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Whither DSM and ICD, Chapter V?
- Author:
- MIDDLETON Hugh
- Journal article citation:
- Mental Health Review Journal, 13(4), December 2008, pp.4-15.
- Publisher:
- Emerald
Consideration is given to the extent to which the DSM and ICD approach to psychiatric case definition and treatment supports clinical activity. Their validity as a way of defining 'mental illness' is found wanting and they do not, in themselves, usefully guide treatment. These conclusions are set in a critical realist approach to 'mental illness', which draws attention to the legitimacy of several differing perspectives, each reflecting their own sets of interests and allegiances. DSM-V and ICD-11 are due to be published in 2012 and 2014 respectively, and their architects are called upon to be clear about which of these constituencies they are representing.
Factors associated with experienced discrimination among people using mental health services in England
- Authors:
- HAMILTON S., et al
- Journal article citation:
- Journal of Mental Health, 25(4), 2016, pp.350-358.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Background: Research has found considerable variation in how far individuals with a diagnosis of mental illness experience discrimination. Aims: This study tested four hypotheses: (i) a diagnosis of schizophrenia will be associated with more discrimination than depression, anxiety or bipolar disorder; (ii) people with a history of involuntary treatment will report more discrimination than people without; (iii) higher levels of avoidance behaviour due to anticipated discrimination will be associated with higher levels of discrimination and (iv) longer time in contact with services will be associated with higher levels of discrimination. Method: Three thousand five hundred and seventy-nine people using mental health services in England took part in structured telephone interviews about discrimination experiences. Results: A multiple regression model found that study year, age, employment status, length of time in mental health services, disagreeing with the diagnosis, anticipating discrimination in personal relationships and feeling the need to conceal a diagnosis from others were significantly associated with higher levels of experienced discrimination. Conclusion: Findings suggest that discrimination is not related to specific diagnoses but rather is associated with mental health problems generally. An association between unemployment and discrimination may indicate that employment protects against experiences of discrimination, supporting efforts to improve access to employment among people with a diagnosis of mental illness. (Publisher abstract)
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)
The DSM-5’s proposed new categories of sexual disorder: the problem of false positives in sexual diagnosis
- Author:
- WAKEFIELD Jerome C.
- Journal article citation:
- Clinical Social Work Journal, 40(2), 2012, pp.213-223.
- Publisher:
- Springer
- Place of publication:
- New York
The proposals that have emerged from the DSM-5 revision process have triggered considerable controversy, especially regarding potential invalid inflation of diagnostic categories. To illustrate the kinds of issues that have emerged, the author closely examines the proposed new categories of sexual disorder. The DSM-5 Sexual and Gender Identity Disorders Work Group is proposing the addition of three categories of disorder to the DSM-5—hypersexuality, hebephilia (as part of a revised pedophilia category that would become pedohebephilia), and coercive paraphilic disorder (basically a “nonconsent” or rape paraphilia). These proposals are driven by perceived clinical or forensic needs. The author argues, however, that their conceptual soundness remains problematic; each could lead to large numbers of false positive diagnoses (i.e., diagnoses that mistakenly label a normal variant of behavior as a mental disorder), with potential for serious forensic abuse in “sexually violent predator” civil commitment proceedings. (Publisher abstract)
Improving psychiatric diagnosis in multidisciplinary child and adolescent mental health services
- Authors:
- MICHELSON Daniel, et al
- Journal article citation:
- Psychiatrist (The), 35(12), December 2011, pp.454-459.
- Publisher:
- Royal College of Psychiatrists
Obtaining an accurate clinic diagnosis is a critical process in mental healthcare pathways. This study was designed to develop and test a new one-day diagnostic training intervention for multidisciplinary practitioners (n=63) in out-patient child and adolescent mental health services. The authors examined learning outcomes, practice impacts and the implementation processes. The work was conducted in an inner London area where previous audits had revealed large inconsistencies in rates of recorded diagnoses. Training was viewed positively by most participants and was associated with significant increases in practitioner self-efficacy; this effect was sustained at 8-month follow-up. A comparative audit before and after training indicated that clinicians were significantly more likely to assign an Axis I diagnosis following the training intervention. However, absolute rates of Axis I classification remained relatively low (less than 40%) both before and after training. Practitioners were moderately successful at following through on personal plans for implementing new learning. Support for implementation within teams was inconsistent. The authors conclude that a brief training workshop may have some impact on practitioners’ behaviour so that diagnoses are made more promptly and appropriately recorded. However, they suggest that future workforce development initiatives should consider more comprehensive and diversified strategies, including targeted post-training support, if increased self-efficacy following training is to be translated into sustained changes in diagnostic practice.
Do perceptions of dysfunction and normality mediate clinicians' judgements of adolescent antisocial behavior?
- Authors:
- KIRK Stuart A., HSIEH Derek H.
- Journal article citation:
- Social Service Review, 83(2), June 2009, pp.245-266.
- Publisher:
- University of Chicago Press
The Diagnostic and Statistical Manual of Mental Disorders (DSM) requires clinicians making a judgment of mental disorder to first make complex mediating inferences about internal dysfunction and rule out the possibility that behaviours are normal reactions to a problematic environment. Responding to a case vignette in which the social context of antisocial behaviour was systematically varied, a sample of 1,500 social workers, psychologists, and psychiatrists made judgments about the presence of mental disorder, internal dysfunction, and normality in the antisocial behaviour of a youth. Perceptions about the presence of internal dysfunction and normality are found to be related to judgments of mental disorder, but they do not fully mediate the relationship between the influence of social context and judgments of mental disorder.
Diagnostic manual - intellectual disability (DM-ID): a textbook of diagnosis of mental disorders in persons with intellectual disability
- Authors:
- FLETCHER Robert, et al, (eds.)
- Publisher:
- NADD Press
- Publication year:
- 2007
- Pagination:
- 552p.
- Place of publication:
- Kingston, NY
This diagnostic manual was developed by the National Association for the Dually Diagnosed (NADD), in association with the American Psychiatric Association (APA). It aims to facilitate a more accurate psychiatric diagnosis of people with Intellectual Disabilities. Content includes a description of each psychiatric disorder, a summary of the DSM-IV-TR diagnostic criteria, a review of the research and an evaluation of the strength of evidence supporting the literature conclusions.
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
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.
Shrink-wrapped entertainment
- Author:
- MICKEL Andrew
- Journal article citation:
- Community Care, 20.11.08, 2008, p.32.
- Publisher:
- Reed Business Information
The BBC recently set up a reality TV-style challenge for mental health professionals to diagnose members of the public. This article reviews the show, Horizon's "How mad are you?", and discusses whether its approach was ethical.
The prevalence, incidence and factors predictive of mental ill-health in adults with profound intellectual disabilities. Prospective study
- Author:
- DAGNAN Dave
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(6), November 2007, pp.505-509.
- Publisher:
- Wiley
The paper 'The prevalence, incidence, and factors predictive of mental ill-health in adults with profound intellectual disabilities' by Sally-Ann Cooper, et al makes a number of core assumptions within the methodology and discussion of the results. In this article, the authors identify some of the important assumptions made in the paper and invite further expansion and clarification on these issues. Areas discussed are: the reliability of diagnosis of mental ill-health in people with severe disabilities; factors predictive of mental ill-health in people with severe disabilities; and the phenomenological experience in people with severe disabilities.