Gender and cultural issues in psychiatric nosological classification systems

Much has changed since the two dominant mental health nosological systems, the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM), were first published in 1900 and 1952, respectively. Despite numerous modifications to stay up to date with scientific and cultural changes (eg, exclusion of homosexuality as a disorder) and to improve the cultural sensitivity of psychiatric diagnoses, the ICD and DSM have only recently renewed attempts at harmonization. Previous nosological iterations demonstrate the oscillation in the importance placed on the biological focus, highlighting the tension between a gender- and culture-free nosology (solely biological) and a contextually relevant understanding of mental illness. In light of the release of the DSM 5, future nosological systems, such as the ICD 11, scheduled for release in 2017, and the Research Development Criteria (RDoC), can learn from history and apply critiques. This article aims to critically consider gender and culture in previous editions of the ICD and DSM to inform forthcoming classifications.

Should Sexual Problems Be Included in the Internalizing Spectrum? A Comparison of Dimensional and Categorical Models

Preliminary research has suggested that sexual problems should be included in the internalizing spectrum alongside depressive and anxiety disorders. This study aimed to empirically examine and compare an extended internalizing spectrum model with a categorical framework model implied by the current nosological structure. Responses to an online survey from a community sample (n = 518) were analyzed to compare the fit of six alternative models of the relationship between sexual problems and depressive and anxiety disorders, separately for men and women. The best model for women (n = 336) was a dimensional spectrum model that included sexual arousal, orgasm, and pain difficulties in the internalizing spectrum. The results for men (n = 182) were less clear-cut: there were apparent categorical relationships for a small group (n = 8), and the spectrum model showed a good fit for 96% of the sample. These findings are consistent with a nosology that maintains discrete disorders and diagnostic chapters while recognizing the relationships between them, as in the new structure of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. As such, this study offers further evidence that there are dimensional relationships between sexual problems and depressive and anxiety disorders, which should be explicitly recognized in diagnostic systems.

An exploration of the latent constructs of the STATIC-99

Although actuarial instruments are ubiquitously used in the field of sex offender recidivism risk assessment, there is limited empirical information about the underlying constructs from which they are derived. The following study utilized a nonparametric item response theory procedure, a Mokken analysis, and nonlinear factor analysis (Normal Ogive Harmonic Analysis Robust Method) to explore the underlying constructs of the STATIC-99 scores obtained for male sexual offenders (N = 451) referred for an evaluation to determine if they met criteria for civil commitment under a state's Sexually Violent Persons Law. The results from the analyses indicated that the STATIC-99 comprises the two previously identified constructs associated with sexual deviancy and antisocial behaviors as well as a third, additional construct, associated with the items pertaining to age and past marital-type relationships. These findings support Hanson and Thornton's assertion that sexual offender recidivism risk is multifactorial and not the result of a single underlying trait. Implications for future research are discussed.

The role of negative emotionality and impulsivity in depressive/anxiety disorders and alcohol dependence

BACKGROUND

Much is still unclear about the role of personality in the structure of common psychiatric disorders such as depressive/anxiety disorders and alcohol dependence. This study will therefore examine whether various traits of negative emotionality and impulsivity showed shared or specific associations with these disorders. Method Cross-sectional data were used from the Netherlands Study of Depression and Anxiety (NESDA), including individuals with no DSM-IV psychiatric disorder (n = 460), depressive/anxiety disorder only (i.e. depressive and/or anxiety disorder; n = 1398), alcohol dependence only (n = 32) and co-morbid depressive/anxiety disorder plus alcohol dependence (n = 358). Aspects of negative emotionality were neuroticism, hopelessness, rumination, worry and anxiety sensitivity, whereas aspects of impulsivity included disinhibition, thrill/adventure seeking, experience seeking and boredom susceptibility.

RESULTS

Aspects of negative emotionality formed a homogeneous dimension, which was unrelated to the more heterogeneous construct of impulsivity. Although all aspects of negative emotionality were associated with alcohol dependence only, associations were much stronger for depressive/anxiety disorder only and co-morbid depressive/anxiety disorder with alcohol dependence. The results for impulsivity traits were less profound and more variable, with disinhibition and boredom susceptibility showing modest associations with both depressive/anxiety disorder and alcohol dependence, whereas low thrill/adventure seeking and high disinhibition were more strongly related with the first and the latter, respectively.

CONCLUSIONS

Our results suggest that depressive/anxiety disorder and alcohol dependence result from shared as well as specific aetiological pathways as they showed the same associations with all aspects of negative emotionality, disinhibition and boredom susceptibility as well as specific associations with thrill/adventure seeking and disinhibition.

The quality of life of hematological malignancy patients with major depressive disorder or subsyndromal depression

OBJECTIVE

The purpose of the present study was to compare the quality of life of hematological malignancy patients with major depressive disorder or subsyndromal depression.

METHOD

Sample consisted of 93 hematological malignancy patients recruited from oncology ward of Valieasr hospital for Imam Khomeini complex hospital at Tehran through purposeful sampling. Participants were divided into three groups through diagnostic interview based on DSM-IV-TR criteria and the Beck Depression Inventory-2 (BDI-II): Major depressive disorder (MDD) (n = 41; 44.1%); subsyndromal depression (SSD) (n = 23; 24.7%), and without depression (WD) (n = 29; 31.2%). Participants completed the short-form health survey (SF-36) as a measure of the quality of life. We carried out an analysis of covariance to examine the collected data.

RESULTS

Findings showed that there was not a significant difference between patients with MDD and SSD based on measure of quality of life. But patients with MDD and SSD showed significantly worse quality of life than patients with WD. This finding highlights the clinical importance of subsyndromal depressive symptoms and casts doubt on the clinical utility of separation between MDD and subsyndromal depression in terms of important clinical outcomes.

A cumulative scale of severe sexual sadism

The article assesses the scale properties of the criterion set for severe sexual sadism in a sample of male forensic patients (N = 100). Half of the sample consists of sexual sadists; the remainder is sampled at random from the general group of nonsadistic sex offenders. Eleven of 17 criteria (plus the additional item of inserting objects into the victim's bodily orifices) of Marshall, Kennedy, Yates, and Serran's list form a cumulative scale. More specifically, this scale comprises all the 5 core criteria that Marshall and his colleagues considered particularly relevant. The resulting 11-item scale of severe sexual sadism is highly reliable (r(tt) = .93) and represents a strong scale (H = .83) of the Guttman type (coefficient of reproducibility = .97). The 11-item scale distinguishes perfectly between sexual sadists and nonsadistic sex offenders in the sample.

Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology

Comorbidity has presented a persistent puzzle for psychopathology research. We review recent literature indicating that the puzzle of comorbidity is being solved by research fitting explicit quantitative models to data on comorbidity. We present a meta-analysis of a liability spectrum model of comorbidity, in which specific mental disorders are understood as manifestations of latent liability factors that explain comorbidity by virtue of their impact on multiple disorders. Nosological, structural, etiological, and psychological aspects of this liability spectrum approach to understanding comorbidity are discussed.

Wittgenstein's philosophy and a dimensional approach to the classification of mental disorders -- a preliminary scheme

In this paper the importance of Wittgenstein's philosophical ideas for the justification of a dimensional approach to the classification of mental disorders is discussed. Some of his basic concepts in his Philosophical Investigations, such as 'family resemblances', 'grammar' and 'language-game' and their relations to the concept of mental disorder are explored.

Further assessment of the HEXACO Personality Inventory: Two new facet scales and an observer report form

The HEXACO Personality Inventory (HEXACO-PI) operationalizes the six factors obtained from lexical studies of personality structure in several languages. In this study, psychometric properties of the HEXACO-PI were assessed using a community adult sample and also using observer reports, thereby extending the previous investigation relying only on self-reports from a college student sample. In addition to examining the original 24 HEXACO-PI facet scales, the authors also examined two new facet scales--Altruism versus Antagonism and Negative Self-Evaluation--that assess constructs located interstitially among the factors of the HEXACO space. The HEXACO-PI again showed favorable psychometric properties in terms of reliability and factor structure and also showed high levels of self/observer agreement.