Support for the location of negative posttraumatic cognitions in the diagnosis of posttraumatic stress disorder

ObjectiveTo investigate the extent to which negative posttraumatic cognitions predict, and so can be best located within, the DSM-5 (APA, 2013) individual symptom clusters of posttraumatic stress disorder (PTSD).MethodAn online survey of traumatic experiences, featuring 528 adults.ResultsNegative posttraumatic cognitions seem best placed within the Numbing/Detachment symptom cluster. Negative posttraumatic cognitions relating to the self predict higher levels of symptoms across the clusters. While negative cognitions relating to the world contributed to most symptom groups, self-blame cognitions did not.ConclusionsOur findings support the placement of posttraumatic cognitions as part of the Numbing/Detachment symptom cluster within the DSM-5rather than the Intrusion, Avoidance and Hyperarousal clusters.     

Contributions from personality- and psychodynamically oriented assessment to the development of the DSM-5 personality disorders

Advances in personality assessment over the past 20 years have notably influenced the proposed assessment and classification of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]). However, a considerable body of personality assessment and psychodynamically oriented assessment research has significant relevance to the way in which personality disorders are evaluated that appears to have gone unrecognized in the current proposals for DSM-5. In this article, I discuss the ways in which some of these 2 bodies of literature can and should inform the DSM-5 so that the diagnostic nomenclature can be more scientifically and comprehensively informed and consequently improve the clinical utility of a diagnostic system in need of considerable revision.     

DSM-5 personality traits and DSM-IV personality disorders

Two issues pertinent to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) proposal for personality pathology, the recovery of DSM-IV personality disorders (PDs) by proposed DSM-5 traits and the validity of the proposed DSM-5 hybrid model, which incorporates both personality pathology symptoms and maladaptive traits, were evaluated in a large undergraduate sample (N = 808). Proposed DSM-5 traits as assessed with the Personality Inventory for DSM-5 explained a substantial proportion of variance in DSM-IV PDs as assessed with the Personality Diagnostic Questionnaire-4+, and trait indicators of the 6 proposed DSM-5 PDs were mostly specific to those disorders with some exceptions. Regression analyses support the DSM-5 hybrid model in that pathological traits, and an indicator of general personality pathology severity provided incremental information about PDs. Findings are discussed in the context of broader issues around the proposed DSM-5 model of personality disorders.     

Toward a Cognitive-Behavioral Classification System for Mental Disorders

As is true for its predecessors, the recently published DSM-5 uses arbitrary criteria and cutoffs to define categories of mental disorders that are of questionable validity and that provide no guidance for treatment. Recently, the NIMH introduced an alternative classification system, the Research Domain Criteria (RDoC). Both the DSM-5 and the RDoC initiative make the strong assumption that psychological problems are expressions of specific latent disease entities. In contrast, the complex causal network approach conceptualizes psychological problems as mutually interacting, often reciprocally reinforcing, elements of a complex causal network. The cognitive behavioral model offers a classification framework that is compatible with the complex causal network approach and provides a treatment-relevant alternative to the latent disease model that is the basis for the DSM-5 and the RDoC initiative.     

社会支持对震后青少年创伤后应激障碍和创伤后成长的影响:自我效能感的中介作用

本研究采用创伤暴露问卷、社会支持问卷、自我效能感量表、创伤后应激障碍症状核查表和创伤后成长问卷,在汶川地震8.5年后对地震极重灾区的1185名中学生进行调查,考察社会支持对创伤后应激障碍（PTSD）和创伤后成长（PTG）的影响,并检验自我效能感在其中的中介作用。结果发现：在控制创伤暴露程度、性别和年龄等变量后,社会支持不仅可以直接负向预测PTSD、正向预测PTG,也可以通过自我效能感的中介作用负向预测PTSD、正向预测PTG。这表明,自我效能感在社会支持与PTSD、社会支持与PTG的关系中都具有部分中介效应。     

The prevalence of specific learning disorder in mathematics and comorbidity with other developmental disorders in primary school-age children

Mathematics difficulties are common in both children and adults, and they can have a great impact on people's lives. A specific learning disorder in mathematics (SLDM or developmental dyscalculia) is a special case of persistent mathematics difficulties, where the problems with maths cannot be attributed to environmental factors, intellectual disability, or mental, neurological or physical disorders. The aim of the current study was to estimate the prevalence rate of SLDM, any gender differences in SLDM, and the most common comorbid conditions. The DSM-5 provides details regarding these only for specific learning disorders in general, but not specifically for SLDM. We also compared the prevalence rates obtained on the basis of the DSM-IV and DSM-5 criteria. We investigated the performance of 2,421 primary school children on standardized tests of mathematics, English, and IQ, and several demographic factors over the primary school years. We applied the DSM-5 diagnostic criteria to identify children with a potential diagnosis of SLDM. Six per cent of our sample had persistent, severe difficulties with mathematics, and, after applying the exclusion criteria, 5.7% were identified as having an SLDM profile. Both persistent maths difficulties and consistently exceptionally high performance in maths were equally common in males and females. About half of the children with an SLDM profile had some form of language or communication difficulty. Some of these children also had a diagnosis of autism, social, emotional, and behavioural difficulties or attention deficit and hyperactivity disorder. Our findings have important implications for research and intervention purposes, which we discuss in the study.     

Mental disorders,brain disorders,neurodevelopmental disorders: challenges for the philosophy of psychopathology after DSM-5

The publication of DSM-5 has been accompanied by a fair amount of controversy. Amongst DSM's most vocal ‘insider’ critics has been Thomas Insel, Director of the US National Institute of Mental Health. Insel has publicly criticised DSM's adherence to a symptom-based classification of mental disorder, and used the weight of the NIMH to back a rival research strategy aimed at a more biology-based diagnostic classification. This strategy is part of Insel's vision of a future, more preventative psychiatry in which mental disorders are not only understood as biological disorders of the brain, but also as neurodevelopmental disorders. This paper examines the interest and merit of Insel's views of mental and neurodevelopmental disorder for the philosophy of psychopathology, with a special focus of his neurodevelopmental model of schizophrenia. Pitman's ‘moderate materialism’ will be used both as a philosophical lens through which to examine Insel's position, as well as an example of a philosophical framework that may require updating and revision in the light of moves towards a neurodevelopmental conception of mental disorder.     

Zur Therapie von ADHS bei komorbiden Autismus-Spektrum-Störungen

Until recently, research on the co-occurrence of ADHD with autism spectrum disorder (ASD) has been limited by the fact that current classification systems did not allow a dual diagnosis of these two neurodevelopmental disorders. Since the DSM-5 permits a double diagnosis of ADHD plus ASD, research on their comorbidity has substantially increased. In addition to shared and distinct etiological factors, studies have revealed a high clinical impact of the combined symptomatology on affected individuals. This article provides a selective overview of evidence-based, mainly pharmacological treatment strategies in ADHD/ASD phenotypes.     

The Contribution of Worry Behaviors to the Diagnosis of Generalized Anxiety Disorder

Worry behaviors (i.e., overt acts to avoid or cope with worry-induced distress) have been recognized as being important in the psychopathology and treatment of generalized anxiety disorder (GAD). This study evaluated the worry behaviors criterion proposed for DSM-5 GAD, but was ultimately not adopted due to insufficient evidence. In 800 outpatients with emotional disorders (366 with GAD), most patients with GAD (92.6%) met the proposed worry behaviors criterion, which was at a rate significantly higher than other patient groups (e.g., patients with mood disorders). Patients who met the worry behaviors criterion had more severe GAD than patients who did not. The worry behaviors criterion, and 3 of its 4 constituent behaviors, were associated with no better than “fair” interrater reliability. Diagnostic reliability of GAD was not improved in cases where both interviewers agreed the worry behaviors criterion was met. The worry behaviors criterion significantly predicted DSM-5 GAD holding core GAD features constant (e.g., excessive worry), but this contribution was weak and did not appreciably improve the classification accuracy of GAD diagnostic status. Mixed support was obtained for the discriminant validity of the worry behaviors criterion in relation to mood disorders. Raising the proposed threshold of the criterion (requiring 2 instead of 1 behaviors) did not result in a substantial improvement in reliability, prediction, and classification accuracy. Although additional research is warranted (e.g., importance of worry behaviors in the treatment and natural course of GAD), the results raise questions about the role of worry behaviors in the diagnostic classification of GAD.     

Multidimensional perfectionism and the DSM-5 personality traits

Encouraging further research on the dimensional assessment of personality disorders (PDs), Section III of the DSM-5 introduced a hybrid model for the assessment of six PDs employing self-reports on 25 maladaptive personality traits (“DSM-5 personality traits”). Following suggestions that multidimensional perfectionism is an important characteristic across various personality disorders (Ayearst, Flett, & Hewitt, 2012), the present study investigated how personal (self-oriented) and interpersonal (other-oriented and socially prescribed) forms of perfectionism predicted the DSM-5 personality traits in a sample of 311 university students. Multiple regressions (controlling for the overlap between the different forms of perfectionism) showed that socially prescribed perfectionism positively predicted the traits defining schizotypal, borderline, avoidant, and obsessive-compulsive PD; other-oriented perfectionism positively predicted the traits defining narcissistic PD; and both socially prescribed and other-oriented perfectionism positively predicted the traits defining antisocial PD. In contrast, self-oriented perfectionism positively predicted only one of the four traits defining obsessive-compulsive PD (rigid perfectionism). Showing that multidimensional perfectionism predicted all DSM-5 traits defining the personality disorders of Section III, the findings suggest that future DSM-5 updates may profit from including interpersonal aspects of perfectionism as a diagnostic criterion.     

Posttraumatische Belastungsstörung

There are some problems concerning the concepts of trauma-related disorders and especially the category of posttraumatic stress disorder (PTSD) with respect to classification, diagnosis and epidemiological findings, which can only be understood within the historical framework of the development. Even current diagnostic systems, such as the diagnostic and statistical manual of mental disorders version 4 (DSM-IV) and the international classification of diseases version 10 (ICD-10) differ in the classification of these disorders which led to higher prevalence rates being achieved with ICD-10. The diagnostic algorithms have been opened to included subsyndromal PTSD as well as complex PTSD including more severe psychiatric disorders.     

Introduction to the special issue on personality assessment in the DSM-5

The DSM-5 is poised to dramatically reshape the way clinicians and researchers assess personality by reconfiguring the conceptualization of DSM-IV personality disorders. This special issue brings together leading scholars in personality pathology, including members of the DSM-5 Personality and Personality Pathology Work Group, as well as personality assessors operating from a variety of theoretical perspectives, to describe various facets of these changes and their potential impacts and in some cases to propose alternative solutions. As we describe in this brief introductory article, the articles in this special issue highlight several important and controversial issues in the transition to DSM-5 personality assessment.     

Persönlichkeitsdiagnostik im DSM-5

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in May 2013 and features (in Section III) a new model for the diagnosis of personality disorders. The aim of this paper is to introduce this model to a broader German-speaking readership. The article begins by explaining why a new model seems necessary. Secondly, the different components of the new DSM-5 model are presented, the theoretical and empirical background is explained and it is shown how the model works using a clinical case example. Thirdly, several advantages of the new model as compared to the DSM-IV diagnostic categories (which will be retained in DSM-5 Section II) are discussed. Finally, the article highlights some open questions and problems that require further conceptual and empirical research.     

Connecting DSM-5 Personality Traits and Pathological Beliefs: Toward a Unifying Model

Dissatisfaction with the DSM-IV model of personality disorders has led to the development of alternative conceptualizations, including pathological trait models and models linked to particular theoretical approaches, such as Beck and Freeman’s (1990) cognitive framework. An important issue involves the potential to interweave such models into a single, parsimonious system that combines their distinct advantages. In this study, pathological trait and dysfunctional belief data from 616 individuals in a non-clinical sample were evaluated for commensurability using structural equation modeling. These models can be integrated via five higher-order factors, and that specific dimensions of dysfunctional beliefs can be differentiated based on features of the DSM-5 trait model. Overall, these results suggest that traits provide scaffolding for individual differences in pathological personality, within which dysfunctional beliefs offer specific vectors for clinical intervention in a cognitive framework. Implications of the empirical commensurability of trait and cognitive models are discussed.     

<Emphasis Type="Italic">DSM-5</Emphasis> Posttraumatic Stress Disorder Symptom Structure in Disaster-Exposed Adolescents: Stability across Gender and Relation to Behavioral Problems

Given the significant modifications to posttraumatic stress disorder (PTSD) symptom criteria from DSM-IV to DSM-5, a better understanding of the dimensionality underlying DSM-5 PTSD symptoms among adolescents is needed. However, to date, whether gender moderates the latent structure of DSM-5 PTSD symptoms in youth remains unclear. Meanwhile, little is known about how distinct PTSD dimensions relate to adolescent behavioral problems. The aim of this study was to fill these gaps. A sample of 1184 disaster-exposed Chinese adolescents (53.8 % girls) with age ranging from 13 to 17 years (M = 14.3, SD = 0.8) completed the PTSD Checklist for DSM-5, and the Withdrawn, Aggressive Behavior, and Delinquent Behavior subscales of the Youth Self-Report. Confirmatory factor analyses revealed that the seven-factor hybrid PTSD model provided the best fit to the data for both girls and boys. Measurement equivalence of this model held across gender, although girls had higher mean scores than boys on some factors. Differential patterns of associations emerged between PTSD dimensions and behavioral problems, with anhedonia symptoms most strongly relating to social withdrawal, and externalizing behavior symptoms most strongly relating to aggression and delinquency. These findings further support the gender invariance and external criterion validity of the newly refined hybrid model that best represents DSM-5 PTSD symptom structure in youth, and carry implications for accurate assessment, diagnosis, and gender comparison of DSM-5 PTSD symptomatology, and potential symptom targets for PTSD intervention among adolescent disaster survivors.     

Die Abschaffung der somatoformen Störungen durch DSM-5 – ein akademischer Schildbürgerstreich?

The new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has introduced “somatic symptom disorder” as a diagnosis which is no longer differentiated into medically unexplained and explained physical symptoms. As a consequence, the status of somatoform disorders as an independent clinical group is called into question. Against all original intentions, the semantic, conceptual and practical problems of the previous classification have not been solved. The validity of the new diagnosis is doubtful because of its over-inclusive character. Further points of criticism are the less than optimal selection of psychological features, the abandonment of hypochondriasis as a homogeneous concept and imprecise workmanship of the diagnostic criteria where exclusion criteria needed for differential diagnosis are missing.     

Personality in DSM-5: helping delineate personality disorder content and framing the metastructure

The transition from the Diagnostic and Statistical Model of Mental Disorders (4th ed., text revision [DSM-IV-TR]; American Psychiatric Association, 2000 ) to the fifth edition (DSM-5) represents an unprecedented opportunity to integrate dimensional personality trait models into the official nosology. Not surprisingly, a variety of issues have arisen in contemplating this challenging integration. In this article, we address how a dimensional personality trait model could be a helpful component of DSM-5, from the perspective of our roles as work group members and advisors involved in the creation of a trait model and corresponding assessment instrument. We focus in particular on two potential roles for a trait model in DSM-5 that are under official consideration. First, a dimensional personality trait model might be helpful in delineating the content of personality disorders. Second, a trait model might assist in organizing the "metastructure" of DSM-5 (i.e., the arrangement of chapters and other broader classificatory rubrics).     

An interpersonal analysis of pathological personality traits in DSM-5

The proposed changes to the personality disorder section of the Diagnostic and statistical manual of mental disorders (5th ed.) places an increased focus on interpersonal impairment as one of the defining features of personality psychopathology. In addition, a proposed trait model has been offered to provide a means of capturing phenotypic variation on the expression of personality disorder. In this study, the authors subject the proposed DSM-5 traits to interpersonal analysis using the inventory of interpersonal problems-circumplex scales via the structural summary method for circumplex data. DSM-5 traits were consistently associated with generalized interpersonal dysfunction suggesting that they are maladaptive in nature, the majority of traits demonstrated discriminant validity with prototypical and differentiated interpersonal problem profiles, and conformed well to a priori hypothesized associations. These results are discussed in the context of the DSM-5 proposal and contemporary interpersonal theory, with a particular focus on potential areas for expansion of the DSM-5 trait model.     

Pathologisches Glücksspiel und Delinquenz

Pathological gambling is characterized by excessive gambling behavior which influences the life and well-being of a person in a dysfunctional way. It often leads to severe consequences in social and family life, career and material matters. This can also include illegal acts. In the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) excessive gambling was classified under impulse-control disorders but was renamed as gambling disorder (GD) and reclassified under the category “substance-related and addictive disorders” in DSM-5, due to parallels to substance use disorders in the clinical characteristics as well as genetic and neurobiological factors. In Germany, approximately 0.5?% of the adult population suffer from GD. Especially gambling machines are associated with an increased risk of gambling-related problems. Common comorbidities are substance-related and affective disorders. The most important risk factors are young age, male gender, a history of migration, gambling-related problems in the family, unemployment, a low educational level and low household income. Delinquent behavior was not considered to be a sufficiently discriminative factor for GD, although there is a correlation between delinquency and gambling behavior. In addition, those GD subjects who show delinquent behavior also show a specific risk profile. Thus, mental health professionals should be aware of possible psychosocial consequences in GD, such as illegal acts, and this should be addressed in the effective treatment strategies, such as cognitive behavioral therapy. Moreover, it is necessary to improve the access routes for affected people into healthcare system in order to ensure early detection and treatment of the disease.