Richard C. Friedman

Behavior and the Menstrual Cycle

Because of the existence of multiple individual and environmental factors influencing a persons behavior, no one study can provide a complete analysis of the complex relationships that exist between behavior and the menstrual cycle. In studying that we must focus on influences on the individual arising from biological, psychological, and sociocultural factors. All three have the capacity to modify an individual womans responses, and some factors may be more important than others in accounting for any one womans behavioral changes. Thus dramatic biological changes, perhaps in nerve-cell receptor response to changing hormone levels, may be of such importance in the case of one individual that personality and sociocultural features may be relatively inconsequential. Alternatively, constellations of psychopathological syndromes may be primarily responsible for magnifying the effects of normal variations in hormone levels or receptor sensitivities. In this review, we will focus on selected research studies that have attempted to explore the relationship between behavior and the menstrual cycle. Our purpose is to give an overview of the spectrum of information available. Further resource material will be noted throughout the text for those readers with a particular interest in any of the topics discussed. In considering each study, we shall devote some attention to the kind of individuals studied, the techniques employed in

DSM-III and affective pathology in hospitalized adolescents.

Charts of 76 adolescents, who had been recently discharged from a psychiatric hospital, were reviewed by a research team for evidence of DSM-III axis I and axis II disorders. Research diagnoses were assigned to patients on the basis of documented symptomatology and irrespective of the discharge diagnosis of the clinical staff. Forty-five patients met criteria for an affective disorder. Of these, 15 were diagnosed major depression and 24 dysthymia or atypical depression (i.e., dysthymia of briefer duration than 1 year). Two patients were manic, one was bipolar depressed, one was schizoaffective, and two were atypical depressed with psychotic features. No patient with dysthymia had a past history of major depression as the earliest manifestation of psychiatric disorder. Four patients with major depression, however, had past histories of dysthymia as the earliest manifestation of psychiatric disorder. Forty per cent of patients with major depression had parents with depression. Excepting one schizophrenic, every patient who had ever attempted suicide met criteria for a depressive disorder. Twelve patients fulfilled DSM-III criteria for borderline personality disorder (BPD). Each of these patients manifested a concurrent axis I depressive disorder, and each had a history of attempted suicide. Patients with major depression co-existing with BPD had histories of more frequent and more lethal attempts than other patients. Most depressed borderline patients were female. Sex differences were not found in prevalence of affective disorder occurring alone without the co-existence of BPD. Of the 12 patients with depression plus BPD, all those patients (N = 5) with major depression and BPD had at least one parent who had been treated for depression. In each of these five cases, axis I affective disorder occurred earlier in development than did axis II BPD. Our findings indicate that depression may have an earlier onset in the life cycle than generally appreciated. Dysthymia may in itself be a serious disorder during adolescence and may progress to major depression. The co-existence of a depressive disorder with BPD would appear to be of particular clinical significance during adolescence. More specifically, it appears that adolescents who manifest major depression and BPD actually suffer from a particularly severe variant of affective disorder.

FAMILY HISTORY OF ILLNESS IN THE SERIOUSLY SUICIDAL ADOLESCENT: A Life-Cycle Approach

Highly suicidal, depressed adolescents were compared to nonsuicidal depressed adolescents with regard to family history of illness. Chronic psychiatric illness of a parent, particularly depression occurring during the childhood of patients, was found to be more frequent among families of highly suicidal adolescents. Implications of this finding are considered.

Symptoms of depression among adolescents and young adults

Abstract The authors evaluated the depressive symptomatology of 26 adolescent and 27 young adult, hospitalized patients meeting Research Diagnostic Criteria for Major Depressive Disorder. Few differences were found between these two groups with regard to either symptoms or subtypes of depression. Overall, these data indicate that Major Depressive Disorder can be easily identified in younger samples using established criteria. We also report a particularly high percentage of endogenous subtype among our patients. The RDC endogenous subtype of depression among younger inpatients may be more frequent than generally realized.

Psychoanalysis, Psychobiology, and Homosexuality

The potential role of biological influences in human sexual orientation was considered more seriously during the early phases of psychoanalysis than in the years since World War II. Recently studies of homosexuality and heterosexuality in the neurosciences have attracted widespread attention both in the scientific and lay communities. The salience of these new data for psychoanalytic theory and practice is just beginning to be explored. In this article, we review research on sexual orientation in the following areas: genetics, crosscultural studies, studies of development in individuals with abnormal prenatal hormone exposure, childhood play patterns, and brain studies in both nonhumans and humans. Differences between male and female homosexuality are explored. We propose that psychoanalytic theory can grow and profit from a careful consideration of new findings in the psychobiology of sexuality, and that the interaction between mind and body is the appropriate purview of psychoanalysis.

PSYCHOLOGICAL DEVELOPMENT AND BLOOD LEVELS OF SEX STEROIDS IN MALE IDENTICAL TWINS OF DIVERGENT SEXUAL ORIENTATION

Despite differences in psychological development and personality structure, blood levels of testosterone and estradiol were equivalent in two monozygotic male twins of divergent sexual orientation.

Biology and the Oedipus complex

Recent observations in the behavioral and neurosciences have raised questions about the ubiquity of the oedipus complex as well as about its significance for psychological development. The authors argue that the construct Freud called the oedipus complex in males is best examined in its component parts. One component--the incestuous wish--does not occur in all individuals. Another component--the boys urge to engage competitively with other male figures, including the father--does appear to be biologically based in testosterones effect on the brain and to be manifested in childhood rough and tumble play behavior. It is proposed that reexamination of the oedipus complex in light of recent findings about the brain and behavior is indicated and that play, in particular, can usefully be considered as a separate developmental line.

SEXUAL DIFFERENTIATION OF BEHAVIOR : THE FOUNDATION OF A DEVELOPMENTAL MODEL OF PSYCHOSEXUALITY

The sexual differentiation of the brain and behavior occurs as the result of prenatal hormonal influences. Knowledge of this area is helpful for the construction of an appropriately modern psychoanalytically informed developmental paradigm of psychosexuality.

Primary and secondary affective disorders in adolescents and young adults

ABSTRACT – The concepts of primary and secondary affective disorders have become widely accepted by researchers of adult psychiatric disorders. They are based on the chronological development of certain specified major affective disorders in relation to diagnosable, non‐affective psychiatric disorders. Despite potential etiological implications, little data are currently available on the primary‐secondary classification applied to cases with early onset adolescent and young adulthood affective disorders. This study reports on the application and clinical implications of the primary‐secondary classification in a sample of 65 adolescent and young adult inpatients who meet Research Diagnostic Criteria (RDC) for an index episode of Major Depressive Disorder.

Introduction to the Special Issue on Psychotherapy, the Affordable Care Act, and Mental Health Parity: Obstacles to Implementation

The articles in this Special Issue of Psychodynamic Psychiatry were written by members of The Committee on Psychotherapy of the Group for the Advancement of Psychiatry. Susan Lazar, M.D. is past Chair of The Committee; Frank Yeomans, M.D. is current Chair. The Group for the Advancement of Psychiatry (GAP) was created by the American Psychiatric Association shortly after WWII. It is organized in committees whose function is to publish articles and monographs on issues of contemporary interest. Psychodynamic Psychiatry is pleased to publish this Special Issue which is of substantial psychiatric and public health relevance. The journal staff commends the GAP Committee on Psychotherapy for calling attention to an area that requires sustained attention and action from the mental health community. Despite progressive legislation serious problems in psychiatric care delivery remain unsolved. These are systematically discussed in this Special Issue of Psychodynamic Psychiatry. America has a crisis in mental health care. Psychological difficulties are common and often reach clinical proportions. For example, in a definitive investigation, a representative sample of 9,282 Americans was interviewed to ascertain the lifetime prevalence and age of onset of DSM-IV psychiatric disorders. The investigators found that about 50% of the population met criteria for a psychiatric disorder sometime in their lives. The first onset of the disorder was usually during childhood or adolescence (Kessler, Berglund, Denker et al., 2005). In any given year approximately 57.7 million people suffer from mental disorders. These are severe, chronic, and/or recurrent and often coexist with other mental and physical disorders in about 15% of the population (Green, McLaughlin, Berglund et al., 2010; Kim-Cohen, Caspit, Moffit et al., 2003). Mental disorders are the leading cause of disability