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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by capricorn on March 2, 2007, at 7:34:26
Where does dysfunctionality of personality end and 'mental illness' begin?If there is an overlap what constitutes that overlap?
Posted by capricorn on March 2, 2007, at 9:25:38
In reply to personality dysfunction v 'mental illness', posted by capricorn on March 2, 2007, at 7:34:26
What troubles me most is the way psychiatrists et all move the goalposts when it comes to claims that personality disorders are not mental illnesses.
The prevailing argument re so called 'mental illnesses' is that they involve the admixture of genetic and environmental factors with great emphasis being placed
on heritability of disorders like bipolar and schizophrenia.
However the heritability http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WCV-45V23CS-2&_user=10&_coverDate=11%2F30%2F2000&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=33ceea2f31405b6e5ab0082045769fb5 of so called PDs is ignored in favour of defining PDs in terms of 'learned behaviours' due to environmental factors.The growing body of evidence showing differences in the brains etc of those with so called PDS is making an ever inceasing mockery of the artificial
dichotomy between M.I and PD.Both so called M.I and PD appear to be products of what is called the diathesis-
stress model and yet the tendency is to still define the latter as being non mental illnesses.
This makes no intellectual sense at all. It is akin to two Bananas falling from the same tree and choosing to claim that one is a coconut.To some degree i think PD is a convenient label for shove on patients whose presentation of symptoms illustrate the all too apparent flaws inherent within the DSM or an equally convenient way of pandering to the self appointed Godlike narcissism of many pdocs.
If a patient is hard to treat then better to label him or her PDed than to take the time needed to deal with a difficult case.
Pdocs tend to like patients whose illnesses are straightforward and easier to treat and offer an easy means of reinforcing the pdocs narcissistic definition of him/herself as a paternalistic/maternalistic God like colossus.
It's akin to the tactic of dismissing difficult to solve crimes as non crimes in order to cynically boost the convinction rate and no less dishonest.
Posted by Phillipa on March 2, 2007, at 11:18:16
In reply to Re: personality dysfunction v 'mental illness', posted by capricorn on March 2, 2007, at 9:25:38
I think a personality disorder is an Axix ll and means that therphy might help better than meds? Please step in and correct me. Thanks Phillipa
Posted by one woman cine on March 2, 2007, at 12:02:48
In reply to Re: personality dysfunction v 'mental illness' » capricorn, posted by Phillipa on March 2, 2007, at 11:18:16
that's about the size of it in a nutshell.
Axis I is more biologically based - meaning meds are going to have more of an impact than therapy, though therapy is an adjunct.
Axis II means meds might help, but will not correct the issues of relating/coping to people/world that encompasseses the PD dx. It requires psycho-therapeutic intervention.
Posted by capricorn on March 2, 2007, at 12:53:29
In reply to you don't need correction, phillippa...., posted by one woman cine on March 2, 2007, at 12:02:48
> that's about the size of it in a nutshell.
>
> Axis I is more biologically basedThis is increasingly being proven to be wrong if by that you are saying Axis I is more biologically based
than Axis 11 disorders.
Posted by one woman cine on March 2, 2007, at 13:04:48
In reply to Re: you don't need correction, phillippa...., posted by capricorn on March 2, 2007, at 12:53:29
Can you explain how it is being proven wrong and by whom? Any studies cited by medical/scientific journals would be appreciated. :)
I don't think PD's are biologically based, they are not genetically inheritable - though they exacerbated by environment.
Posted by capricorn on March 2, 2007, at 13:30:24
In reply to hmm, well - » capricorn, posted by one woman cine on March 2, 2007, at 13:04:48
Not genetically inheritable?! Have you been sniffing too much lighter fuel or had a terminal brain f*rt?
There must be some explanation for such a dumbassedly moronic comment.
Posted by one woman cine on March 2, 2007, at 13:33:37
In reply to Re: hmm, well -, posted by capricorn on March 2, 2007, at 13:30:24
Posted by capricorn on March 2, 2007, at 13:58:09
In reply to just answer the question (nm) » capricorn, posted by one woman cine on March 2, 2007, at 13:33:37
Don't tell me what to do.YOU HAVE NO F*CKING RIGHT TO DO SO.
Posted by one woman cine on March 2, 2007, at 14:05:25
In reply to Re: just answer the question, posted by capricorn on March 2, 2007, at 13:58:09
Seriously - you made a statement or a series of statements about axis II, I would just like the "proof" you said you have about them being biological.
that's all.
If you have no data, that's OK too.
Posted by capricorn on March 2, 2007, at 14:22:00
In reply to Re: just answer the question, posted by one woman cine on March 2, 2007, at 14:05:25
http://www.atypon-link.com/GPI/doi/abs/10.1521/pedi.15.1.33.18645
Posted by karen_kay on March 2, 2007, at 14:33:00
In reply to Re: hmm, well -, posted by capricorn on March 2, 2007, at 13:30:24
i must say, i don't think i've heard a string like that in quite a while. i salute you in the sincerest form, and i must add without insulting in any way the person the post was directed at. capricorn, will you pretty please marry me? but only if you promise to ask me if i've been sniffing lighter fuel when i put the maple syrup in the freezer? and call me moronic (blasted i forgot what you said, but whatever it was, it was pure perfection) 'insert what you wrote here' when i ask if ben stiller is ben affleck (i do tend to get them confused. they look the same to me.
honestly, i'm intrigued :)
(and please don't be insulted by my interruption. do continue. i just had to pipe up and spit out that engagement with a quicknesss!)
Posted by Declan on March 2, 2007, at 14:49:04
In reply to :) » capricorn, posted by karen_kay on March 2, 2007, at 14:33:00
I will quite understand it if no one can be bothered, but does someone wanna explain in a couple of basic sentences this Axis 1 and Axis 2 stuff.
Nothing to do with the HPA axis?
Posted by capricorn on March 2, 2007, at 15:30:48
In reply to Axes?, posted by Declan on March 2, 2007, at 14:49:04
> I will quite understand it if no one can be bothered, but does someone wanna explain in a couple of basic sentences this Axis 1 and Axis 2 stuff.
>
> Nothing to do with the HPA axis?http://www.mental-health-matters.com/articles/article.php?artID=1
Posted by 10derHeart on March 2, 2007, at 17:51:18
In reply to Re: hmm, well -, posted by capricorn on March 2, 2007, at 13:30:24
>There must be some explanation for such a dumb*ssedly moronic comment.
Please don't post anything that could lead others to feel accused or put down, or use language that could offend others
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
Respectfully,
10derHeart, acting as deputy for Dr. Bob
Posted by Larry Hoover on March 2, 2007, at 18:17:22
In reply to hmm, well - » capricorn, posted by one woman cine on March 2, 2007, at 13:04:48
> Can you explain how it is being proven wrong and by whom? Any studies cited by medical/scientific journals would be appreciated. :)
>
> I don't think PD's are biologically based, they are not genetically inheritable - though they exacerbated by environment.Capricorn's second post in this thread had a link to evidence of heritability that is in the range of other 'biological' mental illnesses, schizophrenia or bipolar, for example.
I've shortened the link to the following: http://tinyurl.com/2nao58
Lar
Posted by capricorn on March 2, 2007, at 18:17:43
In reply to Please be civil » capricorn, posted by 10derHeart on March 2, 2007, at 17:51:18
> >There must be some explanation for such a dumb*ssedly moronic comment.
>
> Please don't post anything that could lead others to feel accused or put down, or use language that could offend others
>
> If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil
>
> Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
>
> Respectfully,
> 10derHeart, acting as deputy for Dr. Bob
>
>You've just made me feel accused and put down and i'm offended by **your** post.
Do the honest thing and ban yourself for 3 weeks or be deemed a hypocritical fuckwit.
Posted by capricorn on March 2, 2007, at 20:19:05
In reply to Please be civil » capricorn, posted by 10derHeart on March 2, 2007, at 17:51:18
> >There must be some explanation for such a dumb*ssedly moronic comment.
>
> Please don't post anything that could lead others to feel accused or put down, or use language that could offend others
>
> If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil
>
> Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
>
> Respectfully,
> 10derHeart, acting as deputy for Dr. Bob
>
>
I apologise.please don't take this for more than it is, this doesn't mean I was wrong to say what i did.
Posted by Dinah on March 2, 2007, at 23:14:29
In reply to Re: Please be civil, posted by capricorn on March 2, 2007, at 18:17:43
> Do the honest thing and ban yourself for 3 weeks or be deemed a hypocritical f*ckwit.
You've been asked to be civil, so I'm afraid I'm going to have to block you from posting. I'll leave it to Dr. Bob to determine the length.
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Dr. Bob is always free to override deputy decisions. His email is on the bottom of each page. Please feel free to email him if you believe this decision was made in error.
Dinah, acting as deputy to Dr. Bob
Posted by Dr. Bob on March 3, 2007, at 9:23:44
In reply to Please be civil » capricorn, posted by 10derHeart on March 2, 2007, at 17:51:18
> Dr. Bob has oversight over deputy decisions, and he may choose a different action.
Since you've been asked to be civil before, I'm going to choose to make this a block.
But please don't take this personally, this doesn't mean I don't like you or think you're a bad person.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please first see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration.
Thanks,
Bob
PS: According to the current system:
previous block: 2 weeks
period of time since previous block: 22 weeks
uncivil toward a particular individual or group: yes
particularly uncivil: no
different type of incivility: no
clearly didn't understand PBC and made effort to reply: no
provoked: no
uncivil in multiple posts at same time: no
already archived: noIf we take 22 weeks, divide by 10, and round, that's a reduction of 2 weeks. If we apply that to your previous block, that takes you back to 0. And if we go from there, that's 1 week.
Posted by one woman cine on March 4, 2007, at 11:15:34
In reply to Re: hmm, well - » one woman cine, posted by Larry Hoover on March 2, 2007, at 18:17:22
hey larry, thanks for the link - however I read the whole article - that's just the abstract (on an article written 7 years ago - so it's on the "old side")
from the abstract -
"The best-fitting models never included shared-in-families environmental effects. However, a model with only shared familial and unique environmental effects could not be ruled out for dependent PD. Shared familial environmental effects may also influence the development of any PD and borderline PD. Passive-aggressive PD did not seem to be affected by genes or family environment at all. The low occurrence of antisocial PD in the twin sample precluded any model for this disorder. PDs seem to be more strongly influenced by genetic effects than almost any axis I disorder, and more than most broad personality dimensions. However, we observed a large variation in heritability among the different PDs, probably partly because of a moderate sample size and low prevalence of the specific disorders."I think the thrust is not necessarily genetic, but environmental for PD's - I think as I mentioned - they have also stated that there sampling size was "moderate" and biased (low prevalence) in disorder type.
That does not necessarily mean that it's genetic -the study points to the possibility - but many things are possible, though not probable.
Posted by Larry Hoover on March 4, 2007, at 12:01:45
In reply to Re: hmm, well - » Larry Hoover, posted by one woman cine on March 4, 2007, at 11:15:34
> hey larry, thanks for the link - however I read the whole article - that's just the abstract (on an article written 7 years ago - so it's on the "old side")
The subject selection arises from twin registries, which IMHO aren't subject to staleness issues. And SCID-2 is pretty well validated. Statistical methods haven't changed in the meantime. Only if there was now a better psychometric would I be concerned with date.
I wish I had access to the whole article. There are always hidden considerations.....often ones that turn the whole thing on its head. Anyway, I'm stuck with the abstract.
> from the abstract -
Further excerpted....
> "PDs seem to be more strongly influenced by genetic effects than almost any axis I disorder, and more than most broad personality dimensions. However, we observed a large variation in heritability among the different PDs, probably partly because of a moderate sample size and low prevalence of the specific disorders."
Which I read to mean: Collectively, the genetic/PD correlation is strong, whereas individually the correlations are weaker due to insufficient data points.
> I think the thrust is not necessarily genetic, but environmental for PD's - I think as I mentioned - they have also stated that there sampling size was "moderate" and biased (low prevalence) in disorder type.
They couldn't exclude environment, true. It was inconsistent with the data, nonetheless. "The best-fitting models never included shared-in-families environmental effects."
> That does not necessarily mean that it's genetic -the study points to the possibility - but many things are possible, though not probable.
That's what heritability estimates are, of course. The environmental influences are factored into the value obtained; it is the relative proportion of genetic variation to environmental variation that is expressed in one statistic. From wiki: "Heritability only quantifies how much of the total phenotypic variation in a population is attributable to variation among individual genotypes compared to the variation in the their environment."
Put another way, h² > c², and, e² was small. See: http://en.wikipedia.org/wiki/Heritability#Twin_studies
Putting the heritability estimates here obtained into context, they exceed those for schizophrenia, and are similar to those for mood disorders. They are substantially higher than those obtained for introversion/extroversion (to use a personality variable).
Imputing meaning or sociological significance to these statistics is certainly a subjective exercise.
Lar
Posted by Dinah on March 4, 2007, at 12:19:20
In reply to Re: hmm, well - » one woman cine, posted by Larry Hoover on March 4, 2007, at 12:01:45
I thought it was widely agreed that personality disorders had links to more Axis I type problems.
That OCPD and avoidant personality disorder were defenses against anxiety. And that schizoid and schizotypal were almost definitely brain based. And I personally agree with Linehan's conceptualization of borderline personality as mood instability coupled with slow return to baseline, which almost has to have a biological component. Plus, there's the physostigmine challenge.
I was talking to a neurologist the other day who was explaining to me that the brain has only a limited number of responses to an injury or insult to the brain. It makes sense to me that people have only a limited set of behavioral responses to anxiety, mood disorders, etc. And what behavioral responses any given individual uses might be related to that person's culture, more immediate environment, and genetic qualities (what they're *good* at).
Admittedly, habits and habitual ways of responding are hard to change, even if you change the underlying reason they originally came into being. And also, these particular behavioral clusters almost seem to push the anxiety or depression out of conscious awareness so that people may be unlikely to seek help, and certainly may be unlikely to give up something that has worked so well for them.
I think the Axis II diagnoses tend to reduce compassion in some providers though. I'd like to see it replaced with an acknowledgement of the underlying vulnerability and the cluster of behavioral and cognitive techniques that people use to deal with the underlying biological vulnerability.
If that makes sense. I've got headache.
Posted by Declan on March 4, 2007, at 16:26:09
In reply to Re: Axes?, posted by capricorn on March 2, 2007, at 15:30:48
Autism as a mental disorder?
Depends on what the words mean.
This is the end of the thread.
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