you tell somebody outside of that interaction or relationship that they might be able to see, "I think they were gaslighting you." Because it's real, some people become really good, they become professionals at not taking accountability. Rebecca Christianson [13:14]: And the thing about, again, they're very intuitive, very perceptive, very charming, and very bright. So they will learn things about you, your Achilles heel, your soft spots, and that's where they're going to hit. So when they gaslight you, it's not going to be always about the actual thing they're not taking accountability for. They're going to gaslight you and hit where they know it hurts so that you will be blindsided, taken off guard, all these other things. So ultimately they don't have to take accountability. Rebecca Christianson [13:47]: I think those, and then you mentioned self-absorbed, always bringing the conversation back to themselves. I feel like if you're in a relationship or a friendship or a work relationship with somebody who has more than one of those characteristics, they are probably a narcissist. Alyssa Scolari [14:05]: Red flags, red flags, red flags, red flags. Yeah. And I think gaslighting is the narcissists best friend. Best friend, that is their biggest tool. And as you're kind of saying all this, I feel like now's a really good time to read the Narcissist's Prayer. So this perfectly, for the listeners out there, reflects everything that Rebecca is saying and then some. It's like, The narcissist's prayer is, and by the way I did not write this. And I actually don't know who wrote this. I tried to look it up and there's a couple different versions of it, but I don't know. It says the author is unknown when it comes to this specific version of it. Alyssa Scolari [14:50]: But the Narcissist's Prayer is, "That didn't happen. And if it did, it is not a big deal. And if it was a big deal, then it was not my fault. And if it was my fault, well, then I didn't mean it. And if I did mean it, then you deserved it. Now this conversation is over. I am done talking about it." Rebecca Christianson [15:12]: I think that says it perfectly. And so many people, here's the thing about narcissists, right? So many people, as you were saying, all of the kind of DSM-IV criteria, I think two things. I think one on a bad day, we all feel selfish, right? It's normal to have moments of time where we feel selfish, that's normal. But we feel remorse and regret when that selfishness might have been at the expense of someone else. But there's remorse, there's guilt or shame. Rebecca Christianson [15:48]: Narcissists do not feel guilt or shame for that. They are self-absorbed to a pathological point, and you said that in the beginning and I wanted to reiterate that, they're not just having a selfish day. They're not just self-absorbed about the promotion they want at work. It's a way of living for them. It's to a pathological point. Rebecca Christianson [16:11]: And I think we all have narcissist in our lives and it's hard. It's hard because when you get close to, and I know Part Two is going to be more about the relationship with the narcissist, but when you get close to putting up a boundary with a narcissist, they love bomb. And when they love bomb, it feels as if they've heard you and they understand the error of their ways. Rebecca Christianson [16:36]: They don't say that because they can't take accountability. It just feels that way. And then you're hooked again. Then you're hooked again. And these characteristics will show up again. So if you think you're in a relationship or have a friend or a work relationship where you're in, or you think they're a narcissist, and you start to point that out or you start to set different boundaries because that doesn't feel good, and they make you feel like they understand the error of their ways they want to change. But these show back up again, run, run because they're a narcissist. Alyssa Scolari [17:13]: Run far. Rebecca Christianson [17:14]: And they just love bombed you. And now you're going to be right back in the same cycle. And gaslighting is, I think, the number one way that narcissists manipulate, but they also use silent treatment. Alyssa Scolari [17:25]: Yes. Rebecca Christianson [17:26]: Silence actually sets off the same pain receptors as physical pain. Alyssa Scolari [17:33]: Oh, I did not know that. It makes sense. Rebecca Christianson [17:36]: It does. Giving someone the silent treatment sets off the same pain receptors as actual physical pain in our brain. It's so painful to be ignored, rejected, abandoned to feel those feelings to suddenly have silence. So it's also a huge manipulation tactic for narcissists. Rebecca Christianson [17:54]: Stonewalling, the end of the prayer that you read, "And I am done with this relationship," refusing to talk about things is also a huge manipulation tactic. And then comparison. So they need the attention from everyone, right? So they will often compare what you're giving to what other people, past girl friends, other people that they are in their lives can give them, can feed them. So another huge manipulation tactic is to compare what you're offering to other people, whether that's imagined or real, to get you to up your ante, to get you to do more. Alyssa Scolari [18:38]: Yeah. And I also think that another too, well, you mentioned the love bombing, right? And for folks out there who may not have heard of this phrase before or may have heard of it, and don't quite know what it is love bombing is, again, the narcissist isn't taking accountability for his or her or their actions, but they are showering you with gifts, showering you with affection, spending money, maybe money that they don't even have, on you. Alyssa Scolari [19:06]: Suddenly you have that Prada bag that you have always wanted. Suddenly they are paying for you to go on a trip. Suddenly, you've been asking for three years to go and visit, I don't know, the state of Vermont in the fall because it's beautiful and guess what? All of a sudden you're going there. And they might be showering with you with words of affection as well, "I love you. You're so important to me." They tell you everything, like Rebecca said, that you want to hear, that makes you think that they have taken accountability and seen the error of their ways. But without them actually having to say that, right? So that's love bombing. Alyssa Scolari [19:41]: But then the other thing that I always see with narcissists is their attempt at isolation, right? So yes, also the comparison, but they will also do this thing where they will make you feel like you're alone in the world. And they might say very subtle things like, "Oh, did you see the weird way your friend was looking at you there?" Rebecca Christianson [20:06]: Yeah. Alyssa Scolari [20:06]: Right? "Did you see the way she rolled her eyes when you guys were talking? Do you really think she's a good friend?" When I was in a relationship with a narcissist, he would tell me time and time again, that my family hated me, that they hated me. And after a while, and he wouldn't sit me down and say, "Alyssa, your family hates you." But it was very subtle. It would be, "Huh? Are you sure you're okay with the way your mom said this?" And, "Are you sure you don't feel some kind of way about the way your dad said that." And, "Oh, well, I heard that your friend, so and so, said this about you." These very seemingly small things that suddenly, before you know it, have you feeling like you can't trust anyone else, but the narcissist. Rebecca Christianson [20:53]: Mm-hmm [affirmative]. Alyssa Scolari [20:54]: Do you agree with that? Did I explain that correctly? Rebecca Christianson [20:55]: I totally agree. Yes, I absolutely agree. They will... Until they're the only one that you trust, but they never, ever go, it's never going to actually be about you, it's always going to be about them. And the reason they do that is so that they don't have competition so that when you don't have anyone to say, "You know, he said or she said this to me." And for them to say, "That's gaslighting. They're gaslighting you." Or like, "That's not okay. They're breaking you down. You're not yourself." Rebecca Christianson [21:37]: Isolate you from everyone that can give you perspective, so that they are your only perspective, because they'll isolate you from anyone who can challenge them. Especially anyone whose smart enough to see what they're doing. Alyssa Scolari [21:54]: Yeah. Yeah, exactly. Rebecca Christianson [21:56]: Yep. I think that whenever... Another kind of hallmark I feel like I see a lot in people who come in and they're in a relationship with a narcissist is, they want to change. If you feel like you want to change or teach the person you're in a relationship with something, like about being a decent human, if you feel like they just don't understand how to treat people properly or be nice or kind, right? Sometimes people will say, "I just don't think that they understand." It always is a red flag to me. My ears always perk up and I start to listen because you shouldn't have to teach a normal person how to be decent and respect people. If you're in an adult relationship, you shouldn't have to, that's something that you teach toddlers. That's not something that you should teach an adult. Rebecca Christianson [22:54]: They should know that. That should be... So if you feel that way, be careful, because narcissists can't learn that. Alyssa Scolari [23:04]: Yes. Rebecca Christianson [23:04]: They do not get something from being inherently kind. If they're kind it's to feed their ego. It's to get something fed. It's not just about, it's never about the other person. So that's something else. It's like a hallmark in relationships when you feel like, "Oh, I just don't think they... They just don't understand how they come across." They know exactly how they come across and they're being an asshole to your friends because they don't want you to be in those friendships because those people are picking up on the fact that they're a narcissist. So it's all manipulation. Alyssa Scolari [23:41]: Absolutely. 1000%. 1000%. I think you make a really good point there. And I think before we wrap up with this Part One today, and we're going to get into more on the next episode about some differences between covert and an overt narcissists and what does narcissistic abuse look like in the victim? What are some of the longterm effects of that? What does treatment look like? We're going to talk about that in the next episode, but I also, before we close out, I really wanted to say that it's important for you guys to remember out there that this narcissism is defined by a pattern. Because you could take any one of these things in an isolated incident, and it might not necessarily mean somebody is a narcissist, right? Alyssa Scolari [24:27]: Like Rebecca said, we all have selfish tendencies. Being selfish isn't a bad thing at times, right? We all can be self-absorbed. So in an isolated incident, I don't want you to see this and then think immediately of this podcast and go, "Oh my gosh, this must be a narcissist." Because that's not necessarily the case. It is a pattern, a consistent pattern, so please keep that in mind. Alyssa Scolari [24:54]: And with that being said, I think, unless there's anything else you wanted to add today, Rebecca, I feel like this might be a good place to wrap up with this episode. And then... Rebecca Christianson [25:09]: I think that's great. I think that in our next episode, I want to touch a little bit on, this is something you and I talked about, the covert versus overt narcissist. I do think a lot of times, there are like closet narcissist and sometimes that gets missed and people are in unhealthy relationships. But we can definitely start with that, pick that up, next time. Rebecca Christianson [25:32]: And then start to talk about, there is some interesting characteristics that narcissists look for in people. I think sometimes victims of narcissists feel like there must be something wrong with them, but actually narcissists choose really intelligent victims. And they choose people who have really good qualities that are usually very intelligent. That'll also be a great topic to pick up with next time. Alyssa Scolari [25:58]: Perfect. So at that, I think we are going to wrap up and we will be back with the second part of this series next week. And if you are enjoying what you're hearing and you're enjoying the podcast, please do not forget to leave us a review. Reviews are incredibly important. They help us to continue to grow and that is the goal. We can get people to be aware that they have access to free mental health support and education through the podcast. And we do that by continuing to grow. Alyssa Scolari [26:33]: And if you are a patron on Patreon, don't forget that you can also message me directly through Patreon and you can make episode requests if there's a specific topic that you would like to hear, please feel free to do that. And if you are not a Patreon member yet, please feel free, if you are able to do so to sign up, to become a member. And anything that you are able to give towards the podcast would go a really long way in terms of helping the podcast to pay for itself and helping us to pay for all the different types of things that we do to be able to make this podcast what it is. Alyssa Scolari [27:13]: So thank you all so much. I am holding you in the light and I will see you next week. Alyssa Scolari [27:19]: Thanks for listening everyone. For more information, please head over to lightaftertrauma.com. Or you can also follow us on social media, on Instagram we are @lightaftertrauma and on Twitter, it is @lightafterpod. Alyssa Scolari [27:36]: Lastly, please head over to patreon.com/lightaftertrauma to support our show. We are asking for $5 a month, which is the equivalent to a cup of coffee at Starbucks. So please head on over. Again, that's patreon.com/lightaftertrauma. Thank you. And we appreciate your support.

As autism rates have crept upward year after year, it has become common to shrug off the scorching numbers as little more than artifacts of "better awareness" or "diagnostic substitution." But the overwhelming weight of evidence suggests that the increase is real, the result of increasingly common neurodevelopmental disability, and not mere diagnostic shifts. NCSA President Jill Escher discusses this phenomenon with guests Walter Zahorodny, PhD, Associate Professor of Pediatrics, Rutgers University Medical School, and Josephine Shenouda, co-investigator of the Autism and Developmental Disabilities Monitoring Network in New Jersey. Highlights: • Using stable, reliable, consistent methodologies, autism rates have been seen to climb from less than 1% to more than 5-7% in metropolitan New Jersey, over about 20 years. • The increasing rates are not subtle nor confined to certain populations or areas. • Defying expectations, autism prevalence increases about 11% a year in the U.S., and rates have still not plateaued. • The findings reflect cases of serious underlying functional disability easily recognized by educators and health providers, and not mere differences or traits of autism. • There is no evidence that better detection or surveillance is leading to the growing numbers; there is no evidence of an undetected horde of adults that would have qualified as autistic under the criteria. • Comparing apples:apples, eg, just those with autism and intellectual disability, that population itself has increased dramatically; it's not just mild cases. Autism with ID is about 30-40% of cases. Most cases in the New Jersey studies would satisfy the DSM-IV criteria for "Autistic Disorder." • About 20% of children with autism in New Jersey are not officially diagnosed by age 8. • There is no evidence that in-migration to New Jersey has caused the increasing rates. • Most CDC ADDM sites are underestimating autism prevalence. • Vaccination is not linked to autism risk, and other environmental factors that have thus far been explored cannot explain the increase in autism, though some factors such as adverse perinatal events (like prematurity) contribute to some degree. • Diagnostic substitution, such as with intellectual disability, cannot explain the increasing rates. • Genetic hypotheses attract the bulk of funding but explain little about autism. • Autism screening using a simple 10-question parent survey they developed is 85% effective at detecting autism at 18-36 months. This can reduce disparities and increase access to intervention. • Understanding the true prevalence of autism is absolutely foundational to inform policy: programs, staffing, budgets. Yet we are operating on wildly outdated assumptions about autism rates. Links: Autism in California 2020: A Report to the Public. Shenouda J, Barrett E, Davidow AL, Halperin W, Silenzio VM, Zahorodny W. Prevalence of autism spectrum disorder in a large, diverse metropolitan area: Variation by sociodemographic factors. Autism Research. 2022 Jan;15(1):146-55. Zahorodny W, Shenouda J, Mehta U, Yee E, Garcia P, Rajan M, Goldfarb M. Preliminary evaluation of a brief autism screener for young children. Journal of Developmental and Behavioral Pediatrics. 2018 Apr;39(3):183.

What's New in the DSM-5-TR? Curt and Katie interview Dr. Michael B. First, MD, editor and co-chair of the American Psychiatric Associations' DSM-5 Text revision, coming out March 2022. We explore: What are the differences between a full update and a text revision? What changes have been made (and how were these changes decided)? What new diagnoses can we expect? Can clinicians continue to use the older DSM-5? How can clinicians advocate for changes in future versions of the DSM? All of this and more in the episode. Interview with Dr. Michael B. First, MD Michael B. First, M.D, is a Professor of Clinical Psychiatry at Columbia University, a Research Psychiatrist in the Division of Behavioral Health Sciences and Policy Research, Diagnosis and Assessment Unit at the New York State Psychiatric Institute, and maintains a schematherapy and psychopharmacology practice in Manhattan. Dr. First is a nationally and internationally recognized expert on psychiatric diagnosis and assessment issues and has conducted expert forensic psychiatric evaluations in both civil and criminal matters, including the 2006 trail of the 9/11 terrorist Zacarias Moussaoui. Dr. First is the Editor and Co-chair of the American Psychiatric Associations' DSM-5 text revision, Editorial and Coding Consultant for the DSM-5, and the chief technical and editorial consultant on the World Health Organization's ICD-11 revision project. Dr. First was the Editor of the DSM-IV-TR, and the Editor of Text and Criteria for DSM-IV and the American Psychiatric Associations' Handbook on Psychiatric Measures. He has co-authored and co-edited a number of books, including the fourth edition of the two-volume psychiatry textbook, A Research Agenda for DSM-V, the DSM-5 Handbook for Differential Diagnosis, the Structured Clinical Interview for DSM-F (SCID-5) and Learning DSM-5 by Case Example. He has trained thousands of clinicians and researchers in diagnostic assessment and differential diagnosis. In this podcast episode we talk about latest updates for the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5-TR. With the upcoming release of the new DSM-5-TR, Curt and Katie reached out to Dr. First, the editor and co-chair of the American Psychiatric Association's DSM-5-TR, to find out what's new and how the DSM committee works. “During the development of [DSM-5-]TR, George Floyd happened, and our entire consciousness about systemic racism became sort of raised. Then the question was, are there things in the DSM that are reflective of this kind of systemic racism? So, we actually created a committee that went through the entire DSM.” – Dr. Michael First What changes have been made in the new DSM-5-TR? Text revisions occur to avoid letting the text become stale while supporting ongoing updates. New disorders, specifically Prolonged Grief Disorder, have been added. New codes, modeled off symptom codes, created for documenting suicidality and non-suicidal self-injury with another diagnosis. New categories of Unspecified Mood Disorder. New Criteria set for Autism Spectrum Disorder which is more conservative. How are cultural differences addressed in the DSM-5-TR? Starting with DSM-IV, there has been a special committee created for culture and culture related issues Hypothetically, the criteria sets should apply to everyone, but in the text, there is a section on Culture Related Features which is more specific. The impact of the George Floyd protests inspired the creation of a new committee to look for systemic racism, lack of nuances, and prevalence issues within the DSM. There are conflicting opinions if “transness” should be included in the DSM and if it's even a mental disorder. As the DSM is a diagnostic tool to code for insurance, the DSM takes the stance that the Gender Dysphoria diagnosis stay included so individuals can have access to medical intervention and treatment. The Steering Committee for new diagnosis is small, but there is diversity. Before a diagnosis is approved, it is posted for 45 days on the DSM website for all, including people with lived experience, to comment and advocate for diversity What is the Process for Accepting New Diagnose? The steering committee accepts proposals through the DSM portal for new diagnosis Some diagnoses are qualified based on the United States' continued use of ICD-10, whereas the ICD-11 is more progressive. With Complex Post Traumatic Stress Disorder, some of the criteria from the ICD have been incorporated into the DSM diagnosis of PTSD Proposals are floated around often, but they often don't have enough empirical research yet. Proposals need to show a pool of patients who don't fit other diagnoses, a gap in treatment, and a difference from other possible similar diagnoses. New diagnoses will be approved on a continuum, making the electronic DSM-V-TR the most up to date resource. The committee is more conservative in adding a new diagnosis to the DSM because it is hard to remove a diagnosis once it is included. “I'd say the biggest [change] is Prolonged Grief Disorder… Now for a number of years, the concept of Prolonged Grief Disorder was really a hole in the diagnostic system… patients were out there that… were suffering, so they had some kind of mental disorder… That's not Major Depression, you can have Major Depression, and Prolonged Grief Disorder. But they're not the same at all. Hardly any overlap. So there's a big hole in the system that allows people to come into your office and not have any place for them.” – Dr. Michael First Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: SuperBill Interested in making it easier for your clients to use their out-of-network-benefits for therapy? SuperBill is a service that can help your clients get reimbursed without having to jump through hoops. Getting started is simple - clients complete a quick, HIPAA-compliant sign-up process, and you send their superbills directly to us so that we can file claims with their insurance companies. No more spending hours on the phone wrangling with insurance companies for reimbursement. Superbill eliminates that hassle, and clients just pay a low monthly fee for the service. If your practice doesn't accept insurance, SuperBill can help your clients get reimbursed. SuperBill is free for therapists, and your clients can use the code SUPERBILL22 to get a free month of SuperBill. Also, you can earn $100 for every therapist you refer to SuperBill. After your clients complete the one-time, HIPAA-compliant onboarding process, you can just send their superbills to claims@thesuperbill.com. SuperBill will then file claims for your clients and track them all the way to reimbursement. By helping your clients get reimbursed without the stress of dealing with insurance companies, SuperBill can increase your new client acquisition rate by over 25%. The next time a potential client asks if you accept insurance, let them know that you partner with SuperBill to help your clients effortlessly receive reimbursement. Visit thesuperbill.com to get started. Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Purchase the DSM-5-TR   Learn about the DSM Learn about the Changes for the DSM-5-TR Dr. Michael First's Email Dr. Michael First's Website Dr. Michael First on Wikipedia Provide Feedback on the DSM Submit Proposals for Changes to DSM-5 Relevant Episodes of MTSG Podcast: What the Grief Just Happened? Antiracist Practices in the Room with Dr. Allen Lipscomb Trans Resilience and Gender Euphoria Death, Dying, and Grief with Jill Johnson-Young, LCSW On the APA Guidelines for Boys and Men What to Know When Providing Therapy to Elite Athletes Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Podcast Homepage Therapy Reimagined Homepage Facebook Twitter Instagram YouTube Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group   Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript for this episode of the Modern Therapist's Survival Guide podcast (Autogenerated):   Curt and Katie  00:00 This episode of the Modern Therapist Survival Guide is brought to you by SuperBill. interested in making it easier for your clients to use their out of network benefits for therapy. SuperBill is a service that can help your clients get reimbursed without having to jump through hoops. Getting Started as simple. Clients complete a quick HIPAA compliant signup process and you send their SuperBills directly to us so that we can file claims with their insurance companies. No more spending hours on the phone wrangling with insurance companies for reimbursement. SuperBill eliminates that hassle and clients just pay a low monthly fee for the service. Stay tuned for details on SuperBill therapist referral program and a special discount code for your clients to get a free month of service.   Announcer  00:42 You're listening to the Modern Therapist Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.   Curt Widhalm  00:58 Welcome back modern therapists. This is the Modern Therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about all the things that we do. And we have a pretty big milestone coming up in our profession here where the DSM-5 is transforming into the DSM-5-TR. And we are joined today by one of the very instrumental people behind the updates to this Dr. Michael First. He's professor of psychiatry at Columbia University and editor and co-chair of the DSM-5 talking to us about some of the exciting updates that are happening and a little bit of the process behind it. So thank you very much for joining us here today Dr. First.   Dr. Michael First  01:44 Really, it's a pleasure to be here.   Katie Vernoy  01:46 We're so excited to have you and to have this conversation, we had reached out to our audience for some questions. So we'll try to get to some of those. But our first question that we ask all of our guests is, who are you and what are you putting out into the world?   Dr. Michael First  02:00 Okay, so um, I have a position at Columbia University. I also work at the New York state psychiatric institute. I also have a private practice in New York City, and also a forensic practice. That's pretty pretty busy. And I've my main thing to my life has been DSM, I actually got involved all the way back first at the VA that year, DSM-3 came out in 1986, because I did my residency at Columbia, where Robert Spitzer, who is the king, or whatever, he said, he created the DSM, he put it on the map, so I got to work with him. And I've been working with him and also with the person who did DSM for Alan Francis. And so I've been had my finger in some way, shape, or form every DSM. Oh, and I also work on the ICD 11, who has their own classification. And they're just recently updated theirs as well. So I asked to work on that project.   Katie Vernoy  02:54 Wow, that's awesome.   Curt Widhalm  02:56 So some of us have been practicing a while, my grad school we were on the DSM-4-TR. So I got to see through the transition of DSM-5, but can you maybe provide a little bit of context for what's the goal of a text revision as opposed to a full update and looking at, you know, just kind of jumping into the next number here.   Dr. Michael First  03:18 Let me give you a background of how the text, the 4-TR came about, there was those 3-TR, for example, was the first TR. So it's all started way back in 1980, with DSM-3, which was the first version that had diagnostic criteria. When they were working on it, they had this idea that it was just something that psychiatrist would be interested in. When they publish it, it became this huge hit, you know, it's sold millions of copies really transformed the field, people found that very, very useful. And so, seven years later, they did the DSM-3 are now why that wasn't called DSM-4 simply because the DSM are actually linked to the ICD. And ICD 10 was supposed to be coming out in 1992 or so. Here we were in 1987 today, so we're actually this is an in between DSM-3, DSM 4- revision, so that's why it was called the three R, then DSM-4 comes out in 1994. And then after DSM-4 came out, there was a lot of pushback in the field about APA grinding out a new DSM, every seven years, everybody had to learn it. So things really put the brakes on the DSM. So APA made a decision that we're not going to seven years from now, I'll do with the DSM-5 we're gonna wait and see. What the downside of doing that is the text which is 90 something percent of the book is actually text not just the criteria detects is a really good resource for mental health professionals about diagnosis and prevalence doesn't know anything but treatment, but it's kind of like a super textbook in the sense that it's got the top people in the world working on it. They've kept waiting, waiting, waiting DSM-5, which was clearly going to be at least 10 years if not more away. It ended up being closer to 20 years, the text would have gotten very stale. So that was the motivation to do the DSM-4-TR. Or when they did the 4-TR, or they made the decision, so people wouldn't be bent out of shape about yet another DSM only to revise the text, the diagnostic criteria will go into be unchanged, it turned out there for very, very small changes, because a couple of errors has been found in the DSM 4 like, for example, Tourette's, tic disorders had requirement that the, in order to call somebody diagnose somebody with Tourette's, it had to cause clinically significant impairment and distress. That's a standard DSM phrase. So you're trying to differentiate things that aren't problems, from things that are problems, the neurologist got all bent out of shape about that ticks a tick whether or not it causes impairment, it's still a tick. So we, for example, we deleted that, that criteria, but it's very small stuff like that. So that's why the TR really was just a text revision. So DSM-5 didn't come out until 2013. So with DSM-5 came out, it was a complete redo of all the criteria and the text. And then moving forward, what happened was, is the DSM-5-TR, now, now DSM-5-TR is actually different than the 4-TR, because it is this time, the criteria have changed, they've been changing the criteria. And the way that was accomplished was the fact that we now have APA as a process in place to allow changes to be made on an ongoing basis. That was one of the reasons why the DSM-4 criteria were changed was every time they do a revision, it's a huge expensive, you know, hundreds of people involved process and it because you really want to every time there's a change, you want to make sure that changes, it's been well researched, you consider the pros and cons. So it's a big process. So they realized that moving forward, they APA realized that now that we're not stuck using just books, they could actually have changes made in the DSM on an ongoing basis. And that's what happened since DSM-5 came out. In 2013, there's been a number of changes in the criteria set. So the criteria sets in there five to about 70 of them have some changes, most of them are very, very minor, you're correcting tiny errors, but there's some that are significant. So one of the differences, of course, is that when 4-TR are came out, you could say I want to buy that still say that about five here, but you can say I care about the criteria that he diagnoses, I don't really need to see the text. That's not true. This time, the actual definitions have changed. There's a new disorder in the DSM-5-TR.   Katie Vernoy  07:39 What are the big important changes that we should know about in DSM-5-TR?   Dr. Michael First  07:40 So we've added a disorder it's Prolonged Grief Disorder. So it's much more clinically relevant. The DSM-5-TR, really than the 4-TR was I'd say the biggest is Prolonged Grief Disorder. So you know, when you whenever a new disorders, DSM, that's big news, I've been going through many, many DSM, the press always gets what's the new disorder. So this is a this disorder was has been researched. Now for a number of years, let me the concept of Prolonged Grief Disorder is really a hole in the diagnostic system. So there are individuals who after losing a loved one, normally, you basically adjust at some point, it's always painful maybe to think about the loved one, but you move on with your life. And in that that's a very important part of the grieving process. There are individuals where they're unable to do that they're basically stuck in a grief reaction, month after month. So after a year has elapsed in the person's grieving and preoccupied with grieving, then you could meet the criteria for Prolonged Grief Disorder. So it's can be given until at least a year has elapsed. And these are individuals or a number of individuals who have that problem. And it was really unrecognized, wasn't in the system at all. Now in DSM-5 came out, and there's a pending research appendix in the back. So when DSM-5 was was in preparation, we already knew about this condition, and there was some controversy about how best to define it. So they actually put something in the research appendix called persistent, complex bereavement disorder in the back that is the precursor to what's now called Prolonged Grief Disorder. So it's been around but, So now, after this, we finally got to the point, we felt that the research was clear enough, the case was compelling enough that it would do more harm than good to put it in there. And it went through all the processes within the APA for approval, and it was approved and added to the online version, and now that's going it's in the hardcopy version as well. That's by far the biggest change. Probably the next biggest change has to do with suicide. Now suicide. If you look at the DSM now, suicide is basically a criterion in major depressive episodes, criterion number nine, that's like the biggest suicide of course, as a therapist, what are the most important things that we have to deal with very, very important but the DSM has a little sidelight so to speak. So we felt it was very important for therapists and clinicians and researchers to have a way to indicate the presence of suicidal behavior, independent of depression. Suicidal behavior can occur in a wide variety of mental disorders including no mental disorder at all. So we wanted to have a way to indicate that. So it turns out that there's a mechanism within the ICD 10, which is the coding system. You everybody know that when you write down the diagnostic code, you get paid. That's your that's how the DSM code, that's the code from the International Classification of Diseases, which is a government controlled system, we realize that there are these things called symptom codes in the ICD 10, which are not disorders, but they allow you to list a particular symptom, that is of particular importance. So we actually went and requested from the NCHS, the National Center for Health Statistics to have a new code created for suicidal behavior, current and history of suicidal behavior, and also current non suicidal self injury and history of non suicidal self injury. So there's four separate codes that are now in the book that will allow you, it's optional, obviously, to list those along with the diagnosis. So if you have somebody with Major Depressive Disorder, who's suicidal, you would list both major depressive disorder as a diagnosis. And we also list this special code. In addition, that's so that's a really nice addition. The rest are not quite... so one of them is there's a category that's been added actually restored, called unspecified mood disorder. And what's that? Why is that a big deal? It turns out that, you know, when you first see somebody who has a mixture of mood symptoms, you have to right, you're one of the things about getting paid is you need every time you see the patient or his client, you need to write down a diagnosis.   Katie Vernoy  08:32 Yep!   Dr. Michael First  08:32 What the person look like during that meeting. So let's say you have your first meeting with a client, and they have this, you know, mix of irritability and agitation and a little sad, what would you call that? And you say, Well, you know, I'm going to have to look into maybe I'll check their history more speak to some other previous treaters, we got to write something down. So what the DSM does in general, when you see someone and you don't know what the diagnosis is yet, either because it doesn't fit into any of the diagnoses, or because you simply don't have enough information. That's where these unspecified codes come from. So they typically do you see somebody who is psychotic, and either you don't have enough time to figure out what diagnosis it is, or there simply doesn't fit in the type of psychosis doesn't fit into any diagnosis, you would write down Psychotic Disorder, unspecified. So for mood, there is Bipolar Disorder, unspecified, and Depressive Disorder unspecified. The question is that person who is agitated and irritable, what is it? What would you call that? And there's some implication, if you wrote down Bipolar Disorder, unspecified, then in their record their medical record, the rest of their life will be something that says Bipolar disorder, when in fact, this may simply morph into a case of Major Depressive Disorder, because irritability and agitation is commonly seen in depression. So the real what we had to do, we introduced a new unspecified category that allows you to be neutral about whether it's bipolar or depression. So that's why it's called Unspecified Mood Disorder, which you can use that you're saying no, I don't know what it is. And I'm not I know it's a mood problem, because the symptom is a mood symptom. But I'm not going to commit myself to say whether it's either depressive or bipolar. So it's a new parking place, so to speak, to put your client before you figure out what's going on in a way that's going to be less stigmatized. And that's great. And if it's a couple of corrections to problems in the criteria, that's one of the ones is Autism Spectrum Disorder. So Autism Spectrum, so if you were called in, when we went from DSM-4 to five, that was a new category that was created that used to be autism, autistic disorder, and Asperger's disorder, there are several different and pdds are different types of autism disorders. For DSM-5, they decided to consider the entire thing a spectrum of conditions. So it's now Autism Spectrum Disorder. And it comes with three levels of severity. So Autism Spectrum Disorder is defined, there are two clusters of symptoms. There's the social interaction, social engagement, awkward social reading, social cue, cues, piece of autism, and then there's this preoccupation with unusual interests or repeating words. So there's two separate dimensions of autism, the autism spectrum, so the criteria set was reformulated. And we had to come up with a new algorithm. Now, the challenge here is Autism Spectrum Disorder is really had a huge amount of interest for the past 10, 15 years because of what appears to be this explosion in cases of Autism Spectrum Disorder. And part of that has been argued that people are recognizing it more, and that's why there's more cases, but part of it is over recognizing anyway, that's the kind of little weird and awkward Oh, they're on the spectrum, that's become a common phrase in the English language. Now, if you watch movies and TV start hearing, Oh, that guy's on the spectrum. So it's become incorporated into language. But it also shows that it's been overused and over diagnosed. So when you.. the diagnostic criteria sets, the prevalence often depends upon how you construct the criteria set. So when you have a criteria set, for example, the test five out of 10, if you were to make the requirement three out of 10, the prevalence would go up a lot. If you were to go up to eight out of 10, you would shrink the prevalence. So those kinds of criteria that give you a number out of a larger number has a big effect on prevalence. So when they reformulated the autism criteria set, they wanted to make sure that the the new criteria set was conservative. So that so the way it works is there are three items for the social impairment piece of it, and four of the interest restricted interests problem, the restricted interest is two out of four, the social one was supposed to be three out of three. But if you look at the criteria itself, it just says, including the following wasn't clear if you had to have all the following or any of the following, or whatever it was intended to be all the following because they were very worried about not inflating the rates of Autism Spectrum Disorder. So the new version now has very clearly all of the following. So that I think is good. I don't know how many people were making that error, but certainly was there to be made. And you opened up to different interpretation. I think those are some of the bigger ones. There's lots of small number of small tinkering around. But I think those are probably the most one of the greatest political interest.   Curt Widhalm  16:47 We received a lot of listener feedback and some specific questions as far as some diagnostics that may not be appearing and specifically, some things like Complex PTSD, Developmental Trauma Disorder, Orthorexia, can you explain to our audience a little bit here, as far as what your process is for inclusion, or further research into maybe an inclusion of these in the future? These are things that are being discussed with the APA, and kind of how the decision is made, as far as what do we include? What we kind of continue to  just monitor and see what's out there.   Dr. Michael First  17:21 So that's another a change in process when the DSM-5 was done over, however, eight years, they had all these committees, and they would would look what's out there in the literature, and people would write in suggestions. So there's a whole process during the DSM-5 to make lots of major major changes, those committees don't exist anymore. Instead, there's a steering committee. And what the steering committee does is we entertain proposals for new new disorder. So the Prolonged Grief Disorder, even though it was in the appendix, somebody had to come and propose that it be added to DSM-5. But when you put together the proposal, that is, on the DSM portal, there's a whole complicated... we they give an indication of what kind of empirical information is required you and submit your evidence of validity, reliability will make your cost benefit analysis is the harm versus the advantages is balanced in the right direction. So yeah, there's some hurt hurdles to go through to get one of these things in there. And the website lays out what those hurdles are. So now, the system is more reacting to what people suggest rather than coming up with diagnoses on our own. So he says, a little bit of a change. So that's now the process. All the changes you've just mentioned so far were suggested, and then ultimately approved, but let's cover some of the ones you met. So right now, there's really no unless somebody were to write in and say I want Complex PTSD in there. We're not going to be considered unless somebody actually outside the system proposes it and makes it formal proposals. Now, complex PTSD is interesting, because the ICD 11 I mentioned in the beginning that I worked on the ICD 11. On past Complex PTSD, they both PTSD and complex PTSD, in ICD 11. So they made the decision to include that condition. Now, the DSM, turns out that the DSM version of PTSD if you compare it to the ICD, PTSD and complex PTSD, they're elements in the complex PTSD, much of that has been incorporated to the criteria set for PTSD. So it's kind of a little blurry with what's and what's not emphasized, is it typically when Complex PTSD was first proposed, it was a type of PTSD that happened in response to chronic early traumatic experiences often ongoing. That was the original concept, but it turns out, this is from the ICD 11. If you look at the ICD 11 definition, even though they say that's often the kind of trauma that causes Complex PTSD, that's not required. That defines Complex PTSD, at least in the ICD. It's like PTSD, plus some chronic changes in the person to soon have a chronic sense of disconnection, chronic inability to social impairments, they basically been changed, the trauma is so extensive, it's almost like change them as a person. So you have more typical symptoms of PTSD like re experiencing, and avoiding things plus these more fundamental differences in the person. Now, some of those complex PTSD symptoms are now in the PTSD criteria set. So that's what I meant by saying that we sort of took some of the complex and added it to the regular one. So that so here's an example where there are a number of examples where the ICD 11 and the DSM-5 differ. And that's one of them, you know, DSM-5 decided to have a single PTSD category that was a little bit more broad, where ICD 11 decided that they wanted to have two. Some of the other proposals, some I've heard some other proposals, but a lot of these proposals that have been floating around, haven't really reached the stage of enough empirical research, really, to be able to be seriously considered for the DSM, they're potentially good ideas, but none of them have been offered as actual proposals, with proposed evidence to be able to be evaluated, but any of those somebody, and if you're any people listening, want to make such a proposal, you go to the way which you could do that. There's a website, which is easy, www.DSM5.org, if you go to that website, that's the DSM website. On the front page, you'll see there's a it tells you how you can make a proposal and what you need to do to fill out the application.   Katie Vernoy  21:44 It seems like what you're describing is a process to really allow a feedback loop to the steering committee. And you also described the the DSM as being because it's electronic, being a little bit more dynamic in being able to pick these things up.You know, what is the likelihood that one of these diagnoses assuming they've got the empirical research attached with my ended up in the next DSM like like is that?   Dr. Michael First  22:10 Well, to say that there is no next DSM for the time being, it could go in if somebody were to write a proposal today, for Complex PTSD and arguing that the current PTSD isn't covering a very important group of patients that there's a these are the kinds of things you would kind of argument you could make for something like that would include things like the fact that I that diagnosis does exist is hurting people because people are not recognizing it. More so the reason it's hurting them, the treatment for complex PTSD would be different than regular PTSD. That's another part of the compelling case. Another part of the argument is that you need to show that it's somehow distinct from regular PTSD and distinct from other conditions, like adjustment disorder, or, or, you know, this new Prolonged Grief Disorder. So those are the kinds of things you would need to do to make a convincing case, and then you would submit it. And if it goes through the whole process, and was approved, it would now go into the DSM. The hardcopy version, of course, you know, it's not if you buy it, it's not in your version you bought, but the electronic version, it will go into there. So we're in a funny transition now where you have the hardcopy version and the electronic version living side by side. And therefore, if you buy the hardcopy version, you're not, you know, it's it's easy to see the ongoing changes, but APA considers what's approved and in the electronic version to be the official DSM. And the hardcopy, like, the one that's going on sale now is a snapshot of where the electronic version looks like, you know, it looks like now. So everything that's in electronic version is now in hardcopy version. But as things happen, if somebody were to get complex PTSD in there, and it gets in there before the next hardcopy version comes out, then you'll have the situation where it's only on the electronic version, and not in the hardcopy version, but it's it's on the electronic version, you could use it, you know, it doesn't have to be in the hardcopy version to be legitimate diagnosis to make when one of your clients   Katie Vernoy  24:03 That's decided then, I'm not buying a new copy, then I'm just gonna get the electronic version.   Curt Widhalm  24:11 So when you're looking at the research that's submitted, what kind of thresholds are you looking at here? It sounds like part of this is not only the criteria that's maybe showing up in people's offices, but also some of the ways that things are being treated as some of the factors that you look at in how things are included, how things are rolled out, you're kind of kept under some of the existing diagnostics that are there, but what are you really looking for in the research that people are proposing?   Dr. Michael First  24:43 Well, this does not that no one thing I mean, I personally, I'm a clinical utility persons so to me, the most compelling thing is making a case that is going to help people and not hurt them. I mean that person, but that's not sufficient. I mean, you can make a proposal that that's the case but if because there's two things. One is this, say this is a good category to put in there. And then it's how to define it. That's a big problem and lots of concepts are out there. But what would be the criteria set, for example, for Complex PTSD that actually is a distinct group, and wouldn't by accident, include people who don't have complex PTSD? So it's a technical thing is the case for complex PTSD is, like, let's look at what happened with Prolonged Grief Disorder. There's a perfect, so that's already happened. How did that get in there? Well, patients were out there that people were noticing that didn't fit in any of the DSM categories. And they clearly were suffering. So they had some kind of mental disorder. They didn't have as I people say, Oh, well, they have Major Depression. That's not Major Depression, you can have Major Depression, and Prolonged Grief Disorder. But they're not the same at all. Hardly any overlap. So there's a big home system that allows people to come into your office and not have any place for them. So that's the first piece of it, then another compelling thing about comp, Prolonged Grief Disorder is is that psychotherapy that has specifically been developed, it's a variation when a CBT for treating Prolonged Grief Disorder that's been successful. So that's another compelling reason not only are you calling it something, but you have something to offer your clients by saying, Well, this is the recommended treatment. So that's the kind of argument you know, the DSM, it's very the spin, especially since DSM-4 detector, in fact it was a paper that came out before DSM-4 came out called holding the line on diagnostic proliferation, it was very easy, used to be very easy, it sounds like a good idea, we go into the DSM, a couple of problems is that once a category gets into the DSM, it's very, very, very hard to get it out. There's been very few diagnoses which have been deleted, because always some constituency says you will ruin my practice if you get rid of this diagnosis. So that's why knowing that it's easy to get in easier to get in than to get pulled out, you really want to make sure that things that are in the DSM won't need to be pulled out because you've too hastily added. I think there's been kind of a much more conservative view about putting categories in the DSM nowadays than there were back in 20, 30 years ago.   Katie Vernoy  27:13 We also got some some questions and we've had some conversations actually recently about diagnostic criteria that potentially needs to be adapted to fit a more diverse population or an understanding of the diversity in our population. I'm just curious, how culture, other demographic differences, all that all the things, how those things have been addressed in the the text revision, but also kind of the the concept around how you're making sure that the criteria, the descriptions all of the pieces really align with a very diverse population that we that we live in?   Dr. Michael First  27:50 That's a great question. In fact, there's been major efforts, since DSM-4, there was a special committee starting with DSM-4 for culture, culture related issues, how disorders present differently in different cultures. Now, the criteria sets are hypothetically supposed to be vanilla, that apply across all cultures, the way you deal with cultural variations in the text is one section called Culture Related Features. If you look at the content of that text, it's very specific than in this population and may look like this. So it's trying to show how that variability is taken into account. But it's an opportunity to let me tell you about a very important thing that we did with the TR that was basically, it's very interesting was they taking your during the development, During the development of TR, George Floyd happen, and our entire consciousness about systemic racism became sort of raised. Then the question was, are there things in the DSM that are reflective of this kind of systemic racism? So we actually created a committee that went through the entire DSM, looking for, um, not necessarily races as the most extreme case, but things that were not quite nuanced enough, like very often, you know, like, the big one of the big problems, of course, it's like what is race anyway? But that is because you're, you're an African American, are you really different than other people? If you are different, like very often in the DSM, the prevalence section will say this, if we break it down by ethnic group will say of depression in blacks is this and in Latinos Is this the question is why is it different? Is it because of biological reasons among these groups is out twice as if it is a different life experiences? It's lots of huge amount of data that the the disadvantage social settings for some of these groups, is the reason why they're different, not something essential about being Black or Latino. So that was one of the things when they went through the whole book, they're looking to avoid giving a message that something about the race itself is what's causing it to happen. So the way they dealt with it, is that they have a statement that says it's this in blacks and it's not and an extra sentence that says, this difference is likely due to differential exposure to racism or things like that. So it was a very, very thoughtful way of trying to make it clear and de emphasize it also get rid of stigmatizing statements, that to the whole, the whole book went through that thing, and that was really triggered by the awareness that was that was not originally part of the original plan of the TR it was the fact that that happened during the process. A new committee was been doing the process. I'm glad that we had enough time was early enough in the process, that we're able to get it in the DSM-5, I was a little dubious. But we they worked really, really hard that committee to be able to go through the all areas of the text revision to make sure it it worked for across culture, and also not not taking the certain minorities, stigmatized,   Katie Vernoy  30:54 Were any of the diagnoses assessed in that way and determining whether those diagnoses were appropriate across all the different demographic considerations. So one that comes to mind specifically, we recently had a discussion on Trans mental health and Gender Dysphoria is one that that kind of is a requirement to be able to kind of move forward with some of the things for transition. And it was interesting, the conversation was like, Well, I'm not dysphoric it's it's socially, you know, kind of everyone around me is dysphoric about my gender, I'm not and I have to kind of go through this process of saying that I'm dysphoric in order to get the letter that I need for the hormones or whatever, were there, or are there plans to look at kind of the impact of diagnoses or how diagnoses are put together and the impact on folks that are in in typically marginalized populations?   Dr. Michael First  31:44 Well, culturally, I think Trans is a special case, I could get to that whole issue of should trans even be in the DSM. I mean, lots of people in the Trans community don't consider it a mental disorder. So let's get general, we do consider that like Conduct Disorder is a good example, about a lot of the items and Conduct Disorder in minority populations living in high crime area, it's normal, it's like adaptive to do some of the items in the Conduct Disorder criteria sets. And we don't want to give people who are trying to adapt to their typical environment a diagnosis simply because in a different population, it advantage suburban population, it would be evidence of pathology, so you get into text for Conduct Disorder has things in there and the criteria sets get adjusted to drop items that might be overly influenced by culture and not apply to other cultures. And now Trans is a different story. So...   Katie Vernoy  32:38 Okay   Dr. Michael First  32:38 Let me get into that. So the name is also changed DSM-5, it's now called Gender Dysphoria. It used to be Gender Identity Disorder, that's what it was, is up to DSM-5, so they actually changed it from Gender Identity Disorder to Gender Dysphoria to make it less stigmatizing it was felt that saying, there was something wrong with your identity, there's a disorder and your identity was much more stigmatizing than saying that you're upset or it's creating a dysphoria. The fact that the term used in the ICD for this condition is Gender Incongruence, which is very well descriptive term, it's the sense that your assigned gender and your experience gender are incongruent. So the recent the problem, is it. So the individual they say, Well, I'm not dysphoric. I agree, you could say that they shouldn't get any mental disorder. But there's a big problem. How do you get qualified for treatment? Unfortunately, we live in a country, there's lots of things that are very harmful, like, you know, marital strife, child abuse, you can't get paid if you put a code for marital relationship problem on your billing form and submit it, nobody's gonna cover it because the insurance companies and the government have made a decision, unwise in my perspective, that's not my call, to not inlcude, not cover things that are not really ensuring the way they look at us insurance is for medical conditions. That's the basic concept, we're not going to, for example, if you want to get plastic surgery to make yourself look better, and make you feel better, their government says we're not going to cover that because that's sort of a cosmetic thing, even though it makes you feel better. You're not treating a disorder, to have a nose job, for example. There's a whole bunch of things that the government doesn't want to cover, unfortunately, basically, in the ICD, everything is outside of the disorder section, you won't get covered for. Now Gender Dysphoria is in the mental disorder of section, actually, therefore, you could qualify for treatment. If they were to remove it from the DSM entirely, then you would never be able to, insurance companies would not, not to say the insurance companies are happy about covering it, but they would really have a weapon to say well, if it's on the DSM, we have no obligation to cover so what what happened in the ICD 11 which I saw just came out they had the same problem, but they had a different solution. The ICD 11 is all of medicine not just mental disorders. So they had the option of moving Gender Incongruence out of the mental disorder section and moving it somewhere else so that it could still get paid for. And where did they move it, they created a new chapter called Conditions of Sexual Health or something like that. And therefore they were able to put it there. And now it's a condition that could get paid for. The United States, which is still using ICD 11. United States still using ICD 10. So there's no place in ICD 10 to move it. So that's why we're kind of frozen in the situation of it continuing to be in the DSM in that spot, for very utilitarian reasons. I mean, I'll give you another example, somebody who actually heard this case, person had sexual reassignment surgery, and broke took it off as a tax deduction under the health thing. They were challenged by the IRS, they said, Oh, no sex reassignment surgery is a cosmetic procedure, you can't take a deduction for that's their attitude.   Katie Vernoy  35:59 Wow   Dr. Michael First  36:01 It's  very tricky, because again, they don't want to cover things. So it's a balance, yes, it's stigmatizing. But on balance, is it better to deal with the stigma, by virtue of the placement in the DSM, or not have the services covered anymore, we're kind of stuck, there's some talk about moving maybe to a different spot in the DSM to try to help with that. But the code, still, the code, and the code is still mental disorder code. So until the ICD code actually changes, it's going to, it's gonna be a mental disorder, we don't have any control over that. That's the government.   Katie Vernoy  36:35 Sounds really complex.   Curt Widhalm  36:37 So if I can kind of synthesize down some of the important points that I'm hearing here is, in this process, you've taken some of the criticisms from the field of the DSM and made it more inclusive. As far as feedback opportunities for professionals. It's not, you know, committees hidden away in dark rooms, you know, twirling their mustaches, or running their fingers and just, you know, being the arbiters of mental health diagnostics. But one of the major things that I want to emphasize that you've brought up here a couple of times, is that there's a lot of parts of the DSM that are not just the diagnostic lists, that people should read from time to time. And I think that outside of maybe some of the psychopathology classes that grad students have to go through, we sometimes forget that and that a lot of the information that we do break up in our conversations that the text parts, this is the major emphasis of the text revision here is go and read these parts. And it probably answers a lot of the questions and criticisms that we have from the field. And now, more so than ever, it's had an opportunity for a lot more people to at least make suggestions and that feedback has been looked at.   Dr. Michael First  37:51 I can't agree with you more they criteria pretty bare bones. So yeah, on their own, they lots of could discuss argue about what what generally means that's what the text is there for. The text allows you to explain what they are, how do you assess it? As I said, the text is like 99% of the words in the DSM and the criteria, maybe 1% or less. So the text is extremely important. That's why we did the text revision. The difference to the from the last one is we did just leave it to the text, we also have the criteria. But you're absolutely right. Many of these things we dealt with, like this whole thing about systemic racism, if you look at the criteria set, there's nothing in the criteria in the TR, that would indicate that we did anything having to do with our sense sensitivity to race. That's all in the text.   Katie Vernoy  38:35 So to that point, I wanted to check in on a couple of things, because it seems like there's an opportunity for anyone anywhere who's able to do some research make the case they can submit to the committee. But I'm curious about who's at the table who's who's on the steering committee? And are you including folks that is there a diverse population of folks, there are other people with lived experience that are giving feedback, like how are you making sure that there's enough folks at the table to make sure that you continue this process of assessing how you're not managing just not even just culture, but also the lived experience of being autistic or, or other areas of neurodiversity? That there are folks who have psychotic symptoms that are weighing in on some of these things? And what the presentations, those things? I mean, it just it seems like there's, there's such a huge opportunity to have a lot of perspectives. How are you navigating that internally with a steering committee?   Dr. Michael First  39:33 Well, the steering committee is very small, then it goes to a committee are experts, there are women on the steering committee, and there are people who are African American, but it's still Well, obviously, just because there's one African American and a couple of women, it doesn't mean all perspectives are covered. We realize you're not simply a bunch of white guys making the decisions here. Got it tomorrow to the to where but you're making it where do we get those other perspectives? Well, the way we try to deal with that is before when something gets like, lets this go to Prolonged Grief Disorder is a good example. That category was controversial because there are a number of people who felt that you're calling people who are having normal grief, you're calling them having a disorder. And there's a lot of pushback against that category. So what we did is when before somebody gets into the final DSM and approved, it gets posted on the DSM-5 website for 45 days, it's open for comment and we get lots of comments. And that's really the opportunity for people with lived experience to say, you know, you, you clearly didn't take into account this aspect that I live with this, if you didn't get it to committee would read all of that. If they make a good case, then they could change it. Absolutely. So that's the way I mean, being on this tiny group of people who make the decisions. Unfortunately, the limit to how diverse we can make this, there's not that many people, but there are many layers. I mean, even within the American Psychiatric Association, it's got to be approved by this thing called the APA Assembly, which is sort of like Congress, so to speak, with lots of diversity built into that. And then so the so many different levels of approval, that's where some of the diversity comes in. It could it could be make it more, maybe, but that's what we're able to do.   Katie Vernoy  41:15 Well it seems like there's also an opportunity to reach out to diagnostic communities when when a new diagnosis is being presented to make sure that you're getting some of that feedback, it seems like there's there's mechanisms in place, my hope is that there's also efforts to connect with folks with lived experience or those elements so that people can really be ready to take on that 45 day period.   Dr. Michael First  41:37 Right? That's actually quite how do we, We do our best to publicize it. Yeah, but you're right, it'd be great. In fact, we've done that before, I think that this particular case, with Prolonged Grief, I think there are organizations, you know, patient groups, we could go to them and say, you know, like, we made a change in the psychotic section, or clearly, individuals have lots of experience. NAMI and, those kinds of groups. So there have not been any changes, you know, recently that would affect that. But that would be obviously something we would want to do is to go perfect sure that they're aware that the change is there and give them an opportunity to give their feedback.   Curt Widhalm  42:14 Where can people find out more about you and your work?   Dr. Michael First  42:17 I have a website at Columbia, at Columbia, every faculty member gets a website, I happen to have a Wikipedia page. So you could look at that. My email, I don't keep my email addresses secret. That's one thing. I mean, it was very interested in me working with this, if I have to contact an expert to get their email address could be incredibly difficult. You take them in and you type an email. It's nowhere you have to. I don't know why people are so afraid to have their email address public. But I mine has been public. It's been public the entire time I've been in the field. And I'm happy for people to let me know what they think.   Curt Widhalm  42:54 And we'll drop Dr. First's email in our show notes. You can check that out over at mtsgpodcast.com. And we'll include links to a couple of other episodes where we've had some relevant guests in the past talking about things like Prolonged Grief Disorder and some of the other things that we've done and follow us on our social media. Until next time, I'm Curt Widhalm with Katie Vernoy, and Dr. Michael First.   Katie Vernoy  43:21 Thanks again to our sponsor SuperBill.   Curt Widhalm  43:23 If your practice doesn't accept insurance super bill can help your clients get reimbursed. SuperBill is free for therapists and your clients can use the code SuperBill22. That's Super Bill two two to get a free month of SuperBill. Also you can earn $100 For every therapist you refer to super bill. After your clients complete the one time HIPAA compliant onboarding process, you can just send their super bills to claims@the superbill.com. SuperBill will then file claims for your clients and track them all the way to reimbursement by helping your clients get reimbursed without the stress of dealing with insurance companies SuperBill can increase your new client acquisition rate by over 25%.   Katie Vernoy  44:06 The next time a potential client asks if you accept insurance, let them know that you partner with SuperBill to help your clients effortlessly receive reimbursement. Visit thesuperbill.com to get started.   Announcer  44:18 Thank you for listening to the Modern Therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

Trauma Report writer Lotus Huyen Vu speaks to David Lukoff, Professor Emeritus of Psychology at Sofia University in Palo Alto, CA and a licensed psychologist in California. He has been an active researcher and proponent of spiritual competency in the field of psychology and authored 80 articles and chapters on spiritual issues and mental health, co-authored the DSM-IV category Religious or Spiritual Problem, and has been an active workshop presenter internationally on spiritual competency, loss and grief, death and illness, spiritual problems and emergencies. He has been actively involved with the mental health consumer movement for 30 years.

Buckle in people, we are all over the place in this one.  We start off detouring into our Valentine's Day date at the Forbidden Ballet.  We talk about the history of filmmaker, Adrian Lyne (the first 2 time director on our list, but we will see him again).  We talk about the year's awards season and Jenny can't figure out the difference between Empire in the Sun and The Last Emperor.  Zack deep dives etiquette manuals to try to figure out the right way to eat spaghetti.  We discuss the potential DSM-IV diagnoses that could be applied to the film and talk about the British slang term "Bunny Boiler".  We go deep on the laws of stalking, spousal abuse, and rape in our home state and find some encouraging and shameful statistics.  We accuse the Metro Nashville Police Department of systematic abuse of power and call for a bold rethinking of policing strategies in the current time. We discuss how prolific a year 1987 has been for our podcast and how Zack has basically "worn out his Playboys" so we have to really go deep on the Washington PA Observer Reporter.  We find some real gems and share them with the world.

What was your experience like as co-chair of the Revision Subcommittee and DSM-5-TR editor? How was the impact of racism and discrimination on the diagnosis and manifestations of mental disorders addressed? In this important and timely episode, Dr. Michael First addresses these questions and much more about the upcoming release of the DSM-5-TR in March 2022. Dr. Michael B. First is a Professor of Clinical Psychiatry at Columbia University and a Research Psychiatrist at the Biometrics Department at the New York State Psychiatric Institute. He maintains a schematherapy and psychopharmacology practice in Manhattan. Dr. First is a nationally and internationally recognized expert on psychiatric diagnosis and assessment issues and has conducted expert forensic psychiatric evaluations in both civil and criminal matters, including the 2006 trial of the 9/11 terrorist Zacarias Moussaoui. Dr. First is the Editorial and Coding Consultant for the DSM-5, the chief technical and editorial consultant on the World Health Organization's ICD-11 revision project and is an external consultant to the NIMH Research Domain Criteria project. Dr. First has an undergraduate degree in Electrical Engineering and Computer Science from Princeton University, received a Masters in Computer Science and a Medical Degree from the University of Pittsburgh, completed his psychiatry residency at Columbia University, and also completed a fellowship in Biometrics Research under the direction of his mentor, Dr. Robert Spitzer. He was the Editor of the DSM-IV-TR, the Editor of Text and Criteria for DSM-IV and the American Psychiatric Association (APA)'s Handbook on Psychiatric Measures. He has co-authored and co-edited a number of books, including A Research Agenda for DSM-V, the DSM-IV-TR Guidebook, the DSM-5 Handbook for Differential Diagnosis, and the Structured Clinical Interview for DSM-5 (SCID-5). Notably, he is also the co-chair of the Revision Subcommittee and Editor of the DSM-5-TR

By the end of today's episode, the learner will be able to: Describe basic terms relating to about the transgender community Comfortably use inclusive language and pronouns Describe the DSM-IV diagnosis of gender dysphoria, and Recognize the elements of the pathway to receiving gender affirming surgery in Canada

Dr. David Spiegel is Willson Professor and Associate Chair of Psychiatry & Behavioral Sciences, Director of the Center on Stress and Health, and Medical Director of the Center for Integrative Medicine at Stanford University School of Medicine, where he has been a member of the academic faculty since 1975, and was Chair of the Stanford University Faculty Senate from 2010-2011. Dr. Spiegel has more than 40 years of clinical and research experience studying psycho-oncology, stress and health, pain control, psychoneuroendocrinology, sleep, hypnosis, and conducting randomized clinical trials involving psychotherapy for cancer patients. He has published thirteen books, 404 scientific journal articles, and 170 book chapters on hypnosis, psychosocial oncology, stress physiology, trauma, and psychotherapy. His research has been supported by the National Institute of Mental Health, the National Cancer Institute, the National Institute on Aging, the National Center for Complementary and Integrative Health, the John D. and Catherine T. MacArthur Foundation, the Fetzer Institute, the Dana Foundation for Brain Sciences, and the Nathan S. Cummings Foundation. He was a member of the work groups on stressor and trauma-related disorders for the DSM-IV and DSM-5 editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. He is Past President of the American College of Psychiatrists and the Society for Clinical and Experimental Hypnosis, and is a Member of the National Academy of Medicine.Research publications:https://scholar.google.com/citations?user=tpy76ewAAAAJ&hl=enhttps://profiles.stanford.edu/david-spiegel?tab=publicationsApp- Reveri Healthhttps://reverihealth.com/abouthttps://apps.apple.com/us/app/reveri/id1547020650Book- Trance and Treatmenthttps://www.amazon.com/Trance-Treatment-Clinical-Uses-Hypnosis-dp-1585621900/dp/1585621900/ref=mt_other?_encoding=UTF8&me=&qid= 4:20 Philosophy major before med school. “What's fundamental to the way we think?”6:20 Lessons from the Dalai Lama10:00 Emotions- child vs adult13:00 Hypnosis- western equivalent to mindfulness in many ways14:40 Difference between mindfulness and hypnosis15:50 fMRI results with hypnosis and mindfulness20:00 3 stages of hypnosis23:35 Reveri hypnosis app29:00 Self-hypnosis32:15 Modulate pain with hypnosis38:00 Athletes control domain of awareness42:30 Stanford women's swim team45:30 Inverse functionality in the brain47:50 Hypnosis to quit smoking and addiction52:00 Habit change and hypnosis59:45 Unconscious/subconscious1:02:00 Child mind1:05:40 L frontal theta dominant in hypnosis1:10:30 ACL tear rehab1:11:24 PTSD/trauma treatment1:15:00 Finding a hypnosis expert1:18:25 Learning more about hypnosis

Dr. Winarick and I dive deep into Schizoid Personality Disorder.  He discusses the history of the Schizoid character throughout psychiatry and psychology, the changes in the DSM when Schizoid Personality Disorder broke off into three distinct personality disorders (Schizotypal, Avoidant, and Schizoid), and the difference between descriptive diagnostics and Psychoanalytic diagnostics. He reviews the main findings in his dissertation, which examined the differences and similarities between Schizoid and Avoidant Personality Disorders.  We also talk about the Schizoid spectrum, as viewed in Nancy McWilliams' Psychoanalytic Diagnosis, where there is a neurotic-borderline-psychotic axis measuring the degree of disturbance.  And more!  Daniel Winarick, Ph.D. has been assistant clinical professor of psychiatry at the Ichan School of Medicine at Mt. Sinai Hospital; an adjunct assistant professor of psychology at Queens College-CUNY and Adelphi University as well as of social work at Long Island University - Brooklyn. He is currently a licensed clinical psychologist in private practice in New York City.As a doctoral student, he partook externships at Columbia University Medical Center/New York Presbyterian Hospital and Weill Cornell Medical Center – Payne Whitney Westchester. He completed his doctoral dissertation research on schizoid personality disorder (SPD), with a focus on its construct validity and diagnostic distinction from avoidant personality disorder (AVPD) in the DSM-IV and DSM-5. Dr. Winarick completed his pre-doctoral clinical psychology internship and postdoctoral fellowship training at the New York Psychoanalytic Society & Institute and Mt. Sinai Hospital/Ichan School of Medicine, and as a postdoctoral fellow, he received an appointment as Assistant Clinical Professor in the Department of Psychiatry at the Ichan School of Medicine at Mt. Sinai Hospital in New York City. He received his M.A. and Ph.D. in Clinical Psychology from Adelphi University and his B.A. in Psychology from Washington University in St. Louis.The Sanity Sessions: Exploring Mental Illness And Maladaptations is a biweekly podcast featuring interviews with leading experts in psychology and mental health.Clint Sabom is Creative Director of Contemplative Light. He lived in Budapest, Hungary in 2003 as a Gilman Scholar. He speaks English, Spanish, and Portuguese. In 2007, he lived for six months in a silent monastery.. He holds bachelor's degrees in Religious Studies and one in Spanish literature. He has traveled extensively through Europe and South America. He has spoken and/or performed at Amnesty International, Health Conferences, High Schools, and art galleries across the US. He has studied and done in his own work in Advaita Vedanta, Buddhism, Shamanism, NLP, and hypnosis.   Clint offers a powerful audio mini-course on emotional release, with powerful techniques you can use the rest of your life.  Learn more here: https://contemplativelight.teachable.com/p/emotional-release

This week we extoll the virtues of the 3.5 hour workday, offer an uncharacteristically calm attitude toward Kylie Jenner's pandemic globe-trotting, deep dive into Brad Pitt's new relationship with Nicole Poturalski, rejoice at the birth but mourn the unfortunate name of Daisy Dove Bloom, break out the DSM-IV to psychoanalyze an obscure-but-alarming IG story from Kim K this week, and listen to Chanler's weeping and wailing over Bella Thornes continued unwitting attack on her psyche. Learn more about your ad choices. Visit megaphone.fm/adchoices

Show Notes for Podcast Five of Sex & Why Host: Jeannette Wolfe Topic: Stress Response   For Acute Care Medicine and Introduction to Sex and Gender Based Medicine CME Cruise Opportunity click here   Part 2 on biological sex differences in the stress response with special guest Justin Morgenstern We started out with a discussion on different ways to frame potential sex and gender based research using a method described by  Dr. M McCarthy A full discussion of this framework can also be found on my website McCarthy MM et al, The Journal of Neuroscience: the official journal of the Society for Neuroscience. 2012;32(7):2241-2247. There appears to be a significant amount of individual variation in how some individuals respond to and recover from similar stresses. Some of these differences may be influenced by our biological sex. Understanding how we react and respond to stress and how this may perhaps differ from other individuals around us may help us better communicate and lead under stressful situations. Study #1 This was a follow up study to an infamous study the same team did three years before in which they looked at sex differences in reward collection on a computer balloon game (Balloon Analogue Risk Task or BART). In this game, players got 30 balloons and the farther they pumped them up the more points they got however, each balloon was also set to randomly pop somewhere between 1- 128 pumps and if the player popped their balloon before they cashed it in they lost points for that balloon. Study participants were randomized to control vs stress condition (placing hand in neutral versus ice water for 3 min) and then played the game. They found that in neutral conditions there was no significant difference in risk taking (number of pumps 39 for women versus 42 for men, but under stress women decreased their pumping to 32 while men increased to 48). In this 2012 study, Lighthall's group adjusted its protocol so that BART could now be played in an MRI scanner. Unfortunately, the new BART design subtly changed the game because now instead of going through 30 balloons, participants played the game for a set amount of time with unlimited balloons. This inadvertently added a second strategy to get lots of points as the new design allowed participants to get points by either pumping additional air into an individual balloon or rapidly moving through a greater number of balloons while pumping only a few pumps per balloon. Stress intervention was again either a cold or neutral temperature water bath and after submersion the researchers collected cortisol samples and scanned participants while they played the game. Results- no difference in control conditions (room temp water) between men and women in number of balloon pumps or points earned But under stress men acted more quickly and got increased rewards while women appeared to slow down their reaction time and decrease their rewards. Men had higher baseline and stimulated cortisol but there was no difference b/w men and women in the amount of cortisol change between baseline and stressed condition. Under basic non stress conditions- during the control testing it appeared that overall men and women utilized the same brain regions to complete the balloon task (i.e. suggesting that males and females approach the task by using similar neural strategies), however once stressed men and women seemed to use different areas of their brain. Men used their dorsal striatum and anterior insula more. Anterior insula has been associated with switching tasks from a riskier to a safer option (and in both sexes higher activity in this region correlated with higher collection rate) and the dorsal striatum is believed to be associated with obtaining predictable rewards and with integrating sensory, motor, cognitive and emotional signals. Did not find that men had increased risk taking in this study but it may have been masked in that there was now a lower risk strategy available to them that still was associated with an increased reward (pumping balloon a small amount and quickly cashing in to get to next balloon). Concept discussed is that under stress men may possible go into type one systemic thinking (automatic) while women may favor type 2 (deliberate cognitive inquiry). Lighthall, N. R., Mather, M., & Gorlick, M. A. (2009). Acute stress increases sex differences in risk seeking in the balloon analogue risk task. PloS One, 4(7), e6002. https://doi.org/10.1371/journal.pone.0006002 Lighthall, N. R., Sakaki, M., Vasunilashorn, S., Nga, L., Somayajula, S., Chen, E. Y. Mather, M. (2012). Gender differences in reward-related decision processing under stress. Social Cognitive and Affective Neuroscience, 7(4), 476–84. https://doi.org/10.1093/scan/nsr026 Study #2:  Goal to determine if: Under equal subjective sensations of stress (i.e. men and women objectively rate their subjective level of stress the same on a 1-10 point scale) do men and women use the same brain circuitry to process stress or do they use different circuitries. What they did: Collect cognitive, psychiatric, and drug use assessments on 55 men and 41 women aged 19-50 Exclusions TBI, psychoactive meds, history of substance abuse, preg, DSM-IV mental health disorder and currently menstruating or oral contraceptive use (to try and mitigate additional hormonal influences) Over course of 2-3 sessions put them into a MRI scanner and asked them to visualize neutral or stress inducing images (this technique has previously been validated and involved the subjects own audiotaped accounts of stressful –rated as greater than 8 on 1-10 Likert scale- or neutral experience) which was later played back to them in MRI scanner Asked them to rank their level of stress Looked to see which areas of the brain lit up under different conditions Results Men and women appeared to have different strategies for guided visual tasks in general regardless of whether listening to neutral or stressful recordings: Men: More likely to light up areas associated with motor processing and action. Caudate, midbrain, thalamus, and cingulate gyrus and cerebellum Women: More likely to light up areas associated with visual processing, verbal expression and emotional experience             Right temporal gyrus, insula and occipital lobe Women were also more likely to increase their HR regardless of condition (likely from having increased autonomic arousal- though other studies suggest that women have increased HR at baseline compared to men in general) Under stress men and women had firing in opposite directions: Men dampened while women increased firing in: Dorsal Medial pre-frontal cortex, parietal lobes (including inferior parietal lobe and precuneus region) left temporal lobe, occipital area and cerebellum. Believed functions of these different regions Dorsal medial frontal cortex – executive functioning of cognitive control, self-awareness of emotional discomfort, strategic reasoning, and regulation Precuneus- part of the parietal lobe associated with self-referential and self-consciousness Inferior parietal lobe- cognitive appraisal and consideration of response strategies (also area often associated with mirror imaging) Left temporal gyrus- processes verbal information Occipital area- processes visual information Cerebellum- besides coordinating motor movement also is involved in emotional and cognitive processing  “Taken together, the observed differences in these regions suggest that men and women may differ in the extent to which they engage in verbal processing, visualization, self-referential thinking, and cognitive processing during the experience of stress and anxiety.” They also suggest that under stress men may feel anxious due to “hypoactivity” while women may feel stress due to “hyperactivity” in above noted regions. Conclusion: Men and women use different neural strategies under stress even with similarly reported stress levels  This research is still clearly in its infancy but suggests that under stress some men, may turn down activity in areas of their brains involved in executive functioning and that this might increase their vulnerability to impulsivity. Conversely, under stress some women may actually turn up activity in these regions that could lead to excessive rumination and possibly depression. The authors then extrapolate their data to suggest that men and women might possibly benefit from different stress reduction techniques in that some men might benefit more from cognitive behavioral therapy which enhances frontal lobe firing and some women from mindful meditation which dampens it.  Seo, D., Ahluwalia, A., Potenza, M. N., & Sinha, R. (2017). Gender Differences in Neural Correlates of Stress-Induced Anxiety. Journal of Neuroscience Research, 125, 115–125. Study #3 This study literally looks at what conditions men and women might seek out increased physical interaction with their dog after an agility competition. The background here is that in 2000 Dr. SE Taylor questioned whether the flight of fight response which has classically been described as a “universal” stress response, was actually applicable to both males and females. She questioned how realistic it was for a female who might be physically smaller and less muscular than her male peer to successfully fight or run away from a potential attacker. She suggested an alternative response of “tend and befriend” which suggests that under stress that women may naturally migrate towards their children as well as others within their intimate circle with the belief that a larger group may offer protection and a pooling of resources. Additional support for this theory is the idea that oxytocin, which has receptors throughout the brain and is usually found in higher amounts in women, may be released during this affiliative behavior and help to dampen the physiological cortisol stress response. This study was done to see if men and women seek out physical contact with another being (in this case their dog) in similar fashion when they are stressed. They chose to study human contact with a dog versus an interaction with another human to try and mitigate the influence of any “gender expectation” violations. Which in English means that if Rob would normally seek out Carol when he is stressed, he might decide not to do so in public (and in this case being videotaped) because he doesn't want to appear “less masculine”. As public affection with one's dog is considered less gender biased, the authors chose this interaction as a marker for affiliative behavior.  What they did: Videotaped and took cortisol saliva levels from 93 men and  91 women after they had run their dog through a competitive agility course. Recording and samples were taken as participants waited for their official score (although subjectively most participants pretty much already knew whether or not their dog had scored high enough to move on.) The researchers measured cortisol levels and how much participants petted their dog while waiting for this score. Results: 36 of results excluded because dogs did not finish course and were disqualified Overall there was no sex difference in total affiliative behavior Of first 180 seconds of video tape women petted dog on average 27 seconds and men 25 seconds When men and women perceived they lost, their cortisol level increased more than those who perceived they had advanced. Differences occurred however as to when men and women were more likely to pet their dogs Women petted them more when they sensed defeat- an additional 12 seconds compared to women who had won Men petted them more when they sensed victory- an additional 7 seconds when compared to men who had lost Conclusions: women sought out affiliative behavior when they lost, men sought it out when they won. Justin and I use this paper as a discussion point as to understanding how two people may get exposed to the same stressor and respond quite differently and importantly how they sort of bounce back from a stressful situation may also differ. This paper suggests that emotional debriefing after stressful experiences may be more helpful to some individuals than others. For more on the stress response please see Justin's new post on First10EM Sherman G, Rice L, Shuo Jin E, et al: (2017) Sex differences in cortisol's regulation of affiliative behavior. Hormones and Behavior 92, 20- 28

This 2-video compilation focuses on the Narcissist's Manipulation Tactics, including Gaslighting, Denial & Deflection. The psychology of cluster b personality disorders is abnormal, to say the least - and if you consider these kinds of manipulation ploys, trauma bonding is not a shock, right? Cluster B personality disorders are a categorization of personality disorders as defined in the DSM-IV and DSM-5. ... They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder. Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that's vulnerable to the slightest criticism. noun: manipulation; plural noun: manipulations 1. the action of manipulating something in a skillful manner. "the format allows fast picture manipulation" 2. the action of manipulating someone in a clever or unscrupulous way. "there was no deliberate manipulation of visitors' emotions" Discover. Understand. Overcome. It's how smart people change their lives! Subscribe to my channel: vid.io/xoJJ On this channel, I offer free daily video coaching to help you discover, understand and overcome narcissistic abuse in toxic relationships! I like to call it toxic relationship rehab. If that sounds good to you, hit that subscribe button. **LIVE EVERY TUESDAY! Never miss a live session! Just text "AngieLive" (no spaces) to 33222 and I'll send you a text each time I get ready to go live! If you enjoyed this video, please subscribe to my channel! http://youtube.com/angieatkinson Schedule a coaching appointment with me at http://narcissisticabuserecovery.online Learn more at http://queenbeeing.com. Get my books at http://booksangiewrote.com, schedule a coaching appointment and/or pick up your free 5-day fear-busting email course (specially designed for narcissistic abuse survivors) at http://narcissismsupportcoach.com. Join SPAN (Support for People Affected by Narcissistic abuse in toxic relationships) - AKA "The SPANily" - at http://queenbeeing.com/span. Let's Also Connect On: Facebook at https://facebook.com/coachangieatkinson. Instagram: https://www.instagram.com/coachangieatkinson/ Pinterest: https://www.pinterest.com/angyatkinson/ Twitter: https://twitter.com/angieatkinson #gaslighting #narcissist #toxicrelationshipSubscribe to Narcissistic Abuse Recovery with Angie Atkinson on Soundwise

We help busy moms and dads have more energy, sleep better and spend more quality time with their family through custom built resiliency solutions based on the art of Chiropractic care and nutritional medicine. Call or text message our clinic today with your health question: 734-335-0533 www.michiganfamilywellness.com Check out our wellness culture video here: https://youtu.be/orEPhy8ePXUIn an age where there is a growing disconnect between the shapes and sizes of the majority of everyday people “in real life” and those of men and women whose physiques are advertised as some sort of ideal on television, online, and in print media, the issue of body dysmorphia is becoming more common.It's a rare individual who doesn't have something about their body they wish were different.But body dysmorphia is more than that. It involves chronic, unrelenting self-ridicule that may take over someone's thoughts to the extent that it interferes with work, socialization, and mental and physical health.Body dysmorphia—more formally called body dysmorphic disorder (BDD)—is more than fretting over some post-pregnancy stretch marks, a few gray hairs, or a couple of pounds that have crept up around the midsection over the years.BDD is characterized by a self-perception that is detached from reality. Individuals may imagine flaws that are nonexistent, or, they may view very mild and extremely common “faults” in their appearance—things other people don't even notice—as so disfiguring and aesthetically unpleasing that they take over the person's thoughts and interfere with everyday life.Put simply, individuals with BDD see things that aren't there. They become obsessed with perceived shortcomings about their physical body, either completely imagining things, or taking things that are there—blemishes, perhaps, or scars, cellulite, or excess body fat—and blowing them out of all rational proportion.BDD may become so severe that the Mayo Clinic classifies it as “a type of chronic mental illness.” (Indeed, BDD is recognized as a unique, diagnosable condition in the DSM-IV.)Negative thoughts about one's appearance can become so pervasive and all-encompassing that they actually lead to more severe conditions, such as anxiety, eating disorders, substance abuse, and unnecessary and dangerous cosmetic procedures.

An essay, poems, and a short story. Discussed: sisters, best friends, feminist poetry, Belle & Sebastian, California, meteor showers, shacks in the woods, DSM IV 300.6, John Green, tumblr, teens, and the impossibility of knowing another person's experience of the world but the importance of always trying.