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.     

Self-Efficacy for Affect Regulation as a Predictor of Future Life Satisfaction and Moderator of the Negative Affect—Life Satisfaction Relationship

Life satisfaction is an important index of mental health and also predicts other important outcomes such as longevity and decreased mortality. Negative affect has a unique inverse relationship with life satisfaction across the life span. Therefore, determining psychological factors that uniquely predict future life satisfaction and that reduce the trait negative affect—life satisfaction relationship is theoretically and clinically important. In light of recent evidence from long-term longitudinal studies that self-efficacy for regulation of negative emotions (SERN) predicts higher future life satisfaction, as well as evidence from a cross-sectional study that a subtype of SERN—self-efficacy for regulating anger—buffers the relationship between trait negative affect and life satisfaction, we tested whether SERN and subtypes of SERN predicted higher life satisfaction and buffered the negative affect—life satisfaction relationship longitudinally over short time periods. After controlling for time 1 life satisfaction, higher time 1 self-efficacy for regulating despondency and distress (SEDes) predicted higher future life satisfaction over average time periods of 17 days (N = 127), 32 days (N = 83), and 41 days (N = 65) among college students. However, in post hoc exploratory regressions that included self-efficacy for experience and expression of positive emotions (SEPos), SEDes predicted higher time 2 life satisfaction, but only SEPos uniquely predicted higher time 3 and time 4 life satisfaction.     

Positive Automatic Cognitions Mediate the Relationship Between Personality and Trait Positive Affect

Positive affect (PA) has emerged as a key well-being facet and a powerful predictor of physical and psychological well-being. One of the strongest predictors of PA is personality, particularly neuroticism and extraversion. However, the mechanisms via which personality affects PA are not well-understood. Consistent with theories that accord cognitive factors a role in mediating the relationship between personality and outcomes, we tested whether positive automatic thoughts (PATs) mediated the relationship between neuroticism, extraversion, and PA among 199 college students (137 women, 70% White, 66% first and second year students, mean age = 24.13, SD = 8.86). Consistent with hypotheses, structural equation modeling indicated that PATs fully mediated the relationship between both neuroticism and extraversion and PA. The structural model fit the data well, χ²/df = 2.33, CFI = .96, SRMR = .07, RMSEA = .08 (90% CI: .06, .10), AIC = 172.45, and accounted for 58% of the variance in PA. An alternative model in which personality predicted PA, which in turn predicted PATs, did not provide as good a fit to the data, χ²/df = 3.03, CFI = .94, SRMR = .09, RMSEA = .10 (90% CI: .08, .12), AIC = 207.40. Models in which negative automatic thoughts (NATs) were construed as fully [χ²/df = 4.46, CFI = .95, SRMR = .08, RMSEA = .13 (90% CI: .11, .16)] or partially [χ²/df = 4.04, CFI = .96, SRMR = .06, RMSEA = .12 (90% CI: .10, .15)] mediating the relationship between neuroticism and negative affect did not provide a good fit to the data. A final model in which negative affect was tested a mediator of the relationship between neuroticism and NATs also did not fit the data well, χ²/df = 4.03, CFI = .96, SRMR = .07, RMSEA = .12 (90% CI: .10, .15).     

Body ideals in women after viewing images of typical and healthy weight models

Viewing thin models, pervasive in popular culture, is correlated with body dissatisfaction and anxiety in women. Whether or not the same is true when viewing healthy weight models is unknown. In this study we tested whether viewing healthy weight models increases the ideal female body size. Body image, anxiety, happiness and depression were measured in 44 female participants following viewing of images of thin or healthy weight models (within-subject separated by two weeks). We found that after viewing images of healthy weight models, women's body ideals (as measured by a participant-adjusted virtual model) were significantly larger than when the same women viewed images of very thin models. This effect was greatest in those women with the highest levels of baseline anxiety (as measured by the Hospital Anxiety and Depression Scale). These results suggest that viewing healthy weight models results in more healthy body ideals than those typically promoted through media.     

Sub-Abstract Bodies: The Epistemic and Ethical Role of the Body-Mind Relationship in Adorno’s Philosophy

Abstract

The aim of this paper is threefold. In the first place, I should like to show that Adorno’s philosophy is dependent, to a degree perhaps not always directly recognized in the literature, on a deeply contentious view on the relationship between the mind and the body. In order to show this, I explore and bring out the epistemic and ethical stakes for Adorno’s theory of the relationship between mind and body. Secondly, I move to better articulate precisely what Adorno’s view on the nature of this relationship is. I hold that his position revolves around positing a porous boundary between the domains of the somatic and the cognitive. In closing, I show that Adorno’s account relies on this domain boundary being unidirectionally porous, in that determination of somatic impulses by cognitive content does not seem a live option for Adorno. I go on to note that this smuggles in a dubious position which does a lot of unearned work. The stakes which his implicit account of the body and mind relationship served to secure thereby come once more to look highly vulnerable.     

Adorno,Interpretation, and the Body

Abstract

Adorno sees experience as intrinsically interpretative. As interpretation requires normative constraints, in order to guide and channel this interpretative engagement, this opens the question of how experience acquires its motivating criteria. If experience is from the first criterially structured, how are these criteria acquired? Moreover, as these criteria are acquired in isolation from experience – as they are the precondition of that experience – are these criteria sensitive to the particularity of the experiences they produce? In order to address these questions, and the problems they threaten to create for Adorno’s epistemology, I look at Adorno’s theory of impulse and cognition. I argue that Adorno grounds the criterial structure of experience and reason in self-preservation. This provides both a motivation and a determining constraint on the criterial structure of experience. It is also a determining influence which is epistemically flexible and compatible with Adorno’s project of tracing the ‘non-identical’.     

Emergent self-regulation skills among very young ethnic minority children: A confirmatory factor model

Emerging self-regulation skills were assessed in 407 low-income African American and Latino (primarily Mexican-origin) preschoolers. A battery of self-regulation tasks was administered when children were 2½ years old and again approximately 1 year later. Confirmatory factor analyses supported four components of self-regulation: inhibitory control, complex response inhibition, set shifting, and working memory. Complex response inhibition was too rare a skill in this sample to be detected reliably from measures collected at 2½ years of age, but it emerged from measures collected at 3½ years. In addition, significant ethnic differences were found in that African American children scored better on measures of complex response inhibition and set shifting, whereas Latino children scored better on measures of inhibitory control and working memory. Implications of study findings for measuring self-regulation in low-income ethnic diverse populations of young children, as well as for developing interventions to enhance self-regulation development, are discussed.     

Psychologists' attitudes toward aids

Abstract

Practicing psychologists in all areas of the country will see an increasing number of persons at risk for AIDS, or with AIDS-related illnesses. Previous research has shown that AIDS elicits negative reactions from the general public and from certain health care professionals. In the current study, a national sample of randomly selected practicing psychologists completed attitude measures after reading vignettes that described a male patient with either AIDS or leukemia who was either homosexual or heterosexual. Respondents evaluated the AIDS patient more negatively and reported less willingness to interact with him in a professional role or in casual social situations. It is important to develop training and continuing education programs to prepare psychologists to deal with persons affected by AIDS.