Is Gender Identity Disorder in Children a Mental Disorder?

Empirical studies were evaluated to determine whether Gender Identity Disorder (GID) in children meets the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV, American Psychiatric Association, 1994) definitional criteria of mental disorder. Specifically, we examined whether GID in children is associated with (a) present distress; (b) present disability; (c) a significantly increased risk of suffering death, pain, disability, or an important loss of freedom; and if (d) GID represents dysfunction in the individual or is simply deviant behavior or a conflict between the individual and society. The evaluation indicates that children who experience a sense of inappropriateness in the culturally prescribed gender role of their sex but do not experience discomfort with their biological sex should not be considered to have GID. Because of flaws in the DSM-IV definition of mental disorder, and limitations of the current research base, there is insufficient evidence to make any conclusive statement regarding children who experience discomfort with their biological sex. The concluding recommendation is that, given current knowledge, the diagnostic category of GID in children in its current form should not appear in future editions of the DSM.     

Does DSM-IV Asperger's Disorder Exist?

DSM-IV criteria for autistic and Asperger's disorders were applied to 157 children with clinical diagnoses of autism or Asperger's disorder. All children met the DSM-IV criteria for autistic disorder and none met criteria for Asperger's disorder, including those with normal intelligence and absence of early speech delay. The reason for this was that all children had social impairment and restricted and repetitive behavior and interests (required DSM-IV symptoms for both autistic and Asperger's disorders) and all had a DSM-IV communication impairment (which then qualified them for a diagnosis of autistic disorder and not Asperger's disorder). Communication problems exhibited by all children were impaired conversational speech or repetitive, stereotyped, or idiosyncratic speech (or both), which are DSM-IV criteria for autism. These findings are consistent with those of 5 other studies and indicate that a DSM-IV diagnosis of Asperger's disorder is unlikely or impossible.     

Is There Really Mental Disorder?

Proponents of the reality of mental disorder claim that mental disorder is ontologically real in the same sense that the variola virus and smallpox are ontologically real. The chief architect of the DSM-III revolution, Robert Spitzer (Zimmerman & Spitzer, 2005 Zimmerman , M. , & Spitzer , R. , L. ( 2005 ). Psychiatric classification . In B. J. Sadock & V. A. Sadock (Eds.), Comprehensive textbook of psychiatry (pp. 1003 – 1033 ). Philadelphia , PA : Lippincott, Williams, and Wilkins . [Google Scholar]), candidly admits that a diagnosis of primary mental disorder present must be arbitrary because the distress or social impairment under consideration could well be a normal-range reaction to stressful events. Based on Jerome Wakefield's harmful dysfunction thesis, Spitzer hopes that research in evolutionary psychology can solve the perennial “false positive” problem in psychiatric diagnosis. Interestingly, in 1988 Wakefield , J. ( 1988 ). Hermeneutics and empiricism . In S. B. Messer , L. A. Sass & R. L. Woolfolk (Eds.), Hermeneutics and psychological theory (pp. 131 – 150 ). New Brunswick , CT : Rutgers University Press . [Google Scholar] Wakefield argued that the study of meaning (i.e., human behavior and the products of human behavior, such as art and literature) could not be assimilated to empiricism (science), but evidently he subsequently changed his mind. The present paper sides with the 1988 Wakefield , J. ( 1988 ). Hermeneutics and empiricism . In S. B. Messer , L. A. Sass & R. L. Woolfolk (Eds.), Hermeneutics and psychological theory (pp. 131 – 150 ). New Brunswick , CT : Rutgers University Press . [Google Scholar] Wakefield. It is an illusion to hope that research in evolutionary psychology will reveal how people are supposed to react to stressful events and thereby rescue psychiatric diagnosis from the false positive problem. The identification of mental disorder will remain akin to the identification of pornography, i.e., a case of reification based on interpretation and moral reasoning. The fiction that mental disorder is real turns attention away from past and present conditions of living. This may serve some interests, but it is not likely to serve the patient's interests.     

Are DSM-IV-TR Borderline Personality Disorder, ICD-10 Emotionally Unstable Personality Disorder, and CCMD-III Impulsive Personality Disorder Analogous Diagnostic Categories Across Psychiatric Nomenclatures?

This study examined the validity of the borderline construct which encompasses diagnostic criteria from the DSM-IV-TR Borderline Personality Disorder (BPD), ICD-10 Emotionally Unstable Personality Disorder (EUPD), and CCMD-III Impulsive Personality Disorder (IPD) in a sample of 1,419 Chinese psychiatric patients. Participants completed the Chinese Personality Disorder Inventory and the Chinese Personality Assessment Inventory-2 assessing various disordered personality features. Adequate internal consistency was found for the borderline construct (α = .83). Exploratory factor analysis revealed two components: (1) affective and cognitive disturbances, and (2) impulse dysregulation, which were replicated by confirmatory factor analysis. Item analysis indicated that the various borderline criteria displayed similar levels of diagnostic efficiency, which does not support the elimination of fear of abandonment and transient psychotic features from the EUPD and IPD criteria set. Findings of this study suggest that BPD, EUPD, and IPD may represent analogous diagnostic categories across classification systems.     

Influence of Co‐Morbid Generalized Anxiety Disorder,Panic Disorder and Personality Disorders on the Outcome of Cognitive Behavioural Treatment of Obsessive‐Compulsive Disorder

This study examined co‐morbid generalized anxiety disorder and/or panic disorder and personality disorders as predictors of treatment outcomes in adult outpatients with obsessive‐compulsive disorder. The patients received exposure with response prevention (ERP) treatment with the addition of either elements of cognitive therapy (ERP+CT) or relaxation training (ERP+REL). It was hypothesized that the addition of cognitive interventions would yield better treatment outcomes for patients with co‐morbid generalized anxiety disorder and/or panic disorder. It was also hypothesized that patients with any personality disorder would show less treatment gains in both conditions. Using intention‐to‐treat criteria, patients with generalized anxiety disorder and/or panic disorder co‐morbidity showed less treatment gains at post‐treatment across both treatment conditions. This group showed significantly more treatment gains in the ERP+CT condition at the post‐treatment and the 12‐month follow‐up assessments compared with patients in the ERP+REL condition. However, this was not significant when comparing treatment completers. Patients with a co‐morbid Cluster A or B personality disorder showed significantly less treatment gains in both treatment conditions at the 12‐month follow‐up assessment. Among treatment completers, patients with a Cluster C personality disorder showed significantly better outcomes at the post‐treatment assessment in the ERP+REL treatment condition. These results, clinical implications, and the importance of further investigations are discussed.     

Assessment of DSM–5 Personality Disorder

The purpose of this article is to present an approach to defining, identifying, and assessing personality disorders, including the links between these definitions and personality assessment, with a particular reference to the proposed revisions to the personality disorders section of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Routledge.[Crossref] , [Google Scholar]). The article discusses measures of maladaptive variants of the Five-factor model (FFM) that are coordinated with both the traditional personality disorder syndromes as well as the DSM–5 dimensional trait model. Discussed as well is the assessment of the more psychodynamically oriented deficits in sense of self and interpersonal relatedness that are also included within the hybrid model proposed for DSM–5.     

Is 'Normal Grief' a Mental Disorder?

I argue that grief (including 'normal grief') is a mental disorder. I discuss the main concepts involved briefly, and state the prima facie case in favour of the view that grief is a disorder. I consider objections that grief is not a disorder because (a) it is a normal response; (b) it is more healthy than failing to grieve; (c) it involves cognitive good; (d) it is a rational response; (e) it ought not to be medicalized or treated; (f ) it has a 'distinct sustaining cause'. Each objection is flawed, and I conclude that there is a strong case for regarding even 'normal' grief as a disorder. Alternatively, the arguments in this paper may be taken as attacking 'orthodoxrsquo; definitions of mental health (e.g., in DSM 4th edn) by providing an extended discussion of one particular counter-example.     

Can Attention Deficit Hyperactivity Disorder and Fetal Alcohol Spectrum Disorder be differentiated by motor and balance deficits?

There is an ongoing debate regarding the diagnostic overlap between Attention Deficit Hyperactivity Disorder (ADHD) and Fetal Alcohol Spectrum Disorder (FASD). Differential diagnosis is important because of treatment implications. Children aged 7–10 years (47 ADHD, 30 FASD, 39 controls) participated. The Movement Assessment Battery for Children (M-ABC) and the Clinical Observations of Motor and Postural Skills (COMPS) were used. Force plate and electromyography data were collected during static balance and balance perturbation. On the M-ABC both children with ADHD and FASD had more motor problems than controls. The ADHD-Combined and the ADHD-Predominantly Inattentive subgroups were similarly affected in their fine motor skills. On the COMPS, the majority of children in both groups performed in the normal range, but for those children clinically affected, it was the children with ADHD who were more likely to be severely impaired. The children with ADHD were characterized by early onset latencies of the tibialis anterior muscles and increased amplitudes of the gastrocnemius muscles. Difficulty scaling muscle force reflecting medial cerebellar involvement may be the key problem in ADHD. Cerebellar involvement in the postural instability in FASD awaits further study.     

First-Line Treatment for Pediatric Obsessive–Compulsive Disorder

Pediatric obsessive–compulsive disorder (OCD) is a common psychiatric disorder that impairs children’s functioning in home, school, and community settings. Once thought to be an untreatable or treatment refractory disorder, evidence-based treatments now exist for pediatric OCD. Various psychological treatment approaches for pediatric OCD have been investigated and research supports the use of cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) and combined CBT/E/RP with serotonin reuptake inhibitor pharmacotherapy. This paper reviews these approaches and highlights the prominent role of CBT/E/RP as a first-line treatment for pediatric OCD.     

Interpersonal Functioning in Obsessive–Compulsive Personality Disorder

The core symptoms of obsessive–compulsive personality disorder (OCPD) often lead to interpersonal difficulties. However, little research has explored interpersonal functioning in OCPD. This study examined interpersonal problems, interpersonal sensitivities, empathy, and systemizing, the drive to analyze and derive underlying rules for systems, in a sample of 25 OCPD individuals, 25 individuals with comorbid OCPD and obsessive–compulsive disorder (OCD), and 25 healthy controls. We found that OCPD individuals reported hostile-dominant interpersonal problems and sensitivities with warm-dominant behavior by others, whereas OCPD+OCD individuals reported submissive interpersonal problems and sensitivities with warm-submissive behavior by others. Individuals with OCPD, with and without OCD, reported less empathic perspective taking relative to healthy controls. Finally, we found that OCPD males reported a higher drive to analyze and derive rules for systems than OCPD females. Overall, results suggest that there are interpersonal deficits associated with OCPD and the clinical implications of these deficits are discussed.     

Couples’ Negative Interaction Behaviors and Borderline Personality Disorder

Borderline personality disorder (BPD) is a severe mental health problem predisposing to dysfunctional interaction behaviors and negative couple outcomes. This study aimed to assess, through direct observation, the quality of relationships of couples in which women were diagnosed with BPD. The sample consisted of 28 couples in which the woman had BPD, and 82 community couples. Couples’ interactions were coded using three scales—withdrawal/ avoidance, dominance, and criticism/attack/conflict—from the Global Couple Interaction Coding System. Couples in which the women had BPD evidenced significantly more negative behaviors, particularly dominance behaviors, than community couples. Moreover, in BPD couples, women adopted Criticism/Attack/Conflict behaviors more frequently than men.     

A Comparison of Obsessive–Compulsive Personality Disorder Scales

In this study, we utilized a large undergraduate sample (N = 536), oversampled for the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM–IV–TR]; American Psychiatric Association, 2000) obsessive–compulsive personality disorder (OCPD) pathology, to compare 8 self-report measures of OCPD. No prior study has compared more than 3 measures, and the results indicate that the scales had only moderate convergent validity. We also went beyond the existing literature to compare these scales to 2 external reference points: their relationships with a well-established measure of the five-factor model of personality (FFM) and clinicians' ratings of their coverage of the DSM–IV–TR criterion set. When the FFM was used as a point of comparison, the results suggest important differences among the measures with respect to their divergent representation of conscientiousness, neuroticism, and agreeableness. Additionally, an analysis of the construct coverage indicated that the measures also varied in terms of their representation of particular diagnostic criteria. For example, whereas some scales contained items distributed across the diagnostic criteria, others were concentrated more heavily on particular features of the DSM–IV–TR disorder.     

Impact of Tourette’s Disorder on Parent Reported Stress

We examined the relationship between Tourette’s Disorder (TD) and parent reported stress. About 84 parents of children with TD participated by completing questionnaires assessing parental stress, TD symptom severity, co-morbid disorders, services received by the child, and parents’ perception of their child’s academic ability. The results indicate that parent reported stress reached clinically significant levels when a co-morbid disorder was present, but not with a diagnosis of TD alone. Similarly, parents report higher levels of stress when they view their child as performing below other students academically. Finally, the types of services that the child receives were found to have little or no relationship to parent reported stress. Limitations of this study, directions for future research, and implications for intervention are discussed.     

African-American Teenagers’ Stories of Attention Deficit/Hyperactivity Disorder

Cultural differences in illness perceptions and treatment access of teens with attention deficit/hyperactivity disorder (ADHD) are evident yet under studied. The purpose of this qualitative paper is to explore how African-American teenagers describe and narrate stories about their lives with ADHD. Data were gathered from four African-American teens in the Southern United States through a qualitative experience sampling method, and stories were analyzed using narrative analysis framed within the context of African-American rhetorical traditions. We argue that the study of teen-constructed narratives and culturally-situated talk are tools that can improve communication between healthcare providers and teens by illuminating the ways teens construct their personalized realities of ADHD.     

Understanding Obsessive–Compulsive Disorder: Focus on Decision Making

Current approaches to obsessive-compulsive disorder (OCD) have suggested that neurobiological abnormalities play a crucial role in the etiology and course of this psychiatric illness. In particular, a fronto-subcortical circuit, including the orbitofrontal cortex, basal ganglia and thalamus appears to be involved in the expression of OCD symptoms. Neuropsychological studies have also shown that patients with OCD show deficits in cognitive abilities that are strictly linked to the functioning of the frontal lobe and its related fronto-subcortical structures, such as executive functioning deficits and insufficient cognitive-behavioral flexibility. This article focuses on decision making, an executive ability that plays a crucial role in many real-life situations, whereby individuals choose between pursuing strategies of action that involve only immediate reward and others based on long-term reward. Although the role of decision-making deficits in the evolution of OCD requires further research, the collected findings have significant implications for understanding the clinical and behavioral heterogeneity that characterizes individuals with OCD.     

Cultural Dysthymia: An Unrecognized Disorder Among African Americans?

Many African Americans experience low‐grade depression, referred to as dysthymia in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). After more than 250 years of enslavement, prejudice, and discrimination, dysthymia is reflected in chronic low‐grade sadness, anger, hostility, aggression, self‐hatred, hopelessness, and self‐destructive behaviors. To avoid misdiagnosis, counselors need to understand how cultural factors can elicit a collective psychological condition in an oppressed group. Muchos Afroamericanos experimentan depresión leve, llamada distimia en el Diagnostic and Statistical Manual of Mental Disorders (4a ed., texto rev.; American Psychiatric Association, 2000). Después de más de 250 años de esclavitud, prejuicio y discriminación, la distimia se refleja como tristeza crónica leve, ira, hostilidad, agresividad, odio a uno mismo, desesperanza y comportamientos autodestructivos. Para evitar un diagnóstico erróneo, los consejeros deben comprender cómo los factores culturales pueden acarrear una condición psicológica colectiva en un grupo oprimido.     

Hierarchical Structure of Dysfunctional Beliefs in Obsessive‐Compulsive Disorder

The Obsessive Beliefs Questionnaire was developed as a comprehensive measure of dysfunctional beliefs, which cognitive models consider to be etiologically related to obsessive‐compulsive disorder. Obsessive Beliefs Questionnaire subscales tend to be highly correlated, which raises the question of whether obsessive‐compulsive‐related beliefs are hierarchically structured, consisting of lower‐order factors loading on 1 or more higher‐order factors. To investigate the nature and relative importance of these factors, a hierarchical factor analysis was conducted (n = 202 obsessive‐compulsive disorder patients), using a Schmid‐Leiman transformation. Results indicated a higher‐order (general factor) and 3 lower‐order factors: (i) responsibility and overestimation of threat, (ii) perfectionism and intolerance of uncertainty and (iii) importance and control of thoughts. The high‐order factor accounted for more variance in Obsessive Beliefs Questionnaire scores (22%) than did the lower‐order factors (6–7%), thereby underscoring the importance of the higher‐order factor. Despite the importance of the higher‐order factor, the lower‐order factors significantly predicted unique variance in measures of obsessive‐compulsive symptoms, including severity ratings of compulsions. These finding suggest that cognitive models of obsessive‐compulsive disorder should take into consideration the hierarchic structure of obsessive‐compulsive‐related beliefs.     

The “Brightening” Effect: Reactions to Positive Events in the Daily Lives of Individuals With Major Depressive Disorder and Generalized Anxiety Disorder

Depressed individuals are less reactive than healthy individuals to positive stimuli in the laboratory, but accumulating evidence suggests that they are more emotionally reactive to positive events in their daily lives. The present study probed the boundaries of this curious “mood brightening” effect and investigated its specificity to major depressive disorder (MDD) vis-à-vis generalized anxiety disorder (GAD), its closest boundary condition. We used ecological momentary assessment to measure reactions to positive events over one week in individuals with MDD (n = 38), GAD (n = 36), comorbid MDD-GAD (n = 38), and no psychopathology (n = 33). Depressed individuals responded to positive events with larger changes in affect, cognition, reported withdrawal (but not approach) behavior, and symptoms than healthy controls. More severe depression assessed before the sampling week predicted greater brightening. Altered reactivity to positive events was relatively specific to MDD when compared with GAD, similar to patterns found for other positive emotional processes. The robustness, scope, and relative specificity of the brightening effect highlights the need to resolve conflicting findings across laboratory and non-laboratory studies to advance understanding of altered reactivity in emotional disorders.