The incorrect belief that anorexia nervosa is predominantly genetic is maintained in the psychiatric literature by a series of misquotations and misrepresentations of research data. An example of this type of scholarship is as an editorial in The American Journal of Psychiatry. Data from family and twin studies referenced in the editorial provide compelling evidence that the genetic contribution to the etiology of anorexia nervosa is small. The incorrect belief that anorexia nervosa is predominantly genetic is maintained, in addition, by statistical procedures such as heritability estimates. The incorrect belief that anorexia nervosa is predominantly genetic should not be endorsed by the American Psychiatric Association, in either its journals, in its published books, or in DSM–V.

DSM-5 includes a number of statements concerning the biology and genetics of mental disorders, and these represent a significant landmark in the history of psychiatry. According to DSM-5, there are no laboratory tests, x-rays, or other biological markers for any mental disorder; there is no physiological specificity to any mental disorder; there is no genetic specificity to any mental disorder; and there is no symptom specificity to DSM-5 disorders. DSM-5 disorders, according to the manual, have porous boundaries with each other, have high rates of comorbidity, and fluctuate a great deal over time. The risk genes for mental disorders number in the hundreds, each contributes perhaps 1%–2% to the overall risk, and the same genes confer risk for multiple DSM-5 categories of disorder. The idea that DSM disorders are separate diseases with distinct pathophysiologies has been disconfirmed by the DSM-5, and therefore by the American Psychiatric Association, as it has by the National Institutes of Mental Health.

A review of the effectiveness of antipsychotic medications was conducted with a focus on quetiapine, olanzapine, and clozapine. The different antipsychotics are equally effective if given in equivalent doses; therefore, what is true of one is true of all. In large, randomized, placebo-controlled studies, less than 15% of participants respond to antipsychotics, and in many trials less than 10%, if a response is defined as an 80% or greater reduction in symptom scores. Dropout rates are very high in long-term studies such as the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study (74%). A common definition of a “responder” in antipsychotic studies is a score reduction of 40% or greater, but in most studies, a participant can have a score reduction of 40% and still be psychotic enough to be reenrolled in the trial. Given the high percentage of nonresponders to antipsychotic medications, greater research and clinical emphasis should be placed on psychosocial interventions.

Previously undiagnosed dissociative identity disorder (DID) may be present in individuals being assessed for eye movement desensitization and reprocessing (EMDR). Previously undiagnosed DID was present in 3.9% of 1,529 general adult psychiatric inpatients in 10 studies conducted in 6 different countries. In this article, a case of likely DID that was missed in a published case report is presented, and guidelines for when to suspect and how to diagnose DID are provided. Such guidelines are missing from the training of many mental health professionals.

Gender identity disorder is unique among all DSM-IV-TR diagnoses. It is the only disorder in which treatment is designed to confirm, reinforce, and validate the belief that is the basis of the mental disorder. In all other diagnoses, the symptoms in the diagnostic criteria are viewed as pathological and the goal of treatment is to remove the symptoms. In gender identity disorder, however, the body is altered to match the belief that is said to be a symptom of mental disorder. This is self-contradictory. Either gender identity disorder should be dropped from DSM-V, just as homosexuality was dropped from the diagnostic system, or gender reassignment should be discontinued. The core contradiction in the current approach to gender identity is an ethical problem in the mental health field.

The purpose of this article is to analyze and critique repeated claims in the literature that there is a substantial genetic contribution to eating disorders. Data from the existing twin and family studies of eating disorders were tabulated and compared to heritability estimates resulting from complex statistical analyses of the same data. Overall, concordance in monozygotic twins is 26% for bulimia and 35% for anorexia nervosa. Among the relatives of probands with bulimia, 95.1% do not have bulimia, whereas among the relatives of probands with anorexia nervosa, 97.1% do not have the disorder. The raw data refute claims that the genetic heritability of eating disorders is as high as 80%. The erroneous conclusion that there is a substantial genetic contribution to eating disorders needs to be corrected by focusing on the raw data for twin concordance and prevalence in first-degree relatives.

The current study explored the role of early family environment and adult attachment style in explaining long-term outcomes among child abuse survivors. Adult patients (N = 80) in a trauma treatment program were assessed for clinical diagnosis and administered a multiscale questionnaire. Hierarchical regression analyses were significant for dissociative identity disorder (DID), substance abuse, anxiety disorder, posttraumatic stress, somatization, and six personality disorder dimensions. Adult attachment styles were significant predictors of most outcome variables. Of particular note was the strong contribution of attachment avoidance to DID. Five family environment scales (Independence, Organization, Control, Conflict, Expressiveness) also contributed to various psychopathological outcomes. Evidence emerged supporting a mediating role for attachment style in the link between family independence and five personality disorder dimensions.

The philosophical foundations of reductionist biological psychiatry are internally self-contradictory. Mind is simultaneously disallowed and “explained” by the reductionist approach; this internal self-contradiction invalidates reductionist biological psychiatry at the level of its philosophical foundation. Three theories that dominate science today are based on a reductionist approach: the Big Bang theory, the origins of life 3.7 billion years ago, and the emergent property model of the relationship between mind and brain. The problem with these theories is not with the science, rather it is the way the three theories are used to validate a logically untenable philosophical position, which in biological psychiatry insists on a model of mind as an emergent property of brain function. The universe, evolution, and the human mind, within this reductionist philosophy, are all based on the workings of automatic machinery. The purpose of the present article is to analyze the fundamental logical errors underlying biological psychiatry, which is based on a mechanistic model of the universe.

Las autolesiones suelen ser una estrategia de afrontamiento derivada del trauma, que pueden entenderse desde la perspectiva del modelo de procesamiento adaptativo de la información (PAI) y tratarse con terapia de desensibilización y reprocesamiento mediante movimientos oculares (EMDR) (Shapiro, 1995, 2001). Las autolesiones a menudo están conectadas con recuerdos de experiencias adversas y traumáticas en la vida. Identificar y procesar estos recuerdos con terapia EMDR puede poner fin al comportamiento autodestructivo. Además, las autolesiones suelen tener su base en la falta de habilidades de regulación, y estos déficits de habilidades también se pueden abordar en la terapia EMDR. En este artículo, los autores describen estrategias para tratar las autolesiones a lo largo de las 8 fases de EMDR. Aunque no existe un enfoque único que se aplique en todos los casos, el terapeuta debe hacer una historia meticulosa de las autolesiones, sus orígenes históricos, y sus desencadenantes y funciones en el presente para formular un plan de tratamiento. A menudo, según la experiencia de los autores, las autolesiones funcionan como una estrategia de autorregulación que vuelve a disociar las emociones traumáticas de la infancia. Las estrategias de tratamiento para las Fases 3-8 de la terapia EMDR se ilustran a través de ejemplos de casos.

Les sévices auto-infligés constituent une stratégie de coping actionnée par le trauma qui peut se comprendre du point de vue du modèle du Traitement adaptatif de l’information (TAI) et se prendre en charge par la psychothérapie EMDR (désensibilisation et retraitement par les mouvements oculaires) (Shapiro, 1995, 2001). Les sévices auto-infligés sont souvent liés à des souvenirs d’expériences de vie indésirables et traumatiques. L’identification et le traitement de ces souvenirs en thérapie EMDR peut mettre fin aux conduites autodélétères. De plus, les sévices auto-infligés se fondent souvent sur un défaut de compétences régulatrices et la thérapie EMDR permet également de résoudre ce manque. Dans cet article, les auteurs décrivent des stratégies pour prendre en charge les sévices auto-infligés tout au long des huit phases de l’EMDR. Bien qu’il n’existe pas d’approche unique qui puisse s’appliquer à tous les cas, le thérapeute doit soigneusement recueillir les antécédents de sévices auto-infligés, leurs origines historiques, leurs déclencheurs et leurs fonctions au présent afin de concevoir un plan de prise en charge. Dans l’expérience des auteurs, les sévices auto-infligés fonctionnent souvent en tant que stratégie d’autoapaisement qui redissocie les émotions traumatiques de l’enfance. Les stratégies de prise en charge pour les phases trois à huit sont accompagnées d’illustrations de cas.