A growing body of research has found weight stigma to independently drive both morbidity and mortality, regardless of actual weight. This has, however, yet to translate into medical education and practice. Studies have shown doctors to be common sources of weight stigma, which may be driven, in part, by their medical training. Higher-weight doctors may be best placed to understand and support the health needs of higher-weight people. However, significant levels of implicit anti-fat bias towards higher-weight colleagues lingers in the medical profession. Inclusive practices and more holistic education around weight are therefore needed to support and retain higher weight doctors within the workforce, starting within medical schools. This may improve both staff experiences and patient care. This study aims to explore the experiences of higher weight medical students in the UK. This is an interpretive phenomenological study. Three higher-weight medical students (two women, 1 man, all 2nd year medical students, BMI range 31-50 kg/m2) underwent loosely structured interviews over Microsoft Teams. These were audio-recorded. Audio recordings were transcribed verbatim and underwent an interpretive phenomenological analysis. Participants reported logistic and environmental issues, such a lack of provision of larger uniform sizes or narrow small lecture room seat sizes. They also reported negative experiences with peers, teachers, and the general public in relation to their size. Despite this, higher-weight doctors were indeed felt to be important to advocate for higher-weight patients. Negative experiences seemed to stem from wider sociocultural issues and reflect the intersectional nature of weight stigma. To improve matters in the longer term, medical schools should review and update their weight-related teaching, alongside considering the accessibility of their physical environments. Medical schools could consider weight stigma as part of their current efforts to decolonise medical curricula.
Shame is a fundamental human affect that plays a central role in social regulation and psychopathology. In some individuals with antisocial personality disorder (ASPD), chronic and pathological shame—shaped by early experiences of abuse, neglect, and attachment disruption—may contribute to difficulties in affect regulation, mentalization, and interpersonal functioning, and is frequently implicated in violent and antisocial behavior. The authors describe a long-term, psychodynamically informed mentalization-based treatment (MBT) group for men with ASPD. The paper focuses on shame as a clinically organizing affect, examining how unmentalized experiences of shame and humiliation may precipitate transient collapses in mentalization, paranoia, and violent acting out. Drawing on detailed clinical material, the authors consider the developmental origins of pathological shame in early attachment relationships and explore the technical challenges of working therapeutically with profound shame states in a group context. It is proposed that addressing both individual and collective experiences of shame within a stable therapeutic group can foster a sense of safety, support the restoration of mentalizing capacity, and reduce vulnerability to violent behavior. The paper aims to extend existing mentalization-based formulations of ASPD by foregrounding shame as a central affective process within long-term group treatment.
Purpose A long-standing agenda in the field of health is developing practice-based evidence, with research driven by applied research questions and led by practitioner experts. The purpose of this paper is to contribute to a growing literature addressing this type of practice research in mental health by presenting the authors’ experiences embedding practice-based evaluation and research activity in an English NHS context. Design/methodology/approach Efforts in two multidisciplinary settings in a single mental health trust are detailed: a specialist child and adolescent mental health service team and an adult rehabilitation and recovery pathway. This work, developed to inform the meaningful integration of research-based knowledge with care delivery, is described by reference to experiences over a four-year period in which research activity was particularly productive in output compared to other periods. Findings A reflective account is provided in which conditions that animate practice research activity are considered, particularly collaboration with wider professional networks, including academic colleagues, and the involvement of junior and trainee clinicians. Originality/value The reflections presented in the paper provide insights into the “doing” of practice research activity in NHS mental health service provision and virtuous cycles of activity to embed this activity in a local context. Though based on experiences from one specific trust, this paper may have the implication of illustrating a prototype for embedding practice research in other settings across similar provider trusts in the UK.
This preregistered study examined whether the gender identity phenotype differs between autistic and non-autistic children and adolescents, as well as whether gender identity traits aggregate similarly within their families. Study 1 involved four matched groups of autistic and non-autistic gender diverse youth referred to a UK specialist gender clinic, as well as cisgender autistic and non-autistic youth (n = 45 per group). Participants completed measures of gender typicality, discontentedness, anticipated future identity, and (parent-reported) dysphoria. Despite large and significant differences between cisgender and gender diverse youth across all gender-related measures, there were no significant differences between autistic and non-autistic participants within either gender group. Study 2 assessed recalled childhood gender behaviors and current gender dysphoria in the caregivers of participants from each group (N = 203). Caregivers of gender-referred youth, regardless of autism status, reported higher current dysphoric traits than caregivers of cisgender youth, but no differences were observed in recalled childhood gender-related behavior. Overall, the findings indicate that the gender phenotype of autistic youth is comparable to that of non-autistic youth within the same gender identity group, challenging the assumption that gender diversity in autism arises from different underlying mechanisms. Clinically, these results support equitable access to gender-related care for autistic and non-autistic gender diverse youth.
Five articles in this issue's debate discuss whether we over-pathologise young people's mental health. The articles highlight the paradox between inflating diagnoses in the community and under-recognising mental health needs in health and social care settings. Co-production with young people and their families when developing services, community-based initiatives, and research projects is an important method for getting the balance right between increasing awareness and offering support for mental health problems at the earliest possible opportunity, without misinterpreting and mislabelling as 'mental illness' the emotions and behaviours of young people in response to challenging or changing life circumstances.
