Revised DSM–5 Chapters Proposed;
Public Comment Is Invited
By Gary Gintner, PhD, Chair AMHCA DSM-5 Task Force
The American Psychiatric Association (APA) has posted new revisions to DSM-5 on its website at <dsm5.org>. The most significant change is a reconfiguration of the manual’s 16 chapters. The manual’s new organization incorporates recent scientific findings about the relationship between disorders and the role of developmental factors. For example, instead of having a separate child and adolescent chapter, these disorders will be integrated into chapters throughout the manual. Each chapter will be ordered from a lifespan perspective with childhood disorders listed first. New chapters include Trauma and Stress Related Disorders; Obsessive-Compulsive and Related Disorders; Neurodevelopmental Disorders; and Disruptive, Impulse Control, and Conduct Disorders.
APA has invited public comment on these revisions through June 15th. AMHCA urges members to review these changes and take advantage of the opportunity to provide feedback.
AMHCA’s DSM-5 Task Force members are reviewing these revisions and preparing a response as they did for the first comment period in April 2010. AMHCA members can forward comments to the task force by emailing the task force chair, Dr. Gary Gintner, at email@example.com.
Want Lasting Love?
What Matters Is Not More Commitment, But Equal Commitment
New research suggests that supportive, involved mothering in toddlerhood and an ability to work through conflict in adolescence are good predictors of becoming the “strong link”—the person with the bigger stake—in adult relationships. If instead, a person has had a not especially nurturing mother and isn’t skilled at resolving conflict in adolescence, chances are the person will be the “weak link”—the one with one foot out the door.
Interestingly though, it’s not the partners’ individual commitments that most influence how long the relationship lasts or how well it works. It’s how well the partners’ levels of commitment match up. Two strong links will be benevolent and tolerant when the going gets rough. Two weak links may be lax about working things out, but their expectations are equally low—so there’s less friction between them during
But when a weak link and a strong link pair up, the one less invested in making the relationship long-term has more influence—and the relationship’s stability suffers.
The researchers used data in the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA), coupled with a lab procedure. The lab procedure recruited 78 MLSRA participants, 20 or 21 years old, and their heterosexual romantic partners. A questionnaire assessing each participant’s level of commitment was analyzed alongside data from two earlier points in the longitudinal study—when the subjects were 2 and when they were 16. As expected, the couples with disparate commitments were the most hostile.
Trends in Emergency Department Visits
by Women Who Have Attempted Suicide
More than 215,000 emergency department visits involving intentional self-harm were made by females in 2009, and females were involved in three out of five emergency room visits for drug-related suicide attempts. Because suicide attempts are a risk factor for subsequent suicide attempts, the emergency department may represent a key opportunity for mental health intervention.
Suicide ranks seventh in the top 10 leading causes of death for females aged 12 to 65, making suicide prevention among women a public health priority. Although men have higher suicide death rates, women are treated for attempted suicide more often than men.
The number of emergency department (ED) visits for drug-related suicide attempts among females was stable each year from 2005 (92,682 visits) to 2009 (120,418 visits) (see the table below). By age group, only females aged 50 or older had a statistically significant increase in the number of visits. Among that age group, the number of visits increased 49 percent (from 11,235 visits in 2005 to 16,754 visits in 2009). This increase reflects the overall population growth of women aged 50 or older, rather than an increase in the rate of ED visits for drug-related suicide attempts (23.8 ED visits per 100,000 population in 2005 and 32.3 visits per 100,000 population in 2009).
Emergency Department (ED) Visits for Drug-Related Suicide Attempts
Among Females, by Age Group: 2005 and 2009
Age Group 2005 2009
Total 92,682 120,418
Aged 12 to 20 23,313 26,801
Aged 21 to 34 28,796 39,802
Aged 35 to 49 29,300 37,034
Aged 50 or Older * 11,235 16,754
* The change from 2005 to 2009 in women aged 50
or older was statistically significant at the .05 level.
Source: 2005 to 2009 estimates from the 2009 SAMHSA
Drug Abuse Warning Network (DAWN).
Prevention and intervention efforts can reduce the underlying suicidal risk factors in women. Primary care and other health providers who prescribe drugs can monitor the frequency of requested refills, assess medical need, and refer women to mental health services when indicated. Likewise, increased awareness of these trends among ED personnel can help ensure that patients are referred to appropriate mental health and social services, which may reduce the repetition of suicide attempts and address underlying health issues such as depression, anxiety disorders, and domestic violence.
The mental and physical health needs of women vary across the life span, and older women represent one of the nation’s fastest growing populations. Problems such as pain and sleep disorders can lead to increased use of prescription drugs. Also, older women may experience depression because of health changes or other negative life events. Expanded research on women’s aging issues and the potential use of these drugs as a method of, or influence on, suicide attempts is critical.
Source: SAMHSA. The Drug Abuse Warning Network (DAWN) report, posted May 12, 2011.
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Mutinies Reveal Tipping Points for Collective Unrest
Studying naval mutinies of old are worth studying today, researchers point out, because they illuminate how modern-day ill-treatment toward subordinates can lead to violence. Also, mutinies have similarities to other types of rebellions, including worker strikes, riots, prison rebellions, and political uprisings.
The researchers studied British Royal Navy’s ship logs and court martial records from 1740–1820 to learn what factors disrupted social order.
In addition to looking at such things as the demographics of the ship´s crew, the age and size of the ship, and how long the ship had been at sea, the researchers looked at how well each ship was governed as well as the severity of punishments, the extent of reduced rations, sickness, and spoiled food.
In many cases, the researchers find that mutinies emerged because of unpaid and delinquent wages or excessive punishment. Unlike the well-known mutiny on the Bounty, in which mutineers took over the ship and set the captain adrift in a small boat with his supporters, most mutinies were more like worker strikes.
Now the researchers are trying to understand the precise conditions that tipped a restive crew toward rebellion and what inspired some seamen to risk the most by becoming mutiny ringleaders. The researchers are coding data from hundreds of ships’ records from ships with mutinies and—as a control group—ships that did not have mutinies. Then the researchers will perform statistical analyses to isolate the factors that increased the odds of mutiny.
This item is excerpted from a May 13 University of Washington article by Molly McElroy.