DSM-IV-TR classifies hypochondriasis as a complex somatoform disorder, characterised by physical complaints for which no organic cause could be identified. DSM-5 replaced it with two new diagnostic terms: somatic symptoms disorder and illness anxiety disorder. The distinction was based on the presence or absence of somatic symptoms, and concerns have been raised with regards to the validity of these new diagnostic concepts. While there has recently been an increase in recognising the role of the underlying anxiety in this condition, the psychological needs of individuals with hypochondriasis remain unclear. It is conceivable that specific emotional and interpersonal dimensions play a mediating role in the onset of hypochondriacal presentations, and have explanatory power with regards to the improvement of tailored therapeutic interventions. The present study used a mixed methodology, with an emphasis on the qualitative component, to investigate emotions and the interpersonal aspects of hypochondriasis. Six young adult females meeting the diagnostic criteria for both DSM-IV-TR hypochondriasis and DSM-5 illness anxiety disorder formed a clinical group for the present study. Semi-structured interviews were administered and analysed in line with the Interpretative Phenomenological Analysis (IPA). Four major themes emerged from the qualitative data: 1) Early life experience; 2) Inward focus; 3) Learned helplessness; and 4) Experience of psychological therapy. Eight subordinate themes were identified: (i) Unmet emotional needs; (ii) Emotional isolation; (iii) There is something wrong with me; (iv) Emotional reasoning; (v) Self-fulfilling prophecy; (vi) External locus of control; (vii) Over-reliance on other people; and (viii) The experience of psychological therapy. Fifty-one female undergraduate psychology students formed a matched comparison group for the study and enabled a supplementary quantitative analysis to be conducted. The quantitative measures included measures of trait (TEIQue-SF) and ability emotional intelligence (MSCEIT) as well as a measure of sociotropy-autonomy (SAS). The quantitative data showed that the clinical group scored significantly lower than the comparison group on the measures of trait emotional intelligence, understanding emotions, and autonomy. Additionally, the clinical group scored significantly higher than the comparison group on the measure of sociotropy. The theoretical and therapeutic recommendations are discussed in light of the limitations of the present study. In conclusion, emotional and interpersonal aspects of DSM-IV-TR Hypochondriasis and DSM-5 illness anxiety disorder in young women provide a useful framework for the conceptualisation and therapeutic management of these conditions. It appears that with its scientific knowledge base, therapeutic flexibility, focus on reflective practice, and the emphasis on an effective working relationship, the discipline of counselling psychology is well-suited to address the needs of participants with hypochondriacal presentations.

This book is an attempt to formulate a sociological theory of the phenomena which is otherwise known as substance abuse and substance dependency in the medical field. The first step toward such a theory is a critique of how DSM-IV presents diagnostic criteria for substance abuse and substance dependency as if these criteria are valid and reliable ways of measuring mental illness and bodily dysfunction. I point to the fact that these criteria neither are valid or reliable variables for measurement nor theoretically grounded defi nitions of the phenomena. My point is that diagnosis is an elaborate way of disguising moral judgments as medical assessments of illness or dysfunction. The second step towards the formulation of my theory goes via my empirical study of nine men and women who call themselves sex and love addicts. By conducting deep interviews with them I conclude that it is impossible to talk about sex and love addiction without constantly referring to stereotypes and widely held assumptions of alcoholics and drug addicts. Moreover it is apparent that these men and women are making moral judgments about themselves rather than pointing to some form of genuine disruption which they cannot control. From my critique and my empirical study I am able to identify a number of areas that a theory of addiction, as opposed to the medical view where this phenomena are being broken down in two sub categories (abuse and dependency), must be able to handle to explain addiction generally and specifically in relation to alcohol, drugs, sex and other forms of social deviance. A number of philosophical hallmarks of medicine is also identifi ed and seen as part of the problem, therefore I mean that a successful theory of addiction must transcend the mind body dualism of Descartes as it is a cornerstone in the medical view upon and understanding of humans. By reconstructing the habitus and field concepts in Pierre Bourdieus theory of practice I mean that it is possible to understand addiction from an action theory point of view. This discussion is also broadened by a pragmatist discussion of the mind and a neo meadian theory of the emotional self. My conclusion is that addiction can be understood and explained within an action theory which focus upon individual as well as collective action and understand this as habitual practice that is partly embodied and therefore not discursive – habits of which we cannot easily speak is seen as one of the compelling components in addiction rather than a mythical loss of control which is nowhere to be found but as a rhetoric grip stemming from the AA view upon addiction as a disease.

Background: A younger age at onset of use of a specific substance is a well-documented risk-factor for a substance use disorder (SUD) related to that specific substance. However, the cross-substance relationship between a younger age at onset of alcohol use (AU) and nicotine use (NU) and the risk of cannabis use disorders (CUD) in adolescence and early adulthood remains unclear. Aims: To identify the sequence of and latency between initial AU/NU and initial cannabis use (CU). To investigate whether younger age at AU- and NU-onset is associated with any and earlier CU-onset and a higher risk of transition from first CU to CUD, taking into account externalizing disorders (ED) and parental substance use disorders as putative influential factors. Methods: Prospective-longitudinal community study with N = 3021 subjects (baseline age 14–24) and up to four assessment waves over up to ten years with additional direct parental and family history information. Substance use and CUD were assessed with the DSM-IV/M-CIDI. Results: Most subjects with CU reported AU (99%) and NU (94%). Among users of both substances, 93% reported AU prior to CU (87% for NU). After adjustment for ED and parental substance use disorders younger age at AU-onset was associated with any CU. Younger age at NU-onset was associated with earlier CU initiation. Younger age at AU- and NU-onset was not associated with a higher risk of CUD. Conclusions: The cross-substance relevance of younger age at first AU and NU for the risk of CUD is limited to early CU involvement.

Introduction: This paper does not aim to predict the future of clinical psychology in Germany. The future of psychology depends on the complex interaction between political, sociological, economic and health-care related factors as well as on the scientific progress in the discipline itself and in neighbour disciplines. However, it is fair to say that clinical psychology continues to gain even stronger influences in health care and will face a number of new challenges over the next years of its expansion. Our paper will present some of these potential fields of development and change based on a brief description of the status quo. The focus of the article will be specific developments in Germany, although there will be an overlap with general tendencies that describe the situation of clinical psychology in the new millenium in general. Furthermore, for research as well as practice, the specific relationship between clinical psychology and psyciatry will be highlighted.

Background: A younger age at onset of use of a specific substance is a well-documented risk-factor for a substance use disorder (SUD) related to that specific substance. However, the cross-substance relationship between a younger age at onset of alcohol use (AU) and nicotine use (NU) and the risk of cannabis use disorders (CUD) in adolescence and early adulthood remains unclear. Aims: To identify the sequence of and latency between initial AU/NU and initial cannabis use (CU). To investigate whether younger age at AU- and NU-onset is associated with any and earlier CU-onset and a higher risk of transition from first CU to CUD, taking into account externalizing disorders (ED) and parental substance use disorders as putative influential factors. Methods: Prospective-longitudinal community study with N = 3021 subjects (baseline age 14–24) and up to four assessment waves over up to ten years with additional direct parental and family history information. Substance use and CUD were assessed with the DSM-IV/M-CIDI. Results: Most subjects with CU reported AU (99%) and NU (94%). Among users of both substances, 93% reported AU prior to CU (87% for NU). After adjustment for ED and parental substance use disorders younger age at AU-onset was associated with any CU. Younger age at NU-onset was associated with earlier CU initiation. Younger age at AU- and NU-onset was not associated with a higher risk of CUD. Conclusions: The cross-substance relevance of younger age at first AU and NU for the risk of CUD is limited to early CU involvement.

No description available.

Cette étude évalue la faisabilité et l'efficacité d'une intervention cognitive-comportementale visant le jeu contrôlé chez des joueurs à risque de devenir des joueurs pathologiques. La perception de contrôle, la fréquence et les montants dépensés au jeu constituent les variables dépendantes. Quatre joueurs à risque de loterie-vidéo ont participé au programme d'intervention préventive. Les résultats montrent que la perception de contrôle augmente chez tous les participants tandis que la fréquence et les montants dépensés au jeu diminuent. De plus, la plupart des participants maintiennent leurs gains thérapeutiques six mois plus tard. Les implications cliniques de ces résultats sont abordées lors de la discussion.

Background: Rates of accidental overdose mortality from substance use disorder (SUD) have risen dramatically in the United States since 1990. Between 1999 and 2004 alone rates increased 62% nationwide, with rural overdose mortality increasing at a rate 3 times that seen in urban populations. Cultural differences between rural and urban populations (e.g., educational attainment, unemployment rates, social characteristics, etc.) affect the nature of SUD, leading to disparate risk of overdose across these communities. Methods: Multiple-groups latent class analysis with covariates was applied to data from the 2011 and 2012 National Survey on Drug Use and Health (n=12.140) to examine potential differences in latent classifications of SUD between rural and urban adult (aged 18 years and older) populations. Nine drug categories were used to identify latent classes of SUD defined by probability of diagnosis within these categories. Once the class structures were established for rural and urban samples, posterior membership probabilities were entered into a multinomial regression analysis of socio-demographic predictors' association with the likelihood of SUD latent class membership. Results: Latent class structures differed across the sub-groups, with the rural sample fitting a 3-class structure (Bootstrap Likelihood Ratio Test P value=0.03) and the urban fitting a 6-class model (Bootstrap Likelihood Ratio Test P valueThis result supports the hypothesis that different underlying elements exist in the two populations that affect SUD patterns, and thus can inform the development of surveillance instruments, clinical services, and prevention programming tailored to specific communities.

“The relationship between the criminal and victim is much more complicated than the law would care to acknowledge. The criminal and his victim work on each other unconsciously. We can say that as the criminal shapes the victim, the victim also shapes the criminal. The law differentiates distinctly between the attacker and the victim. But their relationship may be, and often is, quite close, so that their roles are reversed and the victim becomes the determining person, while the [victimiser] in the end becomes his own victim.” (Abrahamsen, 1973:35). This research was directed at establishing whether narcissistic individuals will go to extreme levels of violence, specifically murder, if their self-image is threatened. The aim was to determine the extent of pre-existing narcissistic personality disorder (NPD) in these individuals and how this contributed to the murderous action they committed. Emphasis was placed on the psychological motivation of the perpetrator, as well as the relationship that existed between the perpetrator and the victim prior to the event. As the subject of the research was a relatively unknown phenomenon, a qualitative research approach was used. The research focused on analysing specific cases of murder, more particularly cases where rage-type murders were committed. It endeavoured to identify the underlying personality dynamics to determine whether an association between rage-type murder and NPD exists. Case studies illustrating rage-type murderers who had been admitted to Weskoppies Psychiatric Hospital for a 30-day observation period were identified and analysed. These cases were selected through reviewing the case history of each individual to determine whether the murder fitted the outlined definition of a rage-type murder. The cases that met the outlined requirements were deemed suitable for the purpose of the research, where after the Minnesota Multiphasic Personality Inventory (MMPI-2) results of the selected cases were examined to determine the personality organisation of the individuals. This information was then used to determine the possible association between NPD and rage-type murder. The MMPI-2 was selected as the assessment tool as it is the most widely used personality assessment available. For the purposes of this research a two-point code type was used to indicate the presence of narcissistic personality traits. A two-point code type implies an elevation of two scales, for the purposes of this research specifically the Pd (Psychopathic deviance) scale and the Pa (Paranoia) scale, also referred to as the 4-6/6-4 code type. As interpretation based only on a two-scale elevation was considered to be overly simplistic, all the MMPI-2 clinical scales were interpreted independently, and a clinical interpretation provided in the context of each individual’s background. The 4-6/6-4 code type individual was used to indicate whether the individuals did have narcissistic personality traits, and thus were classified as having NPD. Nine cases were identified of individuals thought to be rage-type murderers, who were admitted for a 30-day period of psychiatric observation to Weskoppies Psychiatric Hospital in Pretoria. Only five cases were acknowledged as rage-type murders. All the cases selected were referred to Weskoppies Psychiatric Hospital by order of the court and involved males over the age of 20 years. The individuals involved were admitted to the Forensic Unit of the hospital and were subjected to standard psychiatric hospital observations, which included psychiatric interviews, psychological interviews, psychological testing, as well as general behavioural observations in the ward. All the information obtained during the standard psychiatric hospital observations is held in the clinical case files in the archives at the hospital. All the standard psychiatric hospital observation evaluations were completed prior to the initiation of the research, and the case records had been closed. Although more research is necessary, this research has established an association between the selected cases of rage-type murder and NPD and there is historic documented evidence suggesting that individuals with NPD will most likely react in a similar manner in similar circumstances, as a result of their underlying personality disorder. This suggests that incarceration in a correctional facility is not the most appropriate place to rehabilitate individuals. It also serves as support to why a person with NPD who commits a rage-type murder should be acquitted because of their personality disorder and subsequently be committed to a psychiatric facility as a patient of the state president. / Dissertation (MA)--University of Pretoria, 2010. / Social Work and Criminology / unrestricted

No description available.