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Abstract
Assessment of the variations of clinical course to aid in diagnosis, assessment of patients' functioning and to guide treatment planning has gained momentum in recent years. A specific scale is introduced to plot the temporal course to assist empirically-minded psychotherapists and researchers who treat the DSM-5 Disorders and who want to monitor the quality of the course of psychosocial functioning over time. A Timeline Course Graphing Scale to Chart the Quality of Psychosocial Functioning Affected by Symptom Severity (PFS) is described and accompanied by administration guidelines.
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Affiliation(s)
- James P McCullough
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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52
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First MB. The importance of developmental field trials in the revision of psychiatric classifications. Lancet Psychiatry 2016; 3:579-84. [PMID: 27133547 DOI: 10.1016/s2215-0366(16)00048-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 10/21/2022]
Abstract
Field trials of diagnostic classification systems can be divided into two types: developmental field trials, which are designed to collect performance data from users during the revision process, and summative field trials, which aim to assess what users can expect in terms of the classification's psychometric properties after the classification has been completed. A crucial component of an empirically guided diagnostic revision process is the use of developmental field trials in which data are collected from users regarding the feasibility, reliability, validity, and clinical utility of proposed changes that can assist in refining the proposals before they are finalised. The DSM-III and ICD-10 reliability field trials are best considered summative as they were done primarily to establish whether clinicians using operationalised definitions could achieve adequate diagnostic reliability. The DSM-III-R and DSM-IV field trials, which collected performance data targeting specific diagnostic categories, heralded the use of developmental field trial data as an important component in the construction of diagnostic criteria sets, a process being continued in the ICD-11 revision process. Although initially presented as developmental in nature, the DSM-5 field trials ended up being essentially summative. Although reliability estimates with highly sophisticated methodology were provided for 23 mental disorders, the absence of information regarding the reliability of specific diagnostic items and the reasons for diagnostic disagreement prevented this information from being used to address identified reliability issues. Developmental field trials enhance the empirical basis for stating that psychiatric classifications are evidence based and they ultimately contribute to the improvement of clinical care for patients.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, Columbia University, New York, NY, USA; Division of Clinical Phenomenology, New York State Psychiatric Institute, New York, NY 10032, USA.
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53
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Reed GM, First MB, Elena Medina-Mora M, Gureje O, Pike KM, Saxena S. Draft diagnostic guidelines for ICD-11 mental and behavioural disorders available for review and comment. World Psychiatry 2016; 15:112-3. [PMID: 27265692 PMCID: PMC4911773 DOI: 10.1002/wps.20322] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
- INPRFM-UNAM Center for Global Mental Health Research, Mexico, DF, Mexico
| | - Michael B First
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | | | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Kathleen M Pike
- Global Mental Health Program, Columbia University, New York, NY, USA
| | - Shekhar Saxena
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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54
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Keeley JW, Reed GM, Roberts MC, Evans SC, Medina-Mora ME, Robles R, Rebello T, Sharan P, Gureje O, First MB, Andrews HF, Ayuso-Mateos JL, Gaebel W, Zielasek J, Saxena S. Developing a science of clinical utility in diagnostic classification systems field study strategies for ICD-11 mental and behavioral disorders. Am Psychol 2016; 71:3-16. [PMID: 26766762 DOI: 10.1037/a0039972] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The World Health Organization (WHO) Department of Mental Health and Substance Abuse has developed a systematic program of field studies to evaluate and improve the clinical utility of the proposed diagnostic guidelines for mental and behavioral disorders in the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11). The clinical utility of a diagnostic classification is critical to its function as the interface between health encounters and health information, and to making the ICD-11 be a more effective tool for helping the WHO's 194 member countries, including the United States, reduce the global disease burden of mental disorders. This article describes the WHO's efforts to develop a science of clinical utility in regard to one of the two major classification systems for mental disorders. We present the rationale and methodologies for an integrated and complementary set of field study strategies, including large international surveys, formative field studies of the structure of clinicians' conceptualization of mental disorders, case-controlled field studies using experimental methodologies to evaluate the impact of proposed changes to the diagnostic guidelines on clinicians' diagnostic decision making, and ecological implementation field studies of clinical utility in the global settings in which the guidelines will ultimately be implemented. The results of these studies have already been used in making decisions about the structure and content of ICD-11. If clinical utility is indeed among the highest aims of diagnostic systems for mental disorders, as their developers routinely claim, future revision efforts should continue to build on these efforts. (PsycINFO Database Record
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Affiliation(s)
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization
| | | | | | | | - Rebeca Robles
- National Institute of Psychiatry "Ramón de la Fuente"
| | - Tahilia Rebello
- Global Mental Health Program, Columbia University Medical Center
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan
| | - Michael B First
- Department of Psychiatry, Columbia University Medical Center
| | | | | | | | | | - Shekhar Saxena
- Department of Mental Health and Substance Abuse, World Health Organization
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55
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First MB, Reed GM, Hyman SE, Saxena S. The development of the ICD-11 Clinical Descriptions and Diagnostic Guidelines for Mental and Behavioural Disorders. World Psychiatry 2015; 14:82-90. [PMID: 25655162 PMCID: PMC4329901 DOI: 10.1002/wps.20189] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The World Health Organization is in the process of preparing the eleventh revision of the International Classification of Diseases (ICD-11), scheduled for presentation to the World Health Assembly for approval in 2017. The International Advisory Group for the Revision of the ICD-10 Mental and Behavioural Disorders made improvement in clinical utility an organizing priority for the revision. The uneven nature of the diagnostic information included in the ICD-10 Clinical Descriptions and Diagnostic Guidelines (CDDG), especially with respect to differential diagnosis, is a major shortcoming in terms of its usefulness to clinicians. Consequently, ICD-11 Working Groups were asked to collate diagnostic information about the disorders under their purview using a standardized template (referred to as a "Content Form"). Using the information provided in the Content Forms as source material, the ICD-11 CDDG are being developed with a uniform structure. The effectiveness of this format in producing more consistent clinical judgments in ICD-11 as compared to ICD-10 is currently being tested in a series of Internet-based field studies using standardized case material, and will also be tested in clinical settings.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, Columbia University and
Department of Clinical Phenomenology, New York State Psychiatric Institute1051 Riverside Drive, New York, NY, 10032, USA
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World
Health OrganizationGeneva, Switzerland
| | - Steven E Hyman
- Stanley Center for Psychiatric Research, Broad Institute
of Harvard and Massachusetts Institute of TechnologyCambridge, MA, USA
| | - Shekhar Saxena
- Department of Mental Health and Substance Abuse, World
Health OrganizationGeneva, Switzerland
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56
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Abstract
PURPOSE OF REVIEW To propose options for gradually transitioning to a thoroughgoing dimensional model of personality disorder. RECENT FINDINGS The American Psychiatric Association was less willing to implement a dimensional approach to the diagnosis of personality disorder than the leadership of the DSM-5 anticipated. The next opportunity to implement such an approach will be in the ICD-11 and the DSM 5.1. SUMMARY Instead of seeking a revolutionary change, attempting a more gradual transition that leads to something significantly better in the long run is likely to be more successful. For the long run, in addition to clinical utility and scientific validity, new diagnostic models must possess user acceptability. Professionals will be more likely to accept a new model if they believe it will allow them to do good work. Competent use of a dimensional model is not only a matter of increased familiarity with personality trait profiles, it requires a different kind of clinical expertise.
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Affiliation(s)
- Peter Zachar
- aDepartment of Psychology, Auburn University Montgomery, Montgomery, Alabama bDepartment of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
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57
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Affiliation(s)
- Harold J Burstajn
- Program in Psychiatry and the Law @ BIDMC Psychiatry of Harvard Medical School, 96 Larchwood Drive, Cambridge, MA 02138, USA.
| | - Michael B First
- Columbia University Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
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58
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First MB. Empirical grounding versus innovation in the DSM‐5 revision process: Implications for the future. Clinical Psychology: Science and Practice 2014. [DOI: 10.1111/cpsp.12069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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59
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Strauss KA, Markx S, Georgi B, Paul SM, Jinks RN, Hoshi T, McDonald A, First MB, Liu W, Benkert AR, Heaps AD, Tian Y, Chakravarti A, Bucan M, Puffenberger EG. A population-based study of KCNH7 p.Arg394His and bipolar spectrum disorder. Hum Mol Genet 2014; 23:6395-406. [PMID: 24986916 PMCID: PMC4222358 DOI: 10.1093/hmg/ddu335] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We conducted blinded psychiatric assessments of 26 Amish subjects (52 ± 11 years) from four families with prevalent bipolar spectrum disorder, identified 10 potentially pathogenic alleles by exome sequencing, tested association of these alleles with clinical diagnoses in the larger Amish Study of Major Affective Disorder (ASMAD) cohort, and studied mutant potassium channels in neurons. Fourteen of 26 Amish had bipolar spectrum disorder. The only candidate allele shared among them was rs78247304, a non-synonymous variant of KCNH7 (c.1181G>A, p.Arg394His). KCNH7 c.1181G>A and nine other potentially pathogenic variants were subsequently tested within the ASMAD cohort, which consisted of 340 subjects grouped into controls subjects and affected subjects from overlapping clinical categories (bipolar 1 disorder, bipolar spectrum disorder and any major affective disorder). KCNH7 c.1181G>A had the highest enrichment among individuals with bipolar spectrum disorder (χ2 = 7.3) and the strongest family-based association with bipolar 1 (P = 0.021), bipolar spectrum (P = 0.031) and any major affective disorder (P = 0.016). In vitro, the p.Arg394His substitution allowed normal expression, trafficking, assembly and localization of HERG3/Kv11.3 channels, but altered the steady-state voltage dependence and kinetics of activation in neuronal cells. Although our genome-wide statistical results do not alone prove association, cumulative evidence from multiple independent sources (parallel genome-wide study cohorts, pharmacological studies of HERG-type potassium channels, electrophysiological data) implicates neuronal HERG3/Kv11.3 potassium channels in the pathophysiology of bipolar spectrum disorder. Such a finding, if corroborated by future studies, has implications for mental health services among the Amish, as well as development of drugs that specifically target HERG3/Kv11.3.
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Affiliation(s)
- Kevin A Strauss
- Clinic for Special Children, Strasburg, PA, USA, Franklin & Marshall College, Lancaster, PA, USA, Lancaster General Hospital, Lancaster, PA, USA,
| | - Sander Markx
- Department of Psychiatry, Columbia University, New York, New York, USA
| | | | - Steven M Paul
- Departments of Neuroscience, Psychiatry and Pharmacology, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Robert N Jinks
- Biological Foundations of Behavior Program, Franklin & Marshall College, Lancaster, PA, USA and
| | - Toshinori Hoshi
- Department of Physiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ann McDonald
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Michael B First
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Wencheng Liu
- Departments of Neuroscience, Psychiatry and Pharmacology, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Abigail R Benkert
- Clinic for Special Children, Strasburg, PA, USA, Biological Foundations of Behavior Program, Franklin & Marshall College, Lancaster, PA, USA and
| | | | - Yutao Tian
- Department of Physiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Aravinda Chakravarti
- Center for Complex Disease Genomics, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maja Bucan
- Department of Genetics, Perelman School of Medicine and
| | - Erik G Puffenberger
- Clinic for Special Children, Strasburg, PA, USA, Franklin & Marshall College, Lancaster, PA, USA
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60
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First MB. Preserving the clinician-researcher interface in the age of RDoC: the continuing need for DSM-5/ICD-11 characterization of study populations. World Psychiatry 2014; 13:53-4. [PMID: 24497252 PMCID: PMC3918023 DOI: 10.1002/wps.20107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Michael B. First
- Columbia University and New York State Psychiatric Institute; New York NY USA
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61
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First MB. DSM-5 and paraphilic disorders. J Am Acad Psychiatry Law 2014; 42:191-201. [PMID: 24986346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Given that paraphilic disorders are diagnosed largely in forensic settings, virtually every significant change in the criteria has forensic implications. Several controversial changes were considered during the DSM-5 revision process, but most were ultimately not included in the published text. However, any changes that make it easier to assign a paraphilic disorder diagnosis to an individual must be considered with caution. Criterion A for paraphilic disorders has been changed to reduce one potential risk that could result in false-positive diagnoses (i.e., allowing evaluators to diagnose a paraphilic disorder based entirely on the presence of sexual acts). In contrast, many of the other changes including some of those in the text, make it easier to diagnose a specific paraphilia and thus increase the risk of false-positive diagnoses. Since the assignment of a paraphilic disorder diagnosis can result in adverse legal consequences, the actual forensic impact of the changes will depend on how the legal system incorporates these new definitions into statutes and case law.
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Affiliation(s)
- Michael B First
- Dr. First is Professor of Clinical Psychiatry, Department of Psychiatry, Columbia University, and Research Psychiatrist, Biometrics Department, New York State Psychiatric Institute, New York, NY.
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62
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Kessler RC, Santiago PN, Colpe LJ, Dempsey CL, First MB, Heeringa SG, Stein MB, Fullerton CS, Gruber MJ, Naifeh JA, Nock MK, Sampson NA, Schoenbaum M, Zaslavsky AM, Ursano RJ. Clinical reappraisal of the Composite International Diagnostic Interview Screening Scales (CIDI-SC) in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Int J Methods Psychiatr Res 2013; 22:303-21. [PMID: 24318219 PMCID: PMC4027964 DOI: 10.1002/mpr.1398] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 11/06/2022] Open
Abstract
A clinical reappraisal study was carried out in conjunction with the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) All-Army Study (AAS) to evaluate concordance of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses based on the Composite International Diagnostic Interview Screening Scales (CIDI-SC) and post-traumatic stress disorder (PTSD) checklist (PCL) with diagnoses based on independent clinical reappraisal interviews (Structured Clinical Interview for DSM-IV [SCID]). Diagnoses included: lifetime mania/hypomania, panic disorder, and intermittent explosive disorder; six-month adult attention-deficit/hyperactivity disorder; and 30-day major depressive episode, generalized anxiety disorder, PTSD, and substance (alcohol or drug) use disorder (abuse or dependence). The sample (n = 460) was weighted for over-sampling CIDI-SC/PCL screened positives. Diagnostic thresholds were set to equalize false positives and false negatives. Good individual-level concordance was found between CIDI-SC/PCL and SCID diagnoses at these thresholds (area under curve [AUC] = 0.69-0.79). AUC was considerably higher for continuous than dichotomous screening scale scores (AUC = 0.80-0.90), arguing for substantive analyses using not only dichotomous case designations but also continuous measures of predicted probabilities of clinical diagnoses.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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63
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First MB, Wakefield JC. Diagnostic criteria as dysfunction indicators: bridging the chasm between the definition of mental disorder and diagnostic criteria for specific disorders. Can J Psychiatry 2013; 58:663-9. [PMID: 24331285 DOI: 10.1177/070674371305801203] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
According to the introduction to the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, each disorder must satisfy the definition of mental disorder, which requires the presence of both harm and dysfunction. Constructing criteria sets to require harm is relatively straightforward. However, establishing the presence of dysfunction is necessarily inferential because of the lack of knowledge of internal psychological and biological processes and their functions and dysfunctions. Given that virtually every psychiatric symptom characteristic of a DSM disorder can occur under some circumstances in a normally functioning person, diagnostic criteria based on symptoms must be constructed so that the symptoms indicate an internal dysfunction, and are thus inherently pathosuggestive. In this paper, we review strategies used in DSM criteria sets for increasing the pathosuggestiveness of symptoms to ensure that the disorder meets the requirements of the definition of mental disorder. Strategies include the following: requiring a minimum duration and persistence; requiring that the frequency or intensity of a symptom exceed that seen in normal people; requiring disproportionality of symptoms, given the context; requiring pervasiveness of symptom expression across contexts; adding specific exclusions for contextual scenarios in which symptoms are best understood as normal reactions; combining symptoms to increase cumulative pathosuggestiveness; and requiring enough symptoms from an overall syndrome to meet a minimum threshold of pathosuggestiveness. We propose that future revisions of the DSM consider systematic implementation of these strategies in the construction and revision of criteria sets, with the goal of maximizing the pathosuggestiveness of diagnostic criteria to reduce the potential for diagnostic false positives.
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Affiliation(s)
- Michael B First
- Professor of Clinical Psychiatry, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Research Psychiatrist, Division of Clinical Phenomenology, New York State Psychiatric Institute, New York, New York
| | - Jerome C Wakefield
- Professor of Social Work, Silver School of Social Work, New York University, New York, New York; Professor of Psychiatry, Department of Psychiatry, School of Medicine, New York University, New York, New York
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64
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Wakefield JC, First MB. Diagnostic validity and the definition of mental disorder: a program for conceptually advancing psychiatry. Can J Psychiatry 2013; 58:653-5. [PMID: 24331283 DOI: 10.1177/070674371305801201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jerome C Wakefield
- Professor of Social Work, Silver School of Social Work, New York University, New York, New York; Professor of Psychiatry, Department of Psychiatry, School of Medicine, New York University, New York, New York
| | - Michael B First
- Professor of Clinical Psychiatry, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; Research Psychiatrist, Division of Clinical Phenomenology, New York State Psychiatric Institute, New York, New York
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65
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Abstract
The In Review articles in this issue on normality and disorder by Dr Rachel Cooper and Dr Derek Bolton explore the importance of a value component of harm in the concept of mental disorder. They focus on the Diagnostic and Statistical Manual of Mental Disorder's clinical significance criterion, requiring that symptoms cause significant distress or role impairment, as the expression of the harm component. As Dr Bolton argues, harm in the form of distress or role impairment has always been intimately tied to the concept of disorder and treatment decisions; as Dr Cooper argues, without the harm requirement, any disliked anomaly may be labelled a disorder. Moreover, as Cooper argues, a harm requirement is not incompatible with a natural kinds approach to distinguishing among disorders or to a categorical approach to disorder; the lack of zones of rarity on the harm continuum does not preclude categorical underlying causal processes. However, neither paper systematically develops arguments regarding the other component of disorder, the requirement that the harm must be caused by underlying dysfunction. The dysfunction component distinguishes disorders from the many other negative conditions in life. Cooper's identification of dysfunction with symptom severity ignores the fact that normal suffering can be severe, and Bolton's attempt to encompass risk of harm within harm yields an implausibly expansive conception of disorder. While the harm component is essential, clarification of the dysfunction component of the concept of disorder, pursued in part 2 of this In Review in the December 2013 issue, is also essential to establishing a coherent and plausibly limited domain of psychiatric disorder within the broader arena of harmful conditions.
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Affiliation(s)
- Jerome C Wakefield
- Professor of Social Work, Silver School of Social Work, New York University, New York, New York; Professor of Psychiatry, Department of Psychiatry, School of Medicine, New York University, New York, New York
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66
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Wakefield JC, First MB. Clarifying the boundary between normality and disorder: a fundamental conceptual challenge for psychiatry. Can J Psychiatry 2013; 58:603-5. [PMID: 24246429 DOI: 10.1177/070674371305801104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jerome C Wakefield
- Professor of Social Work, Silver School of Social Work, New York University, New York, New York; Professor of Psychiatry, Department of Psychiatry, School of Medicine, New York University, New York, New York
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67
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Maercker A, Brewin CR, Bryant RA, Cloitre M, van Ommeren M, Jones LM, Humayan A, Kagee A, Llosa AE, Rousseau C, Somasundaram DJ, Souza R, Suzuki Y, Weissbecker I, Wessely SC, First MB, Reed GM. Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World Psychiatry 2013; 12:198-206. [PMID: 24096776 PMCID: PMC3799241 DOI: 10.1002/wps.20057] [Citation(s) in RCA: 412] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The diagnostic concepts of post-traumatic stress disorder (PTSD) and other disorders specifically associated with stress have been intensively discussed among neuro- and social scientists, clinicians, epidemiologists, public health planners and humanitarian aid workers around the world. PTSD and adjustment disorder are among the most widely used diagnoses in mental health care worldwide. This paper describes proposals that aim to maximize clinical utility for the classification and grouping of disorders specifically associated with stress in the forthcoming 11th revision of the International Classification of Diseases (ICD-11). Proposals include a narrower concept for PTSD that does not allow the diagnosis to be made based entirely on non-specific symptoms; a new complex PTSD category that comprises three clusters of intra- and interpersonal symptoms in addition to core PTSD symptoms; a new diagnosis of prolonged grief disorder, used to describe patients that undergo an intensely painful, disabling, and abnormally persistent response to bereavement; a major revision of "adjustment disorder" involving increased specification of symptoms; and a conceptualization of "acute stress reaction" as a normal phenomenon that still may require clinical intervention. These proposals were developed with specific considerations given to clinical utility and global applicability in both low- and high-income countries.
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Affiliation(s)
- Andreas Maercker
- Department of Psychology, Division of Psychopathology, University of ZurichSwitzerland
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College LondonLondon, UK
| | - Richard A Bryant
- School of Psychology, University of New South WalesSydney, Australia
| | - Marylene Cloitre
- Division of Dissemination and Training, National Center for PTSDMenlo Park, CA, USA
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health OrganizationGeneva, Switzerland
| | - Lynne M Jones
- FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard UniversityCambridge, MA, USA
| | - Asma Humayan
- Institute of PsychiatryBenazir Bhutto Hospital, Murree Road, Rawalpindi, Pakistan
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch UniversityStellenbosch, South Africa
| | | | - Cécile Rousseau
- Department of Psychiatry, McGill University Health CenterMontréal, Canada
| | - Daya J Somasundaram
- University of JaffnaSri Lanka,Glenside Mental Health ServicesGlenside, South Australia, Australia
| | - Renato Souza
- International Committee of the Red CrossGeneva, Switzerland
| | - Yuriko Suzuki
- National Center of Neurology and Psychiatry, National Institute of Mental HealthTokyo, Japan
| | | | | | - Michael B First
- Department of Psychiatry, Columbia University Medical CenterNew York, NY, USA
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health OrganizationGeneva, Switzerland
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68
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Maercker A, Brewin CR, Bryant RA, Cloitre M, Reed GM, van Ommeren M, Humayun A, Jones LM, Kagee A, Llosa AE, Rousseau C, Somasundaram DJ, Souza R, Suzuki Y, Weissbecker I, Wessely SC, First MB, Saxena S. Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet 2013; 381:1683-5. [PMID: 23583019 DOI: 10.1016/s0140-6736(12)62191-6] [Citation(s) in RCA: 294] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Andreas Maercker
- Department of Psychology, Division of Psychopathology, University of Zurich, Zurich, Switzerland.
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69
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Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue. Part 4: general conclusion. Philos Ethics Humanit Med 2012; 7:14. [PMID: 23249629 PMCID: PMC3563521 DOI: 10.1186/1747-5341-7-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/20/2012] [Indexed: 06/01/2023] Open
Abstract
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.
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Affiliation(s)
- James Phillips
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Allen Frances
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA
| | - Michael A Cerullo
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH, 45219, USA
| | - John Chardavoyne
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Hannah S Decker
- Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Nassir Ghaemi
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Gary Greenberg
- Human Relations Counseling Service, 400 Bayonet Street Suite #202, New London, CT, 06320, USA
| | - Andrew C Hinderliter
- Department of Linguistics, University of Illinois, Urbana-Champaign, 4080 Foreign Languages Building, 707 S Mathews Ave, Urbana, IL, 61801, USA
| | - Warren A Kinghorn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA
- Duke Divinity School, Box 90968, Durham, NC, 27708, USA
| | - Steven G LoBello
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
| | - Elliott B Martin
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Aaron L Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL, 60654, USA
| | - Joel Paris
- Department of Psychiatry, Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, McGill University, 4333 cote Ste. Catherine, Montreal, QC, H3T1E4, Canada
| | - Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Ronald W Pies
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY, 13210, USA
| | - Harold A Pincus
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA
- New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY, 10032, USA
- Rand Corporation, 1776 Main St Santa Monica, California, 90401, USA
| | - Douglas Porter
- Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA, 70113, USA
| | - Claire Pouncey
- Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA
| | - Michael A Schwartz
- Department of Psychiatry, Texas A & M College of Medicine, 4110 Guadalupe Street, Austin, TX, 78751, USA
| | - Thomas Szasz
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY, 13210, USA
| | - Jerome C Wakefield
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
- Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY, 10016, USA
| | - G Scott Waterman
- Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, VT, 05405, USA
| | - Owen Whooley
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St, New Brunswick, NJ, 08901, USA
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
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First MB. Commentary on Krueger and Eaton's "Personality traits and the classification of mental disorders: toward a more complete integration in DSM-5 and an empirical model of psychopathology": real-world considerations in implementing an empirically based dimensional model of personality in DSM-5. Personal Disord 2012; 1:123-6. [PMID: 22448623 DOI: 10.1037/a0019975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In their article, Krueger and Eaton (pp. 97-118, this issue) advocate for a "more complete and extensive integration of personality traits in future DSMs [Diagnostic and Statistical Manuals of Mental Disorders], via the explicit inclusion of an empirically based, dimensional personality trait model" (p. 97) and review the "diverse ways in which the inclusion of an empirically based personality trait model could constitute a critical innovation in the transition from DSM-IV to DSM-5" (p. 113). Krueger and Eaton's proposal that (DSM-5) adopt a dimensional personality trait approach exemplifies the difficulties of devising a classification scheme that satisfies the needs of the both the clinical and research communities. In this instance, the challenge is adapting a complex dimensional trait scheme developed and utilized almost exclusively by the research community, for clinical use.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, Columbia University, New York, NY, USA.
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Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis. Philos Ethics Humanit Med 2012; 7:8. [PMID: 22512887 PMCID: PMC3390269 DOI: 10.1186/1747-5341-7-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 04/18/2012] [Indexed: 05/31/2023] Open
Abstract
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 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.
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Affiliation(s)
- James Phillips
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven,, CT, 06511, USA
| | - Allen Frances
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St., Durham, NC, 27710, USA
| | - Michael A Cerullo
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH, 45219, USA
| | - John Chardavoyne
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven,, CT, 06511, USA
| | - Hannah S Decker
- Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
| | - Michael B First
- Department of Psychiatry, Division of Clinical Phenomenology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Nassir Ghaemi
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Gary Greenberg
- Human Relations Counseling Service, 400 Bayonet Street Suite #202, New London, CT, 06320, USA
| | - Andrew C Hinderliter
- Department of Linguistics, University of Illinois, Urbana-Champaign 4080 Foreign Languages Building, 707 S Mathews Ave, Urbana, IL, 61801, USA
| | - Warren A Kinghorn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St., Durham, NC, 27710, USA
- Duke Divinity School, Box 90968, Durham, NC, 27708, USA
| | - Steven G LoBello
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
| | - Elliott B Martin
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven,, CT, 06511, USA
| | - Aaron L Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL, 60654, USA
| | - Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University, 4333 cote Ste. Catherine, Montreal, QC, H3T1E4, Canada
| | - Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Ronald W Pies
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY, 13210, USA
| | - Harold A Pincus
- Department of Psychiatry, Division of Clinical Phenomenology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA
- New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY, 10032, USA
- Rand Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Douglas Porter
- Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA, 70113, USA
| | - Claire Pouncey
- Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA
| | - Michael A Schwartz
- Department of Psychiatry, Texas A&M Health Science Center - College of Medicine, 4110 Guadalupe Street, Austin, TX 78751, USA
| | - Thomas Szasz
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY, 13210, USA
| | - Jerome C Wakefield
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
- Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY, 10016, USA
| | - G Scott Waterman
- Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, VT, 05405, USA
| | - Owen Whooley
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St., New Brunswick, NJ, 08901, USA
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
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Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue part 3: issues of utility and alternative approaches in psychiatric diagnosis. Philos Ethics Humanit Med 2012; 7:9. [PMID: 22621419 PMCID: PMC3403926 DOI: 10.1186/1747-5341-7-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 05/23/2012] [Indexed: 06/01/2023] Open
Abstract
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 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.
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Affiliation(s)
- James Phillips
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Allen Frances
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA
| | - Michael A Cerullo
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH, 45219, USA
| | - John Chardavoyne
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Hannah S Decker
- Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Nassir Ghaemi
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Gary Greenberg
- Human Relations Counseling Service, 400 Bayonet Street Suite 202, New London, CT, 06320, USA
| | - Andrew C Hinderliter
- Department of Linguistics, University of Illinois, Urbana-Champaign, 4080 Foreign Languages Building, 707S Mathews Ave, Urbana, IL, 61801, USA
| | - Warren A Kinghorn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA
- Duke Divinity School, Box 90968, Durham, NC, 27708, USA
| | - Steven G LoBello
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
| | - Elliott B Martin
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Aaron L Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL, 60654, USA
| | - Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University, 4333 cote Ste. Catherine, Montreal, H3T1E4, QC, Canada
| | - Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Ronald W Pies
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St, #343CWB, Syracuse, NY, 13210, USA
| | - Harold A Pincus
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA
- New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY, 10032, USA
- Rand Corporation, 1776 Main St Santa Monica, California, 90401, USA
| | - Douglas Porter
- Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA, 70113, USA
| | - Claire Pouncey
- Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA
| | - Michael A Schwartz
- Department of Psychiatry, Texas A & M College of Medicine, 4110 Guadalupe Street, Austin, Texas, 78751, USA
| | - Thomas Szasz
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St, #343CWB, Syracuse, NY, 13210, USA
| | - Jerome C Wakefield
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
- Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY, 10016, USA
| | - G Scott Waterman
- Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, Vermont, 05405, USA
| | - Owen Whooley
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson St, New Brunswick, NJ, 08901, USA
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
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Wakefield JC, First MB. Placing symptoms in context: the role of contextual criteria in reducing false positives in Diagnostic and Statistical Manual of Mental Disorders diagnoses. Compr Psychiatry 2012; 53:130-9. [PMID: 21565335 DOI: 10.1016/j.comppsych.2011.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/05/2011] [Accepted: 03/12/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The Diagnostic and Statistical Manual of Mental Disorders (DSM) definition of mental disorder requires that symptoms be caused by a dysfunction in the individual; when dysfunction is absent, symptoms represent normal-range distress or eccentricity and, if diagnosed as a mental disorder, are false positives. We hypothesized that because of psychiatry's lack of direct laboratory tests to distinguish dysfunction from normal-range distress, the context in which symptoms occur (eg, lack of imminent danger in a panic attack) is often essential to determining whether symptoms are caused by a dysfunction. If this is right, then the DSM diagnostic criteria should include many contextual criteria added to symptom syndromes to prevent dysfunction false positives. Despite their potential importance, such contextual criteria have not been previously reviewed. We, thus, systematically reviewed DSM categories to establish the extent of such uses of contextual criteria and created a typology of such uses. RESULTS Of 111 sampled categories, 68 (61%) used context to prevent dysfunction false positives. Contextual criteria fell into 7 types: (1) exclusion of specific false-positive scenarios; (2) requiring that patients experience preconditions for normal responses (eg, requiring that individuals experience adequate sexual stimulation before being diagnosed with sexual dysfunctions); (3) requiring that symptoms be disproportionate relative to circumstances; (4) for childhood disorders, requiring that symptoms be developmentally inappropriate; (5) requiring that symptoms occur in multiple contexts; (6) requiring a substantial discrepancy between beliefs and reality; and (7) a residual category. CONCLUSIONS Most DSM categories include contextual criteria to eliminate false-positive diagnoses and increase validity of descriptive criteria. Future revisions should systematically evaluate each category's need for contextual criteria.
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Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis. Philos Ethics Humanit Med 2012; 7:3. [PMID: 22243994 PMCID: PMC3305603 DOI: 10.1186/1747-5341-7-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 01/13/2012] [Indexed: 05/12/2023] Open
Abstract
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.
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Affiliation(s)
- James Phillips
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA
| | - Allen Frances
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St., Durham, NC 27710, USA
| | - Michael A Cerullo
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH 45219, USA
| | - John Chardavoyne
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA
| | - Hannah S Decker
- Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Nassir Ghaemi
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Gary Greenberg
- Human Relations Counseling Service, 400 Bayonet Street Suite #202, New London, CT 06320, USA
| | - Andrew C Hinderliter
- Department of Linguistics, University of Illinois, Urbana-Champaign 4080 Foreign Languages Building, 707 S Mathews Ave, Urbana, IL 61801, USA
| | - Warren A Kinghorn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St., Durham, NC 27710, USA
- Duke Divinity School, Box 90968, Durham, NC 27708, USA
| | - Steven G LoBello
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL 36117, USA
| | - Elliott B Martin
- Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA
| | - Aaron L Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago IL, 60654, USA
| | - Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University, 4333 cote Ste. Catherine, Montreal H3T1E4 Quebec, Canada
| | - Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, USA
- VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
| | - Ronald W Pies
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY 13210, USA
| | - Harold A Pincus
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
- New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY 10032, USA
- Rand Corporation, 1776 Main St Santa Monica, California 90401, USA
| | - Douglas Porter
- Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA 70113, USA
| | - Claire Pouncey
- Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320 Philadelphia, PA 19104, USA
| | - Michael A Schwartz
- Department of Psychiatry, Texas AMHSC College of Medicine, 4110 Guadalupe Street, Austin, Texas 78751, USA
| | - Thomas Szasz
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY 13210, USA
| | - Jerome C Wakefield
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA
- Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY 10016, USA
| | - G Scott Waterman
- Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, Vermont 05405, USA
| | - Owen Whooley
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St., New Brunswick, NJ 08901, USA
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL 36117, USA
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First MB, Fisher CE. Body integrity identity disorder: the persistent desire to acquire a physical disability. Psychopathology 2012; 45:3-14. [PMID: 22123511 DOI: 10.1159/000330503] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 07/01/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Body integrity identity disorder (BIID) is a rare and unusual psychiatric condition characterized by a persistent desire to acquire a physical disability (e.g., amputation, paraplegia) since childhood that to date has not been formally described in the psychiatric nosology. Most BIID sufferers experience a chronic and dysphoric sense of inappropriateness regarding their being able-bodied, and many have been driven to actualize their desired disability through surreptitious surgical or other more dangerous methods. This review aims to characterize the history and phenomenology of this condition, to present its differential diagnosis, and to consider possible etiologies, treatment options, and ethical considerations. SAMPLING AND METHOD Review of the psychiatric and neurological literature. RESULTS A growing body of data suggests the existence of a discrete entity with onset by early adolescence and a negative impact on functioning. Parallel neurological conditions and preliminary experimental investigations suggest a possible neurobiological component in at least a portion of cases. While attempts at treatment have been described, no systematic evidence for efficacy has emerged. DISCUSSION BIID is a unique nosological entity with significant consequences for its sufferers and as such may warrant inclusion in some form in the forthcoming DSM-5 and ICD-11.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
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77
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Wakefield JC, First MB. Treatment outcome for bereavement-excluded depression: results of the study by Corruble et al are not what they seem. J Clin Psychiatry 2011; 72:1155; author reply 1155-6. [PMID: 21899820 DOI: 10.4088/jcp.11lr07147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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78
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Rivas Rodríguez M, Reed GM, First MB, Ayuso-Mateos JL. [Contributions from two Latin American psychiatric classifications to the development of ICD-11]. Rev Panam Salud Publica 2011; 29:130-137. [PMID: 21437371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 10/21/2010] [Indexed: 05/30/2023] Open
Abstract
In the context of the updating of the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), this study conducted a code-by-code comparison between the ICD-10 chapter "Mental and Behavioural Disorders" and the diagnostic categories of two Latin American classification schemes: the Third Cuban Psychiatric Glossary (GC-3) and the Latin American Guide to Psychiatric Diagnosis (GLADP). The objective was to help define what categories in the current classification should be broadened and what new categories might be added to the future ICD-11 to make it more applicable in local sociocultural and clinical contexts that differ from those found in regions whose perspectives have historically dominated the ICD, namely, the United States and Europe. It is hoped that the results will contribute to the efforts under way to develop a genuinely international classification system.
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Affiliation(s)
- Mar Rivas Rodríguez
- Departamento de Psiquiatría, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Espana
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79
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Frances A, First MB. Hebephilia is not a mental disorder in DSM-IV-TR and should not become one in DSM-5. J Am Acad Psychiatry Law 2011; 39:78-85. [PMID: 21389170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The paraphilia section of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) is being misinterpreted in the forensic evaluations of sexually violent offenders. The resulting misuse of the term paraphilia not otherwise specified, hebephilia, has justified the inappropriate involuntary commitment of individuals who do not in fact qualify for a DSM-IV-TR diagnosis of mental disorder. This article has two purposes: to clarify what the DSM-IV-TR was meant to convey and how it has been twisted in translation within the legal system, and to warn that the DSM-5 proposal to include pedohebephilia threatens to make the current bad situation very much worse in the future.
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Affiliation(s)
- Allen Frances
- Department of Psychiatry and Behavioral Science, Duke University, Durham, NC, USA.
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80
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Frances A, First MB. Paraphilia NOS, nonconsent: not ready for the courtroom. J Am Acad Psychiatry Law 2011; 39:555-561. [PMID: 22159984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Sexually violent predators (SVP) constitute a serious potential risk to public safety, especially when they are released after too short a prison sentence. Twenty states and the federal government have developed a seemingly convenient way to reduce this risk. They have passed statutes that allow for the involuntary (often lifetime) psychiatric commitment of mentally disordered sexual offenders after prison time is up. In three separate cases, the Supreme Court has accepted the constitutionality of this procedure, but only if the offender's dangerousness is caused by a mental disorder and is not a manifestation of simple criminality. The idea that paraphilic rape should be an official category in the psychiatric diagnostic manual has been explicitly rejected by Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, DSM-III-R, DSM-IV, and, recently, DSM-5. Despite this, paraphilia NOS, nonconsent, is still frequently used by mental health evaluators in SVP cases to provide a mental disorder diagnosis that legitimizes psychiatric commitment and makes it appear constitutional. This commentary will show how the diagnosis paraphilia NOS, nonconsent, is based on a fundamental misreading of the original intent of the DSM-IV Paraphilia Workgroup and represents a misuse of psychiatry, all in the admittedly good cause of protecting public safety.
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Affiliation(s)
- Allen Frances
- Department of Psychiatry and Behavioral Science, Duke University, Durham, NC, USA.
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81
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First MB. The inclusion of child pornography in the DSM-5 diagnostic criteria for pedophilia: conceptual and practical problems. J Am Acad Psychiatry Law 2011; 39:250-254. [PMID: 21653274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The proposal to add use of child pornography to Criterion B of pedophilia is in direct conflict with the newly proposed distinction between paraphilia and paraphilic disorder, muddying rather than clarifying the diagnostic definition of pedophilia. The proposal to distinguish paraphilic disorder from paraphilia derives from the fact that the diagnostic criteria for the paraphilias have two components: Criterion A, defining the presence of a paraphilic erotic interest, and Criterion B, requiring clinically significant distress, impairment, or acting out the paraphilia with a nonconsenting person. Meeting Criteria A and B is necessary for a diagnosis of paraphilic disorder; meeting only Criterion A indicates a paraphilia. Use of pornography is better placed within Criterion A, perhaps as an example of a behavioral manifestation of pedophilia. If the Sexual and Gender Identity Disorders Work Group's true intent was to add a third prong to Criterion B, then the criterion must be modified to restrict it to the use of illegal forms of pornography (i.e., visual depictions of real children), excluding written or aural forms or virtual images.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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First MB. DSM-5 proposals for paraphilias: suggestions for reducing false positives related to use of behavioral manifestations. Arch Sex Behav 2010; 39:1239-44; author reply 1245-1252. [PMID: 20697936 DOI: 10.1007/s10508-010-9657-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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84
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First MB. Paradigm shifts and the development of the diagnostic and statistical manual of mental disorders: past experiences and future aspirations. Can J Psychiatry 2010; 55:692-700. [PMID: 21070696 DOI: 10.1177/070674371005501102] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Work is currently under way on the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, due to be published by the American Psychiatric Association in 2013. Dissatisfaction with the current categorical descriptive approach has led to aspirations for a paradigm shift for DSM-5. METHOD A historical review of past revisions of the DSM was performed. Efforts undertaken before the start of the DSM-5 development process to conduct a state-of-the science review and set a research agenda were examined to determine if results supported a paradigm shift for DSM-5. Proposals to supplement DSM-5 categorical diagnosis with dimensional assessments are reviewed and critiqued. RESULTS DSM revisions have alternated between paradigm shifts (the first edition of the DSM in 1952 and DSM-III in 1980) and incremental improvements (DSM-II in 1968, DSM-III-R in 1987, and DSM-IV in 1994). The results of the review of the DSM-5 research planning initiatives suggest that despite the scientific advances that have occurred since the descriptive approach was first introduced in 1980, the field lacks a sufficiently deep understanding of mental disorders to justify abandoning the descriptive approach in favour of a more etiologically based alternative. Proposals to add severity and cross-cutting dimensions throughout DSM-5 are neither paradigm shifting, given that simpler versions of such dimensions are already a component of DSM-IV, nor likely to be used by busy clinicians without evidence that they improve clinical outcomes. CONCLUSIONS Despite initial aspirations that DSM would undergo a paradigm shift with this revision, DSM-5 will continue to adopt a descriptive categorical approach, albeit with a greatly expanded dimensional component.
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Affiliation(s)
- Michael B First
- Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
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85
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First MB, Wakefield JC. Defining 'mental disorder' in DSM-V. A commentary on: 'What is a mental/psychiatric disorder? From DSM-IV to DSM-V' by Stein et al. (2010). Psychol Med 2010; 40:1779-1934. [PMID: 20102663 DOI: 10.1017/s0033291709992339] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M B First
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY 10032, USA.
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Abstract
Two major approaches can be used for the up-coming revisions of DSM-V and ICD-10: an 'iterative model' in which incremental changes are made or a 'paradigm shift model' in which the existing approach is jettisoned in favour of a new nosological model. We explore each of these two approaches and conclude that although they both have strengths and limitations, our field is not currently ready for a paradigm shift.
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Affiliation(s)
- Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University Medical School, Box 980126, 800 E. Leigh Street, Room 1-123, Richmond, VA 23298-0126, USA.
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Corcoran CM, First MB, Cornblatt B. The psychosis risk syndrome and its proposed inclusion in the DSM-V: a risk-benefit analysis. Schizophr Res 2010; 120:16-22. [PMID: 20381319 PMCID: PMC2923037 DOI: 10.1016/j.schres.2010.03.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 03/12/2010] [Indexed: 11/17/2022]
Abstract
The inclusion of a psychosis risk syndrome has been proposed for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. The appropriateness of inclusion of this new risk syndrome in the DSM depends on a careful analysis of both anticipated benefits and risks. Purported benefits include early recognition and case identification, and the hypothetical benefit of preventive intervention of psychotic disorders, for which there is as yet no clear evidence base. However, there is a potential for high rates of false positives particularly at the community level given the difficulty in discriminating mild symptoms from normal variants and low base rates of the syndrome in the general population. High false-positive rates in and of themselves are not necessarily problematic if the risk-benefit ratio is significantly favorable, as with screening for cardiovascular risk factors. For the psychosis risk syndrome, by contrast, there are substantial risks, for both stigma and discrimination, and for unnecessary exposure to antipsychotic medications, which make the high false-positive rate associated with the psychosis risk designation particularly problematic. More research is needed to improve the positive predictive value of the psychosis risk syndrome so that it can be considered for inclusion in future editions of the DSM.
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Affiliation(s)
- Cheryl M. Corcoran
- Department of Psychiatry, New York State Psychiatric Institute At Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Michael B. First
- Department of Psychiatry, New York State Psychiatric Institute At Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Barbara Cornblatt
- Division of High-Risk Studies, Hillside Hospital, North-Shore Long Island Jewish Health System, Glen Oaks, NY 11004, USA
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88
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Colpe LJ, Barker PR, Karg RS, Batts KR, Morton KB, Gfroerer JC, Stolzenberg SJ, Cunningham DB, First MB, Aldworth J. The National Survey on Drug Use and Health Mental Health Surveillance Study: calibration study design and field procedures. Int J Methods Psychiatr Res 2010; 19 Suppl 1:36-48. [PMID: 20527004 PMCID: PMC7003702 DOI: 10.1002/mpr.311] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The Mental Health Surveillance Study (MHSS) is an ongoing initiative by the Substance Abuse and Mental Health Services Administration (SAMHSA) to monitor the prevalence of serious mental illness (SMI) among adults in the USA. In 2008, the MHSS used data from clinical interviews to calibrate mental health data from the National Survey on Drug Use and Health (NSDUH) for estimating the prevalence of SMI based on the full NSDUH sample. The clinical interview used was the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV; SCID). NSDUH interviews were administered via audio computer-assisted self-interviewing (ACASI) to a nationally representative sample of the population aged 12 years or older. A total of 46,180 NSDUH interviews were completed with adults aged 18 years or older in 2008. The SCID was administered by mental health clinicians to a sub-sample of 1506 adults via telephone. This paper describes the MHSS calibration study procedures, including information on sample selection, instrumentation, follow-up, data quality protocols, and management of distressed respondents.
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Affiliation(s)
- Lisa J Colpe
- Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Rockville, MD, USA.
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89
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Johnson TW, Wassersug RJ, Roberts LF, Sutherland MB, First MB. Desire for Castration Is Not a Body Integrity Identity Disorder (BIID): A Response. J Sex Med 2010. [DOI: 10.1111/j.1743-6109.2009.01603.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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90
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First MB. Clinical utility in the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Professional Psychology: Research and Practice 2010. [DOI: 10.1037/a0021511] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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91
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Affiliation(s)
- M B First
- New York State Psychiatric Institute, New York, NY 10032, USA.
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92
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Abstract
BACKGROUND Differences in the ICD-10 and DSM-IV definitions for the same disorder impede international communication and research efforts. The forthcoming parallel development of DSM-V and ICD-11 offers an opportunity to harmonise the two classifications. AIMS This paper aims to facilitate the harmonisation process by identifying diagnostic differences between the two systems. METHOD DSM-IV-TR criteria sets and the ICD-10 Diagnostic Criteria for Research were compared and categorised into those with identical definitions, those with conceptually based differences and those in which differences are not conceptually based and appear to be unintentional. RESULTS Of the 176 criteria sets in both systems, only one, transient tic disorder, is identical. Twenty-one per cent had conceptually based differences and 78% had non-conceptually based differences. CONCLUSIONS Harmonisation of criteria sets, especially those with non-conceptually based differences, should be prioritised in the DSM-V and ICD-11 development process. Prior experience with the DSM-IV and ICD-10 harmonisation effort suggests that for the process to be successful steps should be taken as early as possible.
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Affiliation(s)
- Michael B First
- New York State Psychiatric Institute, Columbia University Department of Psychiatry, 1051 Riverside Drive - Unit 60, New York, NY 10032, USA.
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93
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Johnson JG, First MB, Block S, Vanderwerker LC, Zivin K, Zhang B, Prigerson HG. Stigmatization and receptivity to mental health services among recently bereaved adults. Death Stud 2009; 33:691-711. [PMID: 19697482 PMCID: PMC2834798 DOI: 10.1080/07481180903070392] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Severe grief symptoms, treatment receptivity, attitudes about grief, and stigmatization concerns were assessed in a community-based sample of 135 widowed participants in the Yale Bereavement Study. There was a statistically significant association between the severity of grief symptoms and reported negative reactions from friends and family members. However, more than 90% of the respondents with complicated grief, a severe grief disorder, reported that they would be relieved to know that having such a diagnosis was indicative of a recognizable psychiatric condition, and 100% reported that they would be interested in receiving treatment for their severe grief symptoms.
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Affiliation(s)
- Jeffrey G Johnson
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
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Olesen J, Steiner T, Bousser MG, Diener HC, Dodick D, First MB, Goadsby PJ, Göbel H, Lainez MJA, Lipton RB, Nappi G, Sakai F, Schoenen J, Silberstein SD. Proposals for new standardized general diagnostic criteria for the secondary headaches. Cephalalgia 2009; 29:1331-6. [PMID: 19673917 DOI: 10.1111/j.1468-2982.2009.01965.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Headache classification is a dynamic process through clinical testing and re-testing of current and proposed criteria. After publication of the second edition of the International Classification of Headache Disorders (ICHD-II), need arose for revisions in the classification of medication overuse headache and chronic migraine. These changes made apparent a further need for broader revisions to the standard formulation of diagnostic criteria for the secondary headaches. Currently, the fourth criterion makes impossible the definitive diagnosis of a secondary headache until the underlying cause has resolved or been cured or greatly ameliorated by therapy, at which time the headache may no longer be present. Given that the main purpose of diagnostic criteria is to enable a diagnosis at the onset of a disease in order to guide treatment, this is unhelpful in clinical practice. In the present paper we propose maintaining a standard approach to the secondary headaches using a set of four criteria A, B, C and D, but we construct these so that the requirement for resolution or successful treatment is removed. The proposal for general diagnostic criteria for the secondary headaches will be entered into the internet-based version of the appendix of ICHD-II. During 2009 the Classification Committee will apply the general criteria to all the specific types of secondary headaches. These, and other changes, will be included in a revision of the entire classification entitled ICHD-IIR, expected to be published in 2010. ICHD-IIR will be printed and posted on the website and will be the official classification of the International Headache Society. Unfortunately, it will be necessary to translate ICHD-IIR into the many languages of the world, but the good news is that no major changes to the headache classification are then foreseen for the next 10 years. Until the printing of ICHD-IIR, the printed ICHD-II criteria remain in place for all other purposes. We issue a plea to the headache community to use and study these proposed general criteria for the secondary headaches in order to provide more evidence for their utility-before their incorporation in the main body of the classification.
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Affiliation(s)
- J Olesen
- Department of Neurology, Danish Headache Centre, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
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Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, Goodkin K, Raphael B, Marwit SJ, Wortman C, Neimeyer RA, Bonanno GA, Bonanno G, Block SD, Kissane D, Boelen P, Maercker A, Litz BT, Johnson JG, First MB, Maciejewski PK. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med 2009; 6:e1000121. [PMID: 19652695 PMCID: PMC2711304 DOI: 10.1371/journal.pmed.1000121] [Citation(s) in RCA: 1016] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 06/25/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. METHODS AND FINDINGS A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. CONCLUSIONS The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for Editors' Summary.
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Affiliation(s)
- Holly G Prigerson
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
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Wakefield JC, Schmitz MF, First MB, Horwitz AV. The importance of the main effect even within an interaction model: elimination vs. expansion of the bereavement exclusion in the diagnostic criteria for depression. Am J Psychiatry 2009; 166:491-2. [PMID: 19339369 DOI: 10.1176/appi.ajp.2009.08121813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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97
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98
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99
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Crawford TN, Cohen P, First MB, Skodol AE, Johnson JG, Kasen S. Comorbid Axis I and Axis II Disorders in Early Adolescence. ACTA ACUST UNITED AC 2008; 65:641-8. [DOI: 10.1001/archpsyc.65.6.641] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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100
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Johnson JG, First MB, Cohen P, Kasen S. Development and validation of a new procedure for the diagnostic assessment of personality disorder: the Multidimensional Personality Disorder Rating Scale (MPDRS). J Pers Disord 2008; 22:246-58. [PMID: 18540797 DOI: 10.1521/pedi.2008.22.3.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Data from a community-based prospective longitudinal study were used to investigate the utility of a structured assessment of the DSM-IV General Diagnostic Criteria for a Personality Disorder (PD). The Structured Clinical Interview for DSM-IV PDs (SCID-II) was administered to 154 adults. After completing the interview, an experienced clinician assessed the General Diagnostic Criteria for a PD using a structured rating scale. PD diagnoses, based solely on the rating scale data, demonstrated strong agreement with diagnoses obtained using the diagnostic thresholds for specific PDs (Kappa = 0.89). The sensitivity, specificity, predictive power, and internal reliability of the rating scale were satisfactory. PD diagnoses, based on both of the assessment procedures, were associated with substantial impairment and distress. These findings suggest that a structured assessment of the DSM-IV General Diagnostic Criteria for a Personality Disorder may constitute a useful alternative or supplement to standard assessments of the diagnostic thresholds for specific DSM-IV PDs.
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