The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM ?C whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.     

Examination of the Hierarchical Structure of the Brief COPE in a French Sample: Empirical and Theoretical Convergences

This study aimed to determine whether the various factors of coping as measured by the Brief COPE could be integrated into a more parsimonious hierarchical structure. To identify a higher structure for the Brief COPE, several measurement models based on prior theoretical and hierarchical conceptions of coping were tested. First, confirmatory factor analysis (CFA) results revealed that the Brief COPE's 14 original factors could be represented more parsimoniously with 5 higher order dimensions: problem-solving, support-seeking, avoidance, cognitive restructuring, and distraction (N = 2,187). Measurement invariance across gender was also shown. Second, results provided strong support for the cross-validation and the concurrent validity of the hierarchical structure of the Brief COPE (N = 584). Results indicated statistically significant correlations between Brief COPE factors and trait anxiety and perceived stress. Limitations and theoretical and methodological implications of these results are discussed.     

Differential reactions of virtual actors and observers to the triggering and interruption of psychological momentum

The present study compared virtual actors’ and observers’ perceptions of positive and negative psychological momentum (PM) and their responses to sudden interruptions of momentum. Participants with experience playing competitive table tennis imagined that they were playing a table tennis game (virtual actors), whereas participants who lacked experience playing competitive table tennis imagined that they were observing a table tennis game (observers). While viewing an audiovisual simulation of a table tennis match, participants were exposed to either an ascending (i.e., positive momentum) or descending (i.e., negative momentum) scoring sequence that was either suddenly interrupted or not interrupted at all. Participants’ PM perceptions were measured at the conclusion of the simulation. Results indicated that observers’ PM perceptions were lower than were virtual actors’ following the negative momentum sequence. More generally, interrupting positive momentum lowered PM perceptions, whereas interrupting negative momentum increased PM perceptions. Implications for the study of PM in sport are discussed.     

Perspective-taking ability in bilingual children: Extending advantages in executive control to spatial reasoning

Monolingual and bilingual 8-year-olds performed a computerized spatial perspective-taking task. Children were asked to decide how an observer saw a four-block array from one of three different positions (90°, 180°, and 270° counter-clockwise from the child's position) by selecting one of four responses – the correct response, the egocentric error, an incorrect choice in which the array was correct but in the wrong orientation for the viewer, and an incorrect choice in which the array included an internal spatial error. All children performed similarly on background measures, including fluid intelligence, but bilingual children were more accurate than monolingual children in calculating the observer's view across all three positions, with no differences in the pattern of errors committed by the two language groups. The results are discussed in terms of the effect of bilingualism on modifying performance in a complex spatial task that has implications for academic achievement.     

Perceived responsibility for disease onset affects HIV/AIDS Education

Abstract

Ninety-nine participants were assigned to one of three experimental conditions in which they viewed an AIDS education videotape that systematically manipulated whether or not the educator would be perceived as responsible for HIV infection. Participants were administered pre and post-video affect measures, and an HlV/AIDS knowledge test after watching the video. Participants who viewed the speaker who acquired HIV through a blood transfusion (perceived not responsible) and those who viewed the speaker who did not reveal mode of acquisition (control) performed significantly better on the knowledge test compared to those who viewed the speaker who acquired HIV through unprotected sexual inttrcourse (perceived responsible). In addition. male participants in the perceived responsible condition reported a significant increase in sensation-sceking after viewing the video. Finally, females experienced a significantly greater increase in anxiety as a result of seeing the video than did males. Implications of these tindings for the design and implmentation of AIDS education programs were discussed.     

Evidence for a Multi-Dimensional Latent Structural Model of Externalizing Disorders

Strong associations between conduct disorder (CD), antisocial personality disorder (ASPD) and substance use disorders (SUD) seem to reflect a general vulnerability to externalizing behaviors. Recent studies have characterized this vulnerability on a continuous scale, rather than as distinct categories, suggesting that the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) take into account the underlying continuum of externalizing behaviors. However, most of this research has not included measures of disorders that appear in childhood [e.g., attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD)], nor has it considered the full range of possibilities for the latent structure of externalizing behaviors, particularly factor mixture models, which allow for a latent factor to have both continuous and categorical dimensions. Finally, the majority of prior studies have not tested multidimensional models. Using lifetime diagnoses of externalizing disorders from participants in the Fast Track Project (n?=?715), we analyzed a series of latent variable models ranging from fully continuous factor models to fully categorical mixture models. Continuous models provided the best fit to the observed data and also suggested that a two-factor model of externalizing behavior, defined as (1) ODD+ADHD+CD and (2) SUD with adult antisocial behavior sharing common variance with both factors, was necessary to explain the covariation in externalizing disorders. The two-factor model of externalizing behavior was then replicated using a nationally representative sample drawn from the National Comorbidity Survey-Replication data (n?=?5,692). These results have important implications for the conceptualization of externalizing disorders in DSM-5.     

The effects of mortality salience on political preferences: The roles of charisma and political orientation

Research has shown that mortality salience (MS) heightens liking for certain political candidates. Yet the particular qualities that make candidates more appealing after MS has been subject to debate. This study tested three possibilities: MS increases liking for charismatic candidates independent of participants’ or candidates’ political orientation; MS increases liking for conservative candidates independent of participants’ or candidates’ political orientation; and MS increases liking only for charismatic candidates who support the individual’s pre-existing political orientation, whether liberal or conservative. Following a MS manipulation, liberal and conservative participants evaluated two hypothetical gubernatorial candidates who differed both in their political orientation and level of charisma. MS heightened liking of charismatic candidates who shared the perceiver’s political orientation, whether liberal or conservative. In contrast, MS reduced liking for uncharismatic and opposing-orientation candidates. Results thus indicated that MS heightens regard for same-political orientation charismatic candidates, rather than just any charismatic candidate or conservative candidates. Implications for the influence of death-related concerns on political preference are briefly discussed.     

Changing Parent’s Mindfulness,Child Management Skills and Relationship Quality With Their Youth: Results From a Randomized Pilot Intervention Trial

We evaluated the efficacy of a mindful parenting program for changing parents’ mindfulness, child management practices, and relationships with their early adolescent youth and tested whether changes in parents’ mindfulness mediated changes in other domains. We conducted a pilot randomized trial with 65 families and tested an adapted version of the Strengthening Families Program: For Parent and Youth 10–14 that infused mindfulness principles and practices against the original program and a delayed intervention control group. Results of pre-post analyses of mother and youth-report data showed that the mindful parenting program generally demonstrated comparable effects to the original program on measures of child management practices and stronger effects on measures of mindful parenting and parent–youth relationship qualities. Moreover, mediation analyses indicated that the mindful parenting program operated indirectly on the quality of parent–youth relationships through changes in mindful parenting. Overall, the findings suggest that infusing mindful parenting activities into existing empirically validated parenting programs can enhance their effects on family risk and protection during the transition to adolescence.