Psychologists' perspectives on the diagnostic classification of mental disorders: Results from the WHO‐IUPsyS Global Survey

This study examined psychologists' views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD‐11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD‐10 used most frequently by 51% and DSM‐IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD‐11 development and dissemination are discussed.     

A case-controlled field study evaluating ICD-11 proposals for relational problems and intimate partner violence

Background/Objective: Intimate partner relationship problems and intimate partner abuse and neglect — referred to in this paper as “relational problems and maltreatment” — have substantial and well-documented impact on both physical and mental health. However, classification guidelines, such as those found in the International Classification of Diseases (ICD-10), are vague and unlikely to support consistent application. Revised guidelines proposed for ICD-11 are much more operationalized. We used standardized clinical vignette conditions with an international panel of clinicians to test if ICD-11 changes resulted in improved classification accuracy. Method: English-speaking mental health professionals (N = 738) from 65 nations applied ICD-10 or ICD-11 (proposed) guidelines with experimentally manipulated case presentations of presence or absence of (a) individual mental health diagnoses and (b) relational problems or maltreatment. Results: ICD-11, compared with ICD-10, guidelines resulted in significantly better classification accuracy, although only in the presence of co-morbid mental health problems. Clinician factors (e. g., gender, language, world region) largely did not impact classification performance. Conclusions: Despite being considerably more explicated, raters’ performance with ICD-11 guidelines reveals training issues that should be addressed prior to the release of ICD-11 in 2018 (e. g., overriding the guidelines with pre-existing archetypes for relationship problems and physical and psychological abuse).     

No more psychiatric labels: Why formal psychiatric diagnostic systems should be abolished

This article argues that psychiatric diagnoses are not valid or useful. The use of psychiatric diagnosis increases stigma, does not aid treatment decisions, is associated with worsening long-term prognosis for mental health problems, and imposes Western beliefs about mental distress on other cultures. This article reviews the evidence base focusing in particular on empirical findings in relation to the topics of: aetiology, validity, reliability, treatment and outcome, prognosis, colonialism, and cultural and public policy impact. This evidence points toward diagnostic based frameworks for understanding and intervening in mental health difficulties being unable to either improve our scientific knowledge or improve outcomes in clinical practice and suggests that we need to move away from reliance on diagnostic based approaches for organising research and service delivery. Alternative evidence-based models for organising effective mental health care are available. Therefore formal psychiatric diagnostic systems such as the mental health section of the International Classification of Diseases Tenth Edition (ICD-10) and Diagnostic Statistical Manual Fifth Edition (DSM 5) should be abolished.     

Posttraumatische Belastungsstörung

There are some problems concerning the concepts of trauma-related disorders and especially the category of posttraumatic stress disorder (PTSD) with respect to classification, diagnosis and epidemiological findings, which can only be understood within the historical framework of the development. Even current diagnostic systems, such as the diagnostic and statistical manual of mental disorders version 4 (DSM-IV) and the international classification of diseases version 10 (ICD-10) differ in the classification of these disorders which led to higher prevalence rates being achieved with ICD-10. The diagnostic algorithms have been opened to included subsyndromal PTSD as well as complex PTSD including more severe psychiatric disorders.     

Evaluation Study of Lawyers' Satisfaction with Expert Witness Reports

This study attempted to evaluate the satisfaction of personal injury lawyers with expert witness reports from psychologists and psychiatrists. A questionnaire was sent to 514 civil litigation lawyers and 79 (15.4%) were completed. It was found that most lawyers were satisfied with reports and that there was no difference between the standard and quality of expert reports of psychologists and psychiatrists. Criticisms were limited and focussed on the cost, length and lack of clarity of some of the reports. These criticisms are discussed within the context of the reforms within the legal aid system and it is concluded that expert reports are perceived by lawyers as being reasonably good value for money.     

Biological explanations and stigmatizing attitudes: using essentialism and perceived dangerousness to predict antistigma intervention effectiveness

The theory of essentialism suggests that biological explanations of stigmatized behavior may not be effective at decreasing stigmatizing attitudes. The effects of biological explanations on stigmatizing attitudes were the topic of two experiments. In the first experiment, participants (N = 243) perceived a biological explanation as a less effective in relation to dangerousness and social distancing attitudes about mental illness than about homosexuality. The second experiment (N = 113) compared the effect of biological and free choice explanations on stigmatizing attitudes about abnormal sexual and eating behaviors. The results indicated that a biological explanation increased belief in essentialism and was most effective for attitudes related to anger and blame. These results suggest that the effectiveness of biological explanations as an antistigma tool varies according to the attitude and stigmatized group.     

An experimental analysis of the civil commitment recommendations of psychologists and psychiatrists

Legal and nonlegal factors influencing the civil commitment recommendations of psychologists and psychiatrists separately and as a whole were investigated using an experimental design. One hundred and seventy-six psychologists and psychiatrists made recommendations for or against commitment for a series of clinical vignettes wherein the five facets of commitment criterion, legal committability, clinical treatability, alternative resources and presence of psychosis were systematically varied. Results revealed that all facets contributed independently and in combination to the commitment decisions of participants as a whole. It was concluded that mental health professionals may utilize a variety of types of information, beyond the relevant legal criteria, in making actual decisions to initiate civil commitments.     

The psychiatric inpatient treatment of children and youth in general hospitals

National attention has recently focused on the mental health needs and services of children and youth. The lack of outpatient services and their coordination has been noted, as well as the consequent press towards inpatient care. We describe the inpatient treatment of children and adolescents (ages 0-18) in short-term, non-Federal general hospitals in 1980. Nationally, 128,300 children were treated for mental disorders in general hospitals at an estimated cost of over $1.5 billion. Compared to adults, children were more likely to be treated in scatter beds (vs. specialty units); have a diagnosis of mental disorder (vs. alcohol/drug disorder); stay much longer; and pay with commercial insurance. Previous work focusing on psychiatric units of general hospitals identified less than 40% of the total episodes, a figure very similar to that for adults. The majority of psychiatric inpatient episodes for children and youth in the United States takes place in short-term general hospitals. Community psychologists need to be aware of national trends in inpatient care and be involved in the development and promulgation of alternative models of care.     

Psychotherapeuten und ihre psychischen Probleme

A cliché about psychotherapists, psychologists and psychiatrists is that they themselves apparently all have mental problems. This review article analyzes the state of research on the topic based on a databank search in PubMed using the terms “(mental disorders OR suicide) AND (psychologists OR psychiatrists OR therapists OR psychoanalysts)” and an analysis of relevant review articles. In the databank search only ten publications were identified which related to any mental problems of therapists. These partially confirmed an increased risk of suicide, increased mental problems, such as depression, increased burnout risk and increased problems in childhood (e.g. sexual abuse and parentification) and showed that research deficits clearly exist. With respect to coping with such risks, the topics training therapy, personal therapy, self-care, and additional opportunities are discussed. In conclusion the implications for research and practice are discussed.     

Biological Explanations and Stigmatizing Attitudes: Using Essentialism and Perceived Dangerousness to Predict Antistigma Intervention Effectiveness

ABSTRACT

The theory of essentialism suggests that biological explanations of stigmatized behavior may not be effective at decreasing stigmatizing attitudes. The effects of biological explanations on stigmatizing attitudes were the topic of two experiments. In the first experiment, participants (N = 243) perceived a biological explanation as a less effective in relation to dangerousness and social distancing attitudes about mental illness than about homosexuality. The second experiment (N = 113) compared the effect of biological and free choice explanations on stigmatizing attitudes about abnormal sexual and eating behaviors. The results indicated that a biological explanation increased belief in essentialism and was most effective for attitudes related to anger and blame. These results suggest that the effectiveness of biological explanations as an antistigma tool varies according to the attitude and stigmatized group.     

The Impact of Films on Viewer Attitudes towards People with Schizophrenia

The media, including television, newspapers, and popular films have been implicated in the facilitation of mental illness stigmatization by presenting negative and inaccurate depictions of various diagnoses. The current study examined the impact of film on participants’ knowledge, attitudes, and behaviors towards people with schizophrenia. A total of 106 participants completed questionnaires before and after viewing a 45-min film excerpt. Films viewed included a fear-based inaccurate, likeable-inaccurate, and an educational-accurate depiction of schizophrenia. There was also a control group. There were significant increases in stigmatizing attitudes for participants in the fear-based inaccurate group compared to the accurate and control group. Fear-based participants reported increased negative affect and endorsed statements suggesting that people with schizophrenia were unpredictable, dependent, and dangerous. These results provide support for the hypothesis that negative, inaccurate portrayals of severe mental illness enhance stigmatizing attitudes. Accurate film depictions, advocacy for social equality, and the continued education of individuals, clients, families, communities and organizations will help to mitigate the impact of films on mental illness stigmatization.     

A demonstration of undergraduate students' first impressions and their ratings of pathology

An interactive team exercise based in the dual topic areas of social and abnormal psychology is described that employs videotaped case studies to sensitize students to the processes by which they form first impressions of other people, and to various issues regarding assessments of mental disorders. Each of three case studies is presented in two parts: Part I simulates a "first impression" condition--involving students' ratings of perceived pathology--by briefly showing only a patient (no soundtrack present), and Part 2 constitutes a "further disclosure" condition by giving more exposure-involving therapists' diagnoses and assessments-of the same patient with both sight and soundtrack presented. Data are reported from 12 introductory psychology classes in which students (N=367) rated the three patients on psychopathology as perceived severity of disorder as compared to the actual assessments (also contained on the videotapes) made by clinical psychologists and psychiatrists. The demonstration is useful in eliciting consistent and predictable first impressions from students, in stimulating classroom discussion about the value and accuracy of person perceptions and first impressions, and in alerting students to problems related to the identification of mental disorders.     

Multicultural Education and Perceived Multicultural Competency of School Counselors

A national survey of practicing school counselors (N = 755) revealed significant differences between participants’ perceived multicultural competence based on the type of multicultural training received. Participants who took infused multicultural coursework had significantly higher mean scores in multicultural awareness, knowledge, and skills than participants who reported taking a single multicultural course. Una encuesta nacional de consejeros escolares en activo (N = 755) reveló diferencias significativas en la competencia multicultural percibida de los participantes según el tipo de capacitación multicultural recibida. Los participantes que tomaron cursos que incluían contenidos multiculturales obtuvieron puntajes medios significativamente más altos en consciencia, conocimientos y habilidades multiculturales que aquellos participantes que indicaron haber tomado un único curso multicultural.     

Psychiatric Diagnosis as a Function of Assessor Profession and Sex

Diagnostic impressions formed by 26 clinicians after intake interviews with 200 randomly assigned outpatients at a community mental health center were analyzed by assessor discipline and sex and by patient sex and age level. Professional status was positively related to diagnostic severity among male assessors—nurses, social workers, psychologists, and psychiatrists made increasingly higher proportions of psychotic diagnoses. Female therapists were less likely than their male counterparts to render psychotic diagnoses. This finding was most robust for doctoral interviewers, especially psychologists, and for patients who were female or under 30. Results are discussed in relation to the need for a model of the diagnostic process that allows for the role of practitioner attributes. Previous largely negative findings may have had their source in the failure of contrived analogue procedures to evoke emotions in the rater comparable in intensity to those aroused in the real-life encounter.     

Systemic Family Therapy Competences in Child and Adolescent Mental Health Care

This article is based on a doctoral research project aiming to identify a comprehensive and detailed outline of the systemic therapist competences in child and adolescent mental health care in Norway. Because of the growing demands to offer specialized services within child and adolescent mental health care, I intended the identified competences to target the psychosocial difficulties that are categorized as associated abnormal psychosocial situations (axis 5) in the multiaxial diagnostic system (WHO, Multiaxial classification of child and adolescent psychiatric disorders. The ICD-10 classification of mental and behavioural disorders in children and adolescents. Cambridge University Press, Cambridge, 1996). The project is based on twelve qualitative in-depth interviews with six experienced systemic family therapists, and fieldwork observations of the therapists (participants) in practice. The qualitative methodology is based on Grounded Theory and five overarching categories were identified through the analysis: (1): the importance of ethical and contextual awareness in systemic therapy; (2) the systemic therapist’s stance; (3) therapeutic processes; (4) therapeutic practices; and (5) session-specific features. Challenges, such as limiting the systemic approach to five overarching competences, are discussed alongside this strengths and limitations of the study. The detailed outline of systemic therapist competences is intended to offer a framework for delivering flexible, yet specialized systemic therapy in the context of child and adolescent mental health care. This research may therefore facilitate a “bridge-building process” between mental health’s biomedical focus and postmodern systemic ideas.     

The triumph of American psychiatry: How it created the modern therapeutic state

Over the past 170 years, American psychiatry has progressively asserted its authority over a larger segment of the American population. From the mid-1800s to the end of World War II, psychiatry had authority over the asylum population, which markedly increased in the first half of the twentieth century due to the influence of eugenics, an ideology that argued the ‘mentally ill’ had to be segregated from society. After the war, American psychiatry adopted Freudian conceptions of mental disorders, which enabled it to begin treating people in the community who were ‘neurotic’ in some way, which dramatically expanded its influence in society. Then, in the 1970s, when many in American society were questioning psychiatry’s legitimacy as a branch of medicine, the American Psychiatric Association (APA) responded by adopting a disease model for diagnosing mental disorders, which it set forth in the third edition of its Diagnostic and Statistical Manual. There were no scientific discoveries that led to this new model, but soon the APA was informing the American public that mental disorders were diseases of the brain, and that psychiatric drugs helped fix those diseases, ‘like insulin for diabetes.’ The APA, in concert with pharmaceutical companies, has successfully exported this belief system to much of the developed world. In order to break free of this ‘therapeutic state,’ the public needs to understand the history of how it came to be, and see the social injury it has caused.     

The public's perception of psychotherapy and counseling: Differential views on the effectiveness of psychologists,psychiatrists, and other providers

This study examined the public's perceptions relative to the effectiveness of psychotherapy and counseling, expectations of treatment efficacy for different psychotherapy and counseling providers (i.e., clinical psychologists, counseling psychologists, counselors, general medical practitioners, marital and family therapists, psychiatrists, self-help groups, and social workers), professional characteristics, and factors that may influence treatment utilization in an adult population. The sample viewed psychotherapy or counseling as moderately effective and perceived psychotherapy/counseling to be effective for 26 to 50 percent of all cases. The perceived amount of time necessary for noticeable improvement in psychotherapy or counseling was approximately four months, and the expected necessary length of treatment was approximately eight months. Participants stated they were moderately willing to seek psychotherapy or counseling if they were to experience a mental problem, and reported discernible differences among the eight psychotherapy/counseling providers in terms of treatment efficacy. Differences were also found in the relative perception of providers' personal/professional qualities and characteristics.     

Prevalence and correlates of ICD-11 adjustment disorder: Findings from the Zurich Adjustment Disorder Study

Background/Objective: The 11th revision of the International Classification of Diseases (ICD-11) will provide a new definition of adjustment disorder (AjD). The aim of the present study is to report on prevalence and correlates of ICD-11 AjD in a high-risk sample. Method: Three hundred thirty persons who had lost their job involuntarily were sampled by local job centres. The Munich Composite International Diagnostic Interview was administered with a new AjD module. Associations between AjD and correlates were investigated with logistic regression analyses. Results: 27.3% of the participants reported the AjD core symptom pattern. 13.8% men and 17.2% women met diagnostic guidelines of ICD-11 AjD. Prevalence increased with age and exposure to multiple stressors. The AjD core symptom pattern was associated with various sociodemographic correlates (e. g., lower financial household budget), whereas the full ICD-11 diagnosis including the exclusion algorithm was not. Regarding work-related factors, AjD occurred with a lower probability if the last job position had higher responsibilities and more general confidence for the future. Conclusions: ICD-11 AjD has a high prevalence among persons who lost their jobs involuntarily. Healthcare professionals should be aware of this problem. Research to investigate the ICD-11 AjD concept in the general populations and other subpopulations is needed.