Social media as an incubator of personality and behavioral psychopathology: Symptom and disorder authenticity or psychosomatic social contagion?

Frailties of Memory: Implications for Therapists Treating Gender Dysphoric Youth

Therapists working with gender-questioning teens often encounter disparate narratives. Teens typically report memories consistent with their transgender identity, often recounting specific childhood events. Many parents, however, have different recollections of their teen's childhood. As sound, ethical care is predicated on reality, therapists face the difficult task of navigating these often-contradictory narratives. We present relevant scientific literature on memory and well documented cognitive mechanisms and reflect on past therapeutic controversies to help clinicians understand the complexity of memory and why it may be prudent for therapists to consider not only their patients' accounts of their pasts, but also that of their patient's parents.

Self-Diagnosis of Mental Disorders: A Qualitative Study of Attitudes on Reddit

There is concern that a growing number of individuals, especially adolescents, are diagnosing themselves with mental disorders. However, there has been limited empirical research into this phenomenon: why it might happen, what the costs and benefits might be, and what the implications are for anyone who is experiencing distress. To address this, this study used reflexive thematic analysis to explore attitudes toward self-diagnosis of mental disorders as expressed on the discussion website Reddit. From 1195 user comments, five themes were generated: (1) There is tension over who is the expert in diagnosis; (2) Self-diagnosis is a route to self-understanding in an inaccessible system; (3) Teenagers on social media are the problem; (4) Self-diagnosis can become self-fulfilling, and (5) Now no one is believed. Together, these themes highlight that there is considerable anger, derision, and criticism targeted toward people who self-diagnose with mental disorders, and that this is particularly targeted toward adolescents who self-diagnose on or as a result of social media. The findings have important implications for understanding how to support and validate people, particularly adolescents, who (sometimes accurately) use diagnostic language to express how they are feeling.

Mental health literacy of adolescents in Bermuda, according to age, gender and race

Mental health literacy (MHL) is an important part of the help-seeking process, yet there is a lack of knowledge about the MHL of adolescents in the Caribbean. This region is important to study as it is underrepresented in mental health research globally. The aim of this study is to explore the ability of adolescents in Bermuda to recognize depression and social phobia (social anxiety) and their beliefs about the sources of help for a peer with these mental health problems. This cross-sectional study surveyed middle and high school students aged 10-19 years in Bermuda. Online surveys conducted between November 2022 and June 2023 gathered demographic data including age, gender and race, and assessed the ability to recognize depression and social anxiety from descriptions provided in randomly assigned vignettes, and beliefs about sources of help. Across 15 middle and high schools, 2423 adolescents (out of 3593 eligible participants) completed all demographic and MHL survey questions (1139 males, 1272 females). Recognition rates for depression and social anxiety were 60% and 53%, respectively. Compared to females, males endorsed a greater variety of help sources. Reporting symptoms of depression or anxiety reduced the likelihood of endorsing multiple sources of help. MHL of adolescents in Bermuda is sub-optimal, particularly for social anxiety. Mental health promotion programs may be useful in improving recognition rates.

Role of social media in the presentation of disorders of gut-brain interaction: Review and recommendations

As clinicians involved in the care of patients with disorders of gut-brain interaction (DGBIs), we-and many colleagues-have the impression that social media are adversely shaping the nature, presentation, and ability to manage these disorders, especially at the severe end of the DGBI clinical spectrum. We turned to the research literature to see if these clinical impressions were corroborated but found it virtually nonexistent. Social media have rapidly become a ubiquitous, pervasive part of the lives of most people on the planet. Although they bring many benefits, they are also replete with health misinformation, reinforcement of abnormal sick-role behavior, and undermining of the legitimacy of psychological care. We first set out four reasons for concern about social media and DGBIs, particularly severe DGBIs. These reasons stem from phenomena described in medical fields outside DGBIs, but there is no reason to think DGBIs should be exempt from such phenomena. We then present the results of a literature search, which yielded only eight disparate recent empirical studies. We review these studies, which, although not uninformative, reveal a field in its infancy. We set out implications, most urgently multidisciplinary research directly addressing the role of social media and evaluation of interventions to mitigate its ill effects. Gastroenterological clinicians involved in DGBI care and research need to collaborate with experts in social media research, which is a very rapidly evolving, specialized field. Although knowledge is at an early stage, there are implications for specialist practice, education and training, and DGBI service delivery.

Gender dysphoria in adolescence: examining the rapid-onset hypothesis

The sharp rise in the number of predominantly natal female adolescents experiencing gender dysphoria and seeking treatment in specialized clinics has sparked a contentious and polarized debate among both the scientific community and the public sphere. Few explanations have been offered for these recent developments. One proposal that has generated considerable attention is the notion of "rapid-onset" gender dysphoria, which is assumed to apply to a subset of adolescents and young adults. First introduced by Lisa Littman in a 2018 study of parental reports, it describes a subset of youth, primarily natal females, with no childhood indicators of gender dysphoria but with a sudden emergence of gender dysphoria symptoms during puberty or after its completion. For them, identifying as transgender is assumed to serve as a maladaptive coping mechanism for underlying mental health issues and is linked to social influences from peer groups and through social media. The purpose of this article is to analyze this theory and its associated hypotheses against the existing evidence base and to discuss its potential implications for future research and the advancement of treatment paradigms.

Functional Tic-like Behaviors: From the COVID-19 Pandemic to the Post-Pandemic Era

During the COVID-19 pandemic, there have been multiple reports about an unforeseen surge in adolescents and young adults exhibiting sudden onset functional tic-like behaviors. This phenomenon has been mainly associated with the female gender and occasionally after exposure to social media content featuring similar patterns of functional tic-like behaviors. A significant portion of these individuals have been directed to specialist clinics for movement disorders with initial misdiagnoses of late-onset refractory Tourette syndrome. Distinguishing between rapid onset functional tic-like behaviors and neurodevelopmental tics as part of Tourette syndrome can be challenging; however, the differential diagnosis is facilitated by focusing on specific clinical and demographic factors, which we have explored in a systematic literature review. Compared to neurodevelopmental tics, functional tic-like behaviors typically present with a more abrupt and intense manifestation of symptoms, onset at a later age, higher prevalence among females, inability to suppress tics, coexisting anxiety and depression, and sometimes a history of exposure to social media content portraying tic-like behaviors of a similar nature. This novel manifestation of a functional neurological disorder may thus be viewed as an emerging neuropsychiatric condition potentially triggered/exacerbated by the psychosocial repercussions of the COVID-19 crisis.

Improving Diagnostic Procedures in Autism for Girls and Women: A Narrative Review

Biases exist in the diagnostic process for autism spectrum disorder (henceforth "autism"), which result in some girls and women being diagnosed later or missed entirely. Current diagnostic tools may not capture the full range of behavioural presentations of autism, leading to under-identification. This review explores why these biases may occur, and how diagnostic procedures could be adapted to better identify autistic girls and women. We recommend that diagnostic assessments are adjusted to capture a broader range of behavioural exemplars of autism; that camouflaging of autistic traits is taken into account; and that care is taken to ensure co-occurring mental health conditions do not overshadow autism diagnosis. We offer recommendations, building on gold-standard diagnostic guidelines, for how diagnostic procedures can be improved for girls and women.

Prodromal or Factitious Psychosis: A Cautionary Tale in the Era of Increasing Social Media Use by Vulnerable Individuals

Research on the prodromal phase of schizophrenia has been ongoing for several decades and, more recently, findings from this research are being incorporated into everyday psychiatric practice, such as the use of interviews to evaluate prodromal symptomatology. This evolution is happening in the midst of an explosion of social media use by teenagers and young adults, increasing the exposure of youth to portrayals of psychiatric experiences. For example, reports from around the world of "TIK-TOK tics" emphasize the role of social media in the "creation" of psychiatric symptoms. This case report highlights the importance of a full psychiatric evaluation in acute care settings where quick treatment of psychotic symptoms is the norm. A 15-year-old patient was initially diagnosed with prodromal schizophrenia but, after a more extensive evaluation during a second admission, she was diagnosed with borderline personality disorder. Her antipsychotic treatment regimen was stopped and appropriate education and treatment were started, without the recurrence of "psychotic symptoms" during follow-up. It may be that patients with borderline personality disorder, a frequent condition on inpatient units, are at particular risk of assimilating symptoms as represented on social media.

European Academy of Paediatrics statement on the clinical management of children and adolescents with gender dysphoria

Gender issues have become a polarised and political subject in modern paediatrics and indeed, in broader society. These include the management of infants with disorders of sex development and transgender sports participation, but especially recently regarding the management of gender dysphoria. The European Academy of Paediatrics (EAP) acknowledges that there are deeply held beliefs about this issue based on conscience and social norms. Several European countries, led by the UK, have recently reviewed the management of gender dysphoria in children and young people. Recognising the need for far more research into treatments such as pubertal suppression and cross-sex hormones in children and young people, we review the current ethical and legal dilemmas facing children with gender dysphoria, their families and the clinical teams caring for them. We suggest an approach that maintains the child's right to an open future whilst acknowledging that the individual child is the crucial person affected by decisions made and must receive appropriate support in decision-making and care for any associated mental health or psychological issues. Noting that national approaches to this vary and are in flux, the EAP advocates a child-centred individual rights-based analytical approach.

Dissociative Identity Disorder in Schools Part I

Dissociation is a normal life adaptation that can become pronounced and disruptive in the setting of repeated or extreme exposure to trauma. Children and adolescents may experience dissociation due to a trauma or stressor-related disorder, anxiety, or depressive disorders. Children and adolescents also may mimic behavior they see online as a way of expressing internally painful and intolerable experiences. Myth and misinformation surround the diagnosis of dissociative identity disorder (DID), formerly multiple personality disorder. The purpose of this article is to provide school nurses with evidence-based information on DID and resources for practice regarding how to provide a secure, consistent approach to students who are being traumatized, misunderstood, or excluded at home or at school. Part 1 of this two-part series describes DID foundations and DID in school-aged children, reviews controversy spurred by social media representation, and presents the Trauma-Informed Care (TIC) model. TIC offers useful perspectives regardless of a student's presentation or diagnostic status. Part 2 will discuss recommendations for managing dissociative presentations using a team-based approach, focusing on the school nurse's roles and responsibilities.

Addressing the Increasing Mental Health Distress and Mental Illness Among Young Adults in the United States

ABSTRACT

Recent surveys show rising numbers of young people who report anxiety and depression. Although much attention has focused on mental health of adolescent youth, less attention has been paid to young people as they transition into adulthood. Multiple factors may have contributed to this steady increase: greater exposure to social media, information, and distressing news via personal electronic devices; increased concerns regarding social determinants of health and climate change; and changing social norms due to increased mental health literacy and reduced stigma. The COVID-19 pandemic may have temporarily exacerbated symptoms and impacted treatment availability. Strategies to mitigate causal factors for depression and anxiety in young adults may include education and skills training for cognitive, behavioral, and social coping strategies, as well as healthier use of technology and social media. Policies must support the availability of health insurance and treatment, and clinicians can adapt interventions to encompass the specific concerns and needs of young adults.

"On Suggestion" by John Bostock, 1923: A comparison with twenty-first century understandings of the placebo effect

OBJECTIVES

This paper describes Australian psychiatrist John Bostock's 1923 concept of suggestion and compares it to our understandings, in 2023, of the placebo effect.

CONCLUSIONS

Bostock's 1923 article on "suggestion" gives us a glimpse of the history of Australian psychiatry. It also stimulates thought about the current understandings of the placebo effect. Now, as then, placebo effects can play a critical role in patient outcomes. However, careful consideration is required to ensure contemporary ethical standards are met and harm is not done.

TV Series in Mainstream Media Depicting Autism and Self-Diagnosis of Autism in a General Population of Young Adults

PURPOSE

The prevalence of autism diagnoses has increased in recent years. The portrayal of autistic characters in mainstream media, such as TV series, may be a contributing factor. This study investigated whether young adults who consume media featuring autistic characters are more likely to self-diagnose with autism.

METHODS

348 participants filled out an online questionnaire exploring their media consumption, subjective diagnosis of autism and objective indicators of autism using an Emotion Recognition Task.

RESULTS

Results from linear regression analysis indicated a significant correlation between media consumption and self-diagnosis, while valence of the series and objective diagnosis did not have a significant influence. The study found no gender differences.

CONCLUSION

The results suggest a need for further research on the relationship between media consumption and self-diagnosis, including for other forms of media beyond TV series.

The Ability of Self-Report Methods to Accurately Diagnose Attention Deficit Hyperactivity Disorder: A Systematic Review

OBJECTIVE

To identify and analyze all studies validating rating scales or interview-based screeners commonly used to evaluate ADHD in adults.

METHOD

A systematic literature search identified all studies providing diagnostic accuracy statistics, including sensitivity and specificity, supplemented by relevant articles or test manuals referenced in reviewed manuscripts.

RESULTS

Only 20 published studies or manuals provided data regarding sensitivity and specificity when tasked with differentiating those with and without ADHD. While all screening measures have excellent ability to correctly classify non-ADHD individuals (with negative predictive values exceeding 96%), false positive rates were high. At best, positive predictive values in clinical samples reached 61%, but most fell below 20%.

CONCLUSION

Clinicians cannot rely on scales alone to diagnose ADHD and must undertake more rigorous evaluation of clients who screen positive. Furthermore, relevant classification statistics must be included in publications to help clinicians make statistically defensible decisions. Otherwise, clinicians risk inappropriately diagnosing ADHD.

Transition Regret and Detransition: Meanings and Uncertainties

Gender transition is undertaken to improve the well-being of people suffering from gender dysphoria. However, some have argued that the evidence supporting medical interventions for gender transition (e.g., hormonal therapies and surgery) is weak and inconclusive, and an increasing number of people have come forward recently to share their experiences of transition regret and detransition. In this essay, I discuss emerging clinical and research issues related to transition regret and detransition with the aim of arming clinicians with the latest information so they can support patients navigating the challenges of regret and detransition. I begin by describing recent changes in the epidemiology of gender dysphoria, conceptualization of transgender identification, and models of care. I then discuss the potential impact of these changes on regret and detransition; the prevalence of desistance, regret, and detransition; reasons for detransition; and medical and mental healthcare needs of detransitioners. Although recent data have shed light on a complex range of experiences that lead people to detransition, research remains very much in its infancy. Little is known about the medical and mental healthcare needs of these patients, and there is currently no guidance on best practices for clinicians involved in their care. Moreover, the term detransition can hold a wide array of possible meanings for transgender-identifying people, detransitioners, and researchers, leading to inconsistences in its usage. Moving forward, minimizing harm will require conducting robust research, challenging fundamental assumptions, scrutinizing of practice patterns, and embracing debate.

Self-Reported Adult ADHD Symptoms: Evidence Supporting Cautious Use in an Assessment-Seeking Sample

OBJECTIVE

Self-report symptom inventories are commonly used in adult ADHD assessment, and research indicates they should be interpreted with caution. This study investigated one self-report symptom inventory for adult ADHD in a clinical sample.

METHOD

Archival data were used to evaluate diagnostic utility of the Conners Adult ADHD Rating Scale-Self-Report: Long Version (CAARS-S:L) in a sample of 122 adults seeking ADHD assessment.

RESULTS

Overall, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) estimates for the ADHD Index and other CAARS-S:L scales demonstrated weak accuracy. Anxiety and depression were the most common diagnoses present when a false positive on the ADHD Index was observed. PPV and specificity for the ADHD Index were higher in males compared to females.

CONCLUSION

The CAARS-S:L may be useful for screening purposes in some cases, but should not be the main method used for diagnostic purposes. Clinical implications of findings are discussed.