The six most essential questions in psychiatric diagnosis: a pluralogue part 3: issues of utility and alternative approaches 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 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 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.     

The six most essential questions in psychiatric diagnosis: a pluralogue. Part 4: general conclusion

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined.     

Doing Good, Feeling Good, and Having More: Resources Mediate the Health Benefits of Altruism Differently for Males and Females with Lumbar Spine Disorders

We evaluated whether resources mediate and/or moderate the relationship between altruism and health outcomes in adults with lumbar spine disorders. Hierarchical regression modeling on 243 persons with lumbar spine disorders evaluated gender differences and whether physical, emotional, and economic resources mediated or moderated the relationship between altruism (Schwartz Altruism) and health (Rand-36, PROMIS Pain Impact). Men and women had similar altruism subscale scores, but there were gender differences in the altruism-health relationships. Both men and women had better mental health with higher levels of Community Connection, after adjusting for Community Pressure, and this effect was mediated by emotional resources. Women evidenced better physical health and less pain impact when they endorsed higher levels of Community Connection and/or General Helping aspects of altruism. Physical and economic resources partially but did not fully mediate women??s altruism-physical health link. The altruism-pain impact link was not significant after adjusting for covariates. Men and women report similar levels of altruism but enjoy different benefits. Emotional resources explained the altruism-mental health link in both genders, but women experienced a physical health benefit of altruism that was not mediated by resources. Future research should test causal relationships.     

Metamemory and memory efficiency: Implications for student learning

Judgments of learning (JOLs) are metamemory judgments about the likelihood of remembering later an item that we are currently studying. Much research has documented that JOLs are accurate at discriminating easy from difficult items (resolution), but often fail to account for other factors such as the advantages of retrieval practice, overlearning, spacing, and desirable difficulty, thus resulting in poor calibration. This implies that JOLs should not be used to determine how long or in what manner to study, although they can be used to determine what to study. To counter poor calibration, explicit metamemory knowledge can be learned and applied in order for students to become more efficient learners. Our goal is to focus on how metamemory influences decisions about studying, and how we might use metamemory to improve our learning efficiency.     

When two wrongs can make a right: Regulatory nonfit, bias, and correction of judgments

We propose that when people consider whether their judgments are accurate enough, feelings of wrongness from regulatory nonfit (inconsistency between regulatory state and strategic means) can suggest that the answer is no and enhance correction of judgments relative to feelings of rightness from regulatory fit. Results from two experiments supported that hypothesis. When we activated an accuracy motive, participants who experienced regulatory nonfit provided judgments more consistent with correction for bias when they experienced regulatory nonfit than when they experienced regulatory fit (Experiment 1). Drawing participants’ attention to an earlier event as a source of rightness feelings eliminated the effect of regulatory fit on apparent correction of judgments (Experiment 2), suggesting attribution of regulatory fit/nonfit feelings to the accuracy of those judgments.     

Defining the Nature and Impact of Goals in Children and Adolescents with a Chronic Health Condition: A Review of Research and a Theoretical Framework

This paper presents a review of research related to goals in youth with a chronic health condition (CHC) and a related framework to inform theory and research. Performed literature review using PsychINFO and Medline with a combination of many key words related to health, goals, and youth. Sixteen studies related to goals in youth with a CHC were identified. An integrative framework to inform research on goals in pediatric CHCs was presented based on studies reviewed. The impact of a CHC on goals and related behaviors, impact of goal conflict and collaboration, interventions with goal-setting components, and impact of developmental, disease, socioeconomic, and cultural factors were described. Recommendations for future research were discussed. The application of theory related to the nature and impact of goals in youth with a CHC will advance the field from a research and clinical standpoint.     

Obesity and body image

Modern western culture emphasizes thinness, denigrates excess weight, and stigmatizes obese individuals, making it likely that obese people internalize these messages and feel badly about the physical presence that brands them. There is clear evidence that obesity is linked with poor body image, but not all obese persons suffer from this problem or are equally vulnerable. Risk factors identified thus far are degree of overweight, being female, and binge eating, with some evidence of risk increasing with early age of onset of obesity, race, and several additional factors. Treatments do exist for improving body image in overweight individuals. Key questions are how to identify those in need of body image intervention, how such programs can be integrated with weight loss treatments, and ultimately, how body image distress can be prevented.     

Accuracy in judgments of aggressiveness

Perceivers are both accurate and biased in their understanding of others. Past research has distinguished between three types of accuracy: generalized accuracy, a perceiver's accuracy about how a target interacts with others in general; perceiver accuracy, a perceiver's view of others corresponding with how the perceiver is treated by others in general; and dyadic accuracy, a perceiver's accuracy about a target when interacting with that target. Researchers have proposed that there should be more dyadic than other forms of accuracy among well-acquainted individuals because of the pragmatic utility of forecasting the behavior of interaction partners. We examined behavioral aggression among well-acquainted peers. A total of 116 9-year-old boys rated how aggressive their classmates were toward other classmates. Subsequently, 11 groups of 6 boys each interacted in play groups, during which observations of aggression were made. Analyses indicated strong generalized accuracy yet little dyadic and perceiver accuracy.     

Studies of operant and reflexive key pecks in the pigeon

The duration of pigeons' key pecks was studied in three experiments. Experiment I revealed that key pecks early in exposure to continuous reinforcement were of short duration, as were key pecks observed on an omission procedure in which pecks prevented food delivery. Key pecks later in exposure to continuous reinforcement, and those that occurred on positive automaintenance procedures, were of long duration. In Experiment II, pigeons were exposed to fixed-interval and fixed-ratio reinforcement schedules, and durations were recorded separately for each quarter of each interval or ratio. On fixed interval, durations were shorter in the first quarter of each interval than in subsequent quarters; on fixed ratio, durations were longer in the first quarter of the ratio than in subsequent quarters. These data parallel observations of concurrent operant responding and salivation in dogs. In Experiment III, pigeons were exposed to a discrete trial, differential-reinforcement-of-low-rate 6-sec schedule. Durations of responses in the first 2 sec of the trial were substantially shorter than those of responses that occurred later. The data from all three experiments support the view that the pigeon's "key peck" actually consists of two subclasses of peck, one reflexive and one operant.