A qualitative metasummary of detransition experiences with recommendations for psychological support.

Objective: The main goal of this article is to identify areas of psychotherapeutic work with detransitioners, that is, individuals who stop or reverse a gender transition, given the scarcity of information and resources. Methods: We conducted a systematic review and metasummary of qualitative data published until April 2023. Data were extracted, grouped, and refined to conform meta-findings. Results: The database search yielded 845 records, of which 15 comprising 2689 people who detransitioned were included in the review. A total of 582 findings were extracted, resulting in 34 meta-findings with frequencies ≥ 15 %. Two main thematic areas with several subthemes were identified. The theme "Gender transition" included "Perspectives" and "Emotions." The theme "Gender detransition" included "Driving factors," "Challenges" (a. Social and emotional difficulties, b. Lack of support and understanding, c. Negative healthcare experiences, d. Detransphobia, and e. Identity concerns), "Needs," "Growth and evolution," and "Identity and future." Based on these meta-findings, we advance broad recommendations for supporting detransitioners in their various emotional, social, and identity needs. Conclusions: Detransitioners are diverse in their experiences and perspectives and face significant challenges. Emotional validation with a focus on personal strengths and meanings, treatment of concurrent psychological issues, development of social networks, and support of identity exploration are key aspects of psychotherapeutic work with this population.

An attachment-based pilot program to promote adolescent adjustment to parental divorce.

The study aimed to assess the impact of an attachment-based intervention on adolescent adaptation to parental divorce. The Adolescent Adjustment Pilot Program to Parental Divorce (AAPPD) employed an experimental group format, targeting improvements in various adaptation indicators (life satisfaction, positive affect, and negative affect). The sample comprised 30 Chilean adolescents aged 12 to 16 (M = 13.6, SD = 1.35), with 60% females and 40% males. After the intervention, the adolescents showed a decrease in negative affect at 6 and 12 months. However, no differences were identified in other dimensions of subjective well-being considered as indicators of divorce adaptation. The findings prompt discussion on theoretical and clinical implications.

Gender detransition: A critical review of the literature.

Gender detransition is the act of stopping or reversing the social, medical, and/or administrative changes achieved during a gender transition process. It is an emerging phenomenon of significant clinical and social interest.

Destransición de género: Una revisión crítica de la literatura / Gender detransition: a critical review of the literature

Introducción. La destransición de género es el acto de detenero revertir los cambios sociales, médicos y/o administrativos conseguidos durante un proceso de transición de género. Se trata de un fenómeno emergente de gran interés a nivel clínico y social. Método. Se condujo una búsqueda sistemática en siete bases de datos entre 2010 y 2022, se rastrearon manualmente las referencias de los artículos y se consultaron libros especializados. Se realizó un análisis cuantitativo y de contenido. Resultados. Se incluyeron 138 registros, 37% correspondientes a estudios empíricos y 38,4% publicados en 2021. Se identifican al menos ocho términos para hacer referencia a la destransición, con diferencias en sus definiciones. La prevalencia difiere en función del criterio utilizado, siendo menor para la destransición/arrepentimiento (0-13,1%) que para la descontinuación de la asistencia/tratamiento médico (1,9%-29,8%),y menor para la destransición/arrepentimiento tras cirugía (0-2,4%) que para la destransición/arrepentimiento tras tratamiento hormonal (0-9,8%). Se describen más de 50 factores psicológicos, médicos y socioculturales que influyen en la decisión de destransicionar, así como 16 factores predictores/asociados a la destransición. No se encuentran guías de abordaje sanitario ni legislativo. Los debates actuales se centran en los interrogantes sobre la naturaleza de la disforia de género y el desarrollo de la identidad, el papel de los profesionales con respecto al acceso a los tratamientos médicos y el impacto de las destransiciones sobre la futura accesibilidad a dichos tratamientos. Conclusiones. La destransición de género es una realidad compleja, heterogénea, poco estudiada y escasamente comprendida. Se requiere un abordaje y estudio sistemático que permita comprender su prevalencia real, implicaciones y manejo a nivel sanitario. (AU)

Introduction. Gender detransition is the act of stoppingor reversing the social, medical, and/or administrative changesachieved during a gender transition process. It is an emergingphenomenon of significant clinical and social interest.Methods. We systematically searched seven databasesbetween 2010 and 2022, manually traced article references,and consulted specialized books. Quantitative and contentanalyses were carried out.Results. We included 138 registers, 37% of which were empirical studies and 38.4% of which were published in 2021. Atleast eight terms related to detransition were identified, withdifferences in their definitions. Prevalence estimates differ according to the criteria used, being lower for detransition/regret (0-13.1%) than for discontinuation of care/medical treatment (1.9%-29.8%), and for detransition/regret after surgery(0-2.4%) than for detransition/regret after hormonal treatment (0-9.8%). More than 50 psychological, medical, and sociocultural factors influencing the decision to detransition and16 predictors/associated factors are described. No health orlegal guidelines are found. Current debates focus on the nature of gender dysphoria and identity development, the role ofprofessionals in accessing medical treatments, and the impactof detransition on future access to these treatments.Conclusions. Gender detransition is a complex, heterogeneous, under-researched, and poorly understood reality. Asystematic study and approach to the topic is needed to understand its prevalence, implications, and management from a healthcare perspective. (AU)

Empirically supported affirmative psychological interventions for transgender and non-binary youth and adults: A systematic review.

Research suggests that transgender and non-binary (TGNB) individuals experience lower levels of psychological well-being than the general population. Although practice recommendations and guidelines exist, there is a paucity of studies evaluating the effects of psychological interventions on this group. This systematic review aimed to synthesize and analyze existing empirical affirmative psychological interventions for TGNB individuals to assess their efficacy. Eight databases (PubMed, Web of Science, PsycINFO, Scopus, LILACS, Cochrane, ProQuest, Google Scholar) were searched from January 2010 to June 2022 to identify relevant studies. Included studies needed to be randomized controlled trials, quasi-experimental, or uncontrolled pre-post. Twenty-two articles were included, of which eight had TGNB participants only, two had mixed samples with separated outcome data for TGNB participants, and 12 had mixed samples with no disaggregated data. Experimental designs, participant samples, assessed variables, and type of interventions varied widely across studies, thus preventing comparisons. Overall results suggest improvements in psychological distress, depression, anxiety, suicidality, substance-related risk behaviors, coping skills/emotion regulation, stress appraisal, self-esteem, self-acceptance, social support, minority stress, resilience, hope, positive identity, and identity acceptance, although conclusions are limited by moderate-to-high risk of bias. Future research should implement more consistent and rigorous methodological designs to assess and compare intervention efficacy.

Fibromyalgia and nonfibromyalgia chronic pain: Differences in psychological characteristics and treatment outcomes.

The aim of this study was to explore differential psychological profiles among patients with chronic pain with and without fibromyalgia, and to determine the results of the cognitive behavioral therapy (CBT) for pain. Thirty patients with chronic pain and 60 patients with fibromyalgia were referred to 10 weekly sessions of CBT in a general hospital and were evaluated in pain-related variables, psychopathological symptoms, coping strategies, resilience, and quality of life. The program was implemented in specific groups for patients with fibromyalgia and nonfibromyalgia chronic pain. After the intervention, patients with fibromyalgia showed higher levels of psychopathology, rated their health status as poorer, and presented larger amplification of symptoms, higher levels of somatization, a more ruminating style of thinking and greater distress. Patients without fibromyalgia achieved better therapeutic results in both pain intensity (d = 0.39 vs. d = 0.12) and psychopathological distress (d = 0.77 vs. d = 0.11) compared to patients with fibromyalgia. Therefore, differential profiles and limited therapeutic results in fibromyalgia patients suggest the need to outline differentiated treatments and include other therapeutic strategies.

Primary and Secondary Caregivers of People with Dementia (PwD): Differential Patterns and Implications for Psychological Support.

Very little attention has been paid to identifying the differential characteristics of primary and secondary dementia caregivers. The aims of this study were: to determine whether differences exist between primary and secondary caregivers of people with dementia (PwD) and to explore the profile of primary and secondary caregivers reporting symptoms of anxiety and/or depression. The participants were 146 caregivers of PwD, 73 primary caregivers and 73 secondary caregivers. The results revealed different patterns for each type of caregiver. Primary caregivers showed a more negative profile in terms of poorer self-rated health and higher levels of anxiety and depression: 61.6% of primary and 42.5% of secondary caregivers reported symptoms of anxiety, and 24.7% and 11% reported depression, respectively. The frequency of problem behavior, subjective burden, health, and the comorbidity between anxiety and depression were associated with depression and anxiety among primary caregivers, whereas gender (being a woman), subjective burden, health, and the comorbidity between anxiety and depression were associated among secondary caregivers. These findings may help to guide professionals in targeting psychological support programs and customizing the strategies and skills that need to be provided in accordance with the type of caregiver in question: primary or secondary. The practical implications of the findings are discussed.

Traumatic events, psychological symptoms, and aggression in male and female prisoners.

Objective: Establish the relationship between the types of traumatic experiences, number of traumas, age at the time of traumatic events with psychopathological symptoms and aggression in an Ecuadorian prison. Method: A cross-sectional study with 101 offenders from Ambato's Detention Center in Ecuador. Results: Of the prisoners in this sample, 27 have PTSD. Incarcerated individuals who have suffered intentional trauma, multiple traumas, and trauma before the age of 18 show higher levels of psychopathological symptoms and aggression. Conclusions: This study highlights the importance of mental health care in prisons. Research outcomes are relevant for future investigation in Latin American prisons for the design and implementation of trauma-related interventions. Trauma-focused interventions can prevent violence and mitigate its consequences. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Online support for family caregivers of people with dementia: a systematic review and meta-analysis of RCTs and quasi-experimental studies.

Online interventions focused on mitigating the negative impact of care on family caregivers of people with dementia have become increasingly popular recently. The aim of this systematic review and meta-analysis was to analyze the effectiveness of these online support programs and to assess whether they do indeed enhance participants' wellbeing. A systematic literature search of 5 scientific databases was performed: PubMed, PsycInfo, CINAHL, Web of Science and Cochrane Library. Online interventions published between January 2014 and July 2018 targeted at informal family caregivers of people with dementia living at home were systemically reviewed. A total of 10 randomized controlled trials (RCTs) or studies with quasi-experimental designs were found. The characteristics of the interventions varied widely, as did their duration and results. In general, the effect size found was medium-small, despite the high methodological quality of the studies. The results reveal that online support interventions are a valid resource for improving caregivers' psychological wellbeing, including depression, anxiety, burden and caregiving competence. The best results were found for multi-component interventions: psychoeducation, training in psychological strategies and skills, professional support and online forums or support groups with other caregivers. The meta-analysis indicated that family caregivers' depression levels were reduced in the intervention group (Hedges' g = -0.21, 95% confidence interval of -0.410 to -0.025; z = -2.216: p = 0.027), although no significant differences were observed between the mean changes found in the intervention and control groups in relation to anxiety, burden or competence.Online interventions targeted at family caregivers can help improve their psychological wellbeing. Nevertheless, more randomized controlled trials are required, with rigorous methodological criteria, in order to provide further evidence of the utility of these interventions which seem to be effective.

Improving clinical symptoms, functioning, and quality of life in chronic schizophrenia with an integrated psychological therapy (IPT) plus emotional management training (EMT): A controlled clinical trial.

Objective: This paper describes the results of testing a multi-component psychological therapy that includes integrated psychological therapy (IPT), together with an adaptation of emotional management therapy (EMT), versus treatment as usual (TAU), delivered in a community mental health setting for individual with chronic schizophrenia. We investigated the effectiveness of a psychological intervention on clinical symptoms, cognitive and social functioning, as well as the feasibility of treatment and its acceptance. Method: 77 outpatients were recruited, 42 in the experimental group, who were treated with IPT + EMT, and 35 participants in control condition (TAU), both during 8 months. The subjects of both groups were assessed pre and postreatment. Results: Treatment attendance was 98% in experimental group and none of patients required hospital admission during therapy, meanwhile 11 patients from the TAU group withdrew and 3 were hospitalized during therapy. After therapy, patients in the experimental group compared to TAU, reduced clinical symptoms and improved cognitive functioning and quality of life. Conclusion: Psychological therapy seems to be a feasible intervention even in the chronic stages of the disease.

Preventing cognitive decline in chronic schizophrenia: Long-term effectiveness of integrated psychological therapy and emotional management training / Prevención del deterioro cognitivo en la esquizofrenia crónica: eficacia a largo plazo de la terapia psicológica integrada y el entrenamiento en manejo de emociones

Background:effective group psychological therapies in the chronic phases of schizophrenia are rare. This paper describes the results of testing a group therapy that includes integrated psychological therapy (IPT) together with an adaptation of emotional management therapy (EMT), delivered in a sample of outpatients with chronic schizophrenia. Method: 42 patients received the psychological intervention during eight months and they were assessed at baseline, posttreatment and 1, 3, 6 and 12 months follow-up. Results: The program was well accepted, and there was only one dropped out during the therapy and 2 hospital admissions during the 20 months of contact with patients along the study. Improvements were observed in cognition, social functioning, and quality of life after the treatment, and these results were maintained to the long-term follow-up. To summarize, patients were better 12 months after the treatment than in baseline. Conclusion: the integrative psychological program applied was effective and it was well accepted and could be used in public mental health services as a protective factor, reducing hospitalizations, preventing cognitive decline, helping patients to manage their daily worries and making them feel more supported

Antecedentes: los programas de tratamiento psicológico grupal eficaces para las fases crónicas de la esquizofrenia son escasos. Este artículo describe los resultados obtenidos tras la aplicación de un programa grupal, que incluye la terapia psicológica integrada (IPT) junto con una adaptación de la terapia de manejo emocional (EMT), en una muestra de pacientes ambulatorios con esquizofrenia crónica. Método: 42 pacientes recibieron el programa durante ocho meses y se evaluaron al inicio, en el post-tratamiento y en los seguimientos de 1, 3, 6 y 12 meses. Resultados: el programa fue bien aceptado ya que únicamente hubo un abandono durante los 8 meses de tratamiento y 2 ingresos hospitalarios durante los 20 meses de duración del estudio. Se obtuvieron mejorías en la cognición, el funcionamiento social y la calidad de vida tras recibir el tratamiento, y éstas se mantuvieron en el seguimiento a largo plazo. En resumen, los pacientes estaban mejor 12 meses después de recibir el tratamiento que en la evaluación inicial. Conclusión: el tratamiento resulta efectivo, ha sido bien aceptado y podría ser útil en los servicios de salud para reducir las hospitalizaciones, prevenir el deterioro cognitivo y ayudar a los pacientes a manejar sus preocupaciones diarias

Global functioning among middle-aged patients with chronic schizophrenia: the role of medication, working memory and verbal comprehension / Funcionamiento global entre pacientes de mediana edad con esquizofrenia crónica: el papel de la medicación, la memoria de trabajo y la comprensión verbal

The chronic phase of schizophrenia is characterized by illness progression and patients encountering difficulties to return to premorbid level of functioning. The objective of this study was to describe the characteristics of a sample of patients with chronic schizophrenia, as well to assess differences between patients under and over 45 years of age. In a clinical sample of 77 chronic schizophrenia patients, we assessed basic symptoms, cognitive performance, social functioning and quality of life. All participants obtained very high scores in residual symptoms, and no differences in sociodemographic or clinical characteristics between the age groups were found. Younger patients had better cognitive performance and older patients obtained better scores for social functioning and quality of life. Number of psychotropic drugs, verbal learning delayed of SCIP, errors in WCST, Similarities and Digit Symbol Coding of WAIS were the most important variables to predict global functioning of patients over 45 years old. Increasing our understanding of differences in characteristics of the chronic phase of the illness and the profile of functioning at different ages, may help us design intervention strategies to improve adaptation in young and middle-aged patients with chronic schizophrenia

La fase crónica de la esquizofrenia se caracteriza por la progresión de la enfermedad y por las dificultades que presentan los pacientes para volver al nivel de funcionamiento premórbido. El objetivo de este estudio fue describir las características de una muestra de pacientes con esquizofrenia crónica, y conocer las diferencias entre los pacientes menores y mayores de 45 años. En una muestra clínica de 77 pacientes con esquizofrenia crónica, se han evaluado síntomas básicos, el rendimiento cognitivo, el funcionamiento social y la calidad de vida. Todos los participantes obtuvieron puntuaciones muy altas en los síntomas residuales, y no se encontraron diferencias en las características sociodemográficas o clínicas entre los grupos de edad. Los resultados señalan que los pacientes más jóvenes tienen mejor rendimiento cognitivo, y los mayores, mejor funcionamiento social y calidad de vida. El número de fármacos utilizados, los valores en la escala de aprendizaje verbal diferido del SCIP, los errores en WCST, los subtests de Semejanzas y Dígitos del WAIS fueron las variables que mejor pronostican el funcionamiento global de los pacientes mayores de 45 años. Por lo tanto, aumentar nuestra comprensión de las características de la fase crónica de la enfermedad y el perfil de funcionamiento en función de la edad, puede ayudarnos a diseñar estrategias de intervención para mejorar la adaptación en pacientes jóvenes y de mediana edad con esquizofrenia crónica

Preventing cognitive decline in chronic schizophrenia: Long-term effectiveness of integrated psychological therapy and emotional management training.

BACKGROUND: Effective group psychological therapies in the chronic phases of schizophrenia are rare. This paper describes the results of testing a group therapy that includes integrated psychological therapy (IPT) together with an adaptation of emotional management therapy (EMT), delivered in a sample of outpatients with chronic schizophrenia. METHOD: 42 patients received the psychological intervention during eight months and they were assessed at baseline, posttreatment and 1, 3, 6 and 12 months follow-up. RESULTS: The program was well accepted, and there was only one dropped out during the therapy and 2 hospital admissions during the 20 months of contact with patients along the study. Improvements were observed in cognition, social functioning, and quality of life after the treatment, and these results were maintained to the long-term follow-up. To summarize, patients were better 12 months after the treatment than in baseline. CONCLUSION: the integrative psychological program applied was effective and it was well accepted and could be used in public mental health services as a protective factor, reducing hospitalizations, preventing cognitive decline, helping patients to manage their daily worries and making them feel more supported.

Outcome of cognitive-behavioral therapy for relatives of people with severe mental disorders / Resultados de la terapia cognitivo-conductual para familiares de personas con trastorno mental severo

BACKGROUND: Over the past 20 years, research shows that families of people affected by severe mental illness (schizophrenia, bipolar disorder, and addiction) may suffer emotional distress and lack of self-esteem. AIMS: In this study, long-term effectiveness of a cognitive-behavioral treatment designed for relatives of people with severe mental illness was evaluated. METHOD: A total of 30 relatives living with a person affected by a severe mental disorder received 10 sessions of tailored cognitive-behavioral therapy. RESULTS: The study shows that the treatment was effective for the reduction of depression-anxiety symptoms, as well as for negative emotions and psychological distress. CONCLUSIONS: This psychological support program has shown to be effective as a treatment for the relatives of people with serious mental health problems both in the posttreatment and in the 12-month follow-up

ANTECEDENTES: en los últimos 20 años, la investigación muestra que los familiares de las personas afectadas por una enfermedad mental grave (esquizofrenia, trastorno bipolar y adicciones) pueden sufrir malestar emocional y falta de autoestima. OBJETIVOS: en este estudio se evalúa la eficacia a largo plazo de un tratamiento cognitivo-conductual diseñado para familiares de personas con enfermedad mental grave. MÉTODO: un total de 30 familiares que viven con una persona afectada por un trastorno mental grave recibió 10 sesiones individuales de terapia cognitivo-conductual. RESULTADOS:el tratamiento fue eficaz para la reducción de los síntomas ansioso-depresivos, así como para la disminución de las emociones negativas. CONCLUSIONES: este programa de apoyo psicológico ha demostrado ser eficaz como tratamiento para los familiares de las personas con graves problemas de salud mental, tanto en el postratamiento como en el seguimiento de los 12 meses

Outcome of cognitive-behavioral therapy for relatives of people with severe mental disorders.

BACKGROUND: Over the past 20 years, research shows that families of people affected by severe mental illness (schizophrenia, bipolar disorder, and addiction) may suffer emotional distress and lack of self-esteem. AIMS: In this study, long-term effectiveness of a cognitive-behavioral treatment designed for relatives of people with severe mental illness was evaluated. METHOD: A total of 30 relatives living with a person affected by a severe mental disorder received 10 sessions of tailored cognitive-behavioral therapy. RESULTS:   The study shows that the treatment was effective for the reduction of depression-anxiety symptoms, as well as for negative emotions and psychological distress. CONCLUSIONS: This psychological support program has shown to be effective as a treatment for the relatives of people with serious mental health problems both in the posttreatment and in the 12-month follow-up.

Normal-weight and overweight female adolescents with and without extreme weight-control behaviours: Emotional distress and body image concerns.

The objective of this study was to analyse emotional distress and concerns related to body image in 712 normal-weight and overweight adolescent girls. A total of 12.3 per cent of the normal-weight girls and 25 per cent of the overweight girls showed extreme weight-control behaviours. In normal-weight adolescents, their engagement in extreme weight-control behaviours was associated with high levels of somatic symptoms, a drive for thinness and control over eating. In overweight girls, high levels of drive for thinness and anxiety were associated with extreme weight-control behaviours. Finally, the implications for preventive and therapeutic programmes are discussed.

Effectiveness of a psychological support program for relatives of people with mental disorders compared to a control group: a prandomized controlled trial.

Families of people affected by mental illness may suffer an adverse effect on well-being. In this study, the effectiveness of a cognitive-behavioral treatment designed for relatives of people with mental health problems was evaluated. The sample comprised 50 individuals: 30 in the experimental group, who completed assessment measures in pre-posttreatment and 6 months later, and 20 participants in the control group, who were assessed at baseline and 6 months later. In the experimental group, significant improvements in well-being were observed following the treatment and 6 months later, when compared to the control group, which did not demonstrate any significant changes in outcomes between the baseline and the second assessment 6 months later. This program has proven to be effective as a treatment for the relatives of people with mental disorders. Finally, several topics that may contribute to future research are discussed.

Risky eating behaviors and beliefs among adolescent girls.

This study investigated the prevalence of weight control and binge eating behaviors in a sample of 767 adolescent girls aged 16-20 years, and the differences between adolescents with and without altered eating behaviors regarding anthropometric and body image variables and beliefs associated with eating disorders. Adolescents who engaged in unhealthy strategies were found to be at a higher risk of eating disorders, since these behaviors were accompanied by higher levels of drive for thinness and body dissatisfaction, as well as by beliefs associated with the importance of weight and body shape as a means of personal and social acceptance.

Nuevos retos en el tratamiento del juego patológico / New challenges in the treatment of disordered gambling

En este artículo se señalan los avances y retos de futuro en el tratamiento del juego patológico. El objetivo terapéutico (abstinencia o juego moderado) es actualmente objeto de controversia. Los tratamientos para la ludopatía incluyen la terapia hospitalaria, los tratamientos cognitivo-conductuales individuales o grupales, Jugadores Anónimos y la farmacoterapia, así como la prevención de recaídas. La terapia cognitivo-conductual presenta unas tasas de éxito del 50 por ciento al 80 por ciento de los casos tratados en un seguimiento a largo plazo. La farmacoterapia es un complemento cuando los pacientes tienen un estado de ánimo deprimido o un elevado nivel de impulsividad. El juego controlado puede ser una alternativa terapéutica para los jugadores jóvenes o que no presentan aún una dependencia severa. Se requiere más información sobre el tratamiento del juego on-line y de poblaciones específicas (mujeres y jóvenes). Se comentan las implicaciones de esta revisión para la práctica clínica y para las investigaciones futuras.

This paper deals with the new developments in the treatment of disordered gambling, as well as with the challenges for further research. Abstinence versus moderated gambling is an issue that raises many concerns and that needs to be addressed. Current treatment for disordered gambling involves a number of different options, including inpatient treatments, individual and group cognitive-behavioral options, Gamblers Anonymous and pharmacotherapy, as well as an intervention in relapse prevention. Cognitive-behavioral therapy may have asuccess rate ranging from 50 percent to 80 percent of treated patients in a long-term follow-up. Psychopharmacological therapy may have incremental benefit when patients have comorbid depression or high impulsivity. Responsible gambling may be a therapeutic option for young gamblers or people without a severe dependence. Further information is required about treatment for online gambling addictions and for dealing with specific populations (women and young people). Unanswered questions for future research in this field are commented upon.

Aportaciones y limitaciones del DSM-5 desde la psicología clínica / Contributions and limitations of DSM-5 from clinical psychology

La reciente publicación del Manual Diagnóstico y Estadístico de los Trastornos Mentales (5ª edición) por la Asociación Americana de Psiquiatría ha suscitado un gran debate. Una clasificación efectiva requiere un sistema fiable y válido de los cuadros clínicos para facilitar la comunicación, elegir los tratamientos, señalar la etiología, predecir los resultados y proporcionar una base sólida para la investigación. El DSM-5 es una clasificación categorial de los trastornos mentales, pero estos no siempre encajan adecuadamente dentro de los límites de un trastorno único. Hay algunas aportaciones interesantes del DSM-5, como los capítulos de adicciones y de trastornos de la personalidad. Las adicciones ya no se limitan a las sustancias químicas, sino que se extienden a los excesos conductuales (por ejemplo, el trastorno del juego). Los trastornos de personalidad no se han modificado, pero se ha añadido un modelo alternativo en la Sección III basado en un enfoque dimensional que podría sustituir a las categorías actualmente existentes. El motivo más importante de controversia es el aumento de diagnósticos psiquiátricos, así como una exigencia menos estricta para los criterios diagnósticos en las categorías antiguamente existentes. Se comentan finalmente algunas cuestiones no resueltas con vista a investigaciones futuras.

The recent release of the Diagnostic and Statistical Manual of Mental Disorders (5th edition) by the American Psychiatric Association has led to much debate. An effective classification requires a reliable and valid system for categorization of clinical phenomena in order to aid communication, select interventions, indicate aetiology, predict outcomes, and provide a basis for research. DSM-5 remains a categorical classification of separate disorders, but mental disorders do not always fit completely within the boundaries of a single disorder. There are some interesting contributions of DSM-5, such as the chapters of addictions and of personality disorders. Addiction label has also been given to behavioral excesses that have no external substance as a goal (e.g. gambling disorder). Personality disorders remain unchanged, but there is an alternative model in Section III based on a dimensional approach which might replace the current categories. The basic reason for controversy is the expansiveness of DSM-5 psychiatric diagnosis, both in terms of newly introduced categories and loosening the criteria for diagnosis in existing categories. Unanswered questions for future research in this field are commented upon.