<![CDATA[Psychlinks Psychology Self-Help & Mental Health Support Forum]]> http://forum.psychlinks.ca/ Psychology self-help and mental health support forums - operated by an Ottawa psychologist in private practice en Thu, 17 May 2012 01:01:12 GMT vBulletin 60 http://forum.psychlinks.ca/images/misc/rss.png <![CDATA[Psychlinks Psychology Self-Help & Mental Health Support Forum]]> http://forum.psychlinks.ca/ Yoda on Coping http://forum.psychlinks.ca/just-for-fun/29267-yoda-on-coping-new-post.html Wed, 16 May 2012 17:06:30 GMT Attachment 4289 (http://forum.psychlinks.ca/attachment.php?attachmentid=4289) yoda-calm.jpg
Attached Images
]]> Just for Fun David Baxter http://forum.psychlinks.ca/just-for-fun/29267-yoda-on-coping.html My brother http://forum.psychlinks.ca/general-support-and-advice/29266-my-brother-new-post.html Wed, 16 May 2012 09:22:16 GMT Hello. I found this site yesterday and have already found many insightful posts. What brought me here is my brother. He is 18 and has been... Hello. I found this site yesterday and have already found many insightful posts.

What brought me here is my brother. He is 18 and has been perfectly healthy his entire life, up till about a month ago. He began experimenting with weed and hanging out with some anti social type kids from school.

He and his friends also experimented with salvia. One morning after he and his friends had been up hanging out I got a phone call from him and he didn't sound like himself. One of his friends had told him that he had been molested when he was a kid. Since hearing this my brother has been extremely absent. He stares into space for times. He thinks of himself very lowly but is unsure why. He claims everyone at school makes fun of him. Sometimes he claims it's because he has a hard time controlling his drip after he pees and some of it gets on his boxers and he smells like urine everywhere he goes. Other times its other things.

He just got worse from there and he seemed to need me around to talk (We have always been very close. We moved around alot growing up and have always been good friends). Talking to him was very difficult. He kept questioning everything in his life. He started saying that his life is a lie. That hes been sheltered his whole life. Our conversations would last for hours just going in loops. When I'd try to bring up a solution to his problem he would find a new one.

I brought him out to a festival because i thought this would bring him out. He turned into someone completely different. He kept asking what was going on. Displaying extreme paranoia. He went to a corn dog booth and ended up throwing a corn dog at the woman behind the counter (something he normally would never think of doing).

Our parents admitted him to a psyche ward and he was given anti psychotics and stabilized. He was fine for about a week. I got a call from him last night (he calls me often to talk in circles about things and it gets frustrating). He claimed he had not been taking his meds (which i later learned was not true at all - he had been taking them every day) and smoking weed (this he was doing) so i was angry at him. Then he exploded and started yelling at me. My phone battery died, When I called back he had woken up our parents screaming at them.

I would really just like anyone input on what is going on and what to do from here. Really I would like to know what could cause something like this to happen so randomly and maybe some ways of talking to my brother when he is in that state. He is almost always like this now. He claims he needs to get high to deal with life and that he hates people. But its not really him talking, I can tell because he'll say phrases that don't make sense or lie about things without even realizing it. ]]> General Support and Advice jmcmonagle http://forum.psychlinks.ca/general-support-and-advice/29266-my-brother.html Free Microsoft Tool: Make Your Laptop Battery Last Longer http://forum.psychlinks.ca/computers-tech-support/29265-free-microsoft-tool-make-your-laptop-battery-last-longer-new-post.html Wed, 16 May 2012 02:50:05 GMT *How to Get an Evaluation of Your Laptop’s Power Efficiency... How to Get an Evaluation of Your Laptop’s Power Efficiency
May 10, 2012

Is your laptop battery running out of power all too quickly? Here’s a quick way to get some suggestions for better power settings - use the Windows command line utility Powercfg.exe. Here is the procedure:

  1. Open a command prompt with elevated privileges (see this link)
  2. Enter the command powercfg –energy
  3. Wait for 60 seconds while Powercfg evaluates your system
  4. When it is finished, you will see something like the screenshot shown below


powercfg-energy-analyisis.png

A file called “energy-report.html” will have been generated. The report is headed “Power Efficiency Diagnostics Report” and contains a lot of information and analysis of any problems with power usage that it thinks have been found. The file will be located in the working directory of the command prompt. Since elevated command prompts often are referenced to the directory Windows\System32, the file may be located there. Because Windows\System32 is a protected directory, you will need to copy or move the file to some convenient place before you can open it.

You may not necessarily agree with all its recommendations but it can help you manage your PC energy consumption
Attached Images
]]> Computers: Tech Support David Baxter http://forum.psychlinks.ca/computers-tech-support/29265-free-microsoft-tool-make-your-laptop-battery-last-longer.html Do non-stick pans cause cancer? http://forum.psychlinks.ca/health-warnings-and-advisories/29264-do-non-stick-pans-cause-cancer-new-post.html Wed, 16 May 2012 02:37:48 GMT *Do non-stick pans cause cancer?... Do non-stick pans cause cancer?
by LESLIE BECK, Globe and Mail
Tuesday, May. 15, 2012

Question: I’ve heard that using Teflon pans can cause cancer. Is this true?

Answer: That’s a common concern, but there’s no need to worry if you use your pans properly. The link between Teflon cookware and cancer risk stems from the way non-stick cookware is manufactured.

One of the chemicals used to make Teflon and other non-stick coatings is called perfluorooctanoic acid or PFOA. The chemical PFOA has been shown to increase the risk of certain tumours in lab rats. However, there’s little data about its ability to increase cancer risk in people. When it comes to Teflon pots and pans, there’s essentially no PFOA left on the cookware after it’s manufactured. So Teflon itself is not suspected to cause cancer.

Although low levels of PFOA occur in most people’s blood questions remain how it got there. PFOA has been found in the air and water around manufacturing plants. It’s also used to make electrical wiring, automotive parts, stain-resistant clothing, drapery and microwave popcorn bags. In 2006, the chemical industry voluntarily agreed to reduce and eventually eliminate the release of PFOA into the environment and its use in products by 2015.

That said, an empty non-stick pan can be risky if it gets too hot. Heating a Teflon pan to 500 degrees F or higher, as can happen if you leave an empty pan on high heat by accident, can result in the release of toxic fumes that cause flu-like condition in humans. (These fumes can be fatal to birds.) Food or liquid in the pan prevents a non-stick coating from overheating.

Bottom line: Don’t leave an empty non-stick pan to heat on a burner and avoid using non-stick pans for broiling, which heats to a higher temperature. Boiling, baking and frying temperatures are safe. ]]> Health Warnings and Advisories David Baxter http://forum.psychlinks.ca/health-warnings-and-advisories/29264-do-non-stick-pans-cause-cancer.html Love - Is it ever too late? http://forum.psychlinks.ca/relationships/29262-love-is-it-ever-too-late-new-post.html Wed, 16 May 2012 01:23:37 GMT *Love - Is it ever too late? (http://suzannesmindscape.blogspot.com/2011/03/love-is-it-ever-too-late.html)* Mindscape May 4, 2012 Love. You... Love - Is it ever too late?
Mindscape
May 4, 2012

Love. You never know when it will touch your life. One thing for sure, from what I've seen, it can appear when you least expect it, so one should never give up hope.

I would like to share with you, two examples that particularly warm my heart.

My husband's Aunt suffered greatly in her late teens. Having been born in 1920 in Prussia, she and my father-in-law saw the days of the invasion of their town by Stalin's Army. They came in taking over their home, which was a waterfront Victorian on the Baltic Sea as their temporary headquarters, forcing them out with nothing but the clothes on their backs. They wandered, along with fellows townspeople for hundreds of miles in search for refuge.

Squatting in a bombed out farm house basement, they found whatever food was available to survive. Unfortunately, his Aunt was captured by Russians soldiers and subject to weeks of endless rape. Later, both she and my father-in-law were taken prisoner and shipped off to Siberia to work camps for the next 5 years.

Not surprisingly, in the years to follow she did not find love, nor did she seek it. A confirmed spinster. she never dated or married. I must say so, when I met her I was taken by her spirit and hardiness. A world wide traveler, she would always send us pictures from her trips. She was and still is a truly amazing and independent woman and survivor.

At age 80 we received news that she had at last met the love of her life. He was age 90; a former doctor. They married in a formal wedding among friends and family; living proof that it is never too late. Together they traveled, and enjoyed every moment together. He passed last year at age 100. Although she is once again on her own, her life has taken full circle and she has experienced the love she without question had rightly earned.

Another story is of a fellow co-worker of my husband. He had met his wife and fallen in love at an early age. They immediately set out to have a family, after all, in his day and age (the 60's) that was what was expected. Unfortunately, he was unhappy, in spite of loving his children and trying to be the best father possible. Once they were grown and had left the nest, he came to the realization that he had been living a life dictated by society and culture, but not his heart and true nature.

One day he finally had had enough. He approached his wife and said he was leaving her. It wasn't that she was a unfit wife or a bad person in any way; it's just that he had comes to grips with the fact that he was gay. After a difficult and painful divorce, he moved out and moved on. One may think this was a simple choice, however, the world (especially here in the U.S) does not make this an easy transition, let alone for an older man.

Finally one day, through an on-line dating service he met someone that he clicked with. They had much in common. Both were scientists, enjoyed the same hobbies and sports and both had been married and divorced. They began dating and shortly afterwards they became partners in a civil union. Again, you never know where or when true love will enter your life.

I tend to believe from my own experience, that it shows up when you least expect it or aren't actively pursuing it. I had been through countless bad relationships and had given up on dating, although in my case I was only 22 at the time. For a year I either sat at home or got together with friends. I truly believed that love was not in my future. Then one night, I was working out at a gym I had just joined and a young man my age walked by and said goodnight. The moment our eyes met, I felt as though I had known him my entire life. We began dating.

Within four weeks, love had blossomed and we knew we were meant to be together for the rest of our lives. Now some may say, that was far too quick; how could we know we were truly in love? Granted, if one of my children said there met someone and considered marriage that fast, I would be concerned, but here we are, 30 years later and still happily married, so I guess it was meant to be.

So be patient and never give up. Love comes in it's own due time. No one misses out unless that's what they have chosen for themselves. It can and will happen. And if you are ever feeling insecure and unsure, reread this post and take it's message to heart. Like my mother always said, "There is a cover for every pot." ]]> Relationships David Baxter http://forum.psychlinks.ca/relationships/29262-love-is-it-ever-too-late.html Hopeless http://forum.psychlinks.ca/anorexia-and-bulimia/29260-hopeless-new-post.html Wed, 16 May 2012 01:02:17 GMT I have struggled with eating disorders for over 30 years and I give up. I can't deal with it anymore. It's going to probably kill me. It's too big. If you can't eat right it messes up so many other things in your life. It really does. I don't know how to eat right. I should know this. If I can't figure this out I'm doomed. ]]> Cat Dancer http://forum.psychlinks.ca/anorexia-and-bulimia/29260-hopeless.html Update on Trichotillomania http://forum.psychlinks.ca/compulsive-behaviors/29259-update-on-trichotillomania-new-post.html Wed, 16 May 2012 00:56:28 GMT * Update on Trichotillomania (http://www.psychiatrictimes.com/conference-reports/apa2012/content/article/10168/2071927)* By Arline Kaplan,... Update on Trichotillomania
By Arline Kaplan, Psychiatric Times
May 14, 2012

Despite its occurrence in up to 3.4% of adults, hair–pulling disorder or trichotillomania (TTM) is often under-diagnosed and inappropriately treated, according to a panel of experts presenting at the recent APA meeting in Philadelphia.

The experts described the phenomenology, epidemiology, symptoms and diagnosis of trichotillomania; discussed psychopharmacologic and behavioral treatment modalities for the disorder, along with recent trials in children and adults; highlighted research advances; and summarized proposed changes for the disorder in the DSM-5.

Presenters were Douglas Woods, PhD, Professor of Psychology at the University of Wisconsin-Milwaukee, who has an NIH grant to study Acceptance-Enhanced Behavior Therapy for Trichotillomania; Jon E Grant, MD, MPH, JD, Professor of Psychiatry and Co-Director of the Impulse Control Disorders Clinic at the University of Minnesota-Milwaukee; and Martin Franklin, PhD, Associate Professor of Clinical Psychology in Psychiatry at the University of Pennsylvania and Director of the Child and Adolescent OCD, Tic, Trich and Anxiety Group (COTTAGe). Others were Michael Bloch, MD, Assistant Professor in the Yale Child Study Center and Assistant Director of the Yale OCD Clinic, and Eric Hollander, MD, Clinical Professor in the Department of Psychiatry and Behavioral Sciences and Director of the Autism and Obsessive Compulsive Spectrum Program at the Albert Einstein College of Medicine, Montefiore Medical Center, in New York. Melissa Rooney, MD, served as Chair.

In his overview of trichotillomania, Woods described TTM as a “poorly understood disorder” that affects “lots of people,” primarily females. The estimated lifetime prevalence in adults ranges between 0.6% and 3.4%. TTM seems to have a bimodal age of onset, he said. The typical onset of TTM is between ages 9 and 13. This group usually has a more chronic form of the disorder and a “more difficult response to treatment,” Woods added. “Baby trich,” with onset between 18 months and 4 years, Woods said, is believed to be short-term, related to attachment issues and related to covarying oral habits.

TTM frequently exists with other disorders, according to several presenters. In one study, Flessner and colleagues1 found that up to 60% of individuals with TTM had another current psychiatric disorder. Disorders often comorbid with TTM include major depression, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, other impulse control disorders and substance use disorder.

While some clinicians have speculated that the hair pulling may be a response to trauma, Woods said that only 5% of patients have comorbid TTM and post-traumatic stress disorder (PTSD).

Impact
Common pulling sites, Woods said, include the scalp, eyelashes, eyebrows and the pubic area. Pulling can be both automatic (ie, outside awareness) and focused (ie,in response to identifiable affective triggers) within each individual, rather than exclusively one form or the other, although automatic pulling seems more prevalent in children.

TTM sufferers can experience medical complications such as skin irritations at the pulling site, dental problems from biting or chewing their hair, infections and repetitive-use hand injuries. A subset of individuals with TTM, who ingest the hairs after pulling, are at risk of GI complications stemming from trichobezoars, which have been documented in children as young as 4 years of age.

In the Trichotillomania Impact Project for Adults (TIP-A), an Internet-based survey of individuals with TTM, those surveyed (1,697 respondents) reported mild to moderate life impairment in social, occupational, academic, and psychological functioning, Woods said. For example, more than 20% said they avoided vacations, 23% said TTM interfered with their job duties, and 24% said they missed school.2 In the Child and Adolescent Trichotillomania Impact Project (CA-TIP), most of surveyed 133 youth (ages 10 to 17) reported some impairment in social and academic functioning.3 Some children with TTM have experienced significant impairment due to peer teasing, avoidance of activities such as swimming and socializing and difficulty concentrating on schoolwork.

Grant, in his presentation, discussed the heterogeneity of TTM and the likely genetic and familial links. “There is probably involvement of multiple genes conferring biological vulnerability” he said. A twin study, he added, showed significant differences. Among 34 identified twin pairs, 24 were monozygotic (MZ) and 10 were dizygotic (DZ). Respective concordance rates for MZ and DZ twin pairs were significantly different at 38.1% and 0% for DSM-IV TTM criteria.4

Grant also explored the neurobiological underpinning of TTM as identified using neuroimaging, neurocognitive assessment and animal models. The Stop-Signal Reaction Task (SSRT) task, which measures inhibition of a response that has already been initiated (ie, the ability to stop), was administered to individuals with TTM and individuals with OCD, Grant said. Chamberlain and coworkers5 found that both OCD and TTM individuals showed impaired inhibition of motor responses, but for those with TTM, the deficit was worse than for those with OCD.

Treatment approaches
The FDA has not approved any pharmacologic treatment for TTM. Several of the presenters emphasized that SSRIs -- the most commonly prescribed pharmacological treatment for trichotillomania -- have little or no efficacy in treating hair-pulling, although they may be helpful for patients with comorbid TTM and depression or anxiety. Clomipramine(Drug information on clomipramine) (Anafranil), a tricyclic antidepressant with serotonergic and other properties, appears to be more efficacious than placebo, but its unfavorable side-effect profile renders it a second-line treatment.

New data have emerged supporting the efficacy of N-acetylcysteine (NAC), a glutamate modulator, and olanzapine (Drug information on olanzapine) (Zyprexa), an atypical antipsychotic, for TTM. In a 12-week, double-blind, placebo-controlled trial involving 50 adults with TTM, Grant and associates6 found that those assigned to receive N-acetylcysteine experienced a mean reduction (improvement) of 40.9% on the primary outcome measure (ie, Massachusetts General Hospital Hair Pulling Scale [MGH-HPS], and a responder rate of 56% (ie, "much" or "very much" improved on the Clinical Global Impressions (CGI) scale by the study endpoint.

Bloch presented results of a randomized, placebo-controlled trial of NAC in children with TTM, in which NAC was not found to be more effective than placebo in treating symptoms of pediatric TTM. He recommended using behavioral therapy for children with TTM before attempting any pharmacologic interventions.

Regarding olanzapine, Van Ameringen and colleagues7 conducted a randomized, double-blind, placebo-controlled trial to determine whether a dopaminergic treatment such as that used in tics and Tourette's syndrome would be effective against trichotillomania. The researchers reported that 85% of olanzapine-treated patients (11 of 13) and 17% of placebo-treated patients (2 of 12) were considered responders according to the primary outcome measure, the Clinical Global Impressions-Improvement (CGI-I) scale (p = 0.001).

Franklin noted that efficacious, nonpharmacologic treatments have been used for TTM, in particular, cognitive-behavioral interventions involving procedures collectively known as habit reversal training.

Core TTM treatment elements, according to Franklin, include psychoeducation; self-monitoring/awareness training, wherein techniques are implemented to improve the patient’s awareness of pulling and the patient’s awareness of the urge that precedes pulling; stimulus control, which includes a variety of methods that serve as ‘speed bumps’ to reduce the likelihood that pulling behavior begins; competing response training, where patients are taught at the earliest sign of pulling or of the urge to pull, to engage in a behavior that is physically incompatible with pulling for a brief period of time until the urge subsides; and addressing internal antecedents and affect regulation functions (e.g., relaxation techniques for stress management).

He emphasized that parents of children with TTM should avoid using guilt to try and control their child’s hair-pulling behaviors and that clinicians should use positive reinforcement. Further discussion of pediatric trichotillomania is contained in a recent article by Harrison and Franklin.8

Some resources for patients mentioned by the presenters include the Trichotillomania Learning Center and StopPulling.com, an online behavioral program designed to help individuals reduce their hair pulling.

Hollander ended the symposium by discussing the rationale for the proposed change in name from trichotillomania to hair-pulling disorder (trichotillomania). In the DSM-IV-TR, TTM is classified as one of five impulse control disorders, he said. In DSM-5, experts are recommending it be listed as an obsessive-compulsive spectrum disorder.

References
1. Flessner CA, Knopik VS, McGeary Hair pulling disorder (trichotillomania): Genes, neurobiology, and a model for understanding impulsivity and compulsivity. Psychiatry Res. 2012;Apr 24. [Epub ahead of print]
2. Woods DW, Flessner CA, Franklin ME, et al. The Trichotillomania Impact Project (TIP): exploring phenomenology, functional impairment, and treatment utilization. J Clin Psychiatry. 2006;67(12):1877-1888.
3. Franklin ME, Flessner CA, Woods DW, et al. The Child and Adolescent Trichotillomania Impact Project: descriptive psychopathology, comorbidity, functional impairment, and treatment utilization. J Dev Behav Pediatr. 2008;29(6):493-500.
4. Novak CE, Keuthen NJ, Stewart SE, Pauls DL. A twin concordance study of trichotillomania. Am J Med Genet B Neuropsychiatr Genet. 2009;150B(7):944-949.
5. Chamberlain SR, Fineberg NA, Blackwell AD, et al. Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania. Am J Psychiatry. 2006;163(7):1282-1284.
6. Grant JE, Odlaug BL, Kim SW. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study. Arch Gen Psychiatry. 2009;66:756–763.
7. Van Ameringen M, Mancini C, Patterson B, et al. A randomized, double-blind, placebo-controlled trial of olanzapine in the treatment of trichotillomania. J Clin Psychiatry. 2010;71(10):1336-1343.
8. Harrison JP, Franklin ME. Pediatric trichotillomania. Curr Psychiatry Rep. 2012;14(3):188-196. ]]> Compulsive Behaviors David Baxter http://forum.psychlinks.ca/compulsive-behaviors/29259-update-on-trichotillomania.html <![CDATA[A Standing Ovation for Sinead O'Connor]]> http://forum.psychlinks.ca/bipolar-disorder/29258-a-standing-ovation-for-sinead-oconnor-new-post.html Wed, 16 May 2012 00:16:07 GMT *A Standing Ovation for Sinead (http://blogs.webmd.com/mental-health/2012/04/a-standing-ovation-for-sinead.html)* By Courtney Rundell Friday, April... A Standing Ovation for Sinead
By Courtney Rundell
Friday, April 27, 2012

Rundell.jpg

Courtney Rundell is a freelance blogger for the International Bipolar Foundation and the North Hollywood Patch. She speaks all over California about thriving with alcoholism, bipolar, and PTSD. When Courtney was diagnosed bipolar in 2006, a life she never knew was possible began. She’s devoted to inspiring and sparking hope in others now that she’s finally a free woman. Her personal blog can be found at www.BeePea.com.

Sinead O’Connor’s recent decision to cancel her upcoming tour “due to bipolar disorder” took courage few know. While putting one’s career on hold due to cancer or Parkinson’s evokes worldwide sympathy, doing so because of mental illness shines a light on how much stigma still surrounds mental health issues.

I know all too well the vulnerability it takes to admit defeat to mental illness. Six years ago, I was placed on a 72-hour hold in a locked down psychiatric unit and diagnosed with bipolar disorder.

I was committed because I was overcommitted.

Shortly after getting my Master’s Degree, I landed my first paying directing gig when I was in the darkest depression I’d ever experienced. I felt like my career was finally taking off so I took the job, banking on the hope that my old frenetic energy would return like Mighty Mouse and save the day.

Normally, I could summon the energy. When I was a stage actress, I used it to memorize lines. When I was a student, I employed it to stay up all night studying for an exam. After my tasks were achieved, I hibernated. I’d literally sleep around the clock until I was able to function again. That was simply how I operated, so it didn’t seem peculiar to me.

But this time was different – that energy was nowhere to be found. My depression grew darker and heavier until I was finally buried and crushed by my rapidly piling responsibilities. My only answer was suicide.

Then I was in an ambulance and the gig was up.

Being diagnosed bipolar was shocking, yet it made sense. I often felt like I had two different personalities – one manic, one depressive. My manic self would run around making promises that my depressive self couldn’t possibly fulfill. Then the shame of not coming through on the promises I’d made only pushed me deeper into depression, creating a vicious circle of darkness and disgrace.

Knowing that I let down many people was beyond humiliating. A deep sense of vulnerability and rawness came with admitting that I was too sick to follow through with my commitments and my sickness only magnified the already negative situation.

My world fell apart, and while I felt like everyone was pointing and laughing at me, I was by no means in the public eye. I can’t begin to imagine what Sinead’s feeling right now.

Sinead O’Connor has lived a life that most people can’t imagine. She’s toured the world. She’s the first-ever priestess to be ordained. She’s given of herself and her celebrity to fight hunger and poverty. She’s a human rights advocate and has spoken out against AIDS/HIV stigma.

And she’s mother to four children. That in itself is a feat unimaginable to me.

Therefore, in lieu of judgment, might I suggest we applaud Sinead’s bravery? Applaud her immeasurable courage. Applaud her honesty. Applaud her humanness.

We are not our accomplishments. Tours can be rescheduled, life cannot.

Brava, Sinead. Brava.
Attached Images
]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/29258-a-standing-ovation-for-sinead-oconnor.html Mood Swings of a Bipolar Friendship http://forum.psychlinks.ca/bipolar-disorder/29257-mood-swings-of-a-bipolar-friendship-new-post.html Wed, 16 May 2012 00:08:14 GMT *Mood Swings of a Bipolar Friendship (http://blogs.webmd.com/mental-health/2012/05/mood-swings-of-a-bipolar-friendship.html)* By Marybeth Smith,... Mood Swings of a Bipolar Friendship
By Marybeth Smith, WebMD
Friday, May 11, 2012

Smith_resized.jpg

Marybeth Smith was diagnosed with Bipolar II at age 26. Marybeth created the website www.askabipolar.com in hopes of helping others understand what it’s like to suffer from mental illnesses. Marybeth is the author of the Amazon Kindle Best Seller and ABNA quarter-finalist, Fall Girl, and is currently working on the sequel while pursuing a degree in Child Psychology. Additionally, Marybeth designs websites, writes for bpHope Magazine and The International Bipolar Foundation, and serves as a board member for NAMI MI.

There are people in this world who meet their best friend in Kindergarten and are friends forever. Others meet in high school. Some in college. They meet, they click, and the friendship grows, making the term ‘BFF’ an actual thing.

Best Friends Forever.

They exist.

Not so much in my life.

I met my best friend in Kindergarten. Then I switched schools. The same happened in first grade, and then I went best friendless until the seventh grade. We went to different high schools, and then she went to college. We stayed in touch, but grew apart.

And then … there were the high school BFF’s.

The symptoms of my illness really came to life in high school. Thus my friendships began to take a bit of a bipolar curve of their own. I’d get depressed and suddenly I was like a magnet with the opposite charge … everyone cleared the area and kept clear until I surfaced. Then I’d switch to a little hypomania and suddenly everyone was my friend. I was funny, I was entertaining, I was friendly, I was fun.

Until I’d fall again.

I’d crash.

I’d turn into an irritable, depressing monster.

Friends were lost, friends were made, and friends were lost again. Then new friends were made again. I was and am great at making friends … still, they pretty much all ended the same way. I’d get depressed and say or do stupid things and it’s goodbye friendship.

I’d like to say this changed as I got older. I’d like to say it became easier to maintain friendships after my diagnosis. Unfortunately, it actually got a bit worse. There were friends I would stop being friends with and then start being friends with again about a year later only to go through the entire ordeal again.

Now maybe these things happen to everyone. And then again, maybe it’s just a problem I have. But sometimes I wonder if it’s a problem that everyone who struggles with bipolar disorder experiences. Do you have a difficult time maintaining friendships? Do you think it has anything to do with your illness?
Attached Images
]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/29257-mood-swings-of-a-bipolar-friendship.html Indicators of Eating Disorder Recovery http://forum.psychlinks.ca/eating-disorders/29256-indicators-of-eating-disorder-recovery-new-post.html Tue, 15 May 2012 23:58:47 GMT *Indicators of Eating Disorder Recovery: Where Are You on the Journey to Recovery?... Indicators of Eating Disorder Recovery: Where Are You on the Journey to Recovery?
by Kate
May 15, 2012

A few weeks ago, I went to a panel of eating disorder professionals in Boulder, Colorado, which was the final event in the “Journey to Wholeness: From Anorexia to Addiction, Bipolar Disorder and Recovery” series sponsored by the Interfaith Network on Mental Illness and featuring renowned author Marya Hornbacher (author of such groundbreaking books as Wasted: A Memoir of Anorexia and Bulimia, and Madness: A Bipolar Life, among many others).

The panel, featuring local eating disorder psychotherapist Isabelle Tierney and Toni Saiber, executive board member of the Eating Disorder Foundation, was truly inspiring to me as a mental health professional working with eating disorders, as well as someone who has recovered from my own eating disorder. The panel members had all recovered themselves from eating disorders as well, and I appreciated the candidness about what it is like for them to pursue the passion in life of helping others find recovery.

A resounding theme of the event was HOPE. What place does hope have in eating disorder recovery? How does it support people in their journeys towards wholeness? All panel members agreed that their own personal experiences have influenced and informed their practice today in a way that makes them, resoundingly, human. I was inspired by the authenticity of panel members: ”sometimes, when I’ve had a challenging week, I still have to notice how I try to use food to cope”; “recovery is a lifetime process, always evolving, always present”; “I’ve learned that when I said no to my eating disorder, there were things I then had to say yes to, which was challenging at first”. These are the voices of recovery, spoken by those who are so inspired by this journey that they now make it their life’s work to help others.

I left with a renewed spirit, a passionate drive, a dedication to commit myself to my own life’s path: to help others find their recovery, too.

I was given a handout at the panel, one so useful that I have shared it with many of my clients. It’s entitled Indicators of Recovery and I have attached it as a PDF :acrobat: at the end of this post. One of the things I love about this handout is that NONE of the indicators have to do with food, weight, or appearance. There is no counting or numbers. These are indicators to a healthy and balanced life, and can be applied to anyone and everyone — not just those with an ED. I like going through this with clients so that, on the sometimes tough days of recovery, they can see where they are and what they’ve already done in terms of recovery. The first step is asking for help and that’s a HUGE one — maybe the most important one of all.

I want to point out a few of these indicators that really stand out to me, as a possible jump-off point to further discussion and reflection:

  • Learning “slips” and “relapses” are signs that something else is really going on and forgiving yourself while investigating the cause. This is one of the more challenging tasks in recovery but one that is essential in embracing the process of the recovery roller coaster. Just because you might have a slip does not mean that you have gone backwards. Slips are opportunities to learn and to practice compassion.
  • Possessing a desire to change. So simple sounding, yet so complex. A client’s readiness to change indicates where they are on the journey to recovery and what challenges and what tasks he/she may find as they move forward. I believe that this factor, as well as asking for help, are the two most essential factors to defining recovery.
  • Feeling negative emotions (or “challenging”) and knowing it is possible to live through them without needing to numb them. This concept is one of the core concepts of Acceptance and Commitment Therapy (ACT), a therapeutic approach that I use in my practice. Learning to sit with feelings, believe that they will pass, and not allowing them to overpower other emotions or desires is an integral part of recovery. We all have feelings, some more challenging than others, and we do not have to allow them to control our experiences.
  • Becoming autonomous and not comparing yourself to others. We are all beautiful and unique in our own ways. Finding and relishing in that inner beauty is the antidote to eating disorder behavior.

Many more Indicators to Recovery are found in the PDF: Indicators of Recovery :acrobat:

Whether you are a professional, a person who is trying to recover from an eating disorder, or a loved one of someone with an eating disorder, I hope you find this pdf helpful.

Which of these indicators are you embracing in your life today? Which are you working on now? Which are goals you have for your recovery?

For more support or resources about eating disorders and recovery, contact Kate at kate@katedaiglecounseling.com, or view her website at www.katedaiglecounseling.com.

Further resources:
www.eatingdisorderfoundation.org.
Attached Files
]]> Eating Disorders David Baxter http://forum.psychlinks.ca/eating-disorders/29256-indicators-of-eating-disorder-recovery.html Separating What’s Bipolar From What’s Not http://forum.psychlinks.ca/bipolar-disorder/29255-separating-what-s-bipolar-from-what-s-not-new-post.html Tue, 15 May 2012 23:12:15 GMT Separating What’s Bipolar From What’s Not
by Joe Kraynak
May 15, 2012

One of the things I hate most about bipolar disorder is how subtly sinister it can be when a loved one is trending toward mania — not manic yet or even hypomanic, just talking faster and louder, blurting out statements that are a little too open and honest and perhaps hurtful, and being more self-centered than usual.

A lot of bad stuff can happen during these times to drive a wedge between loved ones, but nothing bad enough to convince the person or a doctor or therapist that bipolar is at work.

During periods of low-grade pre-hypomania, uncertainty fogs the mind. In our family, we argue more and “walk on eggshells.” Everyone’s afraid to mention the elephant in the room out of fear of being accused of blaming bipolar disorder or the person who has it for our family drama. After all, the rest of us in the family are admittedly less than perfect, and even in a normal, healthy family (whatever that is), interpersonal conflicts arise.

Remember: Blaming all relationship issues on bipolar disorder isn’t fair to the person who has bipolar and may mask non-bipolar related issues, but not acknowledging that bipolar disorder may be the root cause of relationship issues isn’t fair to anyone and can undermine attempts to deal effectively with what may be the underlying cause of those issues.

I begin to doubt my instincts. Maybe it’s not bipolar this time. Maybe it’s something I said or did or a family dynamic we don’t yet comprehend. Perhaps it’s just normal family dysfunction. I find myself trying to referee battles between other family members to keep conflicts to a dull roar. (That never works, by the way.) Then, I get angry and frustrated that adults can’t seem to get along when we’re all essentially living in what a good portion of the world’s population would consider Paradise. Then I do something juvenile and cruel — I stop talking to everyone and mope around throwing myself a pity party.

We all know the number one rule in dealing with family conflict resulting from mood instability: Treat the illness first. But knowing for sure that the illness is what needs treatment isn’t always so clear. We have fire alarms to warn us that the house is on fire and burglar alarms to warn us of intruders, but no alarm sounds and no lights flash when bipolar disorder sneaks in. Nor do we have an objective observer living with us to point out when bipolar disorder is disrupting our lives or it’s just human nature unleashed.

As a result, we often engage in a waiting game until it becomes clear that bipolar disorder is at work or until emotions cool and we enter a period of relative calm. Unfortunately, that game is a dangerous one, during which a lot of relationship damage can occur and the risk of slipping into full-blown mania or depression increases dramatically.

Recently, our daughter started seeing a therapist to work on her own issues that may be exacerbating the tension between her and her mom (my wife) who has bipolar disorder, and all three of us are starting family therapy. While I think that’s all great and long overdue, it seems that sometimes therapy is a pacifier — a drama we play out — until the real problem comes to light and is treated — the bipolar disorder. ]]> Bipolar Disorder David Baxter http://forum.psychlinks.ca/bipolar-disorder/29255-separating-what-s-bipolar-from-what-s-not.html 7 Tips to Improve Your Sleep http://forum.psychlinks.ca/sleep-dreams-insomnia/29250-7-tips-to-improve-your-sleep-new-post.html Tue, 15 May 2012 16:06:02 GMT *7 Tips to Improve Your Sleep! (http://explorewhatsnext.com/7-tips-to-improve-your-sleep/)* by Dr Aletta May 11, 2012 Here are a few quick tips... 7 Tips to Improve Your Sleep!
by Dr Aletta
May 11, 2012

Here are a few quick tips to improve the quality of your sleep:

  1. Only use your bed for sleep, sex, and reading that trashy novel your book club doesn’t know about. No TV!
  2. Create a soothing bedroom that engages all five senses. Lavender scents, soft cotton sheets, low amber light, quiet, soothing music, even vanilla flavored toothpaste!
  3. After the sun sets keep lights low. Think of it as mimicking a camp fire, which signals the brain to release sleep hormones.
  4. Have a before-bedtime ritual, such as washing your face, brushing teeth, putting on pajamas, stretching, prayers, light reading then lights out.
  5. Go to bed and get up at the same time (within half an hour) every day! This is very importnat even on the weekends.
  6. Exercise but not within four hours of bedtime.
  7. Remember to breathe! Once you are in bed, breathe a few deep yoga breaths and relax. Do not be concerned about sleep. Your only desire is to relax.


Sleep is essential to our health generally and our sanity in particular. Interrogators know, if you want to break someone down – deprive them of sleep.

I didn’t appreciate how important sleep was until I became sleep deprived myself. About six years ago, anxiety fed my insomnia, which in turn fed my anxiety. It finally drove me to my doctor’s office. Surely something was very wrong with my thyroid or maybe I had a brain tumor!

A complete workup that took two days and many little tubes of blood… then I met with my medical specialist. With unforgettable kindness he asked what was going on in my life. As I ticked off about five pretty high stress events, I could see where he was going with this, and I didn’t like it. He said, “Well, that would do it for me!” So the good news was my brain and thyroid were fine, the not so good news…it was all in my head.

No, it couldn’t be! I was a psychologist for God’s sake! Wouldn’t I know if stress was making me sick? Turns out, if you are overwhelmed, even if you are a qualified mental health professional, you are often the last to know. A humbling lesson. The frog in the pot syndrome a over again.

ANYWAY… For a couple of weeks I took a sleep medication to get my sleep back on track. Then I got a crash course on sleep hygiene, learned how to breathe to calm down my anxiety and took a serious look at what I could change in my life to allow a better balance. These are lessons I learn over and over again and now pass on to my clients. For really serious sleep troubles I use cognitive behavioral therapy, the best non-medication treatment for insomnia.

Recommended Reading… A Good Night’s Sleep, by a couple of smart guys at Harvard Medical School. ]]> Sleep, Dreams, Insomnia David Baxter http://forum.psychlinks.ca/sleep-dreams-insomnia/29250-7-tips-to-improve-your-sleep.html Sleepwalking in Adults More Common Than Thought http://forum.psychlinks.ca/sleep-dreams-insomnia/29249-sleepwalking-in-adults-more-common-than-thought-new-post.html Tue, 15 May 2012 15:30:04 GMT Sleepwalking in Adults More Common Than Thought
Doctors' Lounge
May 14, 2012

Large study found nearly 4 percent wander at night, often tied to mental woes.By Maureen Salamon
HealthDay Reporter

Sleepwalkers on TV and in movies are often played for drama or laughs, but the phenomenon is surprisingly common in American households, a large, new study suggests.

In what they said is the first research in three decades on sleepwalking prevalence in the United States, scientists from Stanford University School of Medicine found that about 3.6 percent of U.S. adults are prone to sleepwalking, a higher proportion than previously thought. Nocturnal wandering is also tied to certain psychiatric conditions such as depression, anxiety and obsessive-compulsive disorder.

"It's probably more common than we realize, which doesn't surprise me," said Dr. B. Tucker Woodson, professor and chief of the division of sleep medicine at Medical College of Wisconsin in Milwaukee, who wasn't involved in the study. "As clinicians we often see the cases in which it's a problem, so if the occasional sleepwalking episode is not causing any problems, it tends not to be something people seek medical attention for."

The study is published May 15 in the journal Neurology.

Study author Dr. Maurice Ohayon, a professor of psychiatry and behavioral sciences at Stanford, and his colleagues interviewed about 19,000 people aged 18 and older from 15 states, questioning them about their sleeping habits, general health, medications taken and mental disorders. Those who reported sleepwalking were asked about the frequency, duration, family history and any inappropriate or potentially dangerous behaviors during sleep.

Nearly 30 percent of participants reported having sleepwalked at least once in their lifetime, while nearly one-third of the 3.6 percent who had done so within the previous year said they sleepwalked twice or more each month. Family history was a strong predictor, with about 30 percent of those who sleepwalked at least once in the previous year having family members who also experienced the disorder.

"When you have one episode of sleepwalking per month at minimum, you are disturbed by the disorder, no doubt," Ohayon said. "More than once a month is a lot of episodes in a year. It could be harmful for them ... because they don't have the normal reactions. So it could be a big accident coming, but happily that's very rare."

Participants who had experienced depression or obsessive-compulsive disorder were 3.5 times and 3.9 times more likely to sleepwalk, respectively, than people without the conditions, the study found. Those who took antidepressants known as SSRIs, or selective serotonin reuptake inhibitors, were three times more likely to sleepwalk twice a month or more.

Ohayon cautioned that it's not clear whether the psychiatric conditions themselves or drugs used to treat them were responsible for the heightened sleepwalking incidence.

"An association doesn't mean you have a causality link," he said. "It means at maximum, the SSRIs are triggering sleepwalking, but are not the cause. That is clear."

Participants using over-the-counter sleeping pills had a higher chance of reporting sleepwalking at least twice a month, while gender and race weren't associated with the disorder and it seemed to lessen with age.

Ohayon and Woodson agreed that longitudinal research needs to be done that can examine the long-term factors contributing to sleepwalking, which wasn't possible in this cross-sectional study.

"Sleepwalking is a really interesting phenomenon in that it represents the brain in different states -- part of the brain, in a sense, is awake, and part is asleep," Woodson said. "We're learning that other disorders may have similar brain activity . . . with mixed states of wake and sleep. I don't think we understand them all that well. Most are not associated with serious medical consequences, but obviously sometimes they can be."

More information
The U.S. National Library of Medicine has more about sleepwalking.

SOURCES: Maurice Ohayon, M.D., D.Sc., Ph.D., professor, psychiatry and behavioral sciences, Stanford University School of Medicine, Palo Alto, Calif.; B. Tucker Woodson, M.D., professor, and chief, division of sleep medicine, Medical College of Wisconsin, Milwaukee; May 15, 2012, Neurology ]]> Sleep, Dreams, Insomnia David Baxter http://forum.psychlinks.ca/sleep-dreams-insomnia/29249-sleepwalking-in-adults-more-common-than-thought.html <![CDATA[DSM-5 What's In / What's out]]> http://forum.psychlinks.ca/psychology-psychiatry-and-mental-health/29248-dsm-5-whats-in-whats-out-new-post.html Tue, 15 May 2012 15:24:47 GMT DSM-5: What's In, What's Out
MedPage Today
Published: May 10, 2012

PHILADELPHIA -- Reports here provided what may be the last public update on DSM-5, the next edition of American psychiatry's diagnostic guide, before it is formally released in May 2013.

Many changes have been made since the first draft of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was put out for public comment in early 2010, according to workgroup leaders speaking at several heavily attended symposia at the American Psychiatric Association's (APA) annual meeting.

The current version, DSM-IV, was released in 1994.

The update effort has been led by DSM-5 task force chairman David Kupfer, MD, of the University of Pittsburgh, and APA research director Darrel Regier, MD, MPH.

The actual work of rewriting the manual fell to 13 workgroups, which tackled disorders in 20 categories. The final drafts are to be completed by August, then they must be approved by a scientific review committee and the task force leadership, and finally by the APA's governing bodies.

Kupfer said the final version has to be completed by December, when it's set to go to the printer. Its formal release is planned for the APA's annual meeting next May in San Francisco.

Here's a brief overview of the changes you can expect.

WHAT'S OUT

Kupfer and Regier gave the workgroups marching orders at the outset. These included:

  • Eliminate "not otherwise specified" (NOS) diagnoses within categories
  • Remove functional impairments as necessary components of the diagnostic criteria
  • Use scientific evidence to justify classifications and criteria



To a great but not complete extent, the DSM-5 workgroups complied with those instructions. Every one of the dozens of disorder categories has been reorganized and/or rewritten to bring them into line with research conducted over the past 20 years. Often, the groups found no basis for classifications and diagnoses contained in DSM-IV. Here are highlights of what is set to be dumped in DSM-5:

Axes. DSM-IV's main organizational scheme was to divide disorders, contributing factors, and global functional assessments into 5 axes -- notably with Axis I containing clinical, substance-related, and learning disorders and Axis II comprising personality and certain other disability-based disorders.

The DSM-5 leadership determined early on that there was no scientific basis for this distinction, and so disorders in the new edition will be presented as a simple list of 20 chapters for disorder families.

NOS diagnoses. Most disorder families in DSM-IV included an NOS diagnosis that served as a catchall for patients who appeared to have some kind of disorder but who didn't fit into the established categories.

In practice, however, some of these became extremely popular. The head of the eating disorders workgroup, for example, cited data indicating that more than half of all patients diagnosed with an eating disorder were coded for "ED-NOS." Also, some disorders that were now well recognized and characterized were included in NOS categories, such as restless legs disorder.

In DSM-5, NOS categories are either gone entirely or replaced with NEC for "not elsewhere classified." NEC categories will include a list of "specifiers," each with a specific diagnostic code, that will convey clinical information. For example, Depressive Disorder NEC comes with 5 specifiers such as "short duration" that indicate the patient's clinical condition and why it doesn't meet criteria for one of the main depression syndromes.

Bereavement exclusion in major depression. One of the most controversial proposals in DSM-5 does away with the restriction that diagnosis of major depression cannot be given to patients reporting severe grief from the death of a loved one if the death occurred within the preceding two months.

As MedPage Today previously reported, the depression workgroup believes that there is no scientific justification to disqualify patients from diagnosis and treatment if they otherwise meet criteria for major depression.

But in a bow to critics, they have proposed to include a caveat in the checklist criteria for major depression noting that certain symptoms appear in normal grief but that others may warrant attention -- as did DSM-IV though in a different way.

Catatonia as a psychotic diagnosis. The group has reworked the diagnostic criteria for catatonia and removed it as a subtype of schizophrenia. Instead, catatonia is now a specifier in schizophrenia and several other psychiatric diagnoses. The DSM-IV diagnosis of catatonia related to a general medical condition will be retained, and DSM-5 will also create a new "Catatonia NEC" diagnosis for patients showing catatonia of uncertain origin or associated with neurodevelopmental conditions such as autism.

Gender identity disorder. Individuals who believe their biological gender doesn't match their gender identification will no longer be labeled with a disorder. Instead, if they seek psychiatric treatment, they can be labeled with "gender dysphoria."

The workgroup responsible for dealing with the hot-button issue considered a variety of other approaches, addressed later in this article. Ultimately they settled on a formal diagnosis -- potentially qualifying a patient for insurance-paid treatment if they want it -- but with a less pejorative name than "disorder."

Substance abuse. DSM-IV created separate diagnoses for "abuse" and "dependence" in people having problems with mind-altering substances such as marijuana and narcotics. The DSM-5 workgroup in this area agreed that the vast amount of research conducted in recent decades pointed to substance-related problems as occurring on a continuum, such that the abuse-dependence distinction was purely arbitrary.

Hence, DSM-5 will instead feature "substance use disorders" as the diagnosis for people with such problems.

Also out are physical tolerance and withdrawal symptoms as criteria for a disorder diagnosis. O'Brien noted that these reflect the body's adaptation to chemicals and are not necessary to a diagnosis.

WHAT'S IN (or STILL IN)

In a commentary delivered to APA meeting attendees, Norman Sartorius, MD, of the World Health Organization, remarked on "the irresistible tendency to introduce new names" when revising diagnostic criteria. And indeed, the DSM-5 workgroups were unable to resist it.

But Sartorius also noted that new names can be beneficial -- as long as they are accompanied by preparation and education.

In addition to new names, some entirely new disorders and methods of diagnosing them are slated to appear in DSM-5.

Dimensions. Perhaps the most important conceptual innovation in DSM-5 is its use of dimensional assessments in most disorder categories. These are indicators of severity for certain symptoms. They may be common "cross-cutting" features that appear in conjunction with many disorders, such as suicide risk and anxiety. Or they may be specific to a particular disorder, such as the frequency of flashbacks in PTSD.

Biomarkers. For the first time, results of objective testing will be part of the formal diagnostic criteria in psychiatry. Many sleep-wake disorders in DSM-5 will require polysomnography for a diagnosis. Also, narcolepsy is set to become narcolepsy/hypocretin deficiency, with the latter condition diagnosed on the basis of hypocretin measurements in cerebrospinal fluid.

Functional impairments. Despite the leadership's wish to eliminate functional impairments and patient distress as necessary requirements for diagnoses, some of the DSM-5 workgroups found that they couldn't get rid of them.

For example, an autism diagnosis will still require "symptoms [that] together limit and impair everyday functioning." Similarly, proposed criteria for PTSD include "the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."

Regier acknowledged to MedPage Today that impairments are part and parcel of some disorders, particularly those defined by neuropsychiatric deficits. But for many categories -- especially the personality disorders -- functional impairments were transferred from the checklist criteria into the dimensional assessments.

Disruptive Mood Dysregulation Disorder. This is the controversial new designation for children showing persistent foul temper punctuated by bursts of rage. When first proposed, it was widely derided as an attempt to medicalize "toddler tantrums" (even though the criteria clearly stated it was for children older than 5.)

But the workgroup stuck to its guns, although it did drop the name "temper dysregulation with dysphoria" that they had initially proposed.

Autism Spectrum Disorder. This was another controversial move, insofar as it combined Asperger's syndrome with overt autism, as well as two other DSM-IV categories, into a single disorder. Many in the autism community have been unhappy with the proposal -- one member of the workgroup in this area quit in protest -- but the remaining members were adamant that the change was justified and that many of the criticisms were simply wrong.

"Craving." A key innovation in the diagnosis of substance use disorders is a requirement that the patient report or demonstrate craving for the particular substance. Workgroup chairman Charles O'Brien, MD, of the University of Pennsylvania, said this is the key symptom that separates addiction from mere heavy use.

He added that a wealth of recent research has established that craving can be measured -- he had hoped that an objective test might be included in the DSM-5 criteria, but his workgroup felt it was not ready quite yet.

Premenstrual Dysphoric Disorder. Promoted from DSM-IV's appendix to be a full-fledged diagnosis in the depressive disorders family.

Binge Eating Disorder. Promoted from the DSM-IV appendix into the eating disorders.

WHAT DIDN'T MAKE IT

Not everything that was initially considered for DSM-5 ended up in the near-final draft reviewed at the APA meeting. Some proposals left by the wayside include the following.

Other addictions. Despite substantial pressure both within and outside psychiatry, the relevant workgroup rejected proposals to recognize addictions to sex, food, the Internet, and caffeine as diagnosable disorders.

O'Brien said the group recognized that, anecdotally, many people meet most of the criteria for addiction to these behaviors. But the DSM-5 emphasis on scientific justification precluded listing them. Said O'Brien, "We looked at sex addiction, but there was no science at all. None."

However, Internet gaming addiction will be listed in DSM-5's Section III, the equivalent of the DSM-IV appendix, indicating that more research is needed and wanted.

The word "addiction." In fact, it is not used in any DSM-5 names. Instead, they are labeled "use disorders," as in "opioid use disorder." O'Brien said this choice was made over his objection. "They're addictions," he said. "That's the word people are going to use." But others in his group thought the word "disorder" was less pejorative and stigmatizing.

Mixed anxiety-depression. Many patients present with both types of symptoms, creating a diagnostic dilemma -- are they anxious with depression or depressed with anxiety? Early in DSM-5 it was decided to split the difference and create a new diagnosis that included both.

But, as they say in Hollywood, it didn't test well with audiences. In particular, field trials of the proposed definition found that different clinicians interpreted the criteria differently, leading to reliability scores near zero. The condition will go into Section III in DSM-5.

Attenuated psychosis syndrome. This was to be the home for patients with low-level hallucinations and thinking disturbances. Proponents thought that, if someone comes to a psychiatrist with such symptoms, they should receive some type of treatment for which a diagnosis would be needed. Some research also suggested that these symptoms often -- though not always -- precede a full-blown psychotic episode.

But the concept was criticized because it might give patients who might never go on to more severe symptoms the "psychotic" label, and perhaps antipsychotic drug therapy, with little research to back up its effectiveness.

In the end, it was decided to put the condition in Section III after field testing failed to determine whether the criteria were reliable -- confidence intervals were too broad to mean anything.

Posttraumatic Stress Injury. Some in the military and veterans community had lobbied to replace the word "disorder" in PTSD's name with "injury," as less pejorative and permanent-seeming. The workgroup on trauma- and stressor-related disorders did not do so, but they did rewrite its definition considerably -- in particular, adding 9 dimensional assessments to the checklist criteria and splitting PTSD in children from PTSD in adolescents and adults.

Transgenderism as a V code. In seeking to destigmatize what was called gender identity disorder in DSM-IV, one proposal was to list it -- with or without a new name -- as a so-called V code. In DSM-IV, this was a chart code used to flag items of clinical interest that were not diagnosable or treatable conditions in their own right -- such as problems at school or noncompliance with treatment.

It was rejected, as were suggestions that the condition be dropped from DSM-5 altogether.

Other proposed diagnoses. Many additional conditions proposed for inclusion in DSM-5 will be placed in Section III with the hope of attracting more research. These include the following:

Body integrity disorder (wanting healthy limbs cut off because "it feels right")
Male-to-eunuch disorder (wanting surgery to become asexual)
Hypersexual behavior (wanting to have sex all the time)
Persistent Complicated Bereavement Disorder (prolonged or severe grief that does not meet criteria for major depression)
Skin-picking syndrome
Olfactory reference syndrome (believing one smells bad)

WHAT TO LOOK FORWARD TO

Publication of DSM-5 next May is not the end of the process. Here's a peek at what lies down the road.

Primary care version. When DSM-5 comes out, it will be a weighty document like its predecessors. Not only will it include the diagnostic criteria for many dozens of diseases, many of them rare, it will also come with long text explanations for each diagnosis that primary care physicians do not need for everyday practice. DSM-5 officials said they expect to produce a slimmer, trimmer primary care version in 2014.

Code changes. The DSM-5 will also include ICD-9 codes for the individual diagnostic codes, with codes for the U.S. implementation of ICD-10 included as well, probably in parentheses, Regier said.

But the recent delay in ICD-10's implementation -- at least until 2014, perhaps later -- creates some uncertainty for DSM-5.

Regier said that, although he had no inside knowledge, the government may decide to skip ICD-10 altogether, instead going straight to ICD-11, which is to be released internationally in 2015. If that were to happen, DSM-5 would likely be reissued with those codes.

He emphasized that the DSM-5 task force has been working with the developers of ICD-11 to ensure that their respective products are relatively synchronized.

New governance for continued revision. With the completion of what Kupfer has called "DSM-5.0" later this year, a structure within APA to oversee its subsequent revision -- expected to be a more continuous process than in the past -- must be created.

The APA's outgoing president, John Oldham, MD, said no plan has yet been developed for DSM-5.1 and beyond. He said the organization would begin to address that in the near future, although finishing version 5.0 remains the top priority. ]]> Psychology, Psychiatry, and Mental Health Steve http://forum.psychlinks.ca/psychology-psychiatry-and-mental-health/29248-dsm-5-whats-in-whats-out.html Students can criticize prof on Facebook, court rules http://forum.psychlinks.ca/internet-behavior/29247-students-can-criticize-prof-on-facebook-court-rules-new-post.html Tue, 15 May 2012 15:15:16 GMT *Students can criticize prof on Facebook, court rules... Students can criticize prof on Facebook, court rules
CBC News
May 9, 2012

Alberta Court of Appeal finds Charter of Rights protects freedom of speech against university discipline

Alberta's highest court is siding with two University of Calgary students who say their charter rights were violated when the school punished them for criticizing a professor on Facebook.

The Court of Appeal upheld Wednesday a lower court ruling that found the Charter of Rights do apply when universities are handing out discipline to students.

The case involved twin brothers, Keith and Steven Pridgen, who in 2007 posted critical remarks in a Facebook group devoted to complaints about one of their professors.

The university found the brothers guilty of non-academic misconduct and put them on probation, but they appealed to the courts, arguing they had a right to free speech.

When a judge agreed with the brothers, the university took the matter to the next level, arguing that its students don't have the right to freedom of expression because the charter does not apply to universities.

The three judges on the appeals panel all agreed to dismiss the appeal, and each of the judges wrote their own reasons for arriving at their decision.

University responds
The University of Calgary released a statement Wednesday afternoon saying it acknowledges the need to improve its non-academic policy.

The school said it has already revised its disiplinary policy to include centralized non-academic misconduct procedures so they are consistent for all students.

The statement goes on to say it “will be considering the full implications of the Court of Appeal's decision over the coming weeks.” ]]> Internet Behavior David Baxter http://forum.psychlinks.ca/internet-behavior/29247-students-can-criticize-prof-on-facebook-court-rules.html