This book deals with an important and not uncommon clinical problem for psychotherapists and other mental health professionals that is stressful for those who treat these patients. Yet there has been little formal research on this problem, and the clinical literature is also limited. There have been only a few comprehensive articles on chronic suicidality and there are hardly any recent books. This book will develop a broad biopsychosocial perspective on chronic suicidality that provides a framework for understanding the sources of chronic suicidality, tolerating it while working on recovery, and managing cases that promotes autonomy and psychosocial functioning. The book will offer guidelines for the management of these patients that protect therapy and that avoid less helpful interventions such as repeated hospitalization and polypharmacy.

This book deals with an important and not uncommon clinical problem for psychotherapists and other mental health professionals that is stressful for those who treat these patients. Yet there has been little formal research on this problem, and the clinical literature is also limited. There have been only a few comprehensive articles on chronic suicidality and there are hardly any recent books. This book will develop a broad biopsychosocial perspective on chronic suicidality that provides a framework for understanding the sources of chronic suicidality, tolerating it while working on recovery, and managing cases that promotes autonomy and psychosocial functioning. The book will offer guidelines for the management of these patients that protect therapy and that avoid less helpful interventions such as repeated hospitalization and polypharmacy.

Psychiatry and clinical psychology have long been divided about the roles of nature and nurture in the pathways to psychopathology. Some clinicians offer treatment almost entirely based on neuroscience. Some psychologists offer psychotherapies almost entirely based on the impact of environmental stressors. Paris argues for a balanced middle ground between nature and nurture in human development. This book reviews and integrates research showing that the key to understanding the development of mental disorders lies in interactions between genes and environment. It explores why personality is a key determinant of how people respond to stress, functioning as a kind of psychological immune system. This model represents a shift from overly simple and reductionistic constructs, based primarily on biological risks or on psychosocial risks in development. Instead, it offers a complex and multivariate approach that encourages a broader approach to treatment. This book is essential for all mental health clinicians who are interested in understanding the roles of nature and nurture in the development of psychopathology.

An Evidence-Based Critique of Contemporary Psychoanalysis assesses the state of psychoanalysis in the 21st century. Joel Paris examines areas where analysis needs to develop a stronger scientific and clinical base, and to integrate its ideas with modern clinical psychology and psychiatry. While psychoanalysis has declined as an independent discipline, it continues to play a major role in clinical thought. Paris explores the extent to which analysis has gained support from recent empirical research. He argues that it could revive its influence by establishing a stronger relationship to science, whilst looking at the state of current research. For clinical applications, he suggests while convincing evidence is lacking to support long-term treatment, brief psychoanalytic therapy, lasting for a few months, has been shown to be relatively effective for common mental disorders. For theory, Paris reviews changes in the psychoanalytic paradigm, most particularly the shift from a theory based largely on intrapsychic mechanisms to the more interpersonal approach of attachment theory. He also reviews the interfaces between psychoanalysis and other disciplines, ranging from "neuropsychoanalysis" to the incorporation of analytic theory into post-modern models popular in the humanities. An Evidence-Based Critique of Contemporary Psychoanalysis concludes by examining the legacy of psychoanalysis and making recommendations for integration into broader psychological theory and psychotherapy. It will be of great interest to psychoanalysts, psychoanalytic psychotherapists, and scholars and practitioners across the mental health professions interested in the future and influence of the field.

An Evidence-Based Critique of Contemporary Psychoanalysis assesses the state of psychoanalysis in the 21st century. Joel Paris examines areas where analysis needs to develop a stronger scientific and clinical base, and to integrate its ideas with modern clinical psychology and psychiatry. While psychoanalysis has declined as an independent discipline, it continues to play a major role in clinical thought. Paris explores the extent to which analysis has gained support from recent empirical research. He argues that it could revive its influence by establishing a stronger relationship to science, whilst looking at the state of current research. For clinical applications, he suggests while convincing evidence is lacking to support long-term treatment, brief psychoanalytic therapy, lasting for a few months, has been shown to be relatively effective for common mental disorders. For theory, Paris reviews changes in the psychoanalytic paradigm, most particularly the shift from a theory based largely on intrapsychic mechanisms to the more interpersonal approach of attachment theory. He also reviews the interfaces between psychoanalysis and other disciplines, ranging from "neuropsychoanalysis" to the incorporation of analytic theory into post-modern models popular in the humanities. An Evidence-Based Critique of Contemporary Psychoanalysis concludes by examining the legacy of psychoanalysis and making recommendations for integration into broader psychological theory and psychotherapy. It will be of great interest to psychoanalysts, psychoanalytic psychotherapists, and scholars and practitioners across the mental health professions interested in the future and influence of the field.

Childhood has long been considered the major factor in determining adult life. It sets us on the path toward or away from happiness, shapes our personality, and is a major cause of mental disorders. Or is it? Myths ofChildhood strongly challenges these assumptions usually taken for granted in contemporary society and the mental health community. With a healthy dose of scepticism toward clinical impressions and using empirically-based research from areas including behavioral genetics and attachment, Dr. Paris builds a convincing case against the primacy of childhood in the development of adult personality and psychopathology. In its place, he offers an alternative model for development and shows how mental health professionals can apply this model to clinical pracitce. Myths of Childhood represents an important addition to the ongoing debate between mental health professionals regarding nature vs. nurture. For supporters of either side , this book is a valuable resource for further exploration of this controversy.

Over the last two decades, spurred particularly by the decoding of the genome, neuroscience has advanced to become the primary basis of clinical psychiatry, even as environmental risk factors for mental disorders have been deemphasized. In this thoroughly revised, second edition of Nature and Nurture in Mental Disorders, the author argues that an overreliance on biology at the expense of environment has been detrimental to the field—that, in fact, the "nature versus nurture" dichotomy is unnecessary. Instead, he posits a biopsychosocial model that acknowledges the role an individual's predisposing genetic factors, interacting with environmental stressors, play in the etiology of many mental disorders. The first several chapters of the book provide an overview of the theories that affect the study of genes, the environment, and their interaction, examining what the empirical evidence has revealed about each of these issues. Subsequent chapters apply the integrated model to a variety of disorders, reviewing the evidence on how genes and environment interact to shape disorders including: • Depressive disorders • PTSD • Neurodevelopmental disorders • Eating disorders • Personality disorders By rejecting both biological and psychosocial reductionism in favor of an interactive model, Nature and Nurture in Mental Disorders offers practicing clinicians a path toward a more flexible, effective treatment model. And where controversy or debate still exist, an extensive reference list provided at the end of the book, updated for this edition to reflect the most current literature, encourages further study and exploration.

Childhood has long been considered the major factor in determining adult life. It sets us on the path toward or away from happiness, shapes our personality, and is a major cause of mental disorders. Or is it?
"Myths of Childhood" strongly challenges these assumptions usually taken for granted in contemporary society and the mental health community. With a healthy dose of scepticism toward clinical impressions and using empirically-based research from areas including behavioral genetics and attachment, Dr. Paris builds a convincing case against the primacy of childhood in the development of adult personality and psychopathology. In its place, he offers an alternative model for development and shows how mental health professionals can apply this model to clinical pracitce.
"Myths of Childhood" represents an important addition to the ongoing debate between mental health professionals regarding nature vs. nurture. For supporters of either side, this book is a valuable resource for further exploration of this controversy.

In the 1970s, author Joel Paris was one of the first doctors in his hospital to prescribe lithium to a psychiatric patient. In the wake of the drug's success, both in that case and countless others, why this book? As Dr. Paris' historical examination of bipolar diagnosis and critique of the spectrum demonstrates, medicine has often been prone to fads that are assumed correct until proven wrong by science. This book opens discussion about the overdiagnosis of bipolar disorder and the negative impact of this development on clinical care. Dr. Paris explores why patients are being classified as bipolar on dubious grounds and are being prescribed drugs they do not need. He explains the differences between bipolar disorder and depression without mania, personality disorders characterized by unstable mood, and impulsive disorders. A separate chapter discusses the unique issues present in the field of child psychiatry. Fads remain popular as long as they answer elusive and complex questions. Unfortunately, the bipolar spectrum being used to explain a wide variety of psychopathological phenomena has caused classic bipolar disorder to become almost lost in the shuffle. Combining research findings and personal experiences, Dr. Paris documents the damage of overdiagnosis and explores alternative treatments patients could benefit from.

Psychiatry and clinical psychology have long been divided about the roles of nature and nurture in the pathways to psychopathology. Some clinicians offer treatment almost entirely based on neuroscience. Some psychologists offer psychotherapies almost entirely based on the impact of environmental stressors. Paris argues for a balanced middle ground between nature and nurture in human development. This book reviews and integrates research showing that the key to understanding the development of mental disorders lies in interactions between genes and environment. It explores why personality is a key determinant of how people respond to stress, functioning as a kind of psychological immune system. This model represents a shift from overly simple and reductionistic constructs, based primarily on biological risks or on psychosocial risks in development. Instead, it offers a complex and multivariate approach that encourages a broader approach to treatment. This book is essential for all mental health clinicians who are interested in understanding the roles of nature and nurture in the development of psychopathology.

In the 1970s, author Joel Paris was one of the first doctors in his hospital to prescribe lithium to a psychiatric patient. In the wake of the drug's success, both in that case and countless others, why this book? As Dr. Paris' historical examination of bipolar diagnosis and critique of the spectrum demonstrates, medicine has often been prone to fads that are assumed correct until proven wrong by science. This book opens discussion about the overdiagnosis of bipolar disorder and the negative impact of this development on clinical care. Dr. Paris explores why patients are being classified as bipolar on dubious grounds and are being prescribed drugs they do not need. He explains the differences between bipolar disorder and depression without mania, personality disorders characterized by unstable mood, and impulsive disorders. A separate chapter discusses the unique issues present in the field of child psychiatry. Fads remain popular as long as they answer elusive and complex questions. Unfortunately, the bipolar spectrum being used to explain a wide variety of psychopathological phenomena has caused classic bipolar disorder to become almost lost in the shuffle. Combining research findings and personal experiences, Dr. Paris documents the damage of overdiagnosis and explores alternative treatments patients could benefit from.

Dr. Joel Paris' Overdiagnosis in Psychiatry takes a much-needed look at the dangerous epidemic of unnecessary or incorrect treatments in contemporary psychiatry. The last 30 years of psychiatry have seen the development of a system of classification aimed at establishing greater scientific credibility. Unfortunately, the current categories are based entirely on signs and symptoms rather than on causes, which remain unknown. This has inevitably made diagnosis imprecise and uncertain. The result is that well-meaning professionals can have problems separating psychopathology from normality, can be unduly influenced by diagnostic fads, and can ultimately wind up prescribing treatments that do more harm than good. Paris examines prominent examples of overused diagnoses including major depressive disorder, ADHD, bipolar-II disorder, autism spectrum disorders, and PTSD. This new edition expands on Dr. Paris' argument and offers a new section on the link between aggressive psychopharmacology and current diagnostic practices, as well as on transdiagnostic approaches to classification of mental disorders.

This text examines the fads and fallacies, both past and present, that have plagued psychiatric diagnosis, treatments and research. It argues that such practices have led to an over-diagnosis of conditions such as depression, bipolar disorder, ADHD, PTSD and autism. It examines the over-treatment of psychiatric disorders with pharmaceuticals, and asks if neuroscience will actually hold the answers to the biggest questions in the field. Thoroughly updated in light of new research, this new edition addresses some of the more recent developments in psychiatry, including behavioural genetics, genome-wide association studies, and brain imaging. It looks at new advances in psychotherapies and argues for a broad biopsychosocial model. The book will inform psychiatrists, clinical psychologists, other mental health professionals, and medical students of the limits of mental health practice and the importance of adopting cautious conservatism and the principles of evidence-based practice.

Studies reveal that nearly 10% of the adult population meet criteria for an official diagnosis of personality disorder. Personality disorders have been shown to be strongly influenced by biological and psychological factors, however, less attention has been paid to the social context of these disorders. Synthesizing over 25 years of research since the first edition, this book explores how certain social forces can amplify heritable traits into disorders. It considers these interactions in the framework of a broad biopsychosocial model. Chapters cover clinically important categories, including borderline, narcissistic, and antisocial personality, as well as topics such as modernity, exploring how rapid social change is acting as a major risk factor for these disorders. Concise, balanced, and evidence-based throughout, this important book offers a unique perspective and shows how this can inform treatment decisions for all mental health professionals. It will also be of interest to researchers in the social sciences.

The practice of psychiatry has undergone great changes in recent years. In this book, Joel Paris, MD, a veteran psychiatrist, provides a fluently written and accessible "state-of-the-field" assessment. Himself a clinician, researcher, and teacher, Paris focuses on the most striking change within the field - the diverging roles of psychopharmacology and psychotherapy in contemporary practice. Where once psychiatrists were trained in Freudian psychoanalysis - which involved, more than anything else, talking - current pressures in mental health practice, including those imposed by managed care, are leading psychiatrists to treat more and more of their patients exclusively with medication, which is cheaper and faster. At the same time, psychotherapy is increasingly not being taught to new psychiatrists-in-training, even though, as Paris reveals, there is scientific evidence that both talk therapies and medication can play an important role in the treatment of mental illness. These developments are occuring against a backdrop of exploding research in the genetics and neurobiology of mental illness that will continue to drive the field. Paris ends by contemplating how going forward psychiatry can best respond to all these forces and proposes a team-based approach to mental health care. The book will appeal both to specialists and nonspecialists, particularly psychiatric residents and fellows, medical students considering specialization in psychiatry, clinical psychologists, social workers, and general readers, especially consumers of mental health services.

Post-traumatic stress disorder (PTSD) is a serious and sometimes debilitating mental disorder. Yet only about one in ten people who are exposed to significant traumatic events develop PTSD. Since its inclusion in the Diagnostic and Statistical Manual (DSM) in 1980, the definition of PTSD has been controversial. Various changes made to the criteria have gradually widened the diagnostic criteria, which now include experiences that may not involve direct exposure to trauma, which in turn has led to PTSD to be over-diagnosed: clinicians may be tempted to seize on traumatic events in a history as an explanation of mental disorders, while patients may automatically receive the diagnosis if they experienced major trauma in the past. Myths of Trauma is a timely and important book that probes the sensitive, emotional, and often controversial subject of trauma, the difficulties associated with its diagnosis, and the over-diagnosis of PTSD. Trauma has become a catch-all for many kinds of adverse experiences, when in reality, people are significantly resilient to traumatic events. The book also explores how responses to trauma develop in the context of multiple interwoven risk factors, ranging from genetic vulnerability effecting sensitivity to the environment, as well as past adversities; how trauma has become a political issue that interferes with unbiased scientific study of its effects; and how trauma narratives can have a darker side when patients use them to justify feelings of victimhood that interfere with their own agency. Integrating and analysing the vast quantities of scientific literature on the topic, Myths of Trauma teaches us not to think about trauma in isolation or as one thing rather than many different things. The experiences of trauma deserve a place in clinical practice, and it is time for PTSD to be viewed through a more complex and multidimensional lens within the broader biopsychosocial context.

In 2013, the American Psychiatric Association published the 5thedition of its"Diagnostic and Statistical Manual of Mental Disorders"(DSM-5). Often referred to as the "bible" of psychiatry, the manual only classifies mental disorders and does not explain them or guide their treatment. While science should be the basis of any diagnostic system, to date, there is no knowledge on whether most conditions listed in the manual are true diseases. Moreover, in DSM-5 the overall definition of mental disorder is weak, failing to distinguish psychopathology from normality. In spite of all the progress that has been made in neuroscience over the last few decades, the psychiatric community is no closer to understanding the etiology and pathogenesis of mental disorders than it was fifty years ago.

In"Making the DSM-5," prominent experts delve into the debate about psychiatric nosology and examine the conceptual and pragmatic issues underlying the new manual. While retracing the historic controversy over DSM, considering the political context and economic impact of the manual, and focusing on what was revised or left unchanged in the new edition, this timely volume addresses the main concerns of the future of psychiatry and questions whether the DSM legacy can truly improve the specialty and advance its goals.

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Personality disorders have been described as "the stepchildren of psychiatry". They have only recently been recognized as categories of psychiatric illness, and still need to be better defined. So far only the category of antisocial personality disorder has been fully validated, while schizotypal and borderline categories now have reasonable acceptance. This book interprets the personality disorders as products of the interaction between social influences and other etiological factors as part of a broad biopsychosocial model, and sets out to explain how personality traits develop into personality disorders. Strongly oriented towards recent empirical findings, the author's analysis leads him to question certain common assumptions about the origins of personality disorders, and in particular the simplistic notion that they may be traced back to dramatic childhood events. He argues that although biological, psychological, and social factors are all necessary, none of them is by itself sufficient to produce personality disorder. This basic model is also a model of treatment, in which biological, experiential, and social factors should all be addressed in therapy, and his treatment recommendations focus particularly on social adjustment through the adaptive use of personality traits. Illustrated with revealing case vignettes, this balanced, humane, and rational account of a difficult and sometimes contentious area will greatly assist clinicians in the understanding and treatment of individuals with personality disorder.

Synthesizing the latest research and treatment developments, Stepped Care for Borderline Personality Disorder: Making Treatment Brief, Effective, and Accessible aims to make treatment for borderling personality disorder (BPD) more accessible by providing clinicians with innovative brief and targeted intervention methods. Focusing on integrative treatment models, it offers clinicians a vital guide to the management of patients who are difficult to treat. Acknowleding the early developmental roots of BPD, the book includes sections on BPD in adolescence, childhood precursors of the disorder, and a broad range of etiological factors. It looks at the pitfalls clinicians face when trying to treat BPD, and offers a roadmap to avoiding them.

Psychotherapy In an Age of Neuroscience is a critique of the neuroscience model that dominates contemporary psychiatric practice. It shows that while the neurosciences have made great advances, this line of research has thus far had little application to the care of patients. It criticizes the over-use of psychopharmacological interventions for common mental disorders such as depression, anxiety, and substance use. It examines why many, if not most, psychiatrists are seeing patients for 15-minute "med checks" oriented to current symptoms and DSM criteria, and are not taking the time to become familiar with the lives of their patients. The book shows that effective psychotherapeutic interventions are being under-utilized. It proposes that psychiatric practice include the use of psychotherapies that are brief and evidence-based. While most therapy will need to be carried out by psychologists and other mental health professionals, psychiatrists should take on the most complex and difficult cases that require both medication and therapy. By integrating biological and psychosocial interventions, psychiatrists can regain their reputation for breadth of vision and humanism.

The Intelligent Clinician's Guide to the DSM-5 (R) is the second edition of the widely-read book first published in 2013. This second edition is thoroughly revised, and has several new chapters describing the response to the publication of the new manual, as well as suggestions on its use in clinical practice. The Intelligent Clinician's Guide to the DSM-5 (R), Second Edition reviews the history of diagnosis in psychiatry, emphasizing the limitations for classification of our current lack of knowledge of the causes of most mental disorders. It emphasizes that, in the absence of biomarkers, current categories can only be considered provisional. It takes a critical look at schema for spectra and dimensionaliztion of diagnosis, examines the borders between normality and psychopathology, and discusses the problem of clinical utility. The book has chapters on all the major diagnoses in psychiatry, in which the main problems of diagnosis are addressed, and in which all changes in DSM-5 are described.

Acclaimed for its wisdom and no-nonsense style, this authoritative guide has now been revised and expanded with 50% new content reflecting a decade of advances in the field. Distinguished psychiatrist Joel Paris distills current knowledge about borderline personality disorder (BPD) and reviews what works in diagnosis and treatment. Rather than advocating a particular therapy, Paris guides therapists to flexibly interweave a range of evidence-based strategies, within a stepped-care framework. The book presents "dos and don'ts" for engaging patients with BPD, building emotion regulation and impulse control skills, working with family members, and managing suicidality and other crises. It is illustrated throughout with rich clinical vignettes. New to This Edition *Up-to-date findings on treatment effectiveness and outcomes. *Chapter on dimensional models of BPD, plus detailed discussion of DSM-5 diagnosis. *Chapter on stepped care, including new findings on the benefits of brief treatment. *Chapter on family psychoeducation and other ways to combat stigma. *New and expanded discussions of cutting-edge topics--BPD in adolescents, childhood risk factors, and neurobiology.

Acclaimed for its wisdom and no-nonsense style, this authoritative guide has now been revised and expanded with 50% new content reflecting a decade of advances in the field. Distinguished psychiatrist Joel Paris distills current knowledge about borderline personality disorder (BPD) and reviews what works in diagnosis and treatment. Rather than advocating a particular therapy, Paris guides therapists to flexibly interweave a range of evidence-based strategies, within a stepped-care framework. The book presents "dos and don'ts" for engaging patients with BPD, building emotion regulation and impulse control skills, working with family members, and managing suicidality and other crises. It is illustrated throughout with rich clinical vignettes. New to This Edition *Up-to-date findings on treatment effectiveness and outcomes. *Chapter on dimensional models of BPD, plus detailed discussion of DSM-5 diagnosis. *Chapter on stepped care, including new findings on the benefits of brief treatment. *Chapter on family psychoeducation and other ways to combat stigma. *New and expanded discussions of cutting-edge topics--BPD in adolescents, childhood risk factors, and neurobiology.