Browsing by Subject "DSM-5"

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  • Sipilä, Pyry; Gulnara, Harrasova; Mustelin, Linda; Rose, Richard J.; Kaprio, Jaakko; Keski-Rahkonen, Anna (2017)
    Since medieval times, an association between religiosity and anorexia nervosa has been suggested, but few systematic studies exist. This study examines in a nationwide setting whether personal or family religiosity is associated with lifetime anorexia nervosa among women in adolescence and early adulthood. Women (N = 2,825) from the 1975 to 1979 birth cohorts of Finnish twins were screened for lifetime DSM-5 anorexia nervosa (N = 92). Parental religiosity was assessed by self-report when the women were aged 16 years. The women self-reported their religiosity at ages 16 and 22 to 27 years. Parental religiosity did not increase the risk of lifetime anorexia nervosa, and neither did religiosity of the women themselves in adolescence. In early adulthood, a J-shaped curve was compatible with the data, indicating increased risk both at low and high levels of religiosity, but this result was statistically non-significant. Religiosity was weakly negatively correlated with body dissatisfaction. There was some suggestive evidence for socioregional variation in the association of religiosity with lifetime anorexia nervosa. In this first population study to directly address religiosity and anorexia nervosa, no evidence was found for a significant association of religiosity with anorexia nervosa either at the personal or family level. Some regional differences are possible. A modest protective association of religiosity with body dissatisfaction is also possible. Despite compelling case descriptions of holy anorexia, religiosity does not appear to be a central factor in the development of anorexia nervosa in Finland, a highly secularized Christian country.
  • Lehtokari, Vilma-Lotta (Helsingfors universitet, 2015)
    Eating disorders are a group of psychiatric disorders characterized by disturbances in eating behaviors, attitudes towards food, and body image. The diagnoses of eating disorders are based on specific diagnostic criteria agreed upon by expert committees. The disorders and the diagnostic criteria are collected in diagnostic manuals. In this study, the Diagnostic and Statistical research Manual of Mental Disorders (DSM) of American Psychiatric Association was used because it is used consistently in international research into eating disorders. The current Fifth Edition of the DSM (DSM-5).was published in 2013. The previous edition was published in 1994 (DSM-IV). The eating disorders specified in DSM-IV were anorexia nervosa (AN) and bulimia nervosa (BN). The remaining disorders were categorized as Eating Disorders Not Otherwise Specified (EDNOS). EDNOS consists of binge eating disorder (BED), atypical anorexia (A-AN) and atypical bulimia (A-BN). In the updated edition, DSM-5, BED has been recognized as its own separate eating disorder, and the diagnostic criteria of AN, and BN has been revised and broadened. Those eating disorders that still remain outside these definitions are classified as Other Specified Feeding and Eating Disorders (OSFED). OSFED eating disorders are A-AN, A-BN, A-BED, purging disorder (PD) and night eating disorder. The objective of this thesis was to survey and identify atypical eating disorders among Finnish young women in the FinnTwin16-cohort, and to find out how the changes in the diagnostic criteria of the DSM affects this group of eating disorders. The FinnTwin16-cohort includes all Finnish twins born in 1975-1979. The health and well-being of the twins has been followed regularly since the age of 16 using questionnaires and interviews. The questionnaire for mental disorders, including the eating disorders was sent to the twins in 1998.The eating disorder survey focused on women. Of the female twins, 2835 returned the forms, and 548 of them were subsequently interviewed over the telephone for a more detailed picture of the person’s eating disorder. According to the survey, 185 of the women had an eating disorder. Using the diagnostic criteria of DSM-IV, 55 had AN, and 46 BN. The remaining 84 women were diagnosed as having EDNOS. The EDNOS cases were re-classified using the DSM-5 diagnostic criteria, whereby 31 of them were diagnosed with AN, 14 with BN, and one with BED. An OSFED diagnosis was established in 38 women. With the change of diagnostic criteria, the prevalence of atypical eating disorders fell from 3 % to 1.3%, and the 15-year incidence from 180 to 76 new cases per 100 000 person-years. The OSFED cases were sub-categorized as follows: 13 women had A-AN, ten A-BN, four PD 4, and five A-BED. Seven women were classified as having fluctuating OSFED: symptoms that either transformed from one subtype to another or alternated with asymptomatic periods. One patient first had A–BN, and after recovering, years later, A-AN. Night eating disorder was not assessed in this study. A-AN, or PD were more transient than other types of EDNOS: no one had an eating disorder for longer than five years. These groups also included the most underweight patients. Seventy-six percent of the women studied were of normal weight. A-BED, and fluctuating OSFED were longest in duration. The weight of the women in these groups continued to increase. Depression was linked to chronic, long-term OSFEDs and binge eating, whereas life crises lead to more severe but transient forms of OSFED.
  • Tikkinen, Kari A. O.; Rutanen, Jarno; Frances, Allen; Perry, Brea L.; Dennis, Brittany B.; Agarwal, Arnav; Maqbool, Amna; Ebrahim, Shanil; Leinonen, Janne S.; Järvinen, Teppo L. N.; Guyatt, Gordon H. (2019)
    Objective To assess which mental health-related states of being are perceived as diseases by psychiatrists, non-psychiatric physicians, nurses, parliament members and laypeople. Design and setting A population-based, mailed survey in Finland. Participants Respondents from a random sample of 3000 laypeople, 1500 physicians, 1500 nurses and all 200 members of the parliament (MPs) of Finland. Primary outcome measures Respondents' perspectives on 20 mental health-related states of being as diseases, measuring the extent of agreement with the claim: '[This state of being] is a disease'. Results Of the 6200 people approached, we received 3259 eligible responses (53%). Two conditions (schizophrenia and autism) were considered to be diseases by at least 75% and two states (grief and homosexuality) were considered not to be diseases by at least 75% in each group. A majority (at least 50% in each group) considered seven states as diseases (anorexia, attention deficit hyperactivity disorder, bulimia, depression, generalised anxiety disorder, panic disorder and personality disorder) and three not to be diseases (absence of sexual desire, premature ejaculation and transsexualism). In six states, there was a wide divergence of opinion (alcoholism, drug addiction, gambling addiction, insomnia, social anxiety disorder and work exhaustion). Psychiatrists were significantly more inclined to considering states of being as diseases relative to other groups, followed by non-psychiatric physicians, nurses, MPs and laypeople. Conclusions Respondents agreed that some conditions, such as schizophrenia and autism, are diseases and other states, such as grief and homosexuality, are not; for others, there was considerable disagreement. Psychiatrists are more inclined to consider mental health-related states of being as diseases compared with other physicians, who, in turn, are more inclined than other constituencies. Understanding notions of disease may underlie important debates in public policy and practice in areas of mental health and behaviour, and have implications for resource allocation and stigma.
  • Rosenstrom, Tom; Jokela, Markus (2017)
    Background: Diagnostic definitions for depressive disorders remain a debated topic, despite their central role in clinical practice and research. We use both recent evidence and nationally representative data to derive an empirically-based modification of DSM-IV/-5 Major Depressive Disorder (MDD). Method: A modified MDD diagnosis was derived by analyzing data from Collaborative Psychiatric Epidemiology Surveys, a multistage probability sample of adults (n=20 013; age >= 18 years) in coterminous USA, Alaska and Hawaii. The old and the newly suggested MDD definitions were compared for their associated disability (WHO Disability Assessment Schedule and number of disability days in past month), suicide attempt, and other covariates. Results: Our data-driven definition for major depression was "lack of interest to all or most things" plus four other symptoms from the set (weight gain, weight loss, insomnia, psychomotor retardation, fatigue, feelings of worthlessness, diminished ability to think concentrate, suicidal ideation attempt}. The new definition captured all the disability implied by MDD and excluded cases that showed no greater disability than the general population nor increased risk of suicide attempts. The lifetime prevalence of the new diagnosis was 14.7% (95% CI=14-15.4%) of the population, slightly less than for the old definition (16.4%; CI =15.4-17.3%). Limitations: Only conservative modifications of MDD could be studied, because of restrictions in the symptom data. Conclusions: With only small adjusting, the new definition for major depression may be more clinically relevant than the old one, and could serve as a conservative replacement for the old definition. (C) 2016 Elsevier B.V. All rights reserved.