The structure of maladaptive personality traits in childhood: A step toward an integrative developmental perspective for DSM-V.

The present study describes the construction of a taxonomy of trait-related symptoms in childhood, the Dimensional Personality Symptom Item Pool (DIPSI), and examines the replicability of the taxonomy's higher order structure across maternal ratings of referred (N = 205) and nonreferred (N = 242) children and self-ratings of adolescents (N = 453). The DIPSI's 4 higher order factors--that is, Emotional Instability, Disagreeableness, Introversion, and Compulsivity--showed clear correspondence with the dimensions of personality pathology found in adulthood (Dimensional Assessment of Personality Pathology-Basic Questionnaire; W. J. Livesley, 1990; Schedule for Nonadaptive and Adaptive Personality; L. A. Clark, 1993). These 4 factors can be further organized into 2 superfactors, representing Internalizing and Externalizing Traits, demonstrating empirical and conceptual relationships with psychopathology models in childhood and adulthood. The implications for the assessment and conceptualization of early trait pathology are discussed in the context of an integrative developmental perspective on the construction of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relational processes in the DSM-V revision process: Comment on the special section.

With the aim of stimulating research in advance of the revision process of the Diagnostic and Statistical Manual of Mental Disorders, "A Research Agenda for DSM-V" (D. A. Kupfer, M. B. First, and D. A. Regier, 2002) was published, highlighting areas for further study. A white paper included in the research agenda (M. B. First et al., 2002) identified the limited provision for the diagnosis of relational disorders as one of the most important gaps in the current DSM-IV (American Psychiatric Association, 1994). Specific recommendations in the research agenda included developing assessment modules, determining the clinical utility of relational disorders, determining the role of relational disorders in the etiology and maintenance of individual mental disorders, and considering aspects of relational disorders that might be modulated by individual mental disorders. In parallel with the 11 research planning conferences organized by the American Psychiatric Association from 2004 to 2007 under the title "The Future of Psychiatric Diagnosis: Refining the Research Agenda," a research planning conference sponsored by the Fetzer Institute was convened to promote research necessary for more empirically informed deliberations about the role of relational disorders in DSM-V. The current special section summarizes the conference proceedings and should serve as a valuable resource for the DSM-V revision process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Fathers who fail: Shame and psychopathology in the family system.

Reviews the book, Fathers who fail: Shame and psychopathology in the family system by Melvin R. Lansky (see record 1992-98607-000). Melvin Lansky's riveting book is about fathers who cannot find their way in the world of either love or work, but are driven to self-destructive bonds with others by problems with their "paternal imago." This book addresses the central role of the affect of shame, and the defenses against experiencing it, leading to varieties of "impulsive" symptom formation, disturbing the capacity for sustaining work or love relationships and constantly threatening breakdown of fragile self-esteem. Symptoms are viewed as failed efforts to escape shame through rage and to rigidly regulate optimal distance in family relationships. The attempt throughout is to meld a variety of psychoanalytic perspectives with family systems perspectives. The book is organized into several sections, beginning with an overview entitled Symptom, System and Personality in Fathers Who Fail, followed by The Paternal Imago. Next comes Defenses Against Shame: Narcissistic Equilibrium in the Family System, and then a section on shame and symptom formation. A section entitled Treatment Difficulties completes the book. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Item response theory analysis of diagnostic criteria for alcohol and cannabis use disorders in adolescents: Implications for DSM-V.

Item response theory (IRT) has advantages over classical test theory in evaluating diagnostic criteria. In this study, the authors used IRT to characterize the psychometric properties of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) alcohol and cannabis use disorder symptoms among 472 clinical adolescents. For both substances, DSM-IV symptoms fit a model specifying a unidimensional latent trait of problem severity. Threshold (severity) parameters did not distinguish abuse and dependence symptoms. Abuse symptoms of legal problems and hazardous use, and dependence symptoms of tolerance, unsuccessful attempts to quit, and physical-psychological problems, showed relatively poor discrimination of problem severity. There were gender differences in thresholds for hazardous use, legal problems, and physical-psychological problems. The results illustrate limitations of DSM-IV criteria for alcohol and cannabis use disorders when applied to adolescents. The development process for the fifth edition (DSM-V) should be informed by statistical models such as those used in this study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) groups disorders into diagnostic classes on the basis of the subjective criterion of "shared phenomenological features." There are now sufficient data to eliminate this rational system and replace it with an empirically based structure that reflects the actual similarities among disorders. The existing structural evidence establishes that the mood and anxiety disorders should be collapsed together into an overarching class of emotional disorders, which can be decomposed into 3 subclasses: the bipolar disorders (bipolar I, bipolar II, cyclothymia), the distress disorders (major depression, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder), and the fear disorders (panic disorder, agoraphobia, social phobia, specific phobia). The optimal placement of other syndromes (e.g., obsessive-compulsive disorder) needs to be clarified in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contemplating the new DSM-V: Considerations from psychologists who work with school children.

The standard psychiatric classification system, the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; DSM-IV-TR; American Psychiatric Association, 2000), is about to be updated. This is important because the DSM-IV-TR, a touchstone document for service providers across several disciplines, contains only some of the conditions reported in the vast developmental/learning, psychiatric, and health literature that are known to hamper school success. Practicing psychologists who work with school-age children and those who conduct educational research confront further limitations when using DSM-IV-TR or the commonly used special education scheme (the Individuals With Disabilities Education Act [IDEA], 2004). IDEA has limited heuristic potential because it was devised for educational administrative purposes, whereas the DSM-IV-TR is a medical nosological system with little concern for school issues. Neither system fully informs needed studies of epidemiology, natural history, and disorder-specific causes and treatments. This article provides a rationale for a set of proposed changes to the new DSM-V and explains how adopting these changes will benefit psychologists concerned with understanding and treating school-age children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical utility and DSM-V.

The construction of the American Psychiatric Association’s diagnostic manual has been guided primarily by concerns of construct validity rather than of clinical utility, despite claims by its authors that the highest priority has in fact been clinical utility. The purpose of this article was to further articulate the concept and importance of utility when constructing and evaluating a diagnostic construct. It is suggested that a relative emphasis on validity over utility is justifiable but that matters of clinical utility should not be neglected. Discussed in particular is ease of usage, communication, and treatment planning. Suggestions for future research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic categories or dimensions? A question for the Diagnostic and statistical manual of mental disorders--fifth edition.

The question of whether mental disorders are discrete clinical conditions or arbitrary distinctions along dimensions of functioning is a long-standing issue, but its importance is escalating with the growing recognition of the frustrations and limitations engendered by the categorical model. The authors provide an overview of some of the dilemmas of the categorical model, followed by a discussion of research that addresses whether mental disorders are accurately or optimally classified categorically or dimensionally. The authors' intention is to document the importance of this issue and to suggest that future editions of the Diagnostic and Statistical Manual of Mental Disorders give more recognition to dimensional models of classification. They conclude with a dimensional mental disorder classification that they suggest provides a useful model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temperament as a Unifying Basis for Personality and Psychopathology.

Personality and psychopathology long have been viewed as related domains, but the precise nature of their relations remains unclear. Through most of the 20th century, they were studied as separate fields; within psychopathology, clinical syndromes were separated from personality disorders in 1980. This division led to the revelation of substantial overlap among disorders both within and across axes and to the joint study of normal and abnormal personality. The author reviews these literatures and proposes an integrative framework to explain personality-psychopathology relations: Three broad, innate temperament dimensions--negative affectivity, positive affectivity, and disinhibition--differentiate through both biologically and environmentally based developmental processes into a hierarchical personality trait structure and, at their extremes, are risk factors (diatheses) for psychopathology, especially given adverse life experiences (stress). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward the DSM-V: The Withdrawal-Gate Model versus the DSM-IV in the diagnosis of alcohol abuse and dependence.

The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) classifies as dependent many cases of mild alcohol problems. DSM-IV diagnoses have modest relationships with predictive and some concurrent validators and often improperly sequence the onset of abuse vs dependence, perhaps due to insufficient emphasis on physiological features. Testing reliability, syndrome prevalence, syndrome sequencing, and concurrent and predictive validity, this study contrasted the DSM-IV with the Withdrawal-Gate Model (WGM), in which alcohol withdrawal is necessary and sufficient for the dependence diagnosis. Clinical samples of adults (baseline n?=?318) and adolescents (baselinen?=?214) meeting abuse or dependence were assessed for DSM-IV alcohol symptoms and external measures of problem severity and reinterviewed at 6 (adults) and 12 mo (adults and adolescents). Among DSM-IV dependent cases, the WGM shifted 32% of adults and 80% of adolescents to the abuse category, making both categories more symptomatically severe, but had a negligible effect on prevalence of total alcohol diagnoses. The WGM was more reliable than the DSM-IV and temporally sequenced abuse before dependence in a greater number of cases. The WGM was superior to the DSM-IV in concurrent and predictive validity on most measures. Future diagnostic systems may be more reliable and valid if they require evidence of withdrawal for substance dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The clinician’s handbook.

Reviews the book, The clinician's handbook by Robert G. Meyer and Sarah E. Deitsch (see record 1996-97385-000). This book is an integration of a great deal of both diagnostic and clinical information concerning adult and adolescent psychopathology. It brings together a collective wealth of information about various psychological assessment tools. It also attempts to show the relevance of assessment data, both to case formulation and to treatment/intervention. Although, as the reviewer notes, there are a few expected flaws in the text, he believes that the authors should be congratulated for their superb effort to accomplish what they set out to do, which is to give a specific and concrete focus to psychopathology assessment. This book is recommended for psychotherapists, particularly those who are forensically oriented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The challenge of the borderline patient: Competency in diagnosis and treatment.

Reviews the book, The challenge of the borderline patient: Competency in diagnosis and treatment by Jerome Kroll (see record 1988-97021-000). In this new volume on borderline psychopathology, Jerome Kroll has some axes to grind-of the kind found in DSM-III, that is. He offers a refreshing perspective on this popularized topic and casts a healthy skepticism on the current trends and trendiness reflected in the literature. Unique in its back-to-basics, common-sensical approach to diagnosis and treatment, the book, in its essence, aims at demystifying and debunking the aura that surrounds this field. Kroll's volume spans the three predominant areas of inquiry that constitute most of the published works on borderline personality disorders, namely: 1) empirically rooted efforts to establish its construct validity as a diagnostic entity, 2) psychotherapeutic strategies that are primarily enmeshed in larger, unresolved theoretical controversies between the object relations versus self psychology factions within contemporary psychoanalytic thinking, and 3) the search for the magical psychopharmacological bullet that will eradicate borderline symptomotology. For both novice and experienced clinician, this book serves as a useful counterpoint to the current directions in empirical and theoretical work on borderline pathology, a reminder of the potential dangers of getting caught up in methodological precision or overelaborated theory or high-technology psychopharmacology and, as a consequence, of losing sight of the individual, whole patient. It is supportive therapy of the best kind for those of us who face the challenge of treating the borderline patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Finishing well: Aging and reparation in the intergenerational family.

Reviews the book, Finishing well: Aging and reparation in the intergenerational family by Terry D. Hargrave and William T. Anderson (see record 1992-98532-000). The purpose of this book is to help older people and their families complete life in a more satisfactory way through contextual family therapy. The essence of the contextual approach is to resolve family relationships by building trust and commitment in the family through redressing the imbalance of entitlements and obligations within the family. In this review, the dynamics of family relationships are described and the stages of family therapy as detailed in the book are summarized. In the book, the authors focus on the importance of forgiveness and describe the technique by which they promote forgiveness between family members. According to the reviewer, the book is well written because the therapeutic techniques are clearly illustrated with examples from therapy cases. This book can be enthusiastically recommended to all therapists engaged in therapy with older people, and to those doing family therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Family mediation: Theory and practice of dispute resolution.

Reviews the book, Family mediation: Theory and practice of dispute resolution by Howard H. Irving and Michael Benjamin (1987). The major contribution that Irving and Benjamin have made to the rapidly growing field of family mediation is a well-organized theoretical model which integrates a detailed set of procedural steps and specific intervention methods. The scope of the book includes not only the typical custody and access issues in a separated family, but also the financial, property and support issues that are traditionally dealt within the strictly legal domain. Irving's and Benjamin's book would make an excellent text for a training program in mediation in the areas of both academic background and practical interventions. Current practitioners may find the book very useful to integrate their own understanding and skills in this rapidly developing area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Externalizing psychopathology in adulthood: A dimensional-spectrum conceptualization and its implications for DSM-V.

Mental disorders involving antisocial behavior and substance use are genetically linked and vary continuously. The authors present a review and integrative conceptualization of these observations in terms of a dimensional and hierarchically organized externalizing spectrum. As a foundation for this conceptualization, the authors introduce a quantitative, model-based approach to comparing categorical and continuous conceptions of psychopathology and apply this approach in an empirical study of patterns of comorbidity among externalizing disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders. The authors present evidence that comorbidity among externalizing disorders is best modeled by an underlying normally distributed continuum of risk for multiple disorders within the externalizing spectrum. The authors conclude by discussing implications of the externalizing spectrum conceptualization for classification of disorders in the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward an integration of independent practice and clinical research.

For some time there has been tremendous debate about the viability of integrating clinical and scientific endeavors in the practice of clinical psychology. It is argued that clinically relevant research strategies are crucial to the process of treatment evaluation and therapist accountability and therefore are of great importance to clinicians. Furthermore, the clinical expertise of the independent practice sector is acknowledged as a valuable resource that will likely be more fully appreciated with greater practitioner involvement in various research-related activities. To this end, a number of ways in which independent practitioners may incorporate research activities in their clinical efforts are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acculturative family distancing: Theory, research, and clinical practice.

Despite the rapidly growing immigrant population settling in the United States, our knowledge of acculturative processes and their impact on immigrant families remains quite limited. This article describes a theoretical construct called Acculturative Family Distancing (AFD), the distancing that occurs between immigrant parents and children that is a result of immigration, cultural differences, and differing rates of acculturation. AFD occurs along two dimensions: communication and cultural values. Breakdowns in communication and incongruent cultural values between immigrant parents and children are hypothesized to increase over time and place families at risk for mental illness and family dysfunction. Clinical illustrations of AFD's impact on immigrant Asian families are provided and recommendations for dealing with AFD are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research into practice/practice into research.

This article introduces a new section of this journal devoted to the interface between research and clinical practice in the family field. The purpose of this section is to provide a vehicle through which communication between clinicians and researchers can be improved, so that each can benefit most from the work of the other. This article reviews the historical antecedents of researcher/clinician alienation, discusses the specific ways clinicians can enhance research and that research can enhance clinical activity, and describes the plan for this section of the Journal of Family Psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)