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Journal article

The new alternative DSM-5 Model for Personality Disorders: issues and controversies

Author:
PORTER Jeffrey S.
Journal article citation:
Research on Social Work Practice, 24(1), 2014, pp.50-56.
Publisher:
Sage

Purpose: Assess the new alternative Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) model for personality disorders (PDs) as it is seen by its creators and critics. Method: Follow the DSM revision process by monitoring the American Psychiatric Association website and the publication of pertinent journal articles. Results: The DSM-5 PD Work Group’s proposal was not included in the main diagnostic section of the new DSM, but it was published in the section devoted to emerging models. The alternative DSM-5 PD constructs are radically different from those found in DSM, fourth edition, text revision. Discussion: There are some positive conceptual changes in the new model, but reliability and validity are not generally improved. However, social workers may be able to benefit from the use of the personality trait domains/facets of the alternative model. (Publisher abstract)

Journal article

DSM-5 and the general definition of personality disorder

Author:
WAKEFIELD Jerome C.
Journal article citation:
Clinical Social Work Journal, 41(2), 2013, pp.168-183.
Publisher:
Springer
Place of publication:
New York

There is a fundamental change proposed for DSM-5 in the general definition of personality disorder, representing a new conceptualisation that shapes how the DSM distinguishes personality pathology from other undesirable or negative personality features. The change is needed due to serious deficiencies in the current DSM-IV approach. Specifically, personality disorder is to be conceptualised as impairment in both self organisation and interpersonal relating, caused by pathological (extreme) personality traits. This represents progress in that marked impairment in self organisation and interpersonal relating are plausibly characteristic of personality disorder. However, the required level of impairment remains too low, and the kinds of impairment are not restricted to those which indicate disorder versus culturally undesirable features. Moreover, extreme traits are neither necessary nor sufficient for personality disorder because personality represents not the sum of traits but the holistic organisation of traits and other meanings. The DSM-5’s diagnostic focus on traits thus potentially opens the way to massive false positive diagnoses. An earlier proposal to reframe personality disorders using global similarity matching of the patient’s condition to prototypical descriptions of specific personality disorders is argued to also lead toward less valid diagnoses. (Publisher abstract)

Journal article

Substance use and mental health disorders: why do some people suffer from both?

Authors:
REEDY Amanda R., KOBAYASHI Rie
Journal article citation:
Social Work in Mental Health, 10(6), 2012, pp.496-517.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

Co-occurring substance use disorders (SUD) and mental health disorders (MHD) are prevalent in the United States, affecting between 7 and 10 million adults. Social workers frequently practice in mental health and substance use disorder treatment settings where they are likely to encounter clients who have co-occurring disorders. Therefore, social workers should be familiar with the various etiological models of co-occurring disorders and the strengths and weaknesses of these models, in order to effectively assess and assist clients with co-occurring disorders. The purpose of this article is to describe and critique 4 different models of the etiology of co-occurring disorders: MHD leads to SUD - the self-medication model; SUD leads to MHD model; common factor model; and the combination model. The theory that social workers are most familiar with is the self-medication model, but this may not best explain the client's experience. While there is not definitive support for any of the models, each one seems to have its place in helping researchers and practitioners better understand co-occurring disorders. Implications for practice, policy, and research are discussed.

Journal article

Risk factors for mental health diagnoses among children adopted from the public child welfare system

Authors:
HUSSEY David L., FALLETTA Lynn, ENG Abbey
Journal article citation:
Children and Youth Services Review, 34(10), October 2012, pp.2072-2080.
Publisher:
Elsevier

Adoptive youth’s mental health difficulties may pose considerable problems for the stability of the adoptive placement. The aim of this study was to examine potential child and biological family risk factors for mental health diagnosis among a group of adopted children. Data were extracted from children’s charts via extensive case file reviews for 368 children placed for adoption by a special needs adoption programme between February 1997 and April 2005. The findings showed that a significant proportion of the children and biological parents had experienced serious adversity prior to adoptive placement. Demographic diagnosis predictors included: older age at adoptive placement; white race; and male gender. Other predictors included: having more than 1 placement; and a history of sexual abuse. Biological parent incarceration was significantly associated with the absence of a mental health diagnosis. The article concludes that more work is needed to understand the interplay of risk and protective factors, including how these are affected by child welfare policies, informal procedures, and resources to produce varying outcomes for children in peril.

Journal article

Children's mental health service use and maternal mental health: a path analytic model

Authors:
PFEFFERLE Susan G., SPITZNAGEL Edward L.
Journal article citation:
Children and Youth Services Review, 31(3), March 2009, pp.378-382.
Publisher:
Elsevier

Data from the 2002 National Survey of American Families were used to explore the relationship between past month maternal mental health and past year child mental health services use. Observations were limited to the 8072 most knowledgeable adults who were the mothers of target children aged 6–11. Results found multiple factors were associated with odds of any child mental health service use. In the path analytic model poor past month maternal mental health was associated with increased aggravation which in turn was associated with increased use of mental health visits. Negative child behaviours as reported by the mother were also associated with increased maternal aggravation and increased service use. Parental perception of child behaviours influences treatment seeking, both directly and indirectly through parental aggravation. Parental mental health influences tolerance for child behaviours. Findings are consistent with other studies. Interventions should address the entire family and their psychosocial circumstances through collaboration between multiple service sectors.

Journal article

The relationship between challenging behaviour and mental ill-health in people with intellectual disabilities: a review of current theories and evidence

Author:
ALLEN David
Journal article citation:
Journal of Intellectual Disabilities, 12(4), December 2008, pp.267-294.
Publisher:
Sage
Place of publication:
London

Challenging behaviours and problems of mental ill-health are common amongst people with intellectual disabilities. The article examines conceptual similarities and differences between these conditions, examines the data on comorbidity, and explores possible hypothetical relationships between behavioural and psychiatric disorder in this population. While there is little evidence at present to suggest that many of the challenging behaviours seen in people with intellectual disabilities are underpinned by problems of mental ill-health, only qualified conclusions are possible because of limitations in the quality and scope of existing research. A conceptual model for looking at the risk variables that may contribute to both conditions is suggested, and requirements for future research and current multi-disciplinary practice are outlined.

Journal article

Revisiting the structure of mental disorders: borderline personality disorder and the internalizing/externalizing spectra

Authors:
JAMES Lisa M., TAYLOR Jeanette
Journal article citation:
British Journal of Clinical Psychology, 47(4), November 2008, pp.361-380.
Publisher:
Wiley-Blackwell

Researchers have turned to dimensional models of psychopathology as a means of explaining robust patterns of comorbidity. A hierarchical model consisting of internalizing and externalizing dimensions has been a useful approach to understanding comorbidity among some mental disorders, although a limited number of disorders have been examined within this framework. The objective of the present study is to determine how borderline personality disorder fits into this framework. The dimensional measures of nine psychiatric disorders were used in a confirmatory factors analysis to compare five models of comorbidity in 1,197 members (N=541 women) of a population-based sample. Symptom composites were derived from the Michigan Composite International Diagnostic Interview and the International Personality Disorders Examination Questionnaire. Five models were fit to dimensional indicators of nine disorders. A model in which borderline personality disorder served as a multidimensional indicator of the externalizing factor and the anxious-misery subfactor of internalizing disorders provided the best fit to the data in the whole sample and in men. For women, this model also fit well but an alternative model in which borderline personality disorder served only as an indicator of the anxious-misery subfactor of internalizing disorders fit equally well.

Journal article

Paranoia Network and conference: alternative communities and the disruption of pathology

Authors:
JACOBSON Matthew, ZAVOS Alexandra
Journal article citation:
Journal of Critical Psychology Counselling and Psychotherapy, 7(1), Spring 2007, pp.28-39.

This article focuses on the Paranoia Network as an example of current social movements engaged in resisting and creating alternative models to traditional western psyco/medical discourses and practices.

Journal article

Putting users in control

Authors:
HITCHON Gil, et al
Journal article citation:
Mental Health Today, June 2006, pp.16-18.
Publisher:
Pavilion
Place of publication:
Hove

The authors, from the charity Together, argue that mental health organisations need to put service users at the heart of everything they do. They argue that recovery, well-being and quality of life, rather than simply the treatment of symptoms, should drive mental health organisations. The article uses a four quadrant/four-views perspective in order to help integrate the key perspectives that influence people's lives.

Journal article

Transforming systems of care: the American Association of Community Psychiatrists guidelines for recovery oriented services

Author:
SOWERS Wesley
Journal article citation:
Community Mental Health Journal, 41(6), December 2005, pp.757-774.
Publisher:
Springer

Promotion of recovery has recently been recognized as an organizing principle for the transformation of behavioral health services. Recovery is a personal process of growth and change which typically embraces hope, autonomy and affiliation as elements of establishing satisfying and productive lives in spite of disabling conditions or experiences. Recovery oriented services replace paternalistic, illness oriented perspectives with collaborative, autonomy enhancing approaches and represent a major cultural shift in service delivery. Recovery oriented services replace the myth of chronicity and dependence with a message of individualism, empowerment and choice in the context of collaborative relationships with service providers. This article presents the Guidelines for Recovery Oriented Services developed by the  American Association of Community Psychiatrists to facilitate the transformation of services to this new model. The guidelines are divided into three domains: administration, treatment, and supports, each consisting of several elements for which recovery enhancing characteristics are defined. Several example indicators are also provided for each element.

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