IS A LITTLE (PSYCHIATRIC) KNOWLEDGE A DANGEROUS THING?

One hundred thirty-four participants completed a revised Menstrual Distress Questionnaire (MDQ), which included criteria for premenstrual dysphoric disorder (PMDD). Two weeks later the participants again completed the revised MDQ after reading either the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) diagnostic criteria for the PMDD or a copy of the same criteria retitled "Episodic Dysphoric Disorder," with all menstrual cycle references removed. Knowledge of the diagnosis did not affect women's perceptions of their own menstrual cycle-related symptoms, but it increased participants' perceptions of premenstrual changes as a problem for women in general. Chi-square analyses revealed that participants were more willing to attach a psychiatric diagnosis to women they know if they believed the diagnosis was related to the menstrual cycle.     

Parental Alienation Disorder and DSM-V

Although parental alienation disorder (PAD) is a serious mental condition affecting many children and their families, it is not an official diagnosis or even mentioned in the Diagnostic and Statistical Manual of Mental Disorders. This article presents arguments for considering PAD a diagnosis: PAD is a prototypical example of a relational disorder; the phenomenon of PAD is almost universally accepted by mental health professionals; PAD is a valid and reliable construct; adopting criteria for PAD will promote systematic research; adopting criteria will reduce the misuse of the concept of PAD; and adopting criteria will improve the treatment of children with this disorder.     

Frontal EEG asymmetry and premenstrual dysphoric symptomatology

Resting frontal electroencephalographic (EEG) asymmetry has been hypothesized to tap a diathesis toward depression or other emotion-related psychopathology. Frontal EEG asymmetry was assessed in college women who reported high (n = 12) or low (n = 11) levels of premenstrual negative affect. Participants were assessed during both the follicular and the late luteal phases of the menstrual cycle. Women reporting low premenstrual dysphoric symptomatology exhibited greater relative left frontal activity at rest than did women high in premenstrual dysphoric symptomatology, an effect that was not qualified by phase of cycle. Although women with extreme levels of symptomatology were assessed, the question of whether such symptoms qualified for premenstrual dysphoric disorder criteria was not assessed. These results are consistent with a diathesis-stress model for premenstrual dysphoric symptomatology.     

Prospective assessment of late-luteal phase dysphoric disorder

This investigation evaluated a method for the prospective assessment of the symptoms of premenstrual syndrome (PMS). The American Psychiatric Association has proposed a diagnostic category for PMS in the DSM-III-R entitled late-luteal phase dysphoric disorder (LLDD). The criteria for this disorder include prospective documentation of at least two symptomatic cycles. Two groups of women were studied, one group that met the DSM-III-R diagnostic criteria for LLDD and a comparison group that did not. Subjects recorded symptoms related to PMS for two menstrual cycles. A clinically significant worsening of symptoms was defined as a symptom increase during the premenstruum of greater than one standard deviation above normal. These effect sizes were then used to determine if the subject met the DSM-III-R criteria for prospective confirmation. Data analysis showed that although the LLDD group showed evidence for PMS in several symptom groups, only a minority (31%) met the requirement of prospective confirmation of significant PMS symptoms for the two cycles recorded. These results were discussed in terms of the need for prospective behavioral assessment of LLDD and the implications of these findings for past and future research.Portions of this paper were derived from the master's thesis of the first author.     

Effects of comorbid psychopathy on criminal offending and emotion processing in male offenders with antisocial personality disorder

Antisocial personality disorder (ASPD) and psychopathy are two syndromes with substantial construct validity. To clarify relations between these syndromes, the authors evaluated 3 possibilities: (a) that ASPD with psychopathy and ASPD without psychopathy reflect a common underlying pathophysiology; (b) that ASPD with psychopathy and ASPD without psychopathy identify 2 distinct syndromes, similar in some respects; and (c) that most correlates of ASPD reflect its comorbidity with psychopathy. Participants were 472 incarcerated European American men who met Diagnostic and Statistical Manual (4th ed., American Psychiatric Association, 1994) criteria for ASPD and Psychopathy Checklist criteria for psychopathy, who met the criteria for ASPD but not for psychopathy, or who did not meet diagnostic criteria for either ASPD or psychopathy (controls). Both individuals with ASPD only and those with ASPD and psychopathy were characterized by more criminal activity than were controls. In addition, ASPD with psychopathy was associated with more severe criminal behavior and weaker emotion facilitation than ASPD alone. Group differences in the association between emotion dysfunction and criminal behavior suggest tentatively that ASPD with and ASPD without prominent psychopathic features may be distinct syndromes.     

Toward the content validity of premenstrual dysphoric disorder: do anger and irritability more than depressed mood represent treatment-seekers' experiences?

The content validity of Premenstrual Dysphoric Disorder in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) has been questioned in the literature. We tested whether mood-related symptoms reported by 26 women seeking treatment for premenstrual disorders were among the proposed criteria. These women were asked to list their premenstrual symptoms and rate the severities of listed symptoms daily for two menstrual cycles before treatment. They completed semistructured interviews to differentiate symptoms of Premenstrual Dysphoric Disorder from those of other psychiatric disorders in women who had other disorders. All participants reported functional interference due to the symptoms. 19 symptoms of or similar to those of Premenstrual Dysphoric Disorder were among the 22 most frequent premenstrual symptoms experienced. Premenstrual depressed mood was less frequent than premenstrual irritability or anger when other psychiatric disorders such as major depression were taken into account. Results suggest that the DSM-IV-TR criteria have generally good content validity but may need revision to represent treatment-seekers experiences more accurately.     

Assessment of Affect Integration: Validation of the Affect Consciousness Construct

Affect integration, or the capacity to utilize the motivational and signal properties of affect for personal adjustment, is assumed to be an important aspect of psychological health and functioning. Affect integration has been operationalized through the affect consciousness (AC) construct as degrees of awareness, tolerance, nonverbal expression, and conceptual expression of nine discrete affects. A semistructured Affect Consciousness Interview (ACI) and separate Affect Consciousness Scales (ACSs) have been developed to specifically assess these aspects of affect integration. This study explored the construct validity of AC in a Norwegian clinical sample including estimates of reliability and assessment of structure by factor analyses. External validity issues were addressed by examining the relationships between scores on the ACSs and self-rated symptom- and interpersonal problem measures as well as independent, observer-based ratings of personality disorder criteria and the Global Assessment of Functioning (GAF) scale from the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994).     

Construct Validity of the DSM–5 Section III Personality Trait Profile for Borderline Personality Disorder

This study evaluated the nomological network of the borderline personality disorder (BPD) trait profile in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]) Section III. BPD symptoms include a variety of maladaptive thoughts and behaviors, and it is important to determine if the Section III trait operationalization for BPD captures these behavioral symptoms, as well as shows similar associations as the traditional Section II version with external criteria. For this purpose, we used a sample of 285 undergraduate students and conducted correlation and regression analyses to delineate the associations between Section III BPD traits and conceptually relevant external criteria. A Section III Total score was meaningfully associated with all criteria. Moreover, externalizing psychopathology tended to be most highly associated with disinhibitory Section III BPD traits, whereas internalizing psychopathology tended to have its strongest unique associations with traits reflective of negative affectivity. These results provide support for the construct validity of the trait profile for BPD in DSM–5 Section III.     

Chronic stress and depressive disorders in older adults

Current and lifetime rates of Diagnostic and Statistical Manual (rev. 3rd ed.) disorders were compared in 86 older adults caring for a spouse with a progressive dementia and 86 sociodemographically matched control subjects. Dementia caregivers were significantly more dysphoric than non-care givers. The frequencies of depressive disorders did not differ between groups in the years before care giving, and there were no group differences in first-degree relatives' incidence of psychiatric disorder. During the years they had been providing care, 30% of care givers experienced a depressive disorder (major depression, dysthymia, or depression not otherwise specified) versus 1% of their matched controls in the same time period. Only two care givers who met criteria during care giving had met criteria for a depressive disorder before care giving, and family history was not even weakly related to the identification of at-risk care givers. In contrast to these group differences in depressive disorders, there were no significant differences in other Axis I disorders either before or during care giving. Thus, the chronic strains of care giving appear to be linked to the onset of depressive disorders in older adults with no prior evidence of vulnerability.     

Assessing Interpersonal Subtypes in Depression

The context-free diagnoses outlined by the Diagnostic and Statistical Manual of Mental Disorders might not provide enough information to represent the heterogeneity observed in depressed patients. Interpersonal factors have been linked to depression in a mutually influencing pathoplastic relationship where certain problems, like submissiveness, are related to symptom chronicity. This study evaluated interpersonal pathoplasticity in a range of depressive presentations. We examined archival data collected from 407 participants who met criteria for major depressive disorder (MDD), dysthymic disorder (DD), or subthreshold depression (sD). Latent profile analysis (LPA) identified 5 interpersonal subtypes (vindictive, intrusive, socially avoidant, exploitable, and cold). Apart from gender, the subtypes did not differ significantly on demographic characteristics, psychiatric comorbidity, or self-report depression severity. Socially avoidant participants were more likely to meet criteria for a clinical depression diagnosis (MDD or DD), whereas vindictive participants were more likely to have sD. Our results indicate that interpersonal problems could account for heterogeneity observed in depression.     

A Comparison of Obsessive–Compulsive Personality Disorder Scales

In this study, we utilized a large undergraduate sample (N = 536), oversampled for the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM–IV–TR]; American Psychiatric Association, 2000) obsessive–compulsive personality disorder (OCPD) pathology, to compare 8 self-report measures of OCPD. No prior study has compared more than 3 measures, and the results indicate that the scales had only moderate convergent validity. We also went beyond the existing literature to compare these scales to 2 external reference points: their relationships with a well-established measure of the five-factor model of personality (FFM) and clinicians' ratings of their coverage of the DSM–IV–TR criterion set. When the FFM was used as a point of comparison, the results suggest important differences among the measures with respect to their divergent representation of conscientiousness, neuroticism, and agreeableness. Additionally, an analysis of the construct coverage indicated that the measures also varied in terms of their representation of particular diagnostic criteria. For example, whereas some scales contained items distributed across the diagnostic criteria, others were concentrated more heavily on particular features of the DSM–IV–TR disorder.     

The Eating Attitudes Test: validation with DSM-IV eating disorder criteria

The Eating Attitudes Test (EAT; Garner & Garfinkel, 1979) is one of the most widely used self-report eating disorder instruments. Originally developed to diagnose anorexia nervosa, it is often used in nonclinical samples where it has a high false-positive rate, which is likely due to changes in diagnostic criteria. Because the EAT has not been validated with Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria, we examined its criterion validity for discriminating between nonclinical women with and without an undifferentiated DSM-IV eating disorder diagnosis. We also examined differences in mean EAT scores among eating-disordered, symptomatic, and asymptomatic participants. Results show that the EAT has an accuracy rate of at least 90% when used to differentially diagnose those with and without eating disorders and that mean EAT scores differed among eating-disordered, symptomatic, and asymptomatic participants.     

The Assessment of Post‐traumatic Stress Disorder for Workers' Compensation in Emergency Service Personnel

There is considerable debate concerning the diagnosis of post‐traumatic stress disorder (PTSD) in compensation claims. This study reviewed the quality of the assessment reports prepared by clinicians who evaluated 31 emergency service workers making PTSD‐related compensation claims. Assessments were conducted by 4‐year trained psychologists (39%), psychologists holding a masters degree (36%), and psychiatrists (19%). The assessment reports were evaluated relative to the diagnostic criteria for PTSD in the Diagnostic and Statistical Manual of Mental Disorders 4th edition (2000). In the majority of cases (81%), the assessor determined that the emergency service worker had PTSD, but only one report met the minimum standard for that diagnosis. In the majority (65%) of cases the clinician failed to address the possibility of malingering. These data suggest that clinical assessment reports for PTSD frequently fail to meet minimum assessment standards.     

一种新的诊断类别:经前期心境不良障碍

经前期心境不良障碍(PMDD)是一组严重影响女性在家庭、工作和生活等方面功能的经前期不适心理、身体和行为症状。美国精神病学协会管理委员会于2012年底正式将PMDD作为美国精神障碍诊断与统计手册第五版(DSM-5)中的单独诊断类别,这一举措标志着未来PMDD研究将成为热点。而PMDD的诊断与评估标准、发病机理并不明确,未来研究将围绕运用统一规范的PMDD诊断与评估标准,结合生理和心理两方面证据深入探讨PMDD可能的病理机制,从而促进PMDD针对性治疗。     

Men's perception of premenstrual changes on the premenstrual assessment form

Outcome research has shown that partner-spouse support can enhance the therapeutic outcome in a number of clinical problems. In the area of premenstrual tension, studies of treatment have apparently overlooked this issue of partners' support. This study was designed to address how men perceive premenstrual changes. 99 undergraduate men were asked whether they believed that women had premenstrual changes reflected on the 18 unipolar scales of the Premenstrual Assessment Form. Responses suggest that young men acknowledge that some women experience dysphoric features like hostility, mood swings, and low self-esteem as well as physical discomfort and behavioural changes. Clinical implications are outlined.     

A follow-up study of girls with gender identity disorder

This study provided information on the natural histories of 25 girls with gender identity disorder (GID). Standardized assessment data in childhood (mean age, 8.88 years; range, 3-12 years) and at follow-up (mean age, 23.24 years; range, 15-36 years) were used to evaluate gender identity and sexual orientation. At the assessment in childhood, 60% of the girls met the Diagnostic and Statistical Manual of Mental Disorders criteria for GID, and 40% were subthreshold for the diagnosis. At follow-up, 3 participants (12%) were judged to have GID or gender dysphoria. Regarding sexual orientation, 8 participants (32%) were classified as bisexual/homosexual in fantasy, and 6 (24%) were classified as bisexual/homosexual in behavior. The remaining participants were classified as either heterosexual or asexual. The rates of GID persistence and bisexual/homosexual sexual orientation were substantially higher than base rates in the general female population derived from epidemiological or survey studies. There was some evidence of a "dosage" effect, with girls who were more cross-sex typed in their childhood behavior more likely to be gender dysphoric at follow-up and more likely to have been classified as bisexual/homosexual in behavior (but not in fantasy).     

Muscle dysmorphia: Current research and potential classification as a disorder

ObjectiveTo review the literature for scientific evidence in support of inclusion of Muscle Dysmorphia (MD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).DesignThe criteria proposed by Blashfield, Sprock, and Fuller (1990) were used for determining whether scientific evidence supports the introduction of MD as a new disorder into a disease classification system.MethodPeer-reviewed journal articles were identified by searching databases for articles published (in print and electronically) from 2001 to 2011.ResultsThe search identified 59 journal articles that specifically focused on MD, of which 39 were empirical journal articles. There is ample literature on MD, including a common set of diagnostic criteria and assessment instruments to measure MD. However, questions remain about the diagnostic reliability and validity, including inter-rater reliability, and whether MD represents a disorder that consists of symptoms that frequently co-occur. Also, evidence of syndrome differentiation is lacking. Only two of the five criteria proposed by Blashfield et al. have been met.ConclusionLiterature suggests that MD is associated with several indicators of clinical significance and distinctiveness. However the current review has found significant limitations and gaps in the scientific literature on MD. Possible options regarding the status of MD in the DSM-5 are proposed, including introducing MD as an example of an eating disorder not otherwise specified, retaining MD as a body dysmorphic disorder, introducing MD as a new disorder, or introducing MD as a provisional diagnosis in need of further study.     

Mind the gap: assessing impairment among children affected by proposed revisions to the diagnostic criteria for oppositional defiant disorder

The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) workgroup for disruptive behavior disorders is considering adopting a frequency threshold for symptoms of oppositional defiant disorder (ODD). In the present study, the impact of substituting the term "often" with a specific age-based frequency on impairment and prognosis among preschool children was tested in a longitudinal design. Mutually exclusive groups were created to identify children who met criteria for ODD based on a symptom threshold of "often," as in Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-4), and those that met criteria for ODD based on a threshold of "1-2 times per day," which approximated the proposal for DSM-5. Comparisons of these groups to each other and to nondiagnosed peers determined the impact of changing the symptom threshold on impairment and prognosis. Close to one-third of children who met DSM-4 criteria for ODD did not meet criteria under the alternative diagnosis; African American children were overrepresented in this group. Preschoolers who met DSM-4, but not the alternative criteria, had higher rates of ODD, conduct disorder (CD), and were more impaired than their nondiagnosed peers at baseline and follow-up. Preschoolers meeting DSM-4 criteria were less impaired than children meeting the alternative ODD criteria at baseline according to parent, but not according to teacher report. No differences could be detected between those meeting DSM-4 and those meeting the alternative criteria in rate of ODD, CD, or impairment at follow-up. Among clinically referred preschool children, changing the symptom threshold for ODD could result in a sizable group of children who would no longer meet diagnostic criteria, despite demonstrating significant morbidity concurrently and prospectively.     

Capturing the psychopathic female: a prototypicality analysis of the comprehensive assessment of psychopathic personality (CAPP) across gender

Psychopathy in women has been subject to little systematic investigation; no coherent conceptualization of the disorder in women exists. Previous research is constrained by the reliance both on a male conceptualization of psychopathy and on assessment instruments developed, and primarily validated, with men. This study utilized a newly developed, broad, personality-based, and gender-sensitive lexical model of psychopathy, the Comprehensive Assessment of Psychopathic Personality (CAPP). Prototypical analysis was used to explore gender differences in the construct and the content validity of the CAPP model across gender. Symptoms were rated by international mental health professionals (N = 132). The findings support the content validity of the CAPP across gender and suggest that – at symptom and domain levels – psychopathic men and women have key similarities, but also that important gender differences exists. This has implications for the assessment of psychopathy in women, and has relevance for the proposed revision of diagnostic criteria for personality disorders. Copyright © 2011 John Wiley & Sons, Ltd.     

Conflict resolution in women is related to trait aggression and menstrual cycle phase

Twenty‐four women with a diagnosis of premenstrual dysphoric disorder (PMDD) and 18 controls took part in a study of patterns of female aggression. They completed a version of the Conflict Tactics Scale for a premenstrual and a follicular phase of their menstrual cycle and for the past year. The Life History of Aggression was completed during a clinician interview. The women used more aggressive tactics to solve conflicts in the premenstrual than in the follicular phase, but the difference was only significant for the PMDD group. During the past year, reasoning was the most common strategy used by women to resolve conflicts, but verbal aggression was also prevalent. Although physical violence was less common, the prevalence of any act of violence was 33% in the controls and 62% in the clinical group. Women with PMDD used both verbal and physical aggression more frequently than the controls and had a higher lifetime history of aggression. Aggression by women toward partners was associated with a general tendency to act aggressively. Aggr. Behav. 29:228–238, 2003. © 2003 Wiley‐Liss, Inc.