Chapter 16. Psychopathology: Biological Basis of Behavior Disorders
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Alison Abbott Psychiatrist Joshua Gordon wants to use mathematics to improve understanding of the brain. The US National Institute of Mental Health (NIMH) has a new director. On 12 September, psychiatrist Joshua Gordon took the reins at the institute, which has a budget of US$1.5 billion. He previously researched how genes predispose people to psychiatric illnesses by acting on neural circuits, at Columbia University in New York. His predecessor, Thomas Insel, left the NIMH to join Verily Life Sciences, a start-up owned by Google’s parent company Alphabet, in 2015. Gordon says that his priorities at the NIMH will include “low-hanging clinical fruit, neural circuits and mathematics — lots of mathematics", and explains to Nature exactly what that means. What do you plan to achieve in your first year in office? I won’t be doing anything radical. I am just going to listen to and learn from all the stakeholders — the scientific community, the public, consumer advocacy groups and other government offices. But I can say two general things. In the past twenty years, my two predecessors, Steve Hyman [now director of the Stanley Center for Psychiatric Research at the Broad Institute in Cambridge, Massachusetts] and Tom Insel, embedded into the NIMH the idea that psychiatric disorders are disorders of the brain, and to make progress in treating them we really have to understand the brain. I will absolutely continue this legacy. This does not mean we are ignoring the important roles of the environment and social interactions in mental health — we know they have a fundamental impact. But that impact is on the brain. Second, I will be thinking about how NIMH research can be structured to give pay-outs in the short-, medium- and long-terms. © 2016 Macmillan Publishers Limited,
Link ID: 22794 - Posted: 10.27.2016
By NICHOLAS BAKALAR Extremely high or low resting heart rates in young men may predict psychiatric illness later in life, a large new study has found. Researchers used heart rate and blood pressure data gathered at Swedish military inductions from 1969 to 2010, and linked them with information from the country’s detailed health records through the end of 2013. The study, in JAMA Psychiatry, included 1,794,361 men whose average age was 18 at induction. The highest heart rates — above 82 beats a minute — were associated with increased risks of obsessive-compulsive disorder, anxiety disorder and schizophrenia. The lowest, below 62 beats, were associated with an increased risk of substance abuse and violent criminality. Extremes in blood pressure followed similar patterns, but the associations were not as strong. The lead author, Antti Latvala, a researcher at the University of Helsinki, said that the reasons for the association remain unknown. But, he added, “These measures are indicators of slightly different reactivity to stimuli. These people might have elevated heart rates because of an elevated stress level that is then predictive of these disorders.” Still, Dr. Latvala said, a high or low heart rate does not mean future psychiatric disease. “These are very complex illnesses,” he said. “People with high or low heart rate have nothing to worry about because of these findings. This is just a tiny piece of the puzzle.” © 2016 The New York Times Company
By Tori Rodriguez Uric acid is almost always mentioned in the context of gout, an inflammatory type of arthritis that results from excessive uric acid in the blood. It may be surprising, then, that it has also been linked with a vastly different type of disease: bipolar disorder. Elevated uric acid has been observed in patients with acute mania, and reducing uric acid improves symptoms. New evidence supports its potential as a treatment target. Uric acid is a by-product of the breakdown of compounds called purines, found in many foods and manufactured by the body. High levels of uric acid can indicate that these compounds, such as the neurotransmitter adenosine, are being broken down too readily in the body. “Adenosine might play a key role in neurotransmission and neuromodulation, having sedative, anticonvulsant and antiaggressive effects,” says physician Francesco Bartoli, a researcher at the University of Milano-Bicocca in Italy. Bartoli's new study, published in May in the Journal of Psychosomatic Research, examined uric acid levels in 176 patients with bipolar disorder or another severe mental illness and 89 healthy controls. The results show that bipolar disorder was the only diagnosis significantly linked with levels of uric acid. Excess uric acid was found to be linked to male gender, metabolic syndrome, waist size and triglyceride levels. Beyond the too rapid breakdown of adenosine, other potential explanations for increased uric acid include the metabolic abnormalities often present in people with bipolar disorder and frequent consumption of purine-rich foods and drinks, such as liver, legumes, anchovies and alcohol. Fructose consumption can also be a problem because the sugar inhibits uric acid excretion. Dietary interventions may reduce levels, but medication is typically required if dietary changes are insufficient. © 2016 Scientific American
Link ID: 22790 - Posted: 10.26.2016
Andrew Solomon A new virtual-reality attraction planned for Knott’s Berry Farm in Buena Park, Calif., was announced last month in advance of the peak haunted-house season. The name, “Fear VR 5150,” was significant. The number 5150 is the California psychiatric involuntary commitment code, used for a mentally ill person who is deemed a danger to himself or others. Upon arrival in an ersatz “psychiatric hospital exam room,” VR 5150 visitors would be strapped into a wheelchair and fitted with headphones. “The VR headset puts you in the middle of the action inside the hospital,” an article in The Orange County Register explained. “One patient seems agitated and attempts to get up from a bed. Security officers try to subdue him. A nurse gives you a shot (which you will feel), knocking you out. When you wake up in the next scene, all hell has broken loose. Look left, right and down, bloody bodies lie on the floor. You hear people whimpering in pain.” Knott’s Berry Farm is operated by Ohio-based Cedar Fair Entertainment Company, and Fear VR 5150 was to be featured at two other Cedar Fair parks as well. Almost simultaneously, two similar attractions were started at Six Flags. A news release for one explained: “Our new haunted house brings you face-to-face with the world’s worst psychiatric patients. Traverse the haunted hallways of Dark Oaks Asylum and try not to bump into any of the grunting inmates around every turn. Maniacal inmates yell out from their bloodstained rooms and deranged guards wander the corridors in search of those who have escaped.” The Orange County branch of the National Alliance on Mental Illness (NAMI) sprang into action, and Doris Schwartz, a Westchester, N.Y.-based mental-health professional, immediately emailed a roster of 130 grass-roots activists, including me, many of whom flooded Cedar Fair and Six Flags with phone calls, petitions and emails. After some heated back-and-forth, Fear VR 5150 was shelved, and Six Flags changed the mental patients in its maze into zombies. © 2016 The New York Times Company
David Brooks We’ve had a tutorial on worry this year. The election campaign isn’t really about policy proposals, issue solutions or even hope. It’s led by two candidates who arouse gargantuan anxieties, fear and hatred in their opponents. As a result, some mental health therapists are reporting that three-quarters of their patients are mentioning significant election-related anxiety. An American Psychological Association study found that more than half of all Americans are very or somewhat stressed by this race. Of course, there are good and bad forms of anxiety — the kind that warns you about legitimate dangers and the kind that spirals into dark and self-destructive thoughts. In his book “Worrying,” Francis O’Gorman notes how quickly the good kind of anxiety can slide into the dark kind. “Worry is circular,” he writes. It may start with a concrete anxiety: Did I lock the back door? Is this headache a stroke? “And it has a nasty habit of taking off on its own, of getting out of hand, of spawning thoughts that are related to the original worry and which make it worse.” That’s what’s happening this year. Anxiety is coursing through American society. It has become its own destructive character on the national stage. Worry alters the atmosphere of the mind. It shrinks your awareness of the present and your ability to enjoy what’s around you right now. It cycles possible bad futures around in your head and forces you to live in dreadful future scenarios, 90 percent of which will never come true. Pretty soon you are seeing the world through a dirty windshield. Worry dims every sunrise and amplifies mistrust. A mounting tide of anxiety makes people angrier about society and more darkly pessimistic about the possibility of changing it. Spiraling worry is the perverted underside of rationality. This being modern polarized America, worry seems to come in two flavors. © 2016 The New York Times Company
Bret Stetka Every day in the United States, millions of expectant mothers take a prenatal vitamin on the advice of their doctor. The counsel typically comes with physical health in mind: folic acid to help avoid fetal spinal cord problems; iodine to spur healthy brain development; calcium to be bound like molecular Legos into diminutive baby bones. But what about a child's future mental health? Questions about whether ADHD might arise a few years down the road or whether schizophrenia could crop up in young adulthood tend to be overshadowed by more immediate parental anxieties. As a friend with a newborn daughter recently fretted over lunch, "I'm just trying not to drop her!" Yet much as pediatricians administer childhood vaccines to guard against future infections, some psychiatrists now are thinking about how to shift their treatment-centric discipline toward one that also deals in early prevention. In 2013, University of Colorado psychiatrist Robert Freedman and colleagues recruited 100 healthy, pregnant women from greater Denver to study whether giving the B vitamin choline during pregnancy would enhance brain growth in the developing fetus. The moms-to-be were randomly given either a placebo or a form of choline called phosphatidylcholine. Choline itself is broken down by bacteria in the gut; by giving it in this related form the supplement can more effectively be absorbed into the bloodstream. © 2016 npr
By Nathaniel P. Morris When meeting new people, I'm often asked what I do for work. Depending on how I phrase my answer, I receive very different reactions."I'm a doctor specializing in mental health" elicits fascination. People's faces brighten and they say, "Very cool!" But If I instead say, "I'm a psychiatrist," the conversation falls quiet. They get uncomfortable and change the subject. Mental health has made great strides in recent years. Every week, people across the country participate in walks to support mental health causes. The White House now designates May as National Mental Health Awareness Month. In the presidential race, Hillary Clinton released a comprehensive plan to invest in mental health care. Yet psychiatry—the medical specialty focused on mental health—remains looked down upon in nearly every corner of our society. The public often doesn’t regard psychiatrists as medical doctors. Many view psychiatric treatments as pseudoscience at best and harmful at worst. Even among health professionals, it’s one of the least respected medical specialties. The field is in serious decline. Academic papers abound with titles like “Is psychiatry dying?” and “Are psychiatrists an endangered species?” Despite growing mental health needs nationwide, fewer medical students are applying into the field, and the number of psychiatrists in the US is falling. Patients too often refuse treatment because of stigma related to the field. © 2016 Scientific American
By Jessica Hamzelou Is depression caused by an inflamed brain? A review of studies looking at inflammation and depression has found that a class of anti-inflammatory drugs can ease the condition’s symptoms. Golam Khandaker at the University of Cambridge and his colleagues analysed 20 clinical studies assessing the effects of anti-cytokine drugs in people with chronic inflammatory conditions. These drugs block the effects of cytokines – proteins that control the actions of the immune system. Anti-cytokines can dampen down inflammation, and are used to treat rheumatoid arthritis. Together, these trials involved over 5,000 volunteers, and provide significant evidence that anti-cytokine drugs can also improve the symptoms of depression, Khandaker’s team found. These drugs work about as well as commonly used antidepressants, they say. The most commonly used anti-depressant drugs, known as SSRIs, act to increase levels of serotonin in the brain, to improve a person’s mood. But depression might not always be linked to a lack of serotonin, and SSRIs don’t work for everyone. Recent research has found that around a third of people with depression appear to have higher levels of cytokines in their brains, while people with “overactive” immune systems seem more likely to develop depression. Khandaker’s team think that inflammation in the brain might be responsible for the fatigue experienced by people with depression. © Copyright Reed Business Information Ltd.
By Meredith Wadman The second century C.E. Greek physician and philosopher Galen advised patients suffering from disorders of the spirit to bathe in and drink hot spring water. Modern day brain scientists have posited that Galen’s prescription delivered more than a placebo effect. Lithium has for decades been recognized as an effective mood stabilizer in bipolar disease, and lithium salts may have been present in the springs Galen knew. Yet exactly how lithium soothes the mind has been less than clear. Now, a team led by Ben Cheyette, a neuroscientist at the University of California in San Francisco (UCSF), has linked its success to influence over dendritic spines, tiny projections where excitatory neurons form connections, or synapses, with other nerve cells. Lithium treatment restored healthy numbers of dendritic spines in mice engineered to carry a genetic mutation that is more common in people with autism, schizophrenia, and bipolar disorder than in unaffected people, they report today in Molecular Psychiatry. The lithium also reversed symptoms in these mutant mice—lack of interest in social interactions, decreased motivation, and increased anxiety—that mimic those in the human diseases. “They showed there’s a correlation between the ability of lithium to reverse not only the behavioral abnormalities in the mice, but also the [dendritic] spine abnormalities,” says Scott Soderling, a neuroscientist at Duke University in Durham, North Carolina, who studies how dysfunctions in signaling at brain synapses and lead to psychiatric disorders. Soderling adds that the work also sheds light on the roots of these diseases. “It gives further credence to this idea that these spine abnormalities are functionally linked to the behavioral disorders.” © 2016 American Association for the Advancement of Science.
Link ID: 22764 - Posted: 10.18.2016
Bruce Bower Scientists, politicians, clinicians, police officers and medical workers agree on one thing: The U.S. mental health system needs a big fix. Too few people get the help they need for mental ailments and emotional turmoil that can destroy livelihoods and lives. A report in the October JAMA Internal Medicine, for instance, concludes that more than 70 percent of U.S. adults who experience depression don’t receive treatment for it. Much attention focuses on developing better psychiatric medications and talk therapies. But those tactics may not be enough. New research suggests that the longstanding but understudied problem of stigma leaves many of those suffering mental ailments feeling alone, often unwilling to seek help and frustrated with treatment when they do. “Stigma about mental illness is widespread,” says sociologist Bernice Pescosolido of Indiana University in Bloomington. And the current emphasis on mental ills as diseases of individuals can unintentionally inflame that sense of shame. An effective mental health care system needs to address stigma’s suffocating social grip, investigators say. “If we want to explain problems such as depression and suicide, we have to see them in a social context, not just as individual issues,” Pescosolido says. |© Society for Science & the Public 2000 - 2016
Link ID: 22758 - Posted: 10.15.2016
By JOHN C. MARKOWITZ The United States government recently announced its new director of the National Institute of Mental Health, Dr. Joshua Gordon. If you think that’s just bureaucracy as usual, think again. Mental health research, under the leadership of the previous director, Dr. Thomas Insel, underwent a quiet crisis, one with worrisome implications for the treatment of mental health. I hope Dr. Gordon will resolve it. For decades, the National Institute of Mental Health provided crucial funding for American clinical research to determine how well psychotherapies worked as treatments (on their own as well as when combined with medications). This research produced empirical evidence supporting the effectiveness of cognitive behavioral therapy, interpersonal psychotherapy and other talking treatments. But over the past 13 years, Dr. Insel increasingly shifted the institute’s focus to neuroscience, strangling its clinical research budget. Dr. Insel wasn’t wrong to be enthusiastic about the possibilities of neuroscientific research. Compared with the psychiatric diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), which can be vague and flawed, brain-based research holds out the promise of a precise and truly scientific understanding of mental illness. Psychiatric diagnoses depend on clusters of signs and symptoms. For major depression, for example, some criteria are low mood; wanting to die; and sleep, appetite and energy changes. These diagnoses lack the specificity of the biological markers that neuroscience seeks to identify. If we could find a genetic, neuroimaging or brain-circuit explanation for a mental illness, it might even yield a cure, rather than just the treatment of what can be recurrent, chronic conditions. But where does that leave patients whom today’s treatments do not help? Can they wait for neuroscience developments that may take decades to appear, or prove illusory? Staking all your money on one bet, as the institute did under Dr. Insel, has consequences. © 2016 The New York Times Company
Link ID: 22757 - Posted: 10.15.2016
By Daisy Yuhas About 350 million people around the world suffer from depression. Therapists can use many different techniques to help, but none has more rigorous scientific evidence behind it than cognitive-behavioral therapy (CBT). This “inside-out” technique focuses primarily on thought patterns, training patients to recognize and reframe problematic thinking. Now, however, mental health professionals have another option: mounting evidence shows that a technique called behavioral-activation (BA) therapy is just as effective as CBT. BA is an outside-in technique in which therapists focus on modifying actions rather than thoughts. “The idea is that what you do and how you feel are linked,” says David Richards, a health services researcher at the University of Exeter in England. If a patient values nature and family, for example, a therapist might encourage him to schedule a daily walk in the park with his grandchildren. Doing so could increase the rewards of engaging more with the outside world, which can be a struggle for depressed people, and could create an alternative to more negative pastimes such as ruminating on loss. BA has existed for decades, and some of its elements are used in CBT, yet until now it had never been tested with the scale and rigor needed to assess its relative strength as a stand-alone approach. In one of the largest studies of its kind, Richards led a collaboration of 18 researchers working at three mental health centers in the U.K. who put BA and CBT head-to-head. They assigned 440 people with depression to about 16 weeks of one of the two approaches, then followed the patients' progress at six, 12 and 18 months after treatment began. As revealed in a paper, published online in July in the Lancet, the team found the treatments to be equally effective. A year on, about two thirds of the patients in both groups reported at least a 50 percent reduction in their symptoms. © 2016 Scientific American
Link ID: 22741 - Posted: 10.11.2016
Alison Abbott Arrival in a foreign, hostile country causes many refugees great stress. On an ice-cold day in January, clinical psychologist Emily Holmes picked up a stack of empty diaries and went down to Stockholm’s central train station in search of refugees. She didn’t have to look hard. Crowds of lost-looking young people were milling around the concourse, in clothes too flimsy for the freezing air. “It struck me hard to see how thin some of the young men were,” she says. Holmes, who works at Stockholm’s Karolinska Institute, was seeking help with her research — a pilot project on post-traumatic stress disorder (PTSD), which is all too common in refugees. She wanted to see whether they would be willing to spend a week noting down any flashbacks — fragmented memories of a trauma that rush unbidden into the mind and torment those with PTSD. She easily found volunteers. And when they returned the diaries, Holmes was shocked to see that they reported an average of two a day — many more than the PTSD sufferers she routinely dealt with. “My heart went out to them,” she says. “They managed to travel thousands of kilometres to find their way to safety with this level of symptoms.” Europe is experiencing the largest movement of people since the Second World War. Last year, more than 1.2 million people applied for asylum in the European Union — and those numbers underestimate the scale of the problem. Germany, which has taken in the lion’s share of people, reckons that it received more than a million refugees in 2015, tens of thousands of whom have yet to officially apply for asylum. Most came from Syria, Afghanistan and Iraq. Many have experienced war, shock, upheaval and terrible journeys, and they often have poor physical health. The crisis has attracted global attention and sparked political tension as countries struggle to accommodate and integrate the influx. © 2016 Macmillan Publishers Limited
By NICHOLAS BAKALAR Hormonal contraceptives are associated with an increased risk for depression, a large study has found. Danish researchers studied more than a million women ages 15 to 34, tracking their contraceptive and antidepressant use from 2000 to 2013. The study excluded women who before 2000 had used antidepressants or had another psychiatric diagnosis. Over all, compared with nonusers, users of hormonal contraception had an 80 percent increased risk of depression. Some types of contraceptives carried even greater risk. Women who used progestin-only pills more than doubled their risk, for example, while those who used those who used the levonorgestrel IUD (brand name Mirena) tripled their risk. The risk persisted after adjusting for age, age of first intercourse, educational level and other factors. The study, in JAMA Psychiatry, also found that the risk was greater in adolescent girls, but this may be because adolescent girls are especially susceptible to depression. “Even though the risk of depression increases substantially with these drugs — an 80 percent increase is not trivial — most women who use them will not get depressed,” said the senior author, Dr. Oejvind Lidegaard, a clinical professor of obstetrics and gynecology at the University of Copenhagen. “Still, it is important that we tell women that there is this possibility. And there are effective nonhormonal methods of birth control.” © 2016 The New York Times Company
Jon Hamilton There's growing evidence that a physical injury to the brain can make people susceptible to post-traumatic stress disorder. Studies of troops deployed to Iraq and Afghanistan have found that service members who suffer a concussion or mild traumatic brain injury are far more likely to develop PTSD, a condition that can cause flashbacks, nightmares and severe anxiety for years after a traumatic event. And research on both people and animals suggest the reason is that a brain injury can disrupt circuits that normally dampen the response to a frightening event. The result is like "driving a car and the brake's not fully functioning," says Minxiong Huang, a biomedical physicist at the University of California, San Diego. Scientists have suspected a link between traumatic brain injury (TBI) and PTSD for many years. But the evidence was murky until researchers began studying troops returning from Iraq and Afghanistan. What they found was a lot of service members like Charles Mayer, an Army sniper from San Diego who developed PTSD after finishing a deployment in Iraq. In 2010, Mayer was on patrol in an Army Humvee near Baghdad when a roadside bomb went off. "I was unconscious for several minutes," he says. So he found out what happened from the people who dragged him out. The blast fractured Mayer's spine. It also affected his memory and thinking. That became painfully clear when Mayer got out of the Army in 2012. © 2016 npr
By MICHAEL HEDRICK My father said on numerous occasions when I was growing up that he would see other families that had problems like divorce and drug use, and he would thank God that his family was so perfect. Things would change, though. They always do. And that perfect family would face just as much struggle as any other. Growing up in the mountains above Boulder, Colo., our life was good. My parents had left their life in Chicago behind for an ideal they saw in a piece of art they found at a flea market, a haphazardly painted picture of a cabin next to a river with the mountains towering in the background. Born in the early ‘80s, my brothers and I shared a bond as best friends in our small neighborhood, isolated from town, where we spent time outside sledding, building forts and making dams in the ditch that ran by our house. The biggest problems we seemed to face were bloody knees and the occasional broken bone from snowboarding and bike accidents. My dad, a subscriber to “Mother Earth News,” relished our family’s home in the mountains. There were backpacking trips to the national park 30 miles away, where he taught us how to build a fire and to hang our food from tree limbs to keep it out of reach of bears. Other times he would take us on long father-son road trips, where we would drive the long highways with nothing to look at but the passing fields and nothing to pay attention to but the books on tape from Focus on the Family that my father put on the car stereo. Those tapes provided a Christian look at what it meant to be a man, covering issues like lust, sex and puberty, and he’d answer our questions about girls and all manner of things relating to our growing into healthy young men. © 2016 The New York Times Company
Researchers at the National Institutes of Health have discovered a two-way link between depression and gestational diabetes. Women who reported feeling depressed during the first two trimesters of pregnancy were nearly twice as likely to develop gestational diabetes, according to an analysis of pregnancy records. Conversely, a separate analysis found that women who developed gestational diabetes were more likely to report postpartum depression six weeks after giving birth, compared to a similar group of women who did not develop gestational diabetes. The study was published online in Diabetologia. Gestational diabetes is a form of diabetes (high blood sugar level) occurring only in pregnancy, which if untreated may cause serious health problems for mother and infant. “Our data suggest that depression and gestational diabetes may occur together,” said the study’s first author, Stefanie Hinkle, Ph.D., staff scientist in the Division of Intramural Population Health Research at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “Until we learn more, physicians may want to consider observing pregnant women with depressive symptoms for signs of gestational diabetes. They also may want to monitor women who have had gestational diabetes for signs of postpartum depression.” Although obesity is known to increase the risk for gestational diabetes, the likelihood of gestational diabetes was higher for non-obese women reporting depression than for obese women with depression.
By CATHERINE SAINT LOUIS Attention deficit disorder is the most common mental health diagnosis among children under 12 who die by suicide, a new study has found. Very few children aged 5 to 11 take their own lives, and little is known about these deaths. The new study, which included deaths in 17 states from 2003 to 2012, compared 87 children aged 5 to 11 who committed suicide with 606 adolescents aged 12 to 14 who did, to see how they differed. The research was published on Monday in the journal Pediatrics. About a third of the children of each group had a known mental health problem. The very young who died by suicide were most likely to have had attention deficit disorder, or A.D.D., with or without accompanying hyperactivity. By contrast, nearly two-thirds of early adolescents who took their lives struggled with depression. Suicide prevention has focused on identifying children struggling with depression; the new study provides an early hint that this strategy may not help the youngest suicide victims. “Maybe in young children, we need to look at behavioral markers,” said Jeffrey Bridge, the paper’s senior author and an epidemiologist at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio. Jill Harkavy-Friedman, the vice president of research at the American Foundation for Suicide Prevention, agreed. “Not everybody who is at risk for suicide has depression,” even among adults, said Dr. Harkavy-Friedman, who was not involved in the new research. Yet the new research does not definitively establish that attention deficit disorder and attention deficit hyperactivity disorder, or A.D.H.D., are causal risk factors for suicide in children, Dr. Bridge said. Instead, the findings suggest that “suicide is potentially a more impulsive act among children.” © 2016 The New York Times Company
Richard J. McNally The welcoming letter to the class of 2020 in which Jay Ellison, a dean at the University of Chicago, told incoming students not to expect trigger warnings on campus struck a nerve in a highly polarized debate that is embroiling academia. Trigger warnings are countertherapeutic because they encourage avoidance of reminders of trauma, and avoidance maintains P.T.S.D. Trigger warnings, critics claim, imperil academic freedom and further infantilize a cohort of young people accustomed to coddling by their helicopter parents. Proponents of trigger warnings point out that many students have suffered trauma, exemplified by alarming rates of sexual assault on campus. Accordingly, they urge professors to warn students about potentially upsetting course materials and to exempt distressed students from classes covering topics likely to trigger post-traumatic stress disorder, or P.T.S.D., symptoms, such as flashbacks, nightmares and intrusive thoughts about one’s personal trauma. Proponents of trigger warnings are deeply concerned about the emotional well-being of students, especially those with trauma histories. Yet lost in the debate are two key points: Trauma is common, but P.T.S.D. is rare. Epidemiological studies show that many people are exposed to trauma in their lives, and most have had transient stress symptoms. But only a minority fails to recover, thereby developing P.T.S.D. Students with P.T.S.D. are those most likely to have adverse emotional reactions to curricular material, not those with trauma histories whose acute stress responses have dissipated. However, trigger warnings are countertherapeutic because they encourage avoidance of reminders of trauma, and avoidance maintains P.T.S.D. Severe emotional reactions triggered by course material are a signal that students need to prioritize their mental health and obtain evidence-based, cognitive-behavioral therapies that will help them overcome P.T.S.D. These therapies involve gradual, systematic exposure to traumatic memories until their capacity to trigger distress diminishes. © 2015 The New York Times Company
By Jessica Hamzelou After experiencing post-traumatic stress disorder after being raped, Karestan Koenen made it her career to study the condition. Now at Harvard University, Koenen is leading the largest ever genetic study of PTSD, by sifting through the genomes of tens of thousands of people (see Why women are more at risk of PTSD – and how to prevent it”). She tells New Scientist how her experiences shaped her career What was your idea of PTSD before you experienced it yourself? I would have associated it with men who served in the military – the stereotype of a Vietnam veteran who has experienced really horrible combat, and comes back and has nightmares about it. Do you think that is how PTSD is perceived by the public generally? Yes. People know that PTSD is related to trauma, and that people can have flashbacks and nightmares. But they tend to think it is associated with combat. A lot of popular images of PTSD come from war movies, and people tend to associate being a soldier with being a man. They are less aware that most PTSD is related to things that happen to civilians – things like rape, sexual assault and violence, which can affect women more than men. Is this misperception of PTSD problematic? It’s a problem in the sense that women or men who have PTSD from non-combat experiences might not recognise what they have as PTSD, and because of that, may not end up getting help. And if you saw it in a loved one, you may not understand what was going on with them. © Copyright Reed Business Information Ltd.