Alleviation of dysphoria theory

The alleviation of dysphoria theory suggests that people with severe mental illness commonly have a negative self-image, which makes them vulnerable to using psychoactive substances to alleviate these feelings. Despite the existence of a wide range of dysphoric feelings the literature on self-reported reasons for use seems to lend support for the experience of these feelings being the primary motivator for alcoholism and other drug misuse

The etiology of the high prevalence of substance use disorders in patients with severe mental illness (schizophrenia or bipolar disorder) is unclear. We review the evidence of different theories of increased comorbidity, organized according to four general models: common factor models, secondary substance use disorder models, secondary psychiatric disorder models, and bidirectional models. Among common factor models, evidence suggests that antisocial personality disorder accounts for some increased comorbidity. Among secondary substance use disorder models, there is support for the super sensitivity model, which posits that biological vulnerability of psychiatric disorders results in sensitivity to small amounts of alcohol and drugs, leading to substance use disorders. There is minimal support for the self-medication model, but the accumulation of multiple risk factors related to mental illness, including dysphoria, may increase the risk of substance use disorder. Secondary psychiatric disorder models remain to be convincingly demonstrated. Bidirectional models have not been systematically examined. Further clarification of etiologic factors, including the identification of subtypes of dual diagnosis, may have implications for developing more effective prevention efforts and treatment

Genderdysphoria

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)1 defines gender dysphoria (GD) as a condition in which a person has marked incongruence between the expressed or experienced gender and the biological sex at birth. This causes clinically significant distress or impairment in social, occupational or other important areas of functioning. Individuals with GD experience a strong desire to be treated as the other gender (or some alternative gender different from their assigned gender) and/or to be rid of their sex characteristics, and/or the strong conviction of having feelings and reactions typical of the other gender (or some alternative gender). The previous diagnostic term, gender identity disorder, was rejected in the DSM-5 to avoid pathologizing identity

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Regards,
Nancy Ella
Dual Diagnosis: Open Access
Email: dualdiagnosis@emedsci.com
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