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.

Anxiety

idea of anxiety as a defense mechanism- one of the last paragraphs talks about it

i like this definition of GAD and worry 

phobia development through vicarious experiences or watching tv- i would think especially when you're young. very interesting, didn't know that

new forms of social anxiety about saftey?- in school, maybe with health because of covid

I really enjoyed both readings because it took the dynamic approach to disorder that we have been discussing. Anxiety is not simple, it does not show up the same way and that is important. I liked the distinction between anxiety and worry becuase I think that worry can oversimplify anxiety and GAD. As I was reading, I started thinking of anxiety as a defense mechanism and the readings later discussed the same idea. It would make sense that a lack of control in one area can lead your mind finding a way to protect itself from being out of control again. At least Freud might agree (or find a way to relate it to sex at least).  I thought both papers did a great job at explaining how embedded anxiety can be in a person. Therapy for anxiety disorders is so difficult because of the learning dynamic. Yes, if a behavior can be learning it can be unlearned, but what if that behavior feels like a major part of you? The cognitions and behaviors have become so imbedded, people with anxiety disorders might not want to get rid of them out of that fear of losing control again. I think becuase anxiety is so common, people downgrade the severity of it at times. 

I also found it intresting that phobias can sometimes develope through watching TV. I think this goes to show that what we surround ourselves with greatly impacts us rather we know it or not. It also made me think about social anxiety and a possible new wave of it. With COVID and a rise is school shootings, I wonder if there will be an increase in phobias or social anxiety around crowds of people? We are constantly hearing stories on the news about shootings; COVID marked crowds as dangerous and to avoid them. I would think people, esspecially those a few years younger than me, would be fearful of thier safety in schools, malls, concerts, or other crowded places due to these experiences. What will this reasearch show in the next five years?