Introduction to the special issue on diagnoses, dimensions, and DSM-IV: The science of classification.

This special issue grew out of a meeting of the editorial board of the Journal of Abnormal Psychology chaired by Susan Mineka at the annual meeting of the American Psychological Association in 1989 in New Orleans. At that time the processes were in place for developing the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and it was clear that for the first time many psychologists were strongly involved. In addition, committees were completing work on the mental disorders section of the 10th edition of the International Classification of Diseases and Related Health Problems (ICD-10; World Health Organization, 1990), and a concerted effort was underway to make the DSM-IV and ICD-10 as compatible as possible. These developments pointed to something that approaches a worldwide system of nosology for use in both clinical and research endeavors. Quite naturally, these events have resulted in renewed interest in nosology, particularly the scientific basis of our nosological systems. The board felt that a series of invited papers on various scientific issues in this area might be very useful to the field. It also agreed that it would be important to concentrate on the scientific approaches to classification and the scientific underpinnings of the DSM-IV as it approximates some ideal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Locating eating pathology within an empirical diagnostic taxonomy: Evidence from a community-based sample.

Existing structural models of psychopathology need to be expanded to include additional diagnostic constructs beyond mood, anxiety, substance use, and antisocial behavior disorders. The goal of this study was to locate eating disorders within a hierarchical structural model of psychopathology that is anchored by broad Internalizing and Externalizing factors. Participants were female adolescent twins (N = 1,434) from the Minnesota Twin Family Study. The authors compared the fit of 4 models in which eating disorders (a) defined their own diagnostic class, (b) represented a subclass within Internalizing, (c) formed a subclass within Externalizing, and (d) were allowed to cross-load on both Internalizing and Externalizing. In the best fitting model, eating disorders formed a subfactor within Internalizing. These findings underscore the value of developing more comprehensive empirically based models of psychopathology to increase researchers' understanding of diverse mental disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders.

The reliability of current and lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) anxiety and mood disorders was examined in 362 outpatients who underwent 2 independent administrations of the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV–L). Good to excellent reliability was obtained for the majority of DSM-IV categories. For many disorders, a common source of unreliability was disagreements on whether constituent symptoms were sufficient in number, severity, or duration to meet DSM-IV diagnostic criteria. These analyses also highlighted potential boundary problems for some disorders (e.g., generalized anxiety disorder and major depressive disorder). Analyses of ADIS-IV–L clinical ratings (0–8 scales) indicated favorable interrater agreement for the dimensional features of DSM-IV anxiety and mood disorders. The findings are discussed in regard to their implications for the classification of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating Disorder Prevention Programs: A Meta-Analytic Review.

This meta-analysis of eating disorder prevention programs found that intervention effects ranged from an absence of any effects to reductions in current and future eating pathology. Certain effects persisted as long as 2 years and were superior to minimal-intervention control conditions. Larger effects occurred for selected (vs. universal), interactive (vs. didactic), and multisession (vs. single session) programs; for programs offered solely to females and to participants over age 15; for programs without psychoeducational content; and for trials that used validated measures. The results identify promising prevention programs and delineate sample, format, and design features that are associated with larger effects, but they suggest the need for improved methodological rigor and statistical modeling of trials and enhanced theoretical rationale for interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Plate tectonics in the classification of personality disorder: Shifting to a dimensional model.

The diagnostic categories of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders were developed in the spirit of a traditional medical model that considers mental disorders to be qualitatively distinct conditions (see, e.g., American Psychiatric Association, 2000). Work is now beginning on the fifth edition of this influential diagnostic manual. It is perhaps time to consider a fundamental shift in how psychopathology is conceptualized and diagnosed. More specifically, it may be time to consider a shift to a dimensional classification of personality disorder that would help address the failures of the existing diagnostic categories as well as contribute to an integration of the psychiatric diagnostic manual with psychology's research on general personality structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Further comments toward a dimensional classification of personality disorder.

Responds to the comments by H. N. Garb (see record 2007-19520-012) and A. M. Ruscio (see record 2007-19520-013) on the current authors' original article "Plate tectonics in the classification of personality disorder: Shifting to a dimensional model" (see record 2007-01685-001). Unable to respond to all of Garb's and Ruscio's concerns given space limitations, the current authors attempt to respond to key points regarding their article on integrating the classification of personality disorder with a dimensional model of general personality structure. These points include: clinical judgments; feasibility; communication; thresholds; and validity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Shedler-Westen Assessment Procedure-200 as a basis for modifying DSM personality disorder categories.

The Shedler-Westen Assessment Procedure-200 (SWAP) is a Q-sort instrument designed to assess personality pathology on the basis of clinician ratings. On the basis of research with the SWAP, its creators have proposed a group of 12 personality disorder (PD) diagnoses that can be used to replace or modify current Axis II categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The authors discuss conceptual and empirical issues that require clarification before this proposal can be properly evaluated. They identify problematic psychometric features of the SWAP, including its unrepresentative normative sample, its reliance on a fixed skewed distribution, and anomalies in its T-score approach to diagnoses. In addition, a review of research on SWAP-based PD categories indicates that important information regarding diagnostic coverage, validity, and temporal stability is presently lacking. The authors conclude that research evidence is currently insufficient to justify the use of SWAP-based PD categories to guide revision of the DSM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special series.

Eating disorders represent a major health problem in the United States. This special series cannot hope to answer definitively the many questions about eating problems facing the scientific and health care communities. However, it is the intention of this series to clarify some of the issues facing clinicians and scientists. In accomplishing this task, we have tried first to apprise the reader of the scope and significance of the problem. The first article addresses this broad task and pays special attention to anorexia and bulimia. This article provides a suitable overview for the more specific articles that follow. The remaining articles in the series provide the reader with a view of the most persuasive and innovative views of diagnosis, treatment, and prevention. Their topics range from normal eating to obesity, and they review primary preventions and provide information on the biological precursors and consequences of eating disturbances as well as on cultural-familial contributors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Binge Eating Disorder and Night Eating Syndrome: A Comparative Study of Disordered Eating.

The authors compared eating patterns, disordered eating, features of eating disorders, and depressive symptoms in persons with binge eating disorder (BED; n = 177), with night eating syndrome (NES; n = 68), and in an overweight comparison group without BED or NES (comparison; n = 45). Participants completed semistructured interviews and several established measures. Depressive symptoms were greater in the BED and NES groups than in the comparison group. NES participants ate fewer meals during the day and more during the night than BED and comparison participants, whereas BED participants ate more during the day than the comparison participants. BED participants reported more objective bulimic and overeating episodes, shape/weight concerns, disinhibition, and hunger than NES and comparison participants, whereas NES participants reported more eating pathology than comparison participants. This evaluation provides strong evidence for the distinctiveness of the BED and NES constructs and highlights their clinical significance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Self-help approaches for obesity and eating disorders: Research and practice.

Reviews the book, Self-help approaches for obesity and eating disorders: Research and practice edited by Janet D. Latner and G. Terence Wilson (see record 2007-11980-000). This book is an edited text that provides a review of research findings in this area and a discussion of practical strategies related to implementing self-help. The intended audience is researchers and clinicians, and the book provides a good balance of literature review and consideration of practical issues that should meet the needs of both. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moderators of the body dissatisfaction-eating disorder symptomatology relationship: Replication and extension.

In this study, research conducted by T. L. Tylka (2004) was replicated and extended by examining perfectionism (self-oriented and socially prescribed), ego goal orientation, body surveillance, and neuroticism as moderators of the relationship between body dissatisfaction and bulimic and anorexic symptomatology among female undergraduates (N = 398). Hierarchical moderated regression was used to test the main and interactive effects of the models and to control for physical size and social desirability. As expected, body dissatisfaction was strongly related to the measures of disordered eating, accounting for 16% to 26% of the variance. Two variables (neuroticism and body surveillance) received support as moderators of the relationships between body dissatisfaction and bulimic and anorexic symptoms. Ego goal orientation and socially prescribed perfectionism moderated the effects of body dissatisfaction on bulimic symptoms, whereas self-oriented perfectionism served as a moderator only for anorexic symptoms. In all instances, higher levels of body dissatisfaction paired with higher levels of the moderator were associated with more disturbed eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Competing paradigms for anorexia nervosa.

The current author comments on the articles from the April 2007 American Psychologist special issue on eating disorders. The current author states that the contributors to this special issue are to be commended for acknowledging lack of progress in understanding, classifying, and treating anorexia nervosa (AN). They highlighted the acute need to refine diagnosis (see record 2007-04834-004), understand comprehensive causal mechanisms to tune treatments and transcend "hodgepodge diagnoses" (see record 2007-04834-005), study functional neural circuits and link behavior with "genomic, cellular, and systems data" (see record 2007-04834-003), and develop effective treatments (see record 2007-04834-006). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating disorders: National Institute of Mental Health's perspective.

The mission of the National Institute of Mental Health (NIMH) is to reduce the burden of mental and behavioral disorders through research, and eating disorders embody an important fraction of this burden. Although past and current research has provided important knowledge regarding the etiology, classification, pathophysiology, and treatment of the eating disorders, there are still significant challenges that need to be addressed. This article briefly describes some of these challenges, recent NIMH-supported research and research-related activities directed at addressing these challenges, and approaches and areas of research that hold promise for furthering the understanding and treatment of eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coming to Terms With Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy.

The aims of the present review are to apply a recent risk factor approach (H. C. Kraemer et al., 1997) to putative risk factors for eating disorders, to order these along a timeline, and to deduce general taxonomic questions. Putative risk factors were classified according to risk factor type, outcome (anorexia nervosa, bulimia nervosa, binge-eating disorder, full vs. partial syndromes), and additional factor characteristics (specificity, potency, need for replication). Few of the putative risk factors were reported to precede the onset of the disorder. Many factors were general risk factors; only few differentiated between the 3 eating disorder syndromes. Common risk factors from longitudinal and cross-sectional studies were gender, ethnicity, early childhood eating and gastrointestinal problems, elevated weight and shape concerns, negative self-evaluation, sexual abuse and other adverse experiences, and general psychiatric morbidity. Suggestions are made for the conceptualization of future risk factor studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Social Construction of Women and Disordered Eating Patterns.

This investigation examined the impact of the social construction of women on the development of disordered eating. Based on a survey completed by 394 young women from the community, self-silencing of needs and voice, the suppression of the outward expression of anger, and the internalization of the objectified gaze toward one's own body were found, in multiple regression analyses, to significantly predict scores on eating disorder measures. Together, they explain between 27% and 46% of the variance on these measures. This study supports the need to consider the development of disordered eating within the context of multiple gender-based social constructions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The undisordered personality: Normative assumptions underlying personality disorder diagnoses.

Clinical diagnoses are impossible without referring to normative assumptions about what is desirable functioning. In this paper, the authors explicate the implicit normative assumptions that seem to have guided the formulation of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV) personality disorder (PD) criteria. Then the authors discuss various conceptual reference frames in which such assumptions may be grounded: (1) a given diagnostician’s personal value system, (2) the expectations of the culture in which a person currently lives, (3) the expectations of the culture in which a person was raised, (4) models of “natural” personality functioning that are rooted in evolution theory, and (5) the presence of distress and/or impairment. In accordance with Wakefield (1992a, 2006), the authors argue that PD diagnoses necessarily involve both an evolutionary and a cultural component. If PDs were defined completely in cultural terms, investigating their biological underpinnings would be nonsensical. In addition, the values of any specific culture should not be given too much weight, because cultural expectations may themselves be harmful. Future editions of DSM should define personality pathology in less culture-relative terms, and address the inevitable issue of values more explicitly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Males and eating disorders: Gender-based therapy for eating disorder recovery.

Mental health professionals may wonder how males with eating disorders differ from females with eating disorders and how best to treat males with eating disorders. The eating disorder literature largely focuses on females. Limited research has examined assessment and treatment of eating disorders in males. This article offers a unique view of eating disorder treatment for males by integrating it with the literature on the psychology of men. Mental health professionals are given practical suggestions to guide eating disorder recovery in males. A case example shows treatment considerations for working with males with disordered eating behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder.

The authors investigated prospectively assessed eating pathology (body image dissatisfaction and bulimia nervosa symptoms) among an ethnically and socioeconomically diverse sample of adolescent girls with attention-deficit/hyperactivity disorder--combined type (ADHD--C; n=93), ADHD--inattentive type (ADHD--I; n=47), and a comparison group (n=88). The sample, initially ages 6-12 years, participated in a 5-year longitudinal study (92% retention rate). After statistical control of relevant covariates, girls with ADHD--C at baseline showed more eating pathology at follow-up than did comparison girls; girls with ADHD--I were intermediate between these two groups. Baseline impulsivity symptoms, as opposed to hyperactivity and inattention, best predicted adolescent eating pathology. With statistical control of ADHD, baseline peer rejection and parent- child relationship problems also predicted adolescent eating pathology. The association between punitive parenting in childhood and pathological eating behaviors in adolescence was stronger for girls with ADHD than for comparison girls. Results are discussed in terms of the expansion of longitudinal research on ADHD to include female-relevant domains of impairment, such as eating pathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating Disorder Diagnostic Scale: Additional Evidence of Reliability and Validity.

The authors conducted 4 studies investigating the reliability and validity of the Eating Disorder Diagnostic Scale (HDDS; E. Stice, C. F. Telch, & S. L. Rizvi, 2000), a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa, and binge eating disorder. Study 1 found that the HDDS showed criterion validity with interview-based diagnoses, convergent validity with risk factors for eating pathology, and internal consistency. Studies 2 and 3 found that the EDDS was sufficiently sensitive to detect the effects of eating disorder prevention programs. Regarding predictive validity, Studies 3 and 4 found that the EDDS predicted response to a prevention program and future onset of eating pathology and depression. Results provide additional evidence of the reliability and validity of this scale and suggest it may be useful in clinical and research applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)