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Concept: Abnormal psychology


We describe a case of shibari, a double hanging sexual asphyxia practice, which ended fatally for one of the two women involved. We present the autopsy findings and a psychiatric and psychometric evaluation of the surviving participant. The survivor had a borderline personality disorder, had suffered sexual abuse as a child, and had a history of illicit substance consumption, self-harm behavior, and sexual dysregulation. This case study raises doubts regarding the safety measures adopted by participants in masochistic practices and the engagement of people with psychiatric disorders in these extremely dangerous games. Further case studies of living participants in such games are likely to shed light on this practice and facilitate treatment.

Concepts: Mental disorder, Abnormal psychology, Child abuse, Borderline personality disorder, Schizotypal personality disorder, Self-harm, Personality disorder, Antisocial personality disorder


Many people identified as having common mental disorders in community surveys do not receive treatment. Modelling has suggested that closing this “treatment gap” should reduce the population prevalence of those disorders. To evaluate the effects of reducing the treatment gap in industrialized countries, data from 1990 to 2015 were reviewed from four English-speaking countries: Australia, Canada, England and the US. These data show that the prevalence of mood and anxiety disorders and symptoms has not decreased, despite substantial increases in the provision of treatment, particularly antidepressants. Several hypotheses for this lack of improvement were considered. There was no support for the hypothesis that reductions in prevalence due to treatment have been masked by increases in risk factors. However, there was little evidence relevant to the hypothesis that improvements have been masked by increased reporting of symptoms because of greater public awareness of common mental disorders or willingness to disclose. A more strongly supported hypothesis for the lack of improvement is that much of the treatment provided does not meet the minimal standards of clinical practice guidelines and is not targeted optimally to those in greatest need. Lack of attention to prevention of common mental disorders may also be a factor. Reducing the prevalence of common mental disorders remains an unsolved challenge for health systems globally, which may require greater attention to the “quality gap” and “prevention gap”. There is also a need for nations to monitor outcomes by using standardized measures of service provision and mental disorders over time.

Concepts: Psychology, Improve, Hypothesis, Mental disorder, Selective serotonin reuptake inhibitor, Abnormal psychology, Anxiety disorder, Reducing agent


Experiential avoidance (EA) is an important factor in maintaining different forms of psychopathology including borderline personality pathology (BPD). So far little is known about the functions of EA, BPD features and general psychopathology for positive emotions. In this study we investigated three different anticipated pathways of their influence on positive emotions.

Concepts: Psychology, Abnormal psychology, Borderline personality disorder, Psychiatry, Diagnostic and Statistical Manual of Mental Disorders, Avoidant personality disorder, Personality disorder, Histrionic personality disorder


Objectives: There are ongoing uncertainties in the relationship between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). This study aimed to test the proposition that OCPD may be a marker of severity of OCD by comparing groups of OCD individuals with and without OCPD on a number of variables. Method: A total of 148 adults with a principal diagnosis of OCD were administered the Mini International Neuropsychiatric Interview, Yale-Brown Obsessive-Compulsive Scale, Sheehan Disability Scale, Vancouver Obsessional Compulsive Inventory and Symptom Checklist 90-Revised. Participants with a DSM-IV diagnosis of OCPD were compared with those without OCPD. Results: Some 70 (47.3%) participants were diagnosed with OCPD. The groups of participants with and without OCPD did not differ significantly with respect to any of the demographic variables, clinician-rated severity of OCD, levels of disability and mean age of onset of OCD. All self-rated OCD symptom dimensions except for contamination and checking were significantly more prominent in participants with OCPD, as were all self-rated dimensions of psychopathology. Participants with OCPD had significantly more frequent hoarding compulsions and obsessions involving a need to collect and keep objects. Of Axis I disorders, only panic disorder was significantly more frequent in participants with OCPD than in those without OCPD. Conclusions: A high frequency of OCPD among individuals with OCD suggests a strong, although not necessarily a unique, relationship between the two conditions. This finding may also be a consequence of the blurring of the boundary between OCD and OCPD by postulating that hoarding and hoarding-like behaviours characterise both disorders. Results of this study do not support the notion that OCD with OCPD is a marker of clinician-rated severity of OCD. However, individuals with OCPD had more prominent OCD symptoms, they were more distressed and exhibited various other psychopathological phenomena more intensely, which is likely to complicate their treatment.

Concepts: Selective serotonin reuptake inhibitor, Abnormal psychology, Psychiatry, Personality disorders, Obsessive–compulsive disorder, Compulsive hoarding, Obsessive–compulsive personality disorder, Scrupulosity


Background: Turkey is both a source and target for asylum seekers seeking refugee status in countries of European Union. There is a scarcity of research on the mental health issues of asylum seekers and refugees residing in Turkey. Aims: This study aimed: 1) to provide clinical and demographic information on asylum seekers and refugees receiving mental health services from a non-governmental refugee support program in Istanbul between 2005 and 2007, and 2) to evaluate the differences between patients diagnosed with post-traumatic stress disorder (PTSD) with those who did not meet criteria. Methods: The study was conducted at the Mental Health Division of the Refugee Advocacy Support Group. Between July 2005 and February 2007, 1209 asylum seekers applied to the support group; 75 of these individuals (6.2%) were referred for psychiatric evaluation while 57 were diagnosed as having a psychopathology. The number of analyzed subjects was 57. Results: PTSD and major depressive disorder were the most common diagnoses (55.2% for both). The most common criteria of PTSD reported were problems in concentration and social isolation (97.3% for both). Suffering torture and losing a significant other due to violence were found to be associated with a diagnosis of PTSD. Conclusions: This study is the first of its kind to be conducted on a mixed refugee population residing in Turkey and focusing on their mental health problems. Our results should be tested within larger samples of refugees residing in different cities of Turkey.

Concepts: Demography, Europe, Selective serotonin reuptake inhibitor, Abnormal psychology, Cognitive behavioral therapy, Sertraline, Vietnam War, Right of asylum


The stress generation hypothesis posits that individuals actively contribute to stress in their lives. Although stress generation has been studied frequently in the context of depression, few studies have examined whether this stress generation process is unique to depression or whether it occurs in other disorders. Although evidence suggests that stress contributes to the development of eating disorders, it is unclear whether eating disorders contribute to subsequent stress.

Concepts: Symptoms, Selective serotonin reuptake inhibitor, Abnormal psychology, Cultural studies, Primary care, Process, Great Depression, Context switch


Finklestein, M., Laufer, A. & Solomon, Z. (2012). Coping strategies of Ethiopian immigrants in Israel: Association with PTSD and dissociation. Scandinavian Journal of Psychology 53, 490-498. The aim of this study was to examine the relations between coping strategies, posttraumatic stress disorder (PTSD), and dissociation among Jewish Ethiopian refugees in Israel (following exposure to pre-, peri- and post-migration stressful events). Method: A random sample (N = 478) of three waves of refugees took part in the research (N = 165; N = 169; N = 144). Religiosity, coping strategies, stressful and traumatic events, pre- and peri- migration, post-migration difficulties, posttraumatic symptoms, and dissociation were assessed. Results: A significant relationship was found between PTSD symptoms and avoidance coping over and above immigration wave and traumatic events. Dissociation was positively associated with passivity and antisocial coping and negatively associated with social joining and level of religiosity, over and above immigration wave and traumatic events. The findings are discussed in the light of the coping strategies employed by Ethiopian refugees.

Concepts: Psychological trauma, Immigration, Abnormal psychology, Cognitive behavioral therapy, Prolonged exposure therapy, Refugee, PTSD, Vietnam War


Abstract There is evidence that neuropathic pain component in low back pain (LBP) patients is associated with higher ratings of co-morbidities such as depression and anxiety disorders. In line with current findings the purpose of this clinical study is to examine a hypothesis regarding a relationship of neuropathic pain component, depression and other psychopathological symptoms in a specific group of LBP patients with sciatica pain. With respect to findings that depression is related to inflammatory changes and inflammatory mediators may play a role in neuropathic pain generation we have assessed also serum C-reactive protein (CRP). Results of the present study show that increased neuropathic pain component in sciatica patients is associated with elevated levels of depression, anxiety, alexithymia and serum CRP levels. In conclusion results of this study indicate that CRP levels in sciatica patients are closely associated with neuropathic pain.

Concepts: Inflammation, Spinal disc herniation, Back pain, Symptoms, Sciatica, Selective serotonin reuptake inhibitor, Abnormal psychology, C-reactive protein


A significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and affective disorders has been consistently reported in adults. Less data regarding the role of personality traits and the influence of ADHD co-occurrence on clinical characteristics and outcome of mood disorders are currently available. One hundred and six remitted major depressed, 102 euthymic bipolar subjects, and 120 healthy controls, homogeneous with respect to demographic characteristics, were included in the study. ADHD diagnosis was based on DSM-IV-TR criteria. Childhood and adult ADHD features were measured with the Wender Utah Rating Scale, the Adult ADHD Self-rating Scale, and the Brown Attention-Deficit Disorder Scale. The Revised NEO Personality Inventory was also administered to the clinical groups, in order to investigate personality dimensions. The occurrence of adult ADHD in subjects with bipolar disorders (BD) or major depressive disorder (MDD) was 15.7 and 7.5 %, respectively, compared to 3.3 % in healthy controls (HC). Significant associations (p < .001) between personality traits (neuroticism, conscientiousness, and extraversion) and ADHD features were observed. Logistic regression analysis of all clinical subjects (n = 208) showed that those with lower levels of neuroticism (OR = 1.031; p = .025) had a lower frequency of ADHD comorbidity. The present study emphasizes the close relationship between affective disorders, especially BD, and ADHD in adults. Our findings support the need to assess subjects with mood disorders in the clinical setting for possible coexisting ADHD and to further investigate personality traits to better understand the etiology of affective disorders and ADHD co-occurrence.

Concepts: Attention-deficit hyperactivity disorder, Abnormal psychology, Schizophrenia, Bipolar disorder, Major depressive disorder, Dysthymia, Diagnostic and Statistical Manual of Mental Disorders, Big Five personality traits


OBJECTIVE: To review the DSM-5 proposed criteria for mixed depression in light of robust and consistent historical and scientific evidence. METHOD: An extensive historical search, a systematic review of the papers used by DSM-5 as reference papers, and a PubMed search were performed. RESULTS: As Hippocrates, depressive mixed states have been described as conditions of intense psychic suffering, consisting of depressed mood, inner tension, restlessness, and aimless psychomotor agitation. In DSM-5, new criteria are proposed for a mixed features specifier, as part of depression either in major depressive disorder (MDD) or bipolar disorder. Those criteria require, as diagnostically specific, manic/hypomanic symptoms that are the least common kinds of symptoms that actually arise in depressive mixed states. The DSM-5 proposal is based, almost entirely, on a speculative wish to avoid ‘overlapping’ manic and depressive symptoms. Mixed states are, in fact, nothing but overlapping manic and depressive symptoms. CONCLUSION: In this article, we review the psychopathology and research on mixed depressive states, and try to demonstrate that the DSM-5 proposal has weak scientific basis and does not identify a large number of mixed depressive states. This may be harmful because of the different treatment required by these conditions.

Concepts: Abnormal psychology, Bipolar disorder, Major depressive disorder, Seasonal affective disorder, Diagnostic and Statistical Manual of Mental Disorders, Depression, Suicide, Psychomotor agitation