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This chapter introduces the philosophical rationale for investigating emotions in their dimensions of embodiment and existential vulnerability, drawing on phenomenology, psychopathology, and psychotherapy as complementary perspectives. Grounded in phenomenology and enactivism, it argues that emotions are essentially embodied, intersubjective phenomena through which we experience the world as meaningful in the first place. According to this approach, emotions cannot be adequately captured by cognitivist or appraisal-theoretic frameworks alone but must be explored in their embodied dimensions and intertwinement with existential vulnerability. This constitutive vulnerability is described as an ontological condition rooted in the lived body, its essential exposure to others and contingency. The Introduction surveys contemporary philosophy of emotion, mapping competing accounts across cognitive, perceptual, feeling-based, and motivational theories, before arguing that all tend to consider the richness of the lived body insufficiently. The volume’s three parts address the experiential richness of the lived body by moving from phenomenological analyses of emotional life and vulnerability, through psychopathological perspectives, to the transformative role of embodied emotions in psychotherapy. The Introduction thereby establishes embodiment as the conceptual bridge integrating emotion theory, psychopathology, and psychotherapy into a unified inquiry of emotions as a central aspect of human vulnerability.
This volume explores the interrelations between emotions, embodiment, and vulnerability through a phenomenological perspective. Scholars of philosophy, psychology, and psychiatry investigate how the fragilities of embodied existence shape emotions, how these vulnerabilities become visible in psychopathological conditions, and how they figure in therapeutic contexts. A central theme is that emotions can be understood as experiences lived through and enacted – not merely endured – showing them as fundamental to human selfhood and agency. Integrating phenomenological analyses with clinical insights, the text illuminates fluid boundaries between ordinary and pathological emotional experience. Across twenty-one chapters contributed by established researchers, this book builds a framework for understanding how emotions reveal and modulate human vulnerability.
Executive function (EF) deficits are consistently linked to psychopathology symptoms, though the mechanisms linking poor EF to symptom expression remain unclear.
Methods
The study used the Research Domain Criteria (RDoC) approach to examine relationships between teacher-reported latent psychopathology symptoms, including a general psychopathology factor (P-Factor), and EF in young children with emerging mental health problems. Participants were 804 children (70.8% male; aged 49–89 months) referred by their teachers for cognitive, emotional, or behavioral problems at school. To assess psychopathology, teachers completed the Strengths and Difficulties Questionnaire (SDQ). EF measures included inhibition, cognitive flexibility, working memory, sustained attention, and episodic memory, assessed using the NIH Toolbox, Automated Working Memory Assessment, and the Amsterdam Neuropsychological Test battery.
Results
Structural equation modeling (incorporating confirmatory factor analysis) showed reasonable model fit and supported a P-Factor structure. Correlational analyses explored EF–psychopathology associations, followed by a sensitivity analysis controlling for sex. We observed patterns of cognitive processes that showed inverse associations between EF performance and specific clinical problems. Sustained attention was positively associated with emotional problems but negatively associated with hyperactivity problems. Sex-stratified analyses revealed distinct patterns, with inhibition problems strongly linked to conduct and hyperactivity problems, but in females only.
Conclusions
The findings support poor EF as a transdiagnostic risk factor associated with incremental vulnerability for childhood psychopathology. Divergent findings for sustained attentional processes suggest they can be adaptive in some contexts but maladaptive in others. Screening for EF difficulties in children could enhance early identification and inform interventions.
This explores the phenomenon of auditory verbal hallucinations (AVHs) as an example of entanglements of spirituality and psychopathology, and looks at ‘spiritually significant voices’ (identified by those who hear them as having spiritual/religious significance). Some have proposed making a differential diagnosis between ‘genuine’ spiritual experiences and mental illness, but the criteria for making such distinctions can be controversial and misleading, based on a false presupposition that the two are mutually exclusive. Research shows that patients identify some experiences as both part of an illness and spiritually significant. Patients with a psychiatric diagnosis are often subjected to epistemic injustice, wherein their claim to know things (e.g. spiritually) is discredited owing to prejudice associated with their diagnosis. A case study explores entanglement of spirituality with AVHs and considers implications for assessment/treatment. Voices of this kind may be meaningful for those who hear them, whether or not associated with a diagnosis, and affirmation of this and patients’ positive spiritual coping, where possible, can be a positive factor in promoting recovery.
A case study of a patient diagnosed with obsessive-compulsive disorder demonstrates the entanglements of phenomenology of spirituality and psychopathology, and the implications of failing to properly understand the importance of these entanglements when planning treatment. The concepts of entanglement, pragmatic atheism, spirituality and religion are introduced. Spirituality and religion are both complex and contested concepts which elude simple definition, but a person-centred holistic model of psychiatry requires giving attention to the whole person, ‘body, mind and spirit’. The biopsychosocial model does not explicitly address spirituality, but spirituality is entangled with the biological, psychological and social aspects of the matrix. The chapter discusses the secular context within which psychiatry is generally seen to be practised (at least in the Western world), the perceived tension between science and religion that it often evokes, the nature of psychiatry as concerned with the study and treatment of mental illnesses, and the way in which these illnesses affect our self-understanding and identity as human beings.
It is proposed that spirituality and psychiatry, commonly held to be separate concerns, are in fact deeply entangled and inseparable. Meaning-making, an important concern of spirituality, is important to human well-being and needs to be taken more seriously by psychiatry. The damage done by historical antagonisms between psychiatry and religion needs to be undone by affirmation of spiritual concerns within psychiatric practice and by closer partnerships between psychiatry and faith communities. Professional boundaries need to be understood not as protecting psychiatry as secular space (which many religious patients find hostile to their spiritual concerns) but as protecting safe therapeutic space within which psychological recovery and spiritual growth may occur. Psychiatrists need to develop an interest in clinical theology, as a way of understanding the ordinary theological concerns of patients (including their ‘atheologies’). Psychiatry needs to be more spiritually attentive – to shed light on what patients desire spiritually and psychologically – rather than focussing only on the metaphorical shadows of psychopathology. Psychiatry needs to keep spirituality in mind.
Autistic traits (ATs) are associated with difficulties in social functioning, but their impact on the quantity and the quality of daily-life social interactions is not yet fully understood. Hereby, we examined the relationship between AT and daily-life social interactions in adolescents and young adults.
Methods
Data were derived from the TwinssCan cohort (N = 593). ATs were assessed using the Autism Spectrum Quotient (AQ), while the quantity and the quality of daily-life social interactions were evaluated using the Experience Sampling Methodology. Multilevel regressions were performed, with the AQ as the independent variable and each social/solitary quantity/quality variable as the dependent variable. Models were adjusted for age, sex, and general psychopathology, measured with the Symptom Checklist-90.
Results
No significant association was found between AQ total scores and quantity of social interactions. However, AQ total scores were significantly associated with quality of social interactions. Higher ATs were associated with an increased preference to be alone (B = 0.04, 95% CI 0.01–0.07), less pleasure while in-company (B = −0.02, 95% CI −0.04 to −0.01), less feeling of safety while in-company (B = −0.02, 95% CI −0.04 to −0.002), and less feeling of belongingness (B = −0.02, 95% CI −0.03 to −0.001). ATs were differently associated with the quality of social interactions depending on the familiarity. No significant associations were found between ATs and solitary qualities.
Conclusions
Our findings highlight the importance of evaluating ATs during clinical assessments, especially in adolescents and young adults, to evaluate the impact on social interactions and the potential psychopathological consequences.
Substances, such as cannabis, alcohol, and nicotine, have each been associated with an increased risk of mental health concerns in adolescence. These substances are often taken concurrently and less is known about the effects of polysubstance use. We investigated the relationship between polysubstance use and psychopathology in adolescence including internalising, externalising behaviours, and psychotic experiences (PE). As a secondary analysis, we examined gender differences.
Methods:
A sample of 4,404 15–16-year-old adolescents in 40 schools in Ireland was examined. Our exposure was single substance use (cannabis, alcohol, and nicotine) and polysubstance use within the past month. The outcome of interest was psychopathology, measured using the Strengths & Difficulties Questionnaire, and the Adolescent Psychotic Symptoms Scale. Associations were explored using mixed-effects logistic models.
Results:
Adjusted odds ratios were calculated to examine the associations between polysubstance use and each outcome, compared to substance-naive participants. A significant dose response relationship was observed, with increasing substance use associated with higher odds of general psychopathology (aOR range: 1.65–5.09), internalising behaviours (aOR range: 1.18–2.06), externalising behaviours (aOR range: 1.68–5.79), and PE (aOR range: 1.60–3.13). Females engaging in polysubstance use exhibited the poorest mental health outcomes.
Conclusion:
This study highlights the strong associations between adolescent polysubstance use and emerging mental health problems. The findings reinforce the need for mental health services to take polysubstance use into consideration during intervention. Tailored public health messaging is required, acknowledging polysubstance use as a marker for poor mental health among adolescents and young adults.
Mental health encompasses subjective well-being (SWB) as well as psychopathology (PP). SWB and PP are related but separate domains: some individuals experience high SWB despite high PP, and others experience low SWB despite minimal PP. Given substantial and heterogeneous developmental changes in both domains during adolescence, examining their co-developmental trajectories may clarify how they integrate across this period.
Methods
Using data from the Tokyo Teen Cohort (N = 2994), a population-based prospective birth cohort study, we conducted parallel process latent class growth analysis to cluster SWB–PP trajectories at ages 10, 12, 14, and 16 years. We then investigated various sociodemographic, individual, familial, and socioenvironmental correlates for each class.
Results
We identified four distinct classes: high SWB–low PP (55.0%), high SWB–mid PP (20.2%), low SWB–mid PP (17.0%), and mid SWB–high PP (7.7%). SWB declined from ages 10 to 16 years across all four classes. Lower PP did not necessarily correspond to higher SWB, and in some pairs of classes, the relationship between SWB and PP levels was reversed. When comparing the two classes with moderate PP, higher aspirations, more prosocial behavior, and better interpersonal relationships were associated with the high SWB class. In contrast, being female and having a higher household income were associated with the low SWB class.
Conclusions
Discrepant SWB–PP trajectories suggest characteristic patterns of developmental integration between these domains during adolescence. Considering their interplay may complement domain-specific approaches and inform psychosocial supports aimed at maintaining SWB even in the presence of PP.
Spirituality in Mind offers a unique, personal, and critical perspective on the complex entanglements between psychiatry, spirituality, religion, and theology. Drawing on over four decades of experience, the author explores how spirituality, despite often being overlooked or undervalued, is central to holistic, patient-centred psychiatric care. Through compelling case studies and interdisciplinary insights, the book challenges conventional symptom-focused models and advocates for a shift toward meaningful recovery. It engages with the concept of “clinical theology,” highlighting the ordinary theological concerns of patients and the need for psychiatry to be more spiritually attentive. By integrating perspectives from the critical medical humanities, this book demonstrates that spirituality is not an optional extra but a core concern of psychiatry, psychiatrists, and patients alike. Spirituality in Mind raises vital questions about the nature and purpose of psychiatric practice, offering a new vision for mental health care.
Causality extends across many areas of psychiatry, from the purely conceptual and philosophical to the interpretation of genetic, epidemiological, and neurobiological work. This book offers new, interdisciplinary perspectives on causation in psychopathology, exploring it in relation to the latest scientific and philosophical advances, as well as through psychiatric research and practice. It features contributions from many internationally known psychologists, clinical researchers, and philosophers of science actively studying the phenomenology of mental illness. The chapters are organized into four sections: The Causes Themselves; Causes, Genes, and Neuroscience; Causality and Nosology; and Causality and Phenomenology. Each main chapter is preceded by a brief introduction written by the editors and a commentary by another author in this volume. By taking a multidisciplinary approach spanning psychiatry, philosophy, and psychology, the book is written to be accessible for members of all three disciplines.
Parental differential treatment is associated with higher levels of psychopathology symptoms in children. Both higher overall levels of differential treatment (absolute/magnitude of differential treatment) and consistently favoring one child over another (relative differential treatment) are associated with risk in children. This study enhances understanding of parental differential treatment using a genetically informed twin design that clarifies child- and parent-driven effects. Participants included 632 twin pairs (Mage = 7.6 years, SD = 0.94; 96% White, 44% Rural) and parents. Parental differential treatment was assessed using an observed card game interaction and reports from mothers, fathers, and children. Twin modeling indicated heritable influences on parental hostility (h2 = .34 for females, .06 for males) and intrusiveness (h2 = .51 across the sample), suggesting that children’s heritable traits elicit parenting. Observed intrusiveness differences predicted ADHD. Absolute and relative differences in maternal discipline predicted externalizing, internalizing, and ADHD symptoms, with a similar but less strong pattern for paternal discipline. However, absolute differences in paternal affection and paternal partiality proved especially important for children’s psychopathology. Findings show children’s behavior can elicit maladaptive differences in parenting, informing interventions.
Formal thought disorder (FTD), characterized by disruptions in the flow and form of thought, is a core feature of psychosis. But its measurement is fragmented across numerous rating scales, leading to its continued neglect in both research and clinical practice. To determine if different FTD scales measure the same underlying construct, we need to assess the degree to which the content of commonly used FTD scales overlaps with each other.
Methods
We conducted a systematic review to identify all standardized, clinician-rated scales used to measure FTD in psychotic disorders. From this set, we extracted individual items and derived a consensus list of 56 discrete FTD phenomena. Two independent clinical experts conducted item-to-item mapping for every scale item onto these FTD phenomena. Content overlap between scales was quantified using Jaccard Similarity Index (JSI). We determined the overall coverage achieved via several combinations of FTD scales.
Results
The 15 scales, comprising 207 items, showed weak content overlap. The mean JSI across all scale pairs was low, and no single phenomenon featured across all scales. While some core FTD phenomena (e.g. ‘incoherence’, ‘poor speech content’, ‘drifting-off’) were represented in many scales, 20% of all identified features were idiosyncratic, appearing in only one scale.
Conclusions
Existing FTD rating scales capture a wide but heterogeneous array of symptoms with poor content overlap. This lack of harmonization challenges the comparability of mechanistic and interventional studies. We highlight the need for a consensus-based, standardized measurement of FTD and provide a comprehensive checklist to advance the research and clinical practice.
The development of psychopathology during childhood and adolescence is complex and likely to follow diverse patterns. Mapping trajectories of psychopathological difficulties may improve our understanding of the nature of emerging, resolving and persistent psychopathology. The purpose of this study is to examine trajectories of psychopathology throughout childhood and adolescence by examining multiple data sources, including questionnaire-based reports of emotional and behavioural difficulties, psychiatric diagnoses and prescribed psychotropic medications.
Methods
Group-based multi-trajectory modelling was used to identify the psychopathological trajectories. This study included 49,361 full-term live-born singleton children born between 1996 and 2003, recruited into the Danish National Birth Cohort. Strengths and Difficulties Questionnaire data were collected when the children/adolescents were 7, 11 and 18 years old. Annual information about psychiatric diagnoses and redeemed prescriptions for psychotropic medication was retrieved from nationwide registries between the ages of 1 and 18. We included six predefined dimensions to identify the trajectories: internalizing behavioural problems, externalizing behavioural problems, neurodevelopmental diagnoses, affective diagnoses, mixed psychiatric diagnoses and psychotropic medications.
Results
Six distinct trajectory groups were identified for both boys and girls. Approximately 6% of the boys and 8% of the girls receive the bulk of the psychiatric diagnoses and psychotropic medications. We found no support for ‘pure’ internalizing or externalizing patterns in any identified trajectory, as problems in one dimension often indicated the presence of problems in another dimension.
Conclusions
Our results demonstrate substantial psychiatric comorbidity and add new insights to the understanding of child and adolescent well-being and the complex patterns of developmental psychopathology.
The comorbidity of psychiatric and metabolic conditions is prevalent and poses a heavy burden on public health. Several biopsychosocial factors are known to influence both metabolic and psychiatric health, including inflammation, eating behavior, physical activity, and early life stress. Few studies, however, have examined the constellation of interrelationships among multiple risk domains simultaneously.
Methods:
Using a sample of 200 medically healthy adults enrolled in a parent study, we used Gaussian Graphical Modeling, a type of network analysis, to characterize interdependent cross-sectional associations between early life stress (childhood trauma), health behaviors (diet quality and physical activity), blood-based biomarkers of metabolic functioning (insulin resistance, HDL cholesterol, triglycerides) and inflammation (C-reactive protein [CRP]), and three domains of mental health symptoms (depressive, anxious, and post-traumatic stress symptoms). We hypothesized that the network structure would highlight a pattern whereby higher CRP, poorer diet quality, lower physical activity, and higher childhood trauma would associate with increased risk for both metabolic and psychiatric impairments.
Results:
Findings revealed a positive conditional association between CRP and childhood trauma, which may function as an intermediary process to increase risk for both metabolic impairments and psychiatric symptoms in adulthood. Further, higher physical activity was associated with lower insulin resistance and fewer depressive symptoms, and better diet quality was associated with lower CRP levels.
Conclusion:
Results highlight potential avenues for interventions aimed at reducing inflammation, improving health behavior, and addressing the effects of childhood trauma to improve physical and mental health comorbidities.
The Serbian Twin Advanced Registry (STAR), established in 2014, is a multigenerational resource for studying genetic, environmental, and epigenetic influences on behavior and development. STAR currently includes more than 9000 participants, extending the classical twin design to parents and siblings and enabling fine-grained modeling of genetic inheritance, cultural transmission, and shared environments. Methodological innovations include experimental procedures, virtual reality paradigms, and longitudinal, multi-informant assessments from childhood to adulthood, combined with molecular data collection. Published findings highlight heritable structures in executive functions, personality, and psychopathology, alongside environmentally shaped differences in behaviors such as aggression. Epigenetic studies have demonstrated associations between COMT promoter methylation and impulsivity-related traits, while ongoing genomewide analyses aim to identify environmentally mediated methylation variability. By integrating advanced methodologies with open science practices, STAR provides a sustainable platform for behavioral genetics in Serbia and contributes to international research on adaptation and psychopathology across the lifespan.
Language impairments are common in affective and psychotic disorders, yet their patterns and underlying pathomechanisms remain insufficiently understood. A transdiagnostic perspective provides a framework for identifying shared and disorder-specific language alterations across diagnostic boundaries. Combining natural language processing (NLP) with network analysis enables the investigation of complex associations between linguistic, cognitive, and psychopathological features.
Methods
Spontaneous speech from N = 372 participants (119 MDD, 27 BD, 48 SSD and 178 HC) was elicited using four Thematic Apperception Test pictures (~12 min per participant). NLP models were applied to extract latent linguistic variables across various levels, including lexical diversity, syntactic complexity, semantic coherence, and disfluencies. Network analysis was used to relate linguistic variables, psychopathology (SAPS, SANS, HAM-A, HAM-D, YMRS, TLI, GAF), and cognitive performance (attention, verbal memory, recognition, and verbal fluency).
Results
Linguistic variables formed the densest network cluster, with type–token ratio, mean length of utterance, and syntactic complexity emerging as central nodes. Psychopathology variables were less cohesive, while TLI “Impoverishment”, coherence mean, and executive functioning bridged linguistic, cognitive, and psychopathological domains. Network comparison tests revealed no significant differences in linguistic–cognitive network structure across HC, MDD, BD, and SSD.
Conclusions
Linguistic networks show high structural consistency across healthy individuals and patients, whereas psychopathological symptom networks reflect transdiagnostic profiles. These findings support a dimensional and transdiagnostic framework underscore shared language–cognition mechanisms, and highlight executive functioning as key cross-domain connection, which opens up new avenues for dimensional research into the pathophysiological and etiological mechanisms underlying language dysfunctions.
Transgender and gender diverse (TGD) people show different trajectories after gender transition. While some continue to transition, others detransition (DT), that is, stop or reverse the process. Both populations experience poor mental health, but no study has compared whether they have different psychological profiles and needs. This exploratory study compared TGD and DT participants in terms of psychopathological symptoms, personality variables, and the possible presence of eating disorders (ED) and autism spectrum disorders (ASD). A total of 29 TGD participants (M age = 28.28, 72.4% female at birth) and 21 DT participants (M age = 29.19, 66.7% female at birth) completed the Personality Assessment Inventory (PAI), the Sick-Control-One stone-Fat-Food (SCOFF), and the 10-item Autism Quotient (AQ-10). Of these, 28% screened positive for ED and 28% for ASD, and the percentage for ASD was higher in the DT group. TGD participants had elevated scores on borderline features and mania, whereas DT participants had elevated scores on anxiety-related disorders. The TGD group showed significantly higher scores on antisocial features, alcohol problems, and dominance, and significantly higher rates of self-harm; the DT group had significantly higher scores on phobias and significantly higher rates of social detachment. Both groups exhibited elevated scores on suicidal ideation, stress, and nonsupport. The results suggest that TGD and DT participants may have different psychological profiles, with TGD participants exhibiting more externalizing symptoms and DT participants reporting more neurodiversity and internalizing symptoms. The findings highlight common and distinct vulnerabilities and needs that should be considered in clinical practice.
The present chapter describes the twofold interest of the life story investigation in people experiencing mental disorders. First, life narratives provide substantial insights into mental conditions from a first-person perspective. They represent valuable testimonies of patients’ disrupted life trajectories and allow us to understand the subjective experience of mental illness. Second, analyzing the coherence and characteristics of patients’ life stories also enhances our understanding of psychopathology. We present and discuss the alterations of narrative identity possibly caused by mental disorders, either hindering the development of or disrupting the acquired abilities necessary to craft a coherent and meaningful life story. Reversely, low aptitudes in narrating one’s entire life, selecting relevant life experiences, and assembling them into a coherent story might also play a role in both the initiation and maintenance of mental disorders. Building upon these twofold interests, this chapter will open therapeutic perspectives. The importance of working with narrative material when investigating patients’ memories in psychotherapy and how to do so will be discussed.