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.     

The course of adult experiences of abuse in patients with borderline personality disorder and Axis II comparison subjects: a 10-year follow-up study

The first objective of this study was to assess the rates of adult experiences of verbal, emotional, physical, and sexual abuse reported by borderline patients and Axis II comparison subjects over 10 years of prospective follow-up. The second objective was to determine time-to-cessation, recurrence, and new onset of each type of abuse. The Abuse History Interview (AHI) was administered to 290 borderline patients and 72 Axis II comparison subjects at baseline. The AHI Follow-up Version (AHI-FUV) was administered at five contiguous follow-up waves. Over 10 years of follow-up, the rates of all four types of abuse declined significantly for borderline patients. For borderline patients, rates of cessation were high for all types of abuse (>90%). However, recurrences and new onsets of verbal and emotional abuse were relatively common (>60%). Contrastingly, they were relatively uncommon for physical and sexual abuse (<30%), suggesting that verbal and emotional abuse represent more stable forms of abuse.     

Migranten in sozial schwachen Stadtteilen von Berlin

Background

The aim of the present study was to compare psychological distress and substance use between migrant and non-migrant populations in a socially deprived area of Berlin.

Methods

A population-based random sample stratified for age (18?C57?years) and gender (50% female) was retrieved from the registration office. A total of 143 persons were included in the study. The participation rate was 48.5% when contact was established. Psychological distress was assessed using the General Health Questionnaire (GHQ-28) with its four subscales, somatic symptoms, anxiety/insomnia, social dysfunction and severe depression. Substance use was quantified using the Alcohol Use Identification Disorder Test (AUDIT) and the Fagerstr?m Test for Nicotine Dependence (FTND).

Results

Of the study population 51.3% were first or second generation migrants and lived more often in single households. Migrants had lower educational levels and lower employment rates. The mean scores of migrants and non-migrants did not differ on any of the subscales somatic symptoms, anxiety/depression, social dysfunction or severe depression of the GHQ-28. Non-migrants showed significantly higher risks regarding alcohol use.

Discussion

The present study did not reveal any differences regarding symptom profiles in the spectrum of anxiety and depression between non-migrants and migrants who lived in a socially deprived area. Migrants may compensate higher social risk profiles with lower risks regarding alcohol use. Larger samples have to inform on possible differences regarding smoking and other substances.     

Publication bias in psychological science: comment on Ferguson and Brannick (2012)

It is well documented that studies reporting statistically significant results are more likely to be published than are studies reporting nonsignificant results--a phenomenon called publication bias. Publication bias in meta-analytic reviews should be identified and reduced when possible. Ferguson and Brannick (2012) argued that the inclusion of unpublished articles is ineffective and possibly counterproductive as a means of reducing publication bias in meta-analyses. We show how idiosyncratic choices on the part of Ferguson and Brannick led to an erroneous conclusion. We demonstrate that their key finding--that publication bias was more likely when unpublished studies were included--may be an artifact of the way they assessed publication bias. We also point out how the lack of transparency about key choices and the absence of information about critical features of Ferguson and Brannick's sample and procedures might have obscured readers' ability to assess the validity of their claims. Furthermore, we demonstrate that many of the claims they made are without empirical support, even though they could have tested these claims empirically, and that these claims may be misleading. With their claim that addressing publication bias introduces subjectivity and bias into meta-analysis, they ignored a large body of evidence showing that including unpublished studies that meet the inclusion criteria of a meta-analysis decreases (rather than increases) publication bias. Rather than exclude unpublished studies, we recommend that meta-analysts code study characteristics related to methodological quality (e.g., experimental vs. nonexperimental design) and test whether these factors influence the meta-analytic results.     

“The Team Behind the Team”: Exploring the Organizational Stressor Experiences of Sport Science and Management Staff in Elite Sport

This study explored the organizational stressors encountered by the “team behind the team” (viz., those operating in sport science and management roles) in elite sport and the consequences these can have. Forty support personnel working in elite sport were interviewed. Thematic analyses unveiled 36 lower and 6 higher order themes, which were separated into stressors encountered (e.g., relationship and interpersonal, physical resource, contractual and performance development, organizational structure and logistical) and their consequences (e.g., emotions and outcomes). Building on extant work, this study moves the focus beyond athletes' stress experiences to provide novel insight into those operating in sport science and management roles. The findings offer original insight into the educational needs of sport science and management staff, which can inform practitioners who face increasing demands to work with such personnel, and raise sports organizations' awareness of their duty of care to employees and the factors that need to be managed.