The myth of DSM's invention of new categories of disorder: Houts's diagnostic discontinuity thesis disconfirmed

Houts (2001) argues that increases in DSM diagnostic categories are due to the invention of new disorders that are discontinuous with old conceptions of disorder and would not have been previously diagnosed. He maintains that DSM category increases are not comparable in nature to ICD category increases, which are mainly refinements of recognized disorders. I survey categories of disorder introduced after DSM-II and assess whether they are discontinuous with old concepts and categories of disorder. Candidate categories are identified from: Houts and Follette (1998), Mentalism, mechanisms, and medical analogues: Reply to Wakefield. Journal of Consulting and Clinical Psychology; Kutchins and Kirk (1997) Making us crazy: DSM: The psychiatric bible and the creation of mental disorders. New York: Free Press; and my own list. The result is that virtually none of the candidate categories are invented, discontinuous categories. In almost every case, the newly labeled conditions were considered disorders at the time of DSM-II and would have been diagnosed under DSM-II categories. I also reexamine DSM-IV sleep disorder categories, which Houts claims are discontinuous with past diagnostic conceptions. The result is that all DSM-IV sleep disorders were recognized as disorders at the time of DSM-II, and most were recognized as mental disorders. I conclude that DSM category increases are comparable in nature to ICD category increases, and that the invention-of-disorder account cannot explain the vast majority of such increases.     

Diagnostik und Therapie Dissoziativer (Identitäts-) Störungen

In North America, dissociative disorders have gained a central position in psychiatric research of the last 20 years. Their most severe form, the dissociative identity disorder has been explored with utmost thoroughness. The dissociative identity disorder seems to be a complex posttraumatic disorder with a central etiological role of sexual traumatizations in early childhood. Critics, however, expressed their doubts about the validity of the posttraumatic model and the psychiatric diagnosis itself. They assume it to be a matter of the cultural and suggestive impact of the media and of improper psychotherapy. In the present article evidence is provided about the arguments of the socio-cognitive model being scientifically unsubstantiated. A bulk of empirical results supports the assumption that dissociative identity disorder and similar diseases regularly occur both in North America and Europe, but they are rather rarely diagnosed. Therefore, it seemes both to make sense and be necessary to develop diagnostic and treatment programs for dissociative identity disorders and to promote their implementation.     

Impaired performance of right-brain-damaged patients on a sentence anagram task

A sentence anagram task was used to examine the right cerebral hemispheres's role in core grammatical functioning at the syntactic level. The test consisted of two subsets of stimuli involving empty categories: (a) those that required the empty category to be filled, and (b) those that allowed the category to remain empty. Three hypotheses were presented: (1) right-brain-damaged patients (RBDs) would be more sensitive to subset (a) than (b), (2) RBDs would perform similarly to left-brain-damaged subjects, and (3) non-brain-damaged controls would outerperform both brain-damaged groups. With all hypotheses supported, the discussion focuses on an explanation for RBDs' sensitivity to the first subset of stimuli.     

Malingering dissociative identity disorder: objective and projective assessment

Verification of dissociative identity disorder presents challenges given the complex nature of the illness. This study addressed the concern that this disorder can be successfully malingered on objective and projective psychological tests. 50 undergraduate women were assigned to a Malingering or a Control condition, then completed the Rorschach Inkblot Test and the Dissociative Experiences Scale II. The Malingering group were asked to simulate dissociative identity disorder; controls received instructions to answer all materials honestly. Analysis indicated that malingerers were significantly more likely to endorse dissociative experiences on the Dissociative Experiences Scale II in the range common to patients with diagnosed dissociative identity disorder. However, on the Rorschach there were no significant differences between the two groups. Results suggest that the assessment of dissociative identity disorder requires a multifaceted approach with both objective and projective assessment tools. Research is needed to assess these issues in clinical populations.     

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.     

The effects of feature necessity and extrinsicity on gradedness of category membership and class inclusion relations*

Two theories of differences among natural language categories in graded membership and strength of class inclusion are contrasted. The two sets of hypotheses tested were: (1) that categories represented by features which many people believe to be necessary would have less graded memberships, and stronger class inclusion, than those represented by features which few people believe to be necessary, and (2) that categories which people believe are represented primarily by intrinsic features (i.e. features that are true of an entity in isolation; see Barr & Caplan, 1987) would have less graded structures, and stronger class inclusion, than those which people believe are represented primarily by extrinsic features (i.e. features representing relations between an entity and other entities). The findings suggest that feature necessity and feature extrinsicity have independent effects on gradedness of category membership and on class inclusion.     

Necessity and natural categories.

Our knowledge of natural categories includes beliefs not only about what is true of them but also about what would be true if the categories had properties other than (or in addition to) their actual ones. Evidence about these beliefs comes from three lines of research: experiments on category-based induction, on hypothetical transformations of category members, and on definitions of kind terms. The 1st part of this article examines results and theories arising from each of these research streams. The 2nd part considers possible unified theories for this domain, including theories based on ideals and norms. It also contrasts 2 broad frameworks for modal category information: one focusing on beliefs about intrinsic or essential properties, the other focusing on interacting causal relations.     

Pathological Altruism, Narcicissm, and Dissociation as Prerequisite for Infanticide

The international literature about neonaticide, infanticide, and familicide has arrived at a tripartite classification on the basis of the typical pathogenesis and the therapeutic and forensic challenges connected with the emerging situation. The categories can be characterized by altruistic or narcissistic attitudes and those of unawareness and dissociative states towards imminent delivery or the postpartum situation. The psychopathological counterparts to these attitudes are major depressive disorder with melancholia, narcissistic personality disorder, and an immature personality, often in socially disadvantaged environments equivalent to borderline personality disorder with dissociative states and diminished impulse control. Aspects of perinatal bonding disturbances between mother and child play a major role for the focus of psychotherapy and forensic assessment in all three categories. They need differential characterization according to the different pathogenetic pathways of inadequate experience of guilt, inadequate self-esteem regulation, and dissociative neglect and diminished impulse control. Preventive and therapeutic perspectives of intervention are discussed.     

The effects of base rates and individuating information on judgments about another person

Past research suggests that in judging a person's category membership, people largely ignore the population frequency of membership in the category (base rates) in favor of individuating information about the particular person. This study tested the hypothesis that base rates will be utilized to the extent that the usefulness of the individuating information for diagnosing category membership is diminished. Subjects were given problems in which both base rates of membership in each of two categories and individuating information about a target person were presented. Then, in each case, they were asked to assess the probability that the target person belonged to each category. In three sets of problems, the diagnostic usefulness of the individuating information (personality characteristics) was diminished by including individuating information that was either inconsistent or irrelevant, or by increasing the similarity of the two alternative membership categories. In a fourth set of problems, the individualistic information included consistent, relevant personal characteristics and the membership categories were dissimilar. As expected, base rates were used in each of the first three sets of problems but were ignored in the fourth set. The results were interpreted in terms of informational factors that induce a shift away from a habitual, spontaneous reliance on a source of information (e.g., personality traits) for which one has well-developed rules (e.g., intuitive personality theories), and toward a more controlled, deliberate mode of thinking wherein other sources of information (e.g., base rates) are attended to and incorporated into judgment through less frequently used rules (e.g., sampling rules).     

The Underlying Role of Negative Affect in the Association between PTSD,Major Depressive Disorder,and Generalized Anxiety Disorder

Clinicians and researchers have found differential diagnosis to be difficult, particularly for conceptually similar disorders. One category of particular interest has been distress or internalizing disorders, theorized to be related via an underlying construct of generalized distress or negative affect. The present study attempted to address the comorbidity of three distress disorders - posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) - using latent analyses by controlling for the variance attributable to negative affect. The sample consisted of 265 trauma-exposed individuals who completed self-report measures of PTSD, MDD, GAD, and negative affect. Confirmatory factor analysis was used to test initial model fit. Next, the model was re-computed, controlling for negative affect by regressing negative affectivity at the item-level. Results indicated that a significant amount of variance within and between these diagnostic categories is attributable to negative affect at both the item- and factor-level. The hypothesis that MDD’s non-somatic/affective factor and the GAD factor would have the highest attenuations in factor loadings after controlling for negative affect was supported. Therefore, negative affect significantly influences the co-occurrence of PTSD, MDD, and GAD clinically, emphasizing the need for transdiagnostic interventions for trauma victims.     

Asymmetrical international attitudes

In general, attitudes towards nations have a fair amount of reciprocity: nations either like each other, are relatively indifferent to each other, or dislike each other. Sometimes, however, international attitudes are asymmetrical. In this study, we use social identity theory in order to explain asymmetrical attitudes. Parting from social identity theory, asymmetrical attitudes can be predicted to occur most likely between countries that are linguistically either similar or closely related, but differ in size. Europe, more than any other continent, offers a rich variety of nations which represent natural conditions for our study, such as size and degree of linguistic similarity. In order to test hypotheses derived from social identity theory, we asked respondents (N = 405) from (Dutch‐ and French‐speaking) Belgium, France, Germany, and The Netherlands to fill out a questionnaire on three large nations (Germany, Great Britain, France) and three smaller ones (The Netherlands, Belgium, and Denmark). Results strongly supported hypotheses and confirm that a social identity approach may help to better understand international attitudes. Copyright © 2002 John Wiley & Sons, Ltd.     

Dissoziative Störungen (Konversionsstörungen)

The ICD-10 diagnostic category of dissociative disorders encompasses very different clinical pictures. The so called dissociative disorders of consciousness are characterized by functional disturbances to the psychic domains of consciousness, identity, autobiographic memory and experience of self and the world. The core features of conversion disorders are functional alterations in the sensorimotor systems. The phenomenological heterogeneity is reflected by prevalence rates ranging from very rare to 30% in clinical populations. Traumatic experiences play a crucial role in the etiology and pathogenesis of these disorders. High rates of comorbid disorders, a tendency to a chronic course and a somatic illness concept in patients with conversion disorders complicate the psychotherapeutic approach. Depending on the therapeutic goals, both psychodynamic and cognitive-behavioral treatment forms are suitable.     

Eating disorder NOS (EDNOS): an example of the troublesome "not otherwise specified" (NOS) category in DSM-IV

The “Not Otherwise Specified” (NOS) category within DSM-IV is designed for disorders of clinical severity that are not specified within broad diagnostic classes. “NOS” diagnoses are intended to be residual categories and they tend to be neglected by researchers. This can be inappropriate. The problems associated with certain NOS diagnoses are well illustrated by “Eating Disorder NOS” (sometimes termed EDNOS), which is the most common category of eating disorder encountered in routine clinical practice yet it has barely been studied. Indeed, there has been no research on its treatment. Interim and longer-term conceptual and practical solutions to the anomalous status of eating disorder NOS are proposed including the creation of a new diagnosis termed “mixed eating disorder”. Several of these solutions are of relevance to NOS categories in general. All the solutions should fulfil criteria for clinical utility.     

Nirvana Road: Dissociative Experiences Predict “Eastern” Beliefs About Postmortem Existence

Three studies (N = 338) tested the idea that endorsement of postmortem beliefs most closely associated with Eastern religious traditions (that is, continuation of consciousness and the explicit dissolution of personal identity, possibly via reincarnation) would map onto a history of dissociative experiences. As hypothesized, a history of dissociative (including depersonalization/derealization) experiences, as well as altered experience of body/space/time during a discrete positive episode, predicted endorsement of “Eastern” postmortem beliefs among religiously heterogeneous (non-Buddhist, non-Hindu) participants. This relationship became stronger when dissociative tendencies were heightened following a traumatic loss (i.e., the suicide of a close other within the past year; Study 3). In contrast, dissociative tendencies did not predict belief in either annihilation or postmortem continuation without identity loss, most typically linked to atheism and Western religious traditions, respectively. These results suggest that some metaphysical beliefs may be embraced because they “make sense” in light of personal experience.     

维度的结合与分离对归类不确定性预测的影响

探讨在归类不确定的情境下目标与预测特征两个维度的结合或分离对被试特征预测的影响。共包括 3个实验 :实验 1在Murphy和Ross的研究的基础上进一步提高非靶类型中目标及预测特征的基本概率 ,考察被试的特征预测是否会受非靶类型信息的影响。实验 2探讨非靶类型的目标与预测特征结合与否是否会影响被试预测特征时对非靶类型信息的使用。实验 3探讨提高靶类型中目标与预测特征结合的比例是否影响被试对特征的预测。结果表明 :当非靶类型中目标与关键特征处于分离的状态时 ,被试在进行特征预测时没有利用非靶类型的信息 ,符合单类说的假设 ;而当非靶类型中目标与关键特征结合时 ,被试在进行特征预测时则会利用非靶类型的信息 ,符合Bayesian规则 ;靶类型中的目标与关键特征结合的比例提高 ,被试对特征预测的概率也随之提高。据此 ,本研究将目标与预测特征结合比例这个变量加入Bayesian规则的计算公式 ,对该预测模型进行了修正     

Generalizing norms and preferences within social categories and individuals

Under what conditions will people generalize and remember observed social information? Preschool- (n = 44) and young school-age (n = 46) children and adults (n = 40) heard short vignettes describing characters' actions and motives on a single occasion. Characters were introduced using either proper names or category labels. Test questions asked for prediction and memory of motives for the same (individual) or a different (category member) person in a future event. Critical items contrasted behaviors motivated by psychological states with those motivated by normative obligations. The hypothesis was that norms would generalize across members of social categories. In contrast, psychological states would be generalized to the same individual across time. Results supported both these hypotheses and revealed some developmental differences. Preschool-age children seemed most attentive to normative properties of social categories. Young school-age children were most attentive to psychological properties of individuals. Such differences may reflect a shift from early focus on within-category similarities to a later focus on within-category differences.     

Implications of sex and gender differences for self: Perceived advantages and disadvantages of being the other gender

Undergraduate students (34 females and 28 males/44 Caucasian, 16 African-American, 2 Asian) were asked to list the advantages and the disadvantages that they imagined they would experience if they were the other gender. A separate group of undergraduate raters then classified each of the statements into one of four categories designed to reflect social (social roles or social appearance) or physical differences (sexual or non-sexual physical differences) between the sexes. The number of responses each participant generated within each category served as the dependent variable. By far the largest number of responses pertained to the social roles category, and there were no participant gender differences for that category. Participant gender differences were observed in the social appearance and sexual physical difference categories, indicating males and females agreement that males have more advantages. Overall, females listed more advantages to a change in gender, while males indicated more disadvantages. Results are interpreted as providing insights into the personal and practical implications of differences between males and females.The authors would like to acknowledge Tiffany Capers and Millard McCluney for their assistance in collecting the data.     

Current scientific interest in dissociative amnesia: A bibliometric analysis

In a bibliometric analysis, we used the PubMed search engine to count the number of publications identified by the search term “dissociative amnesia” for the years 2011–2020. We then counted publications from the same decade for five representative comparison disorders: “panic disorder,” “anorexia nervosa,” “obsessive–compulsive disorder,” “attention deficit hyperactivity disorder,” and “bipolar disorder.” Our search yielded only 89 publications for “dissociative amnesia,” and only seven of these involved localized or selective amnesia for specific events. By contrast, we found between 3000 and 21,000 publications for each of the five comparison disorders during 2011–2020. We performed several additional secondary analyses, all of which suggested that the diagnosis of “localized or selective dissociative amnesia” has generated little scientific interest in recent years. Examining possible hypotheses to explain this lack of interest, it appears most likely that the concept of localized or selective dissociative amnesia is not widely accepted among scientists at present.