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Premenstrual dysphoric disorder (PMDD) is a new Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnosis characterized by the cyclical emergence of emotional and physical symptoms in the luteal phase of the menstrual cycle, with symptom remission in the follicular phase. Converging evidence highlights the possibility of distinct subtypes of PMDD with unique pathophysiologies, but temporal subgroups have yet to be explored in a systematic way.
In the current work, we use group-based trajectory modeling to identify unique trajectory subgroups of core emotional and total PMDD symptoms across the perimenstrual frame (days −14 to +9, where day 0 is menstrual onset) in a sample of 74 individuals prospectively diagnosed with DSM-5 PMDD.
For the total daily symptom score, the best-fitting model was comprised of three groups: a group demonstrating moderate symptoms only in the premenstrual week (65%), a group demonstrating severe symptoms across the full 2 weeks of the luteal phase (17.5%), and a group demonstrating severe symptoms in the premenstrual week that were slow to resolve in the follicular phase (17.5%).
These trajectory groups are discussed in the context of the latest work on the pathophysiology of PMDD. Experimental work is needed to test for the presence of possible pathophysiologic differences in trajectory groups, and whether unique treatment approaches are needed.
In the history of clinical psychology and psychiatry, troublesome children and adolescents have been referred to with a variety of labels. This chapter focuses on the role of reinforcement in both the early- and late-starter pathways. According to reinforcement theory, anti-social behaviour is learned and practiced within the child's social environment. For many years, parenting practices have been recognized to be among the most powerful predictors of anti-social behavior. The reinforcement theory has also been tested in the context of intervention trials. From a reinforcement point of view, contextual factors, such as family stress and neighbourhood, all affect the microsocial interactions within relationships. Thus, the effects of the larger context on anti-social behaviour are hypothesized, at least in part, to be mediated through the microsocial interactions. A reinforcement model offers a strong tool with which we can address the problems of anti-social behavior.
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