Gender differences and the Defense Mechanism Test: A comparative study of adolescents in psychiatric care and healthy controls

The aim of this paper was to study gender differences in the percept-genetic method Defense Mechanism Test (DMT) among a group of 60 adolescent subjects. Three subgroups were used: patients with psychotic disorders (Axis 1); borderline personality disorder (Axis 2) according to the DSM-IV classification system, and a non-patient group. The test protocols were scored with respect to 124 DMT variables and analyzed by means of the multivariate projection method Partial Least Squares (PLS) in latent structures. The overall results showed considerable gender differences in the whole group as well as in the subgroups. The most striking finding was that girls compared to boys were characterized by the perceptual defense identification with the opposite sex, which means that they perceived male gestalts instead of females in the stimulus picture. When both gender and diagnostic group membership were considered simultaneously, the influence of diagnostic group membership seemed to be stronger than gender even if there was an interaction between diagnoses and gender. It was concluded that gender must be considered when the DMT is used on adolescent populations.     

Sex differences in the eyes of expert personality assessors: unwarranted conclusions.

In a recent paper, Haan and Livson reported sex differences between male and female psychologists in their evaluations of adult men and adult women. Their conclusions have implication for the validity of clinical assessments and were interpreted in terms of stereotypic sex role perceptions. However, their statistical analysis was in fundamental error. When the data they employed were reanalyzed, no reliable sex differences between men and women psychologists were found, a finding in accord with a number of previous investigations of this problem.     

Diagnosis of Schizophrenia by Rorschach Patterns

In the belief that the diagnostic validity of Rorschach methods would gain from formalizing the judgmental processes of clinicians, 14 score patterns were constructed from eight Rorschach variables, each pattern designed to characterize patients in one of three broad diagnostic categories, Schizophrenic, Borderline Psychotic, or “Other.” A random sample of 196 patients of a VA mental hygiene clinic was drawn from clinic files. The “pattern diagnoses” obtained by applying the pattern system to their Rorschach scores were found significantly related to diagnoses formulated by the examining psychologists and by the clinic intake staff. More patients diagnosed schizophrenic by the pattern method engaged in autistic behavior than patients with other pattern diagnoses. The diagnostic efficiency of the pattern method, measured in terms of ability to reach a definite diagnosis, proportion of correct diagnoses, and proportion of false positive errors, did not differ significantly from the diagnostic efficiency of the psychological examiners, and differed significantly from the psychiatrists' diagnostic efficiency only in producing more “indeterminate” diagnoses. The diagnostic validity of the patterns was considered to be established, but their usefulness as a clinical tool depends heavily on population base rates and the relative costs of false positive and false negative diagnostic errors.     

Clinical Utility of the MMPI–2 Restructured Clinical (RC) Scales in Therapeutic Assessment: A Case Study

Summary: In a recent paper, Haan and Livson reported sex differences between male and female psychologists in their evaluations of adult men and adult women. Their conclusions have implication for the validity of clinical, assessments and were interpreted in terms of stereotypic sex rote perceptions. However, their statistical analysis was in fundamental error. When the data they employed were reanalyzed, no reliable sex differences between men and women psychologists were found, a finding in accord with a number of previous investigations of this problem.     

An alternative hierarchical organization of the mental disorders of the DSM-IV

With the approaching publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), alternative organizations of the DSM (4th ed.; DSM-IV; American Psychiatric Association, 1994) categories have been proposed. This article compares several published alternative organizations to clinicians' organization of the DSM-IV categories. As demonstrations of their organization of DSM-IV categories, psychologists and psychiatrists sorted 66 DSM-IV diagnostic categories into groups of similar diagnoses and then made progressively larger and smaller groups of diagnoses or placed similar groups next to each other on a table. Hierarchical agglomerative data analysis of clinicians' individual sortings showed that clinicians retained many lower level DSM-IV categories (e.g., anxiety disorders, mood disorders), but not the higher level DSM-IV categories (e.g., Axis I vs. Axis II). Instead, at the highest hierarchical level, clinicians' categories resembled the structure of the first edition of the DSM (American Psychiatric Association, 1952), which followed clinicians' diagnostic decision-making scheme, dividing mental disorders into organic versus nonorganic and then psychotic versus neurotic disorders. At minimum, these data suggest a DSM organization that makes sense to clinicians.     

Étude de la concordance des diagnostics psychiatriques et psychologiques dans un échantillon de 505 criminels

Our focus is to study how frequently psychologists and psychiatrists make diagnoses in forensic reports, whether structural or nosographic, in relation to judicial expertise. Our goal is thus to assess the conformability ratio between psychologists and psychiatrists for both diagnoses. To do so, we studied the level of inter-observer agreement for the diagnoses of 505 male criminals made in France by expert psychologists and psychiatrists between 1990 and 2003. The measurement of agreement was done with the Kappa coefficient. The inter-observer agreement (psychiatrics versus psychologists) shows a 0.55 to 0.71 variation for the structural diagnoses and 0.51 to 0.89 for the nosographic diagnoses.Furthermore, the results also show a high level of agreement between the psychiatrists and psychologists for not making diagnoses, whether structural (k = 0.66) or nosographic (k = 0.73). Hence, we provide specific advice to improve the consistency of expert diagnoses for criminals in France.     

Comparative Diagnostic Judgments from the Rorschach and the MMPI

Three experienced psychologists made diagnostic judgments from the Rorschach, the MMPI, and gave an overall diagnostic impression for 50 male and 48 female patients. Judgment on the first test viewed was given before looking at the second test. Order of viewing the tests and sex of patient were counterbalanced. The results indicated (a) the judges consistently rated the tests on a given individual as agreeing on diagnostic impression significantly more often than disagreeing; (b) interjudge agreement was low but significant for the MMPI and overall impressions, not significant for the Rorschach impressions; (c) in cases of disagreement, there was a highly significant tendency for the Rorschach to be seen as indicating more pathology than the MMPI.     

Psychologists' perspectives on the diagnostic classification of mental disorders: Results from the WHO‐IUPsyS Global Survey

This study examined psychologists' views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD‐11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD‐10 used most frequently by 51% and DSM‐IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD‐11 development and dissemination are discussed.     

Sexualdelinquenz bei Schizophrenie

Studies suggest a complex relationship between schizophrenia and sexually offensive behaviour. This study aimed to preserve first findings of sex offence features and behaviours exhibited by psychotic men in Germany. Furthermore a typology of the schizophrenic offender group was developed. A comparative trial design was used to differentiate the psychotic and non psychotic offender group. A checklist was developed and applied to the records of 64 male restricted hospital order in-patients in Berlin with an index conviction for a contact sex offence against a woman. Social isolation, antisocial behaviour, psychosexual variables and adverse childhood experiences are found for schizophrenic and sexual offenders in general. Different sexual offensive behaviours appeared in the schizophrenic subgroups. Negative symptoms of schizophrenia as well as antisocial traits had a great impact on schizophrenic sexual offending. A heterogeneous group of psychotic offenders can be supposed.     

Interjudge Agreement of Draw-A-Person Diagnostic Impressions

Summary

The interjudge agreement of Draw-A-Person (DAP)-based diagnostic impressions was assessed. Twenty-four psychologists were asked to categorize 48 DAP protocols as being the productions of organics, paranoid schizophrenics, non-paranoid schizophrenics or normal controls. The mean between-judges proportion of agreement was only .41 and the mean proportion correct was a mere .28. (A proportion of .25 could be anticipated in each case by chance.) Strength of interjudge agreement did not vary with the extent to which judges utilized the test but did seem dependent upon the subjects' diagnoses. The results indicated that diagnostic impressions based on the DAP alone seem to be neither usefully valid nor impressively consistent across psychologists. It is suggested that the profession is due for a re-evaluation of its DAP training techniques and its use of the test.     

ICD-11 guidelines for psychotic,mood, anxiety and stress-related disorders in Mexico: Clinical utility and reliability

Background/Objective: The World Health Organization's diagnostic guidelines for ICD-11 mental and behavioural disorders must be tested in clinical settings around the world to ensure that they are clinically useful and genuinely global. The objective is evaluate the inter-rater reliability and clinical utility of ICD-11 guidelines for psychotic, mood, anxiety- and stress-related disorders in Mexican patients. Method: Adult volunteers exhibiting the selected symptoms were referred from the pre-consultation unit of a public psychiatric hospital to an interview by a pair of clinicians, who subsequently assigned independent diagnoses and evaluated the clinical utility of the diagnostic guidelines as applied to each particular case, on the basis of a scale developed for this purpose. Results: 23 clinicians evaluated 153 patients. Kappa scores were strong for psychotic disorders (.83), moderate for stress-related (.77) and mood disorders (.60) and week for anxiety and fear-related disorders (.43). A high proportion of clinicians considered all diagnostic guidelines to be quite to extremely useful as applied to their patients. Conclusions: ICD-11 guidelines for psychotic, stress-related and mood disorders allow adequate inter-rater consistency among Mexican clinicians, who also considered them as clinical useful tools.     

Effects of experience and training on diagnostic accuracy

In this reexamination of a previously published report (R. Brammer, 1997), psychologists and psychology students (N = 138) were provided an artificial intelligence program that simulated a clinical interview, The "client" provided paragraph-length answers to the questions participants chose to ask. At the end of their interview, the participants provided a brief diagnosis for the client. A path analysis revealed that clinical experience is a strong predictor of the ability of form an accurate diagnosis and that an individual's level of training, mediated by the number of diagnostic questions asked, also helps to derive accurate diagnoses.     

Attention to Sex in Psychological Research as Related to Journal Policy and Author Sex

From 1969 to 1974, Developmental Psychology, but not Child Development , specified that authors analyze for sex differences. The authors examined 503 studies published in Child Development and Developmental Psychology in 1971 and 1975. Sex of senior author, subjects and experimenter(s) were recorded for each study. If subjects of both sexes were used, the presence or absence of the following were noted: (a) analysis of sex differences; (b) hypotheses regarding sex differences; (c) mention of subjects' sex in the abstract. For single-sex-subject studies, mention of subjects' sex in the discussion or conclusion was noted. Using these data as dependent variables, chi-square analyses were performed comparing: (a) the two journals; (b) 1971 and 1975 authors; and (c) male and female authors. The findings were: (a) More attention was paid to sex in Developmental Psychology when the journal had a written editorial policy regarding this factor; (b) Evidence was mixed for increasing awareness of sex as a variable between 1971 and 1975; (c) Female authors were more aware of sex than were male authors in 1971 but not in 1975; (d) In both years, authors used own-sex subjects and experimenters more than those of the opposite sex; (e) Developmental psychologists, as compared to psychologists in other areas previously examined, were more sensitive to sex as a variable.     

Diagnostic Sex-Role Bias and its relation to authoritarianism,Sex-Role Attitudes,and sex of the school psychologist

At the 1973 National Association of School Psychologists' Convention (NASP) in New York City, a national sample of 120 school psychologists (61 female, 59 male), were asked to participate in a survey measuring a wide spectrum of their attitudes. The Chasen Diagnostic Sex-Role Bias scale, consisting of eight equated “somewhat unhealthy” case histories of active and passive girls and boys, developed and validated for this study, was administered with the Trachtman Authoritarianism Scale, and the Hymer Sex-Role Attitude Scale. For the total group, authoritarianism and sex-role attitudes are not related to Diagnostic Sex-Role Bias, yet males with traditional sex-role attitudes exhibit Diagnostic Sex-Role Bias and males with untraditional sex-role attitudes exhibit counterstereotypic Diagnostic Sex-Role Bias. The sex of the school psychologist is related to Diagnostic Sex-Role Bias; that is, male school psychologists do not exhibit Diagnostic Sex-Role Bias, while female school psychologists exhibit counterstereotypic Diagnostic Sex-Role Bias. Females are most accepting of active girls, which may be considered a compensatory diagnostic mechanism to counteract stereotyping.     

Sex bias in the diagnosis of personality disorders: A different approach

There has been considerable controversy regarding a possible sex bias in the diagnosis of personality disorders (PDs). However, prior research has at times confused a bias within clinicians who fail to adhere to the diagnostic criteria with a bias within the diagnostic criteria. Rather than assess whether females are more likely than males to be diagnosed with a respective disorder, the current study assesses whether the thresholds for the diagnosis of female-typed PDs are lower than the thresholds for male-typed PDs. Subjects completed two self-report inventories for the DSM-III-R personality disorders, and three inventories that assessed 30 aspects of personality dysfunction organized with respect to social dysfunction, occupational dysfunction, and personal distress. There was no indication that the diagnostic thresholds for personality disorders that occur more often in females is lower than the thresholds for the personality disorders that occur more often in males. The implications of these findings for the issue of sex biased diagnoses are discussed.     

Feminism and the Evolution of Sex Differences and Similarities

Distrust between most evolutionary psychologists and most feminist psychologists is evident in the majority of the articles contained in this Special Issue. The debates between proponents of these perspectives reflect different views of the potential for transforming gender relations from patriarchal to gender-equal. Yet, with respect to the overall prevalence of sex differences or similarities, the articles in the Special Issue show that neither feminist psychologists nor evolutionary psychologists have uniform positions. Questions about how and if women and men differ are still under negotiation in the articles in this Special Issue as well as in other research related to evolutionary and feminist psychology. Clearer conclusions would be fostered by standardized metrics for representing male?Cfemale comparisons, more varied research methods for assessing both psychological and biological processes, greater diversity in populations sampled, and more researcher openness to taking into account findings that challenge their theories. Theoretical growth also is needed, especially to develop and integrate the many individual feminism-influenced theories represented in this Special Issue. To this end, we propose an integrative evolutionary framework that recognizes human culture in both ultimate and proximal causes of female and male behavior.     

Smooth-pursuit eye tracking in first-episode psychotic patients and their relatives.

We wished to determine the specificity of smooth-pursuit eye tracking dysfunction to schizophrenia and the prevalences of dysfunction among functionally psychotic and normal individuals. Therefore, we investigated pursuit tracking in a large sample of psychotic patients, normal subjects, and first-degree relatives (N = 482). Patients were recruited as part of an epidemiological study of first-episode psychosis that used a broadly based referral network to identify all cases in a major metropolitan area over a 2 1/2-year period. Patients received diagnoses of schizophrenia, schizophreniform disorder, psychotic mood disorder, and paranoid or other psychotic disorder based on the third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980). The distribution of tracking performance was bimodal for the schizophrenic patients and their relatives, perhaps reflecting major gene action. Moreover, poor tracking ran in families. Pursuit tracking dysfunction was relatively specific to schizophrenic patients and their relatives and occurred infrequently in other psychotic patients and normal subjects.     

Distribution of DSM-II diagnoses in a child psychiatric setting

While DSM-II contains more diagnostic categories related specifically to children than did the earlier DSM-I, clinical utilization studies of the various categories have not been extensive. The present study reports data on the distribution of diagnoses of childhood disorders and analyzes relationships among several diagnostic categories and subject variables. Results indicate that clinicians are using a wide range of DSM-II diagnoses for childhood disorders, including some which were intended for use with adults as well as those which were designed specifically for children. Transient Situational Disorders and Behavior Disorders are assigned almost equally to two-thirds of the sample. Chi-square analyses revealed a relationship between diagnostic categories and subject variables of age and sex. These data suggest that boys, particularly between the ages of 6 and 13, are more frequently than girls categorized as Behavior Disorder, and that the Transient Situational Disorder category is overutilized for adolescents, both male and female.The authors are indebted to James H. Johnson for his valuable contributions in all phases of this study and to Peggy Louro for her assistance in data collection.     

The (In)visibility of Psychodiagnosticians' Expertise

This study investigates decision making in mental health care. Specifically, it compares the diagnostic decision outcomes (i.e., the quality of diagnoses) and the diagnostic decision process (i.e., pre‐decisional information acquisition patterns) of novice and experienced clinical psychologists. Participants' eye movements were recorded while they completed diagnostic tasks, classifying mental disorders. In line with previous research, our findings indicate that diagnosticians' performance is not related to their clinical experience. Eye‐tracking data provide corroborative evidence for this result from the process perspective: experience does not predict changes in cue inspection patterns. For future research into expertise in this domain, it is advisable to track individual differences between clinicians rather than study differences on the group level. Copyright © 2015 John Wiley & Sons, Ltd.     

Workaholism,sex, and sex role stereotyping among female professionals

This paper examines the relationship between workaholism, sex, and sex role orientation among professionals. The sample consisted of 86 male and 106 female attorneys, physicians, and psychologists/therapists. Results indicated a significant relationship between sex and sex role stereotyping. Among females, workaholics were grouped exclusively in the sex role categories masculine and androgynous. Implications for counseling include increasing awareness of changing sex role attitudes among professional women and possible role conflict that can occur from integration of work and family.