document_title: Star-Lord

question_text: who is peter from guardians of the galaxy father

text: Star-Lord

text: Publication history[edit]

text: The character first appeared in the black-and-white magazine publication Marvel Preview #4 (Jan 1976). Creator Steve Englehart had plans for the character that went unrealized. He later reflected on his website:

text: I conceived something very large. My hero would go from being an unpleasant, introverted jerk to the most cosmic being in the universe, and I would tie it into my then-new interest in astrology. After his earthbound beginning, his mind would be opened step by step, with a fast-action story on Mercury, a love story on Venus, a war story on Mars, and so on out to the edge of the solar system, and then beyond.

text: But – after his earthbound beginning, where I established him as an unpleasant, introverted jerk, I left Marvel, so no one ever saw what he was to become.[2]

text: Star-Lord continued to appear in Marvel Preview, with writer Chris Claremont revamping the character and using science fiction adventure stories like the Heinlein juveniles for inspiration.[3] Heinlein's lawyers threatened legal action over the cover to Marvel Preview #11, which featured a blurb that described the content as "a novel-length science fiction spectacular in the tradition of Robert A. Heinlein", leading to the issue being pulled and reprinted.[4] The story in #11 was the first teaming of the celebrated X-Men creative trio of writer Chris Claremont, penciller John Byrne, and inker Terry Austin. Star-Lord made sporadic appearances over the next few years in the titles Marvel Super Special,[5] Marvel Spotlight,[6][7] and Marvel Premiere.[8][9] The Marvel Spotlight installments, which were Star-Lord's first appearance in a traditional comic book format, served to consolidate the separate but complimentary origin stories from his two appearances in Marvel Preview.[10] In February 1982, a color reprint of the black-and-white Starlord story from Marvel Preview #11 was published with a new framing sequence by Claremont and artist Michael Golden.[11][12]

text: The character returned in Thanos #8–12 (May–Sept. 2004) and Annihilation #1-6 (2006). The following year, he received a four issue eponymous title (Annihilation: Conquest – Star-Lord) leading into the "Annihilation: Conquest" crossover storyline, in which he played a central role. Spinning out of "Annihilation: Conquest", a second volume of Guardians of the Galaxy featured a team of characters from the crossover who were led by Star-Lord for the duration of the title's 25-issue run. Plot lines from that series were concluded in The Thanos Imperative mini-series.

text: After Star-Lord's introduction to Earth-616 in 2004, the appearances of "classic" Star-Lord have been officially designated as occurring in Earth-791 due to continuity issues.[13]

text: Star-Lord returned, along with other members of the Guardians, in Avengers Assemble #4-8 (June–Oct. 2012). He stars in Guardians of the Galaxy vol. 3, a part of the Marvel NOW! relaunch.[14]

text: In July 2014, Star-Lord received his own ongoing series, Legendary Star-Lord. The character was also given a new costume, matching that seen in the Marvel Studios film Guardians of the Galaxy [15]

text: His solo series and Guardians of the Galaxy vol. 3 ended as Marvel began its 2015 "Secret Wars" storyline.[16] Star-Lord appeared as a main character in the core Secret Wars miniseries, and in a tie-in miniseries during the event, Star-Lord and Kitty Pryde.[17]

text: During publication of "Secret Wars", Marvel premiered a new ongoing Star-Lord series, written by Sam Humphries, as part of the All-New, All-Different Marvel initiative, which focused on the character's revamped origins. This series also saw him leave the Guardians of the Galaxy, and replaced by his fiancée Kitty Pryde, who took over the identity of Star-Lord on the team's roster.[18] The series last for eight issues.[19] A subsequent Star-Lord ongoing series written by Chip Zdarsky began in December 2016.[20]

text: Fictional character biography[edit]

text: When J'son's ship crash lands on Earth, he is taken in by Meredith Quill. The two form a relationship while J'son makes repairs to his ship. Eventually, J'son is forced to leave to return home and fight in a war. He leaves, not knowing Meredith is pregnant with Peter Quill. Ten years later, Meredith is killed when she is attacked by two Badoon soldiers who have come to kill Peter and end J'son's blood line. Peter finds his father’s gun by accident, kills them with a shotgun, and escapes his home before it is destroyed by the Badoon ship. The Badoon presume Peter has been killed and leave. Peter is placed in an orphanage and eventually joins NASA.[21]

text: Later, when his ship malfunctions and he is stranded in space, Peter is found by the Ravagers, a group of space pirates led by Yondu. After the Ravagers saved Peter, he tried to steal their ship. Peter managed to outsmart every member of the Ravagers and even knocked out Yondu before capturing him. After he woke up, Yondu managed to set himself free from his restraints and attacked Peter and gave him a choice between letting himself be released to space without more trouble or get killed right there. Peter instead asked him if he could join his crew. Yondu was not sold on the idea but after he found out Peter was like him as they were both "kids without homes", Yondu changed his mind and let him stay in the ship with the Ravagers as their cleaning boy. Peter decided to stay and try to learn everything he could from space while he was part of the Ravagers.[22]

text: The character encountered the former Herald of Galactus, the Fallen One, and is almost killed defeating the entity, and in addition Star-Lord's vessel "Ship" is destroyed in the conflict. The pair are subsequently imprisoned in the intergalactic prison the Kyln.[23][24][25][26][27] Star-Lord is freed by the hero Nova during the Annihilation War and aids in the war against villain Annihilus.[28][29][30][31][32][33] Quill later acts as military adviser to the Kree General Ronan the Accuser.

text: When the Kree homeworld of Hala is conquered by the Phalanx, Star-Lord leads a band of rebels against the invaders until the war is over.[34][35][36][37] In an effort to prevent another interstellar war, Star-Lord forms a new version of the Guardians of the Galaxy. They are "proactive" and try to end emerging galactic threats early,[38] but are unsuccessful at preventing a war between the Kree and Shi'ar. During a war with an invading universe, Star-Lord and Nova are prepared to sacrifice themselves to defeat Thanos[39] but only Nova dies and Thanos escapes.[40][41][42]

text: New Guardians and Kitty Pryde[edit]

text: Peter decides to remain inactive for a time until he found out his father was planning to pass a law that forbade any interaction of extraterrestrial or space origin with Earth. Knowing this would be an open invitation for invasion, Peter decides to reform the Guardians with six members: Gamora, Rocket, Groot, Drax, and Bug, along with himself, and start protecting Earth from any attack. Soon they aid the Avengers against the returned Thanos.[43][44][45][46][47][48] After this, Star-Lord and his new team of Guardians engage in conflicts with the Badoon. He is soon captured by the army of Spartax but he escapes imprisonment and broadcasts a video showing the unfairness of his father's reign.[49][50][51][52] During the war of the builders, he infiltrated the S.W.O.R.D. facilities and rescued Abigail Brand along with Rocket and new member Angela.[53] He also declared war against the Shi'ar empire after intervening in one of their trials to rescue the kidnapped young Jean Grey along with the X-Men. It was during this mission when he met Kitty Pryde, the woman with whom he would initiate a romantic relationship before long.[54][55][56] After that, all the Guardians were cornered and captured by the Spartax army. Peter was sent to Spartax where he confronted his father again and escaped after exposing once again his father's tyrannical reign. This time a riot formed in the Empire and J'son was deposed as a consequence. Peter decided to keep a low profile and dedicated completely to his long distance relationship with Kitty, the two eventually falling in love with each other. Soon he discovered he was elected by the Spartax people to be their new Emperor.[57] Peter ignored the announcement and kept focusing on Kitty and his search for a gangster named Mr. Knife who had put a bounty on his head. After being captured by Knife, he found out his real identity was J'son, his father. He escaped thanks to Kitty and both disappeared from the radar to spend some time together. Peter convinced Kitty to stay in space with him and both consummated their relationship before deciding to steal an important artifact from J'son as payback.[58]

text: The Black Vortex[edit]

text: Peter and Kitty were successful in stealing the artifact called The Black Vortex, but found themselves outnumbered by J'son's killing squad so they decided to call the X-Men and the remaining Guardians for help. Knowing the artifact could give them the needed power to defeat J'son, Peter wanted everyone to submit to the Vortex to gain cosmic powers. Kitty stood against the idea but some of their friends submitted anyway. After failing to stop them, the submitted cosmic warriors attacked Hala and Peter went with a team to help the Kree in the battle. After some failed negotiations for the Vortex his team had to escape, but J'son found them and destroyed Hala in retaliation. Peter escaped on time. After finding Spartax had been completely covered in amber by Thane, including Kitty, Peter lamented not having heard her since the beginning and apologize to her. Kitty escaped thanks to her phasing powers and both had a reunion. Seeing no other way to defeat J'son and his cosmic empowered team, Peter tried to submit to the Vortex but after seeing the power would eventually make him push Kitty away, he refused. Kitty ended up submitting and saving Spartax. After the war ended, Peter had a romantic talk with Kitty where he proposes to Kitty Pryde, a proposal which she accepts.[59]

text: Secret Wars[edit]

text: When the universe is facing its imminent end, Star-Lord and the rest of the Guardians of the Galaxy come to the world's final battle against the Children of Tomorrow. During the battle, Groot and Rocket Raccoon are killed, and Star-Lord is teleported away by Reed Richards to his ship. In the end, he is one of the few survivors of the apocalypse aboard the Fantastic Four's "life raft".[60] After the end of the universe, Doctor Doom somehow creates a new, patchwork world formed from the remains of dead universes. The life raft that Star-Lord was on remained in cryostasis for the next eight years, until they are awakened by Doctor Strange, a new Thor, and Miles Morales.[61] Doom becomes aware of their location, and ambushes them. Knowing they are the only hope of reviving the old universe, Strange casts a spell to spread the survivors across the world using the wind, with Doom vowing to find them.[62]

text: Star-Lord ends up in the domain of Manhattan, where he gets a job singing in the popular club, "the Quiet Room", singing Disney songs, as Disney films never existed in Battleworld, using the alias of Steve Rogers to hide from Doom. It is here that he runs into an alternate universe version of Kitty Pryde (from the Age of Apocalypse universe), who is hunting down artifacts from before Battleworld's creation. Hoping to talk to who he believes is his fiancé, he accidentally messes up a deal between Kitty and Gambit to obtain an ancient artifact. Gambit leaves, but Kitty uses a scanner to discover that Star-Lord is from before Battleworld's creation, and plans on taking him to Doom. However, they are ambushed by a group of robots connected to Gambit. The two decide to steal an artifact that Gambit has, but it was a trap and the two are captured. Right before Gambit can kill them, a version of Drax appears, who originally hired Peter to work in the Quiet Room, and knocks out Gambit. The three escape with the artifact secured. When they are safe the next morning, Kitty shows it to the two, only to find out its Rocket Racoon's tail. Star-Lord laments the death of his friend, and Kitty decides to allow him to keep it, as it is the one thing left of his old universe. Star-Lord thanks Kitty, who kisses him before heading back to her home of Doomguard. Realizing the two are out of a job for abandoning the Quiet Room in the middle of a show, Star-Lord and Drax decide to go back into Star-Lord's old career as a thief. He asks Drax if he knows a good geneticist, as he plans on using Rocket's tail to make a clone of his friend, possibly an army of them.[63]

text: During the final stand against God Doom, Peter not only piloted a ship to take the two Reed Richards' to the heart of Castle Doom, but also managed to keep Black Swan occupied by using the last twig of Groot, kept in his pocket ever since the Incursions to be planted at the crucial moment.[64]

text: All-New, All-Different Marvel[edit]

text: Following the restoration of reality, Peter ascended to the throne of Spartax, with Rocket taking over leadership of the Guardians while Kitty- now under the alias of Star-Lady- and the Thing- following the disbanding of the FF while the Richards' family worked to restore the multiverse- joined the team.[65] After Kree accuser Hala and the ruthless Yotat the Destroyer caused mass destruction on Spartax while trying to eliminate Quill, he was forced to return to the Guardians due to the accusations of his delegates about his responsibility for the resulting deaths.[66]

text: During the Civil War II storyline, Star-Lord and the Guardians of the Galaxy assist Captain Marvel in the fight against Iron Man as her surprise weapon. During the battle, the Guardians ship explodes, leaving them stranded on Earth. After Iron Man's faction leaves, Gamora overhears a conversation between Peter and Kitty in which she finds out that Peter knew that Thanos was on Earth the entire time they were there without telling the rest of the team. After stopping Gamora from storming into the Triskelion and killing Thanos, Gamora and the other Guardians leave Peter for not telling them the truth. Peter and Kitty then break off their engagement.

text: Grounded

text: Living alone in an apartment given to him by Abigail Brand, Peter calls Howard the Duck to try and have drinks with him, and Howard furiously hangs up. He then finds Kitty and Logan in an art gallery, where Kitty shouts at him for carrying his guns into an art gallery with children. Frustrated, Peter leaves. Logan then catches up to him and has drinks with him in a bar, where they fight hitmen, which attracts the attention of the police. Logan flees the scene and Peter is captured.

text: Peter is prosecuted by Matt Murdock, who argues that unlike other superheroes, Star-Lord was reckless and endangered civilians while causing substantial property damage. The trial is interrupted by Brandt, who gets the judge to reduce Peter's sentence to community service, to which Peter agrees. Brandt and Alpha Flight then give him a new skin-tight costume, and he is assigned to senior citizen Edmund Allen, a retired super criminal. After a day of bonding, Star-Lord is hired as a bartender at a bar for supervillains owned by Edmund's son.

text: Powers and abilities[edit]

text: Star-Lord is a master strategist and problem solver who is an expert in close-quarter combat, various human and alien firearms, and battle techniques. He has extensive knowledge of various alien customs, societies, and cultures, and considerable knowledge about cosmic abstracts, such as Oblivion.

text: As Star-Lord, Peter Quill wears a suit that grants augmented strength and durability and the ability to travel through space. The character uses an "Element Gun", a special meta-pistol capable of projecting one of the four elements (air, earth, fire and water). Star-Lord shares a psychic link with his sentient space vessel, "Ship".

text: "Ship" is actually a sentient energy form. She most often exists in the form of a starship, but can alter her structure at will. She can travel through air, space and water. She possesses many of the conventional starship accessories, including shields, energy blasters, advanced sensors, replicators (able to form any kind of food, drink, etc.), and hologram projectors. She has proven capable of creating a human form, which she can then animate and use as a host. Even if completely destroyed, she is capable of restoring herself, since her true form is her consciousness. In addition, she takes on a number of feminine characteristics, such as a mothering instinct for those she is partnered with. She has felt deeper attachments, including love for her partners.

text: "Ship" can create Widgets—small, mobile droids able to scout out situations, gather information, and then return to her. The full extent of "Ship's" abilities are unknown.

text: During Star-Lord's battle with The Fallen One, his Element Gun, suit and "Ship" were destroyed. Due to severe injury he was grafted with cybernetic implants by doctors on the Kyln, where he was sentenced. The eye implant allows him to see all energy spectra and the memory chip in his brain gives him 100% total recall.

text: On the Kree world of Aladon Prime, Star-Lord's cybernetic implants were removed. Star-Lord was outfitted with a Kree-issued heat-dampening espionage battle-suit, which became the hallmark look for the Guardians of the Galaxy, a battle helmet, and a universal translator, all of which he still uses. His battle helmet can analyze strategy data, improve vision, and regulate oxygen in space.

text: Star-Lord's chosen weapons are two Kree sub-machine guns with various types of ammunition, including explosives.

text: After escaping the Cancerverse, Peter acquires a new element gun(s), but discards his armor.

text: Other characters named Star-Lord[edit]

text: A three-issue limited series, titled Starlord, featured a man named Sinjin Quarrel adopting the identity 12 years after the disappearance of the original Star-Lord (Peter Jason Quill).[67] The series, published from December 1996 to February 1997, was written by Timothy Zahn, with art by Dan Lawlis.[68] Where the events depicted in this miniseries fit into Peter Quill's chronology has never been revealed.

text: Other versions[edit]

text: Star-Lord has adventures in Marvel Preview #4 and #11, but after Peter Quill's introduction to Earth-616 in 2004, these issues and other appearances of "classic" Star-Lord have been officially designated as occurring in Earth-791 due to continuity issues.[citation needed] In these issues, Peter Quill is born during an unusual astronomical phenomenon when many of the planets align. Seeing no resemblance, the man who believed he was Quill's father accuses his wife Meredith of infidelity and attempts to kill the infant, but dies of a sudden heart attack. Peter is raised by his single mother until she is killed by Ariguans when he is eleven (In Earth-616, she is killed by Badoon soldiers).[69] Quill is placed in an orphanage but escapes and eventually becomes a trainee NASA astronaut. An alien entity called the Master of the Sun later visits the space station that Quill and other astronauts are inhabiting, and offers the mantle of Star-Lord (an interplanetary policeman) to a worthy candidate. Quill volunteers, but is rejected in favor of a colleague he once treated badly. Quill is outraged, and NASA orders his return to Earth and discharge for his conduct. Instead, he steals a scout ship, returns to the space station, and takes his colleague's place. Quill becomes Star-Lord, with the Master of the Sun first creating an illusion in which the character is able to find and kill the aliens that murdered his mother to free him of his past. Equipped with a sentient vessel called "Ship", Quill commences his role as Star-Lord.[69][70]

text: Years later, Star-Lord becomes involved in stopping a group of slavers who are destroying worlds. His efforts led him to discover a conspiracy to replace the emperor of the Spartoi Empire. In order to thwart the takeover, Star-Lord travels to the imperial throneworld Sparta where he encounters and kills the alien who killed his mother. Star-Lord then meets Emperor Jason who reveals that he is Peter's father. Jason explains that he had crashed on Earth decades earlier and been rescued by Meredith Quill. During the year that he had spent repairing his ship, Jason and Meredith fell in love. When it came time to leave, Jason, for Meredith's safety, had placed a mindlock on her memories of him, causing her to remember their year together as only a dream.[3][70]

text: "Age of Ultron"[edit]

text: During the 2013 "Age of Ultron" storyline, Wolverine and Susan Storm accidentally create an alternate timeline after traveling back in time and assassinating Hank Pym before he can create Ultron. In the new reality, Star-Lord is seen as a member of the Defenders, who have replaced the defunct Avengers as the world's premier superhero team.[71]

text: In other media[edit]

text: Television[edit]

text:
Star-Lord appears in The Avengers: Earth's Mightiest Heroes episode "Michael Korvac", voiced by Steve Downes.[72][73]
Star-Lord appears in the Ultimate Spider-Man cartoon series, voiced by Chris Cox.[72] In "Guardians of the Galaxy", he is seen as a member of the Guardians of the Galaxy. He and the Guardians of the Galaxy fight Korvac and the Chitauri with the help of Spider-Man and Nova. In "The Return of the Guardians of the Galaxy", Star-Lord is with the Guardians of the Galaxy when they land on Earth to rebuild their ship at the same time when Titus was leading the Chitauri into targeting Nova's helmet.
Star-Lord appears in Avengers Assemble, voiced by Chris Cox (in "Guardians and Spaceknights") and later by Will Friedle (in "Widow's Run"). In "Guardians and Spaceknights", he was seen with the Guardians of the Galaxy when they are in the middle of evacuating the D'Bari from their homeworld before it can be consumed by Galactus. In "Widow's Run", Star-Lord tries to get Tony Stark to have the Infinity Gems in the custody of the Guardians of the Galaxy only to be turned down. This causes Star-Lord to lead the Guardians of the Galaxy into taking the Infinity Gems from the Black Widow leading the group's fight with the Avengers. Using special teleportation disks, the Falcon was able to send the Guardians of the Galaxy back to their ship. Star-Lord's design initially resembles his original comic book appearance, however it changed and now resembles Chris Pratt's character from the Guardians of the Galaxy film.
Star-Lord appeared in Hulk and the Agents of S.M.A.S.H., voiced by Chris Cox (in "It's a Wonderful Smash" and "Guardians of the Galaxy"),[74] and by Will Friedle (in "Planet Monster" Pt. 2).
Star-Lord appears in Marvel Disk Wars: The Avengers episode "Guardians of the Galaxy".
Star-Lord appears in the Guardians of the Galaxy animated series, voiced again by Will Friedle.[75]

text: Film[edit]

text: Marvel Cinematic Universe[edit]

text:
Chris Pratt portrays Peter Quill / Star-Lord in the Marvel Studios film Guardians of the Galaxy.[76] In 1988, when Peter Quill was a young boy in Missouri and unable to accept his mother's death due to cancer, he leaves the hospital in tears, and is subsequently abducted by an extraterrestrial star-ship. Twenty-six years later, he is a member of the Ravagers, the mercenary gang who abducted him as a child led by Yondu Udonta, and has had many adventures with this crew around the galaxy. While on a scavenging job, Peter finds himself embroiled in a significant power struggle and revenge war between two advanced galactic powers, the Kree warlord Ronan the Accuser and Xandar's Nova Corps while also being hunted by Yondu after failing to bring him a stolen relic later revealed to be an Infinity Stone which Ronan seeks. Throughout the movie, Peter is shown listening to a mixtape of various hit songs from 1962 – 1986 that was given to him by his mother, which serves as his only connection with Earth.
Pratt reprises his role in the film Guardians of the Galaxy Vol. 2.[77] In this film, Quill learns that his father is Ego the Living Planet, a primordial Celestial- who manifests a human avatar that allows him to interact with other races- with Ego teaching Quill more about his Celestial abilities. However, Quill is briefly 'seduced' by Ego's power, he turns against his father when it is revealed that Ego killed his mother to ensure his focus on his self-perceived 'duty' to reproduce. Peter kept Ego occupied in combat with his newfound Celestial powers until the other Guardians are able to destroy Ego's brain. After Ego dies and Peter loses his Celestial powers, he is rescued from the planet's destruction by Yondu, who sacrifices his life in the process. The Guardians hold a memorial to give Yondu an honorable funeral, during which Peter recognizes Yondu as his true father and the Ravagers arrive to pay homage. Peter also replaces his destroyed Walkman with a Zune.
Pratt will return as Quill in Avengers: Infinity War and its untitled sequel.[78]

text: Animation[edit]

text: Star-Lord makes a non-speaking cameo appearance in the animated direct-to-video film Planet Hulk.[79] He is seen as an audience member in the Sakaar arena.

text: Video games[edit]

text:
Star-Lord is available as downloadable content for LittleBigPlanet, as part of "Marvel Costume Kit 5".[80]
Star-Lord appears in Marvel Heroes.
Star-Lord appears in Lego Marvel Super Heroes.
Star-Lord appears as a playable character in Disney Infinity: Marvel Super Heroes.
Star-Lord is available in the "Guardians of the Galaxy" skin pack for Minecraft on Xbox and Playstation platforms. This skin pack became unavailable in December 2015 along with the other 2 Marvel skin packs: "The Avengers" and "Spider-Man".
Star-Lord is available in the Facebook game Marvel: Avengers Alliance as the Special Operations 20 unlockable.
Star-Lord is an unlockable and playable character in Marvel Contest of Champions.
Star-Lord is an unlockable and playable character in Marvel: Future Fight.
Star-Lord is a playable character in Disney Infinity 3.0.
Star-Lord is the primary protagonist of the video game Guardians of the Galaxy: The Telltale Series, voiced by Scott Porter as an adult and by Jeremy Shada as a kid. As seen in a flashback, Peter Quill had to promise his mother not to get into fights with a bully. After Meredith Quill died, Peter Quill is taken in by Yondu where Meredith entrusted him to watch over Peter.
There are three playable versions of Star-Lord in the match-three mobile game Marvel Puzzle Quest, the two newest versions of which were added to the game in April 2017.[81][82]

text: Theme Parks[edit]

text: Star-Lord appears in the ride Guardians of the Galaxy Mission Breakout at Disney's California Adventure with Chris Pratt reprising his role from the films.[citation needed]

text: Toys[edit]

text:
Star-Lord was featured in the Marvel Universe toy line as a 3 3/4" figure in his Guardian uniform. He was sold in a three pack with Drax the Destroyer, Rocket Raccoon, and a mini Groot accessory.
Star-Lord appears as a figure in the Groot Build-A-Figure line.
Star-Lord is featured in the Hot Toys 1:6 scale line for Marvel Studios film Guardians of the Galaxy. The head sculpt features an authentic and detailed likeness of Chris Pratt as Star-Lord.
Nerf has released toys of Star-Lord's mask and weapons as they appear in the film.

text: Collected editions[edit]

text:
Star-Lord: Guardian of the Galaxy (collects Marvel Preview #4, 11, 14-15, 18; Marvel Super Special #10; Marvel Spotlight vol. 2 #6-7; Marvel Premiere #61; and Star-Lord Vol. 1 #1-3), 424 pages, July 2014, ISBN 978-0785154495
Legendary Star-Lord Vol. 1: Face It, I Rule (collects Legendary Star-Lord #1-5), 112 pages, February 2015, ISBN 978-0785191599
Legendary Star-Lord Vol. 2: Rise of the Black Vortex (collects Legendary Star-Lord #6-12), 160 pages, August 2015, ISBN 978-0785191605
Legendary Star-Lord Vol. 3: First Flight (collects Star-Lord Vol. 2 #1-5), 112 pages, July 2016, ISBN 978-0785196242
Legendary Star-Lord Vol. 4: Out of Orbit (collects Star-Lord Vol. 2 #6-8, Avengers #28, 51, 174), 128 pages, November 2016, ISBN 978-0785196259
Star-Lord and Kitty Pryde (collects Star-Lord and Kitty Pryde #1-3, Generation Next #1, and Guardians of the Galaxy and X-Men: The Black Vortex Omega), 128 pages, December 2015, ISBN 978-0785198437


question_text: when did the dsm iv tr come out

question_tokens: when did the dsm iv tr come out

root

text: Uses and definition[edit]

text: Many mental health professionals use the manual to determine and help communicate a patient's diagnosis after an evaluation; hospitals, clinics, and insurance companies in the US also generally require a DSM diagnosis for all patients treated. The DSM can be used clinically in this way, and also to categorize patients using diagnostic criteria for research purposes. Studies done on specific disorders often recruit patients whose symptoms match the criteria listed in the DSM for that disorder. An international survey of psychiatrists in 66 countries compared the use of the ICD-10 and DSM-IV; it found the former was more often used for clinical diagnosis while the latter was more valued for research.[11]

tag: p

text: DSM-5, and the abbreviations for all previous editions, are registered trademarks owned by the APA.[6][12]

text: History[edit]

text: This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2017) (Learn how and when to remove this template message)

tag: table

text: The initial impetus for developing a classification of mental disorders in the United States was the need to collect statistical information. The first official attempt was the 1840 census, which used a single category: "idiocy/insanity". Three years later, the American Statistical Association made an official protest to the U.S. House of Representatives, stating that "the most glaring and remarkable errors are found in the statements respecting nosology, prevalence of insanity, blindness, deafness, and dumbness, among the people of this nation", pointing out that in many towns African-Americans were all marked as insane, and calling the statistics essentially useless.

text: The Association of Medical Superintendents of American Institutions for the Insane was formed in 1844, changing its name in 1892 to the American Medico-Psychological Association, and in 1921 to the present American Psychiatric Association (APA).

text: Edward Jarvis and later Francis Amasa Walker helped expand the census, from 2 volumes in 1870 to 25 volumes in 1880. Frederick H. Wines was appointed to write a 582-page volume called Report on the Defective, Dependent, and Delinquent Classes of the Population of the United States, As Returned at the Tenth Census (June 1, 1880) (published 1888). Wines used seven categories of mental illness: dementia, dipsomania (uncontrollable craving for alcohol), epilepsy, mania, melancholia, monomania and paresis. These categories were also adopted by the Association.[13]

text: In 1917, together with the National Commission on Mental Hygiene (now Mental Health America), the APA developed a new guide for mental hospitals called the Statistical Manual for the Use of Institutions for the Insane. This included 22 diagnoses and would be revised several times by the APA over the years.[14] Along with the New York Academy of Medicine, the APA also provided the psychiatric nomenclature subsection of the US general medical guide, the Standard Classified Nomenclature of Disease, referred to as the Standard.[15]

text: DSM-I (1952)[edit]

text: World War II saw the large-scale involvement of US psychiatrists in the selection, processing, assessment, and treatment of soldiers. This moved the focus away from mental institutions and traditional clinical perspectives. A committee headed by psychiatrist Brigadier General William C. Menninger developed a new classification scheme called Medical 203, that was issued in 1943 as a War Department Technical Bulletin under the auspices of the Office of the Surgeon General.[16] The foreword to the DSM-I states the US Navy had itself made some minor revisions but "the Army established a much more sweeping revision, abandoning the basic outline of the Standard and attempting to express present day concepts of mental disturbance. This nomenclature eventually was adopted by all Armed Forces", and "assorted modifications of the Armed Forces nomenclature [were] introduced into many clinics and hospitals by psychiatrists returning from military duty." The Veterans Administration also adopted a slightly modified version of Medical 203.[citation needed]

text: In 1949, the World Health Organization published the sixth revision of the International Statistical Classification of Diseases (ICD), which included a section on mental disorders for the first time. The foreword to DSM-1 states this "categorized mental disorders in rubrics similar to those of the Armed Forces nomenclature." An APA Committee on Nomenclature and Statistics was empowered to develop a version specifically for use in the United States, to standardize the diverse and confused usage of different documents. In 1950, the APA committee undertook a review and consultation. It circulated an adaptation of Medical 203, the VA system, and the Standard's Nomenclature to approximately 10% of APA members. 46% replied, of which 93% approved, and after some further revisions (resulting in its being called DSM-I), the Diagnostic and Statistical Manual of Mental Disorders was approved in 1951 and published in 1952. The structure and conceptual framework were the same as in Medical 203, and many passages of text were identical.[16] The manual was 130 pages long and listed 106 mental disorders.[17] These included several categories of "personality disturbance", generally distinguished from "neurosis" (nervousness, egodystonic).[18]

text: In 1952, the APA listed homosexuality in the DSM as a sociopathic personality disturbance. Homosexuality: A Psychoanalytic Study of Male Homosexuals, a large-scale 1962 study of homosexuality by Irving Bieber and other authors, was used to justify inclusion of the disorder as a supposed pathological hidden fear of the opposite sex caused by traumatic parent–child relationships. This view was widely influential in the medical profession.[19][full citation needed] In 1956, however, the psychologist Evelyn Hooker performed a study that compared the happiness and well-adjusted nature of self-identified homosexual men with heterosexual men and found no difference.[20][full citation needed] Her study stunned the medical community and made her a heroine to many gay men and lesbians,[21][full citation needed] but homosexuality remained in the DSM until May 1974.[22]

text: DSM-II (1968)[edit]

text: In the 1960s, there were many challenges to the concept of mental illness itself. These challenges came from psychiatrists like Thomas Szasz, who argued that mental illness was a myth used to disguise moral conflicts; from sociologists such as Erving Goffman, who said mental illness was merely another example of how society labels and controls non-conformists; from behavioural psychologists who challenged psychiatry's fundamental reliance on unobservable phenomena; and from gay rights activists who criticised the APA's listing of homosexuality as a mental disorder. A study published in Science by Rosenhan received much publicity and was viewed as an attack on the efficacy of psychiatric diagnosis.[23]

text: Although the APA was closely involved in the next significant revision of the mental disorder section of the ICD (version 8 in 1968), it decided to go ahead with a revision of the DSM. It was published in 1968, listed 182 disorders, and was 134 pages long. It was quite similar to the DSM-I. The term "reaction" was dropped, but the term "neurosis" was retained. Both the DSM-I and the DSM-II reflected the predominant psychodynamic psychiatry,[24] although they also included biological perspectives and concepts from Kraepelin's system of classification. Symptoms were not specified in detail for specific disorders. Many were seen as reflections of broad underlying conflicts or maladaptive reactions to life problems, rooted in a distinction between neurosis and psychosis (roughly, anxiety/depression broadly in touch with reality, or hallucinations/delusions appearing disconnected from reality). Sociological and biological knowledge was incorporated, in a model that did not emphasize a clear boundary between normality and abnormality.[25] The idea that personality disorders did not involve emotional distress was discarded.[18]

text: An influential 1974 paper by Robert Spitzer and Joseph L. Fleiss demonstrated that the second edition of the DSM (DSM-II) was an unreliable diagnostic tool.[26] They found that different practitioners using the DSM-II were rarely in agreement when diagnosing patients with similar problems. In reviewing previous studies of 18 major diagnostic categories, Fleiss and Spitzer concluded that "there are no diagnostic categories for which reliability is uniformly high. Reliability appears to be only satisfactory for three categories: mental deficiency, organic brain syndrome (but not its subtypes), and alcoholism. The level of reliability is no better than fair for psychosis and schizophrenia and is poor for the remaining categories".[27]

text: Sixth printing of the DSM-II, 1974[edit]

text: As described by Ronald Bayer, a psychiatrist and gay rights activist, specific protests by gay rights activists against the APA began in 1970, when the organization held its convention in San Francisco. The activists disrupted the conference by interrupting speakers and shouting down and ridiculing psychiatrists who viewed homosexuality as a mental disorder. In 1971, gay rights activist Frank Kameny worked with the Gay Liberation Front collective to demonstrate against the APA's convention. At the 1971 conference, Kameny grabbed the microphone and yelled: "Psychiatry is the enemy incarnate. Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you."[28]

text: This activism occurred in the context of a broader anti-psychiatry movement that had come to the fore in the 1960s and was challenging the legitimacy of psychiatric diagnosis. Anti-psychiatry activists protested at the same APA conventions, with some shared slogans and intellectual foundations.[29][30]

text: Presented with data from researchers such as Alfred Kinsey and Evelyn Hooker, the sixth printing of the DSM-II, in 1974, no longer listed homosexuality as a category of disorder. After a vote by the APA trustees in 1973, and confirmed by the wider APA membership in 1974, the diagnosis was replaced with the category of "sexual orientation disturbance".[31]

text: DSM-III (1980)[edit]

text: In 1974, the decision to create a new revision of the DSM was made, and Robert Spitzer was selected as chairman of the task force. The initial impetus was to make the DSM nomenclature consistent with the International Statistical Classification of Diseases and Related Health Problems (ICD), published by the World Health Organization. The revision took on a far wider mandate under the influence and control of Spitzer and his chosen committee members.[32] One goal was to improve the uniformity and validity of psychiatric diagnosis in the wake of a number of critiques, including the famous Rosenhan experiment. There was also a need to standardize diagnostic practices within the US and with other countries after research showed that psychiatric diagnoses differed markedly between Europe and the US.[33] The establishment of these criteria was an attempt to facilitate the pharmaceutical regulatory process.

text: The criteria adopted for many of the mental disorders were taken from the Research Diagnostic Criteria (RDC) and Feighner Criteria, which had just been developed by a group of research-orientated psychiatrists based primarily at Washington University in St. Louis and the New York State Psychiatric Institute. Other criteria, and potential new categories of disorder, were established by consensus during meetings of the committee, as chaired by Spitzer. A key aim was to base categorization on colloquial English descriptive language (which would be easier to use by federal administrative offices), rather than assumptions of cause, although its categorical approach assumed each particular pattern of symptoms in a category reflected a particular underlying pathology (an approach described as "neo-Kraepelinian"). The psychodynamic or physiologic view was abandoned, in favor of a regulatory or legislative model. A new "multiaxial" system attempted to yield a picture more amenable to a statistical population census, rather than just a simple diagnosis. Spitzer argued that "mental disorders are a subset of medical disorders" but the task force decided on the DSM statement: "Each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome."[24] The personality disorders were placed on axis II along with mental retardation.[18]

text: The first draft of the DSM-III was prepared within a year. Many new categories of disorder were introduced, while some were deleted or changed. A number of the unpublished documents discussing and justifying the changes have recently come to light.[34] Field trials sponsored by the U.S. National Institute of Mental Health (NIMH) were conducted between 1977 and 1979 to test the reliability of the new diagnoses. A controversy emerged regarding deletion of the concept of neurosis, a mainstream of psychoanalytic theory and therapy but seen as vague and unscientific by the DSM task force. Faced with enormous political opposition, the DSM-III was in serious danger of not being approved by the APA Board of Trustees unless "neurosis" was included in some capacity; a political compromise reinserted the term in parentheses after the word "disorder" in some cases. Additionally, the diagnosis of ego-dystonic homosexuality replaced the DSM-II category of "sexual orientation disturbance".

text: Finally published in 1980, the DSM-III was 494 pages and listed 265 diagnostic categories. It rapidly came into widespread international use and has been termed a revolution or transformation in psychiatry.[24][25] However, Robert Spitzer later criticized his own work on it in an interview with Adam Curtis, saying it led to the medicalization of 20-30 percent of the population who may not have had any serious mental problems.

text: When DSM-III was published, the developers made extensive claims about the reliability of the radically new diagnostic system they had devised, which relied on data from special field trials. However, according to a 1994 article by Stuart A. Kirk:

text: Twenty years after the reliability problem became the central focus of DSM-III, there is still not a single multi-site study showing that DSM (any version) is routinely used with high reliably by regular mental health clinicians. Nor is there any credible evidence that any version of the manual has greatly increased its reliability beyond the previous version. There are important methodological problems that limit the generalisability of most reliability studies. Each reliability study is constrained by the training and supervision of the interviewers, their motivation and commitment to diagnostic accuracy, their prior skill, the homogeneity of the clinical setting in regard to patient mix and base rates, and the methodological rigor achieved by the investigator…[23]

text: DSM-III-R (1987)[edit]

text: In 1987, the DSM-III-R was published as a revision of the DSM-III, under the direction of Spitzer. Categories were renamed and reorganized, and significant changes in criteria were made. Six categories were deleted while others were added. Controversial diagnoses, such as pre-menstrual dysphoric disorder and masochistic personality disorder, were considered and discarded. "Ego-dystonic homosexuality" was also removed and was largely subsumed under "sexual disorder not otherwise specified", which can include "persistent and marked distress about one's sexual orientation."[24][35] Altogether, the DSM-III-R contained 292 diagnoses and was 567 pages long. Further efforts were made for the diagnoses to be purely descriptive, although the introductory text stated that for at least some disorders, "particularly the Personality Disorders, the criteria require much more inference on the part of the observer" (p. xxiii).[18]

text: DSM-IV (1994)[edit]

text: In 1994, DSM-IV was published, listing 410 disorders in 886 pages. The task force was chaired by Allen Frances. A steering committee of 27 people was introduced, including four psychologists. The steering committee created 13 work groups of five to 16 members. Each work group had about 20 advisers. The work groups conducted a three-step process: first, each group conducted an extensive literature review of their diagnoses; then, they requested data from researchers, conducting analyses to determine which criteria required change, with instructions to be conservative; finally, they conducted multicenter field trials relating diagnoses to clinical practice.[36][37] A major change from previous versions was the inclusion of a clinical significance criterion to almost half of all the categories, which required that symptoms cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning". Some personality disorder diagnoses were deleted or moved to the appendix.[18]

text: DSM-IV-TR (2000)[edit]

text: A "text revision" of the DSM-IV, known as the DSM-IV-TR, was published in 2000. The diagnostic categories and the vast majority of the specific criteria for diagnosis were unchanged.[38] The text sections giving extra information on each diagnosis were updated, as were some of the diagnostic codes to maintain consistency with the ICD. The DSM-IV-TR was organized into a five-part axial system. The first axis incorporated clinical disorders. The second axis covered personality disorders and intellectual disabilities. The remaining axes covered medical, psychosocial, environmental, and childhood factors functionally necessary to provide diagnostic criteria for health care assessments.

text: The DSM-IV-TR characterizes a mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual [which] is associated with present distress… or disability… or with a significant increased risk of suffering." It also notes that "no definition adequately specifies precise boundaries for the concept of 'mental disorder'… different situations call for different definitions". It states that "there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder" (APA, 1994 and 2000).

text: DSM-IV-TR Categorization[edit]

text: The DSM-IV is a categorical classification system. The categories are prototypes, and a patient with a close approximation to the prototype is said to have that disorder. DSM-IV states, "there is no assumption each category of mental disorder is a completely discrete entity with absolute boundaries" but isolated, low-grade and non-criterion (unlisted for a given disorder) symptoms are not given importance.[39] Qualifiers are sometimes used, for example mild, moderate or severe forms of a disorder. For nearly half the disorders, symptoms must be sufficient to cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning", although DSM-IV-TR removed the distress criterion from tic disorders and several of the paraphilias due to their egosyntonic nature. Each category of disorder has a numeric code taken from the ICD coding system, used for health service (including insurance) administrative purposes.

text: DSM-IV-TR Multi-axial system[edit]

text: With the advent of the DSM-5 in 2013, the APA eliminated the longstanding multiaxial system for mental disorders.[40]

text: Previously, the DSM-IV organized each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

text:
Axis I: All psychological diagnostic categories except mental retardation and personality disorder
Axis II: Personality disorders and mental retardation
Axis III: General medical condition; acute medical conditions and physical disorders
Axis IV: Psychosocial and environmental factors contributing to the disorder
Axis V: Global Assessment of Functioning or Child Global Assessment of Functioning [cGAF]

tag: ul

text: Mental/Psychiatric/Behavioral/Learning conditions include, but are not limited to: depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa, and schizophrenia.

text: Personality Disorders include, but are not limited to: paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder, avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder; and organic intellectual disabilities.

text: Common medical/physical conditions or diseases that may result in and/or exacerbate some of the aforementioned mental/psychiatric conditions OR that may be aggravated by the aforementioned mental/psychiatric conditions include, but are not limited to: brain injuries, terminal diseases, pregnancy, cancer, epilepsy, idiopathic physiological conditions and virtually any other conditions, ailments and/or injuries which may affect the patient's mental health.. Many Biopsychosocial Assessments incorporate multiple factors that adversely affect the patient's, client's and/or subject's overall well-being and homeostasis.

text: Typical psychosocial influences that are usually listed as having negative impact on life, mentality and health include, but are not limited to: Environmental factors of dysfunction such as those experienced within home, school and work; Social factors such as issues with drug use (not diagnosed), enabling friends and conflicts with coworkers; Family complications such as divorce, social service involvement and court ordered placements; Various stressors such as recent accident, natural disaster and other traumatic occurrences (i.e. assault, death, abuse); Financial problems such as bankruptcy, job loss and debts; and service needs such as lack of medical insurance, inability to find adequate treatment and inaccessibility to necessary state and federal programs.

text: Sourcebooks[edit]

text: The DSM-IV does not specifically cite its sources, but there are four volumes of "sourcebooks" intended to be APA's documentation of the guideline development process and supporting evidence, including literature reviews, data analyses and field trials.[41][42][43][44] The Sourcebooks have been said to provide important insights into the character and quality of the decisions that led to the production of DSM-IV, and hence the scientific credibility of contemporary psychiatric classification.[45][46]

text: DSM-5 (2013)[edit]

text: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5, was approved by the Board of Trustees of the APA on December 1, 2012.[47] Published on May 18, 2013,[48] the DSM-5 contains extensively revised diagnoses and, in some cases, broadens diagnostic definitions while narrowing definitions in other cases.[49] The DSM-5 is the first major edition of the manual in twenty years.[50]

text: A significant change in the fifth edition is the deletion of the subtypes of schizophrenia (paranoid, disorganized, catatonic, undifferentiated and residual).[51]

text: The deletion of the subsets of autistic spectrum disorder (namely, Asperger's syndrome, classic autism, Rett syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified) was also implemented, with specifiers with regard to intensity (mild, moderate and severe). Severity is based on social communication impairments and restricted, repetitive patterns of behaviour, with three levels: 1 (requiring support), 2 (requiring substantial support) and 3 (requiring very substantial support).

text: During the revision process, the APA website periodically listed several sections of the DSM-5 for review and discussion.[52]

text: Future revisions and updates (2013 and beyond)[edit]

text: Beginning with the fifth edition, it is intended that diagnostic guidelines revisions will be added more frequently to keep up with research in the field.[53] It is notable that the DSM-5 is identified with Arabic rather than Roman numerals. Beginning with DSM-5, the American Psychiatric Association will use decimals to identify incremental updates (e.g., DSM-5.1, DSM-5.2) and whole numbers for new editions (e.g., DSM-5, DSM-6),[54] similar to the scheme used for software versioning.

text: Criticism[edit]

text: Reliability and validity concerns[edit]

text: The revisions of the DSM from the 3rd Edition forward have been mainly concerned with diagnostic reliability—the degree to which different diagnosticians agree on a diagnosis. It was argued{Henrik Walter} that a science of psychiatry can only advance if diagnosis is reliable. If clinicians and researchers frequently disagree about the diagnosis of a patient, then research into the causes and effective treatments of those disorders cannot advance. Hence, diagnostic reliability was a major concern of DSM-III.[citation needed] When the diagnostic reliability problem was thought to be solved, subsequent editions of the DSM were concerned mainly with "tweaking" the diagnostic criteria.[citation needed] Unfortunately, neither the issue of reliability or validity was settled.[55][better source needed] However, most psychiatric education post DSM-III focused on issues of treatment—especially drug treatment—and less on diagnostic concerns.[citation needed] In fact, Thomas R. Insel, M.D., Director of the NIMH, stated in 2013 that the agency would no longer fund research projects that rely exclusively on DSM criteria due to its lack of validity.[56] Field trials of DSM-5 brought the debate of reliability back into the limelight as some disorders showed poor reliability. For example, major depressive disorder, a common mental illness, had a poor reliability kappa statistic of 0.28, indicating that clinicians frequently disagreed on this diagnosis in the same patients. The most reliable diagnosis was major neurocognitive disorder with a kappa of 0.78.[57]

text: Superficial symptoms[edit]

text: By design, the DSM is primarily concerned with the signs and symptoms of mental disorders, rather than the underlying causes. It claims to collect them together based on statistical or clinical patterns. As such, it has been compared to a naturalist's field guide to birds, with similar advantages and disadvantages.[58] The lack of a causative or explanatory basis, however, is not specific to the DSM, but rather reflects a general lack of pathophysiological understanding of psychiatric disorders. As DSM-III chief architect Robert Spitzer and DSM-IV editor Michael First outlined in 2005, "little progress has been made toward understanding the pathophysiological processes and cause of mental disorders. If anything, the research has shown the situation is even more complex than initially imagined, and we believe not enough is known to structure the classification of psychiatric disorders according to etiology."[59]

text: The DSM's focus on superficial symptoms is claimed to be largely a result of necessity (assuming such a manual is nevertheless produced), since there is no agreement on a more explanatory classification system.[citation needed] Reviewers note, however, that this approach is undermining research, including in genetics, because it results in the grouping of individuals who have very little in common except superficial criteria as per DSM or ICD diagnosis.[6]

text: Despite the lack of consensus on underlying causation, advocates for specific psychopathological paradigms have nonetheless faulted the current diagnostic scheme for not incorporating evidence-based models or findings from other areas of science. A recent example is evolutionary psychologists' criticism that the DSM does not differentiate between genuine cognitive malfunctions and those induced by psychological adaptations, a key distinction within evolutionary psychology but one that is widely challenged within general psychology.[60][61][62] Another example is the strong operationalist viewpoint, which contends that reliance on operational definitions, as purported by the DSM, necessitates that intuitive concepts like depression be replaced by specific measurable concepts before they are scientifically meaningful. One critic states of psychologists that "Instead of replacing 'metaphysical' terms such as 'desire' and 'purpose', they used it to legitimize them by giving them operational definitions…the initial, quite radical operationalist ideas eventually came to serve as little more than a 'reassurance fetish' (Koch 1992) for mainstream methodological practice."[63]

text: A 2013 review published in the European Archives of Psychiatry and Clinical Neuroscience states "that psychiatry targets the phenomena of consciousness, which, unlike somatic symptoms and signs, cannot be grasped on the analogy with material thing-like objects." As an example of the problem of the superficial characterization of psychiatric signs and symptoms, the authors gave the example of a patient saying they "feel depressed, sad, or down", showing that such a statement could indicate various underlying experiences: "not only depressed mood but also, for instance, irritation, anger, loss of meaning, varieties of fatigue, ambivalence, ruminations of different kinds, hyper-reflectivity, thought pressure, psychological anxiety, varieties of depersonalization, and even voices with negative content, and so forth." The structured interview comes with "danger of over confidence in the face value of the answers, as if a simple 'yes' or 'no' truly confirmed or denied the diagnostic criterion at issue." The authors gave an example: A patient who was being administered the Structured Clinical Interview for the DSM-IV Axis I Disorders denied thought insertion, but during a "conversational, phenomenological interview", a semi-structured interview tailored to the patient, the same patient admitted to experiencing thought insertion, along with a delusional elaboration. The authors suggested 2 reasons for this discrepancy: either the patient did not "recognize his own experience in the rather blunt, implicitly either/or formulation of the structured-interview question", or the experience did not "fully articulate itself" until the patient started talking about his experiences.[64]

text: Dividing lines[edit]

text: Despite caveats in the introduction to the DSM, it has long been argued that its system of classification makes unjustified categorical distinctions between disorders and uses arbitrary cut-offs between normal and abnormal. A 2009 psychiatric review noted that attempts to demonstrate natural boundaries between related DSM syndromes, or between a common DSM syndrome and normality, have failed.[6] Some argue that rather than a categorical approach, a fully dimensional, spectrum or complaint-oriented approach would better reflect the evidence.[65][66][67][68]

text: In addition, it is argued that the current approach based on exceeding a threshold of symptoms does not adequately take into account the context in which a person is living, and to what extent there is internal disorder of an individual versus a psychological response to adverse situations.[69][70] The DSM does include a step ("Axis IV") for outlining "Psychosocial and environmental factors contributing to the disorder" once someone is diagnosed with that particular disorder.

text: Because an individual's degree of impairment is often not correlated with symptom counts and can stem from various individual and social factors, the DSM's standard of distress or disability can often produce false positives.[71] On the other hand, individuals who do not meet symptom counts may nevertheless experience comparable distress or disability in their life.

text: Cultural bias[edit]

text: Some psychiatrists argue that current diagnostic standards rely on an exaggerated interpretation of neurophysiological findings and so understate the scientific importance of social-psychological variables.[72] Advocating a more culturally sensitive approach to psychology, critics such as Carl Bell and Marcello Maviglia contend that the cultural and ethnic diversity of individuals is often discounted by researchers and service providers.[73] In addition, current diagnostic guidelines have been criticized as having a fundamentally Euro-American outlook. Although these guidelines have been widely implemented, opponents argue that even when a diagnostic criterion set is accepted across different cultures, it does not necessarily indicate that the underlying constructs have any validity within those cultures; even reliable application can only demonstrate consistency, not legitimacy.[72] Cross-cultural psychiatrist Arthur Kleinman contends that the Western bias is ironically illustrated in the introduction of cultural factors to the DSM-IV: the fact that disorders or concepts from non-Western or non-mainstream cultures are described as "culture-bound", whereas standard psychiatric diagnoses are given no cultural qualification whatsoever, is to Kleinman revelatory of an underlying assumption that Western cultural phenomena are universal.[74] Kleinman's negative view toward the culture-bound syndrome is largely shared by other cross-cultural critics, common responses included both disappointment over the large number of documented non-Western mental disorders still left out, and frustration that even those included were often misinterpreted or misrepresented.[75][page needed] Many mainstream psychiatrists have also been dissatisfied with these new culture-bound diagnoses, although not for the same reasons. Robert Spitzer, a lead architect of the DSM-III, has held the opinion that the addition of cultural formulations was an attempt to placate cultural critics, and that they lack any scientific motivation or support. Spitzer also posits that the new culture-bound diagnoses are rarely used in practice, maintaining that the standard diagnoses apply regardless of the culture involved. In general, the mainstream psychiatric opinion remains that if a diagnostic category is valid, cross-cultural factors are either irrelevant or are only significant to specific symptom presentations.[72] One of the results was the development of the Azibo Nosology by Daudi Ajani Ya Azibo as an alternative to the DSM to treat African and African American patients.[76][77][78]

text: Medicalization and financial conflicts of interest[edit]

text: It has also been alleged that the way the categories of the DSM are structured, as well as the substantial expansion of the number of categories, are representative of an increasing medicalization of human nature, which may be attributed to disease mongering by psychiatrists and pharmaceutical companies, the power and influence of the latter having grown dramatically in recent decades.[79] Of the authors who selected and defined the DSM-IV psychiatric disorders, roughly half have had financial relationships with the pharmaceutical industry at one time, raising the prospect of a direct conflict of interest.[80] The same article concludes that the connections between panel members and the drug companies were particularly strong in those diagnoses where drugs are the first line of treatment, such as schizophrenia and mood disorders, where 100% of the panel members had financial ties with the pharmaceutical industry.[80] In 2005, then APA President Steven Sharfstein released a statement in which he conceded that psychiatrists had "allowed the biopsychosocial model to become the bio-bio-bio model".[81]

text: However, although the number of identified diagnoses has increased by more than 300% (from 106 in DSM-I to 365 in DSM-IV-TR), psychiatrists such as Zimmerman and Spitzer argue it almost entirely represents greater specification of the forms of pathology, thereby allowing better grouping of more similar patients.[6] However, William Glasser refers to the DSM as "phony diagnostic categories", arguing that "it was developed to help psychiatrists – to help them make money".[82] In addition, the publishing of the DSM, with tightly guarded copyrights, has in itself earned over $100 million for the APA.[10]

text: Clients, survivors, and consumer[edit]

text: A client is a person who accesses psychiatric services and may have been given a diagnosis from the DSM, while a survivor self-identifies as a person who has endured a psychiatric intervention and the mental health system (which may have involved involuntary commitment and involuntary treatment).[citation needed] A term adopted by many users of psychiatric services is "consumer." This term was chosen to eliminate the "patient" label and restore the person to an active role as a user or consumer of services.[83] Some individuals[who?] are relieved to find that they have a recognized condition that they can apply a name to and this has led to many people self-diagnosing.[citation needed] Others, however, question the accuracy of the diagnosis, or feel they have been given a "label" that invites social stigma and discrimination (the terms "mentalism" and "sanism" have been used to describe such discriminatory treatment).[84]

text: Diagnoses can become internalized and affect an individual's self-identity, and some psychotherapists have found that the healing process can be inhibited and symptoms can worsen as a result.[85] Some members of the psychiatric survivors movement (more broadly the consumer/survivor/ex-patient movement)[who?] actively campaign against their diagnoses, or the assumed implications, and/or against the DSM system in general. Additionally, it has been noted that the DSM often uses definitions and terminology that are inconsistent with a recovery model, and such content can erroneously imply excess psychopathology (e.g. multiple "comorbid" diagnoses) or chronicity.[86]

text: DSM-5 critiques[edit]

text: This section may lend undue weight to certain ideas, incidents, or controversies. Please help to create a more balanced presentation. Discuss and resolve this issue before removing this message. (March 2017)

text: Psychiatrist Allen Frances has been critical of proposed revisions to the DSM-5. In a 2012 New York Times editorial, Frances warned that if this DSM version is issued unamended by the APA, "it will medicalize normality and result in a glut of unnecessary and harmful drug prescription."[87] In a December 2, 2012 blog post in Psychology Today, Frances provides his "…list of DSM 5's ten most potentially harmful changes":[88][unreliable medical source?]

text:
Disruptive Mood Dysregulation Disorder, for temper tantrums
Major Depressive Disorder, includes normal grief
Minor Neurocognitive Disorder, for normal forgetting in old age
Adult Attention Deficit Disorder, encouraging psychiatric prescriptions of stimulants
Binge Eating Disorder, for excessive eating
Autism, defining the disorder more specifically, possibly leading to decreased rates of diagnosis and the disruption of school services
First time drug users will be lumped in with addicts
Behavioral Addictions, making a "…mental disorder of everything we like to do a lot."[88][unreliable medical source?]
Generalized Anxiety Disorder, includes everyday worries
Post-traumatic stress disorder, changes "…opened the gate even further to the already existing problem of misdiagnosis of PTSD in forensic settings."[88][unreliable medical source?]

text: Frances and others have published debates on what they see as the six most essential questions in psychiatric diagnosis:[89]

text:
are they more like theoretical constructs or more like diseases
how to reach an agreed definition
whether the DSM-5 should take a cautious or conservative approach
the role of practical rather than scientific considerations
the issue of use by clinicians or researchers
whether an entirely different diagnostic system is required.

text: In 2011, psychologist Brent Robbins co-authored a national letter for the Society for Humanistic Psychology that has brought thousands into the public debate about the DSM. Over 15,000 individuals and mental health professionals have signed a petition in support of the letter.[90] Thirteen other American Psychological Association divisions have endorsed the petition.[91] Robbins has noted that under the new guidelines, certain responses to grief could be labeled as pathological disorders, instead of being recognized as being normal human experiences.[92]


document_title: Anne of the Island

question_text: what happens to ruby in anne of green gables

text: Anne of the Island

text: Plot summary[edit]

text: Anne leaves Green Gables and her work as a teacher in Avonlea to pursue her original dream (which she gave up in Anne of Green Gables) of taking further education at Redmond College in Nova Scotia. Gilbert Blythe and Charlie Sloane enroll as well, as does Anne's friend from Queen's Academy, Priscilla Grant. During her first week of school, Anne befriends Philippa Gordon, a beautiful girl whose frivolous ways charm her. Philippa (Phil for short) also happens to be from Anne's birthplace in Bolingbroke, Nova Scotia.

text: The girls spend their first year in boardinghouses and decide to set up house thereafter in a lovely cottage called Patty's Place, near campus. The girls enter their second year at Redmond happily ensconced at Patty's Place, along with Queen's classmate Stella Maynard and her "Aunt Jimsie" (their chaperone), while life continues in Avonlea. Diana Barry becomes engaged to Fred Wright and Davy and Dora continue to keep Marilla busy.

text: Midway through their college years, Gilbert Blythe, who has always loved Anne, proposes to her but Anne rejects him; although she and Gilbert are very close, she holds sentimental fantasies about true love (all featuring a tall, dark, handsome, inscrutable hero) and does not recognize her true feelings for Gilbert. Gilbert leaves, his heart broken, and the two drift apart.

text: Anne's childhood friend Ruby Gillis dies of consumption very soon after finding her own true love. Anne later welcomes the courtship of Roy Gardner, a darkly handsome Redmond student who showers her with attention and poetic gestures. However, when he proposes after two years, Anne abruptly realizes that Roy does not really belong in her life, and that she had only been in love with the idea of him as the embodiment of her childhood ideal.

text: Anne is so ashamed in how she treated Roy that she feels her entire Redmond experience may have been spoiled. She returns to Green Gables, a "full-fledged B.A.", but finds herself a bit lonely. Diana gives birth to her first child, and Jane Andrews, an old school friend, marries a Winnipeg millionaire. Having received an offer to be the principal of the Summerside school in the fall, Anne is keeping herself occupied over the summer when she learns that Gilbert is gravely ill with typhoid fever. With shock, Anne finally realizes how deep her true feelings for Gilbert are, and endures a white night of fear that he will leave this world without knowing that she does care. In the morning, Anne gratefully learns that Gilbert will survive. Gilbert recovers over the summer, bolstered by a letter from Phil assuring him that there is really nothing between Anne and Roy. After several visits to Green Gables, Gilbert and Anne take a late summer walk in Hester Gray's garden, and finally become engaged.[1]

text: Title[edit]

text: The title of the book reflects the development of Anne. While studying away from Prince Edward Island and in particular when visiting the place of her birth, she finds herself identifying the Island as her true home. Several times, she denies being a 'Blue Nose', as those born in Nova Scotia were nicknamed, considering herself an Islander to the core.

text: Characters[edit]

text: Anne Shirley - Now a student at Redmond College, Anne has become an elegant, smart young woman.

text: Marilla Cuthbert - The stern, upright woman who took Anne in when she was just a girl, Marilla has now become a loving mother figure to Anne. She continues to live at Green Gables with the twins, Davy and Dora Keith who are her dead second cousin's children.

text: Gilbert Blythe - Anne's childhood rival and now good friend. Gilbert is now studying at Redmond College and is in Anne's class. After many years, he finally admits his love for Anne and proposes to her. He is rejected the first time but after falling ill and proposing again Anne accepts it.

text: Charlie Sloane - An old schoolmate who has feelings for Anne, but who Anne has always felt indifferent towards and is now in her class at Redmond College. He proposes to Anne but is rejected.

text: Priscilla Grant - Anne's friend from Queen's Academy, Priscilla is one of Anne's roommates at Patty's Place.

text: Stella Maynard - Anne's friend from Queen's Academy, Stella is one of Anne's roommates at Patty's Place.

text: Philippa Gordon - Anne's new friend from Redmond College, Philippa (or Phil for short) is playful and charming and can't choose between her beaus. However, she is also a loyal friend and plays an essential role in bringing Anne and Gilbert together at the end.

text: Royal Gardner - A handsome Redmond student who Anne at first thinks is her dream man having become friends after he shared his umbrella with her. He courts Anne for two years. Anne is at first enamored by his romantic gestures, but eventually finds him rather dull and humorless and rejects his proposal.

text: Diana Barry - Anne's kindred spirit since childhood. The two remain best friends, even as Diana marries and starts a family.

text: Davy Keith - One of the twins who Marilla took in, Davy is mischievous but sweet at heart, and idolizes Anne. He has fair, fuzzy ringlets all over his head, one dimple, roguish hazel eyes, a snub nose and is often smiling.

text: Dora Keith - Dora, Davy's sister, is completely the contrary of her brother. She does everything she is told without mistake and is very docile. She has sleek curls, hazel eyes, a straight nose and "prunes and prisms" mouth.

text: Rachel Lynde - Formerly Marilla and Anne's neighbour, who has since moved to Green Gables after the death of her husband Thomas. While she is outspoken and demanding, she is well-intentioned and kindhearted.

text: Ruby Gillis - Anne's childhood friend. Ruby is fair and beautiful and prepared to marry when she discovers that she is gravely ill and dies later in the book.

text: Jane Andrews - Anne's childhood friend. Jane is a teacher who meets and marries an older millionaire, much to Mrs. Andrews' delight.

text: Billy Andrews - Jane's slow-witted brother, who is Anne's first proposal. Too bashful to go courting, he uses his sister as an intermediary. Anne is disappointed but amused at how unromantic the whole situation and she rejects him.

text: Series[edit]

text: Montgomery continued the story of Anne Shirley in a series of sequels. They are listed in the order of Anne's age in each novel.

text:
Lucy Maud Montgomery's books on Anne Shirley

#
Book
Date published
Anne Shirley's age

1
Anne of Green Gables
1908
11 — 16

2
Anne of Avonlea
1909
16 — 18

3
Anne of the Island
1915
18 — 22

4
Anne of Windy Poplars
1936
22 — 25

5
Anne's House of Dreams
1917
25 — 27

6
Anne of Ingleside
1939
34 — 40

7
Rainbow Valley
1919
41

8
Rilla of Ingleside
1921
49 — 53

text:
Related books in which Anne Shirley plays a lesser part

#
Book
Date published
Anne Shirley's age

—
Chronicles of Avonlea
1912
—

—
Further Chronicles of Avonlea
1920
—

—
The Blythes Are Quoted
2009
—

text: Adaptations[edit]

text: The musical Anne & Gilbert drew from this book in the second act - Anne and Gilbert also draws from Anne of Avonlea.

text: The television mini-series Anne of Green Gables - The Sequel (1987) starring Megan Follows was largely inspired by this book, along with Anne of Avonlea and Anne of Windy Poplars.


document_title: Honda Pilot

question_text: when did they change the honda pilot body style

text: Honda Pilot

text: First generation (2003–2008)[edit]

text:
First generation

Overview

Production
April 2002—2008

Model years
2003–2008

Assembly

Alliston, Ontario, Canada (HCM) (2003-07)
Lincoln, Alabama, United States (HMA)

Designer
Ricky Hsu (1999)

Body and chassis

Related

Acura MDX
Honda Odyssey

Powertrain

Transmission
5-speed automatic

Dimensions

Wheelbase
106.3 in (2,700 mm)

Length
188.0 in (4,775 mm)

Width

2003–05: 77.3 in (1,963 mm)
2003–05 LX: 76.3 in (1,938 mm)
2006–08: 77.5 in (1,968 mm)

Height

2003–05: 71.7 in (1,821 mm)
2003–05: 70.6 in (1,793 mm)
2006–08 2WD LX: 70.1 in (1,781 mm)
2006–08 4WD LX: 70.4 in (1,788 mm)
2006–08 2WD EX/EX-L: 71.3 in (1,811 mm)
2006–08 4WD EX/EX-L: 71.7 in (1,821 mm)

text: Specifications[edit]

text: The 2003-2004 Pilots featured the J35A4 motor, an aluminum-alloy 3.5L V6 producing 240 HP and 242 lb-ft of torque. The 2005 Pilot received a new engine, the J35A6, which featured drive-by-wire throttle and produced 255 HP and 250 lb-ft of torque. Refreshed 2006-2008 Pilots came with either the J35Z1 (FWD) or the J35A9 (4WD). Both engines are rated at 244 HP and 240 lb-ft of torque. Refreshed FWD models feature Honda's Variable Cylinder Management system, which can deactivate up to three cylinders under light load to increase fuel economy. All Pilots from this generation feature a 5-speed automatic transmission. The Pilot has front struts with a coil-spring, multilink rear suspension for a flat rear load floor. Front track is 66.3 in (1,684 mm) and 66.5 in (1,689 mm) at the rear. The Pilot has a 4,500 lb (2,041 kg) boat/3,500 lb (1,588 kg) trailer towing capability with the optional dealer installed towing package.

text: 2003-2005 Pilots came with Honda's Variable Torque Management 4WD system (VTM-4). Under normal driving conditions, most power is transferred to the front wheels while some is sent to the back wheels. If wheel slippage is detected up front, up to 50% of power can be sent to the rear wheels. The system features a VTM-4 lock button on the dashboard which locks the rear differential and sends 25% of the power to each rear wheel. However, the VTM-4 lock function only operates in first, second, and reverse, and automatically disengages above 18mph, then re-engages when the speed drops below 18mph. 2006 refresh models were the first time a Pilot has been offered in FWD.

text: Design[edit]

text: Design of the Pilot was by Honda's Ricky Hsu through 1999, when styling was approved. The Pilot can accommodate up to eight passengers in three rows configured as stadium seating. The third row can seat three, but the limited legroom makes it suitable only for small children or adults on short trips. Similar to the Honda Odyssey, the rear seats can be folded into flat surfaces for larger cargo. Options include powered moonroof, DVD entertainment system, and a navigation system.[5][6]

text: Other features include ABS-equipped four-wheel disc brakes, rack-and-pinion steering, four-wheel independent suspension, and 282° of outward visibility.

text: 2006 Facelift[edit]

text: Honda revised the Pilot for the 2006 model year in October 2005. Changes to the exterior included a new fascia with a different grille insert and halogen projector headlights, and taillights with clear lenses. The EX trim level received redesigned wheels, and the original EX wheels were now found on the LX trim. On the inside, side airbags were provided in the C pillar, the gauge cluster was updated and the center console featured chrome trim and redesigned storage compartments and cup holders.

text: Second generation (2009–2015)[edit]

text:
Second generation

Overview

Production
April 2008 – 2015

Model years
2009 – 2015

Assembly
Lincoln, Alabama, United States (HMA)

Designer
Dave Marek (2006)

Body and chassis

Related

Acura MDX
Honda Odyssey

Powertrain

Transmission
5-speed automatic

Dimensions

Wheelbase
109.2 in (2,774 mm)

Length

2009-11: 190.9 in (4,849 mm)
2012-15: 191.4 in (4,862 mm)

Width
78.5 in (1,994 mm)

Height

2009-11: 72.7 in (1,847 mm)
2012-15: 71.0 in (1,803 mm)

text: The larger second generation Pilot was unveiled as a prototype in January 2008 at the North American International Auto Show. Assembled at Honda Manufacturing of Alabama in Lincoln, Alabama, it was offered in five trims; LX, EX, EX-L, Touring, and SE (2015 only). It received a new 3.5-liter V6 VTEC engine producing 250 hp (186 kW; 253 PS) SAE net at 5700 rpm and 253 lb⋅ft (343 N⋅m) of torque at 4800 rpm.[7] EPA fuel economy is rated at 17 mpg city /23 mpg highway with front-wheel-drive and 16 mpg city / 22 mpg highway for all-wheel-drive.

text: Both drivetrains were equipped with five-speed automatics. The second generation's wheelbase is 109.2 in, with a length of 190.9 in, a width of 78.5 in, a height of 71.0 in and interior space of 153.7 cu-ft. The redesigned headlights lost the previous generation's halogen projectors and return to standard halogen reflectors. Features included new two-position memory settings for the driver's seat, a new power tailgate, and the gear shift was relocated from the steering column to the center console between the front seats. The Touring trim included a 120-volt power outlet and a satellite-linked Honda navigation system.

text: 2012 facelift[edit]

text: The 2012 model year introduced a redesigned front fascia, new alloy wheels, and updates to the interior along with changes to the bumper.

text: 2013 changes[edit]

text: The 2013 model year included a standard rearview backup camera, i-MID central dashboard 8-inch LCD screen, USB connector, Bluetooth hands-free calling and wireless audio streaming, and tri-zone climate control.

text: Safety[edit]

text: The Pilot uses Honda's Advanced Compatibility Engineering front bracket. For the 2013 model year a rear-view backup camera was made standard. The Insurance Institute for Highway Safety (IIHS) found the Pilot a driver death rate of 2 deaths per million registered years among the ten lowest released in their report[8][9]

text:
IIHS crash test scores:[10][11]

Moderate overlap frontal offset
Good

Small overlap frontal offset
Poor*

Side impact
Good

Roof strength
Marginal (2009-11 models)

Roof strength
Good (2012 models)

text: *vehicle structure also rated "Poor"

text:
NHTSA 2011 Pilot†:[12][13]

Overall:

Frontal Driver:

Frontal Passenger:

Side Driver:

Side Passenger:

Side Pole Driver:

Rollover FWD:
 / 17.4%

Rollover AWD:
 / 16.4%

text: Third generation (2016–present)[edit]

text:
Third generation

Overview

Production
May 2015-present

Model years
2016-present

Assembly
Lincoln, Alabama, United States (HMA)

Designer
Ben Davidson (2012)

Body and chassis

Related

Acura MDX
Honda Odyssey
Honda Ridgeline[14]

Powertrain

Transmission

6-speed automatic
9-speed ZF 9HP automatic (optional)

Dimensions

Wheelbase
111.0 in (2,819 mm)

Length
194.5 in (4,940 mm)

Width
78.6 in (1,996 mm)

Height
69.8 in (1,773 mm)

Curb weight

4,054–4,140 lb (1,839–1,878 kg) (FWD)
4,220–4,317 lb (1,914–1,958 kg) (AWD)

text: The third-generation 2016 Pilot debuted at the Chicago Auto Show in February 2015, production began during May, and was made available for sale in June.

text: The exterior is sleeker in appearance compared to its boxier predecessor. Added to the exterior are optional LED headlamps with automatic high-low beam switching, LED daytime running lights (DRLs), and LED brake tail lights and the new Elite model. New features also include heated rear seats, ventilated front seats, and a panoramic roof to Elite models only. Alloy wheels became standard.

text: Newly available safety features include Honda's LaneWatch passenger side mirror camera or Blind Spot Information (BSI) and rear Cross Traffic Monitor.[15] Additional options include Lane Departure Warning (LDW) with Lane Keeping Assist System (LKAS) and Road Departure Mitigation (RDM), Forward Collision Warning (FCW) with Collision Mitigation Braking System (CMBS), Adaptive Cruise Control (ACC). A tri-angle backup camera is standard with dynamic guidelines optional.

text: The revised 3.5-liter V6 engine has direct-injection and start-stop system with improved power at 280 hp (209 kW; 284 PS), a 6-speed automatic is standard while a ZF 9-speed automatic is optional. With all-wheel drive models the amount of engine torque sent to each rear wheel is variable. EPA-estimated fuel economy is improved with front-wheel drive (FWD) 6-speed models registering 19/27/22 mpg, and all-wheel drive (AWD) models registering 18/26/21 mpg (city/highway/combined). 9-speed models see fuel economy of 20/27/23 mpg in FWD configuration and 19/26/22 mpg in AWD.[16]

text: Overall dimensions are larger, while weight is down approximately 300 pounds with noise, vibration, and harshness (NVH) reduced. Structurally 21.3% of the Pilot's body is composed of 980, 1300 and 1,500 MPa ultra-high-strength steels, 5% is from aluminum or magnesium, an additional 34.5% is 270 MPa mild strength steel used in areas to minimize repair costs.[17]

text: Safety[edit]

text:
IIHS 2016 Pilot[18]

Moderate overlap frontal offset
Good

Small overlap frontal offset
Good1

Side impact
Good

Roof strength
Good2

Headlights
Acceptable3

text:
NHTSA 2016 Pilot:[20][21]

Overall:

Frontal Driver:

Frontal Passenger:

Side Driver:

Side Passenger:

Side Pole Driver:

Rollover FWD:
 / 17.5%

Rollover AWD:
 / 16.4%

text: Sales[edit]

text:
Calendar year
US sales

2002
52,062

2003
106,917

2004
128,158

2005
143,353

2006
152,154

2007
117,146

2008
96,746

2009
83,901

2010
102,323

2011
116,297

2012
114,848

2013
126,678

2014
108,857

2015
136,212[22]

2016
120,772[23]

2017
127,279