The American journal of psychiatry
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The tendency for the cycle of abusive and neglectful parenting to be transmitted across generations has been well documented. The authors report on 40 families who broke this family pattern. The mechanisms for change used in these families included reliance on a broad network of resources, a degree of self-differentiation, an attitude of realistic optimism, and the ability to marshall extra resources to meet crisis situations. The authors recommend further study of such exceptions and a more hopeful approach to the problem of abusive families.
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The authors present the proposed DSM-III classification of the traditional hysterical disorders, i.e., disorders that suggest physical illness but in which psychological factors are judged to be of importance. The use of the DSM-III inclusion and exclusion criteria--physical mechanism explains the symptoms, symptoms are linked to psychological factors, symptom initiation is under voluntary control, and there is an obvious recognizable environmental goal--are discussed in the differential diagnosis of somatoform disorder, factitious disorder, malingering, psychological factors affecting physical condition, and undiagnosed physical illness.
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Our largely separate mental health system has developed in relationship to a health care system oriented toward specialization and solo practice. Now the health care system is moving in the direction of primary care and group and organizational practice. ⋯ Issues discussed include mutual roles, changes in services, the referral process, and provider relationships. The advantages of such integrated programs include decreased stigma, increased prevention through earlier detection and referral, increased family orientation, greater coordination of care, and less duplication.
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The authors conducted prenatal interviews and behavior observation sessions with 46 families in which the woman was pregnant. These families were again interviewed and observed 7 days, 1 month, 2 months, and 6 months after the child was born. The authors found that the most significant variable predicting the variance of maternal attachment was the length of separation of mother and infant: less separation was associated with greater attachment. The next most significant variable was birth experience, followed in importance by the length of labor and prenatal attitudes and expectations.