Assessment and DSM-IV Diagnosis of Personality Disorders: A Primer for Counselors

The DSM-IV categorizes 10 personality disorders, long-term patterns of personality traits that result in impairment of social and occupational functioning. The author details steps in the recognition and diagnosis of personality disorders, with emphasis on using the DSM-IV diagnostic framework.     

Analogue Measures of DSM-IV Mood and Anxiety Disorders Based on Behavior Checklists

Although symptom checklists are commonly used to assess childpsychopathology, confusion arises due to differences between empirically derived checklist syndromes and rationally derived DSM-IV diagnostic categories. This paper explores analogue measures of DSM-IV mood and anxiety disorders created using items from the Youth Self-Report and Child Behavior Checklist (T. M. Achenbach, 1991a, 1991b) that parallel DSM-IV symptoms. In a matched sample of clinically referred and nonreferred adolescents, analogue measures demonstrated expected patterns of age differences, sex differences, and comorbidity. Meeting criteria for an analogue diagnosis was also associated with referral for mental health services and poor social competence. Informant effects are highlighted and the potential benefits and limitations of using existing behavior checklists to assess DSM disorders are discussed. These findings suggest the utility of checklists in identifying analogues of anxiety and mood disorders in children and adolescents.     

Use of the TAT in the Assessment of DSM-IV Cluster B Personality Disorders

The Social Cognition and Object Relations Scale (SCORS), developed by Westen, Lohr, Silk, Kerber, and Goodrich (1985), is a diagnostic instrument used to assess an array of psychological functioning by using clinical narratives such as the Thematic Apperception Test (TAT; Murray, 1943) stories. This study investigated the utility of the SCORS to differentiate between Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) antisocial personality disorder (ANPD), borderline personality disorder (BPD), narcissistic personality disorder (NPD), and Cluster C personality disorder (CPD). A sample of 58 patients was separated into four groups: ANPD (n = 9), BPD (n = 21; 18 with a primary BPD diagnosis and 3 with prominent borderline traits who met 4 of the 5 DSM-IV criteria necessary for a BPD diagnosis), NPD (n = 16; 8 with a primary NPD diagnosis and 8 with prominent narcissistic traits who met 4 of the 5 DSM-IV criteria necessary for a NPD diagnosis), and CPD (n = 12). These groups were then compared on the 8 SCORS variables by using 5 TAT cards (1, 2, 3BM, 4, and 13MF). Spearman-Brown correction for 2-way mixed effects model of reliability for the 8 SCORS variables ranged from .70 to .95. The results of categorical and dimensional analyses indicate that (a) the SCORS variables can be used to differentiate ANPD, BPD, and NPD; (b) the BPD group scored significantly lower (greater maladjustment) than did the CPD group on certain variables; (c) the BPD group scored significantly lower (greater maladjustment) than did the NPD group on all 8 SCORS variables; (d) the ANPD group scored significantly lower than did the NPD group on certain variables; (e) certain variables were found to be empirically related to the total number of DSM-IV ANPD, BPD, and NPD criteria; and (f) certain variables were found to be empirically related to Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) personality disorder scales. The results of this study are discussed in terms of clinical utility, conceptual, and theoretical implications.     

Anxiety Disorders in Late Life: Considerations for Assessment and Cognitive-Behavioral Treatment

Anxiety disorders are among the most frequently diagnosed mental disorders in late life. As older adults comprise a growing segment of the population, evidence-based treatments for anxiety disorders in late life have come into sharper focus. Cognitive-behavioral therapy (CBT) for anxiety disorders in late life has received less empirical attention and widespread dissemination relative to other age groups. Increasing older adults’ access to timely assessment and effective treatment can help reduce the personal and societal costs of anxiety disorders. The purpose of this review paper is to discuss important considerations for the assessment of anxiety disorders in older adults and offer adaptations to CBT treatment for this population. As part of assessment considerations, we discuss how physical health conditions, cognitive impairment, and functional limitations can impact anxiety disorder diagnoses with older adults. We also outline validated self-report measures of anxiety disorder symptoms for older adults and highlight the importance of assessing older adults’ suitability for CBT. Several recommendations for adapting CBT protocols for older adults with anxiety disorders are described, such as extending psychoeducation, altered treatment pacing, use of content aids, and medical contraindications for interoceptive exposure. A case study is included that illustrates helpful assessment and treatment adaptions for an older woman with panic disorder. We highlight the pressing need to increase research and dissemination of CBT for anxiety disorders for older adults to meet the needs of an increasing segment of the population worldwide.     

Assessment and Diagnosis of the Substance Use Disorders (SUDs)

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) provides counselors with an updated method for diagnosing Substance Use Disorders (SUDs). In this article, the author presents information that demonstrates the need for all counselors to be knowledgeable concerning the SUDs and examines the essential features of the SUDs and the use of the DSM-IV in their diagnosis. A review of select instruments and techniques for assessment of the SUDs is presented.     

The Neurotherapy of Anxiety Disorders

Only five studies of patients met criteria for this review. Four of the five had a good clinical outcome. The only one without efficacy reported no enhancement of the target waveform. Of the other four, two reported some enhancement, whereas two gave no details about changes in the target waveform. There were 10 studies of nonpatients with generalized anxiety, of which eight had a good outcome. The decrease of anxiety in these eight studies was correlated with enhancement of the target waveform in five. Three of the eight had no increase of alpha, showing placebo plays a part in neurotherapy. There were nine studies of nonpatients with phobic anxiety, of which six had enhancement of the target waveform accompanied by good outcome. The remaining three studies had poor outcome in spite of enhancement of the target waveform.     

Fear and Anxiety in COVID-19: Preexisting Anxiety Disorders

The general population has experienced a significant elevation in fear and anxiety during COVID-19 both as a direct result of the virus but also due to measures taken to prevent it spreading, such as the need to stay inside and increase hand-washing. Lockdown has been used in many/most countries to prevent widespread infection. The advice and imposed actions are necessary to prevent the virus from spreading, but they might exacerbate the problems experienced by people with a preexisting anxiety-related disorder. The treatment of anxiety-related disorders can be provided while in quarantine. Staying at home in self-isolation does not preclude obtaining psychological treatment for anxiety-related disorders. Dealing with cognitive biases, over-estimations of threat, intolerance of uncertainty, inflated responsibility and excessive safety behavior, are useful clinical directions.     

Assessment and Diagnosis of Eating Disorders: A Guide for Professional Counselors

Despite the prevalence of and risk associated with disordered eating, there are few guidelines for counselors on how to conduct an eating disorder assessment. Given the importance of the clinical interview, the purpose of this article is to provide recommendations for the assessment and diagnosis of eating disorders that (a) specifically focus on assessment in the context of a clinical interview and (b) can be used by counselors whether or not they specialize in eating disorder treatment.     

Diagnosing Oppositional Defiant Disorder Using the Anxiety Disorders Interview Schedule for DSM-IV: Parent Version and the Diagnostic Interview Schedule for Children

The purpose of this study was to determine whether the Anxiety Disorders Interview Schedule for DSM–IV: Parent Version (ADIS–P) is a valid diagnostic tool for the assessment of Oppositional Defiant Disorder (ODD) in youth. Although there is considerable evidence that the ADIS–P is effective in diagnosing anxiety disorders in youth, no studies have yet examined its validity in assessing ODD. In contrast, a number of studies support the Diagnostic Interview Schedule for Children–Version IV (DISC–IV) as a reliable and valid tool in the assessment of ODD. In the present study, the ADIS–P and DISC–IV ODD modules were administered in a counterbalanced order to the parents of a clinical sample of 106 children between 7 and 14?years of age referred for the treatment of ODD. It was hypothesized that the ODD module of the ADIS–P would be valid as determined by its concurrent and convergent validity with the DISC–IV, the Behavior Assessment System for Children (BASC) Aggression and Conduct Problems scales, and the Disruptive Behavior Disorders rating scale (DBD). Results demonstrated that ADIS–P ODD diagnoses had moderate agreement with DISC–IV ODD diagnoses (κ?=?.46, p?<?.001) and that Pearson correlations of ADIS symptom counts with questionnaire scales were similar in magnitude with correlations of DISC–IV symptom counts with the same questionnaires. Overall, findings suggest that clinicians and researchers can use the ADIS–P as an empirically-supported diagnostic interview for assessing children’s oppositional problems.     

Interventions for Children's Anxiety Disorders

ABSTRACT

Anxiety problems represent common types of childhood disorders that can range from simple to complex, and are characterized as comprising cognitive, behavioral, physiological, and affective components. Current diagnostic nomenclature describes three types of childhood anxiety disorders: separation anxiety disorder, overanxious disorder, and avoidant anxiety disorder. Also, test anxiety may be manifested in school-aged children, in which concerns about performance contribute to lowered achievement. This article describes the nature of childhood anxiety disorders and test anxiety, and discusses interventions that may be effective in remediation efforts.     

Obtaining Systematic Teacher Reports of Disruptive Behavior Disorders Utilizing DSM-IV

This study examines the psychometric properties of the Vanderbilt AD/HD Diagnostic Teacher Rating Scale (VADTRS) and provides preliminary normative data from a large, geographically defined population. The VADTRS consists of the complete list of DSM-IV AD/HD symptoms, a screen for other disruptive behavior disorders, anxiety and depression, and ratings of academic and classroom behavior performance. Teachers in one suburban county completed the scale for their students during 2 consecutive years. Statistical methods included (a) exploratory and confirmatory latent variable analyses of item data, (b) evaluation of the internal consistency of the latent dimensions, (c) evaluation of latent structure concordance between school year samples, and (d) preliminary evaluation of criterion-related validity. The instrument comprises four behavioral dimensions and two performance dimensions. The behavioral dimensions were concordant between school years and were consistent with a priori DSM-IV diagnostic criteria. Correlations between latent dimensions and relevant, known disorders or problems varied from .25 to .66.     

Perfectionism in Pediatric Anxiety and Depressive Disorders

Although perfectionism has been identified as a factor in many psychiatric disorders across the life span, it is relatively understudied in pediatric anxiety and depressive disorders. Furthermore, there exists little cohesion among previous research, restricting the conclusions that can be made across studies. In this review, research associating perfectionism with pediatric anxiety and depression is examined and a framework is presented synthesizing research to date. We focus on detailing the current understanding of how perfectionism develops and interacts with other developmental features characteristic of anxiety and depression in children and potential pathways that result in anxiety and depressive disorders. This includes: how perfectionism is measured in children, comparisons with relevant adult literature, the development of perfectionism in children and adolescents, mediators and moderators of the link between perfectionism and anxiety and depression, and the role of perfectionism in treatment and prevention of these disorders. We also present research detailing perfectionism across cultures. Findings from these studies are beginning to implicate perfectionism as an underlying process that may contribute broadly to the development of anxiety and depression in a pediatric population. Throughout the review, difficulties, limitations, and gaps in the current understanding are presented while offering suggestions for future research.     

焦虑障碍的虚拟现实暴露疗法研究述评

虚拟现实暴露疗法(VRET)是传统的行为疗法的一种转换形式, 也是经典的现实情境暴露疗法的替代性治疗形式。虚拟现实整合了即时计算机图形学、身体感觉传感、视觉成像技术, 给来访者提供近似真实的、可以沉浸(immersion)和交互作用的虚拟环境。研究者采用虚拟现实暴露疗法治疗幽闭恐怖症、恐高症、飞行恐怖症、创伤后应激障碍、惊恐障碍等焦虑障碍, 并且关注虚拟现实暴露疗法的认知机制以及心理生理机制。实验研究表明, 虚拟现实暴露疗法在治疗焦虑障碍时是有效的。被试经过治疗之后, 对情境的控制感和自我效能感提升, 消极自我评价降低, 对创伤事件的容忍力提高, 重新获得对情境的控制感。与心率指标相比, 皮肤电是预测虚拟现实暴露疗法治疗效果更好的指标。虚拟现实暴露疗法还处于实验验证阶段, 并没有应用到实际临床中, 需要更加规范的实验设计验证该疗法的认知机制以及心理生理机制。虚拟现实暴露疗法结合功能磁共振成像(FMRI)用于心理治疗, 会是未来发展的新方向。     

Comorbid Substance Use and Anxiety Disorders in Adolescents

To explore the coexistence of substance use disorders and anxiety disorders in adolescents, we assessed adolescents presenting for treatment to an inpatient substance abuse treatment facility (SUH), an inpatient psychiatric treatment facility (IPH), and a community-based psychiatric facility (CMHC) for comorbid substance use and psychiatric diagnoses. Thirty subjects from each facility (N=90) were interviewed using the revised Child Schedule for Affective Disorders and Schizophrenia (K-SADS) and the Structured Clinical Interview DSM-III-R (SCID-R) for substance use diagnoses. Overall, comorbidity (anxiety and substance use disorders) prevalence was 67% (20/30) of adolescents in the SUH group, 33% (10/30) of the CMHC adolescents, and 33% (10/30) of the IPH adolescents. Alcohol and marijuana were the most frequently abused substances. Anxiety disorders commonly coexist with substance use disorders in adolescents. Early identification and treatment of anxiety disorders may in fact prevent substance abuse in this population.     

Peer Perceptions and Liking of Children with Anxiety Disorders

Examined three aspects of childhood anxiety and peer liking: (1) whether or not children can detect anxiety in age-mates, (2) the degree to which peer-reported anxiety, self-reported anxiety, and presence of anxiety disorders are associated with peer liking, and (3) whether or not self-reported anxiety and presence of anxiety disorders are associated with peer liking after controlling for peer-reported anxiety. Peer raters (9.5–12.5 years) rated videotaped speech samples of target children with anxiety disorders (AD; 9.5–13 years) and target children without anxiety disorders (NAD; 9.5–13 years). Peer-rated anxiety was positively correlated with target children’s self-reported anxiety and was higher among children with AD and children with social phobia (SP). Peer liking was inversely related to peer-reported anxiety and was lower for target children with SP. Target children with SP were liked less regardless of how anxious peers perceived them to be. Peer rater and target child demographics did not moderate the relationship between peer-rated anxiety and peer liking.     

Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis

There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.     

Diagnosis of Mood Disorders

This article provides an overview of mood disorders according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria and other relevant information. Differential diagnosis is facilitated through discussion of differences and similarities among mental disorders, age and gender-related patterns of mood disorders, and useful diagnostic tools.