The DSM-III and pastoral practice

This essay provides a conceptual bridge between psychiatry and pastoral practice which may facilitate cooperative efforts. The conceptual link is the theological and psychiatric answer to the question, “What is personhood?” found in the biblical doctrine of personhood and theDiagnostic and Statistical Manual of Mental Disorders, 3rd Edition. The essay argues that both views are holistic, compatible, and provide a base for cooperative effort.     

Personal computer software for teaching differential psychodiagnostics

The third edition of theDiagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980), outlines for the student what symptoms to consider when attempting to arrive at an accurate differential diagnosis of eight broad psychiatric categories. This paper describes a program developed to instruct a medical or graduate student in the science of such decision making.     

Psychopathology: A Simple Twist of Fate or a Meaningful Distortion of Normal Development? Toward an Etiologically Based Alternative for the DSM Approach

In this comment, I focus on a central issue that spans the entirety of Sidney Blatt's research career, namely his contributions to the development of a theoretically consistent and clinically relevant classification system of psychopathology. First, I discuss empirical evidence concerning the key assumptions underlying the currently dominant classification system of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Second, I compare these assumptions with assumptions underlying Blatt's categorization of psychopathology based on his distinction between two developmental lines, that is, self-definition and relatedness, together with a discussion of recent research on these two developmental lines in the context of the development of a more etiologically based classification system of depression and other disorders. Finally, I argue that research concerning Blatt's model of normal and pathological development—aside from direct contributions—may also inform empirically derived criteria for the development of a theoretically consistent and clinically useful way of classifying psychopathology.     

DSM‐5 and Bereavement: The Loss of Normal Grief?

The mood disorder work group has proposed to eliminate the bereavement exclusion criterion from the diagnosis of major depression in the 5th edition of the American Psychiatric Association's (2012) Diagnostic and Statistical Manual of Mental Disorders. The proposal would break tradition with the long‐held distinction between depression and normal bereavement. This article reviews the development of the bereavement exclusion, discusses evidence for and against the proposal, and offers some relevant implications for counselors in light of the research on depression and bereavement.     

Group comparisons of DSM-IV subtypes of chronic depression: validity of the distinctions, part 2

The nosology of chronic depression in Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) is highly complex and requires clinicians to differentiate among several chronic course subtypes. This study replicates an earlier investigation (J. McCullough et al., 2000; see record 2000-05424-007) that found few differences among Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.; DSM-III-R; American Psychiatric Association, 1987) categories of chronic depression. In the present study, 681 outpatients with chronic major depression, double depression, recurrent major depression without full interepisode recovery, and chronic major depression superimposed on antecedent dysthymia were compared. Few differences were observed on a broad range of demographic, clinical, psychosocial, family history, and treatment response variables. The authors suggest that chronic depression should be viewed as a single, broad condition that can assume a variety of clinical course configurations.     

An Introduction to the New DSM-III

The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) published in 1980 is increasingly used by counselors. This article discusses and clarifies DSM-III's diagnostic system.     

Assessment of DSM–5 Personality Disorder

The purpose of this article is to present an approach to defining, identifying, and assessing personality disorders, including the links between these definitions and personality assessment, with a particular reference to the proposed revisions to the personality disorders section of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Routledge.[Crossref] , [Google Scholar]). The article discusses measures of maladaptive variants of the Five-factor model (FFM) that are coordinated with both the traditional personality disorder syndromes as well as the DSM–5 dimensional trait model. Discussed as well is the assessment of the more psychodynamically oriented deficits in sense of self and interpersonal relatedness that are also included within the hybrid model proposed for DSM–5.     

Personality Disorders Are Not as We Thought: Hierarchical Factor Structure at the Criterion Level

The use of personality disorder (PD) categories persists, despite the evidence against them. An often overlooked reason for this is the fact that the true structure underlying the Diagnostic and Statistical Manual of Mental Disorders (DSM) taxonomy is still unknown: We cannot be certain which disorders are valid, and which ones are arbitrary mixtures of heterogeneous traits. To address this gap, we factor analyzed the Personality Diagnostic Questionnaire (PDQ–4+; Hyler, 1994 Hyler, S. E. (1994). PDQ–4+ Personality Diagnostic Questionnaire–4+. New York, NY: New York State Psychiatric Institute. [Google Scholar]) at the criterion level in a mixed clinical and nonclinical sample of 2,519 individuals. The resulting structure was more similar to current dimensional taxonomies than to the DSM classification at all hierarchical levels. Whereas paranoid and antisocial PDs—and to a lesser extent avoidant, dependent, depressive, and schizoid PDs—were fairly homogeneous, all other disorders turned out to be combinations of 2 or 3 unrelated dimensions. Our results strongly support the structure of empirically based dimensional taxonomies and relocate DSM criteria within this emerging framework, thus contributing to preserving much of the knowledge accumulated to date.     

Evolution of Millon's Personality Prototypes

In 1969, Millon proposed 8 personality prototypes that could be conceptualized at lower levels of severity than the level of the personality disorders. These personalities were fit into a theoretical system that emphasized the strength of the interpersonal attachment and the mode of accommodation. Disorders such as schizophrenia and depression were pictured as a decompensation of the basic personality. This article traces the evolution of Millon's theory from the original inception, through the influence of the 3rd and 4th editions of the Diagnostic and Statistical Manual of Mental Disorders, and onto its present form. Now visualized as resulting from 3 polarities, the model has expanded the number of personalities to include 3 additional prototypes.     

DSM-IV: WhatY's New

The significant differences between the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987) and the DSM-IV (American Psychiatric Association, 1994) are described, focusing on the types of mental disorders counselors frequently diagnose and treat. These include several disorders included in the children's section as well as Adjustment Disorders, Substance-Related Disorders, Mood Disorders, Anxiety Disorders, and Personality Disorders.     

Cultural Dysthymia: An Unrecognized Disorder Among African Americans?

Many African Americans experience low‐grade depression, referred to as dysthymia in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). After more than 250 years of enslavement, prejudice, and discrimination, dysthymia is reflected in chronic low‐grade sadness, anger, hostility, aggression, self‐hatred, hopelessness, and self‐destructive behaviors. To avoid misdiagnosis, counselors need to understand how cultural factors can elicit a collective psychological condition in an oppressed group. Muchos Afroamericanos experimentan depresión leve, llamada distimia en el Diagnostic and Statistical Manual of Mental Disorders (4a ed., texto rev.; American Psychiatric Association, 2000). Después de más de 250 años de esclavitud, prejuicio y discriminación, la distimia se refleja como tristeza crónica leve, ira, hostilidad, agresividad, odio a uno mismo, desesperanza y comportamientos autodestructivos. Para evitar un diagnóstico erróneo, los consejeros deben comprender cómo los factores culturales pueden acarrear una condición psicológica colectiva en un grupo oprimido.     

The Parable of the Squirrel: Alleviating the Anxiety of Agoraphobia

This article focuses on agoraphobia, one of the anxiety disorders, and draws on William James (James 1890/1905), the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 2000) and Aaron T. Beck and Gary Emery (1985) to present and explore the psychodynamics of agoraphobia, including its behavioral manifestations, the personality features that may predispose a person to become agoraphobic, and the factors that may precipitate its emergence at a particular time in one??s life. A parable concerning a squirrel having difficulty crossing the street frames the discussion.     

Rumination as a common mechanism relating depressive risk factors to depression

Rumination was examined as a potential common mechanism linking risk factors with depression. Initially nondepressed individuals (N = 137) were assessed for presence of a ruminative response style and 4 other hypothesized risk factors for depression. They were followed for 2.5 years. Negative cognitive styles, self-criticism, dependency, neediness, and history of past depression were all significantly associated with rumination. Rumination mediated the predictive relationships of all risk factors except dependency with the number of prospective Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) major depressive episodes (MDEs; definite and subthreshold) during the follow-up period. In contrast, private self-consciousness did not mediate any relationships between risk factors and subsequent MDEs. Thus, rumination, as a special kind of self-focus, may act as a general proximal mechanism through which other vulnerability factors affect depression.     

The diagnostic efficiency of the Rorschach Depression Index and the Schizophrenia Index: a review

This review focuses on the diagnostic efficiency of the new versions of the Rorschach Comprehensive System Depression Index (DEPI) and the Schizophrenia Index (SCZI). Clinical diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders was chosen as the external validation criteria. The sensitivity, specificity, and overall classification rates for the indices were presented from the studies or computed from the data when possible. The positive and negative predictive validity was estimated at three different base rates. As regards the DEPI the results showed a large variation in diagnostic performance as the index seemed to have relatively more success in identifying nonpsychotic and unipolar depression than psychotic and bipolar depression. The DEPI did not successfully identify depression among adolescent patients. As regards the SCZI the results more consistently indicated that the index effectively discriminates between psychotic and nonpsychotic patients and the predictive validity of both a positive and negative SCZI was found to be high.     

Hierarchical Structure and Cross-Cultural Measurement Invariance of the Norwegian Version of the Personality Inventory for DSM–5

The Personality Inventory for DSM–5 (PID–5) was created to aid a trait-based diagnostic system for personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013a American Psychiatric Association. (2013a). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.[Crossref] , [Google Scholar]). In this study, we aimed to evaluate the Norwegian version of the PID–5 by examining its score reliability, hierarchical structure, congruency with international findings, and cross-cultural measurement invariance with a matched U.S. sample. For this purpose, 503 university students (76% females) were administered the PID–5. The Norwegian PID–5 showed good score reliability and structural validity from 1 to 5 factors. The 5-factor structure was generally congruent with international findings, and support for measurement invariance across the Norwegian and a matched U.S. sample was found. Conclusively, the results indicate that scores on the Norwegian PID–5 have sound psychometric properties, which are substantially comparable with the original U.S. version, supporting its use in a Norwegian population.     

Theodore Millon's Contributions to Conceptualizing Personality Disorders

We review Theodore Millon's contributions to conceptualizing personality disorders in contemporary clinical science and practice. Millon worked tirelessly across professional domains and theoretical orientations, developing a rich integrative theory of personality and its pathology, directly and indirectly impacting the evolving iterations of the Diagnostic and Statistical Manual of Mental Disorders (DSM–III through DSM–5), and advocating for the personality disorders through his contributions to cofounding the International Society for the Study of Personality Disorders and the Journal of Personality Disorders. We conclude with a closer look at Millon's final major contributions to conceptualizing personality disorders as well as the strengths and limitations of his approach.     

Trauma Models of the Effects of Childhood Maltreatment

Abstract

Trauma models of child maltreatment effects are addressed, with emphasis on the Diagnostic and Statistical Manual of Mental Disorders' diagnosis of posttraumatic stress disorder and the degree to which it fails to account for many salient symptoms and behaviors associated with maltreatment and victimization in children and adults. Research is presented to support the idea that posttraumatic stress disorder is best conceptualized as a dimensional outcome rather than a categorical all-or-none diagnosis. The PTSD model(s) needs to be either expanded to correct deficiencies or to be integrated into a larger model of the effects of trauma and victimization.