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Article

Trauma  

Nancy J. Smyth

This entry summarizes the current state of knowledge about the nature of trauma and intervention with trauma reactions. It includes the history of traumatology, demographics, theory, research and best practices, controversies, and current trends as well as diversity issues and international and interdisciplinary perspectives.

Article

This article presents information regarding the evolving understanding of the relationships between impulse-control disorders, compulsion-related disorders, and addictions (both substance-related and behavioral). The traditional model describing the relationship between impulse-control disorders and compulsion-related disorders is now considered overly simplistic. New research suggests that this relationship is complex, and distinctions between these disorders are not as solid as previously thought. Information about this dynamic relationship also has implications for substance use disorders and behavioral addictions.

Article

Åsa Jansson

Depression is defined in diagnostic literature as a mood disorder characterized by depressed mood, loss of interest or pleasure in activities, significant changes in weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, difficulty concentrating, and suicidal ideation and/or attempts. Research suggests a link between depressed mood and monoamine depletion, elevated cortisol, and inflammation, but existing laboratory evidence is inconclusive. Current treatments for depression include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and lifestyle changes; however, more severe forms of the disorder can require other medication, sometimes in combination with electroconvulsive therapy (ECT). Disagreement persists over how to define and classify depression, in part due to its ambivalent relationship to melancholia, which has existed as a medical concept in different forms since antiquity. Melancholia was reconfigured in 19th-century medicine from traditional melancholy madness into a modern mood disorder. In the early 20th century, melancholia gradually fell out of use as a diagnostic term with the introduction of manic-depressive insanity and unipolar depression. Following the publication of DSM-III in 1980 and the introduction of SSRIs a few years later, major depressive disorder became ubiquitous. Consumption of antidepressants have continued to rise year after year, and the World Health Organization notes depression as the leading cause of disability worldwide. At present, internationally recognized systems of classification favor a single category for depressive illness (alongside a circular mood disorder, bipolar I and II), but this view is challenged by clinicians and researchers who argue for the reinstatement of melancholia as a separate and distinct mood disorder with marked somatic and psychotic features.

Article

As a field of study, sport psychology is relatively young, gaining its formalized start in the United States in the 1920s. Then and now, the practice of sport psychology is concerned with the recognition of psychological factors that influence performance and ensuring that individuals and teams can perform at an optimal level. In the past 30 years, sport psychologists have made their way into intercollegiate athletics departments providing mental health and performance enhancement services to intercollegiate student-athletes. The differentiation between mental health practice and performance enhancement practice is still a source of some confusion for individuals tasked with hiring sport psychology professionals. Additionally, many traditionally trained practitioners (in both mental health and performance enhancement) are unaware of the dynamics of an intercollegiate athletic department. The interplay of the practitioner and those departmental dynamics can greatly influence the efficacy of the practitioner.

Article

Jutta Lindert

People who are forcibly displaced are forced to flee by serious threats to fundamental human rights, caused by factors such as persecution, armed conflict, and indiscriminate violence. Contemporary drivers of forced displacement are increasingly complex and interrelated. They include population growth, food insecurity, and water scarcity, at times compounded and multiplied by the effects of climate change. A refugee is someone who fled his or her home and country owing to “a well-founded fear of persecution because of his/her race, religion, nationality, membership in a particular social group, or political opinion,” according to the United Nations 1951 Refugee Convention. Internally displaced persons (IDPs) are people who have not crossed an international border but were forced to move to a different region than the one they call home within their own country. People who cannot return home without serious risk to their human rights have specific needs. Forced displacement, both within a country and to other countries, is a major life event that abruptly changes environmental living conditions, such as social networks, language, and cultural environment of the displaced populations. The changes in environmental living conditions and disruptions in life challenge both the individual and the families of the displaced persons. Both types of forced displacement challenge adaptational mechanisms of individuals and families. Accordingly, the challenges can contribute to changes in mental health and mental disorders. However, estimates of mental health, mental disorders, and mental health determinants vary across and between forcibly displaced persons. This heterogeneity in estimates is associated with differences between refugee groups and with methodological difficulties in assessing refugees’ mental health. Instruments to assess mental health need to be culture-grounded and gender-sensitive to capture the scope and extent of refugees’ mental health and mental disorders. Based on reliable and valid instrument needs for assessing mental health and mental disorders, determinants can be identified and intervention can be developed and evaluated.

Article

Carolyn Smith

The following article on juvenile delinquency has three major objectives: First, it defines delinquency and discusses its measurement and extent; second, it reviews theory and risk factor data on causes of delinquency; third, it discusses current trends in juvenile justice intervention and delinquency prevention, including social worker involvement.

Article

Susan Frauenholtz and Amy Mendenhall

Mental-health disorders are widely prevalent in children and adolescents, and social workers are the primary service providers for children and families experiencing these disorders. This entry provides an overview of some of the most commonly seen disorders in children and adolescents: attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, separation anxiety disorder, and specific learning disorders. The prevalence, course, diagnostic criteria, assessment guidelines, and treatment interventions are reviewed for each disorder. In addition, the key role of social workers in the identification and intervention of these disorders, as well as ways social workers can support the children and families experiencing these disorders, is discussed.

Article

Although the specific prevalence rates may vary, eating disorders (ED) affect male and female athletes regardless of sport type and competitive level. Generally, rates of subclinical disorders are much higher than clinical ones, with the most frequent clinical classification being Eating Disorders Not Otherwise Specified. Further, EDs occur not only among active athletes, but are also found in samples of retired athletes as well. Existing research on the prevalence of EDs in athletes, however, has been limited due to its reliance on out-of-date diagnostic criteria, sometimes small samples, and a focus on point prevalence to the exclusion of examining how rates might change over time. Central to prevalence research and clinical assessments is the ability to accurately assess EDs in athletes. Although structured clinical interviews represent the most valid approach, they are time consuming and not often used in determining prevalence. Researchers have relied on self-report measures instead. Such measures include those developed initially in nonathletes, but used to study athletes (e.g., Questionnaire for Eating Disorder Diagnosis; Mintz, O’Halloran, Mulholland, & Schneider, 1997), and those specifically for athletes (e.g., Athletic Milieu Direct Questionnaire; Nagel, Black, Leverenz, & Coster, 2000). Most of these measures, though having adequate psychometric properties, are based on diagnostic criteria that are no longer in use, so additional research that employs prevalence measures that reflect DSM-5 criteria is needed with athletes. Most ED research in sport has used samples of active athletes; few studies have considered how the transition out of sport might affect athletes’ perceptions of their bodies, their relationship to food, and their approaches to exercise and being physically active. Retirement from sport generally is considered to be a developmental stressor and thus may exacerbate ED symptoms and body image concerns in some athletes. Yet, for other athletes, retirement may represent a positive transition in which they emerge from a sport culture, focused on weight and appearance, to reclaim themselves and their bodies. Initial qualitative findings appear to support each hypothesis in part, though longitudinal quantitative studies that track athletes from active competition through retirement are needed to understand the changes athletes experience in relation to their bodies, food, and exercise, and when such changes are most likely to occur.

Article

Alan E. Kazdin

Research in psychotherapy has developed a number of treatments, numbering well over 300, that have a strong evidence base. These treatments can be applied to a broad range of psychiatric disorders (e.g., depression, anxiety, schizophrenia, and others) as well as other sources of impairment in psychological functioning among children, adolescents, and adults. This article provides an overview of evidence-based psychotherapies, including current advances in how treatments are applied. Examples of treatments for depression and autism spectrum disorder are provided to illustrate the diversity of procedures in use and how they are applied. Key challenges related to evidence-based psychotherapies are highlighted, and these include disseminating the research findings, so that effective treatments are being used in clinical practice, and devising novel ways of delivering treatment to reach the large number of individuals who are in need of psychological services but do not yet receive care.

Article

Psychopathic personality (a term that has been largely supplanted in psychologists’ and psychiatrists’ nosologies by anti-social personality disorder) and narcissism are venerable, widely used, and fiercely contested categories of personality disorder. Psychopathic personality was originally delineated in the early years of the 20th century to encompass behavior that was, in experts’ estimation, decidedly not normal but that fit none of the other categories of mental disease. Critics of the diagnosis claimed it was but another label for individuals’ non-conformity with social norms, used to punish the poor and marginal. Narcissism has had an even more tumultuous history than psychopathy. Referring simultaneously to traits considered pathological (grandiosity, exploitativeness, manipulativeness) and to traits thought desirable (high self-esteem, capacity for leadership and authority), narcissism has been at the center of debates over national decline and the character of the modal American for the past half-century. Both categories have also sparked controversy along the trait/ state, dimensional/ categorical divide that flared in the run-up to the publication of the 5th edition of psychiatry’s Diagnostic and Statistical Manual of Mental Disorders in 2013. Thousands of papers have attempted to resolve the ambiguities surrounding both diagnoses, but these ambiguities have proven productive (of research and new knowledge) and are unlikely to be resolved soon.

Article

Louise Cummings

Clinical linguistics is the branch of linguistics that applies linguistic concepts and theories to the study of language disorders. As the name suggests, clinical linguistics is a dual-facing discipline. Although the conceptual roots of this field are in linguistics, its domain of application is the vast array of clinical disorders that may compromise the use and understanding of language. Both dimensions of clinical linguistics can be addressed through an examination of specific linguistic deficits in individuals with neurodevelopmental disorders, craniofacial anomalies, adult-onset neurological impairments, psychiatric disorders, and neurodegenerative disorders. Clinical linguists are interested in the full range of linguistic deficits in these conditions, including phonetic deficits of children with cleft lip and palate, morphosyntactic errors in children with specific language impairment, and pragmatic language impairments in adults with schizophrenia. Like many applied disciplines in linguistics, clinical linguistics sits at the intersection of a number of areas. The relationship of clinical linguistics to the study of communication disorders and to speech-language pathology (speech and language therapy in the United Kingdom) are two particularly important points of intersection. Speech-language pathology is the area of clinical practice that assesses and treats children and adults with communication disorders. All language disorders restrict an individual’s ability to communicate freely with others in a range of contexts and settings. So language disorders are first and foremost communication disorders. To understand language disorders, it is useful to think of them in terms of points of breakdown on a communication cycle that tracks the progress of a linguistic utterance from its conception in the mind of a speaker to its comprehension by a hearer. This cycle permits the introduction of a number of important distinctions in language pathology, such as the distinction between a receptive and an expressive language disorder, and between a developmental and an acquired language disorder. The cycle is also a useful model with which to conceptualize a range of communication disorders other than language disorders. These other disorders, which include hearing, voice, and fluency disorders, are also relevant to clinical linguistics. Clinical linguistics draws on the conceptual resources of the full range of linguistic disciplines to describe and explain language disorders. These disciplines include phonetics, phonology, morphology, syntax, semantics, pragmatics, and discourse. Each of these linguistic disciplines contributes concepts and theories that can shed light on the nature of language disorder. A wide range of tools and approaches are used by clinical linguists and speech-language pathologists to assess, diagnose, and treat language disorders. They include the use of standardized and norm-referenced tests, communication checklists and profiles (some administered by clinicians, others by parents, teachers, and caregivers), and qualitative methods such as conversation analysis and discourse analysis. Finally, clinical linguists can contribute to debates about the nosology of language disorders. In order to do so, however, they must have an understanding of the place of language disorders in internationally recognized classification systems such as the 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association.

Article

Oren Shtayermman

This article reviews the changes in the autism spectrum disorder (ASD) diagnosis in the Diagnostic Statistical Manual (DSM)-5. It reviews the risk factors associated with suicide in the general population and the link between these risk factors and individuals on the autism spectrum. When discussing autism and suicide (as a spectrum), the complexities that the two present influence parents, researchers, and practitioners. As an added dimension of convolution, there are only a small number of published studies in the area of autism and suicide, and many have marked the importance of awareness and connection between autism and suicide. The article presents the most recent and available research on ASDs and suicide. Methodological challenges related to these studies will be discussed as well as the implications for research, practice, and education.

Article

Felipe B. Schuch and Brendon Stubbs

Depression is a leading cause of global burden affecting people across all ages, genders, and socioeconomic groups. Antidepressants are the cornerstone of treatment, yet treatment response is often inadequate. While some psychological interventions such as cognitive behavioral therapy can also help alleviate depressive symptoms, alternative and complimentary treatment options are required. In particular, therapeutic interventions that also address the greatly increased levels of obesity and cardiovascular disease among people with depression may offer added value. With the rising burden of premature mortality due to cardiovascular disease in people with depression and promising evidence base for physical activity to improve depressive symptoms, it is important to review the role, benefits, and underlying neurobiological responses of exercise among people with depression. There has been a growing body of evidence to suggest that higher levels of physical activity reduce a person’s risk of incident depression. It appears that lower levels of cardiorespiratory fitness increase an individual risk of depression, suggesting that physical activity and physical fitness have a key role in the prevention of depression. Moreover, exercise can improve depressive symptoms in those with subthreshold depressive symptoms and major depressive disorder. Despite the effectiveness of exercise, the optimal dose and frequency are yet to be fully elucidated. Nonetheless, exercise appears to be well accepted by people with depression, with relatively low levels of dropout from interventions, particularly when supervised by qualified professionals with expertise in exercise prescription. Various barriers to engaging in exercise exist and motivational strategies are essential to initiate and maintain exercise. A number of hypotheses have been postulated to determine the antidepressant effect of exercise; however, most are based on animal models or models elucidated from people without depression. Therefore, future representative research is required to elucidate the neurobiological antidepressant response from exercise in people with depression. Physical activity interventions targeting fitness should be a central part of the prevention and management of depression. In particular, physical activity interventions offer a viable option to prevent and address cardiometabolic abnormalities and cardiovascular disease, which account for a significant amount of premature deaths in this population and are not addressed by standard pharmacological and psychological therapies.

Article

Schema therapy has evolved since the late 1980s as an efficacious and increasingly widely used psychotherapeutic treatment for personality disorders and many other complex disorders that correlate with underlying maladaptive schemas. Only recently, attention among clinical geropsychologists has been growing for the application of schema therapy in older adults. Schema therapy is very feasible for both therapists and older patients. Schema therapy is an integrative psychotherapy, which draws on the cognitive-behavioral, attachment, psychodynamic, and emotion-focused traditions. In this treatment model, early maladaptive schemas are considered core elements of persistent and pervasive psychopathology, including personality disorders. The goal of treatment is to decrease the impact of maladaptive schemas and to replace negative coping responses and maladaptive schema modes with more healthy alternatives so that patients succeed in getting their core emotional needs met. The emerging attention for schema therapy in older adults is in line with the increased attention for personality disorders in later life, and also with the maturing field of psychotherapy for older adults. The first scientific evidence for the feasibility and the effectiveness of schema therapy has recently been shown. Despite these developments, much work is still to be done. The question is whether schema theory, which was developed for adults in young and middle adulthood, equally applies to those in later life. Although the first tests of effectiveness of schema therapy in older adults are encouraging, age-specific adaptations of existing therapy protocols, both for individual and group schema therapy, are wanted. Furthermore, the research that has been conducted so far has focused on the young-old. Especially for the growing and highly complex group of oldest-old patients, the development of feasible and effective schema-based interventions is needed. Integrating age-specific moderators for change, such as wisdom enhancement, attitudes to aging, and integrating the action of positive schemas, deserves recommendation.

Article

Laurence B. Leonard

Children with specific language impairment (SLI) have a significant deficit in their ability to acquire language that cannot be attributed to intellectual disability, neurological damage, hearing loss, or a diagnosis of autism. These deficits can be long-standing, and adversely affect other aspects of the affected individual’s life. There seems to be a genetic component to SLI, but the disorder is not likely to be traced to a single gene. The problem appears to be universal, but symptoms vary depending on the language being learned. Current attempts to account for SLI have increased our understanding of the most salient symptoms of the disorder, but a full understanding of SLI is not yet within reach.

Article

Janette Atkinson

Human visual development is a complex dynamic psychological/neurobiological process, being part of the developing systems for cognition, action, and attention. This article reviews current knowledge and methods of study of human visual development in infancy and childhood, in relation to typical early visual brain development, and how it can change in developmental disorders, both acquired (e.g., related to at-risk births) and genetic disorders. The newborn infant starts life with a functioning subcortical visual system which controls newborn orienting to nearby high contrast objects and faces. Although visual cortex may be active from birth, its characteristic stimulus selectivity and control of visual responses is generally seen to emerge around six to twelve weeks after birth. By age six months the infant has adequate acuity and contrast sensitivity in nearby space, and operating cortical mechanisms for discriminating colors, shapes, faces, movement, stereo depth, and distance of objects, as well as the ability to focus and shift attention between objects of interest. This may include both feedforward and feedback pathways between cortical areas and between cortical and subcortical areas. Two cortical streams start to develop and become interlinked, the dorsal stream underpinning motion, spatial perception and actions, and the ventral stream for recognition of objects and faces. The neural systems developing control and planning of actions include those for directed eye movements, reaching and grasping, and the beginnings of locomotion, with these action systems being integrated into the other developing subcortical and cortical visual networks by one year of age. Analysis of global static form (pattern) and global motion processing allows the development of dorsal and ventral streams to be monitored from infancy through childhood. The development of attention, visuomotor control and spatial cognition in the first years show aspects of function related to the developing dorsal stream, and their integration with the ventral stream. The milestones of typical visual development can be used to characterize visual and visuo-cognitive disorders early in life, such as in infants with perinatal brain injuries and those born very prematurely. The concept of “dorsal stream vulnerability” is outlined. It was initially based on deficits in global motion sensitivity relative to static form sensitivity, but can be extended to the planning and execution of visuomotor actions and problems of attention, together with visuospatial and numerical cognition. These problems are found in the phenotype of children with both genetic developmental disorders (e.g., Williams syndrome, autism, fragile-X, and dyslexia), and in acquired developmental disorders related to very preterm birth, or in children with abnormal visual input such as congenital cataract, refractive errors, or amblyopia. However, there are subtle differences in the manifestation of these disorders which may also vary considerably across individuals. Development in these clinical conditions illustrates the early, but limited, plasticity of visual brain mechanisms, and provides a challenge for the future in designing successful intervention and treatment.

Article

Depression and bipolar mood disorders are mental disorders that are characterized by mood disturbance combined with decreased functioning of the affected individuals. This entry focuses on major depressive disorder and bipolar I and II disorders among adults in the United States. Bipolar disorder has unique clinical features and intervention options, and so it is discussed in a separate section after depression. Diagnosis, prevalence, comorbidity, risk factors, course, assessment, treatment, service utilization, and international perspectives are reviewed for each disorder. The implications for social work are briefly addressed at the end of this entry.

Article

Ruth I. Wood and Kathryn G. Wallin-Miller

Anabolic-androgenic steroids (AAS) are both performance-enhancing substances and drugs of abuse. Although AAS are banned in competitive sports, they are widely used by both elite and rank-and-file athletes. All AAS are derived from testosterone, the principle endogenous androgen produced by the testes of adult men. While AAS increase muscular strength and athletic performance, they also have serious consequences for health and behavior. AAS are implicated in maladaptive behavioral and cognitive changes such as increased risk-taking and altered decision-making. However, effects of AAS on cognition are not well understood. Studies of human AAS users are limited by an inability to control for pre-existing psychopathology and behavioral differences. Furthermore, in order to understand AAS effects on behavior, it is important to discover how AAS impact the brain. Animal models of AAS abuse parallel human studies to uncover effects on cognition, decision-making, and underlying neurobiological mechanisms. In operant discounting tests, rats treated with chronic high-dose testosterone are less sensitive to effort, punishment, and delay but are more sensitive to uncertainty. Likewise, they demonstrate impaired cognitive flexibility when tested for set-shifting and reversal learning. It appears that AAS induce many of these cognitive changes via effects on the mesocorticolimbic dopamine system, particularly through the dopamine D1- and D2-like receptors in subnuclei of the nucleus accumbens. AAS also have rewarding effects mediated by similar neural circuits. In preclinical studies, animals will voluntarily self-administer AAS. Human users may develop dependence. These findings highlight the vulnerability of brain circuits controlling cognition and reward to androgens at high doses.

Article

Diana M. DiNitto

This entry defines comorbidity and similar terms used in various fields of practice. It addresses the prevalence of comorbidity, suggests explanations for comorbidity, and discusses integrated treatment for comorbid conditions and the importance of the concept of comorbidity in social work practice.

Article

Selena T. Rodgers

Trauma literature has seen a paradigm shift from pathology to embracing positive trajectories. Posttraumatic growth (PTG), defined as a positive psychological change resulting from a struggle with traumatic or life-changing events, may occur in a variety of populations and events. This entry, therefore, aims to increase our understanding of PTG. The entry begins with the conceptualization of PTG, followed by a discussion of protective factor associations, measures, and psychometric priorities. Nuanced attention is given to global translations and cultural aspects. The entry then presents debates about the challenges, controversy, and biases, as well as an overview of the empirical literature. The entry concludes with PTG contributions for social-work practice and pedagogy, together with recommendations for future research.