The current study explores the role of individual and environmental determinants on students’ fear of crime. Based on a large-scale survey among students of a Belgian university (n = 1,463), the relationship between perceived social and physical disorder and the three dimensions of fear of crime (perceived risk of victimization, feelings of anxiety, avoidance behaviour) is examined. Support was found for a relationship between perceived social and physical disorder and perceived risk of victimization. Moreover, a relationship (...) was found between students’ perception of social disorder and anxiety and students’ perception of physical disorder and avoidance behaviour. Based on the results, this study suggests that preventing or reducing visible signs of disorder on campus should inevitably be included in the university’s security policy. This research offers universities more insight in the determinants of students’ fear of crime and potential measures to increase their (perception of) safety. (shrink)

This perspective paper aims at discussing theoretical principles that could explain how emotion regulation and physical diseases mutually influence each other in the context of borderline personality disorder (BPD). Furthermore, this paper discusses the clinical implications of the functional relationships between emotion regulation, BPD and medical conditions considering dialectical behavior therapy (DBT) as a well-validated therapeutic intervention, which encompasses these issues. The inflexible use of maladaptive emotion regulation strategies (e.g., suppression, experiential avoidance, and rumination) might directly increase the (...) probability of developing physical diseases through a physiological pathway, or indirectly through a behavioral pathway. Some metabolic and chronic medical conditions could significantly impact emotional functioning through biological alterations involved in emotion regulation. Several empirical studies have shown high co-occurrence rates between BPD and several chronic physical diseases, especially ones linked to emotion-based maladaptive behaviors. DBT addresses physical diseases reported by individuals with BPD reducing problematic behaviors functionally associated to emotion dysregulation and identifying physical health as a goal forBuilding a Life Worth Living. (shrink)

School-aged children with Developmental Coordination Disorder (DCD) are at greater risk for physical inactivity, lower global self-worth, and internalizing problems, such as depression and anxiety. Based on the Environmental Stress Hypothesis (ESH), recent research has shown that physical inactivity and lower global self-worth sequentially mediate the relationship between DCD and internalizing problems, suggesting that DCD leads to lower levels of physical activity, which in turn, leads to lower levels of global self-worth, and ultimately, a greater amount (...) of internalizing problems. However, physical activity and global self-worth may also buffer (i.e., moderate) the adverse effect of DCD on internalizing problems. To date, this has yet to be tested. Participants were 1206 children aged 12-14 years (611 boys, 79 with probable DCD (pDCD)). All children received assessments of motor coordination, physical activity, global self-worth, and internalizing problems. Children with pDCD were less physically active, had lower self-worth, and experienced more internalizing problems compared to typically developing (TD) children (p’s <.05). Furthermore, the moderated moderating effect (three-way interaction) of physical activity and global self-worth was also evident (p <.05), indicating that internalizing problems in both TD and pDCD groups decreased with concurrent increases in physical activity and global self-worth. Importantly, when compared to TD children, increases in physical activity and global self-worth were associated with a greater reduction in internalizing problems among children with pDCD. The findings support several pathways in the ESH and highlight that, in addition to improving motor skills, interventions should also target both physical activity and global self-worth to mitigate potential mental health issues for children with motor difficulties. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Intentional OrderRichard Gipps (bio)Bengt Brülde and Filip Radovic inform the reader that they will assume "there is such a thing as a general category of disorder, of which mental and somatic disorders can be regarded as subcategories" (2006, 100). With this assumption in place, they take up a fascinating discussion of what warrants our categorizations of certain disorders as mental as opposed to (...) class='Hi'>physical. The answers they then canvass include the possibilities that it is the mentality of the internal causes, or of the symptomatic effects, of these disorders which renders them mental, or that there is no single answer, or that there is no valid distinction to be drawn.In what follows I wish to question the initial assumption, and then offer an understanding of the nature of mentality that I hope will lead to a different way of answering the question, what is mental about mental disorder? It worries me that the views I develop here may share too little by way of common framework assumptions with the views developed in Brülde and Radovic's paper. I hope that this does not render dialogue impossible, or make the thoughts that were inspired by their thoughtful paper appear just too off field to be seriously entertained.The Concept of DisorderBrülde and Radovic assume that "mental disorders" and "physical disorders" are subtypes of a general category of disorder. (In what follows I describe this as the assumption.) They also distinguish between two questions: (1) What is mental about mental disorder? (in what follows I describe this as the question) and (2) What does it take for a condition to be a disorder? This latter question is, they acknowledge, certainly important, but is set aside for the time being.Mental disorder, physical disorder, and we might perhaps also add social disorder, are then subcategories of disorder. They are perhaps not natural kinds, but nevertheless they are subcategories within a general category. With their assumption in place it makes good sense to reject accounts of the mentality of mental disorders that seem to simply presuppose the concepts of mind and body when they address the question.There is of course a trivial sense in which everyone must agree that mental disorders and physical disorders are to be considered subcategories of disorder. There is what could be described as a logical sense of category and subcategory, in which any noun is said to designate a category and any adjectival qualification of it to introduce a subcategory. However, we can also distinguish what I call a "semantic" sense, in which talk of categories and subcategories is more restricted. Here we rely on there being a unitary sense to the putative category if we are to talk meaningfully of subcategories of this single category. [End Page 117]The philosophy of the individuation of senses is not within my expertise, but I am relying on an intuitive notion spelled out by the following. First, that a good dictionary would elaborate these senses by providing different definitions of the putative category rather than a single definition followed by examples. Second, that when we do not have to do with categories in the semantic sense, we would find ourselves more in want of true understanding of what was being said, and not so much in want of mere further knowledge, if we are offered a description that included the noun (disorder) without the qualifier (mental). Third, that we are less likely to be dealing with subcategories within a general semantic category if we easily can turn the adjective–noun pair (e.g., mental disorder) around to provide two nouns in a short phrase (e.g., disorder of the mind), or if there are verbal and adjectival forms of the second noun that can also be used in conjunction with the first noun (e.g., disordered mind).An example serves to make things clearer. Consider a chemist who has a reaction in her laboratory. What is referred to may be an emotional reaction (to her sudden scientific breakthrough), or a chemical reaction. In this case, I suggest, we do not have to do with a semantic category of "reaction," which... (shrink)

I shall begin with the "anti-psychiatry" view that the lack of a physical basis excludes many familiar mental disorders from the category of "illness". My response to this argument will be that anti-psychiatrists are probably right to hold that most mental disorders do not involve any physical disorder, but that they are wrong to conclude from this that these mental disorders are not illnesses.

BackgroundPhysical activity and Physical fitness have received tremendous attention in the field of physical and mental health. However, limited attention has been given to the associations of self-reported physical fitness with some health-related outcomes. Given the COVID-19 pandemic is still active in many Chinese regions, assessing health-related physical fitness in adolescents using field-based assessment is unrealistic, therefore, this study was conducted via a self-reported questionnaire.PurposeThe present cross-sectional study was aimed at delving into the relationship between self-reported (...) physical fitness with self-rated health, depression, anxiety, and body satisfaction in adolescents. Three thousand eight hundred and seven study participants from 12 public schools in South-eastern China were recruited and 2,407 of them provided valid data on variables that this study needed for analysis.Materials and methodsStudy participants were asked to self-report their sociodemographic factors, independence, and outcomes. Generalized linear models were used to explore the associations of self-reported physical fitness with depression, anxiety, and body satisfaction. A total of 2,407 children and adolescents with a mean age of 13.82 years were included in the final study analysis.ResultsHigher self-reported levels of general physical fitness and cardiorespiratory fitness were associated with better self-rated health, and body satisfaction but with lower risks of depression and anxiety.ConclusionThe current study offered evidence on the roles of self-reported physical fitness and health-related outcomes. To facilitate health in children and adolescents, advocating fitness education, and promotion could be a feasible approach. (shrink)

The traditional view that having a personality disorder, unlike other mental disorders, is not usually reason enough to consider a person incompetent to make healthcare decisions is challenged. The example of a case in which a woman was treated for a physical disorder without her consent illustrates that personality disorder can render a person incompetent to refuse essential treatment, particularly because it can affect the doctor–patient relationship within which consent is given.

Applying a necessary condition communication theory formalism roughly similar to that of Dretske, but focused entirely on the statistical properties of long sequences of signals emitted by the interacting cognitive modules of human biology, we explore the regularities apparent in comorbid psychiatric and chronic physical disorders using an extension of recent perspectives on autoimmune disease. We find that structured psychosocial stress can literally write a distorted image of itself onto child development, resulting in a life course trajectory to characteristic (...) forms of comorbid mind/body dysfunction affecting both dominant and subordinate populations within a pathogenic social hierarchy. (shrink)

It is commonly thought that mental disorder is a valid concept only in so far as it is an extension of or continuous with the concept of physical disorder. A valid extension has to meet two criteria: determination and coherence. Essentialists meet these criteria through necessary and sufficient conditions for being a disorder. Two Wittgensteinian alternatives to essentialism are considered and assessed against the two criteria. These are the family resemblance approach and the secondary sense approach. (...) Where the focus is solely on the characteristics or attributes of things, both these approaches seem to fail to meet the criteria for valid extension. However, this focus on attributes is mistaken. The criteria for valid extension are met in the case of family resemblance by the pattern of characteristics associated with a concept, and by the limits of intelligibility of applying a concept. Secondary sense, though it may have some claims to be a good account of the relation between physical and mental disorder, cannot claim to meet the two criteria of valid extension. (shrink)

I hope to show that mental disorders are not analogous to physiological diseases. I hope to show that a mental disorder like bipolar disorder cannot be located in the brain in the way a physiological disease like cirrhosis can be located in the liver. Mental disorders, unlike physiological diseases, lack a locatable corporeal basis to serve as a visible fulcrum on which to be based. However, I hope to also demonstrate that it is a mistake to infer the (...) inexistence of disorders from such an absence of a locatable corporeal basis. There are countless phenomena including the force fields pointed out by physics that lack such a basis but whose reality isn’t doubted; by the fact of such absence alone, we have no reason to doubt the existence of mental disorders, nor, for that matter, the existence of the minds thatexperience them. (shrink)

A growing body of research highlights that adults with autism spectrum disorder have poor health outcomes, yet effective health interventions are lacking for this population. While mobile health applications demonstrate potential for promoting physical activity in adults with ASD, scientific evidence for supporting this tool’s long-term effectiveness on PA behavior change remains inconclusive. This study aimed to provide the latest information on PA research and the prospective role of mobile health applications for promoting PA in adults with ASD. (...) A literature review demonstrated that a few available studies show contradictory results regarding PA levels in adults with ASD, and behavior change techniques and gamification-guided mobile health applications can be promising tactics to leverage autism’s strengths and increase PA in these individuals. Optimizing design decisions based on needs analysis and user feedback is crucial to identifying and developing a sustainable mobile health intervention for PA promotion in adults with ASD. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What Makes a Mental Disorder Mental?Jerome C. Wakefield (bio)Keywordsharmful dysfunction, mental disorder, intentionality, mental dysfunction, mental functioning, phenomenality, somatic disorderWhat makes a medical disorder mental rather than (exclusively) somatic or physical? Psychiatry to some extent depends for its existence as a medical specialty on the distinction between mental and somatic disorders, yet the history of this distinction presents a bewildering array of puzzling judgments, radical (...) shifts, and seemingly arbitrary distinctions. The historical observation that putative mental disorders are often reclassified as physical disorders as soon as their physiologic basis is understood further confuses matters. Moreover, recent debates about such classifications often seem to reflect desires to protect professional turf or obtain optimal reimbursement for treatment more than they do the application of a coherent conceptual distinction. No wonder that Brülde and Radovic (2006) disarmingly admit at the outset of their exploration of this question that there is a case to be made that their topic is relatively unimportant or even meaningless intellectually, a rare way to start an inquiry!Could there nonetheless be a cogent conceptual distinction lurking here? Brülde and Radovic usefully invite us to reframe the question, in effect as follows: Suppose we pay attention to professional and lay judgments as evidence but at the same time try to avoid being ensnared by the distortions resulting from turf issues and other pragmatic motives and constraints. Can we then identify some principled distinction in this domain that is worth making and that interestingly corresponds to the distinction generally made between mental disorders and strictly somatic disorders? Brülde and Radovic do not come to any confident or compelling conclusion about this.My answer, based on my harmful dysfunction analysis of disorder (Wakefield, 1992a, 1992b, 1999a, 1999b), is that a mental disorder is a harmful mental dysfunction, where a mental dysfunction is a failure of the capacity of some mental mechanism to perform a function for which it was biologically designed. I argue that, owing to a series of logical missteps, Brülde and Radovic needlessly reject this view. After some preliminary comments and clarifications, I defend the internal dysfunction approach from the objections posed by Brülde and Radovic, and then conclude by elaborating this view in some new ways. Note that Brülde and Radovic critique something they call the "internal cause view" of what makes a disorder mental, and they name others who hold that view. However, my work figures prominently in their discussion, and for expository simplicity, I will presume to simply construe their arguments as aimed at the harmful dysfunction analysis. [End Page 123]Clarifying the QuestionIt is easy to misconstrue the question "What makes a mental disorder mental" as demanding a precise account of the mental, an error to which Brülde and Radovic succumb in their repeated complaints that various writers do not present principled accounts of the mental but rely on lists of prototypical mental states or tentative guidelines to fix the reference of mental. We would need a precise definition of mental if the problem were how to classify cases in which it is ambiguous whether some phenomenon is mental or physical. We might imagine, for example, someone being genuinely puzzled as to whether inability to sleep is failure of a mental function or process. But this sort of puzzle about the boundaries of the mental is not the problem with which Brülde and Radovic are concerned; anyway, ambiguous cases may just be inherently ambiguous. The problem, which a crisp definition of mental will not resolve, is what relation mental states or mechanisms must have to a disorder to make it a mental disorder; must there be mental symptoms, or mental dysfunctions, or either one, and so on? But, even if a precise resolution of the nature of the mental is not needed, some notion of the mental domain is essential in pursuing this discussion. We can pick out the mental ostensively, by pointing to lots of examples (e.g., perception, motivation, emotion, thought, and sensation) much more confidently than we can define it in a principled way. But because Brülde and Radovic find fault in such ostensive reference fixing, let me... (shrink)

There are different ways of responding to the absence of a shared physical causal core among the range of mental disorders currently recognized by the International Statistical Classification of Diseases and Related Health Problems and the Diagnostic and Statistical Manual of Mental Disorders. Obviously enough, some of the listed disorders are not physically explicable in principle, while others are merely likely to be biological in origin. Only a minority of disorders can be explained as the outcomes of impaired biological (...) function, and in some of those cases biological explanations capture their phenomena little more than partially. Psychiatry nevertheless is perceived as and understands itself... (shrink)

Jerome Wakefield’s harmful dysfunction analysis of medical disorder is an influential hybrid of naturalist and normative theories. In order to conclude that a condition is a disorder, according to the HDA, one must determine both that it results from a failure of a physical or psychological mechanism to perform its natural function and that it is harmful. In a recent issue of this journal, I argued that the HDA entails implausible judgments about which disorders there are and (...) how they are individuated. The same arguments apply to other views that incorporate a harm criterion. More recently, David G. Limbaugh has modified the HDA by providing a novel account of the way in which a disorder must be harmful. Here, I briefly review the relevant issues and then critically assess Limbaugh’s account. I argue in the end that Limbaugh’s revisions do not succeed in making accounts like the HDA more attractive. (shrink)

This focused review is based on earlier studies which have shown that both children and adults diagnosed as having developmental coordination disorder (DCD), benefited from sensorimotor therapy according to the method Retraining for Balance (RB). Different approaches and assessments for children and adults in regard to DCD are scrutinized and discussed in comparison to RB which mainly includes (a) vestibular assessment and stimulation (b) assessment and integration of aberrant primary reflexes and (c) assessment and stimulation of auditory and visual (...) perception. Earlier results indicate that the process of sensorimotor therapy using RB techniques could be described according to a conceptual Kinesthetic-Vestibular Developmental Model (KVDM) whereby the training elicited temporary physical and psychological regressions followed by transformations i.e. positive physical and psychological development. We have also seen that this recurring pattern is similar for children and adults. In our conceptual model vestibular stimulation (perceptual priming) stimulates the nervous system, which might enhance object-related priming. This perceptual priming will also assist the suppression of persistent aberrant primary reflexes. In order to develop effective methods for assessment and intervention of DCD over the life span the importance of primary reflex inhibition and vestibular stimulation as well as a combination of bottom-up and top-down approaches have to be considered. (shrink)

Most clinicians and mental health practitioners are reluctant to work with people with dangerous and severe personality disorders because they believe there is nothing that mental health services can offer. Dangerous and severe personality disorder also signals a diagnosis which is problematic morally. Moral philosophy has not found an adequate way of dealing with personality disorders. This paper explores the question: What makes a person morally responsible for his actions and what is a legitimate mitigating factor? How do psychiatric (...) nurses working with this client group understand the awful things some clients do? What concepts do they need, if they are to know how to explain and how to react? It is suggested that dangerous and severe personality disorder is best regarded as a moral category, framed in terms of goodness, badness, obligation and other ethical concepts. It seems plausible that in important ways the dangerous and severe personality disordered client does not understand morality or understands it differently. The peculiar position of the dangerous and severe personality disordered individual in our system of moral responsibility stems from his apparent inability to see the importance of the interests of others. It might be more helpful to regard personality disordered clients as we do children: partially but not fully reasonable for their actions. We might regard the dangerous and severe personality disordered client responsible for those actions which he most clearly understands, such as causing others physical pain, but not for those with which he is only superficially engaged, such as causing emotional pain. The paper concludes by suggesting that the dangerous and severe personality disordered individual does not fit easily into any conventional moral category, be it criminal, patient, animal or child, and thus an assessment of his moral accountability must take into consideration his special circumstances. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 13.2 (2006) 133-141MuseSearchJournalsThis JournalContents[Access article in PDF]Dysfunctions, Disabilities, and Disordered MindsBengt BrüldeFilip RadovicRichard Gipps' and Jerome Wakefield's commentaries on our article are so different from each other that we have decided to deal with them separately. Gipps suggests that we adopt a different framework altogether. In his view, our main question—"What makes a mental disorder mental?"—is somehow defective, and it ought to be replaced (...) by an alternative question, namely, "What makes a mind disordered?" He thinks he can answer this question by providing an alternative account of the mental in terms of intentionality and suigeneris psychological understanding. He also suggests that mental disorders are "alterations within the intentional order." Wakefield, on the other hand, shares most of our "framework assumptions"; for example, he accepts the way we formulate our central question and how we present the different possible answers. The only part of our general project to which he objects is the attempt to find a principled account of what makes a mental function (dysfunction, mechanism, ability, or the like) mental. His main purpose is to defend and develop his own version of the internal cause view, namely, the idea that mental disorders are (harmful) mental dysfunctions. Because Gipps' comments are of a far more general nature than Wakefield's, we respond to Gipps first. This gives us an opportunity to make our "framework assumptions" more explicit.Gipps' Criticism of the Notion of Mental DisorderLet us first note that Gipps' suggestions are often vague. As Gipps himself puts it, his account is "clearly in need of much further clarification and elaboration" (121). This means that we sometimes have to reconstruct what he says to attribute sufficiently clear views to him.Gipps questions our assumption that there is such a thing as a general category of disorder, of which mental and somatic disorders can be regarded as subcategories. Or more precisely, he rejects the view that "disorder" is a proper category (or "semantic category," as he puts it), and he also seems to deny that "mental disorder" is a category. This is supposed to imply that our central question is somehow wrongly formulated, and to pave the way for his reformulation of this question (from now on, "the move").To determine whether Gipps' objection is valid or not, we need to know what he means by the term "category." However, all we are told is that a noun designates a (semantic) category if and only if it has a "unitary sense." Unfortunately, he does not specify what this "unitary sense" consists in. For example, does he implicitly assume that a noun designates a category if and only if there are necessary conditions for membership that are jointly sufficient? The example he offers (see [End Page 133] p. 118) suggests another possible interpretation, however. Here, he claims that the relation between the terms "mental disorder" and "physical disorder" are analogous to the relation between the terms "chemical reaction" and "emotional reaction." This suggests that the term "disorder" as it occurs in the phrase "physical disorder" and the term "disorder" as it occurs in the phrase "mental disorder" have different senses. This is an interesting suggestion that may well be correct, but Gipps does not offer any arguments for the assumption that "disorder" behaves like "reaction." Neither does he offer any examples of proper (semantic) categories.The Move from "Mental Disorders" to "Disordered Minds"In Gipps' view, mental disorders are best conceived of as disorders of the mind, and physical disorders as disorders of the body, and he therefore suggests that we ask what makes a disordered mind disordered rather than what makes a mental disorder mental. But why does Gipps believe that this move from "mental disorder" to "disordered minds" constitutes an improvement? The first reason has already been given, namely that the term "disorder" might not designate a proper category. But this is not a good reason for making the move Gipps suggests unless we assume that "mind" and "body" are proper categories. At this... (shrink)

The various jurisdictions worldwide that now legally permit assisted suicide (or voluntary euthanasia) vary concerning the medical conditions needed to be legally eligible for assisted suicide. Some jurisdictions require that an individual be suffering from an unbearable and futile medical condition that cannot be alleviated. Others require that individuals must be suffering from a terminal illness that will result in death within a specified timeframe, such as six months. -/- Popular and academic discourse about assisted suicide paradigmatically focuses on individuals (...) with ‘physical,’ i.e., non-psychiatric medical conditions, such as cancer or AIDS. Here I defend analyses of the notions of unbearable suffering, futility, and terminality that imply that, regardless of which of these medical conditions is invoked, at least some individuals with severe and persistent psychiatric illnesses satisfy these conditions and ought to be classified as legally eligible for assisted suicide. The legal and moral case for a right to assisted suicide is therefore not in principle weaker for the severely psychiatrically disordered than for those with ‘typical’ terminal or futile medical conditions. (shrink)

Major depressive disorder (MDD) is a severe mental illness that affects 5 to 20% of the general population. Current antidepressant drugs exerts only a partial clinical efficacy because approximately 30% of depressed patients failed to respond to these drugs and antidepressants produce remission only in 30% of patients. This can be explained by the fact that the complex pathophysiology of depression has not been completely elucidated, and treatments have been mainly developed following the “monoaminergic hypothesis” of depression without considering (...) the key role of other factors involved in the pathogenesis of MDD, such as the role of chronic stress and neuroinflammation. Chronic stress acts as a risk factor for the development of MDD through the impairment of neurotrophins signaling such as brain-derived neurotrophic factor (BDNF) and transforming-growth-factor-β1 (TGF-β1). Stress-induced depressive pathology contributes to altered BDNF level and function in MDD patients and, thereby, an impairment of neuroplasticity at the regional and circuit level. Recent studies demonstrate that aerobic exercise strongly increases BDNF production and it may contribute as a non-pharmacological strategy to improve the treatment of cognitive and affective symptoms in MDD. Here we will provide a general overview on the possible synergism between physical activity and antidepressants in MDD. Physical activity can synergize with antidepressant treatment by rescuing neurotrophin signaling in MDD patients, promoting neuronal health and recovery of function in MDD-related circuits, finally enhancing pharmacotherapeutic response. This synergism might be particularly relevant in elderly patients with late-life depression, a clinical subgroup with an increased risk to develop dementia. (shrink)

“Identity disorders” constitute a large class of psychiatric disturbances that, due to deviant forms of self-modeling, result in dramatic changes in the patients’ phenomenal experience of their own personal identity. The phenomenal experience of selfhood and transtemporal identity can vary along an extremely large number of dimensions: There are simple losses of content. There are also various typologies of phenomenal disintegration as in schizophrenia, in depersonalization disorders and in_ Dissociative Identity Disorder_, sometimes accompanied by multiplications of the phenomenal self within (...) one and the same physical system. It is important to not only analyze these state-classes in terms of functional deficits or phenomenology alone, but as _self-representational _content as well. For instance, in the second type of cases just mentioned, we confront major redistributions of the phenomenal property of "mineness” in representational space, of what is sometimes also called the “sense of ownership”. Finally, there are at least four different delusions of misidentification. Being a philosopher, I will discuss two particular types of identity disorder _ 2 _ in this contribution - disorders, which are of direct philosophical relevance: A specific form of DM, and the Cotard delusion. Why should philosophers do this? And why should psychiatrists care? (shrink)

Dr. Vukov analyzing patients with disorders of consciousness, proposed that medical well-regarded policy recommendations cannot be justified by looking solely to patients’ actual levels of consciousness (minimally conscious state – MCS versus vegetative state – VS), but that they can be justified by looking to patients’ potential for consciousness. One objective way to estimate this potential (actual physical possibility) is to consider a neurophysiologically informed strategy. Ideally such strategy would utilize objective brain activity markers of consciousness/unconsciousness. The Operational Architectonics (...) (OA) theory of brain-mind functioning is an example of such a strategy. Besides being mathematically simple, neurophysiologically accurate, and compatible with the cognitive/phenomenal perspectives on consciousness, application of OA strategy to quantitative EEG analysis of patients in VS and MCS revealed that the absence of consciousness in VS is paralleled by impairment of overall EEG operational architecture. Specifically, neuronal assemblies become smaller, their life span shortened, and they became highly unstable and functionally disconnected (desynchronized). At the same time, fluctuating (minimal) awareness in patients in MCS was paralleled by partial restoration of EEG operational architecture (increased size, life span, and stability of neuronal assemblies, together with an increased number and strength of functional connections among them), approaching the level found in healthy fully conscious participants. Moreover OA strategy to EEG analysis allowed predicting the emergence of consciousness in VS patients after six years following the brain trauma. Therefore, the OA methodology could reliably predict which patients may regain consciousness, and thus determine which patients may have the potential for consciousness. (shrink)

In this chapter, I first review and assess evidence regarding brain damage or neural abnormalities associated with some psychopathologies and cognitive deficits, such as hemispatial neglect, agnosias, amnesia, somatoparaphrenia, and others. It becomes clear just how closely normal mental functioning and consciousness depend upon normal brain functioning as well as how some very specific mental changes occur when, and only when, very specific brain damage occurs. I then explore the metaphysical implications of these results with respect to the nature of (...) mind and consciousness. In particular, I examine the plausibility of materialism, roughly the view that mental processes are brain processes, in light of the evidence discussed and in contrast to a dualist conception of the mind (whereby mental states are not physical in some sense). I also explore the prospects for a conscious afterlife based both on the brain damage evidence adduced and the metaphysical implications discussed. (shrink)

Eating disorders can be viewed as “embodied acts” that help to cope with internal and external demands that are perceived as overwhelming. The maintenance of EDs affects the entire identity of the person; the lack of a defined; or valid sense of self is expressed in terms of both physical body and personal identity. According to attachment theory, primary relationships characterized by insecurity, traumatic experiences, poor mirroring, and emotional attunement lead to the development of dysfunctional regulatory strategies. Although the (...) literature shows an association between attachment style or states of mind, trauma, behavioral strategies, and various EDs, the debate is still ongoing and the results are still conflicting. Therefore, we believe it is important to examine and treat EDs by understanding which narrative trajectory intercepts distress in relation to narrative and embodied self-concept. Drawing on clinical observation and a narrative review of the literature, we focus on the construction and organization of bodily and narrative identity. Because bodily representations are the primary tools for generating meaning, organizing experience, and shaping social identity from the earliest stages of life, we focus on the role that bodily interactions and sensorimotor and proprioceptive patterns have played in the development of EDs. We consider the role that lack of attunement, insecure attachment, and relational trauma play in mentalizing, affecting self-representation and emotion regulation strategies. The paper also considers a semantic mode of trauma in EDs that involves a top-down pathway through beliefs and narratives about oneself based on lack of amiability, on devaluation, and on humiliation memories. Finally, we would like to highlight the proposal of an integrated model with multiple access model to psychotherapy that takes into account the complexity of ED patients in whom aspects related to dysregulation, body image disintegration, and post-traumatic symptoms are associated with a suffering sense of self and a retraumatizing narrative. (shrink)

We propose that human self-domestication favored the emergence of a less aggressive phenotype in our species, more precisely phenotype prone to replace (reactive) physical aggression with verbal aggression. In turn, the (gradual) transition to verbal aggression and to more sophisticated forms of verbal behavior favored self-domestication, with the two processes engaged in a reinforcing feedback loop, considering that verbal behavior entails not only less violence and better survival, but also more opportunities to interact longer and socialize with more conspecifics, (...) ultimately enabling the emergence of more complex forms of language. Whereas in the case of self-domestication sexual selection has been proposed to work against physical aggression traits, in the case of verbal insult the selection has been proposed to work in favor of verbal aggression. The tension between these two seemingly opposing forces gets resolved/alleviated by a tendency to replace physical aggression with verbal aggression, and with verbal behavior more generally. This also helps solve the paradox of the Self Domestication Hypothesis regarding aggression, more precisely why aggression in humans has been reduced only when it comes to reactive aggression, but not when it comes to proactive aggression, the latter exhibiting an increase with the advent of modern language. We postulate that this feedback loop was particularly important during the time period before 50 kya, arguably between 200 kya and 50 kya, when humans were not fully modern, neither in terms of their skull/brain morphology and their behavior/culture, nor in terms of their self-domestication. The novelty of our approach lies (i) in giving an active role to early forms of language in interacting with self-domestication processes; (ii) in providing specific linguistic details and functions of this early stage of grammar (including insult and humor); (iii) in supplying neurobiological, ontogenetic, and clinical evidence of a link between (reactive) aggression and (reactive) verbal behavior; (iv) in identifying a variety of proxies of the earlier stages in evolution among cognitive disorders; and (v) in identifying specific points of contact and mutual reinforcement between these two processes (self-domestication and early language evolution), including reduction in physical aggression and stress/tension, as well as sexual selection. (shrink)

BackgroundThe effectiveness of physical activity as an intervention against anxiety disorders and depression is undeniable in clinical psychology. Therefore, the question arose whether these effects also occur when a fear stimulus, like the COVID-19 pandemic, affects otherwise healthy adolescents. Boredom is closely linked to symptoms of fear and anxiety, but the connection between PA, boredom and fear is partly unclear.MethodsA cross-sectional online study was conducted that involved 122 students. Participants were 13–19 years old. The survey was available online from (...) April 27th to May 3rd, 2020. At this time, schools in Germany had already been closed for 6 weeks. A self-report questionnaire was used to measure physical activity, boredom, and fear of COVID-19. A multiple linear regression model was conducted.ResultsThe reported fear of COVID-19 significantly correlates with total PA, quantity of strenuous PA, and boredom. Furthermore, a significant regression equation was found. The variables boredom, PA, and age contribute significantly to predicting the fear of COVID-19 [R2 = 0.127, F = 6.876, p < 0.000], among adolescents.ConclusionOur results indicate that there is an association between PA, boredom and the quarantine experience of adolescents. Students who were physically more active, especially with strenuous intensity, did not feel bored and showed less fear of COVID-19. (shrink)

Perfectionism is a multidimensional construct with both positive and negative aspects. Recently, the concept of appearance-oriented perfectionism has been introduced, which is associated with body image dissatisfaction and weight and shape control behaviors. The Physical Appearance Perfectionism Scale is a 12-item two-factor instrument developed to assess this new dimension of perfectionism. The aim of the study is to validate the Spanish version of PAPS among a representative sample of 850 male university students in Spain. Exploratory and confirmatory factorial structure, (...) internal consistency, convergent and concurrent validity, and associated predictor variables analyses have been carried out. Results showed that the Spanish version of the PAPS maintains the original factor structure with all items and proves to be a reliable instrument. Physical appearance-oriented perfectionism is associated with general perfectionism, higher body dissatisfaction, Eating Disorders and Muscle Dysmorphia symptomatology, and compulsive exercise, particularly in the Worry about Imperfection subscale. These variables also act as predictors of physical appearance perfectionism. The use of the PAPS-S and the analysis of its subscales is recommended in the context of body image-related pathologies such as Eating Disorders and Muscle Dysmorphia. (shrink)

Introduction. Eating Disorders (EDs) are serious psychiatric disorders, impacting physical and psychosocial functioning, often with a chronic course and high mortality rates. The two continua model of mental health states that mental health is a complete state, that is not merely the absence of mental illness, but also the presence of mental health. This model was studied among ED patients by comparing the levels of well-being to the Dutch general population and by examining the of well-being and psychopathology. Method. (...) A total of 468 female ED patients participated in this study during application and intake at a specialized ED treatment centre in the Netherlands. They filled out questionnaires about well-being (MHC-SF), general psychopathology (OQ-45), and ED psychopathology (EDE-Q). Categorical and mean well-being levels were calculated. Also, the correlates of these variables were examined with Pearson correlation and multiple hierarchical regression analysis. Results. ED patients showed lower levels of emotional, psychological and social well-being on average compared to the general population. About 26% of the ED patients experienced low levels of well-being (languishing). However, also 13% experienced high levels of well-being (flourishing), varying between 9% in Anorexia Nervosa to 25% in Binge Eating Disorder. ED psychopathology and general well-being showed a moderate negative correlation. For patients with Bulimia Nervosa and Binge Eating Disorder however no such correlation was found. Lower general psychopathology, not having a history of hospitalization for the ED, and adaptive personal functioning were correlated with well-being among ED patients. Conclusion This study shows initial support for the two continua model of mental health among ED patients. Psychopathology and well-being should be considered as related, but distinct dimensions of mental health in ED patients. Further research should focus on the possible reciprocal relationships between psychopathology and well-being during recovery. It is recommended to monitor well-being during treatment and to implement interventions for well-being to realize complete recovery for those patients with inadequate levels of well-being. (shrink)

The co-occurrence of stress-induced posttraumatic stress disorder (PTSD) and obesity is common, particularly among military personnel but the link between these conditions is unclear. Individuals with comorbid PTSD and obesity manifest other physical and psychological problems, which significantly diminish their quality of life. Current understanding of the pathways connecting stress to PTSD and obesity is focused largely on behavioral mediators alone with little consideration of the biological regulatory mechanisms that underlie their co-occurrence. In this work, we leverage prior (...) knowledge to systematically highlight such bio-behavioral mechanisms and inform on the design of confirmatory pilot studies. We use natural language processing (NLP) to extract documented regulatory interactions involved in the metabolic response to stress and its impact on obesity and PTSD from over 8 million peer-reviewed papers. The resulting network describes the propagation of stress to PTSD and obesity through 34 metabolic mediators using 302 documented regulatory interactions supported by over 10,000 citations. Stress jointly affected both conditions through 21 distinct pathways involving only two intermediate metabolic mediators out of a total of 76 available paths through this network. Moreover, oxytocin (OXT), Neuropeptide-Y (NPY), and cortisol supported an almost direct propagation of stress to PTSD and obesity with different net effects. Although stress upregulated both NPY and cortisol, the downstream effects of both markers are reported to relieve PTSD severity but exacerbate obesity. The stress-mediated release of oxytocin, however, was found to concurrently downregulate the severity of both conditions. These findings highlight how a network-informed approach that leverages prior knowledge might be used effectively in identifying key mediators like OXT though experimental verification of signal transmission dynamics through each path will be needed to determine the actual likelihood and extent of each marker’s participation. (shrink)

This new edition of Mind, Meaning, and Mental Disorder addresses key issues in the philosophy of psychiatry, drawing on both philosophical and scientific theory. The main idea of the book is that causal models of mental disorders have to include meaningful processes as well as any possible lower-level physical causes, and this propsoal is illustrated with detailed discussion of current models of common mental health problems. First published in 1996, this volume played an important role in bridging the (...) gap between philosophy and psychiatry, and introducing those in psychiatry to philosophical ideas somewhat neglected in their field. Completely updated, the new edition of this acclaimed volume draws on the strengths of the first edition, and will be a central text in the burgeoning field of philosophy of psychiatry. (shrink)

In this article some of the presuppositions that underly the current ideas about decision making capacity, autonomy and independence are critically examined. The focus is on chronic disorders, especially on chronic physical disorders. First, it is argued that the concepts of decision making competence and autonomy, as they are usually applied to the problem of legal (in)competence in the mentally ill, need to be modified and adapted to the situation of the chronically (physically) ill. Second, it is argued that (...) autonomy and dependence must not be considered as two mutually exclusive categories. It is suggested that decision making may take on the form of a more or less conscious decision not to be involved in making all kinds of explicit and deliberate decisions. Elaborating on Agich's distinction between ideal and actual autonomy, the concept of Socratic autonomy is introduced. (shrink)

Critics of attention-deficit/hyperactivity disorder (ADHD) have repeatedly argued that there is no proof for the condition being symptomatic of an organic brain disease and that the current "ADHD epidemic" is an expression of medicalization. To this, the supporters of ADHD can retort that the condition is only defined as a mental disorder and not a physical disease. As such, ADHD needs only be a harmful mental dysfunction, which, like other genuine disorders, can have a complex and obscure (...) etiology. This article argues that such a line of argument fails to save ADHD as a valid diagnostic category. Given the general diagnostic logic of the DSM-IV and how ADHD has been defined in terms of everyday (male) child behaviors, there are compelling grounds to disbelieve that ADHD can be a true medical syndrome united by some type of harmful dysfunction. Indeed, strong logical and empirical reasons will be adduced to show that people may qualify for ADHD diagnosis without suffering from any type of underlying pathology. (shrink)

Although the “Introduction” to the DSM makes it clear that the presence of “clinical” distress or impairment is insufficient for a diagnosis of “mental disorder” , in practice the clinician is completely unshackled from the conceptual definition and is free to decide on a case-by-case basis if “enough” distress or impairment is present, regardless of circumstances, to judge that “mental disorder” can be diagnosed. It is argued that reference to a biological or psychological dysfunction cannot raise “mental (...) class='Hi'>disorder” from a judgment quite like “This is pornography, not literature” to a technical–scientific term because “biological dysfunction” must be tied to an outcome that is itself less ambiguous than “mental disorder,” and “psychological dysfunction” erroneously assumes that how people are supposed to think, feel, and act, regardless of circumstances, can be as uncontentious as ideas about physical well being, and in addition erroneously assumes that human behavior can be causally explained. (shrink)

This commentary on Bengt Brülde's paper on mental disorder in this edition argues that this insightful analysis of the way values inform the concept of mental disorder may also apply to physical disorders. Using the example of the way values are ascribed in both visual and performing arts, and using Rudyard Kipling's leitmotif " but is it art?" taken from his poem "The Conundrum of the Workshops", the question of what is 'good' art is addressed using the (...) same questions applied in the paper to mental disorder. It is concluded that the questions: where is the evaluative element located? what kind of values or evaluations do we rely on? are there specific standards against which to judge the value? how do the judgments enter the picture? can be applied just as usefully to physical disorders. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Religious ExperienceThe Need for a Humble, Pragmatic PluralismWarren Kinghorn, MD (bio)Mohammed Abouelleil Rashed follows Charles Taylor’s argument that in the “therapeutic turn” of modernity, “certain human struggles, questions, issues, difficulties, problems are moved from a moral/spiritual to a therapeutic register,... from a hermeneutic of sin, evil or spiritual misdirection, to one of sickness” (Taylor, 2007, pp. 619–620). While the project of construing mental disorder (...) in naturalistic, non-religious terms carries the risk of subsuming “the rest of life” into the realm of the medical, it is nonetheless needed in order “to protect a region of illness and incapacity from the reach and excesses of the hermeneutic disciplines with their tendency to over-interpretation, and from cultural traditions, including religious discourse, that can implicate the person in narratives of evil, sin, faithlessness, spiritual misdirection, and moral deviance.” Rashed notes, however, that this medical narrative is challenged not only by religious communities but also by various forms of identity-based activism including the Mad Pride and Neurodiversity movements. He argues that strict illness/purpose, deficit/value, mechanism/meaning dichotomies have become “unstable” and encourages scholars to focus their attention on resolving the apparently contradictory realities that people sometimes demand and require medical forms of care while investing significance in the sociocultural and existential context of their distress and refusing reductionistic constructions of their distress as illness.I agree wholeheartedly with Rashed’s conclusion that clinicians and scholars must move beyond a strict mechanism/meaning dichotomy with respect to unwanted and/or disvalued experience and behavior, and must remain open to the social and contextual interpretations that particular cultural communities—including religious communities—offer. But as a psychiatrist who is also [End Page 215] a Christian theological ethicist, I suggest that this sensible conclusion can be reached more straightforwardly by adopting a more flexible approach to “religious experience” and by abandoning the assumptions that mental disorder is “a fully areligious type of suffering” and that religious experience and mental disorder are “fundamentally separate apprehensions of our experience.”Although Rashed never defines religious experience, he posits a distinction between “psychological distress or anomalous experience that has a religious origin, content, or end (purpose)” and “psychological distress or anomalous experience that has no religious origin, content, or end (purpose).” He then helpfully describes how Islamic tradition narrates psychological suffering as deviation from fitrah and as God’s trial, arguing that in Islamic perspective “mental disorder cannot be disentangled from the person’s religious situation and from the religious origin, content, or end (purpose) of his distress.” I make no claim about Rashed’s interpretation of Islam, but would observe that many voices within Christian tradition resist both the equation of psychological suffering with wrongdoing and the assertion that God is the direct cause of psychological suffering (see, for example, John Paul II, 1984). Suffering may instead have to do with being sinned against (as in the case of war, assault, or oppression), or the experience of living in a fallen world that God will one day make right. When the psalmist cries, “Save me, O God, for the waters have come up to my neck” (Psalm 69:1, NRSVue), many Christians observe that it is the psalmist’s enemies, not God, who are the proximate cause of the psalmist’s distress. That is to say, Christian tradition allows for a broad range of interpretations about the cause of distress, including distress resulting from injury, physical illness, and oppression. Christians are encouraged to regard all of their lives as in some way related to God as the creator, sustainer, and orienting end of life—and so in that sense all experience is “religious” in nature. But at least for Christians this does not preclude more naturalistic or sociological interpretations of distress and suffering.Rashed is right that a “fully areligious type of suffering” with “no religious origin, content, or end (purpose)” can only be invoked from a secular standpoint—if “secularity” is taken in Charles Taylor’s first sense of “public spaces... [that] have been allegedly emptied of God, or of any reference to ultimate reality” (Taylor, 2007, p. 2). This is not because... (shrink)

This article seeks to explore a neglected perspective in pastoral theology: namely that of the influence of conservative family culture and church practice on the spiritual, emotional, and physical development of young Christian women, particularly in the area of disordered eating patterns and negative self-image. It shows the ways in which hidden tensions, particularly within somewhat marginal Christian communities, or for groups which seek to define themselves strongly against prevailing secular cultural norms, can play themselves out in the inner (...) conflicts of vulnerable young women. Such conflicts often centre on their difficulties in trying to define themselves in relation to their family and culture when they may have neither the opportunity nor the language to articulate the burden of such hidden conflicts. The author suggests models of pastoral care which involve working with Christian tradition and scriptural narratives to help Christian communities, and particularly women within them, to redefine assumptions about female roles and norms, and to develop a more open and physically grounded spirituality. (shrink)

The Hospital for Rehabilitation, Stavern, in Norway has treated patients with physical symptoms with no organic cause, so called conversion disorder patients, for over a decade. For four years research on the treatment has been carried out. Patients with conversion disorder seem not to fit in traditional somatic hospitals because their patienthood depends upon psychiatric diagnosis. Ironically, they appear not to belong in psychiatric hospitals because of their physical symptoms. The treatment offered these patients at hospitals (...) for rehabilitation is adapted physical activity consisting of behaviour elements such as positive reinforcement of normal function and lack of positive reinforcement at dysfunction. The pedagogical approach is seen as crucial in the successful rehabilitation of the patients. The disorder and treatment can be understood by using theories about the ecstatic body, radical behaviourism and phenomenology. When patients have problems in behaviour concerning both body and mind, it would be natural to employ both in the road to recovery. This article describes the various treatments and discusses them from phenomenological, ethical and philosophical perspectives. (shrink)

Background: The literature has shown a significant association between traumatic experiences and eating psychopathology, showing a greater symptomatology in patients with trauma history. Less is known about the associations between trauma and cognitive schemas, and personality traits and the differences between childhood and adulthood trauma experiences. Thus, this paper aims to assess the clinical and psychological characteristics of eating disorder (ED) patients, looking for differences between patients without a history of trauma and patients with trauma experiences, as well as (...) at possible differences between exposure in childhood, adulthood, or repeated events. Another aim of the paper is to evaluate the possible mediation role of cognitive schemas and personality traits in the relationship between early trauma and eating psychopathology.Methods: From January to November 2020, 115 consecutive inpatients admitted for a specific multidisciplinary ED treatment in a dedicated Unit were evaluated for trauma, differentiating between trauma occurring in childhood and adulthood. The subjects were evaluated for early maladaptive schemas (EMS), personality traits, trauma symptomatology, quality of life, and specific psychopathologies linked to EDs. Mediation analyses between childhood and adulthood trauma and eating psychopathology were performed, with EMS and personality traits as mediators.Results: Patients with a history of trauma showed higher physical and psychological symptomatology scores, with a more impaired clinical profile in patients with both childhood and adulthood trauma exposure. The mediation analysis showed a specific mediator role for the “disconnection and rejection (DR)” EMS factor in the relationship between childhood trauma (cT) and eating psychopathology.Conclusion: Trauma experiences are associated with more severe clinical symptomatology in EDs and may need a specific assessment in patients with failed outpatient standard treatments. Specific cognitive schemas linked to DR domain should be evaluated in treatments for ED patients with history of trauma due to the mediation role between trauma and eating psychopathology. The need for outcome studies about treatment approaches for ED patients with history of trauma is discussed. (shrink)

Externalist theories hold that a comprehensive understanding of mental disorder cannot be achieved unless we attend to factors that lie outside of the head: neural explanations alone will not fully capture the complex dependencies that exist between an individual’s psychiatric condition and her social, cultural, and material environment. Here, we firstly offer a taxonomy of ways in which the externalist viewpoint can be understood, and unpack its commitments concerning the nature and physical realization of mental disorder. Secondly, (...) we apply a strongly externalist approach to the case of Autistic Spectrum Disorder, and argue that this condition can be illuminated by appeal to the hypothesis of extended cognition. We conclude by briefly considering the significance this strongly externalist approach may have for psychiatric practice and pedagogy. (shrink)

Within a relatively brief period of time, there has been a veritable outpouring of research on anorexia nervosa and bulimia nervosa. This article presents a concise overview of some of the major works on these eating disorders from a variety of disciplines including biomedicine, psychology, sociology, and history. The article establishes a general context of Americans' preoccupation with food and diet. However, since the majority of those suffering from anorexia nervosa and bulimia nervosa are female, this article places these eating (...) disorders in the specific historical context of American women's history. In earlier times, some women reacted to their role expectations with physical responses. While linking modern phenomena to these earlier physical reactions of American women, the article also highlights the various twentieth-century social and cultural factors that push some modern girls and women to respond to their situations either by refusing food or consuming and regurgitating large quantities of food.In addition to the historical perspective, which points to the relevance of social and cultural factors as well as biomedical and psychological ones, the article offers an overview of the various theories currently suggested to explain the meaning of food to those who suffer from these disorders. These theories range from the addiction model to food as a metaphor for control and self-definition. Whatever the meaning of food, it is important to note that both anorexia nervosa and bulimia nervosa are determined by an interaction of many factors both personal and biological and social and cultural. (shrink)