Providentia

Does Borderline Personality Disorder Affect Pain Sensitivity?

A research study published in the January 2008 issue of the World Journal of Biological Psychiatry compared pain sensitivity in patients with different psychiatric diagnoses under baseline and stress conditions. The study used a sample of 76 female subjects: 16 patients with borderline personality disorder (BPD), 16 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa and 24 healthy controls. Using a contact thermal probe, heat and cold pain thresholds were determined under baseline and stress conditions while mental stress was induced with a cognitive task (Paced Auditory Serial Addition Task). The results showed that pain thresholds in patients with BPD were significantly higher compared to healthy controls under baseline conditions. Patients with PTSD and bulimia nervosa did not show significant differences in pain thresholds compared to healthy controls. Under stress conditions, the difference between BPD patients and healthy controls became even more prominent, whereas the results in the other patient groups remained insignificant. The authors conclude that reduced pain sensitivity is a prominent feature of BPD, which may differentiate this disorder from other stress-related psychiatric conditions.

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Infidelity and the Capgras Delusion

A fascinating case study described in the June 2008 issue of Clinical Neurophysiology concerns a patient who presented visual hallucinations and identification disorders associated with a Capgras syndrome. During his Capgras episodes, the patient not only misidentified his wife's face, but also perceived her as being an entirely different sexual partner. Not only did he have sexual intercourse with his wife's "double" without having the slightest recollection of any familiarity towards her, he even changed his sexual habits. According to the authors, he is the only known neurological patient who ever made his wife a mistress. In discussing the case, the authors discuss the mechanism of Capgras delusion with reference to the processes involved in face recognition. The complete loss of familiarity not only with face but also with all aspects of sexual intimacy suggests a specific disconnection between the neural pathways linked to face identification and the systems involved in emotional and episodic memory.

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Losing Your Reputation

A study published in the June 2008 issue of Australasian Psychiatry takes a look at the relationship between reputation damage and suicide. By examining public record of the last 20 years, Fifteen cases were identified of individuals with no evidence of mental disorder who suffered actual or threatened reputation damage and committed suicide shortly thereafter. An additional eighteen cases that were less completed were also examined. Of the 15 individual cases, the average age was 55 years, with a range of 40 to 76 years. The available details of the 18 additional cases were consistent with these findings. The authors conclude that middle-aged males without clear evidence of mental disorder, who suffer actual or threatened reputation damage, may be at increased risk of suicide. They particularly caution against the use of "naming and shaming" media campaigns which may have fatal consequences.

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Psychotropic Medications Can Increase Fracture Risk in Older Patients

A study published in the August 2008 issue of the Journal of Clinical Psychopharmacology examined the link between taking selective serotonin reuptake inhibitors (SSRIs),  benzodiazepines, and antipsychotics, and increased risk of fracture in older individuals.  Manitoba-based administrative databases were used to examine psychotropic medication use and fractures in persons aged 50 years and older between 1996 and 200.  A sample of 15,792 patients with osteoporotic fractures (vertebral, wrist, or hip) were compared with 47,289 age, sex, and diagnosis matched controls. The different medications examined included antidepressants, antipsychotics, lithium, and benzodiazepines. The results showed that taking SSRI medication was associated with the highest risk of developing osteoporotic fractures. Other types of antidepressant medication  were also associated with greater fracture risk, although the relationship was weaker. Treatment with lithium was associated with lower fracture risk while treatment with antipsychotic medication was not found to be a significant factor.  The authors conclude SSRIs and benzodiazepines appear to have a dose-specific relationship with fracture risk in the elderly which needs to be taken into consideration when the medication is prescribed for geriatric disorders.

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Are Low Birth Weight Children Prone To Emotional Problems As Adults?

The July 2008 issue of  Pediatrics presents a research study examining adult survivors of premature birth. Prior studies have noted significant personality characteristics associated with preterm birth including elevated neuroticism and cautiousness and lower extraversion. A sample of 71 young adults with extremely low weight at birth (501-1000 g) were compared with a control sample of 83 young adults with normal birth weight on a battery of personality measures, All of the participants were matched for handedness, age, and absence of psychiatric impairments. The results indicated that extremely low birth weight adults reported significantly higher shyness, behavioral inhibition, and socialization (i.e. low risk aversion) than the control adults. They also showed lower sociability and emotional well-being than their normal birth weight counterparts which was consistent with previous studies. The researchers discuss the results and suggest that low birth weight children may be prone to psychiatric and emotional problems in adulthood.

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Disaster Mental Health Workers and the Anniversary Effect

A study published in the April 2008 issue of Journal of Traumatic Stress examined anniversary reactions in mental health disaster relief workers following traumatic exposure at the site of the World Trade Center terrorist attacks. Despite relatively low levels of symptom reporting, workers endorsed an increase in both negative mood symptoms and functional impairment at the one-year anniversary of their traumatic exposure (compared to 6 months postexposure). For individuals who met at least some of the criteria for posttraumatic stress disorder (PTSD) immediately following exposure, overall self-reported PTSD symptoms tended to increase from 6 to 12 months. This tendency resulted specifically from an increase in hyperarousal symptoms. Although only a few of the participants had severe PTSD, the results demonstrated that disaster relief workers may experience an increase in symptomatology at the anniversary of their traumatic exposure.

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When Mothers Kill Their Children

A recent issue of the Journal of Forensic and Legal Medicine provides a review of a disturbing new forensic trend in the Jamnagar region of India's Gujarat state. While Gujarat has an overall low incidence of homicide compared to other parts of India, a series of murder-suicides involving mothers killing their children has been noted. In the 5 year period from 2000 to 2004, 8 mothers committed a total of 13 murders involving 3 male and 10 female children and, in every case, the murder was followed by suicide of the assailant mothers. The annual incidence of murder-suicide was about 1.8 cases per year and the ages of the victims ranged from 6 months to 7 years.Five incidents occurred in rural areas and three in urban areas. Socio-economic status appears to be a factor since the killings only occurred in low income families. Methods both for killing and suicide were either burning or drowning. All the mothers were legally married and living with the family. Family and family related matters were the main motives for killing. In one case there was history of depression of the mother due to her previous miscarriage. Substance abuse was not a significant factor. The need for better intervention strategies to identify high-risk families is discussed.

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What is the Difference between Violent and Non-violent Stalkers?

A study in a recent issue of the Journal of Forensic Sciences examines different factors that differentiated between physically violent and nonviolent stalkers. Using a statistical analysis of 103 Canadian cases of "simple obsessional" stalking, a model was developed that showed an 81% success rate in discriminating between the two types of stalkers. Overall, physically violent stalkers are more likely to: (a) have a stronger previous emotional attachment toward their victim; (b) be more highly fixated/obsessed with their victim; (c) have a higher degree of perceived negative affect towards their victim; (d) engage in more verbal threats toward the victim; and (e) have a history of battering/domestic abuse towards the victim. The variables that best differentiate between physically violent and nonviolent stalkers appear to characterize underlying themes of anger, vengeance, emotional arousal, humiliation, projection of blame, and insecure attachment pathology.

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Violent Deaths in the United States

A report in a recent issue of the Morbidity and Mortality Weekly Report summarizes data from CDC's National Violent Death Reporting System (NVDRS) concerning violent deaths from 16 U.S. states for 2005. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. A total of 15,495 fatal incidents involving 15,962 violent deaths occurred in the 16 NVDRS states included in the report.

The majority (56.1%) of deaths were suicides, followed by homicides and deaths involving legal interventions (29.6%), violent deaths of undetermined intent (13.3%), and unintentional firearm deaths (0.7%). Fatal injury rates varied by sex, race/ethnicity, age group, and method of injury. Rates were substantially higher for males than for females and for American Indians/Alaska Natives (AI/ANs) and blacks than for whites and Hispanics. Rates were highest for persons aged 20-24 years.

For method of injury, the three highest rates were reported for firearms, poisonings, and hanging/strangulation/suffocation. Suicides occurred at higher rates among males, AI/ANs, whites, and older persons and most often involved the use of firearms in the home. Suicides were precipitated primarily by mental illness, intimate partner or physical health problems, or a crisis during the previous 2 weeks. Homicides occurred at higher rates among males and young adult blacks and most often involved the use of firearms in the home or on a street/highway. Homicides were precipitated primarily by an argument over something other than money or property or in conjunction with another crime.

The results indicate that deaths resulting from self-inflicted or interpersonal violence occur to a varying extent among males and females of every age group and racial/ethnic population. Key factors affecting rates of violent fatal injuries include sex, age group, method of injury, location of injury, and precipitating circumstances (e.g., mental health and substance abuse). The data provided in the report is preliminary in nature given the sampling procedures used and states participating in the survey.

Accurate, timely, and comprehensive surveillance data are necessary for the occurrence of violent deaths in the United States to be understood better and ultimately prevented. NVDRS data can be used to track the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths and injuries at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states using NVDRS, with an ultimate goal of full national representation.

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The Politics of Gender Identity Disorder

Gender Identity Disorder (GID) is a clinical term referring to a persistent inability to accept one's own gender. Diagnostic criteria include: a persistent and strong cross-gender identification as well as a strong persistent discomfort about ones's assigned sex (gender dysphoria). While primarily diagnosed in children, cases of GID have also been identified in adolescents and adults. Intended as a diagnostic category to address problems experienced by transsexuals and transgendered patients, GID was first included  in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980.

There is an active controversy concerning use of the GID diagnosis and many activists argue for its removal from the DSM. They maintain that the existence of the diagnosis stigmatizes transgendered people (and, by association, all sexual minorities) by identifying GID as a mental illness. Other transgender activists acknowledge the value of the GID diagnosis for patients seeking sexual reassignment surgery.  Treatment of GID patients has given rise to recommended standards of care although a formal consensus among health professionals has yet to be established.

As part of the ongoing process designed to release the revised version of the DSM in 2012, the American Psychiatric Association announced on May 1 that Dr. Ken Zucker of Toronto's Centre for Addiction and Mental Health (CAMH) would be the chair for the Sexual and Gender Identity Disorders workgroup. Despite his prominence in gender identity research, Dr. Zucker's appointment has met with opposition due to his advocacy of reparative therapy approaches for treating GID in children. Lesbian and gay activists have also voiced concern over articles that he has written which apparently link GID to homosexuality although this interpretation of his work remains controversial.

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