A psychometric analysis of five DSM-III categories

Preliminary studies of interdiagnostician agreement have shown that the DSM-III holds promise for improving diagnostic reliability. This study examined the characteristics of five DSM-III diagnostic categories (schizophrenia, mania and schizotypal, narcissistic and borderline personality disorders) with respect to three psychometric criteria. Examined were the specificity, syndrome association and internal consistency of the diagnostic criteria for these disorders. Results suggested that of the diagnostic categories examined, the criteria for schizophrenia performed best under empirical scrutiny, while criteria for borderline and narcissistic personality disorders were more problematic. Suggestions are made for subsequent investigations into the internal validity of DSM-III.     

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.     

The MCMI as a measure of DSM-III

The Millon Clinical Multiaxial Inventory (MCMI) has been interpreted as a measure of DSM-III disorders. However, the MCMI was constructed and validated primarily as a measure of Millon's (1969, 1981) taxonomy, not DSM-III. Comparison of the two taxonomies and examination of the MCMI's content validity for two of the MCMI scales indicate only a partial congruence between the Millon and DSM-III taxonomies. There has been no published empirical research concerning the relationship between the MCMI and DSM-III, and the derivation and cross-validation research for the MCMI scales employed Millon's taxonomy and not DSM-III. It is suggested that until such data have been presented one should be cautious in one's interpretation of the MCMI as a measure of DSM-III disorders.     

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.     

Empirical clusters of DSM-III personality disorders in violent offenders

Violent male offenders in a maximum security hospital and special units in prisons (N = 164) were interviewed with the Structured Clinical Interview for DSM-III Axis II disorders (SCID-II). Cluster analysis of the personality disorder criteria sets identified six diagnostic patterns: (1) antisocial-narcissistic; (2) paranoid-antisocial; (3) borderline-antisocial-passive-aggressive; (4) borderline; (5) compulsive-borderline; and (6) schizoid. Offenders in the first three groups had more extensive criminal careers, and most were identified as psychopaths by the Psychopathy Checklist-Revised (PCL-R). These Groups also had more frequent lifetime histories of substance abuse. A history of affective and anxiety disorders was more common in Groups 3 and 5, and almost two thirds of Group 2 had a history of psychotic disorder. The results emphasize that dangerous offenders are heterogeneous in personality pathology. They also suggest that personality disorder among violent offenders is more commonly represented by recurring patterns of covarying traits than by single categorical entities proposed in the DSM classification.     

Edited correspondence on the status of homosexuality in DSM-III

In 1973, after a prolonged period of social agitation and professional conflict, the American Psychiatric Association deleted homosexuality from its official listing of psychiatric disorders (DSM-II). In its place a new classification for homosexuals distressed over their orientation was to be included in DSM-II. Four years later an acrimonious dispute surfaced over the status of homosexuality in the revised APA nomenclature of disorders (DSM-III). The edited correspondence of the participants in this dispute is presented here as a way of revealing the lingering conflict over homosexuality within American psychiatry.     

DSM-III and the revolution in the classification of mental illness

A revolution occurred within the psychiatric profession in the early 1980s that rapidly transformed the theory and practice of mental health in the United States. In a very short period of time, mental illnesses were transformed from broad, etiologically defined entities that were continuous with normality to symptom-based, categorical diseases. The third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) was responsible for this change. The paradigm shift in mental health diagnosis in the DSM-III was neither a product of growing scientific knowledge nor of increasing medicalization. Instead, its symptom-based diagnoses reflect a growing standardization of psychiatric diagnoses. This standardization was the product of many factors, including: (1) professional politics within the mental health community, (2) increased government involvement in mental health research and policymaking, (3) mounting pressure on psychiatrists from health insurers to demonstrate the effectiveness of their practices, and (4) the necessity of pharmaceutical companies to market their products to treat specific diseases. This article endeavors to explain the origins of DSM-III, the political struggles that generated it, and its long-term consequences for clinical diagnosis and treatment of mental disorders in the United States.     

MCMI characteristics of DSM-III posttraumatic stress disorder in Vietnam veterans

Compared the MCMI profiles of 25 veterans with a diagnosis of Posttraumatic Stress Disorder (PTSD) with those of 25 veterans carrying psychiatric disorders which typically cause problems in the differential diagnosis of PTSD. The PTSD group had higher elevations on nine of the 20 MCMI scales (all ps less than .05). Profiles were also significantly different in shape and scatter. A discriminant analysis accounted for 100% of the variance and correctly classified 88% of the patients. Resulting MCMI profiles appear to be consistent with DSM-III criteria for PTSD.     

Prevalence of DSM-III conduct and adjustment disorders for adolescent psychiatric inpatients

The prevalence of DSM-III conduct and adjustment disorders in two adolescent psychiatric facilities, both located near large U.S. cities, was investigated. Overall, 31.6% of the adolescent inpatients were conduct disordered while 12.5% were adjustment disordered. The conduct disorders were primarily "aggressive" subtypes suggesting that this characteristic may influence hospitalization and diagnostic decisions. Such data on prevalence assists future treatment planning, allowing anticipation of case loads.     

Comparing borderline definitions: DSM-III borderline and schizotypal personality disorders

Compared the two types of borderline disorder formally defined by DSM-III, borderline personality disorder and schizotypal personality disorder, at the diagnostic category and individual criterion level. Unlike previous research in this area, which has focused on inpatient and outpatient populations, the sample was a psychometrically defined, nonpatient sample including Ss meeting DSM-III criteria for each disorder. The results indicated that the two diagnostic categories each define a type of borderline with distinctive combinations of features. Perceptual and cognitive distortion, however, seem to be present in both and define an area of overlap between the two disorders. The implications of these findings for the revision of the SPD diagnostic criteria in DSM-III-R are discussed, and the theoretical separation of two subtypes of borderline personality is affirmed.     

Estimation of MCMI DSM-III axis II constructs from MMPI scales and subscales

Wiggins, Harris and Lingoes, and Serkownek Minnesota Multiphasic Personality Inventory (MMPI) scores were used to predict Millon Clinical Multiaxial Inventory (MCMI) scores in a 100-patient sample. Equations from the first sample were cross-validated on a sample of 212 inmate subjects. We conclude that scores on 19 of the 20 MCMI scales can be successfully predicted by the Wiggins, Harris and Lingoes, and Serkownek subscales of the MMPI. In further cross-validation, the equations were used to predict the Morey, Waugh, and Blashfield MMPI composites for the prison sample, again with strongly positive results. The results appear quite promising for the estimation of personality disorder constructs from MMPI scales and subscales.     

Estimation of MCMI DSM-III Axis II Constructs From MMPI Scales and Subscales

Wiggins, Harris and Lingoes, and Serkownek Minnesota Multiphasic Personality Inventory (MMPI) scores were used to predict Millon Clinical Multiaxial Inventory (MGMI) scores in a 100-patient sample. Equations from the first sample were cross-validated on a sample of 212 inmate subjects. We conclude that scores on 19 of the 20 MCMI scales can be successfully predicted by the Wiggins, Harris and Lingoes, and Serkownek subscales of the MMPI. In further cross-validation, the equations were used to predict the Morey, Waugh, and Blashfield MMPI composites for the prison sample, again with strongly positive results. The results appear quite promising for the estimation of personality disorder constructs from MMPI scales and subscales.     

MMPI scales for DSM-III personality disorders: their derivation and correlates

Scales tapping the dimensions of personality disorder as represented in the DSM-III were derived using a combined rational/empirical strategy. The final version of the scales demonstrated both content validity as well as internal consistency. Correlations between the derived scales and between these scales and the original MMPI clinical scales were generally found to be in the expected direction providing preliminary evidence of criterion related validity. It is suggested that the derived scales may represent an advance toward the reliable assessment of DSM-III personality constructs.     

The Relationship Between the MCMI Personality Scales and DSM-III,Axis II

Compared were the personality scales of the Millon Clinical Multiaxial Inventory (MCMI) to the diagnosis of personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III]; American Psychiatric Association, 1980), obtained by means of the Structured Interview for the DSM-III Personality Disorders (SIDP). The results from 272 psychiatric outpatients show a good correspondence for the Avoidant and the Dependent scales, a fairly good correspondence for the Schizotypal, the Histrionic, the Borderline, the Narcissistic, and the Paranoid scales, and no correspondence for the Schizoid, the Passive-Aggressive, and the Compulsive scales. The Passive-Aggressive scale seems to be positively correlated to personality disorders in general, whereas the Compulsive scale seems to be negatively correlated to a number of personality disorders.     

The relationship between the MCMI personality scales and DSM-III, axis II

Compared were the personality scales of the Millon Clinical Multiaxial Inventory (MCMI) to the diagnosis of personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III]; American Psychiatric Association, 1980), obtained by means of the Structured Interview for the DSM-III Personality Disorders (SIDP). The results from 272 psychiatric outpatients show a good correspondence for the Avoidant and the Dependent scales, a fairly good correspondence for the Schizotypal, the Histrionic, the Borderline, the Narcissistic, and the Paranoid scales, and no correspondence for the Schizoid, the Passive-Aggressive, and the Compulsive scales. The Passive-Aggressive scale seems to be positively correlated to personality disorders in general, whereas the Compulsive scale seems to be negatively correlated to a number of personality disorders.