Friday, 24 November 2017
Thursday, 23 November 2017
Wednesday, 22 November 2017
"Dr. Brian Halloran, a vascular surgeon at St. Joseph Mercy Ann Arbor, starts planning his garden long before spring arrives in southeast Michigan. His tiny plot, located in the shadow of the 537-bed teaching hospital, helps Halloran cope with burnout from long hours and the stress of surgery on gravely ill patients. "You really have to find the balance to put it a little more in perspective," he said.
Hospitals such as St. Joseph Mercy Ann Arbor have been investing in programs ranging from yoga classes to personal coaches designed to help doctors become more resilient. But national burnout rates keep rising, with up to 54 percent of doctors affected."
Burnout as a syndrome is marked by emotional exhaustion, cynicism and decreased effectiveness. A 2015 Mayo Clinic study found that more than 7% of 7,000 doctors had considered suicide within the prior 12 months, compared with 4 percent of other workers.
Some blame the way medicine is practiced in the United States since the introduction of EMRs, fueled in part by growing clerical demands that have doctors spending two hours on the computer for every one hour they spend seeing patients.
It can cost more than a $1 million to recruit and train a replacement for a doctor who leaves because of burnout.
Atrius Health, Massachusetts' largest independent physicians group, is aiming to cut 1.5 million mouse "clicks" per year.
Tips for managing stress (watch the 2-minute BBC video embedded below)
- Take a few deep breaths
- Get plenty of exercise
- Socialize - don't stress alone, talk to someone and have a laugh
- Get out - go to the park
Read more: http://www.bbc.co.uk/scotland/brainsmart
Counting the costs: U.S. hospitals feeling the pain of physician burnout
Tuesday, 21 November 2017
Monday, 20 November 2017
Moving along the treadmill of life, many of us succumb to the ever-present pressures to be faster, stronger, more efficient, and smarter. Perspective on what is happening in our lives is lost. We focus on failure and lacking within ourselves, rather than the abundance and opportunities for growth that surround us.
We stop taking the time to appreciate the simple pleasures of our lives as we spiral our way into a depleted existence—physically, emotionally, and mentally. Now more than ever, there is a global need to circumvent this pattern of being. We need to learn to unconditionally love and appreciate ourselves just as we are, how we are.
Traditionally, it was believed the cause of stress, anxiety, and depression was attributable to genetic disposition, personality traits, the existence of stressful events, physical health problems, and substance abuse, as well as serotonin, dopamine, and epinephrine imbalances within the brain. Whilst this is largely still the case, this perception has altered over the last decade or so.
In our fast-paced world, we judge ourselves as harshly as we judge others. We are encouraged and manipulated to compete with others with whom we continually compare ourselves. We try so hard to emulate or exceed expectations placed upon us that we forget our personal needs in the process (no time for that!). Stress and anxiety often manifest as a result as we try and prove our worth to the world, and depression looms when we judge ourselves as falling short of the benchmark that is set for us to achieve.
Prolonged periods of stress wreak havoc on the human mind and body. Chronic muscle tension leads to tension headaches and migraines. The cardiovascular, respiratory, and endocrine systems become over-taxed and the risk increases for the development of diseases like asthma, type 2 diabetes, and heart disease (just to name a few).
In recent times the media has reported stress, anxiety, and depression as reaching epidemic proportions, reportedly attributable to numerous causes including an increase in hours in front of computer screens, national and cultural competitiveness, the exposure to a broadening range of choices due to advances in technology, and the belief that worthiness is related to monetary success. Additionally, there is a sense of “collective stress” in regards to issues such as climate change and terrorism.
Mindfulness & Self-Reflection
Whilst living a faster pace, society has forgotten the art of living in the present moment, and yet there is much evidence to support that engaging in mindfulness and self-reflection enables sufferers to break the cycle of anxiety, stress, and depression as it promotes a greater sense of well-being and perspective.
Those who engage in the art of mindfulness and self-reflection can improve their ability relate to the world around them in a more compassionate and empathetic manner. A feeling of gratitude, joy, and abundance is also often a pleasant side effect.
The Value of Meditation & Journaling
Studies have shown that journaling can positively impact a person’s mental health as it allows one to “capture” a thought for long enough to acquire a 360-degree perspective on what that thought is about, where it came from, and how acting on that thought might impact those around us.
Many forms of meditation, like mindfulness meditation, work particularly well with journaling as it takes the mind out of a conscious, judgmental state and into a reflective, sub-conscious state. Such meditative practices smooth the path for writing down thoughts and feelings by prompting less judgment of the thoughts being written down.
Meditative practice can be merely taking five minutes to go for a walk in the park or to focus on breathing patterns—anything that promotes being in the present moment. Likewise, there are many effective journaling techniques that may help people with self-reflection and mindfulness that work well with meditation, and they are not restricted just to writing.
For many, mindfulness can be achieved through writing, art, photography – any means that allows a person to step into a reflective zone. It is for an individual to explore what takes them to that special place where they can set down their emotional and mental baggage to touch base with their soul, and nurturing a sense of gratitude and appreciation for all the simple attainable pleasures within day to day life.
University of Michigan Depression Center, Depression toolkit.org. Journaling http://www.depressiontoolkit.org/takecare/journaling.asp
Tams, L, Journalling To Reduce Stress (1 May, 2013) Michigan State University Extensiona, < href="http://msue.anr.msu.edu/news/journaling_to_reduce_stress">http://msue.anr.msu.edu/news/journaling_to_reduce_stress
Hidaka BH, Depression as a disease of modernity: explanations for increasing prevalence, 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330161/
McCormack, A, “Lovitude: Trying To Calm The Monkey Mind”, 2016, Peacock Dreaming Publications, Nelson (NZ)Read More Here..
Sunday, 19 November 2017
We are the only species on the planet known to practice religion. This feature is universal among humans: there is no nation on Earth that does not practice one or another form of spiritual belief.
The question is what makes our brain different so that we practice spirituality? Does religion serve any purpose to our species in terms of benefiting survival and progress? These questions are very philosophical. Many thinkers believe that religiosity is what distinguishes Homo sapiens from the rest of the animal kingdom and brought our species to dominate this planet. On the other hand, a large numbers of thinkers believe that religion impedes progress and keeps our society in a barbaric state. There is no doubt that religion played a very important role in early human history: providing the first explanations for the existence of the world around us. The need for such explanation highlights an important step in the development of the brain and cognitive processes.
Behavioral traits might become strengthened by evolution if they bring survival benefits. Researchers think that altruism, for instance, is this kind of behavioral trait: it might be disadvantageous for a particular individual at a particular instance, but it brings advantages to the species in general. Altruistic behavior is promoted by the majority of the world’s religions. Therefore, religious practices might have provided evolutionary advantages for early humans in terms of survival too.
Some people are so deeply religious that the system of beliefs they practice shapes their whole life. It would be reasonable to assume that something interesting should be going on in their brain. It is also quite likely that these brain processes are different from the processes in the brains of unbelievers. This is what the new science of neurotheology is aiming to study. Neurotheology investigates the neural correlates of religious and spiritual beliefs. Such studies may help to uncover why some people are more inclined towards spirituality, while others remain deeply skeptical about the whole idea of God’s existence.
There are already some interesting findings from the field of neuroscience that can help to open the window into the spiritual brain.
First, there is no single part of the brain which is “responsible” for an individual’s relationship with their God/s. Like any emotionally intense human experience, religious experiences involves multiple parts and systems of the brain. Several experiments with the use of brain scanners confirm this point of view. In one study, Carmelite nuns were asked to remember their most intense mystical experience while neuroimaging of their brain was conducted. The loci of activation in this experiment were observed in the right medial orbitofrontal cortex, right middle temporal cortex, right inferior and superior parietal lobules, right caudate, left medial prefrontal cortex, left anterior cingulate cortex, left inferior parietal lobule, left insula, left caudate, and left brainstem.
Similarly, an fMRI study on religious Mormon subjects found areas of activation in the nucleus accumbens, ventromedial prefrontal cortex, and frontal attentional regions. The nucleus accumbens is the brain area associated with reward. It is also involved in emotional responses to love, sex, drugs, and music. One recent study also identified a number of changes in regional cortical volumes that are associated with several components of religiosity, such as an intimate relationship with God and fear of God.
It appears likely that life-changing religious experiences may be linked to changes in brain structure. For instance, one study demonstrated that the brains of older adults who reported such experiences feature a degree of hippocampal atrophy. Hippocampal atrophy is an important factor in the development of depression, dementia, and Alzheimer’s disease. It remains unclear exactly how structural changes in the brain and the level of religiosity relate to each other.
It is well known that some drugs simulate spiritual experiences. For instance, psilosybin, the active ingredient in “magic mushrooms”, stimulates temporal lobes and mimics religious experiences. This implies that spirituality is rooted in neuronal physiology. It is no wonder that psychoactive compounds are often used in ritualistic and shamanistic practices around the world.
All studies that involve brain imaging of people in specific states suffer from one major limitation: it is hard to be sure that people are actually in that particular state at the time of measurement. For instance, if we measure the brain activity when a subject is supposed to solve a mathematical task, we can’t be 100% sure that his or her mind is not wondering around instead of focusing on the task. The same applies to the measurement of any spiritual state. Therefore, the patterns of brain activation obtained through brain imaging should not be viewed as ultimate proof of any theory.
Various religious practices have the potential to influence our health, in both positive and negative directions. It was noted that religious people, in general, have a lower risk of anxiety and depression. This, in turn, is linked to a stronger immune system. On the other hand, people engaged in religious struggles might experience the opposite effects. Research into the brain’s response to religious practices might help to develop further our understanding of the connection between health and spirituality.
Beauregard M and Paquette V (2006) Neural correlates of a mystical experience in Carmelite nuns. Neuroscience Letters 405(3):186-90. DOI: 10.1016/j.neulet.2006.06.060
Griffiths RR et al. (2006) Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology. 187 (3): 268–83; discussion 284–92. doi:10.1007/s00213-006-0457-5.
Griffiths RR et al. (2008) Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later. Journal of psychopharmacology. 22 (6): 621–32. doi:10.1177/0269881108094300.
Kapogiannis D et al. (2009) Neuroanatomical Variability of Religiosity. PLoS ONE4(9): e7180. https://doi.org/10.1371/journal.pone.0007180
Kapogiannis D et al. (2009). Cognitive and neural foundations of religious belief. Proceedings of the National Academy of Sciences of the United States of America, 106(12), 4876–4881. http://doi.org/10.1073/pnas.0811717106
Sayadmansour A (2014) Neurotheology: The relationship between brain and religion. Iranian Journal of Neurology, 13(1), 52–55.Read More Here..
Friday, 17 November 2017
Medicinal plants still comprise a nebulous cloud in biomedical science. We know they have been used since the dawn of man, but there are precious few good quality scientific studies that support their use. Unlike pharmaceutical drugs, plant medicines consist of many different molecules that interact together in the body to have a variety of, poorly understood, pharmacological effects. Despite variably successful attempts to identify single molecules in plants for drug development, we should acknowledge that the whole is greater than a single part. There is an increasing number of clinical studies which strongly imply that root, leaf, and flower extracts of medicinal plants can influence the brain and are effective at treating cognitive disorders. This article series will examine plants where we have double-blind, placebo-controlled studies to support their medicinal influence on the human brain.
St. John’s wort is a commonly known plant that is native to Europe and yields bright yellow flowers. Its name comes from flowering around St. John’s day on the 24th June. St. John’s wort has been used as long ago as the ancient Greeks, and the physician Dioscorides (40–90AD) used it in the treatment of sciatica. However, St. John’s wort has become known as less of a treatment for nerve pain and more so for depression, with multiple double-blind, placebo-controlled trials confirming its antidepressant properties. Authors typically compare St. John’s wort with mainstream anti-depressant drugs and find it has a preferable side effects profile. It is not without its downsides however, as excessive use has been linked to serotonin syndrome, sun sensitivity, and easy skin burning, and more generally with increased pharmaceutical drug metabolism by the liver. This means St. John’s wort may not be suitable for applications alongside other pharmaceutical drugs, and it is contraindicated with serotonin reuptake inhibitors.
American skullcap is a member of the mint family that is native to North America and grows wild in meadows and swamps. It was used by the Native Americans as a sedative and America’s 19th century physicians, the Eclectics, widely used the herb for complaints involving an overactive nervous system such as insomnia, anxiety, and epilepsy. A human double-blind, placebo-controlled study supports skullcap’s application against anxiety, and a mood elevating effect has also been noted. Herbalist’s view both St. John’s wort and American skullcap as ‘nervine tonics’, meaning that they act upon the nervous system medicinally and are also considered to have a long-term renewing effect. While, this claim is yet to be verified by scientific studies, it certainly warrants further investigation.
Ashwagandha, the root of which is a popular home remedy in India, is a plant native to India that is mentioned in the traditional Ayurvedic medical text, the Charaka Samhita, approximately 2000 years ago. Here it is recommended as a tonic for emancipation, reproductive ability, and longevity. In Ayurveda, it is classified as a ‘rasayana herb’, a class of plant that are considered to restore and support long-term health and that overlaps to some degree with the Western definition of a ‘tonic herb’. Two double-blind, placebo-controlled human studies support ashwagandha’s role in the reduction of anxiety. It’s wide-ranging medicinal properties are supported by two additional well-controlled, human clinical studies on osteoarthritis and subclinical hypothyroidism. The emerging picture is that ashwagandha possesses a wide range of medicinal properties that will likely be better understood in the future. Ashwagandha has been well-tolerated across clinical trials, with a side effect profile similar to placebo.
Auddy B, Hazra J, Mitra A, Abedon B, and Ghosal S. A standardized Withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: A double-blind, randomized, placebo-controlled study. J Am Nutraceutical Assoc. 2008;11:50–6. Access here.
Brock C, Whitehouse J, Tewfik I, and Towell T. (2014). American Skullcap (Scutellaria lateriflora): A Randomised, Double-Blind Placebo-Controlled Crossover Study of its Effects on Mood in Healthy Volunteers. Phytotherapy Research, 28(5), 692-698. DOI: 10.1002/ptr.5044
Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471. ISBN: 1605298891
Chandrasekhar K, Kapoor J, and Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine 34.3 (2012): 255. DOI: 10.4103/0253-7176.106022
Dannawi M. Possible serotonin syndrome after combination of buspirone and St John’s Wort. Journal of Psychopharmacology 16.4 (2002): 401-401. DOI: 10.1177/026988110201600420
Hoffman, David. Holistic herbal. Element Books, 1988. ISBN: 1852300248
Laakmann G, Schüle C, Baghai T, and Kieser M. St. John’s wort in mild to moderate depression: the relevance of hyperforin for the clinical efficacy. Pharmacopsychiatry 31.S 1 (1998): 54-59. DOI: 10.1055/s-2007-979346
Markowitz JS, Donovan JL, DeVane CL, Taylor RM, Ruan Y, Wang JS, and Chavin KD. Effect of St John’s wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. Jama 290.11 (2003): 1500-1504. DOI: 10.1001/jama.290.11.1500
Ramakanth GS, Uday Kumar C, Kishan PV, and Usharani P. A randomized, double blind placebo controlled study of efficacy and tolerability of Withaina somnifera extracts in knee joint pain. Journal of Ayurveda and integrative medicine 7.3 (2016): 151-157. DOI: 10.1016/j.jaim.2016.05.003
Scudder, John. Specific Medication and Specific Medicines, 1870. ISBN:
Sharma AK, Basu I, and Singh S1. Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. The Journal of Alternative and Complementary Medicine (2017). DOI: 10.1089/acm.2017.0183
Szegedi A, Kohnen R, Dienel A, and Kieser M. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John’s wort): randomised controlled double blind non-inferiority trial versus paroxetine. Bmj 330.7490 (2005): 503. DOI: 10.1136/bmj.38356.655266.82
Woelk, Helmut. Comparison of St John’s wort and imipramine for treating depression: randomised controlled trial. Bmj 321.7260 (2000): 536-539. PMCID: PMC27467
Wolfson P and Hoffmann DL. An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers. Alternative therapies in health and medicine 9.2 (2003): 74. PMID: 12652886Read More Here..
Thursday, 16 November 2017
UN leaders appeal for immediate lifting of humanitarian blockade in Yemen – lives of millions are at risk
When we are confronted with the acts of excessive and unprovoked violence, we can’t help but wonder what is wrong with individuals committing such crimes. Think of serial killers: what motivates them? Both researchers and society, in general, have wanted to know how to explain the extreme brutality observed in some people. In most cases, they have no mental disorders that could explain their behavior. Even without going to the extremes, most of us did at some point in life come across people whose level of aggressiveness seemed beyond any reasonable explanation. Think of a hooligan looking for any excuse to pick a fight and beat someone up. Or a young boy torturing a defenseless animal with a smile on his face. Multiple theories were invented to this end, ranging from religious explanations (satanic possession) to scientific and psychological theories that involve a variety of mental disorders or problems with brain development.
The idea that excessive aggressiveness and criminal tendency might be heritable traits gained popularity with the publication of Dr. Cesare Lombroso’s book “Criminal Man” in 1878. In the book, Lombroso introduced the concept of the “born criminal”. He also developed the field of criminal anthropology that studied specific anatomical differences between normal and criminal individuals. Lombroso’s theory contributed to the science of eugenics that played a crucial role in the Nazi ideology of selective breeding of a superior race and the policy of exterminating the Untermenschen.
Although Lombroso was eventually proven wrong, the concept that criminal behavior might be linked with genes survived. Evidence that criminal and violent behaviors run in some families was a particularly strong argument to investigate the issue further. These investigations produced rather interesting discoveries.
The question to what degree the predisposition for crime might be genetically determined was first answered by a twin study performed in Denmark. Twins are ideal subjects for genetic research: identical twins have exactly the same sets of genes, while non-identical twins are as similar to each other as usual brothers and sisters. However, both identical and non-identical twins, if brought up together, can be considered as having the same upbringing. The study compared the rate of crime offenses among the identical twins with this rate in non-identical twins. It turned out that a Danish man with an identical twin who has a criminal record is 50% more likely to be an offender himself, as compared with the average Danish man. In non-identical twins, the chances of both of them having the criminal records are 15-30% higher than the average for the population. The findings definitely point to a degree of genetic predisposition. In addition, another study performed in Sweden has shown that when the identical twins were brought up separately, the chances of developing a criminal career were higher among children from parents with criminal records, even when the children were brought up in law-abiding adopted families.
Twin studies can detect correlations but certainly can’t help in finding out which genes are behind these correlations. The study performed in the Netherlands provided important information on the possible identity of such genes. Researchers have studied genetic defects in one particular family with 14 males spanning 4 generations that displayed an unusually high level of aggression and criminal offenses. The subjects in question had very low IQ (around 85) and were prone to impulsive behavior and physical and sexual violence. The researchers found a specific hereditary defect in the family: the gene for monoamine oxidase A (MAOA) was mutated. Mutation prevented the enzyme from working properly. This is important as this enzyme is responsible for breaking down neurotransmitters, including serotonin, dopamine, and noradrenaline. A lack of MAOA activity leads to the rising of neurotransmitter levels in the brain and they, in turn, cause the over-excitation of neurons. The gene for MAOA is located on the X chromosome, and this explains why high levels of aggression were observed only in males. Meanwhile, females have a second X chromosome with the non-mutated functional version of the gene.
An important question, which sparked fierce ethical debate, is to what extent criminal behavior might indeed be genetically programmed. This is a classic discussion of nature vs nurture. To what extent do our genes make us who we are? We easily accept the fact that some people are born smarter or physically stronger than the rest of us. We know that genes are involved in making these individuals who they are. Genes responsible for stronger muscles or better brain connections allow these people to excel where others may struggle. Nonetheless, the idea that some of us are born with a predisposition for a higher level of aggression or reduced empathy appears very unpalatable to many people. However, this idea makes perfect biological sense. We evolved as hunter-gatherers, and at this stage of our evolutionary history, aggressiveness was crucially important for survival. Genetically, we didn’t change since the Stone Age. And this aggressiveness still plays an important role in our society, from competition in the workplace to multiple armed conflicts around the world. Aggression levels, like many other human behavioral traits, can be genetically determined to a degree. This means that there is variability: in some people, the level of aggressiveness is very low, while in others it can be quite high.
Aggressiveness still doesn’t equal crime: although violent crime requires a perpetrator to be aggressive, the two things are not the same. Social factors still play a key role when it comes to the expression of aggressive behavior. It works the same way with other genetic attributes. A born athlete will never reach his Olympic dream and could turn into a couch potato if they don’t train. Most scientists, even the very successful ones, are not born geniuses: they simply worked and studied hard. Similarly, people with a predisposition for higher levels of aggression are at higher risk of becoming criminals when they are exposed to the social factors that lead them in that direction.
Baum ML (2013) The Monoamine Oxidase A (MAOA) Genetic Predisposition to Impulsive Violence: Is It Relevant to Criminal Trials? Neuroethics 6, 287-306. doi: 10.1007/s12152-011-9108-6.
Brunner HG; Nelen MR; van Zandvoort P; Abeling NGGM; van Gennip AH; Wolters EC; Kuiper MA; Ropers HH; van Oost BA (1993) X-linked borderline mental retardation with prominent behavioral disturbance: phenotype, genetic localization, and evidence for disturbed monoamine metabolism. Am. J. Hum. Genet. 52 (6): 1032–9. PMID 8503438.
Buades-Rotger, M., & Gallardo-Pujol, D. (2014). The role of the monoamine oxidase A gene in moderating the response to adversity and associated antisocial behavior: a review. Psychology Research and Behavior Management, 7, 185–200. doi: 10.2147/PRBM.S40458
Christiansen KO. Seriousness of criminality and concordance among Danish twins. In: Hood R, editor. Crime, Criminology and Public Policy. The Free Press; New York: 1974. pp. 63–77.
Farrington DP, Gundry G, West DJ (1975) The familial transmission of criminality. Med Sci Law 15(3):177-86. doi: 10.1177/002580247501500306
Hunter P (2010) The psycho gene. EMBO Rep. 11 (9): 667–9. doi: 10.1038/embor.2010.122.
Kendler, K. S., Lönn, S. L., Morris, N. A., Sundquist, J., Långström, N., & Sundquist, K. (2014). A Swedish national adoption study of criminality. Psychological Medicine, 44(9), 1913–1925. doi: 10.1017/S0033291713002638.
McDermott R et al. (2009) Monoamine oxidase A gene (MAOA) predicts behavioral aggression following provocation. Proc Natl Acad Sci USA 106, 2118–2123. doi: 10.1073/pnas.0808376106.
Taylor S (2013) Criminal Minds: The Infuence of the Monoamine Oxidase AGenotype and Environmental Stressors on Aggressive Behaviour. Burgmann Journal II, 71-77. link hereRead More Here..
Wednesday, 15 November 2017
Tuesday, 14 November 2017
Dissociative identity disorder (DID, commonly referred to as multiple personality disorder) is well known to the general public through multiple movies and books. However, the disease remains poorly understood and rather mysterious for the medical specialists. The definition of this disorder implies that a patient has at least two distinctive and relatively long-lasting identities (sometimes called “alters”) that manifest themselves in a person’s behavior. Their presence is accompanied by memory impairments that cannot be explained by usual forgetfulness.
However, there are no clear clinical criteria to help in the diagnostics. There is a whole range of dissociative disorders that range from daydreaming and lapses in attention to serious pathologies. The diagnostics rely on descriptive data rather than something measurable. This leads to lots of confusion, controversies, and inconsistencies.
Historically, the incidence of multiple personality disorder varied wildly. For a long time, the condition was considered among the rarest psychological disorders, with less than 100 cases described before 1944. The incidence of DID rose sharply in the 1970s–1980s, reaching 20,000 by the end of the century. In addition, this growth was accompanied by the increase in the number of alters reported in patients, from just one to 13–16 by the 1980s. These changes in the statistics might have been caused by increasing recognition of the disease symptoms among practitioners, but also led to the growing skepticism in the research community about the very existence of this distinct condition.
The variability on the geographic distribution of this condition is substantial too: the disorder is diagnosed in the US much more frequently than anywhere else. The overwhelming majority of publications on this condition originate from North America, making some researchers believe that DID is a purely American disease confined to this continent. This further adds to the skepticism of many health practitioners: there are no reasons to believe that qualified specialists capable of recognizing this condition are vastly underrepresented in other developed countries.
There is little clarity regarding what causes the disorder. The iatrogenic hypothesis suggests that DID can be a result of psychotherapeutic treatment, while the traumatogenic hypothesis states that the disease develops as a result of severe trauma, usually in childhood. Some researchers believe that most cases of DID are pseudogenic, i.e., simulated. There is an opinion that many patients want to believe that they have the disorder, to explain the inconsistencies in their own behavior.
The incidence of DID is 5–9 times higher in females compared to males. Again, there is no agreement among specialists regarding what causes such a big gender difference.
The potential reasons for the sharp increase in the incidence of DID were examined in the scientific literature. Although there are many possible explanations for this phenomenon, the iatrogenic explanation appears to be the most substantiated. The unusually large number of diagnosis in the 1980s were clustered around a small number of practitioners, many of whom used hypnosis as a therapeutic tool. It is quite possible that under the influence of hypnosis the patients with a higher level of suggestibility may start to believe that they are suffering from split personality disorder, and behave accordingly. The level of hypnotisability of people with the diagnosis of DID is known to be the highest among any clinical population.
The rise of the DID diagnosis numbers also correlated with the growing number of split personality cases in the criminal court cases. The defense on the basis of DID was rarely successful, as it was often assumed that the defenders simply pretend to have the disorder to avoid taking responsibility for their crimes.
An opinion exists that the manifestations of DID are simply the consequences of other disorders such as bipolar disorder, schizophrenia, and borderline personality disorder. Many patients diagnosed with DID have previous history of these and other psychiatric conditions. Another theory suggests that the manifestations of DID are the consequences of trauma. There is plenty of clinical cases in support of this theory, but not so much statistical data.
Nonetheless, it is well proven that people with DID are at higher risk of depression and suicide. The patients often suffer from post-traumatic stress disorder, substance abuse, anxiety and eating disorders. Such statistics are not uncommon in other psychiatric conditions, though.
Importantly, there is a shortage of proper neurological studies of this disorder. Nobody knows what exactly causes it and what kind of changes take place in the brains of patients diagnosed with this disease. The brain imaging data from patients with DID do not reveal any specific diagnostic patterns. Several studies demonstrated that the changes in personality state in the DID patients are associated with certain changes in the blood flow in the brain. There are also differences in the brain blood flow patterns between patients with DID and healthy control subjects. It remains uncertain if these differences can be used in the diagnostics.
The question of how real the majority of DID cases are is yet to be fully answered. In general, researchers agree that there are cases with very pronounced and obvious manifestations that would be rather hard to explain without invoking the concept of DID. However, when it comes to less severe cases, the diagnostic remains really problematic. This creates a problem for patients, as not knowing the specific diagnosis means the lack of clarity with treating the problem. Also, there is no consensus regarding how to treat the split personality disorder. Various psychotherapeutic and hypnotherapeutic techniques are currently used, but their efficacy remains unknown due to the absence of controlled randomised clinical trials. Clearly, there is a lot of room for further research in this field.
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Piper A, Merskey H (2004) The persistence of folly: A critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept. Canadian Journal of Psychiatry. 49 (9): 592–600. PMID 15503730.
Spiegel D, Loewenstein RJ, Lewis-Fernández R, Sar V, Simeon D, Vermetten E, Cardeña E, Dell PF (2011) Dissociative disorders in DSM-5. Depression and Anxiety. 28 (9): 824–852. doi:10.1002/da.20874.Read More Here..