Validity of the distinction between generalized social phobia and avoidant personality disorder.

Disorders of pervasive social anxiety and inhibition are divided into 2 categories, generalized social phobia (GSP) and avoidant personality disorder (APD). We explored the discriminative validity of this categorization by examining the comorbidity of GSP and APD and by comparing these groups on anxiety level, social skills, dysfunctional cognitions, impairment in functioning, and presence of concurrent disorders. Results from 23 subjects showed high comorbidity of the 2 diagnoses: All subjects who met criteria for APD also met criteria for GSP. APD was associated with greater social anxiety, impairment in functioning, and comorbidity with other psychopathology, but no differences in social skills or performance on an impromptu speech. GSP and APD seem to represent quantitatively different variants of the same spectrum of psychopathology rather than qualitatively distinct disorders. We also investigated a proposed social phobia subtyping scheme.     

Diagnostic issues in posttraumatic stress disorder: considerations for the DSM-IV

Four issues of key interest with regard to posttraumatic stress disorder in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are discussed. These include: (a) how to define the stressor criterion, especially, whether or not the victim's response ought to be included and whether low-magnitude traumas qualify etiologically; (b) the cohesiveness of the syndrome and the validity of items across stressor groups; (c) the position of posttraumatic stress disorder within DSM-IV; and (d) comorbidity with other illnesses.     

Commentary on Meehl

The classic article by Meehl (1978) raises fundamental issues regarding the viability of theorizing in the “soft” psychological sciences and the weakness of statistical significance testing in appraising the validity of the field’s theories. These concerns are as valid today as they were a quarter of a century ago. Despite the lack of clear progress that has been made in terms of theory building, I raise several examples from developmental psychopathology research that reveal progress in the field’s conceptual and methodologic rigor, including the testing of genotype by environment interactions, the statistical advances driving longitudinal research, and the use of intervention and prevention trials to address questions of etiology and mechanisms related to psychopathology.     

The subjective–agentic personality sector (SAPS): Introduction to the special issue on self,identity, and psychopathology

This special issue is predicated upon the premise that there exists a subjective–agentic personality sector (SAPS) that is crucially relevant to the understanding and treatment of psychopathology. SAPS is often overlooked by “trait” models in personality psychology. It is comprised of “hot” cognitions about one's self and identity as they unfold throughout the life span and are brought to bear on interpersonal relationships. There are four ways in which SAPS may be involved in psychopathology: (a) inherently, as a component of psychiatric disorders, (b) as a passive vulnerability dimension, namely by interacting with life stress, (c) as an active vulnerability dimension, that is, by propelling external situations that culminate in psychopathology, and (d) by constituting a central consequent of psychopathology (i.e., the scarring pattern, see below). In this Journal of Personality special issue, experts in personality and psychopathology demonstrate the centrality of SAPS in unipolar depression, anxiety disorders, bipolar spectrum disorder, eating disorders, posttraumatic stress disorder, complex trauma and borderline personality disorder, social anxiety disorder, suicidality in the context of mood disorders, and recovery from schizophrenia. A commentary by Dan McAdams, a leader in the study of self and identity, concludes this special issue.     

Understanding general and specific connections between psychopathology and marital distress: a model based approach

Marital distress is linked to many types of mental disorders; however, no study to date has examined this link in the context of empirically based hierarchical models of psychopathology. There may be general associations between low levels of marital quality and broad groups of comorbid psychiatric disorders as well as links between marital adjustment and specific types of mental disorders. The authors examined this issue in a sample (N = 929 couples) of currently married couples from the Minnesota Twin Family Study who completed self-report measures of relationship adjustment and were also assessed for common mental disorders. Structural equation modeling indicated that (a) higher standing on latent factors of internalizing (INT) and externalizing (EXT) psychopathology was associated with lower standing on latent factors of general marital adjustment for both husbands and wives, (b) the magnitude of these effects was similar across husbands and wives, and (c) there were no residual associations between any specific mental disorder and overall relationship adjustment after controlling for the INT and EXT factors. These findings point to the utility of hierarchical models in understanding psychopathology and its correlates. Much of the link between mental disorder and marital distress operated at the level of broad spectrums of psychopathological variation (i.e., higher levels of marital distress were associated with disorder comorbidity), suggesting that the temperamental core of these spectrums contributes not only to symptoms of mental illness but to the behaviors that lead to impaired marital quality in adulthood.     

Substance-related disorders among juvenile offenders: what role do psychopathic traits play?

Substance use disorders are associated with psychopathy, a personality disorder that is heterogeneous in both adults and youth; secondary variants of psychopathy with comorbid psychopathology and primary variants without comorbidity show distinct correlates and outcomes. In adult criminal populations, secondary variants report greater substance abuse compared with primary variants. The primary aim of this study is to replicate and extend these findings to a juvenile offender population. Compared with primary variants of juvenile psychopathy, secondary variants (a) reported significantly more frequent substance use--particularly alcohol--within the 6 months prior to incarceration (d = .43), (b) were almost twice as likely to abuse substances while incarcerated, and (c) were more likely to be diagnosed with a current Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV; American Psychiatric Association, 2000) substance use disorder. Practical implications for working with justice-involved youth are discussed.     

Neuropsychological correlates of psychopathology in an unselected cohort of young adolescents

Members of a birth cohort were assessed for psychopathology and neuropsychological dysfunction at age 13. Ss who met DSM-III criteria for a single disorder, multiple disorders, and no disorder were compared on 5 composite neuropsychological measures. The multiple disorders group performed significantly worse than did the nondisordered group on the Verbal, Visuospatial, Verbal Memory, and Visual-Motor Integration factors. They also showed the highest rate of neuropsychological impairment. The attention-deficit disorder group performed significantly worse than did the nondisordered group on the Verbal Memory and Visual-Motor Integration factors, and the anxiety disorder group performed significantly worse than did the nondisordered group on the Visual-Motor Integration factor. Results suggest that neuropsychological dysfunction is more often associated with multiple rather than single, psychiatric disorders in adolescents. The problem of comorbidity in studies of neuropsychological function in childhood and adolescent psychopathology is highlighted.     

Effects of head orientation on gaze perception: how positive congruency effects can be reversed

Several past studies have considered how perceived head orientation may be combined with perceived gaze direction in judging where someone else is attending. In three experiments we tested the impact of different sources of information by examining the role of head orientation in gaze-direction judgements when presenting: (a) the whole face; (b) the face with the nose masked; (c) just the eye region, removing all other head-orientation cues apart from some visible part of the nose; or (d) just the eyes, with all parts of the nose masked and no head orientation cues present other than those within the eyes themselves. We also varied time pressure on gaze direction judgements. The results showed that gaze judgements were not solely driven by the eye region. Gaze perception can also be affected by parts of the head and face, but in a manner that depends on the time constraints for gaze direction judgements. While “positive” congruency effects were found with time pressure (i.e., faster left/right judgements of seen gaze when the seen head deviated towards the same side as that gaze), the opposite applied without time pressure.     

Psychopathy and comorbidity in a young offender sample: taking a closer look at psychopathy's potential importance over disruptive behavior disorders

The authors examined the construct of psychopathy as applied to 130 adolescent offenders using 3 psychopathy measures and a broad range of DSM-TV Axis I diagnoses and psychosocial problems. Measures used in the study included the following: (a) Psychopathy Checklist-Youth Version, (b) Antisocial Process Screening Device, (c) a modified version of the Self-Report Psychopathy-II scale, and (d) the Adolescent Psychopathology Scale. Results from this study offer incremental support for the construct validity of psychopathy in youth. Psychopathy evidenced better convergent and discriminant validity results than did the disruptive behavior disorders (DBDs) such as oppositional-defiant disorder (ODD) and conduct disorder (CD). Despite this finding, psychopathy scales nonetheless correlated with other forms of psychopathology at a higher rate than was expected, suggesting that comorbidity is high even when psychopathy is used as a classification scheme. Also, hierarchical multiple regression was used to determine whether psychopathy offered an improvement in the prediction of previous violent and nonviolent offenses. The results for the current study were mixed, with only the PCL-YV significantly predicting previous violent and nonviolent offenses beyond the DBDs. The findings indicate that psychopathy may offer incremental improvement over DBDs with regard to level of comorbidity and perhaps even prediction. However, simply extending the adult construct of psychopathy to youth without considering the array of psychopathology that may accompany adolescent psychopathy could be misleading.     

Clarifying boundaries of binge eating disorder and psychiatric comorbidity: a latent structure analysis

Binge eating disorder (BED) presents with substantial psychiatric comorbidity. This latent structure analysis sought to delineate boundaries of BED given its comorbidity with affective and anxiety disorders. A population-based sample of 151 women with BED, 102 women with affective or anxiety disorders, and 259 women without psychiatric disorders was assessed with clinical interviews and self-report-questionnaires. Taxometric analyses were conducted using DSM-IV criteria of BED and of affective and anxiety disorders. The results showed a taxonic structure of BED and of affective and anxiety disorders. Both taxa co-occurred at an above-chance level, but also presented independently with twice-as-large probabilities. Within the BED taxon, diagnostic co-occurrence indicated greater general psychopathology, lower social adaptation, and greater premorbid exposure to parental mood and substance disorder, but not greater eating disorder psychopathology. Eating disorder psychopathology discriminated individuals in the BED taxon from individuals in the affective and anxiety disorders taxon. Diagnostic criteria of BED were more indicative of the BED taxon than were criteria of affective and anxiety disorders. The results show that at the latent level, BED was co-occurring with, yet distinct from, affective and anxiety disorders and was not characterized by an underlying affective or anxiety disorder.     

A practical way to diagnosis personality disorder: a proposal

General criteria for the diagnosis of personality disorder are provided based on rating a few items describing four core features of personality disorder: (a) low Self-directedness, (b) low Cooperativeness, (c) low Affective Stability, and (d) low Self-transcendence. These core features correspond closely with the basic concept of personality disorder in DSM-IV and are based on specific items easy for clinicians to rate in a short time. Criteria are also provided for rating severity of personality disorganization and for subtyping based on a profile of three additional dimensions corresponding to core features of DSM-IV clusters A, B, and C. This approach should facilitate efficient screening in clinical practice, encourage an understanding of the development of comorbidity as a self-organizing process, and provide a theory-driven basis for therapeutic planning with drugs and psychotherapy.     

Diagnosis of Personality Disorders: A Case Study

In this article, I report a case highlighting diagnostic uncertainty about psychopathology on both Axes I and II. It concerns in part the problem of comorbidity in relation to diagnostic classification of Axis II personality disorders. After commenting on these uncertainties in relation to categorical and dimensional models, I also consider a psychoanalytic explanation to illustrate an example in which a theoretical model informs diagnostic interviewing. I emphasize how the clinical information that unfolds from an interview based on this theoretical model generates inferences about psychopathology that extend clinical understanding beyond the formal diagnostic assessment of Axes I and II disorders and assessment by self-report.     

Diagnosis of personality disorders: a case study

In this article, I report a case highlighting diagnostic uncertainty about psychopathology on both Axes I and II. It concerns in part the problem of comorbidity in relation to diagnostic classification of Axis II personality disorders. After commenting on these uncertainties in relation to categorical and dimensional models, I also consider a psychoanalytic explanation to illustrate an example in which a theoretical model informs diagnostic interviewing. I emphasize how the clinical information that unfolds from an interview based on this theoretical model generates inferences about psychopathology that extend clinical understanding beyond the formal diagnostic assessment of Axes I and II disorders and assessment by self-report.     

Effects of head orientation on gaze perception: How positive congruency effects can be reversed

Several past studies have considered how perceived head orientation may be combined with perceived gaze direction in judging where someone else is attending. In three experiments we tested the impact of different sources of information by examining the role of head orientation in gaze-direction judgements when presenting: (a) the whole face; (b) the face with the nose masked; (c) just the eye region, removing all other head-orientation cues apart from some visible part of the nose; or (d) just the eyes, with all parts of the nose masked and no head orientation cues present other than those within the eyes themselves. We also varied time pressure on gaze direction judgements. The results showed that gaze judgements were not solely driven by the eye region. Gaze perception can also be affected by parts of the head and face, but in a manner that depends on the time constraints for gaze direction judgements. While “positive” congruency effects were found with time pressure (i.e., faster left/right judgements of seen gaze when the seen head deviated towards the same side as that gaze), the opposite applied without time pressure.     

The influence of stress hormones on emotional memory: relevance for psychopathology

Substantial progress within recent years has led to a better understanding of the impact of stress on emotional memory. These effects are of relevance for understanding and treating psychopathology. The present selective review describes how emotional memory is modulated through stress hormones. Acute as well as chronic effects are discussed and information from rodent models is compared to human experimental studies and clinical observations. Finally, the relevance of these findings for emotional memory disturbances in psychiatric disorders is exemplified by discussions on neuroendocrine alterations in depression, post traumatic stress disorder and phobias.     

The development of infant intersensory perception: advantages of a comparative convergent-operations approach

Despite impressive demonstrations of human infants' intersensory capabilities over the past several decades, there has been little focus on the contributions of prenatal and postnatal experience or the specific developmental processes underlying the emergence of intersensory functioning. Research with nonhuman animals has, however, provided a number of advances in understanding early intersensory perception. The authors explore the value of a comparative, convergent-operations approach to the study of early intersensory perception and examine how this approach has highlighted the study of (a) prenatal factors, (b) brain-behavior relations, and (c) context and experience variables contributing to infants' intersensory responsiveness. Examples of how human and animal research programs can cross-fertilize one another in their attempts to understand developmental processes underlying intersensory perception are considered.     

Assessment and Diagnosis of Conduct Disorder

Assessment and diagnosis of mental disorders has become standard practice in the counseling profession. In this article, the authors examine problems and solutions associated with accurate assessment and diagnosis of conduct disorder. Problems of conduct disorder assessment and diagnosis include (a) client deceitfulness, (b) parent and teacher misinformation, (c) counselor countertransference, (d) diagnostic comorbidity, and (e) confounding cultural and situational circumstances. Counselors seeking to accurately diagnose conduct disorder should adhere to basic assessment principles; use multi-method, multi-rater, multi-setting approaches; closely review differential explanations and diagnoses; and regularly obtain peer consultation.     

Motivating Operations Affect Stimulus Control: A Largely Overlooked Phenomenon in Discrimination Learning

Several recent studies have explored what Michael (e.g., 1982) termed the value-altering effect and the behavior-altering effect of motivating operations. One aspect of the behavior-altering effect that has garnered no recent attention involves changes in stimulus control produced by motivating operations. To call attention to this aspect of the behavior-altering effect, we herein review 11 studies that are concerned with the influence of varying levels of food or water deprivation on stimulus generalization. These studies suggest that motivating operations influence stimulus control (a) by changing the evocative strength of not just an established discriminative stimulus, but also of stimuli that are physically similar to it; (b) by changing the range of stimuli that evoke the operant in question; and (c) by exerting these effects in a graded fashion. These findings are potentially of conceptual and applied significance, and it appears that further research examining how motivating operations alter stimulus control, including some studies suggested herein, is warranted.