Journal of Trauma and Dissociation

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Open Access
COULD FAMILY WELL-BEING MODERATE THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD EXPERIENCES AND SOMATOFORM DISSOCIATION? A PRELIMINARY INVESTIGATION
(Taylor & Francis Group, 2023-07-09) Cheung, Cherry T. Y.; Cheng, Clement Man-Him; Lee, Vincent Wan Ping; Lam, Stanley Kam Ki; He, Kyle Langjie; Ling, Henry Wai-Hang; Lee, Kunhua; Ross, Colin A.; Fung, Hong Wang
The impacts of adverse childhood experiences (ACEs) have been well documented. One possible consequence of ACEs is dissociation, which is a major feature of post-traumatic psychopathology and is also associated with considerable impairment and health care costs. Although ACEs are known to be associated with both psychoform and somatoform dissociation, much less is known about the mechanisms behind this relationship. Little is known about whether social and interpersonal factors such as family environments would moderate the relationship between ACEs and somatoform dissociation. This paper discusses the importance of having a positive and healthy family environment in trauma recovery. We then report the findings of a preliminary study in which we examined whether the association between ACEs and somatoform dissociation would be moderated by family well-being in a convenience sample of Hong Kong adults (N = 359). The number of ACEs was positively associated with somatoform dissociative symptoms, but this association was moderated by the level of family well-being. The number of ACEs was associated with somatoform dissociation only when the family well-being scores were low. These moderating effects were medium. The findings point to the potential importance of using family education and intervention programs to prevent and treat trauma-related dissociative symptoms, but further investigation is needed.
Open Access
Posttraumatic Growth, Dissociation and Identification With The Aggressor Among Childhood Abuse Survivors
(Taylor & Francis Group, 2023-02-28) Eliav, Ayala Sultana; Lahav, Yael
Childhood abuse puts individuals at risk for psychopathology and psychiatric symptoms such as posttraumatic stress disorder (PTSD) and anxiety symptoms. At the same time, research has indicated that some survivors report positive transformations in the aftermath of their trauma, known as posttraumatic growth (PTG). Yet the essence of PTG reports is questionable, and some scholars claim that it may reflect maladaptive illusory qualities. Furthermore, according to a recent theoretical model, PTG might be dissociation-based and related to survivors’ bonds with their perpetrators. This study aimed to explore these claims by assessing PTG, dissociation, and identification with the aggressor (IWA), as well as PTSD and anxiety symptoms. An online survey was conducted among 597 adult childhood abuse survivors. Study variables were assessed via self-report measures. Analyses indicated positive associations between PTG, dissociation, and IWA. Three distinct profiles were found, reflecting high, medium, and low scores on PTG, dissociation, and IWA. Profile type explained PTSD and anxiety symptoms above and beyond gender, age, and abuse severity. These findings suggest that whereas some childhood abuse survivors might experience a positive transformation subsequent to their trauma, others’ PTG reports might reflect dissociative mechanisms and pathological attachments to their perpetrators, and thus might be maladaptive.
Open Access
The Prevalence of Depersonalization-Derealization Disorder: A Systematic Review
(Taylor & Francis Group, 2022-06-14) Yang, Jinyang; Millman, Merritt; David, Anthony S.; Hunter, Elaine C. M.
Depersonalization-Derealization disorder (DDD) is a psychiatric condition characterized by persistent feelings of detachment from one’s self and of unreality about the outside world. This review aims to examine the prevalence of DDD amongst different populations. A systematic review protocol was developed before literature searching. Original articles were drawn from three electronic databases and included only studies where prevalence rates of DDD were assessed by standardized diagnostic tools. A narrative synthesis was conducted. Twenty-three papers were identified and categorized into three groups of participants: general population, mixed in/outpatient samples, and patients with specific disorders. The prevalence rates ranged from 0% to 1.9% amongst the general population, 5–20% in outpatients and 17.5–41.9% in inpatients. In studies of patients with specific disorders, prevalence rates varied: 1.8–5.9% (substance abuse), 3.3–20.2% (anxiety), 3.7–20.4% (other dissociative disorders), 16.3% (schizophrenia), 17% (borderline personality disorder), ~50% (depression). The highest rates were found in people who experienced interpersonal abuse (25–53.8%). The prevalence rate of DDD is around 1% in the general population, consistent with previous findings. DDD is more prevalent amongst adolescents and young adults as well as in patients with mental disorders. There is also a possible relationship between interpersonal abuse and DDD, which merits further research.
Open Access
The Role of Attachment Style, Adverse Childhood Experiences and Dissociation in Migraine
(Taylor & Francis Group, 2021-10-27) Mays, Iain; Flynn, Jack; McGuire, Brian; Egan, Jonathan
Migraine and chronic migraine are caused by a combination of modifiable and non-modifiable genetic, social, behavioral and environmental risk factors. Further research of possible modifiable risk factors for this headache disorder is merited, given its role as one of the leading causes of years lived with disability per year. The first aim of this online cross-sectional study was to investigate the psychosocial risk factors that predicted chronic migraine and severe migraine-related disability in 507 Irish and UK participants, focusing specifically on childhood maltreatment, attachment and tendency to dissociate, or experience depressed mood and/or anxiety. Additionally, this study aimed to examine variables that mediated the relationships between these psychosocial risk factors and migraine chronicity or severe migraine-related disability. Adjusted binary logistic regression revealed that shutdown dissociation (Odds Ratio [OR] 4.57, 95% Confidence Interval [CI] 2.66–7.85) and severe physical abuse (OR 4.30, 95% CI 1.44–12.83 had significant odds of predicting migraine chronicity, while depression (OR 3.28, 95% CI 1.86–5.77) significantly predicted severe migraine-related disability. Mediation analyses indicated that shutdown dissociation mediated the relationship between seven predictor variables and both chronicity and severe disability including possible predisposing factors emotional abuse, physical neglect, avoidant attachment and anxious attachment. These findings suggest that early life stressors (such as childhood trauma and avoidant attachment style), shutdown dissociation and depression may impact on migraine trajectory. To investigate whether these psychosocial factors are risk factors for migraine chronicity or disability, prospective research should be conducted in this area to account for fluctuations in migraine chronicity over time.
Open Access
A Network Analysis to Identify Associations between PTSD and Dissociation among Teenagers
(Taylor & Francis Group, 2021-10-22) Cardeña, Etzel; Gušić, Sabina; Cervin, Matti
We conducted a network analysis of measures of dissociation and posttraumatic symptoms (PTS) with a varied sample of adolescents (N = 312), some of them previously exposed to war scenarios. The global measure of dissociation (A-DES) was uniquely linked to the arousal PTS symptom cluster (CRIES-13), in particular sleep problems, but not to the reexperiencing and avoidance clusters. Three of four (i.e., depersonalization/derealization, amnesia, mental partition/compartmentalization) dissociation clusters were uniquely linked to PTS severity, but not absorption. The results with the pooled groups were generally representative of both groups. The DP/DR relation to PTS was based on data from both samples, whereas the link between amnesia and partition/parts might have been driven by the normative group, although the refugee sample had significantly higher scores in those variables. The results replicate some previous findings with adult samples and suggest new paths for research and theory.
Open Access
The Clinician-Administered Dissociative States Scale (CADSS): Validation of the German Version
(Taylor & Francis Group, 2021-10-21) Mertens, Yoki L.; Daniels, Judith K.
The Clinician-Administered Dissociative States Scale (CADSS) is a structured clinical interview to assess state dissociation rated by clinicians. The current study aimed to validate the German version of CADSS by comparing it to the established self-report measures for dissociation and exploring its underlying factor structure. Severity of within-session state dissociation was assessed directly following a standard psychotherapy session in a trauma-exposed patient sample (N= 105; 81.9% female). Internal consistency, convergent validity with other dissociation measures, and the factorial structure of the instrument were analyzed. The German version exhibited excellent internal consistency (Cronbach’s α = .94) and correlated significantly with self-report measures of state dissociation (r = .86) and trait dissociation (r = .77) indicative of high convergent validity. Exploratory factor analysis revealed a three-factor solution with the factors (1) Depersonalization/Derealization, (2) Identity Confusion/Alteration, and (3) Amnesia. Results support the CADSS as a useful instrument to assess state dissociation, conceptualized as a multidimensional construct, in clinical practice.
Open Access
Alda Merini’s Memoir: Psychiatric Hospitalization, Institutional Violence And The Politicization Of Illness In 20th Century Italy
(Taylor & Francis Group, 2021-06-20) Zinnari, Alessia
In 1964, the Italian poet Alda Merini was hospitalized in a mental hospital in Milan as the result of a violent fight with her husband. Merini would spend ten years in and out of hospital, while her relationship with her family and with the literary circles in which she moved deteriorated. Merini’s experience in the asylum is narrated in her memoir L’altra verità. Diario di una diversa (1986). Through an analysis of some crucial passages in the memoir, this article seeks to demonstrate that Diario is a work charged with both literary and historical value that deserves more scholarly attention. Merini’s memories shed new light on the situation of psychiatric patients, and especially of women, in Italy before and after Basaglia’s reforms on mental institutions. Demonstrating how the abuse that she suffered in the hospital reflects society’s attitudes toward mental illness, disability, and women, Merini shows that the type of trauma narrative that is produced under institutions of coercive control – such as the mental asylum – will often be one of resistance to oppression.
Open Access
Toward a Theory of Institutions: Institutional Betrayal and Dispersions of Accountability at Johns Hopkins University
(Taylor & Francis Group, 2021-06-20) Smith, Robert D.
To more fully understand how trauma can be inflicted by institutional betrayal, in this article I suggest that we first must ask who or what is the institution. To understand this, I analyze two recent events at Johns Hopkins University (JHU), the establishment of a university private police force and funding cuts to the Women, Gender, and Sexuality Graduate Teaching Fellowships (WGS). Paradoxically, JHU claimed it was necessary to establish a private police force because of a lack of accountability of the Baltimore Police Department; however, simultaneously JHU was unaccountable to direct JHU affiliates by ignoring their explicit disapproval of a private police force. JHU imagined themselves as accountable to an ambiguous ‘us’ beyond direct JHU affiliates and dispersed its accountability, evidenced by advocating for state legislature and making mayoral campaign donations. This lack of accountability was rearticulated in discussions about WGS cuts, when JHU embraced a rhetoric of the market to substantiate their claims and evade the questions of direct JHU affiliates. These cases show how articulations of who the institution imagines itself as accountable to are dynamically mutating, yet build upon precedents that set the conditions of possibility for how trauma is produced and mediated. I conclude by suggesting that it is important to move beyond a monolithic conception of the institution, and to be attuned to how dispersions of institutional accountability create new terrains where institutional contestation take place as well as the institution's strategic rupturing of the concept of the institutional citizen.
Open Access
Psychological trauma at different developmental stages and ICD-11 CPTSD: The role of dissociation
(Taylor & Francis Group, 2021-06-18) Jowett, Sally; Karatzias, Thanos; Shevlin, Mark; Hyland, Philip
Background: Dissociation is commonly reported by individuals who meet criteria for posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD). However, the association between the age of trauma exposure, dissociation, and CPTSD is not well understood. This study aimed to test whether dissociation mediated the relationship between the developmental stage of trauma exposure and CPTSD symptoms. Method: A nationally representative sample from Ireland (N = 1020) completed self-report measures on trauma exposure in childhood, adolescence, adulthood, current trauma symptomatology, and dissociation symptoms. A mediation analysis was conducted. Results: Childhood, adolescent, and adulthood trauma exposure were all related to dissociation and ICD-11 CPTSD symptom clusters. Dissociation mediated the effect of developmental stage of trauma exposure on PTSD and disturbances in selforganization( DSO). The direct and indirect effect models provided the best fit of the data. Childhood trauma exposure was the only developmental stage that was directly associated with both PTSD and DSO symptoms in our sample. Conclusion: Dissociation mediates the relationship between reported trauma exposure and the presence of ICD-11 CPTSD symptom clusters, and this relationship appears at its strongest when trauma occurs in childhood. CPTSD interventions should also promote dissociation management to aid recovery from this debilitating condition.
Open Access
A Meta-Analysis of Hippocampal and Amygdala Volumes in Patients Diagnosed With Dissociative Identity Disorder
(Taylor & Francis Group, 2021-01-12) Blihar, David; Crisafio, Anthony; Delgado, Elliott; Buryak, Marina; Gonzalez, Michael; Waechter, Randall
Dissociative Identity Disorder (DID), an illness characterized by multiple personality states, has long been a controversial diagnosis within the psychiatric community. Demonstrating a neuroanatomical basis for the disorder may help to resolve the controversy. Current literature on the neuroanatomy associated with DID has focused on the hippocampus and amygdala and are inconclusive. This meta-analysis pools the results from n = 3 studies to compare the mean size of these two structures between DID patients, non-DID patients, and healthy controls. Patients diagnosed with both DID & PTSD were found to have smaller hippocampi bilaterally (p< .001) compared to healthy controls; no significant difference was seen in the amygdala. When comparing DID to PTSD patients, the left hippocampus was smaller (p< .001), with a trend for a smaller right hippocampus (p = .06). A comparison of the amygdala was not possible due to a lack of data. These findings suggest that a smaller hippocampus is seen in DID patients beyond what is seen for PTSD, provides neuroanatomical evidence for the memory impairment often seen in DID patients (i.e., amnesia experienced by the host and alters), and presents a potentially novel means to understand this disorder.
Open Access
A Preliminary Investigation of Depression in People with Pathological Dissociation
(Taylor & Francis Group, 2020-05-13) Fung, Hong Wang; Chan, Chitat; Ross, Colin A.; Choi, Tat Ming
Depression is a common and challenging comorbid condition in people with pathological dissociation. To our knowledge, this preliminary study is the first study that has looked at the clinical correlates of depression in a sample of people with pathological dissociation (N = 72). We found that severe depression is common in this sample and that depression is associated with dissociative symptoms, post-traumatic stress disorder (PTSD) symptoms, borderline personality disorder symptoms and clinical recovery; the level of depression is also associated with both childhood and adulthood betrayal trauma but not with childhood and adulthood trauma with less betrayal. PTSD symptoms are the most significant correlates of the level of depression in this sample. Some clinical implications are discussed. Our initial findings imply that it may be important to manage depression by preventing adulthood betrayal trauma and stabilizing PTSD and dissociative symptoms when working with service users with pathological dissociation. Further studies are needed.
Open Access
The Dissociative Subtype of PTSD Interview (DSP-I): Development and Psychometric Properties
(Taylor & Francis Group, 2019-05-28) Eidhof, Marloes B.; June ter Heide, Jackie; van Der Aa, Niels; Schreckenbach, Monika; Schmidt, Ulrike; Brand, Bethany L.; Lanius, Ruth A.; Loewenstein, Richard J.; Spiegel, David; Vermetten, Eric
The inclusion of the dissociative subtype of post-traumatic stress disorder (PTSD-DS) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) reflects the importance of assessing PTSD-DS. We developed the Dissociative Subtype of PTSD Interview (DSP-I). This clinician-administered instrument assesses the presence and severity of PTSD-DS (i.e., symptoms of depersonalization or derealization) and contains a supplementary checklist that enables assessment and differentiation of other trauma-related dissociative symptoms (i.e., blanking out, emotional numbing, alterations in sensory perception, amnesia, and identity confusion). The psychometric properties were tested in 131 treatment-seeking individuals with PTSD and histories of multiple trauma, 17.6 % of whom met criteria for PTSDDS in accordance with the DSP-I. The checklist was tested in 275 treatment-seeking individuals. Results showed the DSP-I to have high internal consistency, good convergent validity with PTSD-DS items of the CAPS-5, and good divergent validity with scales of somatization, anxiety and depression. The depersonalization and derealization scales were highly associated. Moreover, the DSP-I accounted for an additional variance in PTSD severity scores of 8% over and above the CAPS-5 and number of traumatic experiences. The dissociative experiences of the checklist were more strongly associated with scales of overall distress, somatization, depression, and anxiety than scales of depersonalization and derealization. In conclusion, the DSP-I appears to be a clinically relevant and psychometrically sound instrument that is valuable for use in clinical and research settings.
Open Access
Peritraumatic dissociation and post-traumatic stress disorder in individuals exposed to armed conflict in the Democratic Republic of Congo
(Taylor & Francis Group, 2019-04-08) Masika, Yvonne Duagani; Leys, Christophe; Matonda-Ma-Nzuzi, Thierry; Blanchette, Isabelle; Mampunza Ma Miezi, Samuel; Kornreich, Charles
The purpose of this study was to verify the hypothesis that there is an association between peritraumatic dissociation (PD) and posttraumatic stress disorder (PTSD) in individuals exposed to recurrent armed conflict. More specifically, we sought to evaluate whether PD differentially predicts PTSD according to the degree of exposure to the potentially traumatic event (PTE), the level of education, and gender. A total of 120 individuals between 17 and 75 years of age, including 51women, completed the Traumatic Events List, the Peritraumatic Dissociative Experiences Questionnaire, and the French version of the Posttraumatic Stress Disorder Checklist Scale, as well as a questionnaire providing information regarding sociodemographic details. The group of participants with high scores for PD had significantly more PTSD. PD differentially predicts PTSD depending on the level of education and gender of the individual. Those who had been physically assaulted and raped, as well as the less educated, were more likely to be dissociated during PTE· exposure compared to witnesses and those with a higher level of education. The primary target population for prevention and early management should comprise individuals with high levels of PD, low levels of education, and women.
Open Access
Dissociation and psychopathology in residential youth: a brief report
(Taylor & Francis Group, 2019-03-29) Fragkaki MSc, Iro; Weijman MSc, Esther Louise; Cima, Maaike
Although dissociative symptoms are observed in several psychiatric disorders and linked to antisocial behavior and offending, the relation between dissociation and psychopathology or comorbidity has not been consistently investigated in residential youth yet. This brief report documented prevalence and comorbidity rates of several psychiatric disorders and examined their relation to dissociation in residential youth. The study included 100 male adolescents (Mage = 16.51) admitted to residential youth care facilities. Psychopathology was assessed with the Mini International Neuropsychiatric Interview for children and adolescents (MINI-KID) and dissociation was measured with the Adolescent Dissociative Experiences Scale (A-DES). Externalizing problems (conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder) were the most prevalent (81%) followed by substance abuse/dependence (71%), manic/hypomanic symptoms (40%), anxiety (35%), and depression (33%). High comorbidity was also observed in externalizing problems with alcohol/substance abuse/dependence (67%), manic/hypomanic symptoms (35%), depression (31%), and anxiety (30%). Logistic regression analyses revealed a significant link between dissociation and externalizing problems, depression, and manic/hypomanic symptoms, as well as comorbid externalizing problems and depression or manic/hypomanic symptoms. The findings highlight the need to assess dissociation in order to better understand the multifaceted individual profile of residential youth and incorporate it in the treatment plan.
Open Access
Organized abuse in adulthood: Survivor and professional perspectives
(Taylor & Francis Group, 2017-03-21) Salter, Michael
This paper reports on the preliminary findings of a qualitative study of Australian women disclosing organized abuse in adulthood and the mental health professionals who treat them. Drawing on interviews with survivors and mental health professionals, the paper analyses the fraught relationship between mental health and physical safety for adults subject to organized abuse. The therapeutic progress of adult organized abuse victims can be disrupted by ongoing threats, stalking, and group violence, which in turn reinforces the dissociative responses and pathological attachments that render them vulnerable to revictimization. The paper argues that breaking this cycle requires intervention from multiple agencies, and describes the responses of police, medical services, and child protection services to adult organized abuse from the perspective of survivors and mental health practitioners. Highlighting systemic failures but also opportunities, the paper calls for a coordinated response to organized abuse in adulthood, including inter-agency partnerships to support safety and bolster the efficacy of therapeutic interventions.
Open Access
Acupuncture for the Treatment of Adults with Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis
(Taylor & Francis Group, 2017-03-09) Grant, Sean; Colaiaco, Benjamin; Motala, Aneesa; Shanman, Roberta; Sorbero, Melony; Hempel, Susanne
Acupuncture has been suggested as a treatment for posttraumatic stress disorder (PTSD), yet its clinical effects are unclear. This review aims to estimate effects of acupuncture on PTSD symptoms, depressive symptoms, anxiety symptoms, and sleep quality for adults with PTSD. We searched 10 databases in January 2016 to identify eligible randomized controlled trials (RCTs). We performed random effects meta-analyses and examined quality of the body of evidence (QoE) using the GRADE approach to rate confidence in meta-analytic effect estimates. Seven RCTs with 709 participants met inclusion criteria. We identified very low QoE indicating significant differences favoring acupuncture (versus any comparator) at post-intervention on PTSD symptoms (standardized mean difference [SMD] = −0.80, 95% confidence interval [CI] [−1.59, −0.01], 6 RCTs), and low QoE at longer follow-up on PTSD (SMD = −0.46, 95% CI [−0.85, −0.06], 4 RCTs) and depressive symptoms (SMD = −0.56; 95% CI [−0.88, −0.23], 4 RCTs). No significant differences were observed between acupuncture and comparators at post-intervention for depressive symptoms (SMD = −0.58, 95% CI [−1.18, 0.01], 6 RCTs, very low QoE), anxiety symptoms (SMD = −0.82, 95% CI [−2.16, 0.53], 4 RCTs, very low QoE), and sleep quality (SMD = −0.46, 95% CI [−3.95, 3.03], 2 RCTs, low QoE). Safety data (7 RCTs) suggest little risk of serious adverse events, though some participants experienced minor/moderate pain, superficial bleeding, and hematoma at needle insertion sites. To increase confidence in findings, sufficiently powered replication trials are needed that measure all relevant clinical outcomes and dedicate study resources to minimizing participant attrition.
Open Access
Steps to Strengthen Ethics in Organizations: Research Findings, Ethics Placebos, and What Works
(Taylor & Francis Group, 2015-03-03) Pope, Kenneth S.
Research shows that many organizations overlook needs and opportunities to strengthen ethics. Barriers can make it hard to see the need for stronger ethics and even harder to take effective action. These barriers include the organization’s misleading use of language, misuse of an ethics code, culture of silence, strategies of justification, institutional betrayal, and ethical fallacies. Ethics placebos tend to take the place of steps to see, solve, and prevent problems. This article reviews relevant research and specific steps that create change.
Open Access
Trauma-Related Altered States of Consciousness: Exploring the 4-D Model
(Taylor & Francis Group, 2014-06-30) Frewen, Paul A.; Lanius, Ruth A.
Frewen and Lanius (in press) recently articulated a 4-D model as a framework for classifying symptoms of posttraumatic stress into those that potentially occur within normal waking consciousness (NWC) versus those that intrinsically represent dissociative experiences of trauma-related altered states of consciousness (TRASC). Four dimensions were specified: time-memory, thought, body, and emotion. The 4-D model further hypothesizes that in traumatized persons, symptoms of TRASC, compared with NWC forms of distress, will be (a) observed less frequently; (b) less intercorrelated, especially as measured as moment-to-moment states; (c) observed more frequently in people with high dissociative symptomatology as measured independently; and (d) observed more often in people who have experienced repeated traumatization, particularly early developmental trauma. The aim of the present research was to begin to evaluate these 4 predictions of the 4-D model. Within a sample of 74 women with posttraumatic stress disorder (PTSD) primarily due to histories of childhood trauma, as well as within a 2nd sample of 504 undergraduates (384 females), the 1st 2 hypotheses of the 4-D model were supported. In addition, within the PTSD sample, the 3rd hypothesis was supported. However, inconsistent with the 4th hypothesis, severity of childhood trauma history was not strongly associated with TRASC. We conclude that the hypotheses articulated by the 4-D model were generally supported, although further research in different trauma-related disorders is needed, and the role of childhood trauma history in the etiology of TRASC requires further research.
Open Access
Pediatric Bipolar Disorder in an Era of “Mindless Psychiatry”
(Taylor & Francis Group, 2012-01-02) Parry, Peter I.; Levin, Edmund C.
Pediatric bipolar disorder (PBD) reflects shifts in conceptualizing bipolar disorder among children and adolescents since the mid-1990s. Since then, PBD diagnoses, predominantly in the United States, have increased dramatically, and the diagnosis has attracted significant controversy. During the same period, psychiatric theory and practice has become increasingly biological. The aim of this paper is to examine the rise of PBD in terms of wider systemic influences. Method: In the context of literature referring to paradigm shifts in psychiatry, we reviewed the psychiatric literature, media cases, and information made available by investigative committees and journalists. Results: Social historians and prominent psychiatrists describe a paradigm shift in psychiatry over recent decades: from an era of “brainless psychiatry,” when an emphasis on psychodynamic and family factors predominated to the exclusion of biological factors, to a current era of “mindless psychiatry” that emphasizes neurobiological explanations for emotional and behavioral problems with limited regard for contextual meaning. Associated with this has been a tendency within psychiatry and society to neglect trauma and attachment insecurity as etiological factors; the “atheoretical” (but by default biomedical) premise of the Diagnostic and Statistical Manual of Mental Disorders (3rd and 4th eds.); the influence of the pharmaceutical industry in research, continuing medical education, and direct-to-consumer advertising; and inequality in the U.S. health system that favors “diagnostic upcoding.” Harm from overmedicating children is now a cause of public concern. Conclusion: It can be argued that PBD as a widespread diagnosis, particularly in the United States, reflects multiple factors associated with a paradigm shift within psychiatry rather than recognition of a previously overlooked common disorder.

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