Personality Disorders

Humans have just these 2 ways of sorting things--giving them a name or a giving them a number. We have been naming things since the days of Adam.

Here’s why it is painful to see a man cry: he's not supposed to. Emotions are arresting when society tells us they should not be expressed. In the case of a grown man crying, there are some thousands of years of cultural training laying down the prohibitive regulations.

I just attended the 40th year reunion of my medical school class at Yale. As is common at these 5-year reunions, we compare our careers and the progress of medicine, although this time more of the focus seemed to be on our personal lives and our new Medicare cards.

A large and comprehensive study recently performed in Korea has produced a surprising and disturbing result. The rate of autism is reported to be an astounding 1 in 38...

Psychiatry is a wonderful specialty. We have highly effective medication and psychotherapy tools. Forty years of accumulated clinical research have given us a pretty clear idea of optimal treatment guidelines. With an accurate diagnosis and an appropriate treatment, most of our patients benefit greatly and many recover completely.

Excellence in psychopharmacology demands sensitivity to the associated ethical considerations. The key considerations of psychiatry are both complex and dynamic, and psychiatrists who develop and refine their ethics skill set will be in a better position to anticipate and respond to ethical dilemmas as they arise in their practice.

If ketamine is able to turn off a patient’s depression, even for one day, you have accomplished something important, whether or not you can maintain it. This is because you have at least given the patient hope . . . that in itself is very significant from a therapeutic perspective.

Rape is always a heinous, ugly, violent, and cruel crime. But the violence and cruelty that are part of all rapes should not be confused with the specifically motivated violence and cruelty that distinguish sexual sadism...

When my clinic manager told me that prison may be the best place to practice psychiatry nowadays, I didn’t believe him. After all, prisons often seem like a world apart, often in isolated rural areas or in windowless, nondescript urban buildings.

Antidrug vaccines represent an exciting area of development in the pharmacological treatment of chemical dependency. In addition to the clinical trials being conducted on vaccines for cocaine and nicotine dependence, preclinical development of vaccines for methamphetamine and heroin is ongoing.

The title of Gardiner Harris’s front-page story in the March 6 New York Times was blunt: “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy.” For those of us who see our profession as a humanistic calling, this piece is likely to provoke a mixture of sadness and anger.

In previous blogs and papers, I have done my level best to skewer the misuse of the misdiagnosis "Paraphilia NOS." I regard it as no more than a flimsy justification, concocted to allow the psychiatric incarceration of rapists who would otherwise have to be released from prison to the street.

I was asked three interesting questions by a psychologist with 15 years experience evaluating sexually violent predators. She has testified often--both for the prosecution and for the defense in the hearings that determine the legitimacy of involuntary psychiatric commitment under SVP statutes.

Every case of patient violence against clinicians provides lessons to be learned in safety management. Here: some key points that can enhance physician safety and help minimize the risks.

One of the impulse-control disorders, Intermittend Explosive Disorder includes serious acts of aggression against person or property that are completely out of proportion to any provocation.

Charles Moser, PhD, MD, has forwarded an interesting suggestion to solve the problem of weak diagnoses that have received a free ride through previous revisions of DSM. His is a middle way intended to steer between the contrasting risks of continuing questionable diagnoses and the risks of eliminating them.

This book is recommended for therapy trainees who are interested in relational psychodynamic approaches and concerned with putting these seemingly abstract concepts into “real world” practice.

A DSM critic, Andrew Hinderliter sent this perceptive email questioning the wisdom of the most fundamental decision we made in preparing DSM IV-- ie, our goal of keeping the system stable.

The treatment of incest victims is often painful and difficult. With patience, the vast majority of those who have experienced incest can experience considerable improvement and enjoy an enhanced quality of life without succumbing to repeated victimization.

The doctor’s role is to go beyond the obvious and to detect subtle determinants. Good diagnosticians have been trained to look beneath the loud symptom and consider underlying factors.

Dr Allen Frances pleads for the United States Supreme Court to “step up to the plate” and halt the “disturbing misuse” of the “makeshift” psychiatric diagnosis of Paraphilia NOS (nonconsent).

The DSM does and must involve both science and pragmatism. It must use the science that is available, but it must also make countless judgment calls that are not grounded in solid empirical evidence-and surely it makes sense to consider practical consequences in doing the latter.

As I came closer, I could see Mr P more clearly. He was in his own world, wearing a Walkman with earphones on. I puzzled for a brief moment over this-was this to shut out attempts to talk him down? I could also see more clearly the rivulets of blood dripping from the incisions on his wrists to the concrete ground below.

In essence, screen media constitute neurologically potent, arousing input to the developing brain. Unlike conventional toxins, their effects are mediated by sense organs. However, they have demonstrable effects on brain activity, and on behavior and function.

Autism is demanding increased attention by professional and lay audiences; prevalence seems to be increasing. There are differing opinions about whether the increase is due to greater recognition and reporting, diagnostic expansion and substitution, or increasing acceptability.