The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues 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 - 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 will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. 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.     

Dichotic listening performances in the follow-up of Landau and Kleffner syndrome

Abstract

In the follow-up study of 4 children with acquired epileptic aphasia or Landau and Kleffner syndrome, dichotic listening studies evidenced a unilateral ear extinction. In the four cases, the dichotic extinction was contralateral to the temporal cortex involved in the generation of epileptic discharges during the active period of epilepsy. This pattern of dichotic performances persisted several years after the complete recovery from epilepsy and EEG normalization. The long-lasting dichotic extinction revealed a permanent dysfunction in the temporal auditory system that may be a consequence of the presence of an active epileptogenic focus during the critical period of functional differentiation of the temporal cortex.     

Couples in Therapy: Actor-Partner Analyses of the Relationships Between Adult Romantic Attachment and Marital Satisfaction

This study was the first to investigate the relationship between adult romantic attachment and marital satisfaction in a clinical sample of 172 distressed couples seeking therapy. Fifty-six therapy-seeking nondistressed couples were also assessed for comparison. Analyses of variance showed that attachment avoidance was a distinctive characteristic of distressed couples. Actor-partner analyses revealed that attachment avoidance (for men and women) and attachment anxiety (for women only) were predictive of marital dissatisfaction for distressed couples. Gender-stereotype discordant partner effects were also found. Results suggest that attachment orientations (especially avoidance) are relevant predictors of marital dissatisfaction in distressed couples seeking therapy, and that couple therapists can gain important information by assessing partners’ attachment orientations.     

Facial Reactions to Emotional Facial Expressions: Affect or Cognition?

This study investigated whether observers' facial reactions to the emotional facial expressions of others represent an affective or a cognitive response to these emotional expressions. Three hypotheses were contrasted: (1) facial reactions to emotional facial expressions are due to mimicry as part of an affective empathic reaction; (2) facial reactions to emotional facial expressions are a reflection of shared affect due to emotion induction; and (3) facial reactions to emotional facial expressions are determined by cognitive load depending on task difficulty. Two experiments were conducted varying type of task, presentation of stimuli, and task difficulty. The results show that depending on the nature of the rating task, facial reactions to facial expressions may be either affective or cognitive. Specifically, evidence for facial mimicry was only found when individuals made judgements regarding the valence of an emotional facial expression. Other types of judgements regarding facial expressions did not seem to elicit mimicry but may lead to facial responses related to cognitive load.     

Social anxiety biases the evaluation of facial displays: Evidence from single face and multi-facial stimuli

This study examined the contribution of social anxiety to the evaluation of emotional facial stimuli, while controlling for the gender of participants and stimuli. Participants (n=63) completed two tasks: a single face evaluation task in which they had to evaluate angry versus neutral faces and, a facial crowd evaluation task in which they had to evaluate displays with a varying number of neutral and angry faces. In each task, participants had to evaluate the stimuli with respect to (a) the degree of disapproval expressed by the single face/crowd, and (b) the perceived difficulty of interacting with the face/crowd (emotional cost). Consistent with earlier studies, results showed that social anxiety modulated the evaluation of single faces for emotional cost, but not for disapproval ratings. In contrast, the evaluation of facial crowds was modulated by social anxiety on both ratings.     

False belief and emotion understanding in monozygotic twins,dizygotic twins and non-twin children

This study investigated the understanding of false belief and emotion in monozygotic (MZ) and same-sex dizygotic (DZ) twin pairs compared to non-twin children. Aged 3;9 to 5;1 years, the children (N=123) were administered three false belief and three emotion understanding tasks. Age, family socioeconomic status, mother's level of education and language abilities were controlled. Results showed no difference between the three groups in false belief understanding. On emotion tasks, non-twin children and DZ twins did not differ from each other, but they both performed better than MZ twins. Results are discussed in terms of the Peterson's (2000) variety hypothesis and suggest that the affective closeness experienced by MZ twins might interfere with their understanding of others’ emotions.     

The unbearable articulatory nature of naming: on the reliability of word naming responses at the item level

Single-word naming is one of the most widely used experimental paradigms for studying how we read words. Following the seminal study by Spieler and Balota (Psychological Science 8:411–416, 1997), accounting for variance in item-level naming databases has become a major challenge for computational models of word reading. Using a new large-scale database of naming responses, we first provided a precise estimate of the amount of reproducible variance that models should try to account for with such databases. Second, by using an item-level measure of delayed naming, we showed that it captures not only the variance usually explained by onset phonetic properties, but also an additional part of the variance related to output processes. Finally, by comparing the item means from this new database with the ones reported in a previous study, we found that the two sets of item response times were highly reliable (r = .94) when the variance related to onset phonetic properties and voice-key sensitivity was factored out. Overall, the present results provide new guidelines for testing computational models of word naming with item-level databases.     

Conditional reasoning in context: A developmental dual processes account

The way individuals interpret “if p then q” conditionals varies with content and context, often resulting in a biconditional reading. Surprisingly, truth table tasks reveal the existence of two different types of biconditional interpretations: equivalence, as for promises and threats, and defective biconditional, as for causal conditionals or indicative conditionals involving binary terms. The aim of this study was to determine how the interpretation of indicative conditionals is affected in children, adolescents, and adults, by restricting their context of enunciation to only one possible alternative for both the antecedent and the consequent. Moreover, we wanted to determine what is the exact nature of the biconditional interpretation induced by these restricted contexts. For this purpose, third, sixth, and ninth graders and adults performed a truth-value task on indicative conditionals presented either in restricted on non-restricted contexts. Restricted contexts had no effect on children who have a conjunctive interpretation of the conditional, but elicited a predominant defective biconditional reading in adolescents and adults. These results corroborate the developmental dual process account of conditional reasoning proposed by Gauffroy and Barrouillet (2009).     

On the nature of mental models of conditional: The case of If,If then,and Only if

It has recently been reported that forward inferences from if p then q sentences (i.e., from antecedent to consequent) were faster than backward inferences from consequent to antecedent (Barrouillet, Grosset, & Lecas, 2000). The standard mental model theory assumes that this directionality effect is a figural effect due to the order the information enters working memory, whereas we claim that it results from the nature of the mental models that represent oriented relations from hypothetical values introduced by the word If. We tested these hypotheses in an experiment in which adult participants evaluated conditional syllogisms from either if p then q, p only if q, or p if q statements. Contrary to the predictions resulting from the standard theory, the three forms of the conditional provoked a reversed directionality effect and denial inferences took longer to endorse than affirmative inferences for all the forms of conditionals. We argue from these results that mental models of the conditional represent oriented relations instead of mere co-occurrences between events.     

Cognitive Mediators of Age-Related Differences in Language Comprehension and Verbal Memory Performance

The present study tried to specify how much processing speed, working memory capacity, and inhibition capability contribute to the effects of aging on language performance. An individual-differences approach was used to examine the component processes that predict performance in language comprehension and verbal long-term memory tasks. A total of 151 participants aged 31-80 completed language processing tasks and a battery of tasks designed to assess processing speed, working memory, and resistance to interference. Latent-construct structural equation modeling was used to examine the relationships of these factors and age to different types of language tasks. The best fit model showed first that all the significant relationships between age and language performance are mediated through reductions in speed, resistance to interference, and working memory; this confirms the validity of the general factor approach of age-related differences in cognitive performance. The best fit model, however, also showed that the contribution of speed and resistance to interference is indirect and mediated by working memory, which appears to play a crucial role in explaining age-related differences in language performance.