Disorder as harmful dysfunction: a conceptual critique of DSM-III-R's definition of mental disorder.

The Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) operationally defines disorder essentially as "statistically unexpectable distress or disability." This definition is an attempt to operationalize 2 basic principles: that a disorder is harmful and that a disorder is a dysfunction (i.e., an inability of some internal mechanism to perform its natural function). However, the definition fails to capture the idea of "dysfunction" and so fails to validly distinguish disorders from nondisorders, leading to invalidities in many of DSM-III-R's specific diagnostic criteria. These problems with validity are traced to DSM-III-R's strategies for increasing reliability.     

Sensory and affective components of pain: separation and synthesis.

It has become increasingly accepted that pain is not simply a sensation generated by nociceptors, but a perceptual phenomenon with particular emotional qualities. The purpose of this article is to bring together vastly different streams of research on the divisibility of pain into sensory and affective components. Empirical evidence for this divisibility is drawn from recent studies using multivariate statistics, signal detection theory, and unidimensional scaling. An important conclusion is that separable though pain components may be, they are not necessarily independent. In critiquing previous research, new criteria are derived for partitioning pain into sensory and affective components. Finally, speculations are offered as to how these same components might be synthesized on the basis of theories of perceptual organization.     

Depression and immunocompetence: a review of the literature.

Recent evidence suggests that there is a relationship between depression and immunity. On the basis of these studies, it has been argued that depressed mood may increase susceptibility to disease by means of aberrations occurring within the immune system. Empirical research investigating the relationship between depression and immunity is reviewed here. Studies examining both clinical and nonclinical manifestations of depression are discussed and evaluated. This review reveals that indexes of immunocompetence are lower among people exhibiting depressive symptomology and suggests that immune alterations may be more related to dysphoric mood than to specific situations or events. Alternative hypotheses accounting for links between depressed affect and altered immune states are provided, and suggestions for future research are offered.     

Problems in recent tests of two cognitive theories of panic.

Four problems in five recent tests of two cognitive theories of panic are discussed: (a) the ambiguity and indistinguishability of the 'body sensations' and 'cognitions' concepts; (b) the uncertain meaning of 'meaningful relationships'; (c) problems arising from differences in Clark's (Behaviour Research and Therapy, 24, 461-470, 1986) theory and Goldstein and Chambless' (Behavior Therapy, 9, 47-59, 1978) theory; (d) the ambiguity of correlational data. Some desiderata for future research on these theories are proposed.     

Predictors of short-term treatment outcome in bulimia nervosa inpatients.

Recent studies, mostly performed on bulimic outpatients, did not find consistent predictors of treatment outcome in bulimia nervosa. This is the first study to investigate anamnestic and clinical factors predictive of the short-term outcome of hospital treatment in 31 female bulimia nervosa patients with a mean age of 22.9 yr. Treatment outcome was assessed by several self-rating instruments measuring different features of the specific and unspecific psychopathology of bulimia nervosa. The most relevant predictors of the outcome of the 8-week hospital treatment were duration of previous inpatient treatments for bulimia, the intensity of anorexic tendency and the pretreatment level of depression. The majority of predictors tested did not show a strong relationship to treatment outcome. The findings are discussed in relation to results of other studies as well as to possible implications for treatment and research.     

The role of neuropsychology in the assessment and treatment of persons with epilepsy.

Several areas of current interest in the neuropsychology of epilepsy are briefly reviewed in this article. These include variables pertaining to seizures, seizure history, antiepileptic drugs, and methods of neuropsychological evaluation. It is apparent that epilepsy is a multifaceted area: Psychologists not only can be of great assistance to patients with this condition, but may also learn a great deal from this complex disorder.     

Injury control. A promising field for psychologists.

Injury is the fourth leading cause of death for all Americans and the most frequent cause of death for those from age 1 to 45. Moreover, injury is associated with higher treatment costs and with greater lost life-years than the other three leading causes of death. Traffic accidents are the leading cause of severe brain injury, including most paraplegic and quadriplegic cases. Because injury control is essentially psychological, there are many opportunities for psychologists to contribute, both to scientific research on the causes of injury and to clinical interventions for injury control.     

Avoidant personality disorder and the generalized subtype of social phobia.

Social phobia and avoidant personality disorder (APD) may be given as comorbid diagnoses. However, it is not known if the labels provide independent, useful diagnostic information. We classified social phobics by social phobia subtype and presence of APD. Generalized social phobics with and without APD (ns = 10 and 10) and nongeneralized social phobics without APD (n = 10) were distinguished on measures of phobic severity. The generalized groups also showed earlier age at onset and higher scores on measures of depression, fear of negative evaluation, and social anxiety and avoidance than did the nongeneralized group. APD criteria of general timidity and risk aversion were more frequently endorsed by social phobics with APD. The data suggest that both the generalized subtype of social phobia and the presence of APD do provide useful diagnostic information but the additional diagnosis of APD may simply identify a severe subgroup of social phobics.     

The meaning of occupational stress items to survey respondents.

This study tested the effect of using the word stress in the measurement of self-reported occupational stressors and strains. Employees from two organizations responded to a questionnaire that included specific occupational stressors, strains, and 16 items in which the word stress was used. Survey respondents tended to interpret the word stress to refer both to employees' strains or reactions to the work environment and to job stressors or elements of the environment itself. Implications of these findings for occupational stress research are discussed.