Monthly Archives: July 2012

Treatment guidelines for Gender Identity Disorder in development

Treatment guidelines for Gender Identity Disorder in development

2012-07-10

n recent years, stories about transgender people have been front page news. The transformation of Chaz Bono, son of singers Sonny and Cher, from female to male is perhaps the most well known.

“In puberty, I felt like my body was betraying me,” Bono said in an interview. Now the nation’s top psychiatrists are beginning to talk about developing treatment guidelines for transgender people.

Mental health experts say Bono and people like him have Gender Identity Disorder (GID). “People with GID are distressed with the sense that they were born in the wrong body”, says Dr. William Byne, chair of the American Psychiatric Association Task Force that recommended forming the guidelines.

As children, for example, people with GID may insist they are a boy when they are biologically female. Experts say it becomes a problem if they become anxious because of their gender and it interferes with their relationships and work.

It’s difficult to know exactly how many people have GID. Ken Zucker, Psychologist-in-Chief at the Centre for Addiction and Mental Health in Toronto, estimates 1 in 1,000 children have the disorder, but many grow out of it. Only about 1 in 30,000 adult males and 1 in 100,000 adult females seek sex-reassignment surgery.

The Task Force believes that the guidelines will help psychiatrists improve the quality of care for transgender people.

“For all age groups, we hope that having guidelines will increase the number of psychiatrists and other mental health professionals who are trained to provide care in this area,” Byne said.

Among the issues the task force says should be considered:

That the patient knows all treatment options
That the mental health needs of transgender people are addressed
And that ethical issues surrounding treatment are discussed

The biggest concern is how to treat children. Experts say when it comes to treatment, one size doesn’t fit all. Byne hopes the guidelines will help parents make informed decisions about what’s best for their child: Should they wait and watch, discourage the cross-gender actions, or just encourage cross-gender identity?

The Task Force report was published in the journal Archives of Sexual Behavior.
Post by: Krisha Desai – CNN Medical Intern
Filed under: Psychology • Sex

Smoking mothers’ embryos ‘grow more slowly

Smoking mothers’ embryos ‘grow more slowly

Time-lapse photography has shown that embryos of smoking women develop more slowly.

French academics in an IVF clinic took regular pictures of an egg from the moment it was fertilised until it was ready to be implanted into the mother.

At all stages of development, embryos from smokers were consistently a couple of hours behind, a study showed.

The lead researcher, from Nantes University Hospital, said: “You want a baby, quit smoking”.

Smoking is known to reduce the chances of having a child. It is why some hospitals in the UK ask couples to give up smoking before they are given fertility treatment.

As eggs fertilised through IVF initially develop in the laboratory before being implanted, it gave doctors a unique opportunity to film the embryos as they divide into more and more cells.
Slow start

Researchers watched 868 embryos develop – 139 from smokers.

n the clinic the embryos of non-smokers reached the five-cell stage after 49 hours. In the smokers it took 50 hours. The eight-cell stage took 62 hours in smokers’ embryos, while non-smokers’ embryos reached that point after 58 hours.

Senior embryologist and lead researcher, Dr Thomas Freour, told the BBC: “Embryos from smoking women, they behave slower, there is a delay in their development.

“On average it is about two hours, it is significant and nobody knew that before.”

This study cannot say what impact the slower development has, or if this affected the chances of having a child.

Dr Freour speculated that “if they go slower, maybe something is starting to go wrong and they wouldn’t implant.”

His advice was simple: “You should quit smoking, it couldn’t be easier. What else can I say? You want a baby, quit smoking.”

Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield, said it was an “interesting” study which pioneered the use of new technology.

“It uses a fancy piece of equipment called an embryoscope which allows scientists to watch in real time how embryos develop without disturbing them.

“It’s early days for this machine but we need trials like this to test its potential, we know our current methods of embryo selection are based on what looks good down the microscope to a trained eye.”

The findings were presented at the European Society for Human Reproduction and Embryology (ESHRE) meeting in Turkey.

Women who fear childbirth just got something else to worry about: a recent Norwegian study found that women who were scared of giving birth ended up spending more time in labor, about 8 hours versus 6.5 for women who weren’t afraid. According to the study’s authors, 5% to 20% of pregnant women fear giving birth. The reasons vary, from the mothers being young or never having given birth before to their having pre-existing psychological problems, a lack social support or a history of abuse or bad obstetric experiences. The study also found that mothers who feared childbirth were also more likely than unafraid women to need an emergency C-section (11% versus 7%) or assistance with instruments such as forceps for vaginal delivery (17.0% versus 11%). Overall, about a quarter of women who feared childbirth delivered without any obstetric interventions, compared with nearly 45% of women who were not afraid. “Fear of childbirth seems to be an increasingly important issue in obstetric care. Our finding of longer duration of labor in women who fear childbirth is a new piece in the puzzle within this intersection between psychology and obstetrics,” study author Samantha Salvesen Adams of Akershus University Hospital at the University of Oslo in Norway said in a statement. (MORE: Patience, Mom: More Hospitals Say No to Scheduled Delivery Before 39 Weeks) The researchers studied 2,206 women from pregnancy through childbirth. When the women were 32 weeks pregnant, the researchers assessed their fear of childbirth using a standard questionnaire. Women who scored higher than 85 were considered fearful; out of all the women, 165, or 7.5%, scored higher than 85. The researchers then analyzed the time they spent in childbirth. Women who were afraid labored for an hour and 32 minutes longer than did other moms. Even after adjusting for other factors that affect labor, such as epidural anesthesia, induction and instrument-assisted delivery, fearful women took 47 minutes longer to deliver than women who had less apprehension about giving birth. The authors note, however, that despite their fear, 89% scared mothers still succeeded in delivering vaginally, as they’d intended. That proportion was close to the 93% of women without fear who also succeeded. “Generally, longer labor duration increases the risk of instrumental vaginal delivery and emergency caesarean section,” said Adams. “However, it is important to note that a large proportion of women with a fear of childbirth successfully had a vaginal delivery.” Adams suggests that elective C-section shouldn’t be routinely recommended for fearful women, since, as the study’s findings show, they can still deliver vaginally if they wish. (MORE: Pregnant Women Who Control their Epidural Dosage Use Less Medication) The authors offer two theories for why women who are afraid of labor spend more time doing it. One is that they may psych themselves out. “Mental stress is associated with physiological arousal and release of stress hormones. During labor, high levels of stress hormones may weaken uterine contractility and thereby prolong labor in women with fear of childbirth,” says Adams. Another explanation is that fear of childbirth may interfere with clear communication between the mother in labor and the obstetric staff. “Poor communication with health personnel may delay obstetric interventions,” Adams says. “There are a number of reasons why women may develop a fear of childbirth,” said John Thorp, editor-in-chief of BJOG: An International Journal of Obstetrics and Gynaecology, the journal in which the new study is published, in a statement. “This research shows that women with fear of childbirth are more likely to need obstetric intervention and this needs to be explored further so that obstetricians and midwives can provide the appropriate support and advice.”

Women who fear childbirth just got something else to worry about: a recent Norwegian study found that women who were scared of giving birth ended up spending more time in labor, about 8 hours versus 6.5 for women who weren’t afraid. According to the study’s authors, 5% to 20% of pregnant women fear giving birth. The reasons vary, from the mothers being young or never having given birth before to their having pre-existing psychological problems, a lack social support or a history of abuse or bad obstetric experiences. The study also found that mothers who feared childbirth were also more likely than unafraid women to need an emergency C-section (11% versus 7%) or assistance with instruments such as forceps for vaginal delivery (17.0% versus 11%). Overall, about a quarter of women who feared childbirth delivered without any obstetric interventions, compared with nearly 45% of women who were not afraid. “Fear of childbirth seems to be an increasingly important issue in obstetric care. Our finding of longer duration of labor in women who fear childbirth is a new piece in the puzzle within this intersection between psychology and obstetrics,” study author Samantha Salvesen Adams of Akershus University Hospital at the University of Oslo in Norway said in a statement. (MORE: Patience, Mom: More Hospitals Say No to Scheduled Delivery Before 39 Weeks) The researchers studied 2,206 women from pregnancy through childbirth. When the women were 32 weeks pregnant, the researchers assessed their fear of childbirth using a standard questionnaire. Women who scored higher than 85 were considered fearful; out of all the women, 165, or 7.5%, scored higher than 85. The researchers then analyzed the time they spent in childbirth. Women who were afraid labored for an hour and 32 minutes longer than did other moms. Even after adjusting for other factors that affect labor, such as epidural anesthesia, induction and instrument-assisted delivery, fearful women took 47 minutes longer to deliver than women who had less apprehension about giving birth. The authors note, however, that despite their fear, 89% scared mothers still succeeded in delivering vaginally, as they’d intended. That proportion was close to the 93% of women without fear who also succeeded. “Generally, longer labor duration increases the risk of instrumental vaginal delivery and emergency caesarean section,” said Adams. “However, it is important to note that a large proportion of women with a fear of childbirth successfully had a vaginal delivery.” Adams suggests that elective C-section shouldn’t be routinely recommended for fearful women, since, as the study’s findings show, they can still deliver vaginally if they wish. (MORE: Pregnant Women Who Control their Epidural Dosage Use Less Medication) The authors offer two theories for why women who are afraid of labor spend more time doing it. One is that they may psych themselves out. “Mental stress is associated with physiological arousal and release of stress hormones. During labor, high levels of stress hormones may weaken uterine contractility and thereby prolong labor in women with fear of childbirth,” says Adams. Another explanation is that fear of childbirth may interfere with clear communication between the mother in labor and the obstetric staff. “Poor communication with health personnel may delay obstetric interventions,” Adams says. “There are a number of reasons why women may develop a fear of childbirth,” said John Thorp, editor-in-chief of BJOG: An International Journal of Obstetrics and Gynaecology, the journal in which the new study is published, in a statement. “This research shows that women with fear of childbirth are more likely to need obstetric intervention and this needs to be explored further so that obstetricians and midwives can provide the appropriate support and advice.”

2012-07-09

Children who are pushed, grabbed, shoved, slapped or hit are more likely to be diagnosed with mental illness. Just one more reason to embrace alternative forms of discipline
By Bonnie Rochman | @brochman

What if we, as a society, could cut down on the incidence of mental illness by backing away from hitting, grabbing or pushing our children?

That’s a prospect raised by a new study in Pediatrics, which finds that harsh physical punishment increases the risk of mental disorders — even when the punishment doesn’t stoop to the level of actual abuse.

What qualifies as appropriate punishment is a hot-button topic among parents. The American Academy of Pediatrics opposes corporal punishment, but studies have shown that up to 80% of parents report that they rely on it to some extent. What constitutes physical punishment is also wide-ranging: everything from a light slap on the hand to an all-out whipping with a belt or a paddle.

“In the general population, there is a belief that physical punishment is O.K. as long as you’re not doing it in anger and you’re a warm and loving parent,” says Tracie Afifi, the study’s author and an assistant professor in the Department of Community Health Sciences at the University of Manitoba in Canada. “But there’s no data supporting that.”

(MORE: Why Spanking Doesn’t Work)

Afifi and colleagues decided to examine five forms of physical punishment — pushing, grabbing, shoving, slapping and hitting — that took place in the absence of even more severe acts of abuse or neglect such as punching, burning, physical neglect or sexual abuse. Other related research has not specifically included or excluded more severe types of abuse, meaning that the abuse — and not the grabbing or slapping — may be driving the relationship between physical punishment and mental disorders.

She did not examine spanking because it’s not easy to define: what’s considered spanking varies from parent to parent. But, she says, “a push is a push, and a grab is a grab.”

In the study, researchers analyzed more than 20,000 people in the U.S. who were age 20 or older: 1,258 who had experienced pushing, grabbing, shoving, slapping and hitting sometimes or very often, and 19,349 who reported they had experienced it rarely or never. They adjusted results for gender, race, marital status, education and a history of family dysfunction; if the person’s parents had drug problems or were hospitalized for mental illness, that could have affected their use of physical punishment.

Across the board, people who’d experienced physical punishment were more likely to experience nearly every type of mental illness examined. Their risk of mood disorders, including depression and mania, was 1.5 times greater than people who hadn’t been slapped or grabbed. The risk of depression alone was 1.4 times greater, which was the same rate for anxiety. People who’d been physically punished were 1.6 times more likely to abuse alcohol, and 1.5 times more likely to abuse drugs.

(MORE: How Child Maltreatment May Scar the Brain)

“There’s going to be lot of people that think that a parent absolutely needs to use physical force to raise a compliant child,” says Afifi. “It’s pretty well established that physical abuse has a negative impact on mental health, but this is showing the same effect even when you look at milder forms of physical force. This is saying that physical punishment should not be used on children of any age.”

George Holden, a professor of psychology at Southern Methodist University in Dallas who published research last year on the first real-time study of parents physically disciplining their kids, says Afifi’s findings fit into a “large constellation” of studies that show children whose parents use physical force are at greater risk for depression and anxiety. “This is yet another study documenting that this practice can result in unintended negative consequences,” says Holden. “Other studies have shown corporal punishment in childhood carries over to adulthood in terms of aggression, so there’s no reason why it wouldn’t in the area of mental health.”

Afifi hopes that “reasonable” parents will read about her research and decide to swear off physical punishment. Pediatricians can be part of the solution, talking to parents about alternative methods. “It’s never too late to stop,” she says, though she acknowledges a “cultural shift” needs to happen in order to turn the tide.

MORE: The New Science Behind Children’s Temper Tantrums

Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

Read more: http://healthland.time.com/2012/07/02/physical-punishment-increases-your-kids-risk-of-mental-illness/?iid=hl-article-editpicks#ixzz206BL2Na6

Why Women Who Fear Childbirth Spend More Time in Labor

Why Women Who Fear Childbirth Spend More Time in Labor

Women who fear childbirth just got something else to worry about: a recent Norwegian study found that women who were scared of giving birth ended up spending more time in labor, about 8 hours versus 6.5 for women who weren’t afraid.

According to the study’s authors, 5% to 20% of pregnant women fear giving birth. The reasons vary, from the mothers being young or never having given birth before to their having pre-existing psychological problems, a lack social support or a history of abuse or bad obstetric experiences.

The study also found that mothers who feared childbirth were also more likely than unafraid women to need an emergency C-section (11% versus 7%) or assistance with instruments such as forceps for vaginal delivery (17.0% versus 11%). Overall, about a quarter of women who feared childbirth delivered without any obstetric interventions, compared with nearly 45% of women who were not afraid.

“Fear of childbirth seems to be an increasingly important issue in obstetric care. Our finding of longer duration of labor in women who fear childbirth is a new piece in the puzzle within this intersection between psychology and obstetrics,” study author Samantha Salvesen Adams of Akershus University Hospital at the University of Oslo in Norway said in a statement.

(MORE: Patience, Mom: More Hospitals Say No to Scheduled Delivery Before 39 Weeks)

The researchers studied 2,206 women from pregnancy through childbirth. When the women were 32 weeks pregnant, the researchers assessed their fear of childbirth using a standard questionnaire. Women who scored higher than 85 were considered fearful; out of all the women, 165, or 7.5%, scored higher than 85.

The researchers then analyzed the time they spent in childbirth. Women who were afraid labored for an hour and 32 minutes longer than did other moms. Even after adjusting for other factors that affect labor, such as epidural anesthesia, induction and instrument-assisted delivery, fearful women took 47 minutes longer to deliver than women who had less apprehension about giving birth.

The authors note, however, that despite their fear, 89% scared mothers still succeeded in delivering vaginally, as they’d intended. That proportion was close to the 93% of women without fear who also succeeded.

“Generally, longer labor duration increases the risk of instrumental vaginal delivery and emergency caesarean section,” said Adams. “However, it is important to note that a large proportion of women with a fear of childbirth successfully had a vaginal delivery.”

Adams suggests that elective C-section shouldn’t be routinely recommended for fearful women, since, as the study’s findings show, they can still deliver vaginally if they wish.

(MORE: Pregnant Women Who Control their Epidural Dosage Use Less Medication)
The authors offer two theories for why women who are afraid of labor spend more time doing it. One is that they may psych themselves out. “Mental stress is associated with physiological arousal and release of stress hormones. During labor, high levels of stress hormones may weaken uterine contractility and thereby prolong labor in women with fear of childbirth,” says Adams.
Another explanation is that fear of childbirth may interfere with clear communication between the mother in labor and the obstetric staff. “Poor communication with health personnel may delay obstetric interventions,” Adams says.

“There are a number of reasons why women may develop a fear of childbirth,” said John Thorp, editor-in-chief of BJOG: An International Journal of Obstetrics and Gynaecology, the journal in which the new study is published, in a statement. “This research shows that women with fear of childbirth are more likely to need obstetric intervention and this needs to be explored further so that obstetricians and midwives can provide the appropriate support and advice.”

Read more: http://healthland.time.com/2012/06/29/why-women-who-fear-childbirth-end-up-spending-more-time-in-labor/?iid=hl-main-feature#ixzz2068d1Fz1

Nearly 1 in 3 Teens Sext, Study Says. Is This Cause for Worry?

Nearly 1 in 3 Teens Sext, Study Says. Is This Cause for Worry?

2012-07-05

Nearly 1 in 3 teens has sent a nude picture of him or herself to someone else, and more than half have been asked to do so, according to new research on nearly 1,000 Texas teens. The study, published Monday in the Archives of Pediatrics and Adolescent Medicine, also found that teen “sexting” is strongly linked to actual sexual behavior.

About 77% of girls aged 14 to 19 who had sent a sext reported having had intercourse, compared with 42% of those who hadn’t sexted. For boys, 82% of those who had sexted had had sex, while 46% of non-sexters had done so. The study included teens in the 10th and 11th grades, with an average age of about 16 (the overall age range spanned 14 to 19).

The new research suggests that sexting is far more common than past data have indicated. For example, one previous national study of more than 1,500 youth, published in the journal Pediatrics, found that just 1% of children and teens had sent a sext and 7% had received one. The authors of the new study, led by Jeff Temple of the University of Texas Medical Branch, take issue with the sampling of that data, however, noting that it included mainly white teens from two-parent families and many with higher-than-average incomes.

In contrast, the teens included in Temple’s study, recruited from seven public schools, were relatively evenly split between black, white and Hispanic students, with smaller percentages of Asians and mixed-race teens. But a co-author of the Pediatrics paper, David Finkelhor, director of the Crimes Against Children Research Center at the University of New Hampshire, finds the sampling in the newer research problematic as well. “The [authors] don’t describe how the schools were chosen and there’s no analysis of nonresponse,” says Finkelhor, noting that since parental permission was required for participation in the current study, those whose parents said no and were excluded might have been less likely to sext.

However, the new research does conform with earlier studies in another way, suggesting that sexts are generally not sent casually. They are typically intended to be viewed only by an intimate partner with whom the teen already has or wants to start an ongoing relationship. Whether or not the images are actually kept private depends on the trustworthiness of that partner, of course, and more importantly, on their impulse control — a trait that is not usually at its strongest during adolescence.

(MORE: Kids Sexting May Not Be as Big a Problem as We Thought)

The study found a few differences by gender: while girls and boys were equally likely to send nude images, boys were more likely to ask for one and girls were more than twice as likely to report having been asked. Girls were far more likely to say they were “bothered” by such requests, however: more than 90% were at least somewhat bothered, with a majority being bothered “a lot” or “a great deal”; nearly half of boys said that being asked for a nude photo didn’t bother them at all.

For girls, sexting was also linked with risky sexual behavior: more than half (56%) of those who’d sent a sext had had more than one sexual partner in the previous year, compared with 35% who had not sexted. Using alcohol or other drugs before sex was also more common in female sexters than non-sexters: 40% versus 27%. Among boys, only those who had been asked to send a sext were more likely to show risky sexual behaviors.

The authors theorize that these gender differences are linked to the good old double standard that characterizes sexual behavior by males as admirable and acceptable, while scorning the same activity in females. They write:

It is possible that sexting, like actual sexual behaviors, is perceived more permissibly and positively for boys…and therefore less likely to be associated with other risky behaviors. Girls, on the other hand, may risk being stigmatized for their sexting behaviors (e.g., being identified as a “slut”).

(MORE: Blogging Helps Socially Awkward Teens)

Sexting itself does carry legal risks. Even self-created images of teens are considered child pornography by law, if they are sexual in nature, and can lead to prosecution, incarceration and lifetime inclusion on sex offender registries. “The ubiquity of sexting supports recent efforts to soften the penalties of this behavior. Under most existing laws, if our findings were extrapolated nationally, several million teens could be prosecuted for child pornography,” the authors write.

Further, they note: “In an adolescent period characterized by identity development and formation, sexting should not be considered equivalent to childhood sexual assault, molestation and date rape. Doing so not only unjustly punishes youthful indiscretions, but minimizes the severity and seriousness of true sexual assault against minors.”

Our legal system criminalizes behavior that is “normal” for many teens, says psychologist Christopher Ryan, author of the bestselling Sex at Dawn, which looks at the prehistoric origins of human sexuality. “We shouldn’t panic about the fact that kids are sexual beings. We should adopt an approach based upon the Dutch understanding that we must ‘tolerate in order to control,’” he says. “Kids will be kids, whether they’re playing doctor, spin the bottle or sexting. It’s the adults and our legal institutions that have to grow up already.”

(MORE: What the U.S. Can Learn from the Dutch About Teen Sex)

But the worst fears about prosecution may have been overblown. In another Pediatrics study published in December, Finkelhor and his colleagues found that nearly 3,500 cases of sexual images produced by teens came to the attention of law enforcement agencies in the U.S. between 2008 and 2009. Two-thirds of these cases, however, had “aggravating” factors — such as involvement of an adult or use of the images by a teen to harass, bully or intimidate the victim. Teens were arrested in 18% of cases where there was no aggravating factor, and registration as a sex offender occurred in only 10 cases, nine of which involved actual sexual assault, not just the sending of images. In the tenth case, which involved a boy who sent a picture of his penis to a peer, the perpetrator had an extensive criminal history.

The research also found that the majority of the images involved in these cases — two-thirds — had been distributed by cell phone, not over the computer. However, that means one-third were posted somewhere on the Internet.

Finkelhor cautions against making too much of the new stats on sexting. “I just like to point out to people that if you look at the global measures of teen sexual behavior, all of them are moving in the direction we’d like to see: teen pregnancy is down, the number of teens with multiple sex partners is down, the percent who have ever had sexual intercourse has been declining, and the percent of teens who use contraception has been going up,” he says, adding, “I don’t think people should be complacent, but I don’t think that sexting or the Internet is looking like it’s provoking some drastic worsening of sexual risk behavior.”

(MORE: Profanity in Teen Novels: Characters Who Curse Are Often the Most Desirable)

The new research also suggests that pediatricians discuss sexting with their teen patients. Although no parent wants to imagine their child engaged in sexting, the authors argue that there may be a clinical benefit for doctors to talk about it:

Asking about sexting could provide insight into whether a teen is likely engaging in other sexual behaviors for boys and girls, or risky sexual behaviors for girls. … [Q]uestions about sexting may be easier for teens to answer honestly than questions about sex and risky sex behaviors.

The authors encourage pediatricians to use the issue to start a discussion about safer sex, concluding that it is “essential that pediatricians, adolescent medicine specialists and other health care providers become familiar with, routinely ask about and know how to respond to teen sexting.”

Is This Teen Angst or an Uncontrollable Anger Disorder?

Is This Teen Angst or an Uncontrollable Anger Disorder?

With all those raging hormones, every teenager is bound to “lose it” at one time or another. But a recent study suggests that adolescents’ attacks of anger may indicate something more serious than your standard puberty-related mood swings: nearly two-thirds of youth report having had a bout of uncontrollable anger that involved threatening violence, destroying property or engaging in violence toward others, and nearly 8% — or close to 6 million teens — meet the criteria for intermittent explosive disorder (IED), which is characterized by persistent, out-of-control anger attacks that can’t be explained by a mental or medical disorder or substance use.

The findings, by researchers at Harvard Medical School, came from national surveys of nearly 6,500 American teens, aged 13 to 17, and their parents. The researchers found that IED was more common than thought, and that it is severe and persistent; kids usually start showing signs of IED in late childhood and the disorder persists through adolescence, the authors say. IED in teens is also linked with later problems, like depression and substance abuse in adulthood.

The study found, however, that many teens weren’t getting the help they needed. Among the study participants, 38% of those with IED received treatment for emotional problems in the year prior to the survey, but only 17% of these teens — or just 6.5% of all teens who had diagnosable IED — had received treatment specifically for anger.

(MORE: Study: Playing a Video Game Helps Teens Beat Depression)

If IED could be detected and treated early, however, clinicians could help prevent a substantial amount of future violence and related mental harms, said senior author Ronald Kessler, professor of health care policy at Harvard Medical School.

To meet the definition of IED, according to the Diagnostic and Statistical Manual of Mental Disorders, a person must have three episodes of “impulsive aggressiveness grossly out of proportion to any precipitating psychosocial stressor,” at any time during their lives. In the current study, the researchers also used narrower definitions of IED that required attacks of anger within the previous 12 months and found that many teens met the standard. (The study excluded teens with other mental or emotional disorders like bipolar disorder, ADHD, oppositional defiant disorder and conduct disorder.)

“It’s a problem because it really gets in the way of your life,” says Kessler. “There are lots of things people don’t get treatment for because it doesn’t really impact them. This does. The problem is an awful lot of people have it — more than I thought — it’s awfully chronic, and it’s impairing.”

(MORE: Good Grief! Psychiatry’s Struggle to Define Mental Illness Goes Awry)

The authors find that IED is not only underdiagnosed, but understudied as well. They write: “The number of PubMed research reports dealing with panic attacks is roughly 60 times the number dealing with anger attacks even though the lifetime prevalence of IED is considerably higher than the prevalence of panic disorder.”

Part of the problem may be that overly angry or aggressive people fail to acknowledge their own behavior. “I think one reason [IED] is understudied is that people who have these anger problems very often do not consider it a problem. They don’t go in for help. They may get arrested, but they don’t seek help on their own,” says Kessler. “Some things like this and other social disorders can fall through the cracks, and this is one of them.”

The authors say further research is needed to understand the risk factors for IED in teens and to improve diagnosis, screening and treatments.

The findings are published in the journal Archives of General Psychiatry.

Infertility Too Much Coffee Could Hurt Women’s Chances of IVF Success

Infertility Too Much Coffee Could Hurt Women’s Chances of IVF Success

Women who drank five or more cups of coffee a day were about 50% less likely to get pregnant through in-vitro fertilization (IVF) than non-drinkers, according to a recent Danish study.

“Although we were not surprised that coffee consumption appears to affect pregnancy rates in IVF, we were surprised at the magnitude of the effect,” said lead researcher Dr. Ulrik Schiøler Kesmodel of the Fertility Clinic of Aarhus University Hospital, in Denmark, in a statement.

For the study, presented at the annual meeting of the European Society of Human Reproduction and Embryology in Istanbul, Kesmodel and his colleagues followed nearly 4,000 women receiving IVF or intracytoplasmic sperm injection (ICSI) treatments in a large Danish fertility clinic. The women reported their coffee consumption at the start of treatment and at the start of each cycle. The researchers controlled for a variety of factors: the women’s age, smoking and alcohol consumption, the cause of their infertility, weight, ovarian stimulation and number of retrieved embryos.

Their findings showed that the relative chances of pregnancy were cut in half for women who drank more than five cups of coffee per day — “comparable to the detrimental effect of smoking” the authors noted — but there was no effect in women who drank less coffee.

(MORE: Coffee: Drink More Live Longer?)

“There is limited evidence about coffee in the literature, so we would not wish to worry IVF patients unnecessarily,” said Kesmodel in a statement. ”But it does seem reasonable, based on our results and the evidence we have about coffee consumption during pregnancy, that women should not drink more than five cups of coffee a day when having IVF.”

The assumption is that it’s the caffeine in coffee that may interfere with IVF success, but as Kesmodel told the BBC, there are so many substances in coffee, it’s hard to know for sure. However, researchers have long sought to understand whether caffeine affects fertility, and previous studies have found mixed results. Some data suggest that coffee drinkers are more likely to miscarry, while others have found the opposite. Some studies have also linked high caffeine consumption with lower odds of pregnancy, low birthweight and preterm birth, but a 2009 Cochrane review of gold-standard trials couldn’t confirm any benefits of avoiding caffeine during pregnancy.

Women who enjoy a cup-o-joe in the morning shouldn’t fret. “The fact that we found no harmful effects of coffee at lower levels of intake is well in line with previous studies on time-to-pregnancy and miscarriage, which also suggest that, if coffee does have a clinically relevant effect, it is likely to be upwards from a level of four-to-six cups a day,” said Dr. Kesmodel.