The health preoccupation diagnostic interview: inter-rater reliability of a structured interview for diagnostic assessment of DSM-5 somatic symptom disorder and illness anxiety disorder

Somatic symptom disorder (SSD) and illness anxiety disorder (IAD) are two new diagnoses introduced in the DSM-5. There is a need for reliable instruments to facilitate the assessment of these disorders. We therefore developed a structured diagnostic interview, the Health Preoccupation Diagnostic Interview (HPDI), which we hypothesized would reliably differentiate between SSD, IAD, and no diagnosis. Persons with clinically significant health anxiety (n = 52) and healthy controls (n = 52) were interviewed using the HPDI. Diagnoses were then compared with those made by an independent assessor, who listened to audio recordings of the interviews. Ratings generally indicated moderate to almost perfect inter-rater agreement, as illustrated by an overall Cohen’s κ of .85. Disagreements primarily concerned (a) the severity of somatic symptoms, (b) the differential diagnosis of panic disorder, and (c) SSD specifiers. We conclude that the HPDI can be used to reliably diagnose DSM-5 SSD and IAD.     

Interaction of procedural factors in human performance on yoked schedules

The differential effects of reinforcement contingencies and contextual variables on human performance were investigated in two experiments. In Experiment 1, adult human subjects operated a joystick in a video game in which the destruction of targets was arranged according to a yoked variable-ratio variable-interval schedule of reinforcement. Three variables were examined across 12 conditions: verbal instructions, shaping, and the use of a consummatory response following reinforcement (i.e., depositing a coin into a bank). Behavior was most responsive to the reinforcement contingencies when the consummatory response was available, responding was established by shaping, and subjects received minimal verbal instructions about their task. The responsiveness of variable-interval subjects' behavior varied more than that of variable-ratio subjects when these contextual factors were altered. Experiment 2 examined resistance to instructional control under the same yoked-schedules design. Conditions varied in terms of the validity of instructions. Performance on variable-ratio schedules was more resistant to instructional control than that on variable-interval schedules.     

Some factors controlling preference between fixed-ratio and variable-ratio schedules of reinforcement

A multiple schedule of food reinforcement for key-pecking was arranged which consisted of nine fixed-ratios, each of which operated in the presence of a different stimulus. Pigeons could complete a given fixed-ratio within the multiple schedule or, by pecking a second key, could switch from the fixed-ratio schedule to a variable-ratio schedule consisting of the same nine ratios. Stable switching behavior was established which did not maximize simple probability or rate of reinforcement. Instead, the subjects showed a stable preference for the variable-ratio schedule of food reinforcement. Increasing the number of responses required to switch, and removing the occasions on which reinforcement was delivered after a single response in the variable schedule, decreased the number of switches to the variable schedule. Periods of delay interposed between a completed switch and the availability of reinforcement after one response in the variable schedule also decreased switching to the variable schedule, particularly at long delay intervals.     

Two factors to be considered in the design of experiments in anxiety and motor behavior

There are two aspects of Martens' paper which deserve comment. The first deals with experimental design and statistical power while the second concerns the distinction between performance and learning and the implications it has for research in anxiety and motor learning.     

Evaluation of the diagnostic interview for children and adolescents for use in general population samples

This article presents evaluative data on the use of the Diagnostic Interview for Children and AdolescentsRevised (DICAR) to classify DSM-IIIR disorders in the general population. Data for the analyses came from a probability sample (N=251) of parentchild/adolescent dyads aged 6 to 16 separately administered the DICAR on two occasions, 10 to 20 days apart, by trained lay interviewers and child psychiatrists. Data are presented on prevalence,testretest reliability, parentchild/adolescent agreement, and trained lay interviewerchild psychiatrist agreement. High prevalences of oppositional defiant disorder derived from parent assessments and overanxious disorder and dysthymia derived from adolescent assessments suggest that these disorders may be overidentified. Interview data provided by 6 to 11year olds to classify the internalizing disorders were too unreliable to be useful. Agreement between parentchild/adolescent dyads was generally low while agreement between trained lay interviewerschild psychiatrists was generally high.This work was supported by funds from the National Health Research and Development Program (grant number 6606-3760-42) and the Ontario Ministry of Community and Social Services, and was carried out by the Child Epidemiology Unit, Department of Psychiatry, McMaster University and the Child and Family Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario. Dr. Boyle is supported by a William T. Grant Foundation Faculty Scholar Award; Dr. Offord by a National Health Scientist Award, Health and Welfare Canada; Dr. Szatmari by a Research Fellowship, Ontario Mental Health Foundation; and Dr. Fleming by a NARSAD Young Investigator Award. The authors wish to thank the Hamilton Board of Education, particularly Mr. Keith Reilly and Mr. Owen Jackson; principals and teachers of the Board; and parents and students for their help on this project. Our appreciation also extends to Ms. Barb Hall who assisted in the analysis of the data.     

A comparison of interview and self-report methods for the assessment of borderline personality disorder criteria

Interview methods are widely regarded as the standard for the diagnosis of borderline personality disorder (BPD), whereas self-report methods are considered a time-efficient alternative. However, the relative validity of these methods has not been sufficiently tested. The current study used data from the Collaborative Longitudinal Personality disorder Study to compare diagnostic base rates and the relative validity of interview and self-report methods for assessing functional outcome in BPD. Although self-report yielded higher base rates of criteria endorsement, results did not support the common assumption that diagnostic interviews are more valid than self-reports, but instead indicated the combined use of these methods optimally identifies BPD criteria.     

Normative warrant in diagnostic criteria: the case of DSM-IV-TR personality disorders

This article focuses on the kinds of evaluative judgments made when applying DSM-IV-TR diagnostic criteria within the diagnostic interview between clinician and patient. The authors name these kinds of value judgments in diagnosis "normative warrant" because they involve one or more justifications (warrants) for standard-bearing (normative) elements involved in applying diagnostic criteria to actual patients. Seven types of normative warrant judgments are described (Type 1, Semantic-Phenomenal Matching; Type 2, Solicitation Choice; Type 3, Sociocultural Context; Type 4, Performance-Context Matching; Type 5, Deviance Threshold; Type 6, Threshold Characterization; Type 7, Disvalue characterization) and the typology is illustrated by applying it to various DSM-IV-TR personality disorder criteria. A research and clinical understanding of normative warrant may well contribute to the refinement of criteria sets as well as the refinement of the clinical use of criteria sets.     

The relationship between self-concept and selected academic and personal factors

One-hundred sixty-five high school students were the subjects in a study to determine if selected personal and academic variables were predictive of self-concept scores. The full model was moderately predictive of self-esteem, accounting for approximately 46% of the variance of the criterion variable. Also, it was found that, as a subset of variables, both academic and personal variables made a significant, unique contribution to the prediction of self-concept scores. Of the eleven independent variables used in this study, it was noted that grade point average, extracurricular activities, health, and home life individually made a unique contribution to the prediction of self-concept scores. These four variables also were found to be significantly correlated with self-concept. Other independent variables found to be significantly correlated with self-concept were: parents married and parents divorced. However, these variables were not considered as making a unique contribution to the prediction of self-concept.     

Response discriminative and reinforcement factors in stimulus control of performance on multiple and chained schedules of reinforcement

Discriminative control of the response rates of two groups of rats was equated by training them to cease bar pressing in light-out no-tone ( + ) and to respond during tone and light. Multiple-schedule subjects received food at the same rate for responding during tone or light as for nonresponding in + . For the chained-schedule subjects responding in tone or light only produced + where food was received for nonresponding. In extinction tests multiple-schedule subjects emitted approximately twice the responses to tone-plus-light as to tone or light presented individually (additive summation). The rats trained on the chained schedule, in which the tone and light each controlled substantial response rates but were never paired with food, showed no summation when the tone and light were presented together. The results indicate that discriminative control of response rates and reinforcement differences between schedule components determine stimulus control.     

Clinical and research diagnostic criteria for developmental coordination disorder: a review and discussion

The aim of this review was to investigate the selection criteria used in the past in studies of children with developmental motor problems (excluding those suffering from neurological dysfunctions such as cerebral palsy, muscular dystrophy, etc.). We therefore conducted an extensive analysis of 176 publications. First, an overview of the main characteristics of these studies (terminology, population, type and purpose) and the selection criteria that are reported in these publications are presented. Following this, the DSM-IV selection criteria for developmental coordination disorder (DCD) are contrasted with the selection criteria reported in 41 publications that have used this terminology to classify the children. The results of this comparison show that the inclusion criteria are largely followed, albeit with little consistency concerning selection instruments and quantitative cut-offs, while adherence to the exclusion criteria is not common practice. Strengths and weaknesses of the DSM-IV criteria, complementary to the previous discussion by Henderson and Barnett in the HMS special issue on DCD in 1998 on this same topic, are discussed. The results of the review also show that many studies have used additional selection criteria related to the specific research questions of the study concerned. In the broader context of clinical practice as well as basic research, the latter result suggests the usefulness of a distinction between Clinical Diagnostic Criteria and Research Diagnostic Criteria. This distinction helps to develop a unifying view on the use of diagnostic criteria for research and clinical practice. We conclude with a number of recommendations concerning the selection criteria for children with DCD.     

Cultural considerations using the structured clinical interview for DSM-III for mood and anxiety disorders assessment

This paper focuses on the impact that culture has upon standardized or structured interviews. It briefly reviews how these interviews evolved from a primary research function, what they can teach us about clinical work, and the multiple ways that culture influences these supposedly objective instruments and the diagnoses which follow from their use. Although the use of structured interviews and standardized diagnostic criteria has been a major advance for the field in terms of reliability, care needs to be exercised when evaluating individuals from disparate cultural backgrounds.     

Validity of self-report and informant rating scales of adult ADHD symptoms in comparison with a semistructured diagnostic interview

In a study of ADHD symptoms in the relatives of probands diagnosed with ADHD, the validity of self-reported and informant-reported symptoms in childhood and adulthood was investigated with a semistructured diagnostic interview, the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) adapted for adults, as a criterion. The participating relatives were 80 women and 46 men aged 17 to 77. Rating scales based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) were completed by participants and informants. Internal consistency of the scales and interrater reliabilities of the diagnostic interview were satisfactory. Correlations between ratings across sources of information supported convergent and divergent validity. Self-report scales and informant scales predicted interview-based diagnoses in childhood and adulthood with adequate sensitivities and specificities. It was concluded that the rating scales have good psychometric properties, at least in at-risk populations.     

Fixed-ratio and variable-ratio schedules of brief stimuli in second-order schedules of matching to sample

Eight pigeons matched to sample under second-order schedules of food reinforcement. Under fixed-interval unit schedules, the first correct match to occur after a given period of time was followed by the presentation of a brief stimulus. The termination of the last fixed-interval unit schedule was followed by food according to second-order fixed-ratio and variable-ratio schedules. In Experiment 1, as the number of fixed-interval unit schedules increased, long pauses occurred under the second-order fixed-ratio schedules, but not under the variable-ratio schedules. The similarity of performance measures such as local rate and accuracy indicated that the differences engendered by these two types of schedule are in the duration of the periods of not-responding. In Experiment 2, the addition of a brief stimulus at the end of each unit schedule in chained schedules that had different discriminative stimuli present for the duration of each unit did not substantially affect the performance, and long pauses continued to occur. However, few long pauses occurred under schedules with brief stimulus presentations alone. The most inaccurate performances were engendered by chained schedules without brief stimuli.     

Challenges associated with a polythetic diagnostic system: criteria combinations in the personality disorders

Converging research on the diagnostic criteria for personality disorders (PDs) reveals that most criteria have different psychometric properties. This finding is inconsistent with the PD diagnostic system according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), which weights each criterion equally. The purpose of the current study was to examine the potential effects of using equal weights for differentially functioning criteria. Data from over 2,100 outpatients were used to analyze and score response patterns to the diagnostic criteria for 9 PDs within an item response theory framework. Results indicated that combinations that included the same number of endorsed criteria yielded differing estimates of PD traits, depending on which criteria were met. Moreover, trait estimates from subthreshold criteria combinations often overlapped with diagnostic (at-threshold or higher) combinations, indicating that there were subthreshold combinations of criteria that indicated as much or more PD than did some combinations at the diagnostic threshold. These results suggest that counting the number of criteria an individual meets provides only a coarse estimation of his or her PD trait level. Implications for the assessment of polythetically defined mental disorders and for the PD proposal for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders are discussed.     

Gender bias in diagnostic criteria for personality disorders: an item response theory analysis

The authors examined gender bias in the diagnostic criteria for Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; American Psychiatric Association, 2000) personality disorders. Participants (N=599) were selected from 2 large, nonclinical samples on the basis of information from self-report questionnaires and peer nominations that suggested the presence of personality pathology. All were interviewed with the Structured Interview for DSM-IV Personality (B. Pfohl, N. Blum, & M. Zimmerman, 1997). Using item response theory methods, the authors compared data from 315 men and 284 women, searching for evidence of differential item functioning in the diagnostic features of 10 personality disorder categories. Results indicated significant but moderate measurement bias pertaining to gender for 6 specific criteria. In other words, men and women with equivalent levels of pathology endorsed the items at different rates. For 1 paranoid personality disorder criterion and 3 antisocial criteria, men were more likely to endorse the biased items. For 2 schizoid personality disorder criteria, women were more likely to endorse the biased items.