Background. The objective of this paper is to describe and conceptualize an unusual and probably rare condition: the intense longstanding desire to have an amputation.

Method. Structured interviews were conducted by telephone of 52 subjects (mean age: 48·6, range 23–77 years; 47 male, 4 female, 1 intersexed) self-identified as having had a desire to have an amputation.

Results. Seventeen per cent (n=9) had an arm or leg amputated with two-thirds using methods that put the subject at risk of death and one-third enlisting a surgeon to amputate their healthy limb. The most common reported reason for wanting an amputation was the subject's feeling that it would correct a mismatch between the person's anatomy and sense of his or her ‘true’ self (identity). None were delusional. For all but one subject age at onset was during childhood or early adolescence. For those who had psychotherapy or medication there was no change in the intensity of the desire for amputation. The six subjects who had an amputation at their desired site reported that following the amputation they felt better than they ever had and no longer had a desire for an amputation.

Conclusions. These preliminary results suggest the existence of an extremely unusual clinically distinct condition characterized by a lifelong desire to have an amputation of a particular limb. The condition is associated with serious negative consequences: amputation attempts, impairment and marked distress. Reflecting similarities between Gender Identity Disorder and this condition, the author suggests that it may be conceptualized as an unusual dysfunction in the development one's fundamental sense of anatomical (body) identity.

Background. The proposed revisions of the ICD and DSM diagnostic systems have led to increased interest in evaluation of diagnostic criteria. This report focuses on the DSM-IV requirement that episodes of generalized anxiety disorder (GAD) must persist for at least 6 months. Community epidemiological data are used to study the implications of changing this requirement in the range 1–12 months for estimates of prevalence, onset, course, impairment, co-morbidity, associations with parental GAD, and sociodemographic correlates.

Method. Data come from the US National Comorbidity Survey Replication (NCS-R), a US household survey carried out during 2001–2003. Version 3.0 of the WHO Composite International Diagnostic Interview (WMH-CIDI) was used to assess DSM-IV anxiety disorders, mood disorders, substance disorders, and impulse-control disorders.

Results. Lifetime, 12-month, and 30-day prevalence estimates of DSM-IV GAD changed from 6·1%, 2·9%, and 1·8% to 4·2–12·7%, 2·2–5·5%, and 1·6–2·6% when the duration requirement was changed from 6 months to 1–12 months. Cases with episodes of 1–5 months did not differ greatly from those with episodes of [ges ]6 months in onset, persistence, impairment, co-morbidity, parental GAD, or sociodemographic correlates.

Conclusions. A large number of people suffer from a GAD-like syndrome with episodes of <6 months duration. Little basis for excluding these people from a diagnosis is found in the associations examined here.

Background. While general population studies indicate an increase in the rate of psychiatric disorder in adolescence, little is known about the course of mental health and behaviour problems between childhood and adolescence in young people with severe intellectual disabilities.

Method. From a sample of 111 children with severe intellectual disability who had been identified from the registers of six special schools at 4–11 years of age, 82 were traced and reassessed 5 years later at the age of 11–17 years. Behaviour problems were assessed by means of parental interviews conducted in the family home and parent and teacher questionnaires. Parental reports of psychiatric diagnoses were checked against health records.

Results. With most behaviour problems, including aggression, destructive behaviour and self-injury, there was little difference in rates between the two assessment occasions. However, in spite of this overall pattern of stability, the rates of some behaviour problems, including overactivity, showed significant reductions between childhood and early adolescence. Persistence rates for most behaviour problems appeared comparable to those reported for similar behaviours in general population studies of children. There was no significant difference in the proportion of cases with psychiatric diagnoses between the two assessment occasions, although brief psychotic episodes emerged in three cases in adolescence.

Conclusions. The findings suggest that the prevalence of mental health and behavioural problems in young people with severe learning disabilities remains relatively stable between childhood and adolescence, although some specific behaviour problems diminish. However, a small minority of children may develop severe psychiatric disorders in adolescence.