Psychopathology最新文献

Introduction: Childhood maltreatment is associated with both reduced cognitive functioning and the development of psychotic symptoms. However, the specific relationship between childhood maltreatment, cognitive abilities and (pre)psychotic symptoms remains unclear. Therefore, the aim of this study was to investigate the association between childhood maltreatment and tasks of verbal memory and processing speed in a help-seeking sample of an early detection of psychosis service.

Methods: A total of 274 participants consisting of 177 clinical high risk (CHR) for psychosis subjects and 97 clinical controls (CC) with subthreshold CHR underwent a battery of neurocognitive assessments measuring the latent variables verbal memory and processing speed. Additionally, the Trauma and Distress Scale (TADS) was administered to assess varying childhood maltreatment subtypes. Structural equation modeling (SEM) was used to examine associations between verbal memory, processing speed, and maltreatment subtypes. Other factors in the model were age, gender, clinical group (CHR or CC), and the presence of different CHR criteria.

Results: Physical abuse was associated with lower scores in verbal memory and processing speed. The explained variance in the SEM reached up to 9.5% for verbal memory and 24.9% for processing speed. Both latent variables were each associated with the presence of cognitive-perceptive basic symptoms. Lower verbal memory was additionally associated with the clinical high-risk group, and processing speed capacity was associated with higher age and female gender.

Conclusion: Childhood physical abuse in particular was associated with poorer performance on verbal memory and processing speed across both groups of CHR and CC with subthreshold CHR symptoms. This adds to the current literature on reduced cognitive abilities when childhood maltreatment had occurred, albeit subtype dependent. Our findings, together with high prevalence rates of childhood maltreatment in patients with psychosis or CHR states, along with the presence of cognitive deficits in these patients, highlight the importance of not only assessing cognition but also childhood maltreatment in managing these patients. Future research should investigate the specific biological mechanisms of childhood maltreatment on verbal memory and processing speed in CHR subjects, as neurobiological alterations might explain the underlying mechanisms.

The concept of hysteria, although apparently surpassed by contemporary nosographic classifications, continues to be talked about. Following Charbonneau's attempt to de-feminize and de-sexualize hysteria, clinical phenomenology can offer a perspective which, freed from stigma and prejudices through the suspension of judgement, allows us to understand hysteria not as a diagnostic category but as an existential position. In this sense, hysteria would be based on a hypo-sufficiency of the embodied self, which is not perceived as solid and continuous and needs external confirmations of its adequacy. According to the optical-coenaesthetic disproportion hypothesis, the hypo-sufficiency of the embodied self originates from the difficulty of experiencing one's body from the first-person perspective and from the consequent use of the gaze of others as a prosthesis to achieve a sense of selfhood and identity. Hysteric persons develop a mode of access to their corporeality mediated by visual representations - hence the theatricalization, centrality, and seductiveness of hysteric persons' behaviour. We suggest to call "figural body" the visual apprehension of one's body which tries to compensate for the weakness of coenaesthetic apprehension of the lived body. Over time, the figural body ends up superimposing itself on the immediate experience of the lived body. Placing itself on a representative register, this image conveys not only individual ghosts but also cultural aspects, social prejudices, gender stereotypes. Thus, the attempt to experience one's own body with the mediation of the other's gaze becomes an involuntary and unaware throwing of oneself into the meshes of representation that are necessarily alienating for the person. Hysterical persons remain stuck in their inability to access an experience of their body that is not figurative, alienating themselves in representations which always come from outside.

Introduction: Autism has typically been characterized by its external manifestations rather than experienced phenomenology, with consequent impacts on both research and practice. There have recently been increasing calls for more phenomenological enquiry in autism, but little actual work reported.

Method: A shared participatory phenomenological self-investigation was conducted, by the four authors, of lived experience across the autistic/non-autistic divide. The sample size was chosen as necessary for the feasibility and acceptability to participants of such work in this context. Roles of "researcher" and "interviewee" were purposefully alternated between participants to establish trust and reciprocity. Initial phenomenological reduction or bracketing was applied to the description and recording of each participant's intimate lived experience in a number of key domains across social relationships, the physical environment, development, and in adult life. These experiences were shared within dialogue to open them to investigation and questioning from the others, with alternating interviewer and respondent roles. A third step synthesized these shared observations across individuals into themes of continuity and difference.

Results: A number of emergent themes, such as the need for trust and reliability, and the impact of context on regulation of emotion, sociability, and empathy, showed striking commonalities between all participants. Other themes, such as primary sensory experience and social joining, pointed up more clear differences between autism and non-autism in development and the adult world. Themes of interest-focus and attention were marked by both commonalities and difference.

Conclusions: This shared phenomenological method was taken as a first step within a new area of active investigation in autistic phenomenology. It proved successful in eliciting detailed information on self-experience. The results suggested hypotheses for a new understanding of autism within the wider "human" spectrum of experience; for instance, the common basic need for trust and social connection but striking differences in sensory experience. It suggested that some characteristics long thought intrinsic to autism, such as social mis-perception and reduced empathy, may be alternatively understood as state-dependent outcomes contingent on specific contexts and interactions. Implications are suggested for testing in further research, developmental theory, and intervention practice.

Introduction: Embitterment may occur after stressful but normal life events, such as job loss, divorce, or unjust events. Embitterment is a normal affect, but it may become clinically relevant in case it becomes very strong and long-lasting, and impairs daily functioning.

Objective: Until now, no epidemiological data on the frequency of high embitterment in the general population have been available.

Methods: A national representative survey of 2,531 people was carried out in Germany in 2019. The participants gave ratings for their embitterment due to perceived events (Posttraumatic Embitterment Scale), their psychological capacity profile (Mini-ICF-APP-S), sick leave duration, and sociodemographics.

Results: About 11.7% of the investigated representative population report moderate embitterment, and another 3.8% high embitterment. Embitterment was only low correlated with other psychopathology, here work anxiety (r = 0.281**). There are no differences between embittered and nonembittered in respect to age, sex, household members, and professional distribution. Those with the highest embitterment have been unemployed more often and have lower income. At least 7.2% of those with high embitterment have a severe psychological capacity impairment and are in need of support by thirds to fulfill daily duties. In 55% of the 802 who reported a stressful event, injustice by an important person has been reported. Injustice by an institution (14%) or societal injustice (12%) was least often reported as a relevant stressful event.

Conclusion: Physicians, therapists, and public health must be aware of embitterment as a specific mental health problem which occurs frequently and may become chronic with work and life participation problems.

There are indications for a raise in embitterment during the COVID-19 pandemic. As embitterment is related to felt social exclusion, pessimism, and a proneness toward COVID-19-related conspiracy beliefs, embitterment may be a key factor to consider in the current pandemic. However, perceived social support (PSS), which is associated with hope during the COVID-19 pandemic could serve as an important resilience factor for bitterness. We therefore investigated the effects of PSS on embitterment in aftermath of the second wave of the COVID-19 pandemic. 52 individuals participated in our follow-up online study in October 2020 (T1) and May 2021 (T2). Embitterment (measured with the Berne Embitterment Inventory) and PSS were repeatedly assessed at T1 and T2. A double moderation analysis was conducted, using the PROCESS macro to examine the effects of embitterment, PSS, and age on embitterment 6 months later. The results suggest that the prediction of embitterment at T2 by embitterment at T1 was altered by changes in PSS. Here, in particular participants with high embitterment at T1 and a gain in PSS had higher embitterment scores at T2, whereas participants with low embitterment were found to have lower embitterment scores. This interaction effect was further influenced by the age of the participants, where the effects were more pronounced among middle-aged participants than younger participants. As embittered individuals seem to grow in bitterness with a gain in PSS, support is found for the notion that embittered individuals seeking allies supporting their mindset.

Introduction: The fear of scrutiny central in social anxiety disorder (SAD) points to a problem of the interpersonally perceivable body. Whereas the predominant cognitive-behavioral (CBT) account of the disorder understands this as a problem of excessive self-focused attention, the phenomenological literature reveals it as a sign of a fundamental transformation of body experience. The lived body absent from experience becomes the object body at the forefront of it. The present paper contributes to this literature by refining and grounding these notions in first-person descriptions of concrete experiences of social anxiety.

Method: Repeated interviews were conducted with eight informants struggling with social anxiety and collected personal diaries. The interviews were informed by phenomenological concepts and a specific line of inquiry on body experiences. The analysis tested iteratively a set of phenomenologically grounded hypotheses of altered body experience against the first-person descriptions.

Results: A concept of bodily instrumentalization is developed which accounts for the tendency of self-directed attention and behavior central to the disorder. That is, the socially anxious patient experiences their body as entrapped by the Other and thus unable to act freely among them. This felt bodily self-enslavement for the Other shows itself in efforts to conceal the body from the others and to puppeteer it for them.

Discussion: The notion of bodily enslavement captures a central aspect of the suffering experienced by patients with SAD that exceeds the capability of the CBT language. Additionally, the social nature of the bodily instrumentalization that is constitutive of this suffering means that psychotherapy should not treat SAD as a cognitive disorder, but rather as an interpersonal disorder. Specifically, psychotherapy should offer patients shared interpersonal experiences in which they forget their bodily presence.

This paper sheds light on some aspects of what contemporary clinical theory calls "borderline" condition providing a description of a key figure of late-modern culture that I will call Homo dissipans (from Latin dissipatio, -onis = scattering, dispersion). Homo dissipans is the opposite of Homo œconomicus, the form that "narcissism" takes on in contemporary "achievement society," solely concerned with rational action aimed to utility and production. In order to define Homo dissipans, I follow French philosopher, anthropologist, and novelist Georges Bataille's descriptions of two core phenomena: "excess" and "expenditure." The former can be defined as a surplus of energy that according to Bataille characterizes human existence, animated by a general movement of exudation and dilapidation and an inexhaustible drive to "pour out" of oneself, especially outside the limits of composure and reasonableness. The latter is an ethical attitude which gives its approval to excess and to its metamorphic and destructive power. The Homo dissipans' credo is to profitlessly dissipate the surplus of energy, escape into a world of pure intensities in which all forms - including identity - dissolve and surrender themselves to transformation. I argue that Bataille's ideas about "dissipation" can help us reconsider two features attributed to borderline personality disorder which have been extensively described and sometimes stigmatized - "identity diffusion" and "stable instability" - and to better recognize, understand, and make sense of their phenomenology in the clinical context.

Introduction: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) share overlapping symptomatology, particularly with regard to social impairments (including peer relationship difficulties), and they frequently co-occur. However, the nature of their co-occurrence remains unclear. Therefore, the current study aimed to examine the nature of the transdiagnostic link between ASD and ADHD from a symptomatological point of view measured with the Autism Diagnostic Observation Schedule (ADOS Module 3) and the Autism Diagnostic Interview-Revised (ADI-R).

Methods: We analyzed the social and nonsocial ASD symptom domain scores from both diagnostic instruments in 4 clinically referred groups (i.e., ASD, ADHD, ASD + ADHD, and no psychiatric diagnosis) without other co-occurring mental disorders using a two-by-two full-factorial MANOVA design with the factors ASD (yes/no) and ADHD (yes/no).

Results: We found no ASD by ADHD interaction effects across all symptom domain scores of ADOS and ADI-R, except for ADOS imagination/creativity. There were only main effects of the factor ASD but no main effects of ADHD. Follow-up contrasts showed that exclusively, ASD had an impact on the measured symptomatology in case of co-occurring ASD + ADHD.

Conclusion: Overall, the results support an additive model of the symptomatology across areas of communication, social interaction, and stereotyped behaviors and restricted interests in case of the co-occurrence of ASD and ADHD when assessed with ADOS/ADI-R. Thus, one can assume that the phenotypic overlap of ASD + ADHD may be less complicated than suspected - at least with regard to ASD symptomatology - and that in the presence of ADHD, ASD symptomatology is generally well measurable with best-practice diagnostic instruments.

Considering the growing sense of ambivalence about the merits of the DSM, the time seems right for the re-evaluation of nosological attempts and efforts in the pre-DSM era. One example of these attempts is the CHAM system developed by the Dutch psychiatrist R.M. Silbermann (1932-1976). This system is intended as a simple classification with 20 "psychiatric states," which are classified based on the presence of one of 12 hierarchically arranged core symptoms or key characteristics, while all "hierarchically higher" symptoms are excluded without inference about the "hierarchically lower" symptoms. Its scientific evidence is, as yet, insufficiently substantiated. However, disqualifying the CHAM system as an outdated Dutch folklore is like throwing out the baby with the bathwater. The CHAM system emerges as clinically straightforward, didactically fruitful, and consistent with more modern initiatives in descriptive psychopathology. Studying pre-DSM attempts such as Silbermann's CHAM system can stimulate psychopathological thinking and serve as a source of inspiration for future phenomenological research in psychiatry.

Introduction: Research has consistently demonstrated that the COVID-19 pandemic, and resulting sudden shift to online learning (OL), had detrimental impacts on the motivation and mental health of university students. To date however this research has been cross-sectional and quantitative.

Method: This study employed a mixed-methods design to examine the experiences of students at a large national Australian University both at the outset of the pandemic in 2020 (n = 824) and again 6 months later (n = 254) at the conclusion of their academic year.

Results: Key findings from this study highlighted that despite quantitative findings suggesting poorer attitudes toward learning during the pandemic, qualitatively students perceived both positives and negatives to studying online. The qualitative results further highlighted that this experience was not the same for all and suggests the need to reconsider the standard approaches to offering support for students.

Conclusion: Students reported poor mental health in both time points, but outlined avenues which improved not only their mental health but also their motivation for studying such as increased peer engagement and self-care activities. Students reported that OL negatively impacted on both their engagement with studies and their mental health, highlighting the need for universities to prioritize supporting their students' mental health as much as their development of academic skills.