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.     

Reducing Youth Access to Alcohol: Findings from a Community-Based Randomized Trial

Underage drinking continues to be an important public health problem and a challenge to the substance abuse prevention field. Community-based interventions designed to more rigorously control underage access to alcohol through retailer education and greater enforcement of underage drinking laws have been advocated as potentially effective strategies to help address this problem, but studies designed to evaluate such interventions are sparse. To address this issue we conducted a randomized trial involving 36 communities to test the combined effectiveness of five interrelated intervention components designed to reduce underage access to alcohol. The intervention was found to be effective in reducing the likelihood that retail clerks would sell alcohol to underage-looking buyers, but did not reduce underage drinking or the perceived availability of alcohol among high school students. Post hoc analyses, however, revealed significant associations between the level of underage drinking law enforcement in the intervention communities and reductions in both 30-day use of alcohol and binge drinking. The findings highlight the difficulty in reducing youth drinking even when efforts to curtail retail access are successful. Study findings also suggest that high intensity implementation of underage drinking law enforcement can reduce underage drinking. Any such effects of enhanced enforcement on underage drinking appear to be more directly attributable to an increase in perceived likelihood of enforcement and the resultant perceived inconveniences and/or sanctions to potential drinkers, than to a reduction in access to alcohol per se.     

Size contrast as a function of figural similarity

Size contrast occurs in numerous configurations where a test figure appears apparently larger when surrounded by small elements and apparently smaller when surrounded by large elements. Using the Ebbinghaus illusion, the magnitude of this effect is shown to vary as a function of apparent similarity between test and inducing element.     

Competition Between Primary and Non-Primary Relations During Sentence Comprehension

The four eye-tracking experiments reported examined the way in which Adjunct Predicates (APs) located at the beginning of French sentences of the type Tired (feminine/masculine) of calling the woman (s/he) left the room are interpreted and interact with syntactic parsing strategies. The results suggest that the first NP (the woman) was initially interpreted as the potential AP gender controller. Moreover, in the case of gender agreement (the woman is the one who is tired) the syntactic status of the first NP (either the object of the preceding verb or the subject of the main verb) apparently remained ambiguous until the main verb was reached. The implications of these results for Frazier and Clifton's (1996) Construal Theory are discussed.     

Working With Couples and Substance Abuse: Recommendations for Clinical Practice

Misuse of alcohol and drugs is widespread in modern society with the associated emotional and physical tolls on individuals, couples, and families. Yet, many therapists do not assess nor address substance misuse when clients do not identify it as a presenting problem. This article presents an overview of the literature on key aspects of couples and substance use and makes important clinical recommendations for mental health professionals who work with couples that struggle with substance use.     

Draw me a dream

Journal of Contemporary Psychotherapy -     

Empathy and the relationship between attitudinal similarity and attraction

Subjects varying in their levels of trait empathy encountered an attitudinally similar or dissimilar other. Replicating past research, subjects expressed much greater attraction for a similar rather than dissimilar other. Extending past research, the relationship between attitudinal similarity and attraction was much stronger among those having a strong rather than weak empathic tendency. Explanations, theoretical implications, and limitations are discussed.