DOCSLIB.ORG

Why Psychiatrists Are Reluctant to Diagnose Borderline Personality Disorder by JOEL PARIS, MD

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Why Psychiatrists Are Reluctant to Diagnose Borderline Personality Disorder by JOEL PARIS, MD [REVIEW] Why Psychiatrists Are Reluctant to Diagnose Borderline Personality Disorder by JOEL PARIS, MD Dr. Paris is a Professor of Psychiatry, McGill University, Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Montreal, Quebec, Canada. ABSTRACT Clinicians can be reluctant to make a diagnosis of borderline personality disorder (BPD). One reason is that BPD is a complex syndrome with symptoms that overlap many Axis I disorders. This paper will examine interfaces between BPD and depression, between BPD and bipolar disorder, and between BPD and psychoses. It will suggest that making a BPD diagnosis does more justice to patients than avoiding it. WHAT IS BORDERLINE PERSONALITY DISORDER? Borderline personality disorder (BPD) is a diagnosis with an unusual history. The idea that patients might fall on some sort of “borderline” between psychosis and neurosis dates back to 1937, at which time the syndrome was first described.1 BPD patients do have quasipsychotic or micropsychotic symptoms, such as voices telling them to kill themselves, paranoid feelings, and depersonalization.2 However these cognitive symptoms are not essential features of BPD. The core of the syndrome is a striking instability of mood, accompanied by a wide range of impulsive behaviors, particularly self-cutting and overdoses, and with ADDRESS CORRESPONDENCE TO: Joel Paris, MD, Professor of Psychiatry, McGill University, Institute of Community and Family Psychiatry SMBD-Jewish General Hospital, 4333 chemin de la côte ste. catherine, Montreal H3T 1E4, Québec, Canada; E-mail: [email protected] intimate relationships that are impulsive, stormy, and chaotic.3 KEY WORDS: borderline personality disorder, psychiatric diagnosis [JANUARY] Psychiatry 2007 35 Since BPD begins early in life and with stigma. It is an unfortunate category, producing a heterogeneous can continue over many years, it is reality that a diagnosis of BPD can group. classified as a personality disorder. indeed lead to rejection by the It would be better to identify However, BPD differs from other mental health system. If BPD were crucial features without which the categories on Axis II in that it is to be reclassified as, for example, a diagnosis should not be made. One associated with a wide range of mood disorder, patients would tend can group the current DSM criteria active symptoms.4 Moreover, BPD is to be seen as having a biological into affective, impulsive, one of the most common clinical illness instead of having a interpersonal, and cognitive problems psychiatrists see in problematical personality. However, components. Patients should have practice. One study found that half of stigma cannot be removed by most or all of these features to merit all patients with repetitive suicide reclassification. Patients who are the diagnosis. That approach has attempts in emergency rooms meet chronically suicidal and who do not been used in a research measure, the criteria for this diagnosis.5 Due to form strong treatment alliances will Diagnostic Interview for Borderlines suicidal threats and actions, BPD continue to be just as difficult, even (DIB),13 later revised as the DIB-R.14 patients are often admitted to under a different diagnostic label. This semistructured interview scores hospital.6 BPD cases are also common each of four areas of pathology on in out-patient settings,7 where the COMORBIDITY AND DIAGNOSTIC four sub-scales (0–2 for affective and pathology is often serious enough to PROBLEMS cognitive symptoms and 0–3 for use a large amount of clinical Patients with BPD frequently impulsive and interpersonal resources. meet criteria for multiple Axis I symptoms), using an overall cutoff diagnoses.10 Considering that the point of eight out of 10 for positive WHY CLINICIANS ARE RELUCTANT disorder is associated with so many diagnosis. Patients who meet DIB-R TO DIAGNOSE BPD symptoms, this level of comorbidty criteria are much more Structured interviews pick up should not be surprising. Changing homogeneous, as shown by studies many cases of BPD missed in the diagnosis of a patient with BPD, demonstrating that this instrument ordinary practice.7 This finding shows however, to one of these comorbid distinguishes them from patients that practitioners are not consistently disorders focuses on only one aspect with other Axis II disorders, and making this diagnosis. There are a the syndrome and fails to account diagnosis achieves similar specificity number of reasons why clinicians for BPD’s broad range of clinical if one requires six or seven criteria may be reluctant to recognize BPD. phenomena (affective, impulsive, rather than five.15 First, Axis I diagnoses are more interpersonal, and cognitive). familiar to most professionals. Making While it is tempting to conclude BPD AND PSYCHOSIS an accurate Axis II diagnosis requires that diagnoses such as major The original concept of BPD as experience. Personality disorders depression are the “real” problems in lying on a border between neurosis often seem to lack precise BPD, similar symptoms can derive and psychosis found a parallel in the symptomatic criteria, since many of from entirely different causes. diagnostic term pseudoneurotic their features describe problems in Clinical phenomena, such as low schizophrenia.16 The concept was interpersonal functioning that require mood or unstable mood, are no more that patients with such a wide clinical judgment for accurate specific than fever or inflammation. variety of neurotic symptoms could assessment. All that “comorbidity” says is that be latently psychotic. However, this Second, resistance to diagnosing there are enough symptoms in one diagnosis confused personality patients with a personality disorder patient to meet criteria for more disorders primarily affecting mood may be based on the idea that these than one DSM category.11 Moreover, and impulsivity (like BPD) with conditions are untreatable,8 or at overlap is common in the DSM categories that primarily affect least not treatable using the system—major depression has at cognition, such as schizotypal pharmacological tools that have come least as much comorbidity as any personality.17 Neither family history to dominate the treatment of so Axis II disorder.12 studies nor biological markers many other disorders. While there is Another source of confusion is support a link between BPD and good evidence for the efficacy of that the description of BPD in DSM- schizophrenia.18 Nonetheless, some psychotherapy in BPD,9 not every IV-TR is not specific.4 The definition cases are challenging for differential clinical setting has the resources to introduced in DSM-III was an diagnosis, since the cognitive provide that form of treatment. advance because it operationalized symptoms of BPD can occasionally Simpler constructs such as major diagnosis using observable criteria. be florid. However, these phenomena depression lead to more familiar As with other disorders, DSM are transient and stress-related, treatment options, particularly instructs the clinician to make a while insight is retained, as the pharmacotherapy. diagnosis when five out of nine following case example illustrates. Third, clinicians may wish to criteria are met. The result is that Case example—Patient 1. Bill avoid making diagnoses associated many permutations lead to the same was a 25-year-old man under 36 Psychiatry 2007 [JANUARY] IT IS AN UNFORTUNATE REALITY that a diagnosis of BPD can indeed lead to rejection by the mental health system....However, stigma cannot be removed by reclassification. Patients who are chronically suicidal and who do not form strong treatment alliances will continue to be just as difficult, even under a different diagnostic label. treatment for chronic suicidality, common in families than mood antidepressants were no longer unstable relationships, and mood disorders.18 Another argument was considered necessary. instability. He also had paranoid based on commonalities in biological ideas, sometimes thinking that markers, such as REM latency.19 BPD AND THE BIPOLAR neighbors were plotting against him. However, it has never been shown SPECTRUM All these thoughts, however, were that these markers are specific to It has been proposed that exaggerations of real situations and DSM categories. borderline pathology falls within the never had the bizarre quality of There is an important spectrum of bipolar illness,22 based delusions. Bill also heard critical phenomenological distinction on a wish to expand the narrower voices in his head when stressed, but between temporal patterns of diagnostic construct of bipolar knew that such experiences were depressive symptoms in depression disorder into a much broader range imaginary. Bill received a DIB-R and BPD.21 In classical depression, of conditions termed the bipolar score of 9/10. mood is stable over weeks and is spectrum. In this model, the range Nonetheless, Bill was initially relatively unresponsive to the of bipolar spectrum disorders would diagnosed with schizophrenia and environment. In contrast, mood in be extended to include bipolar III treated for psychosis for over five BPD is highly mercurial. Moreover, (antidepressant-induced years with injectable antipsychotic mood can be strikingly unstable in hypomania), as well as bipolar IV medication. Bill actually liked the course of a single day, depending (ultra-rapid-cycling bipolar attending this clinic and getting the on life events. Patients have a disorder). The last category, bipolar injections, since it gave him a reason mixture of
Load more

Recommended publications
  • Paranoid – Suspicious; Argumentative; Paranoid; Continually on The
    Disorder Gathering 34, 36, 49 Answer Keys A N S W E R K E Y, Disorder Gathering 34 1. Avital Agoraphobia – 2. Ewelina Alcoholism – 3. Martyna Anorexia – 4. Clarissa Bipolar Personality Disorder –. 5. Lysette Bulimia – 6. Kev, Annabelle Co-Dependant Relationship – 7. Archer Cognitive Distortions / all-of-nothing thinking (Splitting) – 8. Josephine Cognitive Distortions / Mental Filter – 9. Mendel Cognitive Distortions / Disqualifying the Positive – 10. Melvira Cognitive Disorder / Labeling and Mislabeling – 11. Liat Cognitive Disorder / Personalization – 12. Noa Cognitive Disorder / Narcissistic Rage – 13. Regev Delusional Disorder – 14. Connor Dependant Relationship – 15. Moira Dissociative Amnesia / Psychogenic Amnesia – (*Jason Bourne character) 16. Eylam Dissociative Fugue / Psychogenic Fugue – 17. Amit Dissociative Identity Disorder / Multiple Personality Disorder – 18. Liam Echolalia – 19. Dax Factitous Disorder – 20. Lorna Neurotic Fear of the Future – 21. Ciaran Ganser Syndrome – 22. Jean-Pierre Korsakoff’s Syndrome – 23. Ivor Neurotic Paranoia – 24. Tucker Persecutory Delusions / Querulant Delusions – 25. Lewis Post-Traumatic Stress Disorder – 26. Abdul Proprioception – 27. Alisa Repressed Memories – 28. Kirk Schizophrenia – 29. Trevor Self-Victimization – 30. Jerome Shame-based Personality – 31. Aimee Stockholm Syndrome – 32. Delphine Taijin kyofusho (Japanese culture-specific syndrome) – 33. Lyndon Tourette’s Syndrome – 34. Adar Social phobias – A N S W E R K E Y, Disorder Gathering 36 Adjustment Disorder – BERKELEY Apotemnophilia
    [Show full text]
  • An "Authentic Wholeness" Synthesis of Jungian and Existential Analysis
    Modern Psychological Studies Volume 5 Number 2 Article 3 1997 An "authentic wholeness" synthesis of Jungian and existential analysis Samuel Minier Wittenberg University Follow this and additional works at: https://scholar.utc.edu/mps Part of the Psychology Commons Recommended Citation Minier, Samuel (1997) "An "authentic wholeness" synthesis of Jungian and existential analysis," Modern Psychological Studies: Vol. 5 : No. 2 , Article 3. Available at: https://scholar.utc.edu/mps/vol5/iss2/3 This articles is brought to you for free and open access by the Journals, Magazines, and Newsletters at UTC Scholar. It has been accepted for inclusion in Modern Psychological Studies by an authorized editor of UTC Scholar. For more information, please contact [email protected]. An "Authentic Wholeness" Synthesis of Jungian and Existential Analysis Samuel Minier Wittenberg University Eclectic approaches to psychotherapy often lack cohesion due to the focus on technique and procedure rather than theory and wholeness of both the person and of the therapy. A synthesis of Jungian and existential therapies overcomes this trend by demonstrating how two theories may be meaningfully integrated The consolidation of the shared ideas among these theories reveals a notion of "authentic wholeness' that may be able to stand on its own as a therapeutic objective. Reviews of both analytical and existential psychology are given. Differences between the two are discussed, and possible reconciliation are offered. After noting common elements in these shared approaches to psychotherapy, a hypothetical therapy based in authentic wholeness is explored. Weaknesses and further possibilities conclude the proposal In the last thirty years, so-called "pop Van Dusen (1962) cautions that the differences among psychology" approaches to psychotherapy have existential theorists are vital to the understanding of effectively demonstrated the dangers of combining existentialism, that "[when] existential philosophy has disparate therapeutic elements.
    [Show full text]
  • V O L N E Y P. G a Y R E a D I N G F R E U D
    VOLNEY P. GAY READING FREUD Psychology, Neurosis, and Religion READING FREUD READING FREUD %R American Academy of Religion Studies in Religion Charley Hardwick and James O. Duke, Editors Number 32 READING FREUD Psychology, Neurosis, and Religion by Volney P. Gay READING FREUD Psychology, Neurosis, and Religion VOLNEY P. GAY Scholars Press Chico, California READING FREUD Psychology, Neurosis, and Religion by Volney P. Gay ©1983 American Academy of Religion Library of Congress Cataloging in Publication Data Gay, Volney Patrick. Reading Freud. (Studies in religion / American Academy of Religion ; no. 32) 1. Psychoanalysis and religion. 2. Freud, Sigmund, 1856-1939. 3. Religion—Controversial literature—History. I. Title. II. Series: Studies in Religion (American Academy of Religion) ; no. 32. BF175.G38 1983 200\1'9 83-2917 ISBN 0-89130-613-7 Printed in the United States of America for Barbara CONTENTS Acknowledgments viii Introduction ix Why Study Freud? Freud and the Love of Truth The Goals of This Book What This Book Will Not Do How to Use This Book References and Texts I Freud's Lectures on Psychoanalysis 1 Five Lectures on Psycho-analysis (SE 11) 1909 Introductory Lectures on Psycho-analysis (SE 15 & 16) 1915-16 II On the Reality of Psychic Pain: Three Case Histories 41 Fragment of an Analysis of a Case of Hysteria (SE 7) 1905 "Dora" Notes Upon a Case of Obsessional Neurosis (SE 10) 1909 "Rat Man" From the History of an Infantile Neurosis (SE 17) 1918 "Wolf Man" III The Critique of Religion 69 "The Uncanny" (SE 17) 1919 Totem and Taboo (SE 13) 1912-13 Group Psychology and the Analysis of the Ego (SE 18) 1921 The Future of an Illusion (SE 21) 1927 Moses and Monotheism (SE 23) 1939 References Ill Index 121 Acknowledgments I thank Charley Hardwick and an anonymous reviewer, Peter Homans (University of Chicago), Liston Mills (Vanderbilt), Sarah Gates Campbell (Peabody-Vanderbilt), Norman Rosenblood (McMaster), and Davis Perkins and his colleagues at Scholars Press for their individual efforts on behalf of this book.
    [Show full text]
  • Compensation Neurosis: a Too Quickly Forgotten Concept?
    ANALYSIS AND COMMENTARY Compensation Neurosis: A Too Quickly Forgotten Concept? Ryan C. W. Hall, MD, and Richard C. W. Hall, MD There has been great debate concerning the existence and meaning of compensation neurosis. It is included in the International Classification of Diseases (ICD)-9 and -10 but not listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). On the eve of publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), we re-examine the history and concept of compensation neurosis and conceptually update the condition to reflect current psychiatric thought. We consider its utility as a diagnostic entity for forensic evaluations and its components as they relate to exaggeration in injury claims. We also discuss how compensation neurosis differs from malingering and factitious disorder. J Am Acad Psychiatry Law 40:390–8, 2012 The use of the term compensation neurosis was more which are based more on operationally or function- prevalent in the late 1800s to the mid-1900s than it is ally defined symptom criteria than on the interpreta- today, on the verge of the release of the Diagnostic tion of the patient’s underlying conscious or uncon- and Statistical Manual of Mental Disorders, Fifth scious mental motivations.13,14 Other criticisms are Edition (DSM-5).1–3 Highly revered historical med- that the diagnosis does not have a predictive value, ical figures such as Charcot have commented on as- since many people who receive the diagnosis do not pects of the condition, claiming it was caused by seem to improve or return to work after completion “hysteria and neurasthenia”4–6 (Table 1).
    [Show full text]
  • Office Visits to Psychiatrists; United States, 1985
    Office Visits to Psychiatrists unitedS?ats 1985 Descriptive informationon offiosvisitsto ofk@Msed psychiatristsin 19S5 is pntd. Trend data for 1975-s5 are itwluded. Emphasis is plaoed on patient diagnoses,factors related to the utilization of medkath and psychdkrapy, and typas of -t&n utilized.Ad&ions I information on visit &waowwXispwented* i~l@w ~ i-~, expected source of payment patient disposMon,and visit duration. lxIta Fromthe Ndiond Hedhsurvey slM’ie81&No.94 DHHS PutMoatbn No. (PHS) SS-1755 U.S. Department of Health and Human Public Health Servke centers for Disea8e control National center for Health statistics Hyatlsville,M(I. May 19S8 ., Copyright Informath All material appearing in this report is in the public domain and may be reproduced or copied without parmiseicq citation as to source, however, IS appreciated. suggested txation National Center for Health Statistics, G. J. Gardocki. 1988. Office visits to psychiatrists: United States, 1985. Vita/ and +/ea/th Statistics. Series 13, No. 9$ DHHS Pub. No. (PHS) 88-1755, Pubhc Health service. Washington: U.S. Government Printing Office. Library of Congraee Catalogk@n-PMioatbn Data Gardocki, Gloria J. OffiCOvisits to psychiatrist: Unitad States, 1985. p. cm.—(Vltal & health statistics. Series 13, Data from the National Health Survey; no. 84) (DHHS publication ; no. (PHS) 88-1755) Author: Gloria J, Garaocki. r Bibliography: p. ISBN 0+340S+3904 1. Mental health earvicea-Unitad Statee-Utilization-Stat@lcs. 2. Psychotherapy patiente-United Statee-Statistics. 3. Mental health suweys—Unitad States. 1. National Canter for Health Statistics (U.S.) 11.Title. Ill. Series. IV. Series: DHHS publication ; no. (PHS) 88-1755.
    [Show full text]
  • Psychopathy and Internalizing Psychopathology
    International Journal of Law and Psychiatry 35 (2012) 269–275 Contents lists available at SciVerse ScienceDirect International Journal of Law and Psychiatry Psychopathy and internalizing psychopathology Jochem Willemsen ⁎, Paul Verhaeghe Department of Psychoanalysis and Clinical Consulting, Ghent University, Henri Dunantlaan 2, B-9000 Ghent, Belgium article info abstract Available online 6 May 2012 There is general consensus in clinical and research literature that the core feature of psychopathy consists of an affective deficit. However, previous studies tend to find weak and inconsistent associations between psy- Keywords: chopathy and measures of internalizing psychopathology. In this study we test whether the predominant Psychopathy practice of using questionnaires to assess internalizing psychopathology has influenced the results of previ- PCL-R ous research. We argue that questionnaires measure general distress rather than specific symptoms of inter- Internalizing psychopathology nalizing psychopathology, and that the validity of questionnaires might be impaired by psychopathic traits, General distress Questionnaire such as impression management and lack of affective experience. Combining a questionnaire (Depression Anxiety Stress Scales-21; DASS-21) and a semi-structured interview (Structured Clinical Interview for DSM-IV-R Axis 1 Disorders; SCID-I) for internalizing psychopathology, we test the differential association of both measures with the Psychopathy Checklist—Revised (PCL-R) in a sample of 89 male detainees. In ac- cordance with our prediction, we found moderate negative associations between the Interpersonal and Affec- tive facets of the PCL-R and SCID-I, but no significant associations with the DASS-21. We found no evidence that psychopathic traits decrease the validity of the responses on a questionnaire.
    [Show full text]
  • Borderline Personality Disorder: an Information Guide for Families Isbn: 978-0-88868-819-4 (Print) Isbn: 978-0-88868-817-0 (Pdf) Isbn: 978-0-88868-818-7 (Html) Pm083
    For more information on addiction and mental health issues, or a copy of this booklet, please contact the CAMH McLaughlin Information Centre: Ontario toll-free: 1 800 463-6273 Borderline Toronto: 416 595-6111 This publication may be available in other formats. For informatinoaboutalternate formats, to order multliecopies of thsibooklet, or to order othreCAMH publiactions, pleasecontact personality Sales and Distribution: Toll-free: 1 800vvqmqqqq Toronto: 416 595-6059 E-mail: [email protected] disorder Online store: http://store.camh.net To make a donation, please contact the CAMH Foundation: Tel.: 416ywymvypy E-mail: [email protected] An If you have questions, concerns or compliments about services at CAMH, please contact the Client Relations Service: Tel.: 416usumxupq ext. 2028 or 2078 Website: ww.wcamh.net information guide for families ISBN 978-0-88868-819-4 3 - 2 0 0 9 M p x s A Pan American Health Organization / World Health Organization Collaborating Centre Borderline personality disorder An information guide for families Library and Archives Canada Cataloguing in Publication Borderline personality disorder: an information guide for families isbn: 978-0-88868-819-4 (print) isbn: 978-0-88868-817-0 (pdf) isbn: 978-0-88868-818-7 (html) pm083 Printed in Canada Copyright © 2009 Centre for Addiction and Mental Health No part of this work may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without written permission from the publisher—except for a brief quotation (not to exceed 200 words) in a review or professional work.
    [Show full text]
  • Connecting Neurosis and Psychosis: the Direct Influence of Emotion On
    Behaviour Research and Therapy 41 (2003) 923–947 www.elsevier.com/locate/brat Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations Daniel Freeman a,∗, Philippa A. Garety a,b a Department of Psychology, Institute of Psychiatry, King’s College London, University of London, Denmark Hill, London SE5 8AF, UK b Department of Academic Clinical Psychology, GKT School of Medicine, King’s College London, University of London, St. Thomas’ Hospital, London, UK Accepted 19 June 2002 Abstract Diagnostic classification systems contain a core divide between neurosis and psychosis, leading to their separate study and treatment. The basis for the separation of the disorders is outlined and reassessed. It is argued that the empirical evidence does not support such a sharp distinction between neurosis and psychosis. The frequent occurrence of emotional disorder prior to and accompanying psychosis indicates that neurosis contributes to the development of the positive symptoms of psychosis. Psychological theories and experi- mental evidence concerning the influence of emotion on the content and form of delusions and halluci- nations are therefore reviewed. It is argued that in many cases delusions are a direct representation of emotional concerns, and that emotion contributes to delusion formation and maintenance. The content of hallucinations less often directly expresses the emotional concerns of the individual, but emotion can trigger and contribute to the maintenance of hallucinatory phenomena, although how this occurs is not well under- stood. It is concluded that study needs to be made of the interaction between psychotic and neurotic processes in the development of delusions and hallucinations, and that neurotic and psychotic disorders may have common maintenance processes.
    [Show full text]
  • Manipulation Tactics of Patients with Neurotic Disorders in Everyday Life and During Therapy
    Psychiatr. Pol. 2016; 50(1): 65–76 PL ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE) www.psychiatriapolska.pl DOI: http://dx.doi.org/10.12740/PP/39841 Manipulation tactics of patients with neurotic disorders in everyday life and during therapy Eugenia Mandal 1, Adam Horak 2 1 Institute of Psychology, Chair of Social and Environmental Psychology University of Silesia in Katowice 2 Dr Emil Cyran Provincial Neuropsychiatric Hospital in Lubliniec Summary Aim. The objective of the study was to examine the repertoire and intensity of manipula- tion tactics of neurotic patients in everyday life and during therapy, as well as diagnosing the intensity of Machiavellianism in neurotic patients. Methods. There were 111 study subjects: 44 patients with diagnosed neurotic disorders, 44 people from the control group and 23 therapists. The manipulation tactics were measured by means of survey methods of E. Mandal and D. Kocur and Machiavellianism was measured using the MACH-IV scale of M. Christi and F. Geis. Results. In comparison to people from the control group, the patients were more willing to use manipulation tactics such as guilt induction, threatening to break up the relationship, and self-mutilation but less willing to use supplication/begging. The intensity of tendency to undertake manipulation was higher in everyday life than during therapy. The Machiavellian- ism of patients was positively correlated with the tendency to employ manipulation tactics. Differences within the scope of general Machiavellianism between the patients and the control group were not noted. Conclusions. The manipulation tactics of neurotic patients are of morbid nature. They are related to anxiety, feeling of guilt and hostility.
    [Show full text]
  • On Extraordinary Neurosis: an Introduction Renaud Evrard
    On Extraordinary Neurosis: An Introduction Renaud Evrard To cite this version: Renaud Evrard. On Extraordinary Neurosis: An Introduction. Recherches en psychanalyse, Univer- sité Paris 7- Denis Diderot, 2013, Sujet, subjectivités et pratiques de corps dans le monde contem- porain / Subject, Subjectivities, and Practices of the Body in the Contemporary World, pp.78a-86a. 10.3917/rep.015.0078a. halshs-02137214 HAL Id: halshs-02137214 https://halshs.archives-ouvertes.fr/halshs-02137214 Submitted on 22 May 2019 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Evrard, R. (2013g). On Extraordinary Nevrosis: An Introduction. Research in Psychoanalysis, n°15, 78a-86a. 1 – Introduction 1Recent research into the notion of “ordinary psychosis” has shown the considerable fecundity and pertinence of the structuralist conception of psychosis (Miller, 1999, 2009). The first conception of Lacan’s psychoses drew on the “extraordinary psychosis” of President Schreber, with a clinical picture that included above all hallucinations and delusions. The second conception, based around the Borromean knots and the sinthome, concerned Joyce. Lacan showed that Joyce was not delusional in everyday life, but his psychotic structure could be read in his writings and his literary ambitions.
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders
    The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines World Health Organization -1- Preface In the early 1960s, the Mental Health Programme of the World Health Organization (WHO) became actively engaged in a programme aiming to improve the diagnosis and classification of mental disorders. At that time, WHO convened a series of meetings to review knowledge, actively involving representatives of different disciplines, various schools of thought in psychiatry, and all parts of the world in the programme. It stimulated and conducted research on criteria for classification and for reliability of diagnosis, and produced and promulgated procedures for joint rating of videotaped interviews and other useful research methods. Numerous proposals to improve the classification of mental disorders resulted from the extensive consultation process, and these were used in drafting the Eighth Revision of the International Classification of Diseases (ICD-8). A glossary defining each category of mental disorder in ICD-8 was also developed. The programme activities also resulted in the establishment of a network of individuals and centres who continued to work on issues related to the improvement of psychiatric classification (1, 2). The 1970s saw further growth of interest in improving psychiatric classification worldwide. Expansion of international contacts, the undertaking of several international collaborative studies, and the availability of new treatments all contributed to this trend. Several national psychiatric bodies encouraged the development of specific criteria for classification in order to improve diagnostic reliability. In particular, the American Psychiatric Association developed and promulgated its Third Revision of the Diagnostic and Statistical Manual, which incorporated operational criteria into its classification system.
    [Show full text]
  • Neurosis and Sexuality by Eliot Slater (Received 31St January, 1945)
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.8.1-2.12 on 1 January 1945. Downloaded from NEUROSIS AND SEXUALITY BY ELIOT SLATER (RECEIVED 31ST JANUARY, 1945) Introduction They state that 44 per cent. more of the enlisted NEUROTIC men have been found to differ from men than of the patients showed an average sexual normal men in a number of particulars, in the development, 30 per cent. had regular girl friends frequency with which they show qualitative findings 41 per cent. more had intentions to marry. Abso- and in the degree to which they show quantitative lute figures are not given. Also in the U.S.A. -findings. In addition they have been found to be Steinberg and Wittman (1943) have reported on abnormally heterogeneous. In respect of graded their findings on 267 men from the Services. Of characters we may expect them at times to vary these 158 formed a control group, 22 were predomi- from normals at both ends of the scale. If we nantly neurotic, and 87 predominantly psychotic. choose a single criterion for the distinguishing of As tested by the Elgin developmental history, the neurotics from normals, we cannot expect it to be psychotic subjects (of whom 76 per cent. were of value over more than part of the 1ange; it may schizophrenic) made a less satisfactory early sex be useful in distinguishing some neurotics but not adjustment than the controls, but the difference all. For instance, Rees and Eysenck (1945) have between the neurotic patients and the controls was shown that an index relating stature to transverse negligible; the same was largely true for adult sex copyright.
    [Show full text]