Issues in diagnosing anxiety disorders

Research progress in the anxiety disorders is predicated on a useful classification system. In this paper, we review the reliability and validity data for theDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III) anxiety disorders and discuss the salient issues associated with both the conceptualization of anxiety disorders and the diagnostic criteria offered in the DSM-III. It is concluded that the diagnostic reliability for these disorders is, overall, satisfactory. A dearth of validity data, however, hinders progress in both the diagnosis and the treatment of the anxiety disorders. Nevertheless, the DSM-III work group has proposed several changes in the diagnostic criteria for the anxiety disorders. We find some of these proposed changes helpful in that they clarify current diagnostic criteria; changes in diagnostic criteria that alter the basic classification schema, however, seem to be premature.Preparation of this paper was supported in part by MIMH Research Grant 1368.On sabbatical leave from Indiana State University.     

Criteria in lay self-judgment of anger control

The basis of judgment by laypersons in the self-evaluation of difficulties with anger control is examined. Responses to a set of 10 specific criteria of anger control problems and a self-rating of degree of problem were obtained on 190 subjects. The criteria and problem ratings were found to have satisfactory testretest reliability. Stepwise multiple regression analysis showed that certain criteria entered more than others into the self-judgments of anger control problems. Exploratory factor analysis produced three factors, interpreted as Personal Difficulties with Anger, Aggression, and Hostility, which replicated some of the previous research. Implications of the findings for a social constructivist view of self-judgment of anger and aggression and the development of self-report instruments are discussed. Additional studies with other samples are suggested.     

Confirmatory factor analyses of DSM-IV Cluster C personality disorder criteria

Notwithstanding its research and clinical relevance, the dimensionality and validity of the DSM-IV avoidant, dependent, and obsessive-compulsive personality disorders (PDs) criteria is still a largely unexplored topic. The aim of this study was to test the factor structure for DSM-IV Cluster C PD criteria in a sample of 641 consecutively admitted outpatients. Factor analysis results suggested that avoidant, dependent, and obsessive-compulsive PDs share a common latent dimension, and supported the three-factor structure of both observer and self-report ratings of DSM-IV Cluster C PD criteria. The pattern of factor loadings, however, was different from the one expected according to the DSM-IV classification.     

Muscle dysmorphia: Current research and potential classification as a disorder

ObjectiveTo review the literature for scientific evidence in support of inclusion of Muscle Dysmorphia (MD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).DesignThe criteria proposed by Blashfield, Sprock, and Fuller (1990) were used for determining whether scientific evidence supports the introduction of MD as a new disorder into a disease classification system.MethodPeer-reviewed journal articles were identified by searching databases for articles published (in print and electronically) from 2001 to 2011.ResultsThe search identified 59 journal articles that specifically focused on MD, of which 39 were empirical journal articles. There is ample literature on MD, including a common set of diagnostic criteria and assessment instruments to measure MD. However, questions remain about the diagnostic reliability and validity, including inter-rater reliability, and whether MD represents a disorder that consists of symptoms that frequently co-occur. Also, evidence of syndrome differentiation is lacking. Only two of the five criteria proposed by Blashfield et al. have been met.ConclusionLiterature suggests that MD is associated with several indicators of clinical significance and distinctiveness. However the current review has found significant limitations and gaps in the scientific literature on MD. Possible options regarding the status of MD in the DSM-5 are proposed, including introducing MD as an example of an eating disorder not otherwise specified, retaining MD as a body dysmorphic disorder, introducing MD as a new disorder, or introducing MD as a provisional diagnosis in need of further study.     

Psycho-educational evaluations for university students in one clinic

The number of university students requesting services based on the Americans with Disabilities Act for learning disabilities and ADHD-related difficulties has increased, although there are limited reports in the literature describing these evaluations. The current study describes a sample of 140 individuals (59% women) who presented for psycho-educational evaluation at the university psychology clinic. The students were individually administered self-report, cognitive, academic, and attention measures as indicated, and diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Difficulties with mathematics, attention, and reading concerns were the most frequent presenting complaints. 46 students met criteria for one or more learning disorders and 20 students met criteria for a diagnosis of ADHD. Test scores are summarized and findings compared with the literature.     

Reliability and standardization in the assessment of self-reported headache pain

The efficacy of a treatment intervention for head pain is typically evaluated by self-reported data. Self-monitoring schedules used to collect these data vary extensively across studies. The present article reviews conceptual and methodological problems with these self-report inventories. In addition, the most promising procedure was implemented in a study designed to measure the reliability of self-reported headache pain levels. One-hundred twenty-four college students self-monitored headache pain over an 8-week period. Three objective procedures were used to detect inaccurate recording. Subjects were also asked, in a post-experimental questionnaire, to subjectively rate the degree to which they complied with the experimenters' instructions regarding the self-monitoring procedures. Forty percent of the subjects were found to be noncompliant based on the detection techniques. However, responses to the postexperimental questionnaire indicated this to be a conservative estimation of noncompliance. There was no consistent difference between the postexperimental questionnaire for the subjects detected and those not detected. Results are discussed with relation to the need for researchers to adopt a standard methodology for (1) measuring self-reported headache pain and (2) reporting reliability data.Portions of these data were presented at the meeting of the Association for Advancement of Behavior Therapy, Chicago, November 1978.     

Personality disorder not otherwise specified: searching for an empirically based diagnostic threshold

The purpose of this paper is to propose a method for empirically investigating diagnostic criteria for personality disorder not otherwise specified (PDNOS). From a large, nonclinical sample of military recruits and undergraduate students who were screened for personality disorders (PDs), 572 completed the Structured Interview for DSM-IV Personality. Data from the interviewed group were used to identify a diagnostic threshold for PDNOS by comparing those who did (n = 88) and did not (n = 484) qualify for a PD diagnosis. For both groups, subjective distress increased and measures of social and occupational functioning decreased as a function of the number of PD criteria met. A classification and regression tree modeling procedure was applied using self-report scores on measures of mood, anxiety, and personality traits to arrive at probabilities for predicting the presence of a PD diagnosis based on the pattern of reported traits present. These probabilities were then used to derive an empirically based diagnostic threshold for PDNOS. In this sample, the most appropriate threshold for a PDNOS diagnosis appears to be the presence of 10 PD criteria for a person who does not qualify for a diagnosis of any other specific form of PD. This definition identified 5.5% of the young adults who were interviewed in this study.     

Evaluation of empirical methods and methodological foundations of human left-handedness

The methodological and empirical foundations underlying the theories on human left-handedness are examined, including the definition and classification of left-handedness, its relation to pathology, and the results on family, adoption, and twin research. It is argued that major research findings on left-handedness are based on inadequate empirical methods, and the concrete definitions and assessment procedures do not meet validity and reliability criteria. This also casts doubt on the relationship between left-handedness and pathology reported in the literature. Furthermore, findings from family, adoption, and twin studies do not allow interpretation of possible direct genetic contributions to explaining left-handedness. It is concluded that the methodological limitations of a causal explanation should encourage an examination of the epistemological and methodological premises of theory formulation. The functional method and a theoretical framework based on early childhood experiences and the neural plasticity of the brain may be more appropriate for the selection of empirical methods in research of human left-handedness.     

INTEGRITY TESTING FOR PERSONNEL SELECTION: AN UPDATE

Sackett and M. M. Harris (1984) reviewed published and unpublished literature on the use of commercially available paper-and-pencil integrity tests for employee selection. This paper reviews recent developments in this area. Legal issues related to the use of the polygraph, and integrity tests are discussed. Empirical research on the reliability, criterion-related validity, construct validity, fakability, and adverse impact of integrity tests is reviewed. Major changes since the previous review include (1) the emergence of two distinct types of tests, labeled overt integrity tests and personality-oriented measures, (2) a broadening of the criteria used for test validation to include global performance, absence, turnover, and forms of counterproductivity other than theft, and (3) an increase in the use of external criteria (e.g., detected theft, turnover) rather than self-report criteria (e.g., admissions of theft) in validation research. Difficulties in interpreting research findings and practical constraints on the use of integrity tests are discussed.     

Borderline and schizotypal personality disorders: mutually exclusive or overlapping?

This article is concerned with one aspect of the validity of DSM-III Axis II diagnoses, namely, the discriminability of borderline and schizotypal disorders. Forty-nine patients diagnosed by DSM-III criteria as borderline, schizotypal, or "mixed" personality disorders completed the Borderline Syndrome Index (BSI), an independent self-report 52-item instrument that has been shown to be reliable and to have discriminative validity. A one-way analysis of variance and a discriminant function analysis were conducted. Our major finding was that there were no significant differences among the groups on the BSI self-report test, although there were differences on clinical grounds. We discuss this in terms of "fuzzy set" theory and prototypic systems of classification.     

Empathic Insights From the Rorschach: Paul Lerner's Legacy

This article is concerned with one aspect of the validity of DSM-III Axis II diagnoses, namely, the discriminability of borderline and schizotypal disorders. Forty-nine patients diagnosed by DSM-III criteria as borderline, schizotypal, or "mixed" personality disorders completed the Borderline Syndrome Index (BSI), an independent self-report 52-item instrument that has been shown to be reliable and to have discriminative validity. A one-way analysis of variance and a discriminant function analysis were conducted. Our major finding was that there were no significant differences among the groups on the BSI self-report test, although there were differences on clinical grounds. We discuss this in terms of "fuzzy set" theory and prototypic systems of classification.     

The construct validity of burnout

Considerable confusion exists in the burnout literature about the similarities and separateness among the constructs of burnout, depression and job satisfaction. This study examined the construct validity of burnout using Campbell & Fiske's multitrait-multimethod approach. The constructs of burnout, depression and orderliness (chosen as a discriminant construct) were assessed by three types of self-report instruments. Data were analysed for 181 females and 139 male faculty members who spent at least 50 per cent of their time in teaching. Results indicated that measures of burnout largely met Campbell & Fiske's criteria for construct validity: burnout measures possessed adequate to good internal reliability and convergent validity. However, burnout measures also correlated substantially with measures of depression. Results are discussed in terms of possible explanations for the substantial overlap that has been demonstrated among measures of burnout, depression and job satisfaction.     

Reliability and validity of the Coolidge Axis II Inventory: a new inventory for the assessment of personality disorders.

This group of studies describes the development of a 200 item, self-report, 4-point true-false inventory (Coolidge Axis II Inventory [CATI]) to assess personality disorders according to the criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987). The 13 personality disorder scales of the CATI had a mean test-retest reliability of .90 and a median internal consistency (Cronbach's alpha) of .76. There was a 50% concordance rate with clinician's diagnosis for 24 personality disordered patients. The median concurrent validity (raw score sums) between the CATI and the Millon Clinical Multiaxial Inventory-II for the 13 personality disorder scales was .58. Preliminary studies also support the reliability and validity of Depression, Anxiety, and Brain Dysfunction scales.     

Diagnosis and clinical management of headaches

In this article, we will first present an overview of the epidemiology and classification of headaches, distinguishing between primary headaches (in which the headache itself is the primary disorder) and secondary headaches (ie, headaches due to an underlying condition, such as a neoplastic and/or space-occupying lesion, a cerebrovascular accident, or other type of structural brain lesion). We will use the current classification system of the International Headache Society, focusing on primary headache disorders (migraine, tension-type headache, cluster headache), which we will discuss from the practical clinical perspectives of diagnosis and clinical management. Throughout this article, we will emphasize the chronicity and periodicity of headaches as a type of chronic pain syndrome.     

Diagnosing agoraphobia in the context of panic disorder: examining the effect of DSM-IV criteria on diagnostic decision-making

A diagnostic and statistical manual (DSM)-IV diagnosis of agoraphobia in the context of panic disorder (PD) is based on three nosologically sufficient criteria: (1) avoidance, (2) use of companions, and (3) endurance of situations despite distress. Therefore, an agoraphobia diagnosis can be made across an extremely broad range of cases including when there are no avoidance behaviors (e.g., the patient endures the situation). It was hypothesized that clinicians do not weight these criteria equally and that the DSMs individual, sufficient criteria lead to poor inter-rater reliability. Clinicians (N=48) rated hypothetical patients with symptom profiles emphasizing each of these three criteria. Consistent with expectation, clinicians differentially weighted these criteria. Avoidance was relatively more apt to produce a diagnosis when only one criterion was emphasized in clinical vignettes. Inter-rater reliability was poor in instances when only one sufficient criterion was highlighted. Knowledge concerning DSM criteria resulted in a greater rate of agoraphobia endorsement, but knowledge did not account for the overall pattern of findings.     

The impact of wording effect on reliability and validity of the Core Self-Evaluation Scale (CSES): A bi-factor perspective

“Wording effect” refers to the systematic method variance caused by positive and negative item wordings on a self-report measure. Using the Core Self-Evaluation Scale (CSES) as an example, this study modeled the wording effect, and examined the impact of such wording effect on the reliability and validity of CSES. Five competing models were compared, and the findings suggested that the bi-factor model with a negative group factor best represented the CSES structure. The impact of wording effect on the reliability and validity of CSES was investigated, and the results showed that such impact existed and was non-negligible. Failure to model the wording effect would lead to biased estimates of the reliability and criterion-related validity of CSES. Limitations of the study are discussed, and considerations for future research directions are suggested.     

A comparison of interview and self-report methods for the assessment of borderline personality disorder criteria

Interview methods are widely regarded as the standard for the diagnosis of borderline personality disorder (BPD), whereas self-report methods are considered a time-efficient alternative. However, the relative validity of these methods has not been sufficiently tested. The current study used data from the Collaborative Longitudinal Personality disorder Study to compare diagnostic base rates and the relative validity of interview and self-report methods for assessing functional outcome in BPD. Although self-report yielded higher base rates of criteria endorsement, results did not support the common assumption that diagnostic interviews are more valid than self-reports, but instead indicated the combined use of these methods optimally identifies BPD criteria.     

Sample size requirements for the design of reliability studies: precision consideration

In multilevel modeling, the intraclass correlation coefficient based on the one-way random-effects model is routinely employed to measure the reliability or degree of resemblance among group members. To facilitate the advocated practice of reporting confidence intervals in future reliability studies, this article presents exact sample size procedures for precise interval estimation of the intraclass correlation coefficient under various allocation and cost structures. Although the suggested approaches do not admit explicit sample size formulas and require special algorithms for carrying out iterative computations, they are more accurate than the closed-form formulas constructed from large-sample approximations with respect to the expected width and assurance probability criteria. This investigation notes the deficiency of existing methods and expands the sample size methodology for the design of reliability studies that have not previously been discussed in the literature.     

Bootstrap区间估计在认知诊断模型误设中的应用

认知诊断模型选择是认知诊断评估中重要研究问题之一。在实际应用中实践者并不知道真正拟合数据的模型,通常会用模型拟合指标检验模型与数据的拟合程度。从测量结果质量来看,除保证模型与数据拟合之外,还需要重点评价模型诊断结果的信度和效度等。考虑到以往研究大都采用基于信息量的拟合指标去判定模型与数据的匹配性,本研究提出综合考虑模型拟合指标与信度指标用于模型选择或评价模型误设。考虑实验因素为真实模型或分析模型（DINA模型、G-DINA模型、R-RUM模型）、样本量、题量和属性个数,在五因素（3×3×2×2×2）实验设计条件下,比较Bootstrap区间估计的属性分类一致性信度平均数与标准误和常用的拟合统计量-2LL、AIC、BIC对正确模型的选择率。结果表明：-2LL在题目数量多的情况下表现较好,而AIC、BIC在被试量较大的情况下表现较好,在不同的研究条件下,-2LL、AIC、BIC的模型选择率很不稳定,而用Bootstrap法估计的属性分类一致性信度平均数和标准误在不同研究条件的模型选择率较稳定,总体表现较好。