Integrating normal and abnormal personality structure: a proposal for DSM-V

The personality disorders section of the American Psychiatric Association's fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is currently being developed. The purpose of the current paper is to encourage the authors of DSM-V to integrate normal and abnormal personality structure within a common, integrative model, and to suggest that the optimal choice for such an integration would be the five-factor model (FFM) of general personality structure. A proposal for the classification of personality disorder from the perspective of the FFM is provided. Discussed as well are implications and issues associated with an FFM of personality disorder, including validity, coverage, feasibility, clinical utility, and treatment implications.     

Classification of depressive disorders in the DSM-V: proposal for a two-dimension system

The number of categories and specifiers for mood disorders has increased with each successive edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM). Many of these categories and specifiers can be viewed as an effort to map the various permutations of severity and chronicity that characterize the depressive disorders. However, this has resulted in a system that (a) is unnecessarily complex and unwieldy, (b) has created problems with artificial distinctions between categories and artifactual comorbidity, and (c) at the same time obscures what may be more fundamental distinctions. A potentially useful and more parsimonious approach to capturing much of the heterogeneity of depressive disorders is to classify the depressive disorders along 2 dimensions, 1 reflecting severity and the other, chronicity. Considerations in the development of these dimensions are discussed, and a set of examples is presented. Although further research and discussion are needed to determine the optimal form of these dimensions, the next edition of the DSM should consider replacing many of the existing categories and specifiers for depressive disorders with the simpler approach of classifying depressive disorders using the 2 dimensions of severity and chronicity.     

Ecosystemic epistemology: an alternative paradigm for diagnosis.

An alternative paradigm for diagnosis based on cybernetics, ecology, and systems theory is proposed. This paradigm, termed "ecosystemic epistemology," suggests that diagnosis focus on knowing problematic situations in an ecological and systemic way. Theoretical statements concerning this approach are delineated with specific references to major family therapists. This discussion provides a foundation for an ecosystemic epistemology for diagnosis that addresses the following issues: (a) the meaning of system; (b) the symptom's presence in the system; (c) the therapist's presence in the system; (d) the ecological relationship system that emerges in diagnosis; and (e) the relation between ecosystemic epistemology and the process of diagnosis. In effect, this paper attempts to formally describe the underlying epistemology inherent in the work of therapists who approach diagnosis in an ecological and systemic way.     

Symptom dimensions in obsessive-compulsive disorder: implications for the DSM-V

In the absence of definitive etiological markers of vulnerability or a unitary profile of pathophysiology for obsessive-compulsive disorder (OCD), obsessive-compulsive (OC) symptom dimensions seem to offer a fruitful point of orientation. The complex clinical presentation of OCD can be summarized using a few consistent and temporally stable symptom dimensions. These can be understood as a spectrum of potentially overlapping features that are likely to be continuous with "normal" worries and extend beyond the traditional nosological boundaries of OCD. Although the understanding of the dimensional structure of obsessive-compulsive symptoms (OCS) is still imperfect, this quantitative approach to phenotypic traits has the potential to advance our understanding of OCD and may aid in the identification of more robust endophenotypes. Preliminary data suggest that these dimensional phenotypes may be useful in studies of the natural history, genetics, neurobiology, and treatment outcome of OCD. A dimensional approach is not mutually exclusive of other methods to parse the larger spectrum of disorders related to OCD. Thus far, age-of-onset of OCS and the individual's "tic-related" status seem to be particularly useful categorical distinctions. Finally, existing assessment methods are inadequate and new dimensional scales are needed to take full advantage of a dimensional approach in clinical and population-based studies.     

Personality disorder research agenda for the DSM-V

The American Psychiatric Association is sponsoring a series of international conferences to set a research agenda for the development of the next edition of the diagnostic manual. The first conference in this series, "Dimensional Models of Personality Disorder: Etiology, Pathology, Phenomenology, and Treatment," was devoted to reviewing the existing research and setting a future research agenda that would be most effective in leading the field toward a dimensional classification of personality disorder. The purpose of this article, authored by the Steering Committee of this conference, was to provide a summary of the conference papers and their recommendations for research. Covered herein are the reviews and recommendations concerning alternative dimensional models of personality disorder, behavioral genetics and gene mapping, neurobiological mechanisms, childhood antecedents, cross-cultural issues, Axes I and II continuity, coverage and cutoff points for diagnosis, and clinical utility.     

Prediction of longevity of volunteer service: a basic alternative proposal

A problem for many organizations is the low continuity of volunteers. Diverse theoretical models have been developed to explain sustained volunteerism, but most of these models have focused on the study of welfare volunteerism and not have verified whether their results could be generalized to other types of volunteerism. In this study, we propose a basic model to explain sustained volunteerism in any type of volunteerism. The aim of this study is to examine this basic model empirically in a sample of socio-assistential volunteers and in a sample of environmental volunteers. For this purpose, 290 volunteers completed a questionnaire and subsequently, two telephone follow-ups were carried out to determine whether the volunteers remained in the NGO one year later. The results show that the basic model offers an acceptable explanation of sustained volunteerism in the two types of volunteer samples studied, but it accounted for a low percentage of variance of the duration of service in both samples. Various relevant implications for the practical management of volunteerism in organizations are derived from theses findings.     

Supportive psychoanalytic psychotherapy for borderline patients: an empirical approach

The author describes a reformulation for research purposes of a supportive psychoanalytic therapy for patients with borderline personality disorder. The major influences on the thinking that led to the modification of prior formulations and the historical background of treatment manuals are described. Supportive treatment is contrasted with transference-focused psychotherapy and dialectic behavior therapy in the interest of creating a clear comparison that lends itself to empirical study.     

The efficacy of progressive relaxation in systematic desensitization and a proposal for an alternative competitive response--the relaxation response.

The theoretical basis of systematic desensitization is reciprocal inhibition in which an alternative, competitive response to anxiety is conditioned to arousal-producing, phobic stimuli. Abbreviated training in progressive relaxation is believed to serve as a competitive response to anxiety by decreasing autonomic nervous system activity. However, physiologic studies of progressive relaxation have not substantiated that its practice is associated with such decreased autonomic activity. Consequently, the use of progressive relaxation has been a confounding factor in the determination of the function of reciprocal inhibition in systematic desensitization. To confirm and refine the theoretical constructs of reciprocal inhibition, it is necessary to test the effects of a response which is competitive to the anxiety response. Such a response may be the relaxation response which is characterized by physiologic changes consistent with decreased autonomic nervous system activity. Derived from meditational practices, techniques which ehcit the relaxation response incorporate the element of focused attention which has been implicated as a critical factor in systematic desensitization. Thus, the use of the relaxation response should be a more appropriate method than progressive relaxation if the therapeutic usefulness of systematic desensitization is indeed due to reciprocal inhibition.     

Preference for fixed-interval schedules: an alternative model

Pigeons were trained under concurrent chain schedules in which the initial links were equal aperiodic schedules and the terminal links were fixed-interval schedules. Choice proportions in the initial links were measured in 26 experimental conditions. The data showed the inadequacy of previous models of concurrent chain performance. A new model was suggested in which choice is a joint function of terminal-link times, overall reinforcement rates, and terminal-link entries. This model accounted for 94% of the variance in the present data and for substantial percentages of the variance in previously reported data. The model simplifies to matching between response ratios and obtained reinforcement rate ratios for simple concurrent schedule performance.     

A practical way to diagnosis personality disorder: a proposal

General criteria for the diagnosis of personality disorder are provided based on rating a few items describing four core features of personality disorder: (a) low Self-directedness, (b) low Cooperativeness, (c) low Affective Stability, and (d) low Self-transcendence. These core features correspond closely with the basic concept of personality disorder in DSM-IV and are based on specific items easy for clinicians to rate in a short time. Criteria are also provided for rating severity of personality disorganization and for subtyping based on a profile of three additional dimensions corresponding to core features of DSM-IV clusters A, B, and C. This approach should facilitate efficient screening in clinical practice, encourage an understanding of the development of comorbidity as a self-organizing process, and provide a theory-driven basis for therapeutic planning with drugs and psychotherapy.     

Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) groups disorders into diagnostic classes on the basis of the subjective criterion of "shared phenomenological features." There are now sufficient data to eliminate this rational system and replace it with an empirically based structure that reflects the actual similarities among disorders. The existing structural evidence establishes that the mood and anxiety disorders should be collapsed together into an overarching class of emotional disorders, which can be decomposed into 3 subclasses: the bipolar disorders (bipolar I, bipolar II, cyclothymia), the distress disorders (major depression, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder), and the fear disorders (panic disorder, agoraphobia, social phobia, specific phobia). The optimal placement of other syndromes (e.g., obsessive-compulsive disorder) needs to be clarified in future research.     

The diagnosis of borderline disorders: criteria and their empirical evaluation

Until now "Borderline-Syndrom" is a controversial diagnosis especially because of many uncertainties to determine the definition. In our examination various discrimination analyses were realised on a sampling of 62 patients (32 neurotic and 30 Borderline-Patients) and 47 variables in order to get various selective combinations of variables. Useful as a screening to separate neurotic and Borderline-Patients seems to be a combination of the items "often changing partnership", "homosexually episodes" and "incrimination/disciplinary punishment" with an error rate of 6.5 per cent.     

Semantic anomalies at the borderline of consciousness: an eye-tracking investigation

We report an eye-tracking study in which participants read passages containing difficult-to-detect semantic anomalies. Would there be any evidence of the registration of the anomaly within the comprehension system (reflected in eye tracking) when anomalies were not noticed? Using early and late processing measures, there was no evidence for registration independent of conscious detection. Comparisons were made between detected and undetected anomalies and between these and nonanomalous controls. There was evidence of disruption to the tracking measures only when a conscious report was also made. These data fit the view that shallow semantic processing underlies the failure to detect anomalies. Implications for language processing are discussed.     

The structure of maladaptive personality traits in childhood: a step toward an integrative developmental perspective for DSM-V

The present study describes the construction of a taxonomy of trait-related symptoms in childhood, the Dimensional Personality Symptom Item Pool (DIPSI), and examines the replicability of the taxonomy's higher order structure across maternal ratings of referred (N = 205) and nonreferred (N = 242) children and self-ratings of adolescents (N = 453). The DIPSI's 4 higher order factors--that is, Emotional Instability, Disagreeableness, Introversion, and Compulsivity--showed clear correspondence with the dimensions of personality pathology found in adulthood (Dimensional Assessment of Personality Pathology-Basic Questionnaire; W. J. Livesley, 1990; Schedule for Nonadaptive and Adaptive Personality; L. A. Clark, 1993). These 4 factors can be further organized into 2 superfactors, representing Internalizing and Externalizing Traits, demonstrating empirical and conceptual relationships with psychopathology models in childhood and adulthood. The implications for the assessment and conceptualization of early trait pathology are discussed in the context of an integrative developmental perspective on the construction of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition.     

Lessons from longitudinal studies for new approaches to the DSM-V: the FFM and FFT

After brief comments about each target article, we discuss their significance for the DSM-V, the implications for personality disorders of universal trait developmental trends, and our emerging theoretical model, the Five-Factor Theory, which provides an integrative context for these remarkable findings.     

Projective identification: an alternative hypothesis

The concept of projective identification as a primitive defense mechanism is reassessed. An alternative hypothesis is offered: that projective identification can best be understood as a compromise formation which includes as its major component an "identification with the aggressor" or a "turning of passive into active." This reversal is demonstrated within a two-tiered transference/countertransference of the analyst as powerful parent and the patient as the helpless child. On the deeper level the patient enacts the role of dominant parent and the analyst experiences the feelings which the patient had felt as a child.     

Acculturative stress in Latin-American immigrants: an assessment proposal

The aim of this paper was to develop an instrument to assess levels of stress experienced by Latin-American immigrants in their acculturative process in Spain. A sample of 692 immigrants from Latin America, aged 20 to 63 years, took part on this study (54.9% males and 45.1% females). A 24-item questionnaire with high reliability (.92) was elaborated. Six factors related to acculturative stress were found: 1) discrimination and rejection; 2) differences with the out-group (native Spaniards); 3) citizenship problems and legality; 4) problems concerning social relationships with other immigrants; 5) nostalgia and longing; and 6) family break-up. Our findings show that participants have a high level of stress related to nostalgia and longing, family break-up, and the perception of discrimination and rejection by natives. The usefulness of the instrument and its applications and restrictions are discussed.