Dissociative identity disorder

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Encoding (memory) Psychiatric medication Parietal lobe Psychotherapy Identity formation Psychogenic amnesia Splitting (psychology) Behaviour therapy Fugue state

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Dissociative identity disorder
Dissociative Identity Disorder
Classification and external resources ICD-10 ICD-9 MeSH F44.8 [1] [2] [3]

300.14

D009105

Dissociative identity disorder is a psychiatric diagnosis and describes a condition in which a person displays multiple distinct identities (known as alters or parts), each with its own pattern of perceiving and interacting with the environment. In the International Statistical Classification of Diseases and Related Health Problems the name for this diagnosis is multiple personality disorder. In both systems of terminology, the diagnosis requires that at least two personalities (one may be the host) routinely take control of the individual's behavior with an associated memory loss that goes beyond normal forgetfulness; in addition, symptoms cannot be the temporary effects of drug use or a general medical condition.[4] DID is less common than other dissociative disorders, occurring in approximately 1% of dissociative cases,[5] and is often comorbid with other disorders.[6] There is a great deal of controversy surrounding the topic of DID. The validity of DID as a medical diagnosis has been questioned, and some researchers have suggested that DID may exist primarily as an iatrogenic adverse effect of therapy.[7] [8] [9] [10] [11] DID is diagnosed significantly more frequently in North America than in the rest of the world.[12] [13]

Signs and symptoms

Individuals diagnosed with DID demonstrate a variety of symptoms with wide fluctuations across time; functioning can vary from severe impairment in daily functioning to normal or high abilities. Symptoms can include:[14] Multiple mannerisms, attitudes and beliefs which are not similar to each other Unexplainable headaches and other body pains Distortion or loss of subjective time ( a long time) Depersonalization Derealization Severe memory loss Depression Flashbacks of abuse/trauma Sudden anger without a justified cause Frequent panic/anxiety attacks Unexplainable phobias

Patients may experience an extremely broad array of other symptoms such as pseudoseizures that may appear to resemble epilepsy, schizophrenia, anxiety disorders, mood disorders, post traumatic stress disorder, personality

Dissociative identity disorder disorders, and eating disorders.[14]

Physiological findings
Reviews of the literature have discussed the findings of various psychophysiologic investigations of DID.[15] [16] Many of the investigations include testing and observation in a single person with different alters. Different alter states have shown distinct physiological markers[17] and some EEG studies have shown distinct differences between alters in some subjects,[18] [19] while other subjects' patterns were consistent across alters.[20] Neuroimaging studies of individuals with dissociative disorders have found higher than normal levels of memory encoding and a smaller than normal parietal lobe.[21] Another study concluded that the differences involved intensity of concentration, mood changes, degree of muscle tension, and duration of recording, rather than some inherent difference between the brains of people diagnosed with DID.[22] Brain imaging studies have corroborated the transitions of identity in some DID sufferers.[23] A link between epilepsy and DID has been postulated but this is disputed.[24] [25] Some brain imaging studies have shown differing cerebral blood flow with different alters,[26] [27] [28] and distinct differences overall between subjects with DID and a healthy control group.[29] A different imaging study showed that findings of smaller hippocampal volumes in patients with a history of exposure to traumatic stress and an accompanying stress-related psychiatric disorder were also demonstrated in DID.[30] This study also found smaller amygdala volumes. Studies have demonstrated various changes in visual parameters between alters.[31] [32] [33] One twin study showed hereditable factors were present in DID.[34]

Causes
This disorder is theoretically linked with the interaction of overwhelming stress, traumatic antecedents,[35] insufficient childhood nurturing, and an innate ability to dissociate memories or experiences from consciousness.[14] A high percentage of patients report child abuse.[10] [36] People diagnosed with DID often report that they have experienced severe physical and sexual abuse, especially during early to mid childhood.[37] Several psychiatric rating scales of DID sufferers suggested that DID is strongly related to childhood trauma rather than to an underlying electrophysiological dysfunction.[38] Others believe that the symptoms of DID are created iatrogenically by therapists using certain treatment techniques with suggestible patients,[7] [9] [10] [11] but this idea is not universally accepted.[36] [39] [40] [41] [42] [43] Skeptics have observed that a small number of US therapists were responsible for diagnosing the majority of individuals with DID there, that patients did not report sexual abuse or manifest alters until after treatment had begun, and that the "alters" tended to be rule-governed social roles rather than separate personalities[11] which is consistent with replacing the personalities-focused MPD term with the identities-focused DID term. Additionally in China with "virtually no popular or professional knowledge of DID (...)"[44] where "contamination cannot exist"[44] it has been concluded that "the findings are not consistent with (...) iatrogenic models (...)".

Development theory
It has been theorized that severe sexual, physical, and/or psychological trauma in childhood by a primary caregiver predisposes an individual to the development of DID. The steps in the development of a dissociative identity disorder are theorized to be as follows: 1. The child is harmed by a trusted caregiver and splits off the awareness and memory of the traumatic event to survive in the relationship. 2. The memories and feelings go into the subconscious and are experienced later in the form of a separate part of the self.

Dissociative identity disorder 3. The process reoccurs at future traumatic events resulting in more parts of the self to develop, each containing different memories and performing different functions that are meant to keep the child safe and to allow them to form an attachment to the caregiver. Sometimes abusers attempt to do this deliberately, as in the case of the more morbid abusive group practices of various sects, or torture variations. 4. Dissociation becomes a coping mechanism for the individual when faced with further stressful situations.[45]

Diagnosis
The diagnosis of dissociative identity disorder is defined by criteria in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM-II used the term multiple personality disorder, the DSM-III grouped the diagnosis with the other four major dissociative disorders, and the DSM-IV-TR categorizes it as dissociative identity disorder. The ICD-10 continues to list the condition as multiple personality disorder. The diagnostic criteria in section 300.14 (dissociative disorders) of the DSM-IV require that an adult, for non-physiological reasons, be recurrently controlled by multiple discrete identity or personality states while also suffering extensive memory lapses.[46] While otherwise similar, the diagnostic criteria for children requires also ruling out fantasy. Diagnosis should be performed by a therapist, psychiatrist or psychologist clinically trained in the specific material who may use specially designed interviews (such as the SCID-D) and personality assessment tools to evaluate a person for a dissociative disorder.[4] The psychiatric history of individuals diagnosed with DID frequently but not always contains multiple previous diagnoses of various mental disorders and treatment failures. The proposed diagnostic criteria for DID in the DSM-5 is:[47] 1. Disruption of identity characterized by two or more distinct personality states (one can be the host) or an experience of possession, as evidenced by discontinuities in sense of self, cognition, behavior, affect, perceptions, and/or memories. This disruption may be observed by others, or reported by the patient. 2. Inability to recall important personal information, for everyday events or traumatic events, that is inconsistent with ordinary forgetfulness. 3. Causes clinically significant distress and impairment in social, occupational, or other important areas of functioning. 4. The disturbance is not a normal part of a broadly accepted cultural or religious practice and is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (e.g., complex partial seizures). NOTE: In children, the symptoms are not attributable to imaginary playmates or other fantasy play. These specifiers are under consideration. a) With pseudoseizures or other conversion symptoms b) With somatic symptoms that vary across identities The proposed Criterion C is intended to "help differentiate normative cultural experiences from psychopathology." This phrase, which occurs in several other diagnostic criteria, is proposed for inclusion in 300.14 as part of a proposed merger of dissociative trance disorder with DID. For example, professionals would be able to take shamanism, which involves voluntary possession trance states, into consideration, and not have to diagnose those who report it as having a mental disorder.[48] [49]

Dissociative identity disorder

Screening
The SCID-D[50] may be used to make a diagnosis. This interview takes about 30 to 90 minutes depending on the subject's experiences. The Dissociative Disorders Interview Schedule (DDIS)[51] is a highly structured interview that discriminates among various DSM-IV diagnoses. The DDIS can usually be administered in 3045 minutes. The Dissociative Experiences Scale (DES)[52] is a simple, quick, and validated[53] questionnaire that has been widely used to screen for dissociative symptoms. Tests such as the DES provide a quick method of screening subjects so that the more time-consuming structured clinical interview can be used in the group with high DES scores. Depending on where the cutoff is set, people who would subsequently be diagnosed can be missed. An early recommended cutoff was 15-20[54] and in one study a DES with a cutoff of 30 missed 46 percent of the positive SCID-D[50] diagnoses and a cutoff of 20 missed 25%.[55] The reliability of the DES in non-clinical samples has been questioned.[56] There is also a DES scale for children and DES scale for adolescents. One study argued that old and new trauma may interact, causing higher DID item test scores.[35]

Differential diagnoses
Conditions which may present with similar symptoms include borderline personality disorder, and the dissociative conditions of dissociative amnesia and dissociative fugue.[57] The clearest distinction is the lack of discrete formed personalities in these conditions. Malingering may also be considered, and schizophrenia, although those with this last condition will have some form of delusions, hallucinations or thought disorder.[57]

Treatment
Treatment of DID may attempt to reconnect the identities of disparate alters into a single functioning identity with all its memories and experiences intact - functioning much like the normal brain. In addition or instead, treatment may focus on symptoms, to relieve the distressing aspects of the condition and ensure the safety of the individual. Treatment methods may include psychotherapy and medications for comorbid disorders.[4] Some behavior therapists initially use behavioral treatments such as only responding to a single identity, and using more traditional therapy once a consistent response is established.[58] It has been stated that treatment recommendations that follow from models that do not believe in the traumatic origins of DID might be harmful due to the fact that they ignore the posttraumatic symptomatology of people with DID.[41]

Prognosis
DID does not resolve spontaneously, and symptoms vary over time. Individuals with primarily dissociative symptoms and features of post traumatic stress disorder normally recover with treatment. Those with comorbid addictions, personality, mood, or eating disorders face a longer, slower, and more complicated recovery process. Individuals still attached to abusers face the poorest prognosis; treatment may be long-term and consist solely of symptom relief rather than personality integration. Changes in identity, loss of memory, and awaking in unexplained locations and situations often leads to chaotic personal lives.[14] Individuals with the condition commonly attempt suicide.[6]

Dissociative identity disorder

Epidemiology
The DSM does not provide an estimate of incidence; however the number of diagnoses of this condition has risen sharply. A possible explanation for the increase in incidence and prevalence of DID over time is that the condition was misdiagnosed as schizophrenia, bipolar disorder, or other such disorders in the past; another explanation is that an increase in awareness of DID and child sexual abuse has led to earlier, more accurate diagnosis. Other clinicians believe that DID is an iatrogenic condition over diagnosed in highly suggestive individuals,[59] though there is disagreement over the ability of the condition to be induced by hypnosis.[39] [40] Figures from psychiatric populations (inpatients and outpatients) show a wide diversity from different countries:[60]
Country India Switzerland China Germany Netherlands Prevalence in mentally ill populations 0.015% 0.05 - 0.1% 0.4% 0.9% 2% Source study Chiku et al. (1989) Modestin (1992) [61]

[62] [44]

Xiao et al. (2006) Gast et al. (2001)

[63] [64]

Friedl & Draijer (2000) Bliss & Jeppsen (1985) Ross et al. (1992) [66] [55]

United States 10% United States 6 - 8% United States 6 - 10% Turkey 14%

[65]

Foote et al. (2006) Sar et al. (2007)

[67]

Figures from the general population show less diversity:

Country Canada Turkey (male) Prevalence 1% 0.4% Source study Ross (1991) [68] [69]

Akyuz et al. (1999) Sar et al. (2007)

Turkey (female) 1.1%

[70]

Dissociative identity disorder is diagnosed in a sizable minority of patients in drug abuse treatment facilities.[10]

Comorbidity
Dissociative identity disorder frequently co-occurs with other psychiatric diagnoses, such as anxiety disorders (especially post-traumatic stress disorder-PTSD), mood disorders, somatoform disorders, eating disorders, as well as sleep problems and sexual dysfunction.[6] Dissociative identity disorder has been found to more commonly occur with particular personality disorders including Avoidant Personality Disorder (76% co-morbidity), Self-defeating Personality Disorder (68% co-morbidity), Borderline Personality Disorder (53% co-morbidity) and Passive-Aggressive Personality Disorder (45% co-morbidity).[71] Schizotypal Personality Disorder also had a 58% crossover with dissociative tendencies.[71]

Dissociative identity disorder

History
Before the 19th century, people exhibiting symptoms similar to those were believed to be possessed.[6] An intense interest in spiritualism, parapsychology, and hypnosis continued throughout the 19th and early 20th centuries,[13] running in parallel with John Locke's views that there was an association of ideas requiring the coexistence of feelings with awareness of the feelings.[72] Hypnosis, which was pioneered in the late 18th century by Franz Mesmer and Armand-Marie Jacques de Chastenet, Marques de Puysgur, challenged Locke's association of ideas. Hypnotists reported what they thought were second personalities emerging during hypnosis and wondered how two minds could coexist.[13] The 19th century saw a number of reported cases of multiple personalities which Rieber[72] estimated would be close to 100. Epilepsy was seen as a factor in some cases,[72] and discussion of this connection continues into the present era.[20] [24] By the late 19th century there was a general acceptance that One of ten photogravure portraits of Louis Viv published in Variations de la personnalit by emotionally traumatic experiences could cause long-term disorders Bourru and Burot. which might display a variety of symptoms.[73] These conversion disorders were found to occur in even the most resilient individuals, but with profound effect in someone with emotional instability like Louis Viv (1863-?) who suffered a traumatic experience as a 13 year-old when he encountered a viper. Viv was the subject of countless medical papers and became the most studied case of dissociation in the 19th century. Between 1880 and 1920, many great international medical conferences devoted a lot of time to sessions on dissociation.[74] It was in this climate that Jean-Martin Charcot introduced his ideas of the impact of nervous shocks as a cause for a variety of neurological conditions. One of Charcot's students, Pierre Janet, took these ideas and went on to develop his own theories of dissociation.[75] One of the first individuals diagnosed with multiple personalities to be scientifically studied was Clara Norton Fowler, under the pseudonym Christine Beauchamp; American neurologist Morton Prince studied Fowler between 1898 and 1904, describing her case study in his 1906 monograph, Dissociation of a Personality.[75] Fowler went on to marry one of her analyst's colleagues.[76] In the early 20th century interest in dissociation and multiple personalities waned for a number of reasons. After Charcot's death in 1893, many of his so-called hysterical patients were exposed as frauds, and Janet's association with Charcot tarnished his theories of dissociation.[13] Sigmund Freud recanted his earlier emphasis on dissociation and childhood trauma.[13] In 1910, Eugen Bleuler introduced the term schizophrenia to replace dementia praecox. A review of the Index medicus from 1903 through 1978 showed a dramatic decline in the number of reports of multiple personality after the diagnosis of schizophrenia became popular, especially in the United States.[77] A number of factors helped create a large climate of skepticism and disbelief; paralleling the increased suspicion of DID was the decline of interest in dissociation as a laboratory and clinical phenomenon.[74] Starting in about 1927, there was a large increase in the number of reported cases of schizophrenia, which was matched by an equally large decrease in the number of multiple personality reports.[74] Bleuler also included multiple personality in his category of schizophrenia. It was concluded in the 1980s that DID patients are often misdiagnosed as suffering from schizophrenia.[74]

Dissociative identity disorder

The public, however, was exposed to psychological ideas which took their interest. Mary Shelley's Frankenstein, Robert Louis Stevenson's Strange Case of Dr Jekyll and Mr Hyde, and many short stories by Edgar Allan Poe had a formidable impact.[72] In 1957, with the publication of the book The Three Faces of Eve and the popular movie which followed it, the American public's interest in multiple personality was revived. During the 1970s an initially small number of clinicians campaigned to have it considered a legitimate diagnosis.[74] Between 1968 and 1980 the term that was used for dissociative identity Jekyll and Mr Hyde is known for its portrayal of a disorder was "Hysterical neurosis, dissociative type". The APA wrote: split personality "In the dissociative type, alterations may occur in the patient's state of consciousness or in his identity, to produce such symptoms as amnesia, somnambulism, fugue, and multiple personality."[78] The highly influential book Sybil (which was purported to be true, but has since been identified as likely heavily fictionalized[79] ) was published in 1974, which popularized the diagnosis through a detailed discussion of the problems and treatment of the pseudonymous Sybil. An October, 2011 report on NPR included discussions with Debbie Nathan, author of the book "Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case", and other psychology professionals, about the allegations that the "Sybil" story was, if not a fraud, then a case that involved questionable or duplicitous behavior by the patient, as well as by her doctor, who was interested in the theory and who wanted to believe this was an actual case and who may have been intent on making sure it would be seen as such, and also by the original "Sybil" book's author, who had a large amount of money involved in the book contract.[80] Six years following the publication of the book "Sybil", the diagnosis of multiple personality disorder appeared in the DSM III.[6] Controversy over the iconic case has since arisen, with some calling Sybil's diagnosis the result of iatrogenic therapeutic methods[81] while others have defended the treatment and reputation of Sybil's therapist, Cornelia B. Wilbur.[82] As media coverage spiked, diagnoses climbed. There were 200 reported cases of DID as of 1980, and 20,000 from 1980 to 1990.[83] Joan Acocella reports that 40,000 cases were diagnosed from 1985 to 1995.[84] The majority of diagnoses are made in North America, particularly the United States, and in English-speaking countries more generally[85] with reports recently emerging from other countries.[44] [61] [62] [63]
[64] [67] [69] Robert Louis Stevenson's Strange Case of Dr

Controversy
DID is a controversial diagnosis and condition, with much of the literature on DID still being generated and published in North America, to the extent that it was once regarded as a phenomenon confined to that continent.[7] [13] Even among North American psychiatrists there is a lack of consensus regarding the validity of DID.[8] [86] Practitioners who do accept DID as a valid disorder have produced an extensive literature with some of the more recent papers originating outside North America.[87] Criticism of the diagnosis continues, with Piper and Merskey describing it as a culture-bound and often iatrogenic condition which they believe is in decline.[7] [9] In China with "virtually no popular or professional knowledge of DID (...)"[44] where "contamination cannot exist"[44] it has been concluded that "the findings are not consistent with (...) iatrogenic models (...)". There is considerable controversy over the validity of the multiple personality profile as a diagnosis. Unlike the more empirically verifiable mood and personality disorders, dissociation is primarily subjective for both the patient and the treatment provider. The relationship between dissociation and multiple personality creates conflict regarding the DID diagnosis. While other disorders require a certain amount of subjective interpretation, those disorders more readily present generally accepted, objective symptoms. The controversial nature of the dissociation hypothesis is shown

Dissociative identity disorder quite clearly by the manner in which the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) has addressed, and re-addressed, the categorization over the years. The second edition of the DSM referred to this diagnostic profile as multiple personality disorder. The third edition grouped MPD in with the other four major dissociative disorders. The current edition, the DSM-IV-TR, categorizes the disorder as dissociative identity disorder (DID). The ICD-10 (International Statistical Classification of Diseases and Related Health Problems) continues to list the condition as multiple personality disorder. Psychiatrist Colin A. Ross has stated that based on documents obtained through freedom of information legislation, psychiatrists linked to Project MKULTRA claimed to be able to deliberately induce dissociative identity disorder using a variety of aversive techniques.[88]

Over-representation in North America

In a review,[12] Joel Paris offered three possible causes for the sudden increase in people diagnosed with DID: 1. The result of therapist suggestions to suggestible people, much as Charcot's hysterics acted in accordance with his expectations. 2. Psychiatrists' past failure to recognize dissociation being redressed by new training and knowledge. 3. Dissociative phenomena are actually increasing, but this increase only represents a new form of an old and protean entity: "hysteria". Paris believes that the first possible cause is the most likely. The debate over the validity of this condition, whether as a clinical diagnosis, a symptomatic presentation, a subjective misrepresentation on the part of the patient, or a case of unconscious collusion on the part of the patient and the professional is considerable. There are several main points of disagreement over the diagnosis. Skeptics claim that people who present with the appearance of alleged multiple personality may have learned to exhibit the symptoms in return for social reinforcement. One case cited as an example for this viewpoint is the "Sybil" case, popularized by the news media. Psychiatrist Herbert Spiegel stated that "Sybil" had been provided with the idea of multiple personalities by her treating psychiatrist, Cornelia Wilbur, to describe states of feeling with which she was unfamiliar. One of the primary reasons for the ongoing recategorization of this condition is that there were once so few documented cases (research in 1944 showed only 76[89] ) of what was once referred to as multiple personality. Dissociation is recognized as a symptomatic presentation in response to trauma, extreme emotional stress, and, as noted, in association with emotional dysregulation and borderline personality disorder.[90]

Footnotes
[1] [2] [3] [4] [5] [6] [7] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ F44. 8 http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=300. 14 http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?field=uid& term=D009105 "Mental Health: Dissociative Identity Disorder (Multiple Personality Disorder)" (http:/ / www. webmd. com/ content/ article/ 118/ 112901. htm). Webmd.com. . Retrieved 2007-12-10. Elmore, JL (2000). "Dissociative Spectrum Disorders in the Primary Care Setting". Primary care companion to the Journal of clinical psychiatry 2 (2): 3741. PMC181202. PMID15014580. Sadock 2002, p.681 Piper A, Merskey H (2004). "The persistence of folly: a critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept" (http:/ / ww1. cpa-apc. org:8080/ Publications/ Archives/ CJP/ 2004/ september/ piper. pdf) (pdf). Canadian Journal of Psychiatry 49 (9): 592600. PMID15503730. . Pope HG, Oliva PS, Hudson JI, Bodkin JA, Gruber AJ (1999). "Attitudes toward DSM-IV dissociative disorders diagnoses among board-certified American psychiatrists". The American journal of psychiatry 156 (2): 3213. PMID9989574.

[8]

[9] Piper A, Merskey H (2004). "The persistence of folly: critical examination of dissociative identity disorder. Part II. The defence and decline of multiple personality or dissociative identity disorder". Canadian Journal of Psychiatry 49 (10): 67883. PMID15560314. Full Text (http:/ / ww1. cpa-apc. org:8080/ Publications/ Archives/ CJP/ 2004/ october/ piper. pdf)

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[10] "Dissociative Identity Disorder, patient's reference" (http:/ / www. merck. com/ mmhe/ sec07/ ch106/ ch106e. html). Merck.com. 2003-02-01. . Retrieved 2007-12-07. [11] Carroll, RT (2007-12-03). "Multiple personality disorder (dissociative identity disorder)" (http:/ / www. skepdic. com/ mpd. html). Skeptics Dictionary. . Retrieved 2008-01-22. [12] Paris J (1996). "Review-Essay : Dissociative Symptoms, Dissociative Disorders, and Cultural Psychiatry". Transcult Psychiatry 33 (1): 5568. doi:10.1177/136346159603300104. [13] Atchison M, McFarlane AC (1994). "A review of dissociation and dissociative disorders". The Australian and New Zealand journal of psychiatry 28 (4): 5919. doi:10.3109/00048679409080782. PMID7794202. [14] "Dissociative Identity Disorder" (http:/ / www. merckmanuals. com/ professional/ sec15/ ch197/ ch197e. html). Merck.com. 2010. . [15] Putnam FW (1984). "The psychophysiologic investigation of multiple personality disorder. A review". Psychiatr. Clin. 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Dissociative identity disorder

[38] Coons, PM; Bowman, ES; Milstein, V (1988). "Multiple personality disorder. A clinical investigation of 50 cases". The Journal of nervous and mental disease 176 (9): 51927. PMID3418321. [39] Braun, B.G. (1989) (PDF). Dissociation: Vol. 2, No. 2, p. 066-069: Iatrophilia and Iatrophobia in the diagnosis and treatment of MPD (https:/ / scholarsbank. uoregon. edu/ dspace/ bitstream/ 1794/ 1425/ 1/ Diss_2_2_3_OCR. pdf). . Retrieved 2008-05-04. [40] Brown, D; Frischholz E, Scheflin A. (1999). "Iatrogenic dissociative identity disorder - an evaluation of the scientific evidence". The Journal of Psychiatry and Law XXVII No. 3-4 (FallWinter 1999): 549637. [41] Gleaves, D. (July 1996). "The sociocognitive model of dissociative identity disorder: a reexamination of the evidence". Psychological Bulletin 120 (1): 4259. doi:10.1037/0033-2909.120.1.42. PMID8711016. [42] Ross, C; Norton, G. & Fraser, G. (1989). "Evidence against the iatrogenesis of multiple personality disorder" (https:/ / scholarsbank. uoregon. edu/ dspace/ bitstream/ 1794/ 1424/ 1/ Diss_2_2_2_OCR. pdf) (PDF). Dissociation 2 (2): 6165. . Retrieved 2008-02-10. [43] Kluft, R.P. (1989). "Iatrongenic creation of new alter personalities" (https:/ / scholarsbank. uoregon. edu/ dspace/ bitstream/ 1794/ 1428/ 1/ Diss_2_2_6_OCR. pdf) (PDF). Dissociation 2 (2): 8391. . Retrieved 2008-04-21. [44] Xiao Z, Yan H, Wang Z et al. (2006). "Trauma and dissociation in China". The American journal of psychiatry 163 (8): 138891. doi:10.1176/appi.ajp.163.8.1388. PMID16877651. [45] Carson VB; Shoemaker, NC & Varcarolis E. Foundations of Psychiatric Mental Health Nursing: A Clinical Approach (5 ed.). St. Louis: Saunders Elsevier. pp.266267. ISBN1-4160-0088-7. [46] American Psychiatric Association (2000). "Diagnostic criteria for 300.14 Dissociative Identity Disorder" (http:/ / behavenet. com/ capsules/ ). Diagnostic and Statistical Manual of Mental Disorders (4th, text revision (DSM-IV-TR) ed.). ISBN0-89042-025-4. . Retrieved 2010-03-14. [47] Spiegel, D. (2010). "Dissociation in the DSM5". Journal of Trauma & Dissociation 11: 261265. doi:10.1080/15299731003780788. [48] Dissociative identity disorder at the DSM-V (http:/ / www. dsm5. org/ ProposedRevisions/ Pages/ proposedrevision. aspx?rid=57) showing proposed revision, page found 2011-06-05. [49] Dissociative Trance Disorder at the DSM-V (http:/ / www. dsm5. org/ ProposedRevisions/ Pages/ proposedrevision. aspx?rid=436#) showing proposed merger with Dissociative Identity Disorder, page found 2011-06-05. [50] Steinberg M, Rounsaville B, Cicchetti DV (1990). "The Structured Clinical Interview for DSM-III-R Dissociative Disorders: preliminary report on a new diagnostic instrument". The American journal of psychiatry 147 (1): 7682. PMID2293792. [51] Ross CA, Ellason JW (2005). "Discriminating among diagnostic categories using the Dissociative Disorders Interview Schedule". Psychological reports 96 (2): 44553. doi:10.2466/PR0.96.2.445-453. PMID15941122. [52] Bernstein EM, Putnam FW (1986). "Development, reliability, and validity of a dissociation scale". J. Nerv. Ment. Dis. 174 (12): 72735. doi:10.1097/00005053-198612000-00004. PMID3783140. [53] Carlson EB, Putnam FW, Ross CA et al. (1993). "Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: a multicenter study". The American journal of psychiatry 150 (7): 10306. PMID8317572. [54] Steinberg M, Rounsaville B, Cicchetti D (1991). "Detection of dissociative disorders in psychiatric patients by a screening instrument and a structured diagnostic interview". The American journal of psychiatry 148 (8): 10504. PMID1853955. [55] Foote B, Smolin Y, Kaplan M, Legatt ME, Lipschitz D (2006). "Prevalence of dissociative disorders in psychiatric outpatients". The American journal of psychiatry 163 (4): 6239. doi:10.1176/appi.ajp.163.4.623. PMID16585436. Full Text (http:/ / ajp. psychiatryonline. org/ cgi/ content/ full/ 163/ 4/ 623) [56] Wright DB, Loftus EF (1999). "Measuring dissociation: comparison of alternative forms of the dissociative experiences scale". The American journal of psychology (The American Journal of Psychology, Vol. 112, No. 4) 112 (4): 497519. doi:10.2307/1423648. JSTOR1423648. PMID10696264. Page 1 (http:/ / links. jstor. org/ sici?sici=0002-9556(199924)112<497>2. 0. CO) [57] Sadock 2002, p.683 [58] Kohlenberg, R.J.; Tsai, M. (1991). Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Relationships. Springer. ISBN0306438577. [59] American Psychiatric Association (2000-06). Diagnostic and Statistical Manual of Mental Disorders DSM-IV TR (Text Revision). Arlington, VA, USA: American Psychiatric Publishing, Inc.. pp. 526528 (http:/ / books. google. com/ books?id=3SQrtpnHb9MC& pg=PA527& lpg=PA535). doi:10.1176/appi.books.9780890423349. ISBN978-0890420249. [60] Boon S, Draijer N (1991). "Diagnosing dissociative disorders in The Netherlands: a pilot study with the Structured Clinical Interview for DSM-III-R Dissociative Disorders". The American journal of psychiatry 148 (4): 45862. PMID2006691. [61] Adityanjee, Raju GS, Khandelwal SK (1989). "Current status of multiple personality disorder in India". The American journal of psychiatry 146 (12): 160710. PMID2589555. [62] Modestin J (1992). "Multiple personality disorder in Switzerland". The American journal of psychiatry 149 (1): 8892. PMID1728191. [63] Gast U, Rodewald F, Nickel V, Emrich HM (2001). "Prevalence of dissociative disorders among psychiatric inpatients in a German university clinic". J. Nerv. Ment. Dis. 189 (4): 24957. doi:10.1097/00005053-200104000-00007. PMID11339321. [64] Friedl MC, Draijer N (2000). "Dissociative disorders in Dutch psychiatric inpatients". The American journal of psychiatry 157 (6): 10123. doi:10.1176/appi.ajp.157.6.1012. PMID10831486. [65] Bliss EL, Jeppsen EA (1985). "Prevalence of multiple personality among inpatients and outpatients". The American journal of psychiatry 142 (2): 2501. PMID3970252. [66] Ross CA, Anderson G, Fleisher WP, Norton GR (1992). "Dissociative experiences among psychiatric inpatients". General hospital psychiatry 14 (5): 3504. doi:10.1016/0163-8343(92)90071-H. PMID1521791.

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[67] Sar V, Koyuncu A, Ozturk E et al. (2007). "Dissociative disorders in the psychiatric emergency ward". General hospital psychiatry 29 (1): 4550. doi:10.1016/j.genhosppsych.2006.10.009. PMID17189745. [68] Ross CA (1991). "Epidemiology of multiple personality disorder and dissociation". Psychiatr. Clin. North Am. 14 (3): 50317. PMID1946021. [69] Akyz G, Doan O, Sar V, Yargi LI, Tutkun H (1999). "Frequency of dissociative identity disorder in the general population in Turkey". Comprehensive psychiatry 40 (2): 1519. doi:10.1016/S0010-440X(99)90120-7. PMID10080263. [70] Sar V, Akyz G, Doan O (2007). "Prevalence of dissociative disorders among women in the general population". Psychiatry Res 149 (13): 16976. doi:10.1016/j.psychres.2006.01.005. PMID17157389. [71] Dell, PF (1998). "Axis II pathology in outpatients with dissociative identity disorder". The Journal of nervous and mental disease 186 (6): 3526. PMID9653419. [72] Rieber RW (2002). "The duality of the brain and the multiplicity of minds: can you have it both ways?". History of psychiatry 13 (49 Pt 1): 317. doi:10.1177/0957154X0201304901. PMID12094818. [73] Borch-Jacobsen M, Brick D (2000). "How to predict the past: from trauma to repression". History of Psychiatry 11 (41 Pt 1): 1535. doi:10.1177/0957154X0001104102. PMID11624606. [74] Putnam, Frank W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. New York: The Guilford Press. pp.351. ISBN0-89862-177-1. [75] van der Kolk BA, van der Hart O (December 1989). "Pierre Janet and the breakdown of adaptation in psychological trauma" (http:/ / ajp. psychiatryonline. org/ cgi/ pmidlookup?view=long& pmid=2686473). Am J Psychiatry 146 (12): 153040. PMID2686473. . [76] Bethune, B (2007-11-26). "What drove women mad?" (http:/ / www. macleans. ca/ culture/ lifestyle/ article. jsp?content=20071115_98997_98997). Maclean's (Rogers Communications). . Retrieved 2009-02-18. [77] Rosenbaum M (1980). "The role of the term schizophrenia in the decline of diagnoses of multiple personality". Arch. Gen. Psychiatry 37 (12): 13835. PMID7004385. [78] American Psychiatric Association. 1968. Hysterical Neurosis. Diagnostic and statistical manual of mental disorders second edition pg 40. Washington, D.C. [79] Rieber, R. W. (1999). "Hypnosis, false memory and multiple personality: A trinity of affinity". History of psychiatry 10 (37): 311. PMID11623821. [80] Exploring Multiple Personalities In 'Sybil Exposed' (http:/ / www. npr. org/ 2011/ 10/ 21/ 141591185/ exploring-multiple-personalities-in-sybil-exposed) [81] Rieber, R (1999). "Hypnosis, false memory and multiple personality: a trinity of affinity". History of Psychiatry 10 (37): 311. doi:10.1177/0957154X9901003701. PMID11623821. [82] Ritter, M (1998-08-16). "Doubt Cast on Story of 'Sybil'". Associated Press. [83] Adams, C (2003). "Does multiple personality disorder really exist?" (http:/ / www. straightdope. com/ columns/ 031003. html). The Straight Dope. . Retrieved 2008-01-22. [84] Acocella, JR (1999). Creating hysteria: Women and multiple personality disorder. San Francisco: Jossey-Bass Publishers. ISBN0-7879-4794-6. [85] Spanos, Nicholas P. (1996). Multiple Identities & False Memories: A Sociocognitive Perspective. American Psychological Association (APA). ISBN1557983402. [86] Lalonde JK, Hudson JI, Gigante RA, Pope HG (2001). "Canadian and American psychiatrists' attitudes toward dissociative disorders diagnoses". Canadian Journal of Psychiatry 46 (5): 40712. PMID11441778. [87] Rhoades, G. F., Sar, V. (editors) (2006) Trauma And Dissociation in a Cross-cultural Perspective: Not Just a North American Phenomenon. Routledge. ISBN 978-0-7890-3407-6 [88] Ross, C (2000). Bluebird: Deliberate Creation of Multiple Personality Disorder by Psychiatrists. Manitou Communications. ISBN978-0970452511. [89] "Creating Hysteria by Joan Acocella" (http:/ / www. nytimes. com/ books/ first/ a/ acocella-hysteria. html). The New York Times. 1999. . [90] Marmer S, Fink D (1994). "Rethinking the comparison of Borderline Personality Disorder and multiple personality disorder". Psychiatr Clin North Am 17 (4): 74371. PMID7877901.

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References
Sadock, Benjamin J.; Sadock, Virginia A. (2002). Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (9th ed.). Lippincott Williams & Wilkins. ISBN0781731836.

Further reading
Goettmann, B. A.; Greaves BG; Coons MP (1994). Multiple personality and dissociation, 1791-1992: a complete bibliography (http://boundless.uoregon.edu/cdm4/item_viewer.php?CISOROOT=/diss&CISOPTR=38). Lutherville, MD: The Sidran Press. pp.85. ISBN0-9629164-5-5.

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External links
Dissociative identity disorder (http://www.dmoz.org//Health/Mental_Health/Disorders/Dissociative/ Multiple_Personality//) at the Open Directory Project International Society for the Study of Trauma and Dissociation (http://www.isst-d.org/)

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additional infomation
Encoding (memory)
Memory has the ability to encode, store and recall information. Memories give an organism the capability to learn and adapt from previous experiences as well as build relationships. Encoding allows the perceived item of use or interest to be converted into a construct that can be stored within the brain and recalled later from short term or long term memory. Working memory stores information for immediate use or manipulation.

Types
Visual, acoustic, and semantic encodings are the most intensively used. Other encodings are also used.

Visual encoding
Visual encoding is the process of encoding images and visual sensory information. Visual sensory information is temporarily stored within our iconic memory[1] and working memory before being encoded into permanent long-term storage.[2] [3] Baddeleys model of working memory states that visual information is stored in the visuo-spatial sketchpad.[1] The amygdala is a complex structure that has an important role in visual encoding. It accepts visual input in addition to input from other systems and encodes the positive or negative values of conditioned stimuli.[4]

Acoustic encoding
Acoustic encoding is the processing and encoding of sound, words, and all other auditory input for storage and later retrieval. According to Baddeley, processing of auditory information is aided by the concept of the phonological loop, which allows input within our echoic memory to be sub vocally rehearsed in order to facilitate remembering.[1] Studies indicate that lexical, semantic and phonological factors interact in verbal working memory. The phonological similarity effect (PSE), is modified by word concreteness. This emphasizes that verbal working memory performance cannot exclusively be attributed to phonological or acoustic representation but also includes an interaction of linguistic representation.[5] What remains to be seen is whether linguistic representation is expressed at the time of recall or whether they participate in a more fundamental role in encoding and preservation.[5]

Other senses
Tactile encoding is the processing and encoding of how something feels, normally through touch. Neurons in the primary somatosensory cortex (S1) react to vibrotactile stimuli by activating in synchronisation with each series of vibrations.[6] Odors and tastes may also lead to encode. In general encoding for short-term storage (STS) in the brain relies primarily on acoustic rather than semantic encoding.

Semantic encoding
Semantic encoding is the processing and encoding of sensory input that has particular meaning or can be applied to a context. Various strategies can be applied such as chunking and mnemonics to aid in encoding, and in some cases, allow deep processing, and optimizing retrieval.

Encoding (memory) Words studied in semantic or deep encoding conditions are better recalled as compared to both easy and hard groupings of nonsemantic or shallow encoding conditions with response time being the deciding variable.[7] Brodmanns areas 45, 46, and 47 (the left inferior prefrontal cortex or LIPC) showed significantly more activation during semantic encoding conditions compared to nonsemantic encoding conditions regardless of the difficulty of the nonsemantic encoding task presented. The same area showing increased activation during initial semantic encoding will also display decreasing activation with repetitive semantic encoding of the same words. This suggests the decrease in activation with repetition is process specific occurring when words are semantically reprocessed but not when they are nonsemantically reprocessed.[7]

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Long-term potentiation
Encoding is a biological event that begins with perception. All perceived and striking sensations travel to your brains hippocampus where all these sensations are combined into one single experience.[8] The hippocampus is responsible for analyzing these inputs and ultimately deciding if they will be committed to your long-term memory; these various threads of information are stored in various parts of the brain. However, the exact way in which these pieces are identified and recalled later remains unknown.[8] Encoding is achieved using a combination of chemicals and electricity. Neurotransmitters are released when an electrical pulse crosses the synapse which serves as a connection from nerve cells to other cells. The dendrites receive these impulses with their feathery extensions. A phenomenon called Long-Term Potentiation allows a synapse to increase strength with increasing numbers of transmitted signals between the two neurons. These cells also organise themselves into groups specializing in different kinds of information processing. Thus, with new experiences your brain creates more connections and may rewire. The brain organizes and reorganizes itself in response to your experiences, creating new memories prompted by experience, education, or training.[8] Therefore the use of a brain reflects how it is organised.[8] This ability to re-organize is especially important if ever a part of your brain becomes damaged. Scientists are unsure of whether the stimuli of what we do not recall are filtered out at the sensory phase or if they are filtered out after the brain examines their significance.[8]

Mapping activity
Positron emission tomography (PET) demonstrates a consistent functional anatomical blueprint of hippocampal activation during episodic encoding and retrival. Activation in the hippocampal region associated with episodic memory encoding has been shown to occur in the rostral portion of the region whereas activation associated with episodic memory retrieval occurs in the caudal portions.[9] This is referred to as the Hippocampal Encoding/Retrieval model or HIPER model. One study used PET to measure cerebral blood flow during encoding and recognition of faces in both young and older participants. Young people displayed increased cerebral blood flow in the right hippocampus and the left prefrontal and temporal cortices during encoding and in the right prefrontal and parietal cortex during recognition.[10] Elderly people showed no significant activation in areas activated in young people during encoding, however they did show right prefrontal activation during recognition.[10] Thus it may be concluded that as we grow old, failing memories may be the consequence of a failure to adequately encode stimuli as demonstrated in the lack of cortical and hippocampal activation during the encoding process.[10] Recent findings in studies focusing on patients with post traumatic stress disorder demonstrate that amino acid transmitters, glutamate and GABA, are intimately implicated in the process of factual memory registration, and suggest that amine neurotransmitters, norepinephrine and serotonin, are involved in encoding emotional memory.[11]

Encoding (memory)

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Molecular perspective
The process of encoding is not yet well understood, however key advances have shed light on the nature of these mechanisms. Encoding begins with any novel situation, as the brain will interact and draw conclusions from the results of this interaction. These learning experiences have been known to trigger a cascade of molecular events leading to the formation of memories.[12] These changes include the modification of neural synapses, modification of proteins, creation of new synapses, activation of gene expression and new protein synthesis. However, encoding can occur on different levels. The first step is short-term memory formation, followed by the conversion to a long-term memory, and then a long-term memory consolidation process.[13]

Synaptic plasticity
Synaptic plasticity is the ability of the brain to strengthen, weaken, destroy and create neural synapses and is the basis for learning. These molecular distinctions will identify and indicate the strength of each neural connection. The effect of a learning experience depends on the content of such an experience. Reactions that are favoured will be reinforced and those that are deemed unfavourable will be weakened. This shows that the synaptic modifications that occur can operate either way, in order to be able to make changes over time depending on the current situation of the organism. In the short term, synaptic changes may include the strengthening or weakening of a connection by modifying the preexisting proteins leading to a modification in synapse connection strength. In the long term, entirely new connections may form or the number of synapses at a connection may be increased, or reduced.[13]

The encoding process

A significant short-term biochemical change is the covalent modification of pre-existing proteins in order to modify synaptic connections that are already active. This allows data to be conveyed in the short term, without consolidating anything for permanent storage. From here a memory or an association may be chosen to become a long-term memory, or forgotten as the synaptic connections eventually weaken. The switch from short to long-term is the same concerning both implicit memory and explicit memory. This process is regulated by a number of inhibitory constraints, primarily the balance between protein phosphorylation and dephosphorylation.[13] Finally, long term changes occur that allow consolidation of the target memory. These changes include new protein synthesis, the formation of new synaptic connections and finally the activation of gene expression in accordance with the new neural configuration.[14] The encoding process has been found to be partially mediated by serotonergic interneurons, specifically in regard to sensitization as blocking these interneurons prevented sensitization entirely. However, the ultimate consequences of these discoveries have yet to be identified. Furthermore, the learning process has been known to recruit a variety of modulatory transmitters in order to create and consolidate memories. These transmitters cause the nucleus to initiate processes required for neuronal growth and long term memory, mark specific synapses for the capture of long-term processes, regulate local protein synthesis and even appear to mediate attentional processes required for the formation and recall of memories.

Encoding and genetics

Human memory, including the process of encoding, is known to be a heritable trait that is controlled by more than one gene. In fact, twin studies suggest that genetic differences are responsible for as much as 50% of the variance seen in memory tasks.[12] Proteins identified in animal studies have been linked directly to a molecular cascade of reactions leading to memory formation, and a sizeable number of these proteins are encoded by genes that are expressed in humans as well. In fact, variations within these genes appear to be associated with memory capacity and have been identified in recent human genetic studies.[12]

Encoding (memory)

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Complementary processes
The idea that the brain is separated into two complementary processing networks (task positive and task negative) has recently become an area of increasing interest. The task positive network deals with externally oriented processing whereas the task negative network deals with internally oriented processing. Research indicates that these networks are not exclusive and some tasks overlap in their activation. A study done in 2009 shows encoding success and novelty detection activity within the task-positive network have significant overlap and have thus been concluded to reflect common association of externally-oriented processing.[15] It also demonstrates how encoding failure and retrieval success share significant overlap within the task negative network indicating common association of internally oriented processing.[15] Finally, a low level of overlap between encoding success and retrieval success activity and between encoding failure and novelty detection activity respectively indicate opposing modes or processing.[15] In sum task positive and task negative networks can have common associations during the performance of different tasks.

Depth of processing
Different levels of processing influence how well information is remembered. These levels of processing can be illustrated by maintenance and elaborate rehearsal.

Maintenance and elaborative rehearsal

Maintenance rehearsal is a shallow form of processing information which involves focusing on an object without thought to its meaning or its association with other objects. For example the repetition of a series of numbers is a form of maintenance rehearsal. In contrast, elaborative or relational rehearsal is a deep form of processing information and involves thought of the object's meaning as well as making connections between the object, past experiences and the other objects of focus. Using the example of numbers, one might associate them with dates that are personally significant such as your parents birthdays (past experiences) or perhaps you might see a pattern in the numbers that helps you to remember them.[16] Due to the deeper level of processing that occurs with elaborative rehearsal it is more effective than maintenance rehearsal in creating new memories.[] This has been demonstrated in peoples lack of knowledge of the details in everyday objects. For example, in one study where Americans were asked about the orientation of the face on their countrys penny few recalled this with any degree of certainty. Despite the fact that it is a detail that is often seen, it is not remembered as there is no need to because the color discriminates the penny from other coins.[17] The ineffectiveness of maintenance rehearsal, simply being repeatedly exposed to an item, in creating memories has also been found in peoples lack of memory for the layout of the digits 0-9 on calculators and telephones.[18]

American Penny

Maintenance rehearsal has been demonstrated to be important in learning but its effects can only be demonstrated using indirect methods such as lexical decision tasks,[19] and word stem completion[20] which are used to assess implicit learning. In general, however previous learning by maintenance rehearsal is not apparent when memory is being tested directly or explicitly with questions like Is this the word you were shown earlier?

Encoding (memory)

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Intention to learn
Studies have shown that the intention to learn has no direct effect on memory encoding. Instead, memory encoding is dependent on how deeply each item is encoded, which could be affected by intention to learn, but not exclusively. That is, intention to learn can lead to more effective learning strategies, and consequently, better memory encoding, but if you learn something incidentally (i.e. without intention to learn) but still process and learn the information effectively, it will get encoded just as well as something learnt with intention.[21] The effects of elaborative rehearsal or deep processing can be attributed to the number of connections made while encoding that increase the number of pathways available for retrieval.[22]

Optimal encoding
Organization can be seen as the key to better memory. As demonstrated in the above section on levels of processing the connections that are made between the to-be-remembered item, other to-be-remembered items, previous experiences and context generate retrieval paths for the to-be-remembered item. These connections impose organization on the to-be-remembered item, making it more memorable.[23]

Mnemonics
For simple material such as lists of words Mnemonics are the best strategy. Mnemonic Strategies are an example of how finding organization within a set of items helps these items to be remembered. In the absence of any apparent organization within a group organization can be imposed with the same memory enhancing results. An example of a mnemonic strategy that imposes organization is the peg-word system which associates the to- be-remembered items with a The mnemonic "Roy G. Biv" can be used to remember the colors of the rainbow list of easily remembered items. Another example of a mnemonic device commonly used is the first letter of every word system or acronyms. When learning the colours in a rainbow most students learn the first letter of every colour and impose their own meaning by associating it with a name such as Roy. G. Biv which stands for red, orange, yellow, green, blue, indigo, violet. In this way mnemonic devices not only help the encoding of specific items but also their sequence. For more complex concepts, understanding is the key to remembering. In a study done by Wiseman and Neisser in 1974 they presented participants with picture (the picture was of a Dalmatian in the style of pointillism making it difficult to see the image).[24] They found that memory for the picture was better if the participants understood what was depicted.

Chunking
Another way understanding may aid memory is by reducing the amount that has to be remembered via chunking. Chunking is the process of organizing objects into meaningful wholes. These wholes are then remembered as a unit rather than separate objects. Words are an example of chunking, where instead of simply perceiving letters we perceive and remember their meaningful wholes: words. The use of chunking increases the number of items we are able to remember by creating meaningful packets in which many related items are stored as one.

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State-dependent learning
For optimal encoding, connections are not only formed between the items themselves and past experiences, but also between the internal state or mood of the encoder and the situation they are in. The connections that are formed between the encoders internal state or the situation and the items to be remembered are State-dependent. In a 1975 study by Godden and Baddeley the effects of State-dependent learning were shown. They asked deep sea divers to learn various materials while either under water or on the side of the pool. They found that those who were tested in the same condition that they had learned the information in were better able to recall that information, i.e. those who learned the material under water did better when tested on that material under water than when tested on land. Context had become associated with the material they were trying to recall and therefore was serving as a retrieval cue.[25] Results similar to these have also been found when certain smells are present at encoding.[26] However, although the external environment is important at the time of encoding in creating multiple pathways for retrieval, other studies have shown that simply creating the same internal state that you had at the time of encoding is sufficient to serve as a retrieval cue.[27] Therefore putting yourself in the same mindset that you were in at the time of encoding will help recall in the same way that being in the same situation helps recall. This effect called context reinstatement was demonstrated by Fisher and Craik 1977 when they matched retrieval cues with the way information was memorized.[28]

Encoding specificity
The context of learning shapes how information is encoded.[29] For instance, Kanizsa in 1979 showed a picture that could be interpreted as either a white vase on a black background or 2 faces facing each other on a white background.[30] The participants were primed to see the vase. Later they were shown the picture again but this time they were primed to see the black faces on the white background. Although this was the same picture as they had seen before, when asked if they had seen this picture before, they said no. The reason for this was that they has been primed to see the vase the first time the picture was presented, and it was therefore unrecognizable the second time as two faces. This demonstrates that the stimulus is understood within the context it is Vase or faces? learned in as well the general rule that what really constitutes good learning are tests that test what has been learned in the same way that it was learned.[30] Therefore, to truly be efficient at remembering information, one must consider the demands that future recall will place on this information and study in a way that will match those demands.

Computational Models of Memory Encoding

Computational models of memory encoding have been developed in order to better understand and simulate the mostly expected, yet sometimes wildly unpredictable, behaviors of human memory. Different models have been developed for different memory tasks, which include item recognition, cued recall, free recall, and sequence memory, in an attempt to accurately explain experimentally observed behaviors.

Item Recognition
In item recognition, one is asked whether or not a given probe item has been seen before. It is important to note that the recognition of an item can include context. That is, one can be asked whether an item has been seen in a study list. So even though one may have seen the word apple sometime during their life, if it was not on the study list, it should not be recalled.

Encoding (memory) Item recognition can be modeled using Multiple trace theory and the attribute-similarity model.[31] In brief, every item that one sees can be represented as a vector of the items attributes, which is extended by a vector representing the context at the time of encoding, and is stored in a memory matrix of all items ever seen. When a probe item is presented, the sum of the similarities to each item in the matrix (which is inversely proportional to the sum of the distances between the probe vector and each item in the memory matrix) is computed. If the similarity is above a threshold value, one would respond, Yes, I recognize that item. Given that context continually drifts by nature of a random walk, more recently seen items, which each share a similar context vector to the context vector at the time of the recognition task, are more likely to be recognized than items seen longer ago.

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Cued Recall
In cued recall, one is asked to recall the item that was paired with a given probe item. For example, one can be given a list of name-face pairs, and later be asked to recall the associated name given a face. Cued recall can be explained by extending the attribute-similarity model used for item recognition. Because in cued recall, a wrong response can be given for a probe item, the model has to be extended accordingly to account for that. This can be achieved by adding noise to the item vectors when they are stored in the memory matrix. Furthermore, cued recall can be modeled in a probabilistic manner such that for every item stored in the memory matrix, the more similar it is to the probe item, the more likely it is to be recalled. Because the items in the memory matrix contain noise in their values, this model can account for incorrect recalls, such as mistakenly calling a person by the wrong name.

Free Recall
In free recall, one is allowed to recall items that were learnt in any order. For example, you could be asked to name as many countries in Europe as you can. Free recall can be modeled using SAM (Search of Associative Memory) which is based on the dual-store model, first proposed by Atkinson and Shiffrin in 1968.[32] SAM consists of two main components: short-term store (STS) and long-term store (LTS). In brief, when an item is seen, it is pushed into STS where it resides with other items also in STS, until it displaced and put into LTS. The longer the an item has been in STS, the more likely it is to be displaced by a new item. When items co-reside in STS, the links between those items are strengthened. Furthermore, SAM assumes that items in STS are always available for immediate recall. SAM explains both primacy and recency effects. Probabilistically, items at the beginning of the list are more likely to remain in STS, and thus have more opportunities to strengthen their links to other items. As a result, items at the beginning of the list are made more likely to be recalled in a free-recall task (primacy effect). Because of the assumption that items in STS are always available for immediate recall, given that there were no significant distractors between learning and recall, items at the end of the list can be recalled excellently (recency effect). Incidentally, the idea of STS and LTS was motivated by the architecture of computers, which contain short-term (see Cache) and long-term storage.

Sequence Memory
Sequence memory is responsible for how we remember lists of things, in which ordering matters. For example, telephone numbers are a ordered list of one digit numbers. There are currently two main computational memory models that can be applied to sequence encoding: associative chaining and positional coding. Associative chaining theory states that every item in a list is linked to its forward and backward neighbors, with forward links being stronger than backward links, and links to closer neighbors being stronger than links to farther neighbors. For example, associative chaining predicts the tendencies of transposition errors, which occur most often with items in nearby positions. An example of a transposition error would be recalling the sequence apple, orange, banana instead of apple, banana, orange.

Encoding (memory) Positional coding theory suggests that every item in a list is associated to its position in the list. For example, if the list is apple, banana, orange, mango apple will be associated to list position 1, banana to 2, orange to 3, and mango to 4. Furthermore, each item is also, albeit more weakly, associated to its index +/- 1, even more weakly to +/- 2, and so forth. So banana is associated not only to its actual index 2, but also to 1, 3, and 4, with varying degrees of strength. For example, positional coding can be used to explain the effects of recency and primacy. Because items at the beginning and end of a list have fewer close neighbors compared to items in the middle of the list, they have less competition for correct recall. Although the models of associative chaining and positional coding are able to explain a great amount of behavior seen for sequence memory, they are far from perfect. For example, neither chaining nor positional coding is able to properly illustrate the details of the Ranschburg effect, which reports that sequences of items that contain repeated items are harder to reproduce than sequences of unrepeated items. Associative chaining predicts that recall of lists containing repeated items is impaired because recall of any repeated item would cue not only its true successor but also the successors of all other instances of the item. However, experimental data have shown that spaced repetition of items resulted in impaired recall of the second occurrence of the repeated item.[33] Furthermore, it had no measurable effect on the recall of the items that followed the repeated items, contradicting the prediction of associative chaining. Positional coding predicts that repeated items will have no effect on recall, since the positions for each item in the list act as independent cues for the items, including the repeated items. That is, there is no difference between the similarity between any two items and repeated items. This, again, is not consistent with the data. Because no comprehensive model has been defined for sequence memory to this day, it makes for an interesting area of research.

20

History
Encoding is still relatively new and unexplored but origins of encoding date back to age old philosophers such as Aristotle and Plato. A major figure in the history of encoding is Hermann Ebbinghaus (18501909). Ebbinghaus was a pioneer in the field of memory research. Using himself as a subject he studied how we learn and forget information by repeating a list of nonsense syllables to the rhythm of a metronome until they were committed to his memory.[34] These experiments lead him to suggest the learning curve.[34] He used these relatively meaningless words so that prior associations between meaningful words would not influence learning. He found that lists that allowed associations to be made and semantic meaning was apparent were easier to recall. Ebbinghaus results paved the way for experimental psychology in memory and other mental processes. During the 1900s further progress in memory research was made. Ivan Hermann Ebbinghaus Pavlov began research pertaining to classical conditioning. His research demonstrated the ability to create a semantic relationship between two unrelated items. In 1932 Bartlett proposed the idea of mental schemas. This model proposed that whether new information would be encoded was dependent on its consistency with prior knowledge (mental schemas).[35] This model also suggested that information not present at the time of encoding would be added to memory if it was based on schematic knowledge of the world.[35] In this way, encoding was found to be influenced by prior knowledge. With the advance of Gestalt theory, came the realisation that memory for encoded information was often perceived as different than the stimuli that triggered it. In addition it was also influenced by the context that the stimuli were embedded in.

Encoding (memory) With advances in technology, the field of neuropsychology emerged and with it a biological basis for theories of encoding. In 1949 Hebb looked at the neuroscience aspect of encoding and stated that neurons that fire together wire together implying that encoding occurred as connections between neurons were established through repeated use. The 1950s and 60s saw a shift to the information processing approach to memory based on the invention of computers, followed by the initial suggestion that encoding was the process by which information is entered into memory. At this time George Armitage Miller in 1956 wrote his paper on how our short-term memory is limited to 7 items, plus-or-minus 2 called The Magical Number Seven, Plus or Minus Two. This number was appended when studies done on chunking revealed that seven, plus or minus two could also refer to seven packets of information. In 1974, Alan Baddeley and Graham Hitch proposed their model of working memory, which consists of the central executive, visuo-spatial sketchpad, and phonological loop as a method of encoding. In 2000, Baddeley added the episodic buffer.[1] Simultaneously Endel Tulving (1983) proposed the idea of encoding specificity whereby context was again noted as an influence on encoding.

21

References
[1] Baddeley, A., Eysenck, M.W., & Anderson, M.C. (2009). Memory. London: Psychology Press. p. 27, 44-59 [2] Sperling, G. (1963). A model for visual memory tasks. Human Factors, 5, 19-31. [3] Sperling, G. (1967). Successive approximations to a model for short term memory. Acta Psychologica, 27, 285-292. [4] Belova, M.A., Morrison, S.E., Paton, J.J., & Salzman, C.D. (2006). The primate amygdala represents the positive and negative value of visual stimuli during learning. Nature; 439(7078): 865-870. [5] Acheson, D.J., MacDonald, M.C., & Postle, B.R. (2010). The Interaction of Concreteness and Phonological Similarity in Verbal Working Memory. Journal of Experimental Psychology: Learning, Memory and Cognition; 36:1, 17-36. [6] Crawley, AP., Davis, KD., Mikulis. DJ. & Kwan, CL. (1998). Function MRI study of thalamic and cortical activation evoked by cutaneous heat, cold, and tactile stimuli. Journal of Neurophysiology: 80 (3): 1533-46 [7] Demb,JB., Desmond, JE., Gabrieli, JD., Glover, GH., Vaidya, CJ., & Wagner, AD. Semantic encoding and retrieval in the left inferior prefrontal cortex: a functional MRI study of task difficulty and process specificity. The Journal of Neuroscience; 15, 5870-5878. [8] Mohs, Richard C. "How Human Memory Works." 08 May 2007. HowStuffWorks.com. <http://health.howstuffworks.com/human-memory.htm> 23 February 2010. [9] Lepage, M., Habib, R. & Tulving. E. (1998). Hippocampal PET activations of memory encoding and retrival: The HIPER model. Hippocampus, 8:4: 313-322 [10] Grady, CL., Horwitz, B., Haxby, JV., Maisog, JM., McIntosh, AR., Mentis, MJ., Pietrini, P., Schapiro, MB., & Underleider, LG. (1995) Age-related reductions in human recognition memory due to inpaired encoding. Science, 269:5221, 218-221. [11] Birmes, P., Escande, M., Schmitt, L. & Senard, JM. (2002). Biological Factors of PTSD: neurotransmitters and neuromodulators. Encephale, 28: 241-247. [12] Wagner, M. (2008). The His452Tyr variant of the gene encoding the 5-HT(2a) receptor is specifically associated with consolidation of episodic memory in humans. International Journal of Neuropsychopharmacology, 11, 1163-1167. [13] Kandel, E. (2004). The Molecular Biology of Memory Storage: A Dialog Between Genes and Synapses. Bioscience Reports, 24, 4-5. [14] Sacktor, T.C. (2008). PKMz, LTP Maintenance, and the dynamic molecular biology of memory storage. Progress in Brain Research, 169, Ch 2. [15] Cabeza, R., Daselaar, S.M., & Hongkeun, K. (2009). Overlapping brain activity between episodic memory encoding and retrieval: Roles of the task-positive and task-negative networks. Neuroimage;49: 1145-1154. [16] Craik, F. I. M., & Watkins, M. J. (1973). The role of rehearsal in short-term memory. Journal of Verbal Learning and Verbal Behavior, 12(6, pp. 599-607) [17] Nickerson, R. S. (., & Adams, M. J. (1979). Long-term memory for a common object. Cognitive Psychology, 11(3, pp. 287-307) [18] Rinck, M. (1999). Memory for everyday objects: Where are the digits on numerical keypads? Applied Cognitive Psychology, 13(4), 329-350. [19] Oliphant, G. W. (1983). Repetition and recency effects in word recognition. Australian Journal of Psychology, 35(3), 393-403 [20] Graf, P., Mandler, G., & Haden, P. E. (1982). Simulating amnesic symptoms in normal subjects. Science, 218(4578), 1243-1244. [21] Hyde, Thomas S. & Jenkins, James J. (1973). Recall for words as a function of semantic, graphic, and syntactic orienting tasks. Journal of Verbal Learning and Verbal Behavior, 12(5), 471-480 [22] Craik, F. I., & Tulving, E. (1975). Depth of processing and the retention of words in episodic memory. Journal of Experimental Psychology: General, 104(3), 268-294. [23] Katona, G. (1940). Organizing and memorizing. New York, NY, US: Columbia University Press. [24] Wiseman, S., & Neisser, U. (1974). Perceptual organization as a determinant of visual recognition memory. American Journal of Psychology, 87(4), 675-681.

Encoding (memory)
[25] Godden, D. R., & Baddeley, A. D. (1975). Context-dependent memory in two natural environments: On land and underwater. British Journal of Psychology, 66(3), 325-331. [26] Cann, A., & Ross, D. A. (1989). Olfactory stimuli as context cues in human memory. American Journal of Psychology, 102(1), 91-102. [27] Smith, S. M. (1979). Remembering in and out of context. Journal of Experimental Psychology: Human Learning and Memory, 5(5), 460-471. [28] Fisher, R. P., & Craik, F. I. (1977). Interaction between encoding and retrieval operations in cued recall. Journal of Experimental Psychology: Human Learning and Memory, 3(6), 701-711. [29] Tulving, E. (1983). Elements of episodic memory. Oxford, England: Oxford University Press. [30] Kanizsa, G. (1979). Organization in vision. New York: Praeger. [31] Hintzman, Douglas L. & Block, Richard A. (1971) Repetition and memory: Evidence for a multiple-trace hypothesis. Journal of Experimental Psychology, 88(3), 297-306. [32] Raaijmakers, J. G. W., Schiffrin, R. M. (1981). Search of associative memory. Psychological Review, 8(2), 98-134 [33] Crowder, R. G. (1968). Intraserial repetition effects in immediate memory. Journal of Verbal Learning and Verbal Behavior, 7, 446-451. [34] Ebbinghaus, H. (1885). Memory: A Contribution to Experimental Psychology. [35] Bartlett, F. C. (1932). Remembering: A study in experimental and social psychology. Cambridge, England: Cambridge University Press.

22

Psychiatric medication
A psychiatric medication is a licensed psychoactive drug taken to exert an effect on the mental state and used to treat mental disorders. Usually prescribed in psychiatric settings, these medications are typically made of synthetic chemical compounds, although some are naturally occurring, or at least naturally derived.

Administration
Prescription psychiatric medications, like all prescription medications, require a prescription from a physician, such as a psychiatrist, or a psychiatric nurse practitioner, PMHNP, before they can be obtained. Some U.S. states and territories, following the creation of the prescriptive authority for psychologists movement, have granted prescriptive privileges to clinical psychologists who have undergone additional specialised education and training in medical psychology.[1]

Research

Ritalin Slow-Release (SR) 20 mg tablets.

Psychopharmacology studies a wide range of substances with various types of psychoactive properties. The professional and commercial fields of pharmacology and psychopharmacology do not typically focus on psychedelic or recreational drugs, and so the majority of studies are conducted on psychiatric medication. While studies are conducted on all psychoactives drugs by both fields, psychopharmacology focuses on psychoactive and chemical interactions with the brain. Physicians who research psychiatric medications are psychopharmacologists, specialists in the field of psychopharmacology. Recently there have been more studies into the field of psychedelics, this is due to the fact that this overly demonized class of drugs have recently been found, or atleat admitted to, being beneficial in psychiatry.

Psychiatric medication

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Adverse effects
Psychiatric medications sometimes have adverse effects that may reduce patients' drug compliance. Some of these adverse effects can be further treated by using other medications such as anticholinergics (antimuscarinics). Some adverse effects, including the possibility of a sudden or severe re-emergence of psychotic features, may appear when the patient stops taking the drug, particularly if a drug is suddenly discontinued instead of slowly tapered off.[2]

Types
There are six main groups of psychiatric medications. Antidepressants, which treat disparate disorders such as clinical depression, dysthymia, anxiety, eating disorders and borderline personality disorder.[3] Stimulants, which treat disorders such as attention deficit hyperactivity disorder and narcolepsy, and suppress the appetite. Antipsychotics, which treat psychoses such as schizophrenia and mania. Mood stabilizers, which treat bipolar disorder and schizoaffective disorder. Anxiolytics, which treat anxiety disorders. Depressants, which are used as hypnotics, sedatives, and anesthetics.

Antipsychotics
Antipsychotics are drugs used to treat various symptoms of psychosis, such as those caused by psychotic disorders or schizophrenia. Antipsychotics are also used as mood stabilizers in the treatment of bipolar disorder, even if no symptoms of psychosis are present. Antipsychotics are sometimes referred to as neuroleptic drugs and some antipsychotics are branded "major tranquilizers". There are two categories of antipsychotics: typical antipsychotics and atypical antipsychotics. Most antipsychotics are available only by prescription. Common antipsychotics:[4] Typical antipsychotics Chlorpromazine (Thorazine) Haloperidol (Haldol) Perphenazine (Trilafon) Thioridazine (Melleril) Thiothixene (Navane) Flupenthixol (Fluanxol) Trifluoperazine (Stelazine)

Atypical antipsychotics Aripiprazole (Abilify) Clozapine (Clozaril) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon)

Psychiatric medication

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Antidepressants
Antidepressants are drugs used to treat clinical depression, and they are also often used for anxiety and other disorders. Most antidepressants will restrain the catabolism of serotonin or norepinephrine or both. Such drugs are called selective serotonin reuptake inhibitors (SSRIs), and they actively prevent these neurotransmitters from dropping to the levels at which depression is experienced. SSRIs will often take 35 weeks to have a noticeable effect: the brain struggles to process the flood of serotonin, and reacts by downregulating the sensitivity of the autoreceptors, which can take up to 5 weeks. Bi-functional SSRIs are currently being researched, which will occupy the autoreceptors instead of 'throttling' serotonin. Another type of antidepressant is a monoamine oxidase inhibitor, which is thought to block the action of MAO, an enzyme that breaks down serotonin and norepinephrine. MAOIs are typically only used when tricyclic antidepressants or SSRIs exacerbate or fail to prevent depression. Common antidepressants:[5] Fluoxetine (Prozac), SSRI Paroxetine (Paxil, Seroxat), SSRI Citalopram (Celexa), SSRI Escitalopram (Lexapro), SSRI Sertraline (Zoloft), SSRI Duloxetine (Cymbalta), SNRI Venlafaxine (Effexor), SNRI Bupropion (Wellbutrin), NDRI[6] Mirtazapine (Remeron), NaSSA Isocarboxazid (Marplan), MAOI Phenelzine (Nardil), MAOI

Hallucinogens
Hallucinogens have been used in psychiatric medication in the past, and are currently being reevaluated for several uses. Contrary to their demonized public image, many hallucinogens and psychedelics have shown vastly better potential for actual curing of mental diseases that current medications only temporarily fix and in most cases worsen over time. Hallucinogens used for psychiatric medication include: LSD Psilocybin Mescaline Ibogaine Cannabis DMT

Mood stabilizers
In 1949, the Australian John Cade discovered that lithium salts could control mania, reducing the frequency and severity of manic episodes. This introduced the now popular drug lithium carbonate to the mainstream public, as well as being the first mood stabilizer to be approved by the U.S. Food & Drug Administration. Many antipsychotics are used as mood stabilizers as a drugs of choice. In some regions, first resort still remains a classic mood stabilizer such as lithium carbonate. Many mood stabilizers are from the drug group of anticonvulsants. The mechanism of action of mood stabilizers is not well elucidated nor understood. Common mood stabilizers: Lithium Carbonate (Carbolith), first and typical mood stabilizer Carbamazepine (Tegretol), anticonvulsant and mood stabilizer

Psychiatric medication Oxcarbazepine (Trileptal), anticonvulsant and mood stabilizer Valproic acid, and Valproic acid salts (Depakine, Depakote), anticonvulsant and mood stabilizer Lamotrigine (Lamictal), atypical anticonvulsant and mood stabilizer Gabapentin, atypical GABA-related anticonvulsant and mood stabilizer Pregabalin, atypical GABA-ergic anticonvulsant and mood stabilizer Topiramate, GABA-receptor related anticonvulsant and mood-stabilizer Olanzapine, atypical antipsychotic and mood stabilizer

25

Stimulants
Stimulants are some of the most widely prescribed drugs today. A stimulant is any drug that stimulates the central nervous system. Adderall, a collection of amphetamine salts, is one of the most prescribed pharmaceuticals in the treatment of attention-deficit hyperactivity disorder (ADHD). Stimulants can be addictive, and patients with a history of drug abuse are typically monitored closely or even barred from use and given an alternative. Discontinuing treatment without tapering the dose can cause psychological withdrawal symptoms such as anxiety and drug craving. Many stimulants are not physiologically addictive. Common stimulants: Caffeine, typical methylxanthine stimulant, found in many edibles worldwide Methylphenidate (Ritalin, Concerta), atypical stimulant Dexmethylphenidate (Focalin), active D-isomer of methylphenidate Dextroamphetamine (Dexedrine), more active amphetamine isomer Dextroamphetamine & levoamphetamine (Adderall), D,L -Amphetamine salt mix Methamphetamine (Desoxyn), potent amphetamphetamine-based stimulant Modafinil (Provigil) , a stimulant related to sildenafil (Viagra)

Anxiolytics & hypnotics

Barbiturates were first used as hypnotics and as anxiolytics, but as time went on, benzodiazepines (Lowell Randall and Leo Sternbach, 1957) were developed in the 1960s and 1970s. Eventually they led to billions of doses being consumed annually. Originally thought to be non-dependence forming in therapeutic doses, unlike barbiturates, as prescriptions increased, problems with addiction and dependence came to light. Benzodiazepines have widely supplanted barbiturates for treatment of almost all conditions in developed countries due to a much greater therapeutic ratio and less proclivity for overdose and toxicity. Common anxiolytics & hypnotics: Diazepam (Valium), benzodiazepine derivative, anxiolytic Nitrazepam (Mogadon), benzodiazepine derivative, hypnotic Zolpidem (Ambien, Stilnox), an imidazopyridine, non-benzodiazepine hypnotic Zopiclone (Imovan), non-benzodiazepine hypnotic ("Z-drug") Zaleplon (Sonata), non-benzodiazepine hypnotic ("Z-drug") Chlordiazepoxide (Librium), benzodiazepine derivative, anxiolytic Alprazolam (Xanax), benzodiazepine derivative, anxiolytic Temazepam (Restoril), benzodiazepine derivative Clonazepam (Klonopin), benzodiazepine derivative Lorazepam (Ativan), benzodiazepine derivative, anxiolytic

Psychiatric medication

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References
[1] Murray, Bridget (October 2003). "A Brief History of RxP" (http:/ / www. apa. org/ monitor/ oct03/ rxp. html). APA Monitor. . Retrieved 4/11/2007. [2] Moncrieff, Joanna (23 March 2006). "Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse" (http:/ / www3. interscience. wiley. com/ journal/ 118626311/ abstract). Acta Psychiatrica Scandinavica (John Wiley & Sons A/S) 114 (1): 313. doi:10.1111/j.1600-0447.2006.00787.x. ISSN1600-0447. PMID16774655. . Retrieved 3 May 2009. [3] Schatzberg, A.F. (2000). "New indications for antidepressants". Journal of Clinical Psychiatry 61 (11): 917. PMID10926050. [4] "Tardive dyskinesia" (http:/ / www. healthatoz. com/ healthatoz/ Atoz/ ency/ tardive_dyskinesia. jsp). . [5] "Monoamine Oxidase Inhibitors" (http:/ / www. healthyplace. com/ Communities/ depression/ treatment/ antidepressants/ maoi. asp). . [6] Stephen M. Stahl, M.D., Ph.D.; et al. (2004) (pdf). A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor (http:/ / www. psychiatrist. com/ pcc/ pccpdf/ v06n04/ v06n0403. pdf). Journal of Clinical Psychiatry; 6(04) 159-166 2004 PHYSICIANS POSTGRADUATE PRESS, INC. . Retrieved 2006-09-02.

External links
Children and Psychiatric Medication - a multimodal presentation (http://childadvocate.net/childpresentations/ child_medication.htm) Psychiatric Drugs: Antidepressant, Antipsychotic, Antianxiety, Antimanic Agent, Stimulant Prescription Drugs (http://www.psychiatricdrugs.net/)

Parietal lobe

27

Parietal lobe
Brain: Parietal lobes

Frontal lobe Temporal lobe Parietal lobe Occipital lobe Principal fissures and lobes of the cerebrum viewed laterally. (Parietal Lobe is shown in yellow)

Lateral surface of left cerebral hemisphere, viewed from the side. (Parietal Lobe is shown in orange.) Latin Gray's Part of Artery Vein NeuroNames MeSH NeuroLex ID lobus parietalis subject #189 822 Cerebrum Anterior cerebral Middle cerebral Superior sagittal sinus hier-77
[2] [3] [1]

Parietal+Lobe birnlex_1148

[4]

The parietal lobe is a part of the Brain positioned above (superior to) the occipital lobe and behind (posterior to) the frontal lobe. The parietal lobe integrates sensory information from different modalities, particularly determining spatial sense and navigation. For example, it comprises somatosensory cortex and the dorsal stream of the visual system. This enables regions of the parietal cortex to map objects perceived visually into body coordinate positions. The name derives from the overlying parietal bone, which is named from the Latin pariet-, wall.

Parietal lobe

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Anatomy
The parietal lobe is defined by three anatomical boundaries: the central sulcus separates the parietal lobe from the frontal lobe; the parieto-occipital sulcus separates the parietal and occipital lobes; the lateral sulcus (sylvian fissure) is the most lateral boundary separating it from the temporal lobe; and the medial longitudinal fissure divides the two hemispheres. Immediately posterior to the central sulcus, and the most anterior part of the parietal lobe, is the postcentral gyrus (Brodmann area 3), the secondary somatosensory cortical area. Dividing this and the posterior parietal cortex is the postcentral sulcus. The posterior parietal cortex can be subdivided into the superior parietal lobule (Brodmann areas 5 + 7) and the inferior parietal lobule (39 + 40), separated by the intraparietal sulcus (IPS). The intraparietal sulcus and adjacent gyri are essential in guidance of limb and eye movement, and based on cytoarchitectural and functional differences is further divided into medial (MIP), lateral (LIP), ventral (VIP), and anterior (AIP) areas.
Animation. Parietal lobe (red) of left cerebral hemisphere.

Function
The parietal lobe plays important roles in integrating sensory information from various parts of the body, knowledge of numbers and their relations,[5] and in the manipulation of objects. Portions of the parietal lobe are involved with visuospatial processing. Although multisensory in nature, the posterior parietal cortex is often referred to by vision scientists as the dorsal stream of vision (as opposed to the ventral stream in the temporal lobe). This dorsal stream has been called both the 'where' stream (as in spatial vision)[6] and the 'how' stream (as in vision for action).[7] Various studies in the 1990s found that different regions of the posterior parietal cortex in Macaques represent different parts of space. The lateral intraparietal (LIP) contains a map of neurons (retinotopically-coded when the eyes are fixed[8] ) representing the saliency of spatial locations, and attention to these spatial locations. It can be used by the oculomotor system for targeting eye movements, when appropriate.[9] The ventral intraparietal (VIP) area receives input from a number of senses (visual, somatosensory, auditory, and vestibular[10] ). Neurons with tactile receptive fields represented space in a head-centered reference frame.[10] The cells with visual receptive fields also fire with head-centered reference frames[11] but possibly also with eye-centered coordinates[10] The medial intraparietal (MIP) area neurons encode the location of a reach target in nose-centered coordinates.[12] The anterior intraparietal (AIP) area contains neurons responsive to shape, size, and orientation of objects to be grasped[13] as well as for manipulation of hands themselves, both to viewed[13] and remembered stimuli.[14] More recent fMRI studies have shown that humans have similar functional regions in and around the intraparietal sulcus and parietal-occipital junction.[15] The human 'parietal eye fields' and 'parietal reach region', equivalent to LIP and MIP in the monkey, also appear to be organized in gaze-centered coordinates so that their goal-related activity is 'remapped' when the eyes move.[16] Both the left and right parietal systems play a determining role in self transcendence, the personality trait measuring predisposition to spirituality [17] This lobe is divided into two hemispheres- left and right. The left hemisphere plays a more prominent role for right handers and is involved in symbolic functions in language and mathematics. Meanwhile, the right hemisphere plays a more prominent role for left handers and is specialised to carry out images and understanding of maps i.e.spatial relationships. Damage to the right hemisphere of this lobe results in the loss of imagery, visualization of spacial

Parietal lobe relationships and neglect of left side space and left side of the body. Even drawing may be neglected from the left side. Damage to the left hemisphere of this lobe will result in problems in mathematics, long reading, writing and understanding symbols. The parietal association cortex enables individuals to read, write, and solve mathematical problems.The sensory inputs from the right side go to the left side and vice-versa.

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Pathology
Gerstmann's syndrome is associated with lesion to the dominant (usually left) parietal lobe.[18] Balint's syndrome is associated with bilateral lesions. The syndrome of hemispatial neglect is usually associated with large deficits of attention of the non-dominant hemisphere. Optic ataxia is associated with difficulties reaching toward objects in the visual field opposite to the side of the parietal damage. Some aspects of optic ataxia have been explained in terms of the functional organization described above.[19]

Additional images

Lobes

Drawing to illustrate the relations of the brain to the skull.

References
[1] [2] [3] [4] [5] [6] http:/ / education. yahoo. com/ reference/ gray/ subjects/ subject?id=189#p822 http:/ / braininfo. rprc. washington. edu/ Scripts/ hiercentraldirectory. aspx?ID=77 http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2007/ MB_cgi?mode=& term=Parietal+ Lobe http:/ / www. neurolex. org/ wiki/ birnlex_1148 Blakemore & Frith (2005). The Learning Brain. Blackwell Publishing. ISBN 1-4051-2401-6 Mishkin M, Ungerleider LG. (1982) Contribution of striate inputs to the visuospatial functions of parieto-preoccipital cortex in monkeys. Behav Brain Res. 1982 Sep;6(1):57-77. [7] Goodale MA, Milner AD. Separate visual pathways for perception and action. Trends Neurosci. 1992 Jan;15(1):20-5. [8] Kusonoki M, Goldberg ME. (2003) The time course of perisaccadic receptive field shifts in the lateral intraparietal area of the monkey. J Neurophysiol. 89(3):1519-27. PMID 12612015 [9] Goldberg ME, Bisley JW, Powell KD, Gottlieb J. (2006) Saccades, salience and attention: the role of the lateral intraparietal area in visual behavior. Prog Brain Res. 155:157-75. PMID 17027387 [10] Avillac M, Deneve S, Olivier E, Pouget A, Duhamel JR. (2005) Reference frames for representing visual and tactile locations in parietal cortex. Nat Neurosci. 8(7):941-9. [11] Zhang T, Heuer HW, Britten KH. (2004) Parietal area VIP neuronal responses to heading stimuli are encoded in head-centered coordinates. Neuron 42(6):993-1001. [12] Pesaran B, Nelson MJ, Andersen RA. (2006) Dorsal premotor neurons encode the relative position of the foot, eye, and goal during reach planning. Neuron 51(1):125-34. [13] Murata A, Gallese V, Luppino G, Kaseda M, Sakata H. (2000) Selectivity for the shape, size, and orientation of objects for grasping in neurons of monkey parietal area AIP. J Neurophysiol 83(5):2580. PMID 10805659

Parietal lobe
[14] Murata A, Gallese V, Kaseda M, Sakata H. (1996) Parietal neurons related to memory-guided hand manipulation. J Neurophysiol 75(5):2180-6. PMID 8734616 [15] Culham JC, Valyear KF. (2006) Human parietal cortex in action. Curr Opin Neurobiol. 16(2):205-12. [16] Medendorp WP, Goltz HC, Vilis T, Crawford JD. (2003) Gaze-centered updating of visual space in human parietal cortex. J Neurosci. 16;23(15):6209-14. [17] http:/ / www. cell. com/ neuron/ abstract/ S0896-6273%2810%2900052-8 [18] Vallar G. (2007). Spatial neglect, Balint-Homes' and Gerstmann's syndrome, and other spatial disorders. CNS Spectr. 12(7):527-36. [19] Khan AZ, Pisella L, Vighetto A, Cotton F, Luaut J, Boisson D, Salemme R, Crawford JD, Rossetti Y. (2011) Optic ataxia errors depend on remapped, not viewed, target location. Nat Neurosci. 8(4):418-20.

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Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group. The problems addressed are psychological in nature and of no specific kind or degree, but rather depend the specialty of the practitioner. You do not need any specific training to be called a psychotherapist. Psychotherapy aims to increase the individual's sense of his own well-being. Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behavior change that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family). Psychotherapy may also be performed by practitioners with a number of different qualifications, including psychiatry, clinical psychology, counseling psychology, clinical or psychiatric social work, mental health counseling, marriage and family therapy, rehabilitation counseling, school counseling, play therapy, music therapy, art therapy, drama therapy, dance/movement therapy, occupational therapy, psychiatric nursing, psychoanalysis and those from other psychotherapies. It may be legally regulated, voluntarily regulated or unregulated, depending on the jurisdiction. Requirements of these professions vary, but often require graduate school and supervised clinical experience. Psychotherapy in Europe is increasingly being seen as an independent profession, rather than being restricted to being practiced only by psychologists and psychiatrists as is stipulated in some countries.

Regulation
Continental Europe
In Germany, the Psychotherapy Act (PsychThG, 1998) restricts the practice of psychotherapy to the professions of psychology and psychiatry.[1] In Italy, the Ossicini Act (no. 56/1989, art. 3) restricts the practice of psychotherapy to graduates in psychology or medicine who have completed a four-year postgraduate course in psychotherapy at a training school recognised by the state;[2] French legislation restricts use of the title "psychotherapist" to professionals on the National Register of Psychotherapists;.[3] The inscription on this register requires a training in clinical psychopathology and a period of internship which is only open to physicians or titulars of a master's degree in psychology or psychoanalysis. Austria and Switzerland (2011) have laws that recognize multidifunctional-disciplinary approaches; other European countries have not yet regulated psychotherapy.

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United Kingdom
In the United Kingdom, psychotherapy is voluntarily regulated. National registers for psychotherapists and counsellors are maintained by three main umbrella bodies:[4] 1. the United Kingdom Council for Psychotherapy (UKCP) 2. the British Association for Counselling and Psychotherapy (BACP) 3. the British Psychoanalytic Council (BPC - formerly the British Confederation of Psychotherapists). There are many smaller professional bodies and associations such as the Association of Child Psychotherapists (ACP)[5] and the British Association of Psychotherapists (BAP).[6] The United Kingdom Health Professions Council (HPC) have recently consulted on potential statutory regulation of psychotherapists and counsellors. The HPC [7] is an official state regulator that regulates some 15 professions at present.

Etymology
Psychotherapy is an English word of Greek origin, deriving from Ancient Greek psyche ( meaning "breath; spirit; soul") and therapia ( "healing; medical treatment"). According to the Oxford English Dictionary, psychotherapy first meant "hypnotherapy" instead of "psychotherapy". The original meaning, "the treatment of disease by psychic [i.e., hypnotic] methods", was first recorded in 1853 as "Psychotherapeia, or the remedial influence of mind". The modern meaning, "the treatment of disorders of the mind or personality by psychological or psychophysiological methods", was first used in 1892 by Frederik van Eeden translating "Suggestive Psycho-therapy" for his French "Psychothrapie Suggestive". Van Eeden credited borrowing this term from Daniel Hack Tuke and noted, "Psycho-therapy ... had the misfortune to be taken in tow by hypnotism."[8] The psychiatrist Jerome Frank defined psychotherapy as the relief of distress or disability in one person by another, using an approach based on a particular theory or paradigm, and a requirement that the agent performing the therapy has had some form of training in delivering this. It is these latter two points which distinguish psychotherapy from other forms of counseling or caregiving.[9]

Forms
Most forms of psychotherapy use spoken conversation. Some also use various other forms of communication such as the written word, artwork, drama, narrative story or music. Psychotherapy with children and their parents often involves play, dramatization (i.e. role-play), and drawing, with a co-constructed narrative from these non-verbal and displaced modes of interacting.[10] Psychotherapy occurs within a structured encounter between a trained therapist and client(s). Purposeful, theoretically based psychotherapy began in the 19th century with psychoanalysis; since then, scores of other approaches have been developed and continue to be created. Therapy is generally used in response to a variety of specific or non-specific manifestations of clinically diagnosable and/or existential crises. Treatment of everyday problems is more often referred to as counseling (a distinction originally adopted by Carl Rogers). However, the term counseling is sometimes used interchangeably with "psychotherapy". While some psychotherapeutic interventions are designed to treat the patient using the medical model, many psychotherapeutic approaches do not adhere to the symptom-based model of "illness/cure". Some practitioners, such as humanistic therapists, see themselves more in a facilitative/helper role. As sensitive and deeply personal topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality. The critical importance of confidentiality is enshrined in the regulatory psychotherapeutic organizations' codes of ethical practice.

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Systems
There are several main broad systems of psychotherapy: Psychoanalytic - it was the first practice to be called a psychotherapy. It encourages the verbalization of all the patient's thoughts, including free associations, fantasies, and dreams, from which the analyst formulates the nature of the unconscious conflicts which are causing the patient's symptoms and character problems. Behavior Therapy/applied behavior analysis focuses on changing maladaptive patterns of behavior to improve emotional responses, cognitions, and interactions with others. Cognitive behavioral - generally seeks to identify maladaptive cognition, appraisal, beliefs and reactions with the aim of influencing destructive negative emotions and problematic dysfunctional behaviors. Psychodynamic - is a form of depth psychology, whose primary focus is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. Although its roots are in psychoanalysis, psychodynamic therapy tends to be briefer and less intensive than traditional psychoanalysis. Existential - is based on the existential belief that human beings are alone in the world. This isolation leads to feelings of meaninglessness, which can be overcome only by creating one's own values and meanings. Existential therapy is philosophically associated with phenomenology. Humanistic - emerged in reaction to both behaviorism and psychoanalysis and is therefore known as the Third Force in the development of psychology. It is explicitly concerned with the human context of the development of the individual with an emphasis on subjective meaning, a rejection of determinism, and a concern for positive growth rather than pathology. It posits an inherent human capacity to maximize potential, 'the self-actualizing tendency'. The task of Humanistic therapy is to create a relational environment where this tendency might flourish. Humanistic psychology is philosophically rooted in existentialism. Brief - "Brief therapy" is an umbrella term for a variety of approaches to psychotherapy. It differs from other schools of therapy in that it emphasizes (1) a focus on a specific problem and (2) direct intervention. It is solution-based rather than problem-oriented. It is less concerned with how a problem arose than with the current factors sustaining it and preventing change. Systemic - seeks to address people not at an individual level, as is often the focus of other forms of therapy, but as people in relationship, dealing with the interactions of groups, their patterns and dynamics (includes family therapy & marriage counseling). Community psychology is a type of systemic psychology. Transpersonal - Addresses the client in the context of a spiritual understanding of consciousness. Body Psychotherapy - Addresses problems of the mind as being closely correlated with bodily phenomena, including a person's sexuality, musculature, breathing habits, physiology etc. This therapy may involve massage and other body exercises as well as talking. There are hundreds of psychotherapeutic approaches or schools of thought. By 1980 there were more than 250;[11] by 1996 there were more than 450.[12] The development of new and hybrid approaches continues around the wide variety of theoretical backgrounds. Many practitioners use several approaches in their work and alter their approach based on client need.

History
In an informal sense, psychotherapy can be said to have been practiced through the ages, as individuals received psychological counsel and reassurance from others. According to Colin Feltham, "The Stoics were one of the main Hellenistic schools of philosophy and therapy, along with the Sceptics and Epicureans (Nussbaum, 1994). Philosophers and physicians from these schools practised psychotherapy among the Greeks and Romans from about the late 4th century BC to the 4th century AD."[13] Psychoanalysis was perhaps the first specific school of psychotherapy, developed by Sigmund Freud and others through the early 20th century. Trained as a neurologist, Freud began focusing on problems that appeared to have no

Psychotherapy discernible organic basis, and theorized that they had psychological causes originating in childhood experiences and the unconscious mind. Techniques such as dream interpretation, free association, transference and analysis of the id, ego and superego were developed. Many theorists, including Anna Freud, Alfred Adler, Carl Jung, Karen Horney, Otto Rank, Erik Erikson, Melanie Klein, and Heinz Kohut, built upon Freud's fundamental ideas and often formed their own differentiating systems of psychotherapy. These were all later categorized as psychodynamic, meaning anything that involved the psyche's conscious/unconscious influence on external relationships and the self. Sessions tended to number into the hundreds over several years. Behaviorism developed in the 1920s, and behavior modification as a therapy became popularized in the 1950s and 1960s. Notable contributors were Joseph Wolpe in South Africa, M.B. Shipiro and Hans Eysenck in Britain, and John B. Watson and B.F. Skinner in the United States. Behavioral therapy approaches relied on principles of operant conditioning, classical conditioning and social learning theory to bring about therapeutic change in observable symptoms. The approach became commonly used for phobias, as well as other disorders.

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Some therapeutic approaches developed out of the European school of existential philosophy. Concerned mainly with the individual's ability to develop and preserve a sense of meaning and purpose throughout life, major contributors to the field in the US (e.g., Irvin Yalom, Rollo May) and Europe (Viktor Frankl, Ludwig Binswanger, Medard Boss, R.D.Laing, Emmy van Deurzen) and later in the 1960s and 1970s both in the United Kingdom and in Canada, Eugene Heimler [14] [15] attempted to create therapies sensitive to common 'life crises' springing from the essential bleakness of human self-awareness, previously accessible only through the complex writings of existential philosophers (e.g., Sren Kierkegaard, Jean-Paul Sartre, Gabriel Marcel, Martin Heidegger, Friedrich Nietzsche). The uniqueness of the patient-therapist relationship thus also forms a vehicle for therapeutic inquiry. A related body of thought in psychotherapy started in the 1950s with Carl Rogers. Based on existentialism and the works of Abraham Maslow and his hierarchy of human needs, Rogers brought person-centered psychotherapy into mainstream focus. The primary requirement of Rogers is that the client should be in receipt of three core 'conditions' from his counsellor or therapist: unconditional positive regard, also sometimes described as 'prizing' the person or valuing the humanity of an individual, congruence [authenticity/genuineness/transparency], and empathic understanding. The aim in using the 'core conditions' is to facilitate therapeutic change within a non-directive relationship conducive to enhancing the client's psychological well being. This type of interaction enables the client to fully experience and express himself. Others developed the approach, like Fritz and Laura Perls in the creation of Gestalt therapy, as well as Marshall Rosenberg, founder of Nonviolent Communication, and Eric Berne, founder of Transactional Analysis. Later these fields of psychotherapy would become what is known as humanistic psychotherapy today. Self-help groups and books became widespread. During the 1950s, Albert Ellis originated Rational Emotive Behavior Therapy (REBT). A few years later, psychiatrist Aaron T. Beck developed a form of psychotherapy known as cognitive therapy. Both of these generally included relatively short, structured and present-focused therapy aimed at identifying and changing a person's beliefs, appraisals and reaction-patterns, by contrast with the more long-lasting insight-based approach of psychodynamic or humanistic therapies. Cognitive and behavioral therapy approaches were combined and grouped under the heading and umbrella-term Cognitive behavioral therapy (CBT) in the 1970s. Many approaches within CBT are oriented towards active/directive collaborative empiricism and mapping, assessing and modifying clients core beliefs and dysfunctional schemas. These approaches gained widespread acceptance as a primary treatment for

Starting in the 1950s Carl Rogers brought Person-centered psychotherapy into mainstream focus.

Psychotherapy numerous disorders. A "third wave" of cognitive and behavioral therapies developed, including Acceptance and Commitment Therapy and Dialectical behavior therapy, which expanded the concepts to other disorders and/or added novel components and mindfulness exercises. Counseling methods developed, including solution-focused therapy and systemic coaching. During the 1960s and 1970s Eugene Heimler, after training in the new discipline of psychiatric social work, developed Heimler method of Human Social Functioning, a methodology based on the principle that frustration is the potential to human flourishing.[14] [15] Postmodern psychotherapies such as Narrative Therapy and Coherence Therapy did not impose definitions of mental health and illness, but rather saw the goal of therapy as something constructed by the client and therapist in a social context. Systems Therapy also developed, which focuses on family and group dynamicsand Transpersonal psychology, which focuses on the spiritual facet of human experience. Other important orientations developed in the last three decades include Feminist therapy, Brief therapy, Somatic Psychology, Expressive therapy, applied Positive psychology and the Human Givens approach which is building on the best of what has gone before.[16] A survey of over 2,500 US therapists in 2006 revealed the most utilized models of therapy and the ten most influential therapists of the previous quarter-century.[17]

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General description
Psychotherapy can be seen as an interpersonal invitation offered by (often trained and regulated) psychotherapists to aid clients in reaching their full potential or to cope better with problems of life. Psychotherapists usually receive remuneration in some form in return for their time and skills. This is one way in which the relationship can be distinguished from an altruistic offer of assistance. Psychotherapists and counselors often require to create a therapeutic environment referred to as the frame, which is characterized by a free yet secure climate that enables the client to open up. The degree to which client feels related to the therapist may well depend on the methods and approaches used by the therapist or counselor. Psychotherapy often includes techniques to increase awareness and the capacity for self observation, change behavior and cognition, and develop insight and empathy. A desired result enable other choices of thought, feeling or action; to increase the sense of well-being and to better manage subjective discomfort or distress. Perception of reality is hopefully improved. Grieving might be enhanced producing less long term depression. Psychotherapy can improve medication response where such medication is also needed. Psychotherapy can be provided on a one-to-one basis, in group therapy, conjointly with couples and with entire families. It can occur face to face (individual), over the telephone, or, much less commonly, the Internet. Its time frame may be a matter of weeks or many years. Therapy may address specific forms of diagnosable mental illness, or everyday problems in managing or maintaining interpersonal relationships or meeting personal goals. Treatment in families with children can favorably influence a childs development, lasting for life and into future generations. Better parenting may be an indirect result of therapy or purposefully learned as parenting techniques. Divorces can be prevented, or made far less traumatic. Treatment of everyday problems is more often referred to as counseling (a distinction originally adopted by Carl Rogers) but the term is sometimes used interchangeably with "psychotherapy". Therapeutic skills can be used in mental health consultation to business and public agencies to improve efficiency and assist with coworkers or clients. Psychotherapists use a range of techniques to influence or persuade the client to adapt or change in the direction the client has chosen. These can be based on clear thinking about their options; experiential relationship building; dialogue, communication and adoption of behavior change strategies. Each is designed to improve the mental health of a client or patient, or to improve group relationships (as in a family). Most forms of psychotherapy use only spoken conversation, though some also use other forms of communication such as the written word, artwork, drama, narrative story, or therapeutic touch. Psychotherapy occurs within a structured encounter between a trained therapist and client(s). Because sensitive topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality.

Psychotherapy Psychotherapists are often trained, certified, and licensed, with a range of different certifications and licensing requirements depending on the jurisdiction. Psychotherapy may be undertaken by clinical psychologists,counseling psychologists, social workers, marriage-family therapists, adult and child psychiatrists and expressive therapists, trained nurses, psychiatrists, psychoanalysts, mental health counselors, school counselors, or professionals of other mental health disciplines. Psychiatrists have medical qualifications and may also administer prescription medication. The primary training of a psychiatrist uses the ' Bio-Psycho-Social' model, medical training in practical psychology and applied psychotherapy. Psychiatric training begins in medical school, first in the doctor patient relationship with ill people, and later in psychiatric residency for specialists. The focus is usually eclectic but includes biological, cultural, and social aspects. They are advanced in understanding patients from the inception of medical training. Today there are two doctoral degrees in psychology, the PsyD and PhD. Training for these degrees overlap, but the PsyD is more clinical and the Phd stresses research. Both degrees have clinical education components. Clinical Social Workers have specialized training in clinical casework. They hold a masters in social work which entails two years of clinical internships, and a period of at least three years in the US of post-masters experience in psychotherapy. Marriage-family therapists have specific training and experience working with relationships and family issues. A licensed professional counselor (LPC) generally has special training in career, mental health, school, or rehabilitation counseling to include evaluation and assessments as well as psychotherapy. Many of the wide variety of training programs are multiprofessional, that is, psychiatrists, psychologists, mental health nurses, and social workers may be found in the same training group. All these degrees commonly work together as a team, especially in institutional settings. All those doing specialized psychotherapeutic work, in most countries, require a program of continuing education after the basic degree, or involve multiple certifications attached to one specific degree, and 'board certification' in psychiatry. Specialty exams are used to confirm competence or board exams with psychiatrists .

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Medical and non-medical models

A distinction can also be made between those psychotherapies that employ a medical model and those that employ a humanistic model. In the medical model the client is seen as unwell and the therapist employs their skill to help the client back to health. The extensive use of the DSM-IV, the diagnostic and statistical manual of mental disorders in the United States, is an example of a medically-exclusive model. The humanistic model of non medical in contrast strives to depathologise the human condition. The therapist attempts to create a relational environment conducive to experiential learning and help build the client's confidence in their own natural process resulting in a deeper understanding of themselves. An example would be gestalt therapy. Some psychodynamic practitioners distinguish between more uncovering and more supportive psychotherapy. Uncovering psychotherapy emphasizes facilitating the client's insight into the roots of their difficulties. The best-known example of an uncovering psychotherapy is classical psychoanalysis. Supportive psychotherapy by contrast stresses strengthening the client's defenses and often providing encouragement and advice. Depending on the client's personality, a more supportive or more uncovering approach may be optimal. Most psychotherapists use a combination of uncovering and supportive approaches.

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Specific schools and approaches

In practices of experienced psychotherapists, the therapy is typically not of one pure type, but draws aspects from a number of perspectives and schools.[18] [19]

Psychoanalysis
Psychoanalysis was developed in the late 19th century by Sigmund Freud. His therapy explores the dynamic workings of a mind understood to consist of three parts: the hedonistic id (German: das Es, "the it"), the rational ego (das Ich, "the I"), and the moral superego (das berich, "the above-I"). Because the majority of these dynamics are said to occur outside people's awareness, Freudian psychoanalysis seeks to probe the unconscious by way of various techniques, including dream interpretation and free association. Freud maintained that the condition of the unconscious mind is profoundly influenced by childhood experiences. So, in addition to dealing with the defense mechanisms used by an overburdened ego, his therapy addresses fixations and other issues by probing deeply into clients' youth.

Freud , seated left of picture with Jung seated at right of picture. 1909

Other psychodynamic theories and techniques have been developed and used by psychotherapists, psychologists, psychiatrists, personal growth facilitators, occupational therapists and social workers. Techniques for group therapy have also been developed. While behaviour is often a target of the work, many approaches value working with feelings and thoughts. This is especially true of the psychodynamic schools of psychotherapy, which today include Jungian therapy and Psychodrama as well as the psychoanalytic schools.

Gestalt therapy
Gestalt Therapy is a major overhaul of psychoanalysis. In its early development it was called "concentration therapy" by its founders, Frederick and Laura Perls. However, its mix of theoretical influences became most organized around the work of the gestalt psychologists; thus, by the time 'Gestalt Therapy, Excitement and Growth in the Human Personality' (Perls, Hefferline, and Goodman) was written, the approach became known as "Gestalt Therapy." Gestalt Therapy stands on top of essentially four load bearing theoretical walls: phenomenological method, dialogical relationship, field-theoretical strategies, and experimental freedom. Some have considered it an existential phenomenology while others have described it as a phenomenological behaviorism. Gestalt therapy is a humanistic, holistic, and experiential approach that does not rely on talking alone, but facilitates awareness in the various contexts of life by moving from talking about situations relatively remote to action and direct, current experience.

Group psychotherapy
The therapeutic use of groups in modern clinical practice can be traced to the early 20th century, when the American chest physician Pratt, working in Boston, described forming 'classes' of 15 to 20 patients with tuberculosis who had been rejected for sanatorium treatment. The term group therapy, however, was first used around 1920 by Jacob L. Moreno, whose main contribution was the development of psychodrama, in which groups were used as both cast and audience for the exploration of individual problems by reenactment under the direction of the leader. The more analytic and exploratory use of groups in both hospital and out-patient settings was pioneered by a few European psychoanalysts who emigrated to the USA, such as Paul Schilder, who treated severely neurotic and mildly psychotic out-patients in small groups at Bellevue Hospital, New York. The power of groups was most influentially demonstrated in Britain during the Second World War, when several psychoanalysts and psychiatrists proved the

Psychotherapy value of group methods for officer selection in the War Office Selection Boards. A chance to run an Army psychiatric unit on group lines was then given to several of these pioneers, notably Wilfred Bion and Rickman, followed by S. H. Foulkes, Main, and Bridger. The Northfield Hospital in Birmingham gave its name to what came to be called the two 'Northfield Experiments', which provided the impetus for the development since the war of both social therapy, that is, the therapeutic community movement, and the use of small groups for the treatment of neurotic and personality disorders. Today group therapy is used in clinical settings and in private practice settings. It has been shown to be as or more effective than individual therapy.[20]

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Cognitive behavioral therapy

Cognitive behavioral therapy refers to a range of techniques which focus on the construction and re-construction of people's cognitions, emotions and behaviors. Generally in CBT, the therapist, through a wide array of modalities, helps clients assess, recognize and deal with problematic and dysfunctional ways of thinking, emoting and behaving.

Behavior therapy
Behavior therapy focuses on modifying overt behavior and helping clients to achieve goals. This approach is built on the principles of learning theory including operant and respondent conditioning, which makes up the area of applied behavior analysis or behavior modification. This approach includes acceptance and commitment therapy, functional analytic psychotherapy, and dialectical behavior therapy. Sometimes it is integrated with cognitive therapy to make cognitive behavior therapy. By nature, behavioral therapies are empirical (data-driven), contextual (focused on the environment and context), functional (interested in the effect or consequence a behavior ultimately has), probabilistic (viewing behavior as statistically predictable), monistic (rejecting mind-body dualism and treating the person as a unit), and relational (analyzing bidirectional interactions).[21]

Body-oriented psychotherapy
Body-oriented psychotherapy or Body Psychotherapy is also known as Somatic Psychology, especially in the USA. There are many very different psychotherapeutic approaches. They generally focus on the link between the mind and the body and try to access deeper levels of the psyche through greater awareness of the physical body and the emotions which gave rise to the various body-oriented based psychotherapeutic approaches, such as Reichian (Wilhelm Reich) Character-Analytic Vegetotherapy and Orgonomy; neo-Reichian Alexander Lowen's Bioenergetic analysis; Peter Levine's Somatic Experiencing; Jack Rosenberg's Integrative body psychotherapy; Ron Kurtz's Hakomi psychotherapy; Pat Ogden's sensorimotor psychotherapy; David Boadella's Biosynthesis psychotherapy; Gerda Boyesen's Biodynamic psychotherapy; etc. These body-oriented psychotherapies are not to be confused with alternative medicine body-work or body-therapies that seek primarily to improve physical health through direct work (touch and manipulation) on the body because, despite the fact that bodywork techniques (for example Alexander Technique, Rolfing, and the Feldenkrais Method) can also affect the emotions, these techniques are not designed to work on psychological issues, neither are their practitioners so trained.

Expressive therapy
Expressive therapy is a form of therapy that utilizes artistic expression as its core means of treating clients. Expressive therapists use the different disciplines of the creative arts as therapeutic interventions. This includes the modalities dance therapy, drama therapy, art therapy, music therapy, writing therapy, among others. Expressive therapists believe that often the most effective way of treating a client is through the expression of imagination in a creative work and integrating and processing what issues are raised in the act.

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Interpersonal psychotherapy
Interpersonal psychotherapy (IPT) is a time-limited psychotherapy that focuses on the interpersonal context and on building interpersonal skills. IPT is based on the belief that interpersonal factors may contribute heavily to psychological problems. It is commonly distinguished from other forms of therapy in its emphasis on interpersonal processes rather than intrapsychic processes. IPT aims to change a person's interpersonal behavior by fostering adaptation to current interpersonal roles and situations.

Narrative therapy
Narrative therapy gives attention to each person's "dominant story" by means of therapeutic conversations, which also may involve exploring unhelpful ideas and how they came to prominence. Possible social and cultural influences may be explored if the client deems it helpful.

Integrative psychotherapy
Integrative psychotherapy is an attempt to combine ideas and strategies from more than one theoretical approach.[22] These approaches include mixing core beliefs and combining proven techniques. Forms of integrative psychotherapy include multimodal therapy, the transtheoretical model, cyclical psychodynamics, systematic treatment selection, cognitive analytic therapy, Internal Family Systems Model, multitheoretical psychotherapy and conceptual interaction. In practice, most experienced psychotherapists develop their own integrative approach over time.

Hypnotherapy
Hypnotherapy is therapy that is undertaken with a subject in hypnosis. Hypnotherapy is often applied in order to modify a subject's behavior, emotional content, and attitudes, as well as a wide range of conditions including dysfunctional habits, anxiety, stress-related illness, pain management, and personal development.

Adaptations for children

Counseling and psychotherapy must be adapted to meet the developmental needs of children. Many counseling preparation programs include courses in human development. Since children often do not have the ability to articulate thoughts and feelings, counselors will use a variety of media such as crayons, paint, clay, puppets, bibliocounseling (books), toys, board games, et cetera. The use of play therapy is often rooted in psychodynamic theory, but other approaches such as Solution Focused Brief Counseling may also employ the use of play in counseling. In many cases the counselor may prefer to work with the care taker of the child, especially if the child is younger than age four. Yet, by doing so, the counselor risks the perpetuation of maladaptive interactive patterns and the adverse effects on development that have already been affected on the child's end of the relationship[23] Therefore, contemporary thinking on working with this young age group has leaned towards working with parent and child simultaneously within the interaction, as well as individually as needed.[24]

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Confidentiality
Further information: client confidentiality, and physician-patient privilege Confidentiality is an integral part of the therapeutic relationship and psychotherapy in general.

Criticisms and questions regarding effectiveness

Within the psychotherapeutic community there has been some discussion of empirically-based psychotherapy, e.g.[25] Virtually no comparisons of different psychotherapies with long follow-up times have been done.[26] The Helsinki Psychotherapy Study[27] is a randomized clinical trial, in which patients are monitored for 12 months after the onset of study treatments, of which each lasted approximately 6 months. The assessments are to be completed at the baseline examination and during the follow-up after 3, 7, and 9 months and 1, 1.5, 2, 3, 4, 5, 6, and 7 years. The final results of this trial are yet to be published because follow-up evaluations continued up to 2009. There is considerable controversy about which form of psychotherapy is most effective, and more specifically, which types of therapy are optimal for treating which sorts of problems.[28] Furthermore, it is controversial whether the form of therapy or the presence of factors common to many psychotherapies best separates effective therapy from ineffective therapy. Common factors theory asserts it is precisely the factors common to the most psychotherapies that make any psychotherapy successful: this is the quality of the therapeutic relationship. The dropout level is quite high; one meta-analysis of 125 studies concluded that the mean dropout rate was 46.86%.[29] The high level of dropout has raised some criticism about the relevance and efficacy of psychotherapy. For a brief review article on dropout or attrition in therapy see link attached http:/ / www. lenus. ie/ hse/ bitstream/ 10147/121474/1/DropoutRelatedfactorsPSI.pdf. Psychotherapy outcome researchin which the effectiveness of psychotherapy is measured by questionnaires given to patients before, during, and after treatmenthas had difficulty distinguishing between the success or failure of the different approaches to therapy. Those who stay with their therapist for longer periods are more likely to report positively on what develops into a longer-term relationship. This suggests that some "treatment" may be open-ended with concerns associated with ongoing financial costs. As early as 1952, in one of the earliest studies of psychotherapy treatment, Hans Eysenck reported that two thirds of therapy patients improved significantly or recovered on their own within two years, whether or not they received psychotherapy.[30] Many psychotherapists believe that the nuances of psychotherapy cannot be captured by questionnaire-style observation, and prefer to rely on their own clinical experiences and conceptual arguments to support the type of treatment they practice. In 2001, Bruce Wampold of the University of Wisconsin published the book The Great Psychotherapy Debate.[31] In it Wampold, a former statistician who went on to train as a counseling psychologist, reported that 1. psychotherapy is indeed effective, 2. the type of treatment is not a factor, 3. the theoretical bases of the techniques used, and the strictness of adherence to those techniques are both not factors, 4. the therapist's strength of belief in the efficacy of the technique is a factor, 5. the personality of the therapist is a significant factor, 6. the alliance between the patient(s) and the therapist (meaning affectionate and trusting feelings toward the therapist, motivation and collaboration of the client, and empathic response of the therapist) is a key factor. Wampold therefore concludes that "we do not know why psychotherapy works".

Psychotherapy Although the Great Psychotherapy Debate dealt primarily with data on depressed patients, subsequent articles have made similar findings for post-traumatic stress disorder[32] and youth disorders.[33] There have also been studies of Panic Disorder, where treatment effectiveness is measured in the abatement of panic attacks. Psychoanalytic psychotherapy has been found to be as effective as Cognitive Behavioral Therapy for immediate relief and more effective over the long term [34] [35] Some report that by attempting to program or manualize treatment, psychotherapists may be reducing efficacy, although the unstructured approach of many psychotherapists cannot appeal to patients motivated to solve their difficulties through the application of specific techniques different from their past "mistakes." Critics of psychotherapy are skeptical of the healing power of a psychotherapeutic relationship.[36] Because any intervention takes time, critics note that the passage of time alone, without therapeutic intervention, often results in psycho-social healing.[37] Social contact with others is universally seen as beneficial for all humans and regularly scheduled visits with anyone would be likely to diminish both mild and severe emotional difficulty. Many resources available to a person experiencing emotional distressthe friendly support of friends, peers, family members, clergy contacts, personal reading, healthy exercise, research, and independent copingall present considerable value. Critics note that humans have been dealing with crises, navigating severe social problems and finding solutions to life problems long before the advent of psychotherapy.[38] Of course, it may well be something in the patient that does not develop these "natural" supports that requires therapy. Further critiques have emerged from feminist, constructionist and discursive sources. Key to these is the issue of power. In this regard there is a concern that clients are persuadedboth inside and outside the consulting roomto understand themselves and their difficulties in ways that are consistent with therapeutic ideas. This means that alternative ideas (e.g., feminist, economic, spiritual) are sometimes implicitly undermined. Critics suggest that we idealise the situation when we think of therapy only as a helping relation. It is also fundamentally a political practice, in that some cultural ideas and practices are supported while others are undermined or disqualified. So, while it is seldom intended, the therapist-client relationship always participates in society's power relations and political dynamics.[39]

40

References
[1] "Gesetz ber die Berufe des Psychologischen Psychotherapeuten und des Kinder- und Jugendlichenpsychotherapeuten" (http:/ / bundesrecht. juris. de/ psychthg/ index. html). . Retrieved 21 July 2010. "The title "psychotherapist" may not be used by persons other than physicians, psychological psychotherapists or child and adolescent psychotherapists." [2] "Ordinamento della professione di psicologo: Esercizio dell'attivit psicoterapeutica" (http:/ / www. psico. unifi. it/ upload/ sub/ Tirocinio/ L56-1989. pdf). . Retrieved 22 July 2010. "The practice of psychotherapy is subject to specific professional training, to be acquired after graduation in psychology or in medicine and surgery, through specialized courses of at least four years duration providing adequate training in psychotherapy, at specialized schools or university institutes approved for that purpose by procedures under Article 3 of Presidential Decree no 162 of March 10, 1982." [3] "Arrt du 9 juin 2010 relatif aux demandes d'inscription au registre national des psychothrapeutes" (http:/ / www. legifrance. gouv. fr/ affichTexte. do?cidTexte=JORFTEXT000022336754& dateTexte=& categorieLien=id). . Retrieved 21 July 2010. "Permission to use the title of psychotherapist is reserved for professionals on the national register of psychotherapists, in accordance with the provisions of Article 7 of the Decree of May 20, 2010 ... The provisions of this Order shall come into force from 1 July 2010" [4] Priebe, Stefan; Wright, Donna (2006). "The provision of psychotherapy an international comparison" (http:/ / webspace. qmul. ac. uk/ spriebe/ / publications/ 2006/ 2006_The_provision_of_psychotherapy-an_international_comparison. pdf). Journal of Public Mental Health 3: 16. . Retrieved 15 July 2010. "The three national registers for psychotherapists and counsellors are maintained by three main umbrella bodies in the fields of psychotherapy and counselling: the United Kingdom Council for Psychotherapy (UKCP), the British Association for Counselling and Psychotherapy (BACP), and the British Psychoanalytic Council (BPC) for psychoanalytic psychotherapists." [5] "Entry requirements and training as a psychotherapist" (http:/ / www. nhscareers. nhs. uk/ details/ Default. aspx?Id=461). UK National Health Service. . Retrieved 15 July 2010. [6] "Psychotherapist Job Profile" (http:/ / careersadvice. direct. gov. uk/ LSCGOVUK/ Templates/ CareersAdviceService/ JobProfiles/ JobProfile. aspx?NRMODE=Published& NRNODEGUID={364AB16C-F07E-4284-96DC-5CEC464365CC}& NRORIGINALURL=/ helpwithyourcareer/ jobprofiles/ JobProfile?jobprofileid=1390& jobprofilename=Psychotherapist& code=355874219& NRCACHEHINT=Guest& jobprofilename=Psychotherapist& jobprofileid=1390& code=355874219). UK Government Careers Advice Service. . Retrieved 15 July 2010.

Psychotherapy
[7] http:/ / www. hpc-uk. org [8] Oxford English Dictionary, online edition, 2004, s.v. "psychotherapy". [9] Frank, Jerome (1988) [1979]. "What is Psychotherapy?". In Bloch, Sidney (ed.). An Introduction to the Psychotherapies. Oxford: Oxford University Press. pp.12. ISBN0-19-261469-X. [10] Schechter DS, Coates SW (2006). Relationally and Developmentally Focused Interventions with Young Children and Their Caregivers Affected by the Events of 9/11. In Y. Neria, R. Gross, R. Marshall, E. Susser (Eds.) September 11, 2001: Treatment, Research and Public Mental Health in the Wake of a Terrorist Attack, New York: Cambridge University Press. pp. 402-427. [11] Henrick 1980 [12] Maclennan 1996 [13] " Which psychotherapy?: leading exponents explain their differences (http:/ / books. google. com/ books?id=ryqW330yYCUC& pg=PA80& dq& hl=en#v=onepage& q=& f=false)". Colin Feltham (1997). p.80. ISBN 0-8039-7479-5 [14] Heimler, E. (1975), Survival in Society, London, Weidenfeld and Nicolson [15] http:/ / www. heimler-international. org [16] Corp, N.; Tsaroucha, A.; Kingston, P. (2008). "Human Givens Therapy: The Evidence Base" (http:/ / pavilionjournals. metapress. com/ index/ P83X3Q14J6J5187J. pdf). Mental Health Review Journal 13 (4): 4452. doi:10.1108/13619322200800027. . Retrieved 2009-06-03 [17] The Top 10: The Most Influential Therapists of the Past Quarter-Century. (http:/ / www. psychotherapynetworker. org/ magazine/ populartopics/ 219-the-top-10) Psychotherapy Networker.: 2007, March/April (retrieved 7 Oct 2010) [18] Hans Strupp and Jeffrey Binder, Psychotherapy in a New Key. New York, Basic Books, 1984, ISBN 978-0-465-06747-3 [19] Anthony Roth and Peter Fonagy, What Works for Whom? A Critical Review of Psychotherapy Research, Guilford Press, 2005, ISBN 572306505 [20] Dr. Cara Gardenswartz 2009, Los Angeles, CA [21] Sundberg, Norman (2001). Clinical Psychology: Evolving Theory, Practice, and Research. Englewood Cliffs: Prentice Hall. ISBN0130871192. [22] Handbook of Psychotherapy, (Norcross&Goldried, 2005) [23] Schechter DS, Willheim E (2009). When parenting becomes unthinkable: Intervening with traumatized parents and their toddlers. Journal of the American Academy of Child & Adolescent Psychiatry, 48(3), 249-254. [24] Lieberman, A.F., Van Horn, P., Ippen, C.G. (2005). Towards evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 1241-1248. [25] Silverman, DK (2005). "What Works in Psychotherapy and How Do We Know?: What Evidence-Based Practice Has to Offer". Psychoanalytic Psychology 22 (2): 306312. doi:10.1037/0736-9735.22.2.306 [26] Hrknen, T; Knekt, P; Virtala, E; Lindfors, O; the Helsinki Psychotherapy Study Group (2005). "A case study in comparing therapies involving informative drop-out, non-ignorable non-compliance and repeated measurements". Statistics in medicine 24 (24): 37733787. doi:10.1002/sim.2409. PMID16320283 [27] Helsinki Psychotherapy Study (http:/ / www. ktl. fi/ tto/ hps/ index. en. html) [28] For Psychotherapy's Claims, Skeptics Demand Proof (http:/ / www. nytimes. com/ 2004/ 08/ 10/ health/ psychology/ 10ther. html?pagewanted=1& ei=5090& en=e6560227dc7526f7& ex=1249876800& partner=rssuserland) Benedict Carey, The New York Times, August 10, 2004. Retrieved December 2006. [29] Wierzbicki, M; Pekarik, G (May 1993). "A Meta-Analysis of Psychotherapy Dropout" (http:/ / psycnet. apa. org/ index. cfm?fa=search. displayRecord& uid=1993-30339-001). Professional Psychology: Research and Practice 24 (2): 190195. doi:10.1037/0735-7028.24.2.190. [30] Eysenck, Hans (1952). The Effects of Psychotherapy: An Evaluation. Journal of Consulting Psychology. pp.16: 319324. [31] The Great Psychotherapy Debate (http:/ / www. education. wisc. edu/ cp/ faculty/ book. asp) Bruce E. Wampold, Ph.D. University of Wisconsin-Madison . Retrieved December 2006. [32] Benish, S. G., Imel, Z. E., \& Wampold, B. E. (in press). The Relative Efficacy of Bona Fide Psychotherapies for Treating Posttraumatic Stress Disorder: A Meta-Analysis of Direct Comparisons Clinical Psychology Review. [33] Miller, S. D., Wampold, B. E., & Varhely, K. (In press). Direct comparisons of treatment modalities for youth disorders: A meta-analysis. Psychotherapy Research [34] Milrod, B., Leon, A., Busch, F., Rudden, M., Schwalberg, M., Clarkin, J., Aronson, A., Singer, M. Turchin, W, Klass, E., Graf, E., Teres, J., Shear, M. (2007), A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry, 164:265-272. [35] Blechner, M. (2007) Approaches to panic attacks. Neuro-Psychoanalysis, 9:93-102. [36] 1988. Against Therapy: Emotional Tyranny and the Myth of Psychological Healing. ISBN 0-689-11929-1, Jeffrey Moussaieff Masson [37] Therapy's Delusions, The Myth of the Unconscious and the Exploitation of Today's Walking Worried (http:/ / www. antipsychiatry. org/ br-thdel. htm) by Ethan Watters & Richard Ofshe published by Scribner, New York, 1999 [38] Fredi, F. (2003) Therapy Culture: Cultivating Vulnerability in an Uncertain Age (http:/ / books. google. com/ books?id=gGkHK7Y9-dwC& pg=PA137& dq=isbn:041532159X& sig=fXiDQ1Zayaf4EQvuFFgo1YhzwIM#PPP1,M1): Routledge, (ISBN 0-415-32159-X) [39] Guilfoyle, M. (2005). From therapeutic power to resistance: Therapy and cultural hegemony. Theory & Psychology, 15(1), 101-124:

41

Psychotherapy Henrik, R. (ed) The Psychotherapy Handbook. The A-Z handbook to more than 250 psychotherapies as used today (1980) New American Library. Maclennan, Nigel. Counselling For Managers (1996) Gower. ISBN 0-566-08092-3 Asay, Ted P., and Michael J. Lambert (1999). The Empirical Case for the Common Factors in Therapy: Quantitative Findings. In Hubble, Duncan, Miller (Eds), The Heart and Soul of Change (pp.2355)

42

Psychodynamic schools
Aziz, Robert (1990). C.G. Jung's Psychology of Religion and Synchronicity (10 ed.). The State University of New York Press. ISBN0-7914-0166-9. Aziz, Robert (1999). "Synchronicity and the Transformation of the Ethical in Jungian Psychology". In Becker, Carl. Asian and Jungian Views of Ethics. Greenwood. ISBN0-313-30452-1. Aziz, Robert (2007). The Syndetic Paradigm: The Untrodden Path Beyond Freud and Jung. The State University of New York Press. ISBN978-0-7914-6982-8. Aziz, Robert (2008). "Foreword". In Storm, Lance. Synchronicity: Multiple Perspectives on Meaningful Coincidence. Pari Publishing. ISBN978-88-95604-02-2. Bateman, Anthony; Brown, Dennis and Pedder, Jonathan (2000). Introduction to Psychotherapy: An Outline of Psychodynamic Principles and Practice. Routledge. ISBN0-415-20569-7. Bateman, A.; and Holmes, J. (1995). Introduction to Psychoanalysis: Contemporary Theory and Practice. Routledge. ISBN0-415-10739-3. Oberst, U. E. and Stewart, A. E. (2003). Adlerian Psychotherapy: An Advanced Approach to Individual Psychology. New York: Brunner-Routledge. ISBN 1-58391-122-7 Ellenberger, Henri F. (1970). The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. Basic Books. ISBN0465016723.

Humanistic schools
Schneider (et al.), Kirk (2001). The Handbook of Humanistic Psychology. SAGE Publications. ISBN0-7619-2121-4. Rowan, John (2001). Ordinary Ecstasy. Brunner-Routledge. ISBN0-415-23632-0. Ansel Woldt, Sarah Toman (eds) (2005). Gestalt Therapy History, Theory, and Practice. Gestalt Press. ISBN0-7619-2791-3 (pbk.). Crocker, Sylvia (1999). A Well-Lived Life, Essays in Gestalt Therapy. SAGE Publications. ISBN0-88163-287-2 (pbk.). Russon, John (2003). Human Experience: Philosophy, Neurosis, and the Elements of Everyday Life. State University of New York Press. ISBN9780791457542 (pbk.). Yontef, Gary (1993). Awareness, Dialogue, and Process. The Gestalt Journal Press, Inc.. ISBN0-939266-20-2 (pbk.).

External links
National Council of Psychotherapists UK (http://www.ncphq.co.uk/) Royal College of Psychiatrists UK (http://www.rcpsych.ac.uk/) United Kingdom Council for Psychotherapy UK (http://www.psychotherapy.org.uk/) What is Psychotherapy? (http://chandospractice.org/page1/page1.html)

Identity formation

43

Identity formation
Identity formation is the development of the distinct personality of an individual regarded as a persisting entity (known as personal continuity) in a particular stage of life in which individual characteristics are possessed and by which a person is recognised or known (such as the establishment of a reputation). This process defines individuals to others and themselves. Pieces of the entity's actual identity include a sense of continuity, a sense of uniqueness from others, and a sense of affiliation. Identity formation leads to a number of issues of personal identity and an identity where the individual has some sort of comprehension of him or herself as a discrete and separate entity. This may be through individuation whereby the undifferentiated individual tends to become unique, or undergoes stages through which differentiated facets of a person's life tend toward becoming a more indivisible whole.

Theory of developmental stages

In developmental psychology, a stage is a distinct phase in an individual's development. Many theories in psychology characterise development in terms of designated stages. Most stages are distinct, yet may overlap. Erik Erikson's stages of psychosocial development, expanding on Freud's psychosexual stages, defined eight stages that describe how individuals relate to their social world. James W. Fowler's stages of faith development is seen as a holistic orientation and is concerned with the individual's relatedness to the universal. Sigmund Freud's psychosexual stages describe the progression of an individual's unconscious desires. Lawrence Kohlberg's stages of moral development to describe how individuals develop in and through reasoning about morals. Jane Loevinger developed a theory with stages of ego development. Margaret Mahler's psychoanalytic developmental theory contained three phases regarding the child's object relations. Jean Piaget's theory of cognitive development describes how children reason and interact with their surroundings. James Marcia's theory focuses on identity achievement and has four identity statuses. Maria Montessori's sensitive periods of development is concerned with the series of leaps in learning during the preschool years.{{Citation needed|date=February 2008}

Self-concept
Self-concept or self-identity is the sum of a being's knowledge and understanding of his or her self. The self-concept is different from self-consciousness, which is an awareness of one's self. Components of the self-concept include physical, psychological, and social attributes, which can be influenced by the individual's attitudes, habits, beliefs and ideas. These components and attributes can not be condensed to the general concepts of self-image and self-esteem. Cultural identity is the (feeling of) identity of a group or culture, or of an individual as far as she/he is influenced by her/his belonging to a group or culture. Cultural identity is similar to and has overlaps with, but is not synonymous with, identity politics. There are modern questions of culture that are transferred into questions of identity. Historical culture also influences individual identity, and as with modern cultural identity, individuals may pick and choose aspects of cultural identity, while rejecting or disowning other associated ideas. An ethnic identity is the identification with a certain ethnicity, usually on the basis of a presumed common genealogy or ancestry. Recognition by others as a distinct ethnic group is often a contributing factor to developing this bond of identification. Ethnic groups are also often united by common cultural, behavioral, linguistic, ritualistic, or religious traits. Processes that result in the emergence of such identification are summarised as ethnogenesis. Various cultural studies and social theory investigate the question of cultural and ethnic identities. Cultural identity remarks upon: place, gender, race, history, nationality, sexual orientation, religious beliefs and ethnicity. National identity is an ethical and philosophical concept whereby all humans are divided into groups called nations. Members of a "nation" share a common identity, and usually a common origin, in the sense of ancestry, parentage or

Identity formation descent. A religious identity is the set of beliefs and practices generally held by an individual, involving adherence to codified beliefs and rituals and study of ancestral or cultural traditions, writings, history, and mythology, as well as faith and mystic experience. The term "religious identity" refers to the personal practices related to communal faith and to rituals and communication stemming from such conviction. This identity formation begins with association in the parents' religious contacts, and individuation requires that the person chooses to the same--or different--religious identity than that of his/her parents. In business, a professional identity is the "persona" of a professional which is designed to accord with and facilitate the attainment of business objectives. A professional identity comes into being when there is a philosophy which is manifest in a distinct corporate culture - the corporate personality. A business professional is a person in a profession with certain types of skills that sometimes requires formal training or education. The career development of an individual focuses on how individuals manage their careers within and between organisations and how organisations structure the career progress of their members, and can be tied into succession planning within some organizations. In sociology, gender identity describes the gender with which a person identifies (i.e., whether one perceives oneself to be a man, a woman, or describes oneself in some less conventional way), but can also be used to refer to the gender that other people attribute to the individual on the basis of what they know from gender role indications (social behavior, clothing, hair style, etc.). Gender identity may be affected by a variety of social structures, including the person's ethnic group, employment status, religion or irreligion, and family.

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Interpersonal identity development

Social relation can refer to a multitude of social interactions, regulated by social norms, between two or more people, with each having a social position and performing a social role. In sociological hierarchy, social relation is more advanced than behavior, action, social behavior, social action, social contact and social interaction. Social relations form the basis of concepts such as social organization, social structure, social movement and social system. Interpersonal identity development is composed of three elements: Categorisation: Labeling others (and ourselves) into categories. Identification: Associating others with certain groups. Comparison: Comparing groups. Interpersonal identity development allows an individual to question and examine various personality elements, such as ideas, beliefs, and behaviors. The actions or thoughts of others create social influences that change an individual. Examples of social influence can be seen in socialisation and peer pressure. This is the effect of other people on a person's behavior, thinking about one's Self, and subsequent acceptance or rejection of how other people attempt to influence the individual. Interpersonal identity development occurs during exploratory self-analysis and self-evaluation, ending at various times with the establishment of an easy-to-understand and consolidative sense of self or identity.

Self, other, and interaction

During the interpersonal identity development an exchange of propositions and counter-propositions occurs, resulting in a qualitative transformation of the individual in the direction of the interaction. The aim of the interpersonal identity development is to try to resolve the undifferentiated facets of an individual. The individual's existence is undifferentiated but this, upon examination, is found to be indistinguishable from others. Given this, and with other admissions, the individual is led to a contradiction between self and others, thus forcing the withdrawal of the undifferentiated self as a truth. In resolution of this incongruence, the person integrates or rejects the encountered elements. This process results in a new identity. During each of these exchanges which human beings encounter as

Identity formation they go through life, the person must resolve the exchange and then face future exchanges. The exchanges are recurring, since the changing world constantly presents exchanges between individuals and thus allows individuals to redefine themselves. An individual is also influenced by their family, whether they be biological, extended or even adoptive families. Each has their own influence on identity through the interaction that takes place between the family members and with the individual person.[1] "Information regarding possible identities of possible selves comes from various contexts that surround adolescents and temporal commitments are tested and practiced in interaction with others."[2] Researchers and theorists basically state that an individual's identity(more specifically an adolescent's identity) is influenced by the people around them and the environment in which they live. Also if a family does not have integration this seems to help create identity diffusion (this is one of James Marcia's 4 identity statuses, meaning that an individual has not made commitments and does not try to make commitments.[3] ) This is true for both males and females.[4] These concepts prove that a family has influence on an individual no matter if the influence be good or bad.

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Affiliation
Individuals gain a social identity and group identity by their affiliation. This is from membership in various groups. These groups include, among various categories,: family ethnic education and occupation friendship dating sex roles religion

The term collective identity is a sense of belonging to a group (the collective) that is so strong that a person who identifies with the group will dedicate his or her life to the group over individual identity: he or she will defend the views of the group and assume risks for the group, sometimes as great as loss of life. The cohesiveness of the collective goes beyond community, as the collective suffers the pain of grief from the loss of a member.

Identity Formation in Management

It is a Management Task that enhances leadership, by creating an environment where all team members know and assume responsibility for their roles. Employees' Self-concept and Affiliation are managed to be aligned with their roles in the organization. Training is a well known form of Identity Setting, since it has not only effects on knowledge, but also effects on the team member's Self-concept. Knowledge, on the other hand, introduces a new path of less effort to the trainee, prolonging the effects of training toward a stronger Self-Concept. Other forms of Identity Setting in an Organization include Business Cards, Specific Benefits by Role, Task Forwarding, ....[5]

Identity formation

46

References
[1] Grotevant, H. D. (1997). Family processes, identity development, and behavioral outcomes for adopted adolescents. Journal of Adolescent Research, 12(1), 139. [2] Goossens, L. (2008). Dynamics of perceived parenting and identity formation in late adolescence. Journal of Adolescence, 31(2), 165-184. [3] Steinberg, L. (2008). Adolescence. Boston: McGraw Hill. [4] Willemsen, E. ., & Waterman, K. (1991). Dynamics of perceived parenting and identity formation in late adolescence. Psychological Reports, 66, 1203-1212. [5] Salvador, Jos (2009). MBA CookBook.

External articles and references

Further reading
A Erdman,A Study of Bisexual Identity Formation. 2006. A Portes, D MacLeod, What Shall I Call Myself? Hispanic Identity Formation in the Second Generation. Ethnic and Racial Studies, 1996. AS Waterman, Identity Formation: Discovery or Creation? The Journal of Early Adolescence, 1984. AS Waterman, Finding Someone to be: Studies on the Role of Intrinsic Motivation in Identity Formation. Identity: An International Journal of Theory and Research, 2004. A Warde, Consumption, Identity-Formation and Uncertainty. Sociology, 1994. A Wendt, Collective Identity Formation and the International State. The American Political Science Review, 1994. CF Schryer, Genre Theory, Health-Care Discourse, and Professional Identity Formation. Journal of Business and Technical Communication 19.3 (2005):249-278. CG Levine, JE Ct, JE Cot, Identity Formation, Agency, and Culture: a social psychological synthesis. 2002. DL Blustein, Relationship between the Identity Formation Process and Career Development. Journal of Counseling Psychology, 1989. HD Grotevant, Toward a Process Model of Identity Formation. Journal of Adolescent Research, 1987. G Robert, C Bate, C Pope, J Gabbay, A le May, Processes and dynamics of identity formation in professional organisations. 2007. HL Minton, GJ McDonald, Homosexual identity formation as a developmental process. I Abu-Saad, State-Controlled Education and Identity Formation Among the Palestinian Arab Minority in Israel (http://abs.sagepub.com/cgi/content/abstract/49/8/1085). American Behavioral Scientist, Vol. 49, No. 8, 1085-1100 (2006). JE Ct, Sociological perspectives on identity formation: The culture-identity link and identity capital. Journal of Adolescence, 1996. L Craig-Bray, GR Adams, WR Dobson, Identity formation and social relations during late adolescence. Journal of Youth and Adolescence, 1988. MC Boyes, M Chandler, Cognitive development, epistemic doubt, and identity formation in adolescence. Journal of Youth and Adolescence, 1992. MD Berzonsky, Self-construction over the life-span: A process perspective on identity formation. Advances in personal construct theory, 1990. RB Hall, (Reviewer) Uses of the Other: 'The East' in European Identity Formation (by IB Neumann) University of Minnesota Press, Minneapolis, 1999. 248 pages. ISBN 0816630828 International Studies Review Vol.3, Issue 1, Pages 101-111 (http://www.politicalreviewnet.com/polrev/reviews/MISR/R_1521_9488_003_20157.asp) RM Sabatelli, A Mazor, Differentiation, individuation, and identity formation. Adolescence, 1985. SJ Schwartz, WM Kurtines, MJ Montgomery, A comparison of two strategies for facilitating identity formation processes in emerging adults. Journal of Adolescent Research, 2005.

Identity formation T Postmes, SA Haslam, RI Swaab, Social influence in small groups: An interactive model of social identity formation. European Review of Social Psychology, 2005. VC Cass, Homosexual identity formation: a theoretical model. J Homosex, 1979. VC Cass, Homosexual identity formation: Testing a theoretical model. Journal of Sex Research, 1984. VC Cass, Sexual orientation identity formation: A Western phenomenon. Textbook of homosexuality and mental health, 1996. WR Penuel, JV Wertsch, Vygotsky and identity formation: A sociocultural approach. Educational Psychologist, 1995.

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Websites
A positive approach to identity formation of biracial children (http://ematusov.soe.udel.edu/final.paper.pub/ _pwfsfp/00000085.htm)". ematusov.soe.udel.edu Identity (http://www.ssc.uwo.ca/sociology/identity/): An International Journal of Theory and Research. "Identity" is the official journal of the Society for Research on Identity Formation.

Psychogenic amnesia

48

Psychogenic amnesia
Psychogenic amnesia/functional amnesia/dissociative amnesia
Classification and external resources ICD-10 ICD-9 MedlinePlus F44.0 300.1 [1] [2] [3]

003257

Psychogenic amnesia, also known as functional amnesia or dissociative amnesia, is a memory disorder characterized by extreme memory loss that is caused by extensive psychological stress and that cannot be attributed to a known neurobiological cause.[4] Psychogenic amnesia is defined by (a) the presence of retrograde amnesia (the inability to retrieve stored memories leading up to the onset of amnesia), and (b) an absence of anterograde amnesia (the inability to form new long term memories).[5] [6] [7] Dissociative amnesia is due to psychological rather than physiological causes and can sometimes be helped by therapy.[8] There are two types of psychogenic amnesia, global and situation-specific.[9] [10] Global amnesia, also known as fugue state, refers to a sudden loss of personal identity that lasts a few hours to days,[7] and is typically preceded by severe stress and/or depressed mood. Fugue state is very rare, and usually resolves over time, often helped by therapy.[8] In most cases, patients lose their autobiographical memory and personal identity even though they are able to learn new information and perform everyday functions normally. Other times, there may be a loss of basic semantic knowledge and procedural skills such as reading and writing.[9] Situation-specific amnesia occurs as a result of a severely stressful event, as in post-traumatic stress disorder, child sex abuse, military combat[11] or witnessing a family member's murder or suicide, and is somewhat common in cases of severe and/or repeated trauma.[12] [13] [14] [15]

Memory and the brain

Overview
There are three types of memory sensory, short-term, and long-term memory. Sensory memory lasts up to hundreds of milliseconds; short-term memory lasts from seconds to minutes; while anything else longer than short-term memory is considered to be a long-term memory.[5] [16] Information obtained from the peripheral nervous system (PNS) is processed in four stages - encoding, consolidating, storage, and retrieval.[5] During encoding, the limbic system is responsible for "bottlenecking" or filtering information obtained from the PNS. According to the type of information being processed in a given instance, the duration of consolidating stage varies drastically. The majority of consolidated information gets stored in the cerebral cortical networks where the limbic system record episodic-autobiographical events. These stored episodic and semantic memories can be obtained by triggering the uncinate fascicle that interconnects the regions of the temporofrontal junction area. Emotion seems to play an important role in memory processing in structures like the cingulated gyrus, the septal nuclei, and the amygdala that is primarily involved in emotional memories.[5] [17] Functional imaging of normal patients reveal that right-hemisperic amygdala and ventral prefrontal regions are activated when they were retrieving autobiographical information and events. Additionally, the hippocampal region is known to be linked to recognizing faces.

Psychogenic amnesia Researchers have found that emotional memories can be suppressed in non-mentally ill individuals via the prefrontal cortex in two stages - an initial suppression of the sensory aspects of the memory, followed by a suppression of the emotional aspect.[18] It has also been proposed that glucocorticoids can impair memory retrieval; rats[19] and human males[20] have been shown to be affected by this mechanism. Traumas can interfere with several memory functions. Dr. Bessel van der Kolk divided these functional disturbances into four sets: traumatic amnesia, global memory impairment, dissociative processes and traumatic memories' sensorimotor organization. Traumatic amnesia involves the loss of remembering traumatic experiences. The younger the subject and the longer the traumatic event is, the greater the chance of significant amnesia. Global memory impairment makes it difficult for these subjects to construct an accurate account of their present and past history. Dissociation refers to memories being stored as fragments and not as unitary wholes. Not being able to integrate traumatic memories seems to be the main element which leads to PTSD. In the sensorimotor organization of traumatic memories, sensations are fragmented into different sensory components.[21]

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Comparison with organic causes

Clinically, psychogenic amnesia is characterized by the loss of the ability to retrieve stored memory without any apparent neurological damage; while organic amnesia is characterized by damages to the medial or anterior temporal and/or prefrontal regions caused by stroke, traumatic brain injury, ischemia, and encephalitis.[5] [9] Some characteristics that define organic amnesia is the maintenance of personal identity, basic semantic knowledge and procedural skills as well as neuroradiological images showing cerebral damage to the cortical and/or subcortical areas known to be associated with long-term memory while some characteristics that define psychogenic amnesia is the loss of personal identity, semantic knowledge, and procedural abilities at least in the early phase of amnesia as well as damage directly affecting cerebral areas critical for memory functioning that cannot be detected in clinical history or neuroradiological exams.[9]

Imaging
Psychogenic amnesia is defined by the lack of structural damage to the brain, but upon functional imaging, an abnormal brain activity can be seen.[22] Tests using functional magnetic resonance imaging suggest that patients with psychogenic amnesia are unable to retrieve emotional memories normally during the amnesic period, suggesting that changes in the limbic functions are related to the symptoms of psychogenic amnesia.[17] By performing a positron emission tomography activation study on psychogenic amnesic patients with face recognition, it was found that activation of the right anterior medial temporal region including the amygdala was increased in the patient whereas bilateral hippocampal regions increased only in the control subjects, demonstrating again that limbic and limbic-cortical functions are related to the symptoms of psychogenic amnesia.[6]

Risk factors
Patients exposed to physically or emotionally traumatic events are at a higher risk for developing psychogenic amnesia because they seem to have damaged the neurons in the brain.[4] [5] Examples of individuals at greater risk of psychogenic amnesia due to traumatic events include soldiers who have experienced combat, individuals sexually and physically abused during childhood and individuals who have experienced domestic violence, natural disasters, or terrorist acts; essentially any sufficiently severe psychological stress, internal conflict, or intolerable life situation.[17] Child abuse, especially chronic child abuse starting at an early age has been related to the development of high levels of dissociative symptoms, including amnesia for abuse memories. The study strongly suggested that "independent corroboration of recovered memories of abuse is often present" and that the recovery of the abuse memories generally is not associated with psychotherapy.[23]

Psychogenic amnesia

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Prevalence
Elliot's[12] study of a randomized nationwide sample (n=505) found that situation-specific psychogenic amnesia was somewhat common in the general population. 72% of subjects reported a profoundly distressing emotional trauma; 32% of these reported amnesia about part or all of the trauma, followed by "delayed recall" of the event. Traumatic events most commonly associated with psychogenic amnesia were witnessing a suicide or murder, and being sexually abused. Elliott also found that psychogenic amnesia was most strongly associated with severe and/or repeated traumas, and with traumas during childhood. When encountering stimuli similar to the trauma(s), subjects often reported many episodes of dissociation prior to the delayed recall. The most common "trigger" for recalling the traumatic event was a media event (e.g., while watching television or a movie), the least common trigger was psychotherapy or counseling. Several studies have found that situation-specific psychogenic amnesia is common in verified victims of severe child abuse: In a 1994 study, Williams[13] found that amongst women with confirmed histories of childhood sexual abuse, about one third of subjects did not recall the abuse during interviews as adults; because these same women were usually willing to discuss other potentially embarrassing or shameful incidents (e.g, abortions, prostitution, sexual assaults as adults) Williams concluded the women had genuinely lost access to the traumatic memories. In a follow-up study published the next year, Williams[14] found that in women (n=129)with documented histories of childhood sexual abuse, 16% reported a period when they were unable to recall all or part of the abuse. Widom and Morris[15] found that in adults (n=450) with confirmed childhood histories of severe neglect and abuse (physical and/or sexual), 59.3% reported periods of partial or complete amnesia for the maltreatment. Amnesia for abuse was most associated with cases of multiple perpetrators and fears of death if the abuse was disclosed. Dahlenberg[24] studied 17 women who recovered memories of childhood sexual abuse while in therapy; six independent evaluators determined that all 17 women adequately corroborated the memories.

Theoretical explanations
Psychogenic amnesia is far from being completely understood and while several explanations have been proposed, none of them have been verified as the mechanism that fits all types of psychogenic amnesia. Different theories include: Freudian psychology states that psychogenic amnesia is an act of self-preservation, an alternative to suicide.[] Cognitive point-of-view states that this disorder utilizes the bodys personal semantic belief system to repress unwanted memories from entering the consciousness by altering neuropeptides and neurotransmitters released during stressful events, affecting the formation and recall of memory.[4] "Betrayal trauma theory suggests that psychogenic amnesia is an adaptive response to childhood abuse. When a parent or other powerful figure violates a fundamental ethic of human relationships, victims may need to remain unaware of the trauma not to reduce suffering but rather to promote survival. Amnesia enables the child to maintain an attachment with a figure vital to survival, development, and thriving. Analysis of evolutionary pressures, mental modules, social cognitions, and developmental needs suggests that the degree to which the most fundamental human ethics are violated can influence the nature, form, and processes of trauma and responses to trauma."[25] Normal autobiographical memory processing is blocked by imbalance or altered release of stress hormones such as glucocorticoids and mineralocorticoids in the brain.[5] [17] The regions of expanded limbic system in the right hemisphere are more vulnerable to stress and trauma, affecting the body's opioids, hormones, and neurotransmitters such as norepinephrine, serotonin, and neuropeptide Y.[16] Increased levels of glucocorticoid and mineralocorticoid receptor density may affect the anterior temporal, orbitofrontal cortex, hippocampal, and amygdalar regions. These morphological changes may be caused by loss of regulation of gene expressions in

Psychogenic amnesia those receptors along with inhibition of neurotrophic factors during chronic stress conditions. Stress may directly affect the medial temporal/diencephalic system, inhibiting the retrieval of autobiographical memories and producing a loss of personal identity. Negative feedback produced by this system may dampen the patient's emotions, giving a perplexed or 'flat' appearance.[10]

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Treatments
Currently, various treatments are available for patients with psychogenic amnesia although no well-controlled studies on the effectiveness of different treatments exist. Psychoanalysis - uses dream analysis, interpretation and other psychoanalytic methods to retrieve memories; may also involve placing patients in threatening situations where they are overwhelmed with intense emotion.[4] Medication and relaxation techniques - in conjunction with benzodiazepines and other hypnotic medications, the patient is urged to relax and attempt to recall memories.[4] With the help of psychotherapy and learning their autobiographies from family members, most patients recover their memories completely. It has been proposed that abreaction could be used in conjunction with midazolam to recover memories. This technique was used during the second World War but is currently much less popular. The technique is thought to work either through depressing the function of the cerebral cortex and therefore making the memory more tolerable when expressed, or through relieving the strength of an emotion attached to a memory which is so intense it suppresses memory function.[26] Some studies about psychogenic amnesia have concluded that psychotherapy is not connected to recovered memories of child sexual abuse.[23] [27] Data suggests that ones amnesic recovered memory is spontaneous, and that this is triggered by abuse-related stimuli.[27]

In popular culture
Memory loss due to emotional upset or shock has been recognized since at least the first century: Pliny the Elder wrote, Nothing whatever, in man, is of so frail a nature as the memory; for it is affected by disease, by injuries, and even by fright; being sometimes partially lost, and at other times entirely so.[28] Psychogenic amnesia is a common plot device in many films and books and other media. Examples include Shakespeares King Lear who experienced amnesia and madness following a betrayal by his daughters;[29] the title character Nina in Nicolas Dalayrac's opera of 1786[30] and the character of Jason Bourne as depicted in the Bourne film series;[31] Jackie Chan in Who Am I?; the character Teri Bauer in 24; Goldie Hawn in Overboard; Leroy Jethro Gibbs in NCIS and the character Victoria Lord in One Life to Live.

Real life examples

A man later identified as Edward Lighthart woke up in Seattle's Discovery park, with supposed dissociative amnesia, on July 30, 2009, and briefly became a local mystery.[32] A man discovered unconscious on August 31, 2004, in Richmond Hill, Georgia who adopted the pseudonym Benjaman Kyle.

References
[1] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ F44. 0 [2] http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=300. 1 [3] http:/ / www. nlm. nih. gov/ medlineplus/ ency/ article/ 003257. htm [4] Brandt J, Van Gorp WG (2006). "Functional ("psychogenic") amnesia". Semin Neurol 26 (3): 33140. doi:10.1055/s-2006-945519. PMID16791779. [5] Markowitsch HJ (2003). "Psychogenic amnesia". Neuroimage 20 Suppl 1: S1328. doi:10.1016/j.neuroimage.2003.09.010. PMID14597306.

Psychogenic amnesia
[6] Yasuno F, Nishikawa T, Nakagawa Y, et al. (2000). "Functional anatomical study of psychogenic amnesia". Psychiatry Res 99 (1): 4357. doi:10.1016/S0925-4927(00)00057-3. PMID10891648. [7] Mackenzie Ross S (2000). "Profound retrograde amnesia following mild head injury: organic or functional?". Cortex 36 (4): 52137. doi:10.1016/S0010-9452(08)70536-7. PMID11059453. [8] Myers, Catherine E. (2006). "Memory Loss & The Brain" (http:/ / www. memorylossonline. com/ glossary/ psychogenicamnesia. html). Rutgers University. . Retrieved 2007-12-05. [9] Serra L, Fadda L, Buccione I, Caltagirone C, Carlesimo GA (2007). "Psychogenic and organic amnesia: a multidimensional assessment of clinical, neuroradiological, neuropsychological and psychopathological features". Behav Neurol 18 (1): 5364. PMID17297220. [10] Kopelman MD (2002). "Disorders of memory" (http:/ / brain. oxfordjournals. org/ cgi/ content/ full/ 125/ 10/ 2152). Brain 125 (Pt 10): 215290. doi:10.1093/brain/awf229. PMID12244076. . Retrieved 2008-04-05. [11] Hart O, P Brown, M Graafland. (1999) Traumainduced dissociative amnesia in World War I combat soldiers (http:/ / onlinelibrary. wiley. com/ doi/ 10. 1046/ j. 1440-1614. 1999. 00508. x/ full). Australian and New Zealand Journal of Psychiatry, Volume 33, Issue 1, pages 3746, February 1999. [12] Elliott, D. M. (1997). Traumatic events: Prevalence and delayed recall in the general population. Journal of Consulting and Clinical Psychology, 65, 811-820. [13] Williams, L. M. (1994). Recall of childhood trauma: A prospective study of women's memories of child sexual abuse. Journal of Consulting and Clinical Psychology, 62, 1167-1176. [14] Williams, L. M. (1995). Recovered memories of abuse in women with documented child sexual victimization histories (http:/ / www. springerlink. com/ content/ h03180r4nm021mg1/ ). Journal of Traumatic Stress, 8, 649-673. DOI: 10.1007/BF02102893 [15] Widom, C. S. & Morris, S. (1997). Accuracy of adult recollections of childhood victimization: Part 2. Childhood sexual abuse. Psychological Assessment, 8, 412-421. [16] Reinhold, N; Kuehnel, S, Brand, M & Markowitsch, HJ (2006). "Functional neuroimaging in memory and memory disturbances" (http:/ / www. ingentaconnect. com/ content/ ben/ cmir/ 2006/ 00000002/ 00000001/ art00004). Current Medical Imaging Reviews 2 (1): 3557. doi:10.2174/157340506775541668. . Retrieved 2007-12-05. [17] Yang JC, Jeong GW, Lee MS, et al. (2005). "Functional MR imaging of psychogenic amnesia: a case report". Korean J Radiol 6 (3): 1969. doi:10.3348/kjr.2005.6.3.196. PMC2685044. PMID16145296. [18] Depue BE, Curran T, Banich MT (2007). "Prefrontal regions orchestrate suppression of emotional memories via a two-phase process". Science 317 (5835): 2159. doi:10.1126/science.1139560. PMID17626877. [19] Roozendaal B, de Quervain DJ, Schelling G, McGaugh JL (2004). "A systemically administered beta-adrenoceptor antagonist blocks corticosterone-induced impairment of contextual memory retrieval in rats". Neurobiol Learn Mem 81 (2): 1504. doi:10.1016/j.nlm.2003.10.001. PMID14990235. [20] Buss C, Wolf OT, Witt J, Hellhammer DH (September 2004). "Autobiographic memory impairment following acute cortisol administration". Psychoneuroendocrinology 29 (8): 10936. doi:10.1016/j.psyneuen.2003.09.006. PMID15219661. [21] van der Kolk BA, Fisler R (1995). "Dissociation and the fragmentary nature of traumatic memories: overview and exploratory study" (http:/ / www. trauma-pages. com/ a/ vanderk2. php). J Trauma Stress 8 (4): 50525. PMID8564271. . Retrieved 2008-03-22. [22] Heilbronner, R; Martelli, MF, Nicholson, K, Zasler, ND (2002). "Brain injury and functional disorders part IV" (http:/ / villamartelli. com/ CCPN2006Handout1. pdf) (pdf). Journal of Controversial Medical Claims 9 (3): 17. . Retrieved 2007-12-05. [23] Chu JA, Frey LM, Ganzel BL, Matthews JA (1999). "Memories of childhood abuse: dissociation, amnesia, and corroboration" (http:/ / ajp. psychiatryonline. org/ cgi/ content/ full/ 156/ 5/ 749). Am J Psychiatry 156 (5): 74955. PMID10327909. . [24] Dahlenberg, C. (1996). Accuracy, timing and circumstances of disclosure in therapy of recovered and continuous memories of abuse. The Journal of Psychiatry and Law, Vol 24(2) 229-275 [25] Freyd, J. (1994). "Betrayal Trauma: Traumatic Amnesia as an Adaptive Response to Childhood Abuse." (http:/ / www. questia. com/ read/ 95814385). Ethics & Behavior 4 (4): 307330. doi:10.1207/s15327019eb0404_1. . Retrieved 2008-01-13. [26] Vattakatuchery, JJ; Chesterman, P (2006). "The use of abreaction to recover memories in psychogenic amnesia: A case report" (http:/ / www. informaworld. com/ smpp/ 432725912-4932359/ content~content=a759276300~db=all~order=page). Journal of Forensic Psychiatry and Psychology 17 (4): 647653. doi:10.1080/14789940600965938. . Retrieved 2007-12-05. [27] Albach, Francine; Peter Paul Moormann, Bob Bermond (Dec-1996). "Memory recovery of childhood sexual abuse". Dissociation 9 (4): 261273. ISSN0896-2863. hdl:1794/1774. [28] quoted in Goldsmith, R.E., Cheit, R.E., and Wood, M.E. (2009) Evidence of Dissociative Amnesia in Science and Literature: Culture-Bound Approaches to Trauma in Pope, Poliakoff, Parker, Boynes, and Hudson (2007) (http:/ / www. informaworld. com/ smpp/ content~db=all~content=a912962184). Journal of Trauma & Dissociation, Volume 10, Issue 3 July 2009, pp. 237 - 253, DOI: 10.1080/15299730902956572 [29] Goldsmith et al., 2009 [30] Goldsmith et al, 2009 [31] Bruce Bennett (2008-05-28). "Jason Bourne Takes His Case to MoMA" (http:/ / www. nysun. com/ arts/ jason-bourne-takes-his-case-to-moma/ 78614/ ). New York Sun. . Retrieved 2009-09-10. [32] The Seattle Times - Reactions to Edward Lighthart, aka Jon Doe - Editorial Page - August 21, 2009 - (http:/ / seattletimes. nwsource. com/ html/ northwestvoices/ 2009709654_reactions_to_edward_lighthart. html)

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Splitting (psychology)

53

Splitting (psychology)
Splitting (also called all-or-nothing thinking in cognitive distortion) may mean two things: splitting of the mind, and splitting of mental concepts (or black and white thinking). The latter is thinking purely in extremes (e.g., goodness vs. evil, innocence vs. corruption, victimization vs. oppression, etc.), and as such can be seen as a developmental stage and as a defense mechanism. In psychoanalysis, there are the concepts of splitting of the self as well as splitting of the ego. This stems from existential insecurity, or instability of one's self-conception.

Relationships
Splitting creates instability in relationships, because one person can be viewed as either personified virtue or personified vice at different times, depending on whether he or she gratifies the subject's needs or frustrates them. This along with similar oscillations in the experience and appraisal of the self lead to chaotic and unstable relationship patterns, identity diffusion, and Other-directed mood swings. Consequently, the therapeutic process can be greatly impeded by these oscillations, because the therapist too can become the target of splitting. To overcome the negative effects on treatment outcome, constant interpretations by the therapist are needed.[1] Splitting contributes to unstable relationships and intense emotional experiences, something that has been noted especially with narcissists. Alexander Abdennur writes in his book on narcissistic personality disorder, Camouflaged Aggression, that "[t]hrough this splitting mechanism, the narcissist can suddenly and radically shift his allegiance. A trusted friend can become an enemy; the partner may become an adversary."[2] Treatment strategies have been developed for individuals and groups based on dialectical behavior therapy, and for couples.[3] There are also self help books on related topics such as mindfulness and emotional regulation that have been helpful for individuals who struggle with the consequences of splitting.[4]

Borderline personality disorder

The borderline personality is not able to integrate the good and bad images of both self and others, so that people who suffer from borderline personality disorder have a bad representation which dominates the good representation.[5] This makes them experience love and sexuality in perverse and violent qualities which they cannot integrate with the tender, intimate side of relationships.[6] These people can suffer from intense fusion anxieties in intimate relationships, because the boundaries between self and other are not firm. A tender moment between self and other could mean the disappearance of the self into the other. This triggers intense anxiety. To overcome the anxiety, the other is made into a very bad person; this can be done, because the other is made responsible for this anxiety. However, if the other is viewed as a bad person, the self must be bad as well. Viewing the self as all bad cannot be endured, so the switch is made to the other side: the self is good, which means the other must be good too. If the other is all good and the self is all good, the distinction at which the self begins and ends is not clear. Intense anxiety is the result and so the cycle repeats itself.

Narcissistic personality disorder

People matching the diagnostic criteria for narcissistic personality disorder also use splitting as a central defense mechanism. Most often the narcissist does this as an attempt to stabilize his sense of self positively in order to preserve his self-esteem, by perceiving himself as purely upright or admirable and others who do not conform to his will or values as purely wicked or contemptible. Given "the narcissist's perverse sense of entitlement and splitting. . .[s]he can be equally geared, psychologically and practically, towards the promotion and towards the demise of a certain collecively beneficial project." (Abdennur, the Narcissistic Principle of Equivalence)[7]

Splitting (psychology) The cognitive habit of splitting also implies the use of other related defense mechanisms, namely idealization and devaluation, which are preventative attitudes or reactions to narcissistic rage and narcissistic injury.[8]

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Janet and Freud

Splitting was first described by Pierre Janet, who coined the term in his book L'Automatisme psychologique. Sigmund Freud acknowledged Janet's priority, stating that 'we [Breuer and I] followed his example when we took splitting of the mind and dissociation of the personality as the centre of our position'.[9] However he also differentiated 'between our view and Janet's. We do not derive the psychical splitting from an innate incapacity for synthesis...we explain it dynamically, from the conflict of opposing mental forces...repression'.[10] With the development of the idea of repression, splitting moved to the background of Freud's thought for some years, being largely reserved for cases of double personality: 'The cases described as splitting of consciousness...might better be denoted as shifting of consciousness, that function or whatever it may be oscillating between two different psychical complexes which become conscious and unconscious in turn'.[11] Increasingly, however, Freud returned to an interest in how it was 'possible for the ego to avoid a rupture...by effecting a cleavage or division of itself'.[12] His unfinished paper of 1938, "Splitting of the Ego in the Process of Defence", took up the same theme, and in his Outline of Psycho-Analysis (1940a [1938])...[he] extends the application of the idea of a splitting of the ego beyond the cases of fetishism and of the psychoses to neuroses in general'.[13] The concept had meanwhile been further defined by his daughter Anna Freud; while Fenichel summarised the previous half-century of work to the effect that 'a split of the ego into a superficial part that knows the truth and a deeper part that denies it may...be observed in every neurotic'.[14] Kohut would then systematize the Freudian view with his contrast between 'such horizontal splits as those brought about on a deeper level by repression and on a higher level by negation', and ' a vertical split in the psyche...the side-by-side, conscious existence of otherwise incompatible psychological attitudes'.[15]

Melanie Klein
There was, however, from early on, another use of the term "splitting" in Freud, referring rather to resolving ambivalence "by splitting the contradictory feelings so that one person is only loved, another one only hated. . .the good mother and the wicked stepmother in fairy tales."[16] Or, with opposing feelings of love and hate, perhaps 'the two opposites should have been split apart and one of them, usually the hatred, have been repressed'.[17] Such splitting was closely linked to the defense of 'isolation...The division of objects into congenial and uncongenial ones...making "disconnections"'.[18] It was the latter sense of the term which was predominantly adopted and exploited by Melanie Klein. After Freud, 'the most important contribution has come from Melanie Klein, whose work enlightens the idea of "splitting of the object" (in terms of "good/bad" objects)'.[19] In her object relations theory, Klein argues that 'the earliest experiences of the infant are split between wholly good ones with "good" objects and wholly bad experiences with "bad" objects',[20] as children struggle to integrate the two primary drives, love and hate, into constructive social interaction. An important step in childhood development is the gradual depolarization of these two drives. At what Klein called the paranoid-schizoid position, there is a stark separation of the things the child loves (good, gratifying objects) and the things the child hates (bad, frustrating objects), 'because everything is polarised into extremes of love and hate, just like what the baby seems to experience and young children are still very close to'.[21] Klein refers to the good breast and the bad breast as split mental entities, resulting from the way 'these primitive states tend to deconstruct objects into "good" and "bad" bits (called "part-objects")'.[22] The child sees the breasts as opposite in nature at different times, although they actually are the same, belonging to the same mother. As the child learns that people and objects can be good and bad at the same time, he or she progresses to the next phase, the

Splitting (psychology) depressive position, which 'entails a steady, though painful, approximation towards the reality of oneself and others'[23] : integrating the splits and 'being able to balance [them] out...are tasks that continue into early childhood and indeed are never completely finished'.[24] However, Kleinians also utilize Freud's first conception of splitting, to explain the way 'In a related process of splitting, the person divides his own self. This is called "splitting of the ego"'.[25] Indeed, Klein herself maintained that 'the ego is incapable of splitting the object internal or external without a corresponding splitting taking place within the ego'.[26] Arguably at least, by this point 'the idea of splitting does not carry the same meaning for Freud and for Klein': for the former, 'the ego finds itself passively split, as it were. For Klein and the post-Kleinians, on the other hand, splitting is an active defence mechanism'.[27] As a result, by the close of the century 'four kinds of splitting can be clearly identified, among many other possibilities' for post-Kleinians: "a coherent split in the object, a coherent split in the ego, a fragmentation of the object, and a fragmentation of the ego"'.[28]

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Otto Kernberg
In the developmental model of Otto Kernberg,[29] the overcoming of splitting is also an important developmental task. The child has to learn to integrate feelings of love and hate. Kernberg distinguishes three different stages in the development of a child with respect to splitting: First stage: the child does not experience the self and the object, nor the good and the bad as different entities. Second stage: good and bad are viewed as different. Because the boundaries between the self and the other are not stable yet, the other as a person is viewed as either all good or all bad, depending on their actions. This also means that thinking about another person as bad implies that the self is bad as well, so its better to think about the caregiver as a good person, so the self is viewed as good too. 'Bringing together extremely opposite loving and hateful images of the self and of significant others would trigger unbearable anxiety and guilt'.[30] Third stage: Splitting 'the division of external objects into "all good" or "all bad"'[31] begins to be resolved when the self and the other can be seen as possessing both good and bad qualities. Having hateful thoughts about the other does not mean that the self is all hateful and does not mean that the other person is all hateful either. If a person fails to accomplish this developmental task satisfactorily, borderline pathology can emerge. 'In the borderline personality organization', Kernberg found 'dissociated ego states that result from the use of "splitting" defences'.[32] His therapeutic work then aimed at 'the analysis of the repeated and oscillating projections of unwanted self and object representations onto the therapist' so as to produce 'something more durable, complex and encompassing than the initial, split-off and polarized state of affairs'.[33]

Transference
It has been suggested that interpretation of the transference "becomes effective through a sort of splitting of the ego into a reasonable, judging portion and an experiencing portion, the former recognizing the latter as not appropriate in the present and as coming from the past."[34] Clearly, 'in this sense, splitting, so far from being a pathological phenomenon, is a manifestation of self-awareness'.[35] Nevertheless, 'it remains to be investigated how this desirable "splitting of the ego" and "self-observation" are to be differentiated from the pathological cleavage...directed at preserving isolations'.[36]

Splitting (psychology)

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References
[1] Gould, J.R., Prentice, N.M. & Ainslie, R. C. (1996). The splitting index: construction of a scale measuring the defense mechanism of splitting. Journal of personality assessment, 66 (2), 414430 [2] Alexander Abdennur, Camouflaged Aggression (2000) p. 88 [3] Siegel,J.P. Repairing Intimacy,1992 Linehan, M. 1993. [4] Jacobs, B. 2004, Siegel,J. 2010. [5] Siegel, J.P. (2006). Dyadic splitting in partner relational disorders. Journal of Family Psychology, 20 (3), 418422 [6] Mitchell, S.A. & Black, M.J. (1995). Freud and beyond. New York, NY, Basic Books [7] Abdennur, p. 88=9 [8] Siegel, J.P. (2006). Dyadic splitting in partner relational disorders. Journal of Family Psychology, 20 (3), 418422 [9] Sigmund Freud, Five Lectures on Psycho-Analysis (London 1995) p. 25 [10] Freud, Five p. 33 [11] Sigmund Freud, On Metapsychology (Middlesex 1987) pp. 534 [12] Sigmund Freud, On Psychopathology (Middlesex 1987) p. 217 [13] Angela Richards, "Editor's Note", Metapsychology p. 460 [14] Otto Fenichel, The Psychoanalytic Theory of Neurosis (London 1946) p. 145 [15] Heinz Kohut, The Analysis of the Self (Madison 1971) pp. 1767 [16] Fenichel, Neurosis p. 157 [17] Sigmund Freud, Case Histories II (London 1991) p. 119 [18] Fenichel, Neurosis p. 158 [19] T. Bokanowski/S. Lewkowicz, On Freud's "Splitting of the ego in the process of defense" (London 2009) p. x [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] Richard Appignanesi ed., Introducing Melanie Klein (Cambridge 2006) np [173] Robin Skinner/John Cleese, Families and how to survive them (London 1994) p. 98 Appignanesi, Klein p. 123 Appignanesi, Klein p. 131 Skinner, Families p. 98 Appignanesi, Klein p. 125 Quoted in Paul Holmes, The inner world outside (1992) p. 117 Jean-Michel Quinodoz, Reading Freud (London 2005) p. 252 Quoting Robert Hinshelwood, in Quinodoz, Reading Freud p. 252 Mitchell, S.A. & Black, M.J. (1995). Freud and beyond. New York, NY, Basic Books Otto F. Kernberg, Borderline Conditions and Pathological Narcissism (London 1990) p. 165 Kernberg, Borderline p. 29 Paul Brinich/Christopher Shelley, The Self and Personality Structure (Buckingham 2002) p 51 Brinich, Self p. 51 Fenichel, Neurosis p. 570 Charles Rycroft, A Critical Dictionary of Psychoanalysis (London 1995) p. 174 Fenichel, Neurosis p. 570

Behaviour therapy

57

Behaviour therapy
Behaviour therapy
Intervention ICD-9-CM 94.33 [1] MeSH D001521 [2]

Behaviour therapy, or behavior therapy (behaviour modification) is an approach to psychotherapy based on learning theory which aims to treat psychopathology through techniques designed to reinforce desired and eliminate undesired behaviours.[3]

History
Precursors of certain fundamental aspects of behaviour therapy have been identified in various ancient philosophical traditions, particularly Stoicism.[4] For example, Wolpe and Lazarus wrote, While the modern behavior therapist deliberately applies principles of learning to this therapeutic operations, empirical behavior therapy is probably as old as civilization if we consider civilization as having begun when man first did things to further the well-being of other men. From the time that this became a feature of human life there must have been occasions when a man complained of his ills to another who advised or persuaded him of a course of action. In a broad sense, this could be called behavior therapy whenever the behavior itself was conceived as the therapeutic agent. Ancient writings contain innumerable behavioral prescriptions that accord with this broad conception of behavior therapy.[5] Possibly the first occurrence of the term "behaviour therapy" was in a 1953 research project by B.F. Skinner, Ogden Lindsley, Nathan H. Azrin and Harry C. Solomon.[6] Other early pioneers in behaviour therapy include Joseph Wolpe and Hans Eysenck.[7] In general, behaviour therapy is seen as having three distinct points of origin: South Africa (Wolpe's group), The United States (Skinner), and the United Kingdom (Rachman and Eysenck). Each had its own distinct approach to viewing behaviour problems. Eysenck in particular viewed behaviour problems as an interplay between personality characteristics, environment, and behaviour.[8] Skinner's group in the United States took more of an operant conditioning focus. The operant focus created a functional approach to assessment and interventions focused on contingency management such as the token economy and behavioural activation. Skinner's student Ogden Lindsley is credited with forming a movement called precision teaching, which developed a particular type of graphing program called the standard celeration chart to monitor the progress of clients. Skinner became interested in the individualising of programs for improved learning in those with or without disabilities and worked with Fred S. Keller to develop programmed instruction. Programmed instruction had some clinical success in aphasia rehabilitation.[9] Gerald Patterson used programme instruction to develop his parenting text for children with conduct problems.[10] (see Parent Management Training). With age, respondent conditioning appears to slow but operant conditioning remains relatively stable.[11] While many behaviour therapists remain staunchly committed to the basic operant and respondent paradigm, in the second half of the 20th century, many therapists coupled behaviour therapy with the cognitive therapy of Aaron Beck and Albert Ellis, to form cognitive behavioural therapy. In some areas the cognitive component had an additive effect (for example, evidence suggests that cognitive interventions improve the result of social phobia treatment.[12] ) but in other areas it did not enhance the treatment, which led to the pursuit of Third Generation Behaviour Therapies. Third generation behaviour therapy uses basic principles of operant and respondent psychology but couples them

Behaviour therapy with functional analysis and a clinical formulation/case conceptualisation of verbal behaviour more inline with view of the behaviour analysts. Some research supports these therapies as being more effective in some cases than cogntive therapy,[13] but overall the question is still in need of answers.[14]

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Scientific basis
Behaviour therapy is based upon the principles of classical conditioning developed by Ivan Pavlov and operant conditioning developed by B.F. Skinner. There has been a good deal of confusion on how these two conditionings differ and whether the various techniques of behaviour therapy have any common scientific base. Contingency management programs are a direct product of research from operant conditioning. These programs have been highly successful with those suffering from panic disorders, anxiety disorders, and phobias.[15] Systematic desensitisation and exposure and response prevention both evolved from respondent conditioning and have also received considerable research. Social skills training teaches clients skills to access reinforcers and lessen life punishment. Operant conditioning procedures in meta-analysis had the largest effect size for training social skills, followed by modelling, coaching, and social cognitive techniques in that order.[16] Social skills training has some empirical support particularly for schizophrenia.[17] [18] However, with schizophrenia, behavioural programs have generally lost favour.[19]

Applied to problem behaviour

Behaviour therapy based its core interventions on functional analysis. Just a few of the many problems that behaviour therapy have functionally analysed include intimacy in couples relationships,[20] [21] [22] forgiveness in couples,[23] chronic pain,[24] stress-related behaviour problems of being an adult child of an alcoholic,[25] anorexia,[26] chronic distress,[27] substance abuse,[28] depression,[29] anxiety,[30] and obesity.[31] Functional analysis has even been applied to problems that therapists commonly encounter like client resistance, particially engaged clients and involuntary clients.[32] [33] Applications to these problems have left clinicans with considerable tools for enhancing therapeutic effectiveness. One way to enhance therapeutic effectiveness is to use positive reinforcement or operant conditioning. Many have argued that behaviour therapy is at least as effective as drug treatment for depression, ADHD, and OCD.[34] Considerable policy implications have been inspired by behavioural views of various forms of psychopathology. One form of behaviour therapy (habit reversal training) has been found to be highly effective for treating tics.

Third generation
Of particular interest, in behaviour therapy today are the areas often referred to as Third Generation Behaviour Therapy.[35] This movement has been called clinical behavior analysis because it represents a movement away from cognitivism and back toward radical behaviourism and other forms of behaviourism, in particular functional analysis and behavioural models of verbal behaviour. This area includes Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Analysis System of Psychotherapy (CBASP) (McCullough, 2000), behavioural activation (BA), Kohlenberg & Tsai's Functional Analytic Psychotherapy, integrative behavioural couples therapy and dialectical behavioural therapy. These approaches are squarely within the applied behaviour analysis tradition of behaviour therapy. Acceptance and Commitment Therapy is probably the most well-researched of all the third generation behaviour therapy models. It is based on Relational Frame Theory.[36] Functional Analytic Psychotherapy is based on a functional analysis of the therapeutic relationship.[37] It places a greater emphasis on the therapeutic context and returns to the use of in session reinforcement.[38] In general, 40 years of research supports the idea that in-session reinforcement of behaviour can lead to behavioural change.[39]

Behaviour therapy Behavioural activation emerged from a component analysis of cognitive behaviour therapy. This research found no additive effect for the cognitive component.[40] Behavioural activation is based on a matching model of reinforcement.[41] A recent review of the research, supports the notion that the use of behavioural activation is clinically important for the treatment of depression.[42] Integrative behavioural couples therapy developed from dissatisfaction with traditional behavioural couples therapy. Integrative behavioural couples therapy looks to Skinner (1966) for the difference between contingency-shaped and rule-governed behaviour.[43] It couples this analysis with a thorough functional assessment of the couple's relationship. Recent efforts have used radical behavioural concepts to interpret a number of clinical phenomena including forgiveness.[44]

59

Organisations
Many organisations exist for behaviour therapists around the world. The World Assocaition for Behavior Analysis offers a certification in behaviour therapy [45]. In the United States, the American Psychological Association's Division 25 is the division for behaviour analysis. The Association for Contextual Behavior Therapy is another professional organisation. ACBS is home to many clinicians with specific interest in third generation behaviour therapy. The Association for Behavioral and Cognitive Therapies (formerly the Association for the Advancement of Behavior Therapy) is for those with a more cognitive orientation. Internationally, most behaviour therapists find a core intellectual home in the International Association for Behavior Analysis (ABAI) [46].

Characteristics
By nature, behavioural therapies are empirical (data-driven), contextual (focused on the environment and context), functional (interested in the effect or consequence a behaviour ultimately has), probabilistic (viewing behaviour as statistically predictable), monistic (rejecting mindbody dualism and treating the person as a unit), and relational (analysing bidirectional interactions).[47]

Methods
Systematic desensitisation Exposure and response prevention Behaviour modification Flooding Operant conditioning Covert conditioning Observational learning Contingency management Matching law Habit reversal training

Behaviour therapy

60

References
[1] [2] [3] [4] http:/ / icd9cm. chrisendres. com/ index. php?srchtype=procs& srchtext=94. 33& Submit=Search& action=search http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?field=uid& term=D001521 behavior therapy. (n.d.). Memidex/WordNet. Retrieved July 15, 2010, from http:/ / www. memidex. com/ behaviour-therapy Robertson, D. (2010). The Philosophy of CognitiveBehavioural Therapy: Stoicism as Rational and Cognitive Psychotherapy (http:/ / books. google. co. uk/ books?id=XsOFyJaR5vEC& lpg). London: Karnac. ISBN978-1855757561. . [5] Wolpe, J. & Lazarus, A. (1966) Behavior Therapy Techniques: A Guide to the Treatment of Neuroses, pp. 12. [6] Lindsley, O.; Skinner, B.F.; Solomon, H.C. (1953). Studies in behavior therapy (Status Report I). Walthama, MA.: Metropolitan State Hospital. [7] Clark, David M.; Christopher G. Fairburn (1997). Science and Practice of Cognitive Behaviour Therapy. Oxford University Press. ISBN0192627260. [8] Yates, A.J.(1970). Behavior Therapy. New York Wiley [9] Goldfarb, R. (2006). Operant Conditioning and Programmed Instruction in Aphasia Rehabilitation. SLP-ABA, 1(1), 5665 BAO (http:/ / www. baojournal. com) [10] Patterson, G.R. (1969). Families: A social learning approach to family life. [11] Perlmutter, M. & Hall, E. (1985). Adult development and aging. New York: John Wiley. [12] Clark, David M.; Ehlers, A.; Hackmann, A.; McManus, F.; Fennell, M.; Grey, N.; Waddington, L.; Wild, J. (June 2006). "Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial". Journal of Consulting and Clinical Psychology 74 (3): 56878. doi:10.1037/0022-006X.74.3.568. PMID16822113. [13] Block, J.A. & Wulfert, E. (2000) Acceptance or Change: Treating Socially Anxious College Students with ACT or CBGT. The Behavior Analyst Today, 1(2), 310. BAO (http:/ / www. baojournal. com) [14] st, L.G. (2008). "Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis". Behaviour research and therapy, 46(3), 296321 [15] Paul, G.L. & Lentz, R.J. (1977). Psychosocial treatment of chronic mental patients: Milieu versus social learning programs. Cambridge, MA: Harvard University Press. [16] Schnieder, B.H. & Bryne, B.M. (1985). Children's social skills training: A meta-analysis. In B.H. Schneider, K. Rubin, & J.E. Ledingham (Eds.) Children's Peer relations: Issues in assessment and intervention (pp. 17590). New York: Springer-Verlag. [17] Corrigan, P.W. (1997). Behavior therapy empowers persons with severe mental illness. Behavior Modification, 21, 4561 [18] Corrigan, P.W. & Holmes, E.P. (1994). Patient identification of "street skills" for a psychosocial training module. Hospital and Community Psychiatry, 45, 2736. [19] Wong, S.E. (2006). Behavior Analysis of Psychotic Disorders: Scientific Dead End or Casualty of the Mental Health Political Economy? Behavior and Social Issues, 15(2), 15277 (http:/ / www. uic. edu/ htbin/ cgiwrap/ bin/ ojs/ index. php/ bsi/ article/ view/ 365) [20] Cordova, J. (2003). Behavior Analysis and the Scientific Study of Couples. The Behavior Analyst Today, 3(4), 4129 (http:/ / www. baojournal. com) [21] Stuart, R.B. (1998). Updating Behavior Therapy with Couples. The Family Journal, 6(1), 612 [22] Christensen, A.; Jacobson, N.S. & Babcock, J.C. (1995). Integrative behavioral couples therapy. In N.S. Jacobson & A.S. Gurman (Eds.) Clinical Handbook for Couples Therapy (pp. 3164). New York: Guildford. [23] Cordova, J.; Cautilli, J.D.; Simon, C. & Axelrod-sabag, R. (2006). Behavior Analysis of Forgiveness in Couples Therapy IJBCT, 2(2), 192208 (http:/ / www. baojournal. com) [24] Sanders, S.H. (2006). Behavioral Conceptualization and Treatment for Chronic Pain (2006). The Behavior Analyst Today, 7(2), 25361. (http:/ / www. baojournal. com) [25] Ruben, D.H. (2001). Treating Adult Children of Alcoholics: A behavioral approach. San Diego, CA: Academic Press. [26] Lappalainen and Tuomisto (2005): Functional Analysis of Anorexia Nervosa: Applications to Clinical Practice. The Behavior Analyst Today, 6(3), 16675 (http:/ / www. baojournal. com) [27] Holmes, Dykstra Williamns, Diwan, & River, (2003) Functional Analytic Rehabilitation: A Contextual Behavioral Approach to Chronic Distress. The Behavior Analyst Today, 4(1), 3445 BAO (http:/ / www. baojournal. com) [28] Smith, J.E.; Milford, J.L & Meyers, R.J. (2004). CRA and CRAFT: Behavioral Approaches to Treating Substance-Abusing Individuals. The Behavior Analyst Today, 5(4), 391402 BAO (http:/ / www. baojournal. com) [29] Kanter, J.W.; Cautilli, J.D.; Busch, A.M. & Baruch, D.E. (2005). Toward a Comprehensive Functional Analysis of Depressive Behavior: Five Environmental Factors and a Possible Sixth and Seventh. The Behavior Analyst Today, 6(1), 6578. BAO (http:/ / www. baojournal. com) [30] Hopko, D.R.; Robertson, S. & Lejuez, C.W.(2006). Behavioral Activation for Anxiety Disorders. The Behavior Analyst Today, 7(2), 21233 (http:/ / www. baojournal. com) [31] Stuart, R.B. (1967). Behavioral Control of overeating. Behavior research and therapy, 5, 35765 (http:/ / www. garfield. library. upenn. edu/ classics1983/ A1983QN93200001. pdf) [32] Cautilli, J.; Tillman, T.C.; Axelrod, S.; Dziewolska, H. & Hineline, P. (2006). Resistance Is Not Futile: An experimental analogue of the effects of consultee "resistance" on the consultant's therapeutic behavior in the consultation process: A replication and extension. IJBCT, 2(3), 36276. BAO (http:/ / www. baojournal. com)

Behaviour therapy
[33] Cautilli, J.D.; Riley-Tillman, T.C.; Axelrod, S. & Hineline, P. (2005). Current Behavioral Models of Client and Consultee Resistance: A Critical Review. IJBCT, 1(2), 14764 BAO (http:/ / wwww. baojournal. com) [34] Flora, S.R. (2007). Taking America off Drugs: why behavioral therapy is more effective for treating ADHD, OCD, Depression, and other psychological problems. SUNY [35] Kohlenberg, R.J.; Bolling, M.Y.; Kanter, J.W.; Parker, C.R. (2002). "Clinical behavior analysis: Where it went wrong, how it was made good again, and why its future is so bright" (https:/ / pantherfile. uwm. edu/ jkanter/ www/ pdf/ publication/ behavioranalysis. pdf) (PDF). The Behavior Analyst Today 3: 24853. ISSN15394352. . [36] Blackledge, J.T. (2003). An Introduction to Relational Frame Theory: Basics and Applications. The Behavior Analyst Today, 3(4), 42142 BAO (http:/ / www. baojournal. com) [37] Kohlenberg, R.J. & Tsai, M. (1991) Functional Analytic Psychotherapy. New York: Plenum [38] Wulfert (2002) Can Contextual Therapies Save Clinical Behavior Analysis? The Behavior Analyst Today, 3(3), 254 BAO (http:/ / www. baojournal. com) [39] Cautilli, J.T.; Riley-Tillman, C.; Axelrod S. & Hineline, P. (2005). The Role of Verbal Conditioning in Third Generation Behavior Therapy. The Behavior Analyst Today, 6(2), 13857 BAO (http:/ / www. baojournal. com) [40] Jacobson, N.S.; Martell, C.R. & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8, 25570. [41] Cullen, J.M.; Spates, C.R; Pagoto, S. & Doran, N. (2006). Behavioral Activation Treatment for Major Depressive Disorder: A Pilot Investigation. The Behavior Analyst Today, 7(1), 15164. [42] Spates, C.R.; Pagoto, S. & Kalata, A. (2006). A Qualitative And Quantitative Review of Behavioral Activation Treatment of Major Depressive Disorder. The Behavior Analyst Today, 7(4), 50812 BAO (http:/ / www. baojournal. com) [43] Skinner, B.F. (1969). Contingencies of Reinforcement: A Theoretical Analysis. New York: Meredith Corporation. [44] Cordova, J.; Cautilli, J.D.; Simon, C. & Axelrod-sabag, R. (2006). Behavior Analysis of Forgiveness in Couples Therapy. IJBCT, 2(2), 192213 BAO (http:/ / www. baojournal. com) [45] http:/ / worldcenterba. com/ index. html [46] http:/ / www. abainternational. org/ [47] Sundberg, Norman (2001). Clinical Psychology: Evolving Theory, Practice, and Research. Englewood Cliffs: Prentice Hall. ISBN0130871192.

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Fugue state

62

Fugue state
Fugue state
Classification and external resources ICD-10 ICD-9 F44.1 [1] [2]

300.13

A fugue state, formally dissociative fugue or psychogenic fugue (DSM-IV Dissociative Disorders 300.13[3] ), is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality and other identifying characteristics of individuality. The state is usually short-lived (hours to days), but can last months or longer. Dissociative fugue usually involves unplanned travel or wandering, and is sometimes accompanied by the establishment of a new identity. After recovery from fugue, previous memories usually return intact, but there is complete amnesia for the fugue episode. Additionally, an episode is not characterized as a fugue if it can be related to the ingestion of psychotropic substances, to physical trauma, to a general medical condition, or to psychiatric conditions such as delirium, dementia, bipolar disorder or depression. Fugues are usually precipitated by a stressful episode, and upon recovery there may be amnesia for the original stressor (Dissociative Amnesia).

Clinical definition
The etiology of the fugue state is related to Dissociative Amnesia, (DSM-IV Codes 300.12[4] ) which has several other subtypes:[5] Selective Amnesia, Generalised Amnesia, Continuous Amnesia, Systematised Amnesia, in addition to the subtype Dissociative Fugue.[3] Unlike retrograde amnesia (which is popularly referred to simply as "amnesia", the state where someone forgets events before brain damage), Dissociative Amnesia is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, DSM-IV Codes 291.1 & 292.83) or a neurological or other general medical condition (e.g., Amnestic Disorder due to a head trauma, DSM-IV Codes 294.0).[6] It is a complex neuropsychological process.[7] As the person experiencing a Dissociative Fugue may have recently suffered the reappearance of an event or person representing an earlier life trauma, the emergence of an armoring or defensive personality seems to be for some, a logical apprehension of the situation. Therefore, the terminology fugue state may carry a slight linguistic distinction from Dissociative Fugue, the former implying a greater degree of motion. For the purposes of this article then, a fugue state would occur while one is acting out a Dissociative Fugue. The DSM-IV defines[3] as: sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past, confusion about personal identity, or the assumption of a new identity, or significant distress or impairment. The Merck Manual[8] defines Dissociative Fugue as: One or more episodes of amnesia in which the inability to recall some or all of one's past and either the loss of one's identity or the formation of a new identity occur with sudden, unexpected, purposeful travel away from home. In support of this definition, the Merck Manual[8] further defines Dissociative Amnesia as: An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.

Fugue state

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Diagnosis
A doctor may suspect dissociative fugue when people seem confused about their identity or are puzzled about their past or when confrontations challenge their new identity or absence of one. The doctor carefully reviews symptoms and does a physical examination to exclude physical disorders that may contribute to or cause memory loss. A psychologic examination is also done. Sometimes dissociative fugue cannot be diagnosed until people abruptly return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances. The diagnosis is usually made retroactively when a doctor reviews the history and collects information that documents the circumstances before people left home, the travel itself, and the establishment of an alternative life.

Prognosis
The DSM-IV-TR states that the fugue may have a duration from hours to months and recovery is usually rapid. However, some cases may be refractory. An individual usually only has a single episode.

Case studies
Agatha Christie disappeared on 3 December 1926 only to reappear eleven days later in a hotel in Harrogate, apparently with no memory of the events which happened during that time span.[9] Shirley Ardell Mason also known as "Sybil" would disappear and then reappear with no recollection of what happened during the time span. She recalls "being here and then not here" and having no identity of herself; it should be noted that she also suffered from what was formerly called "Multiple Personality Disorder". Jody Roberts, a reporter for the Tacoma News Tribune, went missing in 1985, only to be found 12 years later in Sitka, Alaska, living under the name of "Jane Dee Williams." While there were some initial suspicions that she had been faking amnesia, some experts have come to believe that she genuinely suffered a protracted fugue state.[10] David Fitzpatrick, a sufferer of dissociative fugue disorder, from the United Kingdom, was profiled on Channel Five's television series Extraordinary People. He entered a fugue state on December 22, 2005, and is still working on regaining his entire life's memories.[11] Hannah Upp, a teacher from New York, went missing on August 28, 2008. She was rescued from the New York Harbor on September 16 with no recollection of the time in between. The episode was diagnosed as dissociative fugue.[12]

Pop culture references

In the 1985 film Come and See, the main character Florian, after discovering the remains of a German Einsatzgruppen detachment, who have just destroyed a village and killed all of its inhabitants, ambushed by Byelorussian partisans, finds a girl whom he had previously witnessed being repeatedly gang-raped by German soldiers, wandering around in a fugue state. The UK electronic music act Nero have a song entitled "Fugue State" on their album Welcome Reality. It could conceivably be a titular homage to fellow producers and founders of Nero's label (MTA Records), Chase & Status, as, apart from being a musical term, 'fugue', traced back to its Latin origins, relates to the verb fugare, (to chase). 'State' and 'Status' have a clear etymological link. In the television show Breaking Bad the main character Walter White fakes a fugue state to cover up his other activities. During the Doctor Who episode The Next Doctor it is discovered by the Tenth Doctor that the future incarnation of himself is actually a man named Jackson Lake, suffering a fugue state after the loss of his family to the Cybermen. In the series Twin Peaks, a girl named Ronette Pulaski is found walking down train tracks in a fugue state (though the term is not actually used).

Fugue state David Lynch has said that the character of Fred Madison in his 1997 film Lost Highway is in a fugue state. In the Buffy the Vampire Slayer (TV series) episode Bring on the Night (Buffy the Vampire Slayer) (season 7 episode 10), Dawn says in reference to Andrew, "Or maybe he's in a fugue state?" In the animated comedy series Ugly Americans, Grimes returns from a long memory flashback, told by protagonist Mark Lilly, I have to say--you drive shockingly well in a fugue state.[13] In the Star Trek: The Next Generation episode Tin Man, a telepath, having distantly communicated with the titular alien, is told in a follow-up medical exam Your brain activity suggests that you're coming out of a sort of fugue, or seizure. [14] The character Eddie Morra in the 2011 film Limitless experiences fugue states whilst on the fictional drug NZT. The film Nurse Betty is about a Kansas City waitress (played by Renee Zellweger) who goes into a fugue state after seeing her husband scalped. In the Film and Novel Primal Fear the supporting character Aaron Stampler appears to slip frequently in to and out of a fugue state but it is later revealed to be an act. In the Australian television series Neighbours a main character Harold Bishop went AWOL for five years in a putative fugue state. In Chapter 7 of The Maltese Falcon, by Dashiell Hammett, Spade tells Brigid a story about a man who, after a near-death experience, disappears, abandoning his wife and children, only to be found years later, settled down to the same kind of life with the same kind of family. In a 2011 episode of the TV series Bones, a murder victim had entered a fugue state and assumed a new identity, making it troublesome for the characters to explain the murder.

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References
[1] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ F44. 1 [2] http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=300. 13 [3] Dissociative Fugue (formerly Psychogenic Fugue) ( DSM-IV 300.13, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (http:/ / www. psychiatryonline. com/ content. aspx?aID=9744)) [4] Dissociative Amnesia, DSM-IV Codes 300.12 ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ) (http:/ / www. psychiatryonline. com/ content. aspx?aID=9708) [5] Dissociative Amnesia, DSM-IV Code 300.12 ( PsychNet-UK.com ) (http:/ / www. psychnet-uk. com/ dsm_iv/ dissociative_amnesia. htm) [6] Complete List of DSM-IV Codes ( PsychNet-UK.com ) (http:/ / www. psychnet-uk. com/ dsm_iv/ _misc/ complete_tables. htm) [7] Background to Dissociation ( The Pottergate Centre for Dissociation & Trauma ) (http:/ / www. dissociation. co. uk/ background. asp) [8] Merck Manual 1999 section 15 (Psychiatric Disorders), chapter 188 (Dissociative Disorders) [9] Adams, Cecil, Why did mystery writer Agatha Christie mysteriously disappear? The Chicago Reader, 4/2/82. (http:/ / www. straightdope. com/ columns/ read/ 361/ why-did-mystery-writer-agatha-christie-mysteriously-disappear) Accessed 5/19/08. [10] (http:/ / www. juneauempire. com/ stories/ 071797/ amnesia. html) [11] The Man With No Past (http:/ / five. tv/ programmes/ extraordinarypeople/ manwithnopast/ ) [12] http:/ / www. nytimes. com/ 2009/ 03/ 01/ nyregion/ thecity/ 01miss. html?_r=3& pagewanted=1& ref=nyregion [13] 'Ugly Americans' Recap: "Ride Me to Hell" (http:/ / www. ology. com/ screen/ ugly-americans-recap-ride-me-hell) [14] [http://www.livedash.com/transcript/star_trek__the_next_generation-(tin_man)/8058/SYFYP/Tuesday_June_08_2010/326671/ Star Trek: The Next Generation Tin Man (transcript)

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External links
" Dissociative Fugue (http://www.mental-health-matters.com/disorders/dis_details.php?disID=38/)" from the Mental Health Matters website. " Dissociative Fugue (http://www.merck.com/mmhe/sec07/ch106/ch106c.html)" from the Merck & Co. website.

Article Sources and Contributors

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Article Sources and Contributors

Dissociative identity disorder Source: http://en.wikipedia.org/w/index.php?oldid=458833015 Contributors: ***Ria777, -- April, 100110100, 1210donna, 30, A Kiwi, ABCD, ABF, ANDROBETA, AVonRaab, Absentis, Acdx, Aditya, Aecis, Afort, Ahoerstemeier, Aitias, Alexandria, Allmightyduck, Alphachimp, Alphatango87, Amiodarone, Amorrow, AnaSidney, Andre Engels, Andreas Kaganov, Antaeus Feldspar, Antandrus, Arabiansockdoll, Aranel, Arcadian, ArielGold, Arthur Rubin, Artlung, Ashmodai, Asrais, Astervip, AussieOzborn, Avicennasis, Avocats, Azurefox, Backslash Forwardslash, Bain1211, Banano03, Bartlebee2010, Bassist J-Whitt, Bbatsell, Belovedfreak, Bikeable, Bilbobee, Bishonen, Blackcanoflysol, Blaxxberry, Blehfu, Bluejay Young, Bluemoose, Bongwarrior, BoyyM, Breadmanpaul, Brian1955, Brianga, Brideshead, Bryan Derksen, Buddho, BugEyedMonster, Bunndan, Burmiester, C'est moi, CDN99, Cabinet of Art and Medicine, Cactus Bob, Caffery0368, Caged falcon ft, Calm, CanadianLinuxUser, CapitalR, Capricorn42, Carabas, Carl.bunderson, Carrie Myers, Casliber, CaveatLector, Cbl62, Celestianpower, Cesar Tort, ChaosMaster, Chris Bulgin, ChrisJFry, Chriscourt001, Chronulator, Claritas, Clemmy, CliffordWest, CloudSurfer, Clpo13, Coder Dan, Colbert Fan115900, Corpx, Corvi, Cosmic Latte, Cosmictinker, Courcelles, Crazyvas, Crisses, Crusio, Cyril42e, Czolgolz, DARTH SIDIOUS 2, DPeterson, DVD R W, DaGizza, DakotaMich, DancingPhilosopher, Daniel C. Boyer, Daniel Santos, DanielCD, DanielMcBride, DashaKat, Dataman5, David Latapie, Dawn Bard, Dcoetzee, DeadEyeArrow, Deenoe, Deli nk, Delldot, Denelson83, Deor, DerHexer, Dina, Discospinster, Dnvrfantj, Doczilla, Dogah, Dogface, Dolphonia, Donreed, Dr.Bastedo, Dragonwish, DragoonWraith, DreamGuy, Dribble101, DropDeadGorgias, Drunken Pirate, Dspiegel580, Dstern1, Dweeebis, DxAngels, Dysepsion, E Wing, E2eamon, ELSayles, Earth, Echosmoke, Echris1, Edderso, Eddie-ginnley, Eewilson, Egmontaz, Ekpyrotic Architect, El C, Eli the Barrow-boy, EliasAlucard, Ellenjtown, Elliskev, Ellobello, Eloquence, Ely23, Empacher, Ergito, ErinKM, Error -128, Escape Orbit, Eshahime09, Esprit15d, Eternal-Entropy, Evaluist, Extransit, Ezhiki, Face-2-face, Factomancer, Farosdaughter, FeepingCreature, Felix Wiemann, Fffffggggg, FiachraByrne, Fieldday-sunday, Fighting Dreamer, Firewheel, Firsfron, Fluffernutter, Fnagaton, ForesticPig, Frankie0607, Frecklefoot, Funkyferret7, Fvw, GVOLTT, Gaia Octavia Agrippa, Gaius 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http://en.wikipedia.org/w/index.php?oldid=458862600 Contributors: Allisonmarieanne, Amzyy, Apokrif, Ayanonagon, Beland, Benscripps, Bobo192, DCDuring, DJ Nietzsche, Diberri, Doczilla, Ericoides, Jbuncle, Looie496, Lozeldafan, Luna Santin, Malcolma, Mandarax, MartinPoulter, Mattisse, Mboverload, Mirek2, Nabeth, Ortho, Prunesqualer, Psy3330 W10, R'n'B, Richard001, Sanya3, WLU, Yug, 41 anonymous edits Psychiatric medication Source: http://en.wikipedia.org/w/index.php?oldid=448726134 Contributors: Acdx, Alexrexpvt, Arcadian, Auntof6, BANZ111, Birchmore, C6541, Can't sleep, clown will eat me, Chowbok, Clicketyclack, Crusio, DR04, EverSince, Facts707, FiachraByrne, Fizzybee, Fvasconcellos, Giltramirez, Googie man, Ivaldes1, Justin W Smith, Koavf, Muugokszhiion, Nono64, Ofus, Rich Farmbrough, Robina Fox, Shadowjams, Standardname, Steve carlson, Velella, WhatamIdoing, Wheathusker, Writtenright, 59 anonymous edits Parietal lobe Source: http://en.wikipedia.org/w/index.php?oldid=454739030 Contributors: A little insignificant, A314268, Adoarns, Andy pyro, Arcadian, AxelBoldt, Badseed, Benanhalt, Bentogoa, Bird, Bryan Derksen, Bumm13, CWenger, Cajolingwilhelm, Caliprincess, Commander Keane, Cyp, DARTH SIDIOUS 2, December21st2012Freak, Diberri, Digfarenough, Ffangs, Fifo, Fnielsen, Fyyer, Gail, Giftlite, InternetHero, J-Kama-Ka-C, Jcbutler, Jmarchn, John Reaves, JohnJohn, Joshannon, Jusdafax, Justme89, Karlhahn, Kasunchathuranga, Kpmiyapuram, LaMenta3, Liam Skoda, Looie496, Macy, Mani1, Michaelbusch, Mr.Z-man, Mrs.meganmmc, Mysid, NawlinWiki, NifCurator1, Quercus basaseachicensis, Reach Out to the Truth, RedHillian, Reyk, Satori Son, Selket, Seraphimblade, Sgmanohar, Somerledi, South Bay, Spaully, Tesseract2, The Thing That Should Not Be, Thegoldeneel, Topbanana, Vaughan, Viniciusmc, Was a bee, Washington irving, West.andrew.g, Willpenington, Xanzzibar, Zhang Guo Lao, Zzuuzz, 162 anonymous edits Psychotherapy Source: http://en.wikipedia.org/w/index.php?oldid=457277328 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Ash Bowie, J04n, JAltman752, JOOLSKAVVY, Jagged 85, Jamespkeim, Jandalhandler, Jaxhere, Jayers, Jcleese, Jehochman, Jeremy holmes, Jeremychristey, Jfdwolff, Jfurr1981, Jipy, Jlittlet, JoeSmack, John Talbut, Johnkarp, JohnsonRon, Jon Awbrey, Jonkerz, Jonny peepeeballs, Jopo, Jordan Rothstein, Jordan200, Joresnorman, Joseph Solis in Australia, Julesd, Julia Rossi, Jusdafax, Kamal T, Kane5187, Karada, Karneson99, Karol Langner, Kartano, Katherab, Kay Dekker, Kbdank71, Keahapana, Keeganwade, Kelly Martin, Kentrate, Kiritz, Kleptosquirrel, Knowledge Seeker, Koavf, Kukini, Kuyabribri, LaXian, LeaveSleaves, Lemieu, Leontes, Limegreen, Limsont, Lindsay658, LindsayDF, Loki1138, LouI, Loudsox, Lowellian, Lumos3, Lynch9000s, M9jorodb, MONGO, Madhero88, Magnus Manske, Majorly, MarkWood, Markus Krtzsch, MarylandCSP, Master shepherd, Mattisse, Mauls, MaxghogUK, Mcge, Mdd, Mddombrowski, MearsMan, Meco, Medipsych, Mel Etitis, Mentifisto, Mentisock, Merson12, Michael Hardy, Mike Rinder, Mike.lifeguard, MikeLynch, Mindstore, Miranda Meagan Keefe, Mmacilvaine, Montgomery '39, MrOllie, Murmur74, Mwitkin, Mz.pooh 94, Nanouk, Nealmcb, Netpsych, Neutrality, Nev1, Nicola Gianinazzi, Nirvana2013, Ohka-, Ohnoitsjamie, Olathe, Openend, Oxymoron83, P6trick, PJT30, Patrick, Paulsheer, Pavel Vozenilek, Penbat, Pepita, Pgan002, Phantomsteve, Philbrownell, Philippa Perry, Philips1, Philosophy1807, Pnoble805, Polimerek, Postcrypto, Profcounselor, Proxima Centauri, Pskop, Psychosynergy, Psykhosis, Pupster21, Quarl, R Lowry, R. 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Pray, RDF, Rachlee13, RapidEye0, Raspor, Rbean, Rdsmith4, Reesh, Repabil, Res2216firestar, Rgamble, Rich Farmbrough, RichardF, Ricky81682, Riverboi, Robth, Rosanna Young, Rror, Russell E, SLCostello, Sallyb66, Samsara, Sannse, Sardanaphalus, Savoylettuce, Sdorrance, Seb az86556, Shawn in Montreal, Shrp2edgeswrd, Siafu, Siroxo, Skagedal, Snowmanradio, Solus ipse Inc., Soulwork, Sparkleyone, StAnselm, SteinbDJ, Stephenforrest, Steve carlson, Stonemaccas, SusanLesch, Swhitevt, Tallyd29, Tannin, TeleComNasSprVen, Texture, The Anome, The.Filsouf, Theda, Thefeelingofwhathappens, Thepsychotherapist, Tide rolls, Tijuana Brass, Tim1988 2, Tmh, Tmtj, Tobby72, Tommy2010, Tpaultommy, Trouv, Trumic, Twirligig, Tytrain, Vary, Veronicasp, Vgy7ujm, Vic226, Victor Chmara, Virginialaxer40, Vorash, Walkerma, Walter Vermeir, Wayne InSane (Of RTC), WhatamIdoing, Whatever404, Whicky1978, Whitfield101, Wikicontributions, Wikipelli, Will Beback Auto, Willking1979, Wolfgang K, Woohookitty, Xgkkp, Xinit, Ybbor, Yemal, Yonex2, Yuccara, YvonneBates, Zeke8888, Zigger, Ziji, , 671 anonymous edits Identity formation Source: http://en.wikipedia.org/w/index.php?oldid=446535620 Contributors: Attonbrass, Bobo192, C.m.jones, Cedartrees, Courcelles, Darkwind, Denispir, EagleFan, Emhurd, Iridescent, J04n, Jacobisq, Jakatrpe, Jewelall2002, Jsalvador, Kenneth M Burke, Lova Falk, Mattisse, Mlang.Finn, Philosophistry, R'n'B, Reddi, Sillyfolkboy, SlackerMom, SteinbDJ, 41 anonymous edits Psychogenic amnesia Source: http://en.wikipedia.org/w/index.php?oldid=457890594 Contributors: Altenmann, Arcadian, Bionicscode, BonnoNK, Cliff smith, Coder Dan, Ctac, Danhash, Daniel Santos, Dantheman531, Dataman5, Dillard421, Doczilla, E-Kartoffel, Emwave, Gth627n, HaeB, Hdante, Hende jman, Ingolfson, Iridescent, Jack-A-Roe, Janto, JenKilmer, Ludde23,

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Moshennik, Nightspear, OnePt618, Pataki Mrta, Proxima Centauri, ResearchEditor, Rich Farmbrough, Richard Arthur Norton (1958- ), Rjwilmsi, Shoessss, Standardname, Sticky Parkin, Surv1v4l1st, Tagus, WLU, Waelwulf, 67 ,55 anonymous edits Splitting (psychology) Source: http://en.wikipedia.org/w/index.php?oldid=447255944 Contributors: 97198, AThing, Aetheling, Airplaneman, Akerans, Alpha Ursae Minoris, Anahata9, Anentiresleeve, AstroHurricane001, Belovedfreak, CameronHarris, Ccacsmss, DerHexer, Dictabeard, Doczilla, Ebyabe, Edward, Fred Bauder, Groucho, Hairy Dude, Hartopp, Ingesimons, Jack-A-Roe, Jacobisq, Jhertel, Juggalo wolf, Kai-Hendrik, Kauczuk, Koan911, Kovani, Leondegrance, LilHelpa, Lynch2000s, Martnik, Meand, Musketeer41, Omnipaedista, Opensourcejunkie, Penbat, Pigman, ServngU2, Siegeljp, Some jerk on the Internet, Straw Cat, Sugarbat, Surv1v4l1st, Sutherford, TreasuryTag, Typing monkey, WhatamIdoing, Xavexgoem, Zachorious, Zephyrad, 48 anonymous edits Behaviour therapy Source: http://en.wikipedia.org/w/index.php?oldid=453525360 Contributors: 1000Faces, 10qwerty, AManWithNoPlan, Aaron Kauppi, Action potential, Afterwriting, Anil1956, Antonio Lopez, Arcadian, Augdane, Avoided, Bleeep736ui2, Carlvincent, Cdw1952, Chris the speller, Cyclonenim, DR04, Diderot1, Doczilla, Dr.alf, Dtgriscom, Dwandelt, EverSince, Feigenhain, Fyyer, German arabic teaching sami, Giggy, Graham87, HypnoSynthesis, Ilikeliljon, Imnotminkus, Isnow, J04n, Jcautilli, Jcautilli2003, Jgwilsonw, Jmlk17, JnRouvignac, Jonkerz, Kintaro (usurped), KnowledgeOfSelf, Leontaurus, MER-C, Macy, Mahanga, Mattisse, Mike410, Namenotek, Oanjao, Penbat, Pipedreambomb, Politepunk, Radagast83, RichardF, Rjwilmsi, Sardanaphalus, SchuminWeb, Sheeana, Skagedal, Smalljim, Soap, Some standardized rigour, Stwalkerster, Themfromspace, Unschool, WLoku, Wcbaa01, Welsh, Yun-Yuuzhan (lost password), 196 anonymous edits Fugue state Source: http://en.wikipedia.org/w/index.php?oldid=458931339 Contributors: Aaron Brenneman, Alsocal, AndrewWTaylor, AndySimpson, Andycjp, Antandrus, Arcadian, Autarch, Axlrosen, Backslash Forwardslash, BenEisenbraun, BenFrantzDale, Bertilvidet, Bigmantonyd, Blueberry jew, Bongwarrior, Branddobbe, Brandon.macuser, Buchanan-Hermit, C6541, Cacycle, Caesarjbsquitti, Camembert, Chrylis, Coder Dan, Commander Keane, Conversion script, Cstanners, Ctac, DOHC Holiday, DanielCD, DashaKat, DerHexer, Doczilla, Dolphin51, Dreftymac, Drug user, E0steven, Ed Dadoo, Eequor, EhJJ, Ekpyrotic Architect, El C, Epbr123, Ewlyahoocom, Exeunt, FF2010, Ferrierd, Frecklefoot, Fuzzbox, GHMojo, GabrielF, Garzo, Gecg, Glane23, Graham87, Gyan, Hadal, Hypergeometric2F1(a,b,c,x), Ian Pitchford, JAF1970, Jacklee, Johann Gambolputty, Johnkarp, Jojhutton, Jv821, Kibble13, Kinema, Koavf, Langhorner, Liface, Lkinkade, Mat8989, Mattcain, Mattisse, Mentifisto, Michael Hardy, MickWest, Miradre, Mrs.HippieBurning, Msh210, Nazrani, Nehushtan, Nishkid64, NuclearWarfare, Pacula, PaulWicks, PhilTLL, Philip Trueman, Pjrich, PsychoPiglet, Queenmomcat, Quinling, R Lowry, Radon210, Ranveig, RattleMan, Reswobslc, Revolver, Riverjonas@hotmail.com, Rvitelli, Safalra, Sdrawkcab, Seb144, Sierrab, Somekindofusername, Spinozaxxy, SpuriousQ, Standardname, Ste1n, Surv1v4l1st, Taravatli, Tarnas, The Person Who Is Strange, Thorsten1, Tim Q. Wells, Weekly-slim-picker, Xanzzibar, Z.E.R.O., Zondor, , 223 anonymous edits

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Image:Viv.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Viv.jpg License: Creative Commons Attribution 3.0 Contributors: Henri Bourru & Prosper-Ferdinand Burot File:Dr Jekyll and Mr Hyde poster edit2.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Dr_Jekyll_and_Mr_Hyde_poster_edit2.jpg License: Creative Commons Attribution-Sharealike 3.0 Contributors: Chicago : National Prtg. & Engr. Co.Modifications by Papa Lima Whiskey File:US penny 2003.jpg Source: http://en.wikipedia.org/w/index.php?title=File:US_penny_2003.jpg License: Public Domain Contributors: Arachn0, Chochopk, EdwinHJ, Stauba, 1 anonymous edits File:Rainbow-diagram-ROYGBIV.svg Source: http://en.wikipedia.org/w/index.php?title=File:Rainbow-diagram-ROYGBIV.svg License: Creative Commons Attribution-Sharealike 3.0 Contributors: Oren neu dag File:Facevase.png Source: http://en.wikipedia.org/w/index.php?title=File:Facevase.png License: GNU Free Documentation License Contributors: Emil, Nevit, Paulo Cesar-1, TommyBee, 2 anonymous edits File:Ebbinghaus2.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Ebbinghaus2.jpg License: Public Domain Contributors: Atamari, Avron, DO11.10, Elya, Magog the Ogre, Milgesch, Pierre Audit File:Ritalin-SR-20mg-full.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Ritalin-SR-20mg-full.jpg License: GNU Free Documentation License Contributors: en:User:Sponge Image:Lobes of the brain NL.svg Source: http://en.wikipedia.org/w/index.php?title=File:Lobes_of_the_brain_NL.svg License: Public Domain Contributors: w:User:MysidMysid file:Gray726 parietal lobe.png Source: http://en.wikipedia.org/w/index.php?title=File:Gray726_parietal_lobe.png License: Public Domain Contributors: Gray, vectorized by Mysid, colourd by was_a_bee. File:Parietal lobe animation small.gif Source: http://en.wikipedia.org/w/index.php?title=File:Parietal_lobe_animation_small.gif License: unknown Contributors: Polygon data were generated by Database Center for Life Science(DBCLS). Image:Illu cerebrum lobes.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Illu_cerebrum_lobes.jpg License: Public Domain Contributors: Arcadian, Was a bee Image:Gray1197.png Source: http://en.wikipedia.org/w/index.php?title=File:Gray1197.png License: Public Domain Contributors: Arcadian Image:Carlrogers.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Carlrogers.jpg License: unknown Contributors: Kranar drogin, Nyttend, Psykhosis Image:Hall Freud Jung in front of Clark 1909.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Hall_Freud_Jung_in_front_of_Clark_1909.jpg License: Public Domain Contributors: Athinsz, Croquant, DO11.10, Daderot, Edward, Effib, Faigl.ladislav, Filip em, Gilbertus, Highpriority, Infrogmation, Jkelly, Kilom691, Pieter Kuiper, Rama, The Evil IP address, lfgar, 3 anonymous edits

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