Guided Response: Review several of your classmates’ posts.  Provide a substantive response to at least two of your peers and respond to your Professor.  Are the research methods they selected appropriate for studying the disorders they chose?  Support your opinions with scholarly information and reasoning.  What alternative research design could be employed to study the disorders they discussed? 

Two peer responses and one Professor response:

Discusison #1:

Address the following points in your post:

• What are three controversies discussed in the Halter, Rolin-Kenny, & Dzurec (2013) article? Give your opinions about these controversies. From your point of view, are these legitimate concerns? Why or why not?

One controversy discussed is the grouping of multiple subcategories of autistic-related disorders into one umbrella group labeled Autism Spectrum Disorders (Halter, Rolin-Kenny, & Dzurec, 2013). The concern over this change in the DSM-5 is the loss of certain programs, funding, and services due to this grouping; specifically, those who are diagnosed with Asperger’s, who receive substantial more and different services than those who may be diagnosed with mild autism (Halter, Rolin-Kenny, & Dzurec, 2013). I believe this is a valid concern. Unless there are specifiers denoting the types of autism diagnosed that are relayed to the insurance companies who approve and contract such services, it is assumable that this change could give such companies ample reasons into why they might not approve certain services; something many families already struggle to prove and get as is.

Another controversy is the grouping of disorders that share schizophrenic-like symptoms into an umbrella group labeled schizophrenia spectrum disorders (Halter, Rolin-Kenny, & Dzurec, 2013). This appears to have the least amount of opposition out of the controversies listed in the article, which eliminations to sub-types and a rating scale introduced for severity (Halter, Rolin-Kenny, & Dzurec, 2013). I can see how there may be opponents of this change. As mentioned in the article, “early detection of symptoms and follow-up treatment are neuroprotective and helpful in reducing severity, neurobiological decompensation, and subsequent long-term disability” (Halter, Rolin-Kenny, & Dzurec, 2013, p. 34). By eliminating the sub-types of a disorder, I believe you hinder the details of a potential diagnosis; and therefore, the potential for treatment is also diminished.

The last controversy mentioned is eliminating the omission of bereavement as an inhibition for a major depression diagnosis due to the inability to decipher explanations of major depression from depression due to grief-related situations (Halter, Rolin-Kenny, & Dzurec, 2013). The controversy hinges on the perspective that grief can now be termed as a mental health disorder instead of a normal reaction (Halter, Rolin-Kenny, & Dzurec, 2013). I can see how the opponents for such a change are outraged; however, in my own experience, grief is not always something that can be cured within two months of the death of someone close to you. Grief can last much longer, with detrimental outcomes to one’s health, relationships, and many other aspects of one’s life. I agree with this change and believe that grief due to bereavement can transition into or uncover major depressive symptoms.

• Name a disorder identified as requiring significantly more research and study from the DSM-5 section entitled, “Conditions for Further Study” (Section III of the DSM-5). Construct a research question that is pertinent to the disorder you selected.

The disorder I chose was Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure or ND-PAE. This disorder is caused by minimal alcohol ingestion during pregnancy, either purposeful or accidental before a mother is aware of being pregnant, that results in impairments in IQ, memory, executive functioning, learning disabilities, specific types of reasoning, mood, attention, behavior, motor skills, communication and speech, and social interactions (American Psychiatric Association, 2013). Some symptoms are not present until elementary school age, while others are visible at much younger ages (American Psychiatric Association, 2013). ND-PAE shares many of the same causes and symptoms of Attention Deficit-Hyperactive Disorder (or ADHD), and even is sometimes co-morbid with ADHD (American Psychiatric-Association, 2013). Therefore, my research question is: “How often are individuals diagnosed with ADHD, when they might instead have ND-PAE or vice versa?”

• Briefly outline a research method that could be used to investigate the disorder based on one of the research methods presented in your textbook.

The type of research method I could utilize to investigate this research disorder is through a web-panel survey. Surveys on the internet are an easy way to reach many people who can just fill out or complete the survey quickly based on the guidelines and requirements implemented by the surveyor (Landrum, 2012). They are cost-effective and have greater reliability than phoned surveys (Landrum, 2012). I could make the survey answers that are available based on a Likert rating scale from 1 to 5 (1 would be strongly disagree up to 5 which would be strongly agree) (Landrum, 2012). I would reassure the surveyed participants that responses are confidential without asking for any identifying information. There also would not be any contact between the participants and the surveyor in hopes that responses would be the most accurate and genuine as possible.

References

American Psychiatric Association. (2013). The diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: American Psychiatric Publishing.

Halter, M., Rolin-Kenny, D., & Dzurec, L. (2013). An overview of the DSM-5: Changes, controversy, and implications for psychiatric nursing. Journal of Psychosocial Nursing & Mental Health Services, 51(4), 30-9. doi: http://dx.doi.org/10.3928/02793695-20130226-02Links to an external site.

Landrum, R. (2012). Applied project: Capstone in psychology [Electronic version]. Retrieved from https://content.ashford.edu/ 

Discussion #2:

What are three controversies discussed in the Halter, Rolin-Kenny, & Dzurec (2013) article? Give your opinions about these controversies. From your point view, are these legitimate concerns? Why or why not?

The first two controversies I’d like to address are Non-suicidal self-injury disorder “a diagnosis intended to differentiate patients who engaged in intentional self-inflicted damage to the surface of the body from those mutilating with serious suicidal intent” (Halter, Rolin-Kenny & Dzurec, 2013, pg. 9). And suicidal behavior disorder, “characterized by self-injurious behaviors that would result in death” (Halter, Rolin-Kenny & Dzurec, 2013, pg. 9). I believe that both should be considered disorders as it is so wide spread and happening more and more especially in the area that I live in among teens. One issue unsuccessful field trials which is understandable and the other was the view of stigmatizing the patient deemed unnecessary due to other symptoms and diagnoses that accompany a person who is suicidal. Having worked in a field that dealt with attempted suicides and suicides I think that both of these should not be dismissed as I have seen many suicides that were attempts prior to the final action. Additionally, I do not agree that it is stigmatizing when it comes to an effort to prevent death or grave harm to others.

Last, under sexual dysfunctions; hypersexual disorder, “characterized by intense, recurrent, and distressing sexual urges, fantasies, and behaviors lasting at least 6 months” (Halter, Rolin-Kenny & Dzurec, 2013, pg. 7). The basic argument was lack of studies that included participants other than those seeking help, and lack of evidence to define the disorder (Halter, Rolin-Kenny & Dzurec, 2013). I agree with the need for inclusion due to the same reasoning as my prior argument, great bodily harm to self or others if these acts eventually get carried out. More research can lead to more action post incident and better developed treatment and treatment plans for patients.

Name a disorder identified as requiring significantly more research and study from the DSM-5 section entitled, “Conditions for Further Study” (Section III of the DSM-5).

The disorder I choose to identify is Internet Gaming Disorder, because technology is being placed in the hands of our children at younger ages more than ever, and although we move with evolution or get left behind there can be some serious issues including but not limited to psychological and basic day to day function.

Construct a research question that is pertinent to the disorder you selected.

Do 13 year olds children who are unattended with no set time limit for internet gaming neglect basic daily living requirements?

Briefly outline a research method that could be used to investigate the disorder based on one of the research methods presented in your textbook.

For this study, the dependent variable would be analyzed at the end of the day (8 hour study) which is described by Landrum (2012), as a “posttest only” (para. 1). The hypothesis is that the children will not stop gaming to eat, drink, or take a bathroom breaks without being told to do so. This showing preoccupation causing exclusion of other daily needs. Understanding that most disorders have to be compulsive this is just one test that can open doors for more testing without causing harm to participants, or breaking ethical codes.

Reference

Halter, M.J., Rolin-Kenny, D., Dzurec, L.C. (2013). An overview of the DSM-5: Changes, controversy, and implications for psychiatric nursing. Journal of Psychosocial Nursing & Mental Health Services, 51(4), 30-9. doi:http://dx.doi.org/10.3928/02793695-20130226-02. Retrieved from the ProQuest database.

Landrum, R. E. (2012). Applied project: Capstone in psychology [Electronic version]. Retrieved from https://content.ashford.edu/ 

Professor response:

Hi,

I cannot think of a more personal journey than that of grief. In my personal experience, during first few weeks after a significant loss, you're still trying to get arrangements made and don't have as much time to reflect as there are "things to do." It's after the services are over, the friends and family members have quit stopping by or calling, and the phone calls to lawyers and insurance companies have subsided (depending on the circumstances), the loss begins to set in. When I lost my dad, it was once I got through all of these formalities that I could even begin to grieve. How can someone understand and experience grief only after two weeks?!

Even now that it's been five years, I grieve. Just yesterday I was driving to the grocery store and noticed a man at the stop sign who was the spitting image of my dad. It caught me off guard, and I started crying; I still miss him as much, if not more, than I did two weeks after he passed away. Grief comes in waves, you never know when it will wash over you, and it is a completely normal experience of being a human.

There was an interesting editorial published by the American Family Physician that addressed the changes I wanted to share with you. In their editorial, Kavan and Barone (2014) recognize it's not productive to argue whether the bereavement exclusion should be included, but rather we should focus on better understanding the relationship between MDD and grief and what that means for clinicians:

"First, future studies should continue to focus on differentiating bereavement-related depression from non–bereavement-related depression to enhance a clinician's ability to properly assess and manage each" (p. 694).

What do you think of this suggestion? How do you think our knowledge has changed now that it's 2019?

Thanks!

Julie

Kavan, M. G., & Barone, E. J. (2014, November 15). Grief and major depression- controversy over changes in DSM-5 Diagnostic Criteria. [Editorial]. American Family Physician, 90(10), 690-694. Retrieved from https://www.aafp.org/afp/2014/1115/p690.html.