Personality Disorders

 I have always had an interest in personality disorders, but I knew I didn't want to focus my research on them in graduate school because of how complicated they are. This article showed me that I made the right decision! I think it deserves to be a complicated and highly critiqued area because it is unlike some of the other disorders in the DSM. As the name suggests, it is a disorder of someone's personality. It is a lot harder to identify and understand because we think of it as an integrated part of someone, whereas other disorders are perceived more as separate pieces. We see this in the jargon that we use. We don't say a depressed person, but a person with depression. When it comes to personality disorders, it gets harder to separate the two. I have more experience with cluster two types of PD, and though it is difficult to distinguish what it is exactly, it has been clear that something is off in the people I have worked with. It's like the idea that we might not know what it is, but we know it is something when we see it. One of the most heartbreaking clients I worked with had Borderline Personality Disorder and I had not previously realized the damage it can do to someone's life. With little understanding and treatment options available, PDs can become debilitating. It was encouraging to see the amount of research that went into creating the DSM-V criteria and how many researchers are doing their part in trying to understand these disorders better. 

I found this YouTube Chanel (https://www.youtube.com/@ollupsyc6799) that has interviews with a variety of patients with different personality disorders. These representations are very interesting and it shows how complicated it can be to work with people who have personality disorders. The same channel we watched with the person with schizophrenia has one about living life with a schizoid personality that is interesting as well. 

Schizoid- https://www.youtube.com/watch?v=tjaM-0Ihh8A (I wish he didn't ask so many yes/no      questions); https://youtu.be/GU8VmJsX6-s

Paranoid-https://youtu.be/_MwO3wlChEk

OC personality -https://youtu.be/r53c2e4N9bo

Neurodevelopmental Disorders

    The podcast was very interesting because it gave us two different perspectives on what ADHD is or might look like. I also liked the discussion on overdiagnosis. I found the graphic at the top of the page and it made me laugh because I thought, "is that not just describing people?" We all have different versions of ourselves that tend to show up at different times. It is from a BBC article about a woman who has been diagnosed with ADHD for about ten years. I don't know anything about her or her life, but I think representations like this and that were discussed in the podcast can be dangerous We all have some level of difficulty when it comes to paying attention, but that doesn't always mean it is ADHD. But many people may be misled into believing they have ADHD and take unnecessary medication or feel defeated by it. 

       I think it is especially dangerous for children. It can make a kid feel like there is something wrong with them. A diagnosis could help a kid get the educational services they need, but if it is a misdiagnosis, then they might be pulled out of class unnecessarily. Growing up believing that you can't do things and that you are different from everyone can be very dangerous. I come from a small school and my mom works in education, most of the teachers I interact with are pointing out ADHD symptoms to the parents to tell them to get their child services. No disrespect to teachers, but they should not be unofficially diagnosing kids with ADHD. However, most schools lack the proper resources and can get extra funding based on how many kids are diagnosed. I think ADHD is the next big task we will have to tackle as professionals and it is important for us to be trained well in it. 

    It is important for me to understand the complexities of ADHD because of my forensic work. Since kids with ADHD are more likely to get involved in the criminal justice system, it's very likely that there will be a lot of people undiagnosed. I haven't looked into too much, but there is not a major benefit to having a diagnosis while incarcerated, but it would be important to know during treatment. Some facilities offer GED or other educational services as well as treatment, so it would be helpful to have accurate diagnoses so people can be helped in the most effective way. 

Feeding Disorders

 I think a network analysis with bulimia and anorexia is very useful as it encompasses the variety of symptoms present. There are many factors that can contribute to an eating disorder that are not listed in the DSM and can easily be looked over. For example, diet culture could be a reinforcing element of anorexia nervosa but it would not be routinely identified in the biomedical model. Even within the network, the diet culture can have different levels of influence. When preparing for my presentation, I found many articles that discussed the cultural aspects of eating disorders. One article I found discussed anorexia in relation to ideas of femininity. The social standards of what it means to be a woman were a large indicator in the development of eating disorders. The study didn't just focus on unrealistic beauty standards, but also on the role a woman is supposed to take on. A successful woman is often portrayed as a multitasking, powerhouse that manages kids, a family, and a company. The authors argued that even this idea of "womanhood" contributes to eating disorders because of the stress levels put on women. Women may fall into a restrictive habit because they simply do not have time to eat lunch during the day.  I thought this was an interesting perspective. When working with clients, it would be important to assess their ideas on food and their relationship with eating. Food is fuel, so the less food that is being taken in, the less fuel someone has. A person's relationship with food can affect several other areas in their life for better or for worse. This is an area I don't have much research interest in, but I think there is a lot of clinical utility to assessing for eating disorders with a network model. 

PTSD

Both of these articles were interesting reads. Reading how the professionals go about changing the DSM from one version to the next was very interesting. It is important to know that, as a future clinician, I have a voice and can make a change in the field if needed. One example that stood out in the DSM paper was the inclusion of a preschool subtype. It is something I had not considered before, but it seems useful to have different standards for children who cannot express themselves the same way as adults. The preschool age is a critical development period; if kids cannot receive the help they need because they don't fit into a box, then something should change. I imagine most clinicians that work with PTSD in younger kids are aware that it manifests differently than the previous DSM's allocated for. However, including this subtype can allow for more clinicians to be educated on the issue, and more kids receiving the proper diagnosis and treatment. The articles described control being a major factor in PTSD. As a clinician, I think it would be important to allow the client to take back control after it had been taken from them as the article discusses. However, what would we do if a client overcompensates for a lack of control by trying to control everything? Would a focus on the specific event and where control plays a role help to decrease unnecessary control in other areas?

I also enjoyed reading the paper discussing cultural considerations when it comes to PTSD. I think we are in a critical period that could allow us to learn a lot about trauma, different kinds of trauma, and trauma across cultures. For example, the war in Ukraine and Russia could shed light on PTSD in this part of the world. In addition, the researchers could examine how PTSD manifests in civilians and soldiers. The middle east holds a lot of information regarding historical and prolonged trauma. I wondered while reading- what does PTSD look like in cultures that are always facing some sort of trauma? I thought about the nation of Haiti because I have been traveling there for the past twelve years. These are people that are constantly facing traumatic events, struggle to have basic needs met, and seem to never be able to catch a break. What would PTSD look like there? Is trauma just a normal life experience? Is there little distress because the events are perceived as normal? I wonder what biological and neurological traits are being affected and passed on to generations. Again in the middle east, how does trauma look in a culture that is full of war and oppression? I think there is a lot of room for more research on PTSD and trauma cross-culturally. 

Depression

 I really enjoyed reading the depression article because it encompassed how diverse depression is and how clinicians should approach diagnosis and treatment. During my time at a neuropsychology clinic, we used the BDI, GDI, and MMPI for all able patients. Our main populations were older individuals with memory problems- most still living independently but some who had supervised care of some sort. We saw a large increase in depression (according to the MMPI, GDI, and BDI scores) in this population after COVID. Specifically, we saw more patients with a lack of interest and feelings of being punished. Most patients attributed this to the social isolation factor of the pandemic. This was difficult for us to treat because there wasn't anything we could really do practically. As families came around more and there were more opportunities to do things, these symptoms decreased. 

I think this example goes beyond my small clinic. The pandemic exposed different symptoms of depression that might not have been as common before. A dynamic network model would be my way of assessing and treating depression because it is a better tool to understand depression as it relates to the client. It would also be interesting to track over treatment to see if the patterns change. When looking at examples, I found some very in-depth models that would be useful during a first assessment. After that, I would narrow it down and track the main symptoms. As the article points out, it is important to assess depression by using a multimethod approach. Using three different assesment tools with a network model might be a little much, but I think it would encompass the whole picture. I think that using a very broad network and then narrowing it down would be helpful. Here is one example I found: 

Substance Use Disorders

 

I enjoyed reading about the history of the different substances and how culture, time, and societies have changed the perspective of drug use. It reminds me of the story of the oracle in Greek mythology that would sit at the temple of Apollo in Delphi. People would travel extensively to visit her, including leaders who needed her wisdom before deciding to go to war. She was one of the most important people in ancient Greece, and her prophecies were sacred.  The course of history was actually changed by the woman's ability to predict the future and see into a different dimension. It turns out, there was methane rising from the ground where she sat and she was likely in a different dimension from smelling the gas all day. 

It's clear that despite the time period or the culture, substances have always been a part of society- for better or for worse. Though it seems to be a natural human issue, including SUD in the DSM allows people to understand the severity of these substances and behaviors. In some of my readings for my presentation, I found that American culture has been criticized for increasing the use of illicit substances because of the strong emphasis we put on medication. Our culture uses things, like prescription medication, to fix almost any issue. When it comes to mental health, we are doing the same thing as times. So, it is not a surprise that most people think they need to take something to feel better or different-rather legally or illegally. Substance abuse is an extremely difficult disorder that is often neglected in research. The research that is done usually promotes swapping one drug for another in order to find relief. More research from a psychological standpoint is needed to better understand the disorder and treatment options. As discussed in the readings as well, there is a lack of research in behavioral areas (gambling, sex, shopping). If we get away from the biomedical model a bit, it is better for us, as future clinicians, to focus on our clinicians' problems whether they meet diagnostic criteria or not. While the research tries to find a way to make it clinically significant enough, we can focus on treating people and their problems.

 

OCD

I have not previously looked in depth at OCD and had a superficial understanding of the disorder. I didn't realize the complexities of OCD that are explained in the readings, possibly because of the simplicity the DSM portrays. I can see how the learning model can be used to explain OCD, but I wonder if the cognitive model might be more client friendly? The idea that the obsessions are normal and most people experience them, but some people just perceive them as a bit more threatening might allow the client to feel less stigmatized. The client may feel like they're crazy or be reluctant to share their obsessions, so setting the stage that this is somewhat common may be helpful. I wonder how COVID affected people with OCD or people who didn't know that they have OCD. We were told to wipe down all of our groceries or let them sit in the garage long enough for the germs to wear off. Before a pandemic, these compulsions would follow the contamination part of OCD, but now they are supposed to be normal? What do you do as a clinician when a client comes to you with this? Is it OCD or are they trying to avoid COVID? I would imagine there would be other areas that might or might not line up with OCD behavior that would help to narrow it down. 

I also can see how diagnosing OCD is difficult when it comes to religious practices. Judaism has an emphasis on hand washing and ritualistic practices surrounding the idea of being clean before praying. Many religions have rituals and customs that can appear irrational to someone who is unaware of the customs. In addition, the obsessions around pleasing God, being moral, or questioning existence are valid obsessions if you ask theologians or someone who practices religion. I read a book a while back ("The God-Shaped Brain") that discussed how one's perspective of God can contribute to mental health issues. The author would argue that the obsessions around God are likely unhealthy and that most Christians place an unnecessary pressure on themselves that negatively contributes to their mental health. I find that interesting and helping a religious client change their view of God could increase their mental health. With OCD, it might be a bit more difficult but it could be an interesting area to study.