History of PTSD in the DSM

Evolution / History of PTSD in the DSM: Awareness, Research and Resources

“The DSM definition of PTSD is quite straightforward: A person is exposed to a horrendous event “that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others,” causing “intense fear, helplessness, or horror,” which results in a variety of manifestations: intrusive reexperiencing of the event (flashbacks, bad dreams, feeling as if the event were occurring), persistent and crippling avoidance (of people, places, thoughts, or feelings associated with the trauma, sometimes with amnesia for important parts of it), and increased arousal (insomnia, hypervigilance, or irritability). This description suggests a clear story line: A person is suddenly and unexpectedly devastated by an atrocious event and is never the same again. The trauma may be over, but it keeps being replayed in continually recycling memories and in a reorganized nervous system.” ― Bessel van der Kolk

History: From Shell Shock to PTSD

History of PTSD in the DSM Research

Evolution of PTSD in the DSM

"The concept of Post-Traumatic Stress Disorder (PTSD) has evolved significantly over time. Here’s a brief overview of its history:

1. Early Recognition: Symptoms resembling PTSD have been noted throughout history. Ancient texts, including works by Hippocrates, describe symptoms similar to what we now recognize as PTSD 1.
   
   
2. World Wars: During World War I, the term “shell shock” was used to describe soldiers experiencing symptoms like fatigue, tremors, and nightmares. This term evolved into “combat stress reaction” during World War II 1.
   
   
3. Vietnam War: The term PTSD emerged during the Vietnam War, as researchers studied the psychological effects of combat on soldiers. This period saw the term “post-Vietnam syndrome” being used 1.
   
   
4. DSM Inclusion: In 1980, PTSD was officially added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This inclusion marked a significant shift, recognizing that PTSD was caused by external traumatic events rather than inherent individual weaknesses 2 3.
   
   
5. Modern Understanding: Today, PTSD is understood to affect not only war veterans but also survivors of various traumas, including natural disasters, accidents, and personal assaults. The criteria for diagnosing PTSD have been refined over successive editions of the DSM 4 5.
   
   
6. Treatment Evolution: Treatment approaches have also evolved, from early misconceptions and controversial methods to modern therapies like cognitive-behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and medication 6.

The understanding and treatment of PTSD continue to advance, with ongoing research aimed at improving outcomes for those affected by this condition.


PTSD inclusion in the DSM

Post-Traumatic Stress Disorder (PTSD) has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) since the DSM-III, which was published in 1980. Over the years, the criteria for diagnosing PTSD have evolved, reflecting advances in understanding and research.

DSM-III (1980)

• Introduction: PTSD was first officially recognized and included as a distinct diagnosis.
• Criteria: Focused on the traumatic event and the individual’s response, which had to involve intense fear, helplessness, or horror.

DSM-IV (1994)

• Refinement: Expanded the criteria to include a broader range of symptoms and stressors.
• Symptom Clusters: Introduced three symptom clusters: re-experiencing, avoidance/numbing, and hyperarousal.

DSM-5 (2013)

• New Category: PTSD was moved to a new category called Trauma- and Stressor-Related Disorders.
• Expanded Criteria: The criteria were expanded to include four symptom clusters: intrusion, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity1.
• Additional Features: Included criteria for children under six years old and added a dissociative subtype.

DSM-5-TR (2022)

• Updates:The DSM-5-TR (Text Revision) included updates to reflect scientific advances since the DSM-5’s release but did not change the diagnostic criteria for PTSD 1 2.

Key Criteria in DSM-5-TR

1. Exposure to Trauma: Directly experiencing, witnessing, learning about, or repeated exposure to traumatic events.
2. Intrusion Symptoms: Unwanted memories, nightmares, flashbacks, and severe distress or physical reactions to reminders of the trauma.
3. Avoidance: Efforts to avoid trauma-related thoughts, feelings, or external reminders.
4. Negative Alterations in Cognition and Mood: Inability to recall aspects of the trauma, negative beliefs, distorted blame, persistent negative emotions, diminished interest in activities, and feelings of detachment.
5. Alterations in Arousal and Reactivity: Irritability, reckless behavior, hypervigilance, exaggerated startle response, concentration issues, and sleep disturbances.
6. Duration: Symptoms must persist for more than one month.
7. Functional Impairment: Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning 1 2. (Source: Microsoft Copilot

175 Years of Progress in PTSD Therapeutics: Learning From the Past Psychiatry Online

Evolving DSM Diagnostic Criteria for PTSD: Relevance for Assessment and Treatment Springer Link

From Shell Shock and War Neurosis to Posttraumatic Stress disorder (PTSD): A History of Psychotraumatology NIH

From Shell Shock to PTSD: Proof of War’s Traumatic History The Conversation

From Shell Shock to PTSD, a Century of Invisible War Trauma PBS News

From Shell Shock to PTSD and Traumatic Brain Injury: A Historical Perspective on Responses to Combat Trauma American Psychological Association

History of PTSD and Trauma Diagnoses Trauma Dissociation

History of PTSD in Veterans: Civil War to DSM-5 U.S. Department of Veterans Affairs

How Veterans Created PTSD JSTOR

PTSD History and Overview U.S. Department of Veterans Affairs

Posttraumatic Stress Disorder as a Diagnostic Entity – Clinical Perspectives Taylor and Francis Online

Redefining Posttraumatic Stress Disorder for DSM-5 ScienceDirect

Shell Shock and PTSD: A Tale of Two Diagnoses Mary C. Vance, MD, MSc; Joel D. Howell, MD, PhD PDF Download

The History of Forgetting, From Shell Shock to PTSD Listen ABC

The PTSD Criterion A debate: A brief history, current status, and recommendations for moving forward Wiley Online Library

The PTSD History Timeline Banyan Treatment Center

The Organization of DSM-5-TR™ Updated Edition Mental Health and Motivation

Trauma Redefined in the DSM-5: Rationale and Implications for Counseling Practice The Professional Counselor

The Historical Evolution of PTSD Diagnostic Criteria Springer Link

Understanding the History of PTSD Verywell Health

What’s Shell Shock & Is There a Difference Between It and PTSD? Moment of Clarity

The Evolution Of Post Traumatic Stress Disorder - Video

🎓 Mental Health, Psychology and Relationship Resources

Mental Health Benefits of Pets

Mental Health Benefits of Keeping Pets Awareness Research and Resources

“Animals are reliable, many full of love, true in their affections, predictable in their actions, grateful and loyal: Difficult standards for people to live up to.” – Alfred A. Montapert

Mental Health Benefits of Keeping Pets Research

Mental Health Benefits of Pets

"Pets can have numerous positive effects on mental health and well-being.

Here are some of the mental health benefits of having pets:

1. Companionship and Emotional Support: Pets, such as dogs and cats, offer companionship and unconditional love. They provide a source of emotional support and can help alleviate feelings of loneliness, depression, and anxiety. The presence of a pet can offer comfort, reduce stress levels, and promote a sense of security.

2. Stress Reduction: Interacting with pets has been shown to reduce stress levels and promote relaxation. Petting or cuddling with a cat or dog, for example, can release feel-good hormones like oxytocin and decrease the production of stress-related hormones like cortisol. The rhythmic motion of stroking a pet can have a soothing effect and help regulate emotions.

3. Increased Physical Activity: Owning a pet, particularly a dog, often encourages increased physical activity. Regular exercise, such as walking or playing with a pet, can boost mood, reduce anxiety and stress, and contribute to overall mental well-being. The responsibility of taking care of a pet's exercise needs can also help establish a routine and provide a sense of purpose.

4. Social Connection and Engagement: Pets can serve as social facilitators, making it easier to connect with others. Taking a dog for a walk, for instance, can lead to interactions with other pet owners and provide opportunities for social engagement and conversation. Pets can be a common topic of discussion and help initiate social interactions, especially for individuals who may find it challenging to connect with others.

5. Sense of Purpose and Responsibility: Caring for a pet creates a sense of purpose and responsibility. Having a living being to care for can give individuals a sense of importance and structure in their daily lives. This can be particularly beneficial for people who struggle with low self-esteem or feelings of emptiness.

6. Emotional Regulation: Pets can help improve emotional regulation and provide a calming influence. They offer a non-judgmental presence and can be a source of comfort during times of distress or emotional instability. Their presence and the routines associated with pet care can provide stability and help individuals manage their emotions more effectively.

It's important to note that while pets can provide significant mental health benefits, owning a pet also comes with responsibilities. It's crucial to ensure that individuals have the time, resources, and ability to properly care for and meet the needs of a pet before deciding to adopt one.

Overall, the bond between humans and pets can have a profound positive impact on mental health, providing companionship, emotional support, and promoting overall well-being." (Source: ChatGP)

A Psychologist reveals the Health Benefits of Owning a Dog Women's Health

Americans Note Overwhelming Positive Mental Health Impact of Their Pets in New Poll; Dogs and Cats Equally Beneficial American Psychiatric Association

Animal Love as Emotional Therapy OpenMind BVVA

Animal Therapy Statistics The Zebra

Benefits of Pets for Teens with Mental Health Disorders Teen Rehab

Benefits of Pets' Ownership, A Review based on Health Perspectives ResearchGate

‘Dogs have a magic effect’: how pets can improve our mental health The Guardian

Dogs Supporting Human Health and Well-Being: A Biopsychosocial Approach Frontiers

Evidence shows pets can help people with Mental Health problems University of Manchester

Impact of Pet Dog or Cat exposure during Childhood on Mental Illness during Adolescence: A Cohort Study BMC Paediatrics

How Dogs can Help with your Mental Health Cleveland Clinic

How Dogs contribute to your Health and Happiness Medical Health News Today

How Owning a Pet Can Benefit Your Mental Health MHA

How Pets Affect Mental Health WebMD

How Pet Ownership Benefits Your Mental Health Medivet

How Cats Help Improve Mental Health AKC REUNITE

How Science Supports Pets for Improving Your Mental Health Mental Health America

“I Can’t Give Up When I Have Them to Care for”: People’s Experiences of Pets and Their Mental Health Taylor & Frances Online

Is Having a Dog Good for Your Mental Health? Four Paws

Mental Health Benefits of Pets Psych Central

Mental Health Benefits of Pet Ownership Centrestone

New Survey: 95% of Pet Parents rely on their Pet for Stress Relief Newsroom

Owning a pet is good for your Mental Wellbeing Health Navigator

Pets and Mental Health: How Furry Friends Can Impact Your Child’s Life Nationwide Children's Hospital

Pets and Mental Health: What are the benefits? My Online Therapy

Pets & Wellbeing: 15 Benefits of Emotional Support Animals Positive Psychology

Pets help ease Symptoms of Depression and Anxiety, and the Science Proves It Allure

Pets & Wellbeing: 15 Benefits of Emotional Support Animals Positive Psychology

Psychological Benefits of Owning a Cat Catonsville Cat Clinic

Shareable Infographic: Top 5 Mental Health Benefits Of Pets habri

Stress Awareness: How Your Pet Can Benefit Your Mental Health Veterinary Client Mediation Service

Study Finds a Link between being a  Cat Person and Improved Mental Health Inverse

The Benefits of Owning a Pet – and the Surprsing Science behind it CNN

The Health and Mood-Boosting Benefits of Pets HelpGuide

The Mental Health Benefits of Emotional Support Animals Kentucky Counceling Center

The Most Surprising Pets And Mental Health Statistics And Trends in 2023 

The Power of Pets : Health Benefits of Human-Animal Interactions NIH

The Power of Support from Companion Animals for People living with Mental Health Problems: A Systematic Review and Narrative Synthesis of the Evidence BMC Physiatry

The Science-Backed Benefits of Being a Cat Lover Greater Good

The Truth About Cats and Dogs: Pets Are Good for Mental Health of ‘Everyday People’ American Psychological Association

7 Ways Having a Pet Can Improve Your Mental health - Video

🎓 Mental Health, Psychology and Relationship Resources

Relationship Red Flag Resources

Relationship Red Flag Behaviour, Warning Signs and Research

“If something on the inside is telling you that someone isn’t right for you, they’re NOT right for you, no matter how great they might look on paper. When it’s right for you, you will know. And when it’s not – it’s time to go.” ― Mandy Hale

How to Identify Behavioural Red Flags

Red Flags in Relationships

What are (silent) Red Flags?

Relationship Red Flags

"In relationships, red flags are warning signs or behaviors that indicate potential issues or problems. It's important to be aware of these red flags to help identify and address potential concerns early on. Here are some common relationship red flags to watch out for:

1. Lack of communication: Communication is a fundamental aspect of a healthy relationship. If there is a consistent lack of open and honest communication, difficulty expressing emotions or needs, or avoidance of important discussions, it can be a red flag for potential problems in the relationship.

2. Controlling or manipulative behavior: Control or manipulation can manifest in various ways, such as excessive jealousy, possessiveness, monitoring or restricting your activities, isolating you from friends and family, or making decisions for you without your input. These behaviors are signs of an unhealthy power dynamic and lack of respect for personal boundaries.

3. Disrespectful or demeaning behavior: Any form of disrespect, including insults, belittling remarks, name-calling, or dismissive attitudes, is a major red flag. Respect is crucial for a healthy and fulfilling relationship, and consistently disrespectful behavior is a sign of potential emotional or verbal abuse.

4. Lack of trust: Trust is the foundation of a strong relationship. If there is a constant lack of trust, unfounded accusations, secrecy, or a history of dishonesty, it can significantly impact the relationship's well-being. Trust issues can erode the connection and lead to ongoing conflicts and insecurity.

5. Emotional or physical abuse: Any form of abuse, whether emotional, verbal, or physical, should never be tolerated in a relationship. If you experience intimidation, threats, physical harm, or coercive control, it is essential to prioritize your safety and seek help from friends, family, or professionals.

6. Unbalanced or unequal relationship: Relationships should ideally be built on mutual respect, support, and equality. If one partner consistently dominates decision-making, disregards the other's opinions or needs, or if there is an imbalance of power or contributions, it can indicate an unhealthy dynamic.

7. Lack of support or empathy: Healthy relationships involve emotional support and empathy for one another. If your partner consistently dismisses or invalidates your feelings, lacks empathy, or fails to provide support during challenging times, it can be a sign of an unsupportive or emotionally disconnected relationship.

8. Constant conflict or unresolved issues: While disagreements are a normal part of any relationship, constant conflict, or the inability to resolve issues effectively, may indicate deeper underlying problems. If conflicts escalate into recurring patterns of hostility, disrespect, or emotional withdrawal, it's crucial to address them for the health of the relationship.

9. Isolation from friends and family: If your partner discourages or actively prevents you from spending time with loved ones, it can be a sign of controlling behavior. Healthy relationships should encourage maintaining connections with friends and family, fostering a sense of independence and support.

It's important to note that the presence of one or two red flags doesn't necessarily mean the relationship is doomed. However, multiple or persistent red flags should be taken seriously, and it may be necessary to seek support from trusted individuals or professionals to assess the situation and make informed decisions about the relationship's future." (Source: ChatGPT 2023)

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Ignoring Red Flags : Destructive Patterns to Avoid Article

Intimate Partner Violence: Facilitating the Recognition of Yellow Flags as Early Indicators of Red Flags PDF Document Download

Know the Red Flags of Abuse Article

Learning Relationship Red Flags: What to Look Out For Article

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Red Flags I Completely Missed at the Beginning of My Relationship Article

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Red Flags of a Narcissist / Abuse Article

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Red Flags To Look For In An Abusive Personality PDF Document Download 

Red Flags Therapists Say Not To Ignore In Relationships Article

Red Flags to Look Out for in a Relationship Article

Relationship Expert reveals Red Flags not to be Ignored when Dating Article

Relational Red Flags: Detecting Undesirable Qualities in Initial Romantic Encounters
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Relationship Red Flags and Why We Ignore Them Article

Relationship Red Flags I Ignored (And Hope You Wont) Article

Relationship Red Flags In Women You Should Never Ignore Article

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Social Media and Relationships: Red Flags to Look Out For Article

Silent Red Flags In A Relationship You Need To Know About Article

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Signs (Red Flags) of a Toxic Relationship and Tips For Fixing It Article

Signs (Red Flags) of an Unhealthy Relationship Article

Signs (Red Flags) You Need to Take a Step Back in Your Relationship Article

Signs (Red Flags) Your Partner is Emotionally Unavailable Article

The Red Flags of an Abuser Article

The Red Flags to Watch out for Before You Get Married Article

Top 12 Early Relationship Red Flags & Signs You Should Get Out Now! Regain

Toxic Relationships Have Red Flags In Early Stages Article

Understanding The Red Flags in a Relationship Gadjah Mada University

Relationship Red Flag Behaviour List Relationship Red Flags Ignored for Months

What Are The Red Flags You Can’t Overlook in a Relationship? Article

What is Ghosting? PsychologyWriting

When to Seek Marriage Help: Relationship Red Flags Family Studies

Why Do We Ignore the Red Flags in Our Relationships? Article

Why Relationship Red Flags Should Not Be Ignored Mental Health and Motivation

Why I Continue to Ignore Red Flags Article

7 Red Flags In Dating You Should Watch Out For - Video

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Different Mental Health Research Approaches

 Mental Health Qualitative and Quantitative Research Differences: Awareness

Qualitative, Quantitative and Mix Methods Mental Health Research Approaches

Mental Health Qualitative vs. Quantitative Research

Qualitative and Quantitative Mixed Methods Mental Health Research

Mental Health Qualitative and Quantitative Research Approaches

"The key difference between Qualitative and Quantitative research in the context of mental health lies in their methodologies, goals, and the type of data they collect. Both approaches are valuable in understanding mental health, but they serve different purposes.

Qualitative Research

• Purpose: Explores subjective experiences, meanings, and perceptions. It seeks to understand mental health issues from the perspective of individuals or groups.
• Data: Collects non-numerical data (e.g., interviews, focus groups, case studies, observations).
• Approach: Open-ended and exploratory, often used to generate hypotheses or understand complex emotions, behaviors, or social dynamics.
• Analysis: Involves thematic analysis, narrative analysis, or grounded theory to identify patterns, themes, and meanings in the data.
• Focus: Emphasizes depth and detail, aiming to capture the richness of human experiences, such as how individuals cope with depression, anxiety, trauma, or other mental health issues.
• Example: Studying how people describe their experiences with mental health services.

Quantitative Research

• Purpose: Seeks to measure mental health variables and test hypotheses using statistical techniques.
• Data: Collects numerical data (e.g., surveys, questionnaires, psychometric tests).
• Approach: Structured and controlled, often used to quantify the prevalence of mental health disorders, effectiveness of interventions, or correlation between variables (e.g., stress and depression).
• Analysis: Employs statistical analysis (e.g., t-tests, regressions, ANOVA) to draw conclusions from the data.
• Focus: Emphasizes breadth and generalizability, aiming to uncover patterns or correlations that can be applied to larger populations.
• Example: Measuring the effectiveness of a therapy by comparing pre- and post-treatment anxiety scores in patients.

Comparison

Aspect	Qualitative	Quantitative
Data	Non-numerical (words, experiences)	Numerical (scores, percentages)
Objective	Understanding experiences	Measuring variables and outcomes
Analysis	Thematic or interpretative	Statistical
Scope	Depth-focused (specific cases)	Breadth-focused (generalizable)
Example Question	How do patients feel about therapy?	How effective is therapy in reducing symptoms?

In practice, mental health research often benefits from a mixed-methods approach, combining both qualitative and quantitative techniques to provide a comprehensive view of complex issues.

Mixed methods research in mental health
Mixed methods research in mental health involves combining both quantitative and qualitative approaches to study complex issues like mental health disorders, treatment outcomes, and overall psychological well-being. This type of research is particularly useful in mental health because it allows for a comprehensive understanding of how mental health issues develop, how individuals experience them, and how interventions can be improved.

Key Components of Mixed Methods in Mental Health Research

1. Quantitative Methods:

   • Surveys and Scales: Use of standardized tools like the Depression Anxiety Stress Scales (DASS), General Health Questionnaire (GHQ), or other psychometric instruments to collect measurable data.
   • Clinical Trials: Investigating the effectiveness of therapies, medications, or interventions through controlled, randomized studies.
   • Epidemiological Studies: Statistical analysis of large datasets to examine trends in mental health disorders across populations.

2. Qualitative Methods:

   • Interviews and Focus Groups: Collecting in-depth data about individuals' lived experiences with mental illness, stigma, or therapy.
   • Narrative Analysis: Understanding personal stories and how individuals make sense of their mental health journeys.
   • Case Studies: Providing detailed exploration of a single individual or group over time, often offering insights into rare or complex conditions.

Applications of Mixed Methods in Mental Health

1. Understanding Patient Experiences: Qualitative interviews might reveal insights into patient experiences with therapy that quantitative measures alone may not capture.

2. Improving Interventions: By analyzing both outcomes from clinical trials (quantitative) and patient feedback (qualitative), researchers can fine-tune therapeutic interventions.

3. Policy and Practice: Mixed methods can inform mental health policies by providing robust data on treatment efficacy and patient satisfaction.

Example of a Mixed Methods Study

• A study examining the impact of Cognitive Behavioral Therapy (CBT) for depression might use a randomized controlled trial (quantitative) to measure outcomes, and also conduct patient interviews (qualitative) to understand their emotional responses and treatment satisfaction.

Benefits and Challenges

Benefits:

• Holistic understanding: Combines statistical evidence with personal insights.
• Flexibility: Tailors methods to research questions, offering greater adaptability.

Challenges:

• Time and resource intensive: Requires expertise in both quantitative and qualitative methods.
• Data integration: Merging insights from both types of data can be complex." (Source: ChatGPT 2024)

"Qualitative and quantitative research methods are both crucial in the field of mental health, but they serve different purposes and involve distinct approaches.

Qualitative Research

• Nature: Focuses on understanding the subjective experiences and meanings people attach to their mental health conditions.
• Data: Collects non-numerical data such as words, images, and observations.
• Methods: Common methods include interviews, focus groups, and participant observations.
• Goal: Aims to provide in-depth insights into people’s experiences, emotions, and social contexts 1 2.
• Example: Exploring how individuals with depression describe their daily experiences and coping mechanisms.

Quantitative Research

• Nature: Focuses on measuring and analyzing numerical data to identify patterns and test hypotheses.
• Data: Collects numerical data through surveys, questionnaires, and statistical records.
• Methods: Uses structured tools like standardized tests and statistical analysis.
• Goal: Aims to produce objective, generalizable findings that can predict trends and measure the prevalence of mental health issues 3 4.
• Example: Measuring the prevalence of anxiety disorders in a population and examining correlations with demographic factors.

Key Differences

• Approach: Qualitative research is exploratory and descriptive, while quantitative research is confirmatory and analytical.
• Data Type: Qualitative data is rich and detailed, often in the form of text or images, whereas quantitative data is structured and numerical.
• Outcome: Qualitative research provides contextual understanding and thematic insights, while quantitative research offers statistical evidence and generalizable results.

Both methods are valuable in mental health research, often complementing each other to provide a comprehensive understanding of complex issues.

Mixed Methods of Qualitative and Quantitative Mental Health Research

Mixed methods research in mental health combines qualitative and quantitative approaches to provide a comprehensive understanding of mental health issues.

 Here are some key points:

Definition and Purpose

• Mixed methods research integrates qualitative and quantitative data collection and analysis within a single study. This approach leverages the strengths of both methods to offer a more complete picture than either method alone 1.
• It is particularly useful in mental health research, where understanding complex human behaviors and experiences often requires both numerical data and detailed personal insights 1.

Advantages

• Holistic Understanding: Quantitative data can provide broad generalizations, while qualitative data offers detailed insights, making the findings more robust 1.
• Contextualization: Qualitative data can add depth and context to quantitative findings, helping to explain the “why” behind the numbers 1.
• Credibility: Using multiple methods to study the same phenomenon can enhance the credibility of the results through a process known as triangulation 1.

Common Designs

• Convergent Parallel Design: Both qualitative and quantitative data are collected simultaneously but analyzed separately. The results are then compared to see if they confirm or contradict each other 1.
• Explanatory Sequential Design: Quantitative data is collected and analyzed first, followed by qualitative data to help explain or elaborate on the quantitative findings 1.
• Exploratory Sequential Design: Qualitative data is collected first to explore a phenomenon, followed by quantitative data to test or generalize the initial findings 1.

Examples in Mental Health Research

• Patient Experience: Combining patient surveys (quantitative) with in-depth interviews (qualitative) to understand patient satisfaction and experiences with mental health services 1.
• Treatment Outcomes: Using clinical trial data (quantitative) alongside focus groups with patients (qualitative) to explore the effectiveness and personal impact of new treatments 1.

Challenges

• Complexity: Designing and conducting mixed methods research can be more complex and time-consuming than using a single method 1.
• Integration: Effectively integrating qualitative and quantitative data can be challenging and requires careful planning 1.

Mixed methods research is a powerful approach that can provide richer, more nuanced insights into mental health issues, making it a valuable tool in this field 1." (Source: Microsoft Copilot)

A Mixed-Methods Investigation into the Perspectives on Mental Health and Professional Treatment among Former System Youth with Mood Disorders APA Psycnet 

A Mixed Methods Study to Assess Mental Health Recovery, Shared Decision-Making and Quality of Life (Plan4Recovery) BMC

A Review of Mixed Methods Community-Based Participatory Research Applications in Mental PDF Download Health Journal of Social, Behavioral, and Health Sciences

Mixed-Methods Designs in Mental Health Services Research: A Review Psychiatry Online

Potential Advantages of Combining Randomized Controlled Trials with Qualitative Research in Mood and Anxiety Disorders - A Systematic Review ScienceDirect

Qualitative Research in Psychiatry: A Beginner’s Guide Indian Journal of Private Psychiatry

Qualitative and Mixed Methods in Mental Health Services and Implementation Research NIH

Qualitative vs Quantitative Research Methods & Data Analysis Simple Psychology

Qualitative versus Quantitative Methods in Psychiatric Research NIH

Quantitative Methods for Mental Health Research Elgar Online

Quantitative vs. Qualitative Research in Psychology Verywell Mind

Qualitative vs Quantitative vs Mixed Methods Research: How To Choose Research Methodology

🎓 Mental Health, Psychology and Relationship Resources

Leaving a Borderline Personality Disorder (BPD) Relationship

Leaving a BPD Relationship: Awareness, Research and Resources

“Although the borderline may not be consciously aware of this dilemma, he frequently places a friend or relation in a no-win situation in which the other person is condemned no matter which way he goes.” ― Jerold J. Kreisman

“People with Personality Disorders struggle to maintain distance as well as intimacy within relationships. They push people away if the relationship might show their vulnerability and then become fearful of loss and try to pull the other person back toward them. It is all about controlling distance from the other person.” ― Dian Grier

Leaving a BPD Relationship Research

Leaving a BPD Relationship

Leaving a relationship with someone who has Borderline Personality Disorder (BPD) can be incredibly complex and emotionally draining. These relationships often involve intense emotional highs and lows, making the decision to end them difficult. Here are some steps and insights that might help guide you through the process:

1. Understand the Emotional Rollercoaster

• People with BPD tend to have intense emotional fluctuations, often moving from idealization to devaluation of their partner. This can create a cycle where you feel deeply connected and then suddenly pushed away.
• Recognize that these cycles can make you doubt your decision to leave, as the highs can be euphoric and the lows deeply painful.
  
  

2. Set Clear Boundaries

• Boundaries are crucial, especially if you’re leaving. Make sure you’re clear about your intentions, and try to avoid getting drawn into emotional arguments.
• If the person with BPD threatens self-harm or other drastic behaviors, it can feel like you’re responsible for their well-being. While this is painful, it's essential to remember that you're not responsible for their actions.
  
  

3. Get Support

• Ending a relationship with someone who has BPD can trigger a lot of emotional responses, including guilt, fear, and confusion. Having a solid support system—friends, family, or a therapist—can provide guidance and emotional reassurance.
• Professional help can also be crucial if you feel that the situation may escalate into a crisis.
  
  

4. Prepare for Emotional Reactions

• People with BPD often fear abandonment, so your decision to leave may trigger intense emotional reactions, from pleading to anger to manipulation. It’s vital to stay grounded and not get swayed by these reactions.
• Detach with compassion—be firm but kind in your approach. Acknowledge their pain without engaging in extended emotional battles.
  
  

5. Look After Your Mental Health

• It’s easy to become emotionally drained in such relationships. Be sure to prioritize your mental and emotional well-being throughout the process of leaving.
• Practice self-care, seek therapy if needed, and remind yourself of your reasons for leaving the relationship.
  
  

6. Cut Off Contact, If Necessary

• In some cases, maintaining contact after leaving can prolong the pain and keep the emotional dynamics of the relationship alive. Consider cutting off contact if necessary to fully heal and move on.
• If the relationship was especially toxic or abusive, going “no contact” may be the healthiest choice for both of you.
  
  

7. Plan for Safety, If Needed

• In extreme cases, people with BPD may react unpredictably when faced with the end of a relationship. If you fear for your safety or theirs, make sure to have a plan in place. This may include involving friends, family, or professionals.
  
  

8. Avoid Being Drawn Back In

• After the breakup, you may experience attempts at reconciliation, emotional pleas, or accusations. It can be tempting to return, especially if you're emotionally invested in helping them heal. However, staying firm in your decision is crucial for your long-term well-being." (Source: ChatGPT 2024)

"Leaving a Borderline Personality Relationship

Leaving a relationship with someone who has Borderline Personality Disorder (BPD) can be incredibly challenging and emotionally taxing. 

Here are some key points to consider:

• Understand the Dynamics: Relationships with someone who has BPD can be intense and unpredictable. They may experience extreme mood swings, fear of abandonment, and impulsive behaviors 1 2.
  
  
• Emotional Preparation: Be prepared for a range of emotions, both from yourself and your partner. People with BPD may react strongly to the end of a relationship, experiencing feelings of abandonment, anger, or deep sadness 3.
  
  
• Set Boundaries: It’s important to set clear boundaries to protect your emotional well-being. This might include limiting contact or seeking support from friends, family, or a therapist 4.
  
  
• Seek Professional Help: Consider seeking therapy or counseling to help navigate your feelings and any guilt, sadness, or anger you may be experiencing. A professional can provide strategies to cope with the emotional aftermath 4.
  
  
• Self-Care: Take time to heal and focus on self-care. Engage in activities that bring you joy and help you relax. This is crucial for your emotional recovery 4.

Remember, it’s okay to prioritize your own well-being. If you need more specific advice or support, don’t hesitate to reach out to a mental health professional." (Source: Microsoft Copilot)

All About the Relationship Cycle in Borderline Personality Disorder Psych Central

Borderline Personality: Why People Find It Almost Impossible to Leave Susan Quinn

Borderline Personality Disorder & Relationships Choose Therapy

Borderline Personality And Abuse Cycle Mental Health Center America

Breaking Up With Your Loved One With BPD Psychology Today

Dating Someone with BPD: What to Expect Talkspace

Ending your Relationship with a Borderline Personality Disorder Patient Nation Africa

Facing the Facts Leaving a Partner with Borderline Personality Disorder: Borderline Personality Disorder for Beginners  Joe Carver PhD PDF Download BPDFamily

Do You Have Trauma From Dating Someone With BPD? Overcomers Counseling

Dealing with Trauma from Dating Someone with Borderline Personality Disorder (BPD) Compassion Behavioral Health

Exiting a BPD Relationship BPDFamily

How Do I Leave A BPD? Friendly House

How does BPD Splitting Destroy Relationships? Mental Health Center of America

How to Detach From Someone With Borderline Personality Disorder Marriage

How to End a Relationship When Your Partner Has BPD Patch

How to Say No to Someone with Borderline Personality Disorder Medical News Today

How BPD Affects Romantic Relationships Verywell Mind

Recovering from a Breakup with Borderline Personality Disorder THIRA Health

Saying No to Someone with Borderline Personality Disorder MentalHealth

Surviving a Break-up when Your Partner has Borderline Personality BDPFamily

The BPD Relationship Cycle Nobu

The Breakup Cycle in Borderline Personality Disorder: Understanding and Navigating Grouport

The Health Consequences of Untreated Borderline Personality Disorder Everyday Health

Understanding Chronic Feelings of Emptiness in BPD: A Qualitative Study BMC

Understanding a Mutually Destructive Relationship Between Individuals With Borderline Personality Disorder and Their Favorite Person NIH

What to Know When Your BPD Partner Ends the Relationship Choosing Therapy

What You Need to Know About Borderline Personality Disorder and Relationships Healthline

When to Leave Someone with BPD (Borderline Personality Disorder) FHE Health

Leaving A Borderline Partner, Manipulation, Hoovering, Blame - Video

🎓 Mental Health, Psychology and Relationship Resources

Borderline Personality Disorder Resources

Awareness, Symptoms and Treatment of Borderline Personality Disorder (BPD)

Treatment for Borderline Personality Disorder

“The primary driver to pathological dissociation is attachment disorganization in early life: when that is followed by severe and repeated trauma, then a major disorder of structural dissociation is created (Lyons-Ruth, Dutra, Schuder, & Bianchi, 2006).” ― Frank M. Corrigan

Symptoms of Borderline Personality Disorder (BPD)

What is Borderline Personality Disorder?

Borderline Personality Disorder

"Borderline Personality Disorder (BPD) is a mental health condition characterized by difficulties in regulating emotions and forming stable relationships. People with BPD often experience intense and unstable emotions, have a distorted sense of self, and struggle with impulsive behaviors. It is important to note that BPD affects each individual differently, and symptoms can vary in severity.

Here are some common features and symptoms associated with Borderline Personality Disorder:

1. Intense and unstable emotions: People with BPD may experience frequent and intense mood swings. They can go from feeling extremely happy to deeply depressed or irritable within a short period. These emotional shifts may be triggered by perceived abandonment, conflicts in relationships, or other stressful situations.

2. Fear of abandonment: Individuals with BPD often have an intense fear of being abandoned or rejected by others. They may go to great lengths to avoid real or imagined abandonment, such as becoming overly dependent on others or engaging in impulsive behaviors to keep people close.

3. Unstable relationships: Relationships can be challenging for individuals with BPD. They may have difficulty maintaining stable and healthy relationships due to intense emotions, fear of abandonment, and a tendency to idealize or devalue others. They might experience frequent conflicts, have difficulty trusting others, and struggle with feelings of emptiness or loneliness.

4. Impulsive behaviors: Impulsivity is common in BPD, leading individuals to engage in risky behaviors such as substance abuse, reckless driving, binge eating, self-harm, or unsafe sexual activities. These impulsive actions often serve as a way to cope with emotional pain or fill a sense of emptiness.

5. Distorted self-image: People with BPD often have an unstable and unclear sense of self. They may have difficulty understanding their own identity, values, and goals. This can result in frequent changes in career choices, hobbies, or personal beliefs.

6. Self-destructive behaviors: Individuals with BPD may engage in self-harming behaviors, such as cutting or burning themselves, as a way to cope with emotional distress. It's important to note that self-harm is not a universal feature of BPD, but it can be present in some cases.

Borderline Personality Disorder is typically diagnosed by mental health professionals based on a thorough assessment of symptoms and history. Treatment for BPD often involves a combination of psychotherapy, medication (to address co-occurring conditions), and support from a multidisciplinary team. Dialectical Behavior Therapy (DBT) is a commonly used therapy for BPD, which focuses on developing skills for emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness.

With appropriate treatment and support, individuals with BPD can make significant progress in managing their symptoms, improving relationships, and leading fulfilling lives. It's important for individuals with BPD to seek professional help and maintain consistent therapy to work towards recovery." (Source: ChatGPT 2023)

Women and BPD

"Borderline Personality Disorder (BPD) is characterized by intense emotional instability, fear of abandonment, impulsive behavior, and difficulty in maintaining stable relationships. BPD is more commonly diagnosed in women than men, which may be due to a combination of diagnostic biases and gender-specific presentations. BPD in women often involves emotional intensity and relational challenges, with some distinct features.

Key Points about BPD in Women:

1. Emotional Instability:

   • One of the core features of BPD in women is extreme emotional volatility. Women with BPD may experience mood swings that shift rapidly from feelings of joy and connection to intense anger, sadness, or feelings of emptiness.
   • These mood shifts are often triggered by perceived or actual experiences of rejection, abandonment, or criticism, even when these perceptions are not based on reality.
     
     

2. Fear of Abandonment:

   • A pervasive fear of abandonment is central to BPD, often leading women with this disorder to go to great lengths to avoid real or imagined abandonment. This can manifest in clinginess, neediness, or dramatic attempts to prevent someone from leaving.
   • Relationships may be intense and short-lived, as the woman with BPD struggles to find a balance between idealizing others and then devaluing them when they feel slighted or threatened.
     
     

3. Relationship Challenges:

   • Relationships with a woman who has BPD can be tumultuous due to intense emotional highs and lows, shifting between idealizing and devaluing their partner. They may experience strong emotional connections, but these can quickly turn into feelings of anger, betrayal, or fear.
   • Women with BPD may exhibit behaviors like emotional manipulation, passive-aggressiveness, or threats of self-harm as a means of controlling the relationship and reducing fears of abandonment.
     
     

4. Impulsivity:

   • Impulsive behaviors are common in women with BPD. These might include risky sexual behavior, substance abuse, binge eating, reckless spending, or other forms of self-destructive activity. These behaviors often serve as a way to cope with overwhelming emotions.
   • This impulsivity can lead to regret, shame, or guilt afterward, further perpetuating emotional instability.
     
     

5. Identity Disturbance:

   • Many women with BPD struggle with a fragmented or unstable sense of identity. They may not have a consistent sense of who they are, leading to frequent shifts in interests, goals, or self-image.
   • This can also affect their relationships, as they may adapt their personality to fit the expectations of others, only to feel lost or dissatisfied later.
     
     

6. Self-Harm and Suicidal Behavior:

   • Self-harming behaviors, such as cutting, are common in women with BPD, often as a means to cope with overwhelming emotions or to feel a sense of control. These behaviors may also serve as a cry for help or a way to express inner pain.
   • Suicidal ideation and attempts are also more frequent in individuals with BPD, particularly during periods of intense emotional distress or feelings of abandonment.
     
     

7. Splitting (Black-and-White Thinking):

   • Women with BPD may engage in "splitting," which means viewing people or situations in extremes (all good or all bad). This can lead to rapid shifts in how they perceive others, resulting in idealizing someone one moment and then demonizing them the next.
   • This cognitive distortion can lead to unstable and dramatic interpersonal relationships, where small conflicts escalate into full-blown crises.
     
     

8. Co-occurring Disorders:

   • BPD in women often co-occurs with other mental health conditions, such as depression, anxiety, eating disorders, and substance use disorders. The combination of these conditions can complicate diagnosis and treatment.
   • Women with BPD may also have Post-Traumatic Stress Disorder (PTSD), particularly if they have experienced early childhood trauma, abuse, or neglect, which are common risk factors for developing BPD.
     
     

9. Trauma and Abuse:

   • Many women with BPD have a history of trauma, particularly sexual, emotional, or physical abuse. These experiences can play a significant role in the development of BPD, especially if they occurred during early childhood.
   • Trauma-informed care is crucial in treating women with BPD, as unprocessed trauma may underlie many of their emotional and behavioral symptoms.
     
     

10. Social and Gender Factors:

• Gender roles and societal expectations may shape how BPD manifests in women. Women are often socialized to prioritize relationships and emotional expressiveness, which may influence the relational and emotional instability commonly seen in BPD.
• Gender biases in diagnosis could lead to more frequent identification of BPD in women, while men may be more likely diagnosed with disorders like Antisocial Personality Disorder (ASPD), even when exhibiting similar behaviors.
  
  

BPD in Relationships:

Women with BPD often have difficulty maintaining healthy, stable relationships due to the intense emotional swings and fear of abandonment. Partners may feel overwhelmed by the intensity of the relationship, particularly when the woman with BPD alternates between closeness and rejection.

Many individuals with BPD also experience difficulty managing boundaries, which can lead to codependent or emotionally draining dynamics. Friends and partners might struggle with the unpredictability and emotional demands of someone with BPD.

Treatment:

• Dialectical Behavior Therapy (DBT): DBT is one of the most effective treatments for BPD. It focuses on building skills to manage intense emotions, improve relationships, and reduce self-destructive behaviors. It also helps develop mindfulness, distress tolerance, and emotional regulation.
• Cognitive Behavioral Therapy (CBT): CBT can help women with BPD identify and challenge distorted thinking patterns (like black-and-white thinking) and develop healthier coping strategies.
• Medication: Although no medications are specifically approved for BPD, mood stabilizers, antidepressants, and antipsychotic medications may help manage some symptoms, particularly those related to mood instability or co-occurring conditions like anxiety or depression.
  
  

Treatment success varies but can be effective when the individual is committed to therapy. Recovery often requires long-term commitment, support, and a trauma-informed approach."  (Source: ChatGPT 2024)

Addressing Treatment Motivation in Borderline Personality Disorder: Rationale for Incorporating Values-Based Exercises into Dialectical Behavior Therapy Springer

Borderline Personality Disorder and Empathy Mental Health and Motivation

Borderline Personality Disorder and Nightmares Mental Health and Motivation

Borderline Personality Disorder and Self-Harm Mental Health and Motivation

Borderline Personality Disorder Clinical Trials Center Watch

Borderline Personality Disorder May Be Rooted in Trauma Scientific American

Borderline Personality Disorder (BPD): Risk Factors and Early Detection Article

Borderline Personality Disorder - Symptoms and Causes Mayo Clinic

Borderline Personality Disorder (BPD) Criteria for Diagnosis Verywell Mind

Borderline Personality Disorder (BPD) Support Groups Mental Health and Motivation

Borderline Personality Disorder and Relationships Healthline

Components of Emotion Dysregulation in Borderline Personality Disorder Article

Celebrities & Famous People With Borderline Personality Disorder Article

Chronic Complex Dissociative Disorders and Borderline Personality Disorder: Disorders of Emotion Dysregulation? BMC

DSM Definition: Borderline Personality Disorder Article

DSM-5 Diagnostic Criteria for Borderline Personality Disorder (BPD) Medscape

Dysfunction of Empathy and Related Processes in Borderline Personality Disorder
Harvard Review of Psychiatry

Emotion Regulation in Borderline Personality Disorder Article

Famous People With Borderline Personality Disorder Article

Dr. Gunderson and Borderline Personality Disorder Mental Health and Motivation

How Do You Love Someone With Borderline Personality Disorder? Bridges to Recovery

How to Communicate With Someone With BPD Verywell Mind

How Parents Can Help Their Teen Manage Borderline Personality Disorder Evolve

Moving Toward Connectedness – A Qualitative Study of Recovery Processes for People With Borderline Personality Disorder Frontiers

Quotes About BPD Traits : From Therapists Good Therapy

• Complex Trauma & Wounds
• Taught That Emotional Expression Is Unhealthy
• Background of Chaos & Abandonment
• Trouble Maintaining Distance & Intimacy
• Dysregulation
• Dreading Abandonment
• Strong Feelings of Worthlessness & Self-Harm
• High Sensitivity

Romantic Relationships Involving People With BPD Verywell Mind

Research, Articles & Publications - Australian BPD Foundation

Support Groups and Discussions Forums for BPD Mental Health and Motivation

Structure and Borderline Personality Disorder Verywell Mind

Treatments for Borderline Personality Disorder WebMD

What Is Dissociation in Borderline Personality Disorder (BPD)? Verywell Mind

What you need to know about Borderline Personality Disorder McLean Hospital

Why Do People With BPD Self-Harm? Mental Health and Motivation

Borderline Personality Disorder (BPD) Book Mentions 

Beyond Borderline : True Stories of Recovery from Borderline Personality Disorder
John G. Gunderson / Perry D Hoffman

Borderline Conditions and Pathological Narcissism

Otto F. Kernberg, M.D.

Drawing the Line : An Exploration of Otto Kernberg and Marsha Linehan's Understanding of Borderline Personality Disorder (BPD) Lili. Schwan-Rosenwald (Thesis)

Get Me Out of Here : My Recovery from Borderline Personality Disorder (BPD)
Rachel Reiland

I Hate You, Don't Leave Me - Understanding Borderline Personality Disorder (BPD)

Jerold J, Kreisman, M.D. Hal Straus

Loving Someone with Borderline Personality Disorder (BPD)

Shari Y, Manning PH.D

Leaving a Borderline Personality (BPD) Relationship Mental Health and Motivation

Siren's Dance : My Marriage To A Borderline
Anthony Walker, M.D.

Stop Caretaking the Borderline or Narcissist : How to End the Drama and Get on with Life
Margalis Fjelstad PH.D.

Stop Walking on Eggshells : Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder (BPD) Paul T. Mason / Randi Kreger

The Borderline Personality Disorder Survival Guide: Everything You Need to Know About Living with BPD Alex L. Chapman / Kim L. Gratz / Perry D. Hoffman

The Emotional Rollercoaster called Borderline Personality Disorder (BPD) Neural Correlates of Emotion Regulation and Impulsivity Linda van Zutphen

What Is Borderline Personality Disorder - Video

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