How should we revise diagnostic criteria for substance use disorders in the DSM-V?

This article reviews literature on the validity and performance characteristics of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) diagnostic criteria for substance use disorders (SUDs) and recommends changes in these criteria that should be considered for the next edition of the DSM (DSM-V). Substantial data indicate that DSM-IV substance abuse and substance dependence are not distinct categories and that SUD criteria are best modeled as reflecting a unidimensional continuum of substance-problem severity. The conceptually and empirically problematic substance abuse diagnosis should be abandoned in the DSM-V, with substance dependence defined by a single set of criteria. Data also indicate that various individual SUD criteria should be revised, dropped, or considered for inclusion in the DSM-V. The DSM-V should provide a framework that allows the integration of categorical and dimensional approaches to diagnosis. Important areas for further research are noted.     

Abusive relationships: Is a new category for traumatization needed?

The concept of a spectrum of posttraumatic disorders has been postulated by a variety of major contributors to the field of psychotraumatology. Although Posttraumatic Stress Disorder (PTSD) is one trauma-based mental health disorder, there are other posttraumatic illnesses that do not qualify for PTSD, nor are they accurately described by other diagnostic categories in the DSM-IV. The present paper proposes and delineates a new syndrome, entitled Posttraumatic Relationship Syndrome (PTRS), which is a function of the experience of trauma in the context of an emotionally intimate relationship. It differs from PTSD in four fundamental ways: (1) the nature of the Stressor criterion; (2) the response to the Stressor; (3) the inclusion of a category of relational symptoms; and (4) the way of coping with the trauma (i.e., it lacks the emotional numbing and avoidance of stimuli associated with the trauma). The latter is the most salient difference as it involves a qualitatively different experience of the “world of trauma”-a primarily conscious experience in PTRS and an often unconscious experience in PTSD.     

Abusive relationships: Is a new category for traumatization needed?

The concept of a spectrum of posttraumatic disorders has been postulated by a variety of major contributors to the field of psychotraumatology. Although Posttraumatic Stress Disorder (PTSD) is one trauma-based mental health disorder, there are other posttraumatic illnesses that do not qualify for PTSD, nor are they accurately described by other diagnostic categories in the DSM-IV. The present paper proposes and delineates a new syndrome, entitled Posttraumatic Relationship Syndrome (PTRS), which is a function of the experience of trauma in the context of an emotionally intimate relationship. It differs from PTSD in four fundamental ways: (1) the nature of the Stressor criterion; (2) the response to the Stressor; (3) the inclusion of a category of relational symptoms; and (4) the way of coping with the trauma (i.e., it lacks the emotional numbing and avoidance of stimuli associated with the trauma). The latter is the most salient difference as it involves a qualitatively different experience of the “world of trauma”-a primarily conscious experience in PTRS and an often unconscious experience in PTSD.     

Framework for a new dialogue between psychoanalysis and neurosciences: is the combined neuro-psychoanalytic approach the missing link?

Freud's legacy deriving from his work The project for a scientific psychology (1895) could give a new impetus to the dialogue between psychoanalysis and neurosciences. A rapproachment phase is warrented. Based on the work of psychoanalysts who are themselves neuroscientists (such as Mauro Mancia, Martha Koukkou and Harold Shevrin) or have a long term dialogue with neuroscientists (Arnold Modell), three points of epistemological congruence are described:

1. dualism is no longer a satisfactory solution
2. cautions for the centrality of interpretation (hermeneutics)
3. the self-criticism of neuroscientists

     

Shyness and sociability: a dangerous combination for illicit substance use in adolescent males?

Researchers have hypothesized that behavioral problems are accentuated when a shy person wants to be with other people. This need to be with others--sociability--is a related but separate construct from shyness. The purpose of the present study was to examine the relationship of shyness and sociability to illicit substance use in a sample of 654 male high school students. It was found that, in general, shy male adolescents were significantly more likely to use illicit substances when compared to those who were not shy. Those who were shy and highly sociable were significantly more likely to use hallucinogenic substances than were those who were shy and low to moderate in sociability as well as those who were not shy. Although not significant, there was a trend toward more cocaine and marijuana use among those who were shy and highly sociable. The implications of these findings for those who work with adolescents are discussed.     

Why is a verb like an inanimate object? Grammatical category and semantic category deficits

Semantic category effects, such as difficulties in naming animate things relative to inanimate objects, have been explained in terms of the relative weightings of perceptual and functional features within the semantic representations of these concepts. We argue that grammatical category deficits, such as difficulties in naming nouns relative to verbs, can be explained within the same framework. We hypothesize that verb concepts are richer in functional than sensory features and present a model of the semantic representations of animate nouns, inanimate nouns, and verbs. The model demonstrates that sensory feature damage results in a deficit for naming living things but spares verb naming, and functional feature damage results in a deficit for naming inanimate objects and verbs. We then report the assessment results of two patient groups. In accordance with the model's predictions, the "verb spared" patients were consistently worse at naming living things than inanimate objects, and their definitions of both living and nonliving items were lacking in sensory information. We conclude that damage to sensory features in semantic representations causes difficulties in naming concrete nouns relative to action verbs, and within the grammatical category of nouns, animate items will be more severely affected. Imageability was shown to be a strong predictor of naming performance in the "verb deficit" patients, and when this variable was controlled no class effect remained. Production of definitions revealed no differential damage to sensory or functional features, and no consistent effect of animacy in naming was shown. While the model suggests that verb deficits might occur in patients for whom functional features are damaged relative to sensory features, we conclude that the "verb deficit" shown in our patients (and potentially in many previously reported cases) was an artifact of the lower imageability of verbs in confrontation naming tasks.     

What in the world is weakness of will?

At least since the middle of the twentieth century, philosophers have tended to identify weakness of will with akrasia—i.e. acting, or having a disposition to act, contrary to one’s judgments about what is best for one to do. However, there has been some recent debate about whether this captures the ordinary notion of weakness of will. Richard Holton claims that it doesn’t, while Alfred Mele argues that, to a certain extent, it does. As Mele recognizes, the question about an ordinary concept here is one apt for empirical investigation. We evaluate Mele’s studies and report some experiments of our own in order to investigate what in the world the ordinary concept of weakness of will is. We conclude that neither Mele nor Holton (previously) was quite right and offer a tentative proposal of our own: the ordinary notion is more like a prototype or cluster concept whose application is affected by a variety of factors.     

Recognition-based inference: When is less more in the real world?

Common wisdom tells us that more information can only help and never hurt. Goldstein and Gigerenzer (2002) highlighted an instance violating this intuition. Specifically, in an analysis of their recognition heuristic, they found a counterintuitive less-is-more effect in inference: An individual recognizing fewer objects than another individual can, nevertheless, make more accurate inferences. Goldstein and Gigerenzer emphasized that a sufficient condition for this effect is that the recognition validity be higher than the knowledge validity, assuming that the validities are uncorrelated with the number of recognized objects, n. But how is the occurrence of the less-is-more effect affected when this independence assumption is violated? I show that validity dependencies (i.e., correlations of the validities with n) abound in empirical data sets, and I demonstrate by computer simulations that these dependencies often have a strong limiting effect on the less-is-more effect. Moreover, I discuss what cognitive (e.g., memory) and ecological (e.g., distribution of the criterion variable, environmental frequencies) factors can give rise to a dependency of the recognition validity on the number of recognized objects. Supplemental materials may be downloaded from http://pbr.psychonomic-journals.org/content/supplemental.     

What is happening in the world of therapeutic communities?

This overview of the contributions to the special edition illustrates something of how the collection of papers reflects the marginal nature of therapeutic communities, and makes parallels as to how they are forever struggling to survive, yet generate a passion of ideas and intellectual resilience that no project-managed health service can extinguish. It briefly describes the theoretical and geographical terrain covered, and signals how the cross-disciplinary incorporation of congruent ideas can be added to the traditional bedrock of therapeutic community practice. It ends by stating the context of the new, and seemingly successful, organization which assembled these contributions into its inaugural conference – and suggests that the journey could, and ultimate should, go further.     

Cultural variations on optimistic and pessimistic bias for self versus a sibling: is there evidence for self-enhancement in the west and for self-criticism in the east when the referent group is specified?

A culturally relevant framework was used to examine variations on optimistic and pessimistic bias in Westerners and Easterners. Study 1 showed that 136 European Americans compared with 159 Japanese were more likely to predict typical positive events to occur to self than to a sibling. The opposite pattern emerged in the prediction of typical negative events. Study 2 replicated these findings on the basis of predictions for atypical events in 175 European Americans and 130 Japanese. Across both studies, within-groups analyses indicated that European Americans held an optimistic bias in the prediction of positive and negative events, whereas Japanese held a pessimistic bias for negative events. These findings are taken to offer support for presumed cultural differences in self-enhancement and self-criticism between Westerners and Easterners, respectively.     

Proximity attitudes toward objects and people: reference to a category and a self-representation?

The relative strength of similarity to self and category typicality as predictors of proximity attitudes (social distance) toward people of varying race and objects associated with people of varying race was investigated. Similarity to self and category typicality were significant predictors of proximity attitudes toward both objects and people, but similarity to self was the significantly stronger predictor. The predictive utility of similarity to self was greater for object judgments than person judgments, but category typicality was a better predictor of person judgments than object judgments. Although the results provide evidence of ingroup favoritism in proximity attitudes toward people, the ingroup bias did not extend to objects associated with people. Category typicality was positively related to attitudes, even for distanced groups. The role of predictability of the target in determining proximity attitudes is discussed.