The Collaborative Longitudinal Personality Disorders Study: reliability of axis I and II diagnoses

Both the interrater and test-retest-retest reliability of axis I and axis II disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Fair-good median interrater kappa (.40-.75) were found for all axis II disorders diagnosed five times or more, except antisocial personality disorder (1.0). All of the test-retest kappa for axis II disorders, except for narcissistic personality disorder (1.0) and paranoid personality disorder (.39), were also found to be fair-good. Interrater and test-retest dimensional reliability figures for axis II were generally higher than those for their categorical counterparts; most were in the excellent range (> .75). In terms of axis I, excellent median interrater kappa were found for six of the 10 disorders diagnosed five times or more, whereas fair-good median interrater kappa were found for the other four axis I disorders. In general, test-retest reliability figures for axis I disorders were somewhat lower than the interrater reliability figures. Three test-retest kappa were in the excellent range, six were in the fair-good range, and one (for dysthymia) was in the poor range (.35). Taken together, the results of this study suggest that both axis I and axis II disorders can be diagnosed reliably when using appropriate semistructured interviews. They also suggest that the reliability of axis II disorders is roughly equivalent to that reliability found for most axis I disorders.     

The Collaborative Longitudinal Personality Disorders Study: development, aims, design, and sample characteristics

This paper describes the aims, background, design, and methods used in a collaborative longitudinal study of Axis II personality disorders (PDs). This study examines the putative stability of selected PD diagnoses and criteria, what factors affect their course, and whether their stability and course distinguishes them from a representative Axis I disorder. This article also describes the acquisition and demographics of the sample on whom the study is being done. A prospective, repeated measures investigation of the stability of PDs is now underway at multiple clinical settings in four collaborating urban sites in Boston. New Haven, New York, and Providence. Diagnostic assignments are based on semistructured interview assessments (by clinically trained raters) and confirmed by at least one additional contrasting diagnostic method. The sample consists of 668 treatment seeking and reliably diagnosed adults recruited from a broad range of clinical sites. By design, patients in the sample met standards for one of five diagnostic subgroups: (a) schizotypal (N = 86); (b) borderline (N = 175); (c) avoidant (N = 157); (d) obsessive-compulsive (N = 153) personality disorders or a control group having (e) major depressive disorder without personality disorder (N = 97).     

Sex offenders, sentencing laws and pharmaceutical treatment: a prescription for failure

The phenomenon of adults who have sexual interests involving children as partners, or pedophiles, is considered among the most sociopathological of human conditions. Considerable literature is devoted to issues and problems associated with or related to pedophilia, including prevalence, etiology, treatment, and outcome studies. The sexual victimization of children, based upon data gathered from a number of sources, suggests an intractable problem that is national in scope. Recent manifestations of society's efforts to deal with the sexual victimization of children include the enactment of criminal sentencing laws that mandate the treatment of offenders with certain pharmaceutical agents, such as medroxy-progesterone acetate ("MPA"). Because sentencing laws as a rule vary widely from state to state, there is considerable variation as to who is subject to MPA treatment laws, and how such laws-including specific provisions, such as clinical criteria, if any, required for treatment; type and period of treatment plans; informed consent; etc-are implemented. Most important, these sentencing laws may have remarkably little relation to what is widely considered effective treatment for pedophilia disorders. We examine in detail the most recent sentencing laws pertaining to treatment of persons who have been convicted of sex offenses involving children as victims. Our critique may offer insight and suggestions as to how such sentencing laws can be more suitably tailored to the treatment needs of persons with pedophilia disorders.     

Numerical competence in rats (Rattus norvegicus): Davis and Bradford (1986) extended

The task of rats (Rattus norvegicus) was to enter 1 box of a defined ordinal number among an array of boxes. In Experiments 1 and 2, the rats correctly chose the 4th box from arrays of 6 and 12 boxes, respectively. In Experiments 3 and 4, in which the ordinal number of the correct box was increased in a graduated fashion, they were able to select the correct box even when its position was higher than 10th among 12 and 18 boxes, respectively. In Experiment 5, the possibility that the rats had used cues to the openability of the box doors was ruled out. In Experiments 6 and 7, the rats succeeded in the task even when the total number of boxes was varied from trial to trial. In Experiment 8, both small- and large-sized boxes were used to control for the possibility of using the cumulative length of the boxes as a cue. Overall, the results suggest that performance was based on numerical cues. Intentional acts were occasionally observed but appeared not to be essential for solving the task.     

Longitudinal changes in the contribution of genetic and environmental influences to symptoms of depression in older male twins

Genetically informative longitudinal data on self-reported symptoms of depression allow for an investigation of the causes of stability and change in depression symptoms throughout adult life. In this report, the authors investigated the relative contribution of genetic and environmental influences to symptoms of depression in 83 monozygotic and 84 dizygotic male twin pairs from the National Heart, Lung, and Blood Institute (NHLBI) Twin Study. Participants first completed the Center for Epidemiologic Studies-Depression (CES-D) scale in 1985-1986 and again during 1995-1997. Mean age of twins at baseline was 63 years, range 59 to 70. From cross-sectional genetic analyses we estimated the heritability of CES-D to be 25% (95% confidence interval [CI], 11%-39%) at baseline and 55% (95% CI, 40%-71%) at follow-up. Fitting longitudinal genetic models to the two-wave data, we found that stability of symptoms over the 10-year follow-up was due primarily to continuity of genetic influences.     

Reflections on the future of DSM axis II

Several proposals are enumerated in this article: (a) the need to employ a coherent classification-guiding theory; (b) the wisdom of conceptualizing personality patterns as prototypes; (c) a proposed shift away from the Axis I-Axis II distinction to a three-part continuum; (d) the utility of specifying relationships among the various classification categories of the nosology; (e) a proposal for refining and differentiating personality disorder subtypes; and (f) the utility of expanding the range and comparability of the diagnostic criteria.     

Impact of genetic testing on causal models of heart disease and arthritis: An analogue study

Abstract An analogue study investigated the impact of genetic testing on perceptions of disease. Using a 2 × 2 design, participants (n = 212) imagined receiving the information that they were at increased risk for either heart disease or arthritis. The type of risk information was either genetic or unspecified. Presentation of genetic risk information resulted in the condition being perceived as less preventable. Causal models of disease where investigated using principal components analysis. When hem disease was the stimulus condition, attributions to genes and chance were positively associated following unspecified risk information, and negatively associated following genetic risk information. When arthritis was the stimulus condition, presentation of genetic risk information was associated with attributions to genes becoming separated from the other attributions. One explanation for this is that providing genetic risk information may decrease perceptions of a sense of randomness or uncertainty in disease causation. The extent to which these effects occur in clinical populations. and their behavioural consequences. needs to be established.     

Of wealth and death: materialism, mortality salience, and consumption behavior

Theoretical work suggests that feelings of insecurity produce materialistic behavior, but most empirical evidence is correlational in nature. We therefore experimentally activated feelings of insecurity by having some subjects write short essays about death (mortality-salience condition). In Study 1, subjects in the mortality-salience condition, compared with subjects who wrote about a neutral topic, had higher financial expectations for themselves 15 years in the future, in terms of both their overall worth and the amount they would be spending on pleasurable items such as clothing and entertainment. Study 2 extended these findings by demonstrating that subjects exposed to death became more greedy and consumed more resources in a forest-management game. Results are discussed with regard to humanistic and terror-management theories of materialism.     

Modality effects and the development of the word length effect in children

Two experiments investigated the development of the word length effect in children aged 4 to 10 years, comparing auditory and visual stimuli. The question addressed was whether word length effects emerged earlier with auditory presentation or visual presentation, or whether they emerged at the same age regardless of presentation modality. Results provided evidence that word length effects emerge earlier with visual than auditory presentation. The implication of our results is that with visual presentation, 4-year-olds engage in some form of verbalization strategy that involves obtaining phonological representations of picture names and mapping them on to articulatory output plans. This strategy is clearly verbal in nature, but is not necessarily characterised as cumulative verbal rehearsal.     

The Factor Structure of the Beavers Interactional Scales

Confirmatory factor analysis and regression analyses of the Beavers Interactional Scales did not appear to support the model offered by its developers, namely, several specified family attributes contributing respectively to two global factors of Family Competence and Family Style. Moreover, regression analysis indicated that only three of 12 items predicted raters' assessments of Global Family Health, and one of seven items predicted Global Family Style. Individuals interested in the family dynamic centripetal/centrifugal might best think of that as a unitary entity and rate it accordingly.