Onset and staging of DSM-IV alcohol dependence using mean age and survival-hazard methods.

Orderly onset of psychiatric symptoms has implications for both case detection and the construct validity of the underlying illness. Mean age and survival-hazard techniques were used to study the onset of alcohol abuse and dependence (as defined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Association, 1994) in 369 clinical cases drawn from a heterogeneous regional sample. The methods provided a similar general pattern of symptom sequencing, though only survival-hazard analysis described a punctuated onset of alcoholism in 3 discrete stages: alcohol abuse, dependence, and accommodation to the illness. This model survived a rigorous program of tests for goodness of fit and described the majority of the sample, supporting the construct validity of both alcohol abuse as a discrete first illness phase and of dependence as a set of core constructs distinct from and succeeding abuse. The specific strengths of survival-hazard analysis as a research tool in illness staging research are discussed. (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)     

Reasons for drinking alcohol: Relationships with DSM-IV alcohol diagnoses and alcohol consumption in a community sample.

The relationship between self-reported reasons for drinking and the DSM-IV alcohol use disorders and alcohol consumption was examined. Participants were 777 heavy drinking community residents who completed the Alcohol Use Disorders and Associated Disabilities Interview Schedule (B. F. Grant and D. Hasin, 1992) and a self-report assessment battery. Drinking to reduce negative affect was greater among drinkers with a current DSM-IV alcohol dependence diagnosis compared with drinkers with no DSM-IV alcohol use disorder. The DSM-IV alcohol abuse and the no-diagnosis groups did not differ in reasons for drinking. A positive association was demonstrated between drinking to reduce negative affect and frequency of intoxication. Drinking for enjoyment was positively associated with the frequency of binge drinking, frequency of intoxication, and average daily ethanol consumption. However, the relationship between drinking for enjoyment and average daily ethanol consumption was stronger among those with no alcohol disorder compared to those with DSM-IV alcohol dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex bias in the diagnosis of personality disorders: An evaluation of DSM-IV criteria.

This study considered whether the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) is biased against women by requiring less dysfunction for the personality disorders that are more commonly diagnosed in women (e.g., histrionic). Clinicians estimated the extent of social dysfunction, occupational dysfunction, and personal distress suggested by each of the diagnostic criteria for 6 personality disorders. The results failed to suggest a bias against women, as there was no difference in the overall level of dysfunction associated with the female-typed personality disorder diagnostic criteria (fewer criteria are also required for the male-typed diagnoses). However, the considerable variation in dysfunction across disorders and criteria, and the minimal degree of impairment implied by some of the diagnostic criteria, also raise more general issues that should perhaps be addressed in future editions of the diagnostic manual. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between the DSM-IV and the ICD-10..

The 10th revision of the International Classification of Diseases and Related Health Problems (ICD-10; World Health Organization, 1990) and the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) will both come into use in 1993 and be much more alike than the ICD-9 (World Health Organization, 1978) and the DSM-III (American Psychiatric Association, 1980). The American Psychiatric Association's controversial decision to publish a revision of the DSM-III in 1987 before setting up the Task Force to produce the DSM-IV impaired the association's ability to influence the format of the ICD-10, because by then major decisions had already been made by the World Health Organization. The DSM-IV will be more soundly based on a wider range of empirical data than any previous classification, national or international, and should not be revised again without compelling scientific reasons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of AIDS and alcohol/drug abuse: Psychosocial research.

Reviews the book, AIDS and alcohol/drug abuse: Psychosocial research, edited by Dennis G. Fisher (1991). Substance use, primarily intravenous drug use, accounts for an increasingly large proportion of new acquired immunodeficiency syndrome (AIDS) cases. As such, psychosocial research in the addictions plays an important role in evaluating strategies for reaching out to and educating those at risk for the human immunodeficiency virus (HIV) and in developing effective prevention and risk-reduction strategies for this special population. This book is thus a timely contribution to the field. The seven brief chapters in this volume cover an extremely broad range of topics related to the relationship between AIDS and substance abuse. On the whole, however, the chapters in this volume are strikingly uneven in their sophistication and degree of relevance to the general psychologist working in addictive behaviors. Whereas some of the chapters are too brief to fully explore the implications of some of the issues they raise, the brevity of others is appropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of survival analyses to examine onset and staging of DSM-IV alcohol symptoms in women.

Despite their implications for diagnostic validity. few studies have examined patterns of alcohol symptom onset in women. Using Structured Clinical Interview for the DSM-lV (M. B. First, M. Gibbon, R. L. Spitzer, & J. B. W. Williams, 1995) data, the authors applied survival analysis to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) alcohol symptoms in 87 women in treatment. Legal problems occurred rarely and did not fit a staging model. Compared with men previously studied, women showed a later onset of symptoms, which developed in 4 stages: abuse, consequation, accommodation to the illness, and physiological dependence. Three symptoms-hazardous use, larger/longer use than intended, and lots of time spent using-occurred early and may be useful for screening purposes. (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)     

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)     

Diagnostic issues in posttraumatic stress disorder: Considerations for the DSM-IV.

Four issues of key interest with regard to posttraumatic stress disorder (PTSD) in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are discussed. These include: (1) how to define the stressor criterion, especially, whether or not the victim's response ought to be included and whether low-magnitude traumas qualify etiologically; (2) the cohesiveness of the syndrome and the validity of items across stressor groups; (3) the position of PTSD within DSM-IV; and (4) comorbidity with other illnesses. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The etiology and diagnosis of alcohol dependence: Differences in the professional literature.

Recent epidemiological studies indicate that alcohol-related problems continue to be widespread and include multiple medical, psychological, family, and social consequences. However, numerous debates exist among clinicians, recovery counselors, and researchers regarding a variety of issues related to alcohol dependence assessment and treatment. Controversies include different views about etiology, diagnosis, disease-versus-syndrome concepts, and the relationship between Alcoholics Anonymous and professional researchers and clinicians. This article informs and clarifies these controversies by highlighting recent findings from the empirical and theoretical literature. If the field of psychology is to effectively impact the alcohol treatment field, clinicians must implement specific diagnostic and intervention strategies that are based on the existing alcohol literature rather than theoretical bias. Recommendations include strategies for increasing collaboration among clinicians, researchers, and recovery counselors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy and the DSM-IV criteria for antisocial personality disorder.

The Axis II Work Group of the Task Force on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy and to international criteria. R. D. Hare et al describe an alternative to the approach taken in the DSM-III—Revised (DSM-III—R; American Psychiatric Association, 1987), namely, the revised Psychopathy Checklist. The authors also discuss the multisite APD field trials designed to evaluate and compare 4 criteria sets: the DSM-III—R criteria, a shortened list of these criteria, the criteria for dyssocial personality disorder from the 10th edition of the International Classification of Diseases (World Health Organization, 1990), and a 10-item criteria set for psychopathic personality disorder derived from the revised Psychopathy Checklist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The joint structure of DSM-IV Axis I and Axis II disorders.

The Diagnostic and Statistical Manual (4th ed. [DSM–IV]; American Psychiatric Association, 1994) distinction between clinical disorders on Axis I and personality disorders on Axis II has become increasingly controversial. Although substantial comorbidity between axes has been demonstrated, the structure of the liability factors underlying these two groups of disorders is poorly understood. The aim of this study was to determine the latent factor structure of a broad set of common Axis I disorders and all Axis II personality disorders and thereby to identify clusters of disorders and account for comorbidity within and between axes. Data were collected in Norway, through a population-based interview study (N = 2,794 young adult twins). Axis I and Axis II disorders were assessed with the Composite International Diagnostic Interview (CIDI) and the Structured Interview for DSM–IV Personality (SIDP–IV), respectively. Exploratory and confirmatory factor analyses were used to investigate the underlying structure of 25 disorders. A four-factor model fit the data well, suggesting a distinction between clinical and personality disorders as well as a distinction between broad groups of internalizing and externalizing disorders. The location of some disorders was not consistent with the DSM–IV classification; antisocial personality disorder belonged primarily to the Axis I externalizing spectrum, dysthymia appeared as a personality disorder, and borderline personality disorder appeared in an interspectral position. The findings have implications for a meta-structure for the DSM. (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)     

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)     

Prevalence of alcohol dependence and abuse in general practice

The aim of this study is to deliver representative epidemiological data about the prevalence of alcohol abuse and dependence in general practices in an urban area. In 12 general practices at Luebeck, a Northern German city with 220,000 inhabitants, a total of 929 patients (aged between 14 and 75 years) were screened using the CAGE and the Short Michigan Alcoholism Screening Test. If one of these screening questionnaires or the General Practitioners' assessment of the patient indicated an alcohol problem, the patient underwent a standardized diagnostic interview using the alcohol section of the Schedules for Clinical Assessment in Neuropsychiatry. The prevalence rates according to ICD-10 or DSM-III-R were 3.5% for alcohol abuse and 7.2% for alcohol dependence, the sex ratio was 1:2.8 (female:male). These results are compared with previous findings, and general epidemiological implications of this study are discussed.     

Meta-analyses of ALDH2 and ADH1B with alcohol dependence in Asians.

Meta-analyses were conducted to determine the magnitude of relationships between polymorphisms in 2 genes, ALDH2 and ADH1B, with alcohol dependence in Asians. For each gene, possession of 1 variant *2 allele was protective against alcohol dependence, and possession of a 2nd *2 allele did not offer significant additional protection. The protective effects of these 2 gene polymorphisms were independent. Diagnostic criteria, recruitment strategy, and Japanese ethnicity moderated the effect of ALDH2*2. Recruitment strategy and gender moderated the effect of ADH1B*2. These findings highlight the importance of methodological issues and potential gene-gene and gene-environment interactions that must be considered when examining relationships between genetic polymorphisms and phenotypes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Bulimia Test—Revised: Validation with DSM-IV criteria for bulimia nervosa.

The Bulimia Test —Revised [(BULIT-R) M. H. Thelen, J. Farmer, S. Wonderlich, & M. Smith; see record 78:17280] was given to participants who met the criteria in the fourth edition of the Diagnostic and Siatistical Manual of Mental Disorders (DSM-IV) for bulimia nervosa and control participants to determine if the test continues to be a valid measure of bulimia nervosa. Although the BULIT-R was developed and validated with bulimic individuals as determined by the DSM-III-R criteria, it appears to be a valid instrument with which to identify individuals who meet DSM-IVcriteria for bulimia nervosa. (PsycINFO Database Record (c) 2010 APA, all rights reserved)