Eating behavior in obese BED, obese non-BED, and non-obese control participants: A naturalistic study

Laboratory studies have shown considerable differences between the eating behavior, particularly binge eating behavior, of participants with and without binge eating disorder (BED). However, these findings were not replicated in two field experiments employing ecological momentary assessment (EMA) in which obese BED and obese non-BED participants reported comparable binge eating behavior. In the current study, we examined differences in binge eating with an innovative assessment scheme employing both EMA and a standardized computer-based dietary recall program to avoid some of the limitations of past laboratory and field research. Obese BED, obese non-BED, and non-obese control participants reported significant differences in eating patterns, loss of control, overeating, and binge eating behavior. Of particular importance was the finding that BED participants engaged in more overeating and more binge eating episodes than non-BED participants. These findings suggest that the use of EMA in combination with dietary recall may be a relatively objective and useful approach to assessing binge eating behavior. The findings further suggest that individuals with BED are observably different from those without the disorder, which may have implications for eating disorder diagnoses in DSM-V.     

Sex differences in the genetic and environmental influences on childhood conduct disorder and adult antisocial behavior

Sex differences in the genetic and environmental influences on childhood conduct disorder and adult antisocial behavior were examined in a large community sample of 6,383 adult male, female, and opposite-sex twins. Retrospective reports of childhood conduct disorder (prior to 18 years of age) were obtained when participants were approximately 30 years old, and lifetime reports of adult antisocial behavior (antisocial behavior after 17 years of age) were obtained 8 years later. Results revealed that either the genetic or the shared environmental factors influencing childhood conduct disorder differed for males and females (i.e., a qualitative sex difference), but by adulthood, these sex-specific influences on antisocial behavior were no longer apparent. Further, genetic and environmental influences accounted for proportionally the same amount of variance in antisocial behavior for males and females in childhood and adulthood (i.e., there were no quantitative sex differences). Additionally, the stability of antisocial behavior from childhood to adulthood was slightly greater for males than females. Though familial factors accounted for more of the stability of antisocial behavior for males than females, genetic factors accounted for the majority of the covariation between childhood conduct disorder and adult antisocial behavior for both sexes. The genetic influences on adult antisocial behavior overlapped completely with the genetic influences on childhood conduct disorder for both males and females. Implications for future twin and molecular genetic studies are discussed.     

Hostile attributional biases in severely aggressive adolescents

Adolescent boys (N = 128) from a maximum security prison for juvenile offenders were administered a task to assess hostile attributional biases. As hypothesized, these biases were positively correlated with undersocialized aggressive conduct disorder (as indicated by high scores on standardized scales and by psychiatric diagnoses), with reactive-aggressive behavior, and with the number of interpersonally violent crimes committed. Hostile attributional biases were found not to relate to nonviolent crimes or to socialized aggressive behavior disorder. These findings held even when race and estimates of intelligence and socioeconomic status were controlled. These findings suggest that within a population of juvenile offenders, attributional biases are implicated specifically in interpersonal reactive aggression that involves anger and not in socialized delinquency.     

MMPI and Rorschach indices of schizophrenic and depressive diagnoses among adolescent inpatients

Although adolescent norms have been developed for the MMPI (e.g., Marks, Seeman, & Haller, 1974) and Rorschach (e.g., Exner, 1986a), little is known regarding the discriminate diagnostic validity of these measures with adolescents. This study investigated the usefulness of these measures in the detection of depression and schizophrenia among adolescent inpatients. Subjects (mean age = 15.3) consisted of 134 adolescents who received Rorschach and MMPI administrations at hospital admission. Clinical diagnoses resulted in the following groupings for this sample: schizophrenia = 15, dysthymic disorder = 41, major depression = 26, conduct disorder = 28, personality disorder = 18. MMPI scale Sc elevation was found to be the most effective single predictor of schizophrenic diagnoses, with a hit rate of .76, sensitivity of .62, and specificity of .78. Neither MMPI scale D scores nor Rorschach DEPI scores were found to be significantly related to patients' diagnoses. Results were interpreted in terms of prior findings in adult psychiatric populations and in relation to implications for the clinical assessment of adolescents.     

The diagnosis of neurological disorders in older adults

Are neurological disorders overdiagnosed in older adults? Previous reports suggest that age bias may lead to diagnostic inaccuracies for older adult clients. In the present study, the average test scores for community-dwelling 38-year-old and 74-year-old individuals were presented as the results for a 38-year-old client and a 74-year-old client, respectively. Neuropsychologists did not make diagnoses of neurological disorder or dementiafor either of the clients. The results from this study indicate that age bias is not as serious a problem among neuropsychologists as many psychologists once believed.     

Personality disorders in offenders: categorical versus dimensional approaches.

The present study focused on the consequences of cut-off scores in personality disorder diagnoses for their association with criminal behavior. Using ICD-10 personality disorder criteria eliminating offence-related symptoms, we studied the distributions of categorically diagnosed personality disorders and of dimensional personality disorder scores in a group of offenders and a noncriminal control group. Whereas the dimensional scores of the offender group differed significantly from those of the control group for all personality disorders under study, the frequency of categorical diagnoses differed significantly for two personality for two personality disorders only. Moreover, prediction of group membership (offenders vs. nonoffenders) from personality disorder scores was substantially more precise than prediction from categorical diagnoses. It is concluded that a dimensional approach to personality disorder diagnosis is not only superior theoretically but also yields more precise information about the specific associations with criminal behavior.     

MMPI and Rorschach Indices of Schizophrenic and Depressive Diagnoses Among Adolescent Inpatients

Although adolescent norms have been developed for the MMPI (e.g., Marks, Seeman, & Haller, 1974) and Rorschach (e.g., Exner, 1986a), little is known regarding the discriminate diagnostic validity of these measures with adolescents. This study investigated the usefulness of these measures in the detection of depression and schizophrenia among adolescent inpatients. Subjects (mean age = 15.3) consisted of 134 adolescents who received Rorschach and MMPI administrations at hospital admission. Clinical diagnoses resulted in the following groupings for this sample: schizophrenia = 15, dysthymic disorder = 41, major depression = 26, conduct disorder = 28, personality disorder = 18. MMPI scale Sc elevation was found to be the most effective single predictor of schizophrenic diagnoses, with a hit rate of .76, sensitivity of .62, and specificity of .78. Neither MMPI scale D scores nor Rorschach DEPI scores were found to be significantly related to patients' diagnoses. Results were interpreted in terms of prior findings in adult psychiatric populations and in relation to implications for the clinical assessment of adolescents.     

Is the Continuity of Externalizing Psychopathology the Same in Adolescents and Middle–Aged Adults? A Test of the Externalizing Spectrum’s Developmental Coherence

Externalizing psychopathology (EXT) is a framework for understanding diagnostic comorbidity and etiology of antisocial and substance-use behaviors. EXT indicates continuity in adulthood but the structure of adolescent EXT is less clear. This report examines whether adolescent EXT is trait-like, as has been found with adults, or categorical. We use tests of measurement invariance to determine how diagnostic indicators of EXT differ in adolescents compared to adults. The EXT measures employed were DSM-IIIR diagnoses of adult antisocial behavior, conduct disorder, and alcohol, marijuana, and drug dependence. Latent trait, latent class, and hybrid models were fit to two separate data sets: 2,769 seventeen-year-old adolescents and 2,619 adults from the Minnesota Twin Family Study. The best model in both samples was a single-trait LT model. Parameters from the adolescent and adult models were equivalent for all disorders except alcohol dependence. It appears that EXT in adolescence can be accurately represented by a single-trait model, and the measurement properties of EXT are similar during these time periods with the exception of alcohol dependence.     

Reaction time indices of attention deficits in boys with disruptive behavior disorders

Boys with diagnoses in the disruptive behavior disorder (DBD) spectrum and normal controls were tested in two reaction time (RT) experiments. In Experiment I simple warned RT was measured and the length and regularity of the preparatory intervals were varied in order to study sustained attention in the sense of preparation. With age and IQ controlled, DBD boys had slower and more variable RT overall than controls and showed generally more pronounced effects of variations in the length and sequence of the preparatory intervals. The results suggest that DBD boys are subject to lapses of attention which are increased by a relatively long preparatory interval, and that they have a particular problem with temporal uncertainty. In Experiment II some aspects of selective attention were studied in a paradigm in which stimulus modality uncertainty and response selection were varied. DBD boys showed greater effects of modality uncertainty but not response selection than controls. No differences between subdiagnoses within the DBD spectrum could be demonstrated.     

Developmental consequences of behavioral inhibition: a model in rhesus monkeys (Macaca mulatta)

In children, behavioral inhibition is characterized by a disposition to withdraw in the presence of strangers and novel situations. Later in life, behavioral inhibition can result in an increased risk for anxiety and depression and a decrease in social behavior. We selected rhesus monkeys that, during infancy, showed evidence of behavioral inhibition in response to separation, and contrasted them with non‐inhibited peers. To understand the development of behavioral inhibition at juvenile age, we collected behavioral data in response to relocation; in response to a human intruder challenge; and in naturalistic outdoor field corrals. At 4 years of age (young adulthood), we again collected behavioral data in the outdoor field corrals to understand the adult social consequences of behavioral inhibition. We also included sex, dominance rank, and number of available kin in our analyses. Finally, to understand the consistency in behavior in behaviorally inhibited animals, we conducted exploratory analyses contrasting behaviorally inhibited animals that showed high vs. low durations of non‐social behaviors as adults. At juvenile age, behaviorally inhibited animals continued to show behavioral differences in the novel testing room and during the human intruder challenge, generally showing evidence of greater anxiety and emotionality compared to non‐inhibited controls. In their outdoor corrals, behaviorally inhibited juveniles spent more time alone and less time in proximity and grooming with mother and other adult females. In young adulthood, we found that behavioral inhibition was not related to time spent alone. We did find that duration of time alone in adulthood was related to time alone exhibited as juveniles; sex, dominance rank, or the number of kin were not influential in adult non‐social duration, either as main effects or as moderators. Finally, exploratory analyses revealed that behaviorally inhibited females that were more sociable (less time spent alone) as adults had spent more time grooming as juveniles, suggesting that high‐quality social interaction at a young age might mitigate the social consequences of behavioral inhibition. Overall, we believe that the many similarities with the human data that we found suggest that this monkey model of naturally occurring behavioral inhibition can be valuable for understanding social development.     

Significance of Childhood Conduct Problems to Later Development of Conduct Disorder Among Children With ADHD: A Prospective Follow-Up Study

This study investigates whether low to moderate levels of childhood oppositional defiant disorder (ODD) and conduct disorder (CD) behaviors contribute to the development of clinically diagnosed CD in adolescence, in children with attention deficit hyperactivity disorder (ADHD). Participants were 207 White boys (ages 6-12) with ADHD free of conduct disorder diagnoses. Parent and teacher ratings were obtained. Participants were assessed at mean age 18 by clinicians blind to childhood status. A non-ADHD group (recruited in adolescence) was also studied. ODD behavior ratings did not predict CD in adolescence, whereas CD behavior ratings did. No single ODD or CD behavior predicted adolescent outcome. ADHD probands with very low ratings (Not at all, Just a little) by parents and teachers on all CD behaviors were still at significantly increased risk for CD in adolescence, compared to non-ADHD controls. The same relationships were found between childhood ODD and CD behaviors, and antisocial personality disorder in adulthood (mean age, 25). We conclude that childhood ADHD is a developmental precursor of later antisocial disorder, even in the absence of comorbid ODD or CD in childhood. However, low levels of CD-type problems are not innocuous, because they predict later CD among children with ADHD without comorbid CD.     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

Identification of Oppositional Defiant Disorder in Young Adult College Students

Long-considered a disorder restricted to children and adolescents, more research is needed to understand how oppositional defiant disorder (ODD) affects adults. Recent research suggests that symptoms of ODD persist into adulthood and are associated with specific negative functional outcomes. This current study seeks to investigate the prevalence and associated impairments of ODD symptoms in young adults. Two large samples of college students between the ages of 18–24 years old (N =?1792; N =?1497) completed self-report measures of ODD symptoms, ADHD symptoms, psychiatric diagnoses, and functional impairments. Rates and internal consistency of ODD symptoms were calculated, and multiple regression was used to estimate the association between high levels of ODD severity scores and social and authority-related impairments, as well as online antagonistic behavior. In the two samples, the proportion of individuals reporting four or more symptoms of ODD was estimated to be 3.39 and 4.12% respectively, and did not vary significantly by gender. Higher ODD severity was associated with social impairment, online antagonistic behavior, and greater conflict with authority figures, even after controlling for ADHD symptoms and self-reported depression or anxiety diagnoses. ODD symptoms measured in college students demonstrate acceptable reliability and are uniquely associated with specific impairments. The findings from this study support greater consideration of ODD symptoms in adult populations.     

Personality disorders over time: precursors, course and outcome

Personality disorders cause dysfunction over the course of adult life. A chronic course of disorder tends to be associated with an early onset, and personality disorders are preceded by precursor symptoms in childhood. Long-term outcome varies by personality disorder category: antisocial and borderline personality tend to remit with age, an improvement that is not seen in other diagnoses. The chronicity of personality disorders can usefully guide treatment planning, and psychotherapy for personality disorders can focus on rehabilitation.     

Gender differences in the frequency of personality disorders in depressed outpatients

We examined gender differences in the frequency of DSM-III-R personality disorder diagnoses and symptomatology in a sample of 225 depressed outpatients. This research partially replicates and extends one of the first studies in this area by Golomb et al. (1995). Males were significantly more likely than females to meet diagnoses for schizotypal, paranoid, narcissistic, antisocial, obsessive compulsive, and borderline personality disorder. Compared to females, males were also significantly more likely to have schizoid, schizotypal, narcissistic, antisocial, and obsessive-compulsive personality disorder symptomatology. Females did not predominate in any personality disorder symptomatology or diagnoses. A possible explanation for these findings is discussed. The results of this study challenge traditional assumptions about gender differences in the frequency of personality disorders, and confirm the need for future studies to investigate the relation between gender and personality disorders in specific Axis I samples.     

The Assessment and Diagnosis of Attention Deficit Hyperactivity Disorder in Adult Forensic Psychiatric Outpatients

The primary purpose of the present study was to examine the validity of commonly utilized ADHD rating scales within an adult forensic population. Participants were 120 patients assessed for dysfunctional anger and impulsive aggression at a hospital-based clinic. Two psychiatrists made independent diagnoses about the presence or absence of ADHD among individuals presenting with symptoms consistent with this disorder. Following the diagnoses, participants were assessed with multiple ADHD measures, including measures based on self-report, observer-report, or a computerized neuropsychological measure (IVA + Plus). With the exception of the IVA + Plus, the ADHD measures significantly differentiated individuals diagnosed with ADHD from individuals who were not so diagnosed. These measures also demonstrated good diagnostic utility via test specific parameters (sensitivity, specificity, positive predictive power, and negative predictive power). A sub-set of measures demonstrated particularly good classification accuracy, with high sensitivity (91 %) and good specificity (81 %). Implications of these findings for the effective assessment and diagnosis of ADHD in adult outpatient psychiatric settings are discussed.     

When social anxiety disorder co-exists with risk-prone, approach behavior: Investigating a neglected, meaningful subset of people in the National Comorbidity Survey-Replication

Little is known about people with social anxiety disorder (SAD) who are not behaviorally inhibited. To advance knowledge on phenomenology, functional impairment, and treatment seeking, we investigated whether engaging in risk-prone behaviors accounts for heterogeneous outcomes in people with SAD. Using the National Comorbidity Survey-Replication (NCS-R) dataset, our analyses focused on people with current (N = 679) or lifetime (N = 1143) SAD diagnoses. Using latent class analysis on NCS-R risk-prone behavior items, results supported two SAD classes: (1) a pattern of behavioral inhibition and risk aversion and (2) an atypical pattern of high anger and aggression, and moderate/high sexual impulsivity and substance use problems. An atypical pattern of risk-prone behaviors was associated with greater functional impairment, less education and income, younger age, and particular psychiatric comorbidities. Results could not be subsumed by the severity, type, or number of social fears, or comorbid anxiety or mood disorders. Conclusions about the nature, course, and treatment of SAD may be compromised by not attending to heterogeneity in behavior patterns.     

Parenting in mothers with and without attention-deficit/hyperactivity disorder

The authors examined the impact of maternal attention-deficit/hyperactivity disorder (ADHD) on parenting behaviors. Sixty mothers between the ages of 31 and 50 with (n = 30) and without (n = 30) ADHD and their 8- to 14-year-old children with ADHD completed self-report and laboratory measures of monitoring of child behavior, consistency in parenting, and parenting problem-solving abilities. These parenting behaviors were selected because of their established links to the development of child behavior problems. As predicted, mothers with ADHD were found to be poorer at monitoring child behavior and less consistent disciplinarians compared with mothers without ADHD. There was some evidence to support the prediction that mothers with ADHD were less effective at problem solving about childrearing issues than control mothers. The differences between the 2 groups of mothers persisted after child oppositional and conduct-disordered behavior were controlled. These results indicate that parenting is an area of functioning that requires more attention in adult ADHD research.     

Effects of object complexity and type on the gaze behavior of children with pervasive developmental disorder

The looking behavior of children with pervasive developmental disorder (PDD) and age- and IQ-matched normal control children was studied using infrared oculography. Stimuli varying in complexity and topic were presented to test whether children with PDD have specific abnormalities in looking behavior to complex stimuli and/or to faces. All children showed more and longer fixations on the complex objects than on the simple objects, especially the complex nonsense figure, but group differences were not found. The results show no evidence for specific abnormalities in looking behavior to either faces or to complex stimuli in high functioning children with PDD.     

The classification of neuropsychological deficit

The study involves classification of neuropsychiatric patients on the basis of neuropsychological and intelligence test performance. One hundred twenty-five hospitalized male neuropsychiatric patients with various diagnoses were administered the Halstead-Reitan and Luria-Nebraska neuropsychological test batteries, as well as the Wechsler Adult Intelligence Scale. A cluster analysis was performed for each of those three procedures utilizing Ward's method. It was found in all cases that clusters were determined on the basis of level rather than pattern of performance. Relationships were found between cluster membership and age, education, and presence or absence of structural brain damage but were not found for diagnoses of schizophrenia or alcoholism. Schizophrenic and alcoholic patients were found in all clusters in the case of all three test procedures. Differences in clustering among the three test procedures were noted, with the WAIS being relatively more sensitive to educational differences while the Halstead-Reitan was more sensitive to age differences. The clinical utility of classifying patients on the basis of neuropsychological and cognitive test performance was discussed.Acknowledgement is made to the Veterans Administration for support of this research.