Anxiety in Children with Selective Mutism: A Meta-analysis.

This study evaluates the current conceptualization of selective mutism (SM) as an anxiety disorder in the DSM-5 using a meta-analytic approach. In the absence of any systematic assessment of anxiety in the field of SM, we pooled prevalence data of comorbid anxiety disorders in a random-effects meta-analysis. On the basis of 22 eligible studies (N = 837), we found that 80% of the children with SM were diagnosed with an additional anxiety disorder, notably social phobia (69%). However, considerable heterogeneity was present, which remained unexplained by a priori specified moderators. The finding that SM is often diagnosed in combination with anxiety disorders, indicates that these disorders are not discrete, separable categories. Moreover, this finding does not help to elucidate the relation between SM and anxiety as an etiological mechanism or symptomatic feature. Broadening our research strategies regarding the assessment of anxiety is paramount to clarify the role of anxiety in SM, and allow for proper classification.

Pre-Kraepelin Names for Mental Disorders.

Psychiatric classifications before the early 1900s generally are viewed as chaotic and not worthy of analysis. Sixteen different classificatory systems were identified that were pre-World War I and that were pre-Kraepelinian. A total of 827 names were collected from these 16 classifications. As expected, classification unreliability was a problem in these systems. Across the seven American classifications, the average match rate in names was 15% (i.e., 15% of the diagnoses in one system appeared with the same name in another system). The names that were most consistently recognized across these 16 classifications were "mania," "acute mania," "chronic mania," "melancholia," "general paralysis," "senile dementia," "epileptic insanity," "hysterical insanity," "moral insanity," "idiocy," and "cretinism." These 11 names summarize 19th century American views of psychopathology.

Predicting the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition): The Mystery of How to Constrain Unchecked Growth.

Twenty years ago, slightly after the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition was published, we predicted the characteristics of the future Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (). Included in our predictions were how many diagnoses it would contain, the physical size of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition), who its leader would be, how many professionals would be involved in creating it, the revenue generated, and the color of its cover. This article reports on the accuracy of our predictions. Our largest prediction error concerned financial revenue. The earnings growth of the DSM's has been remarkable. Drug company investments, insurance benefits, the financial need of the American Psychiatric Association, and the research grant process are factors that have stimulated the growth of the DSM's. Restoring order and simplicity to the classification of mental disorders will not be a trivial task.

The cycle of classification: DSM-I through DSM-5.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) was created in 1952 by the American Psychiatric Association so that mental health professionals in the United States would have a common language to use when diagnosing individuals with mental disorders. Since the initial publication of the DSM, there have been five subsequent editions of this manual published (including the DSM-III-R). This review discusses the structural changes in the six editions and the research that influenced those changes. Research is classified into three domains: (a) issues related to the DSMs as measurement systems, (b) studies of clinicians and how clinicians form diagnoses, and (c) taxonomic issues involving the philosophy of science and metatheoretical ideas about how classification systems function. The review ends with recommendations about future efforts to revise the DSMs.

Field trial of a putative research algorithm for diagnosing ICD-11 personality disorders in psychiatric patients: 1. Severity of personality disturbance.

This preliminary field trial examines the reliability and validity of a proposed research algorithm for diagnosing International Classification of Diseases (ICD)-11 personality disorders and its association with other psychiatric assessments for the primary classification of a single dimension of the five severity levels of personality dysfunction. In total, 137 psychiatric patients (119 with personality disorders and 18 without personality disorders) in Korea were assessed. In the first part of the study, inter-rater reliability was evaluated with an independent assessment of personality (personality assessment schedule). In the second part of the study, (1) the algorithm that identified any personality disturbance was compared with the ICD-10 and DSM-IV personality disorder diagnostic equivalents, and (ii) the four levels of severity were examined for their associations with clinical pathology and social functioning. The results showed good agreement between the algorithm and the test instruments for identifying a personality disorder. A graded increase in clinical pathology and social dysfunction was observed with increasing severity of personality disorder. These findings suggest that a simple algorithm for recording severity of a personality disturbance had both construct validity and was useful in practice, which supports severity classification as a valuable concept. These findings need to be confirmed in other cultures and ethnic groups.

Do clinicians conceptualize DSM-IV disorders hierarchically?

OBJECTIVE: All classification systems of psychopathology use hierarchical categories. The purpose of the two studies in this article was to test whether clinicians think hierarchically about mental disorders. METHOD: Seventy six clinicians were asked to sort 67 diagnostic categories into groups using different instruction sets, either to make progressively larger and smaller groups of diagnoses (Study 1) or to place similar groups next to each other (Study 1 and Study 2). RESULTS: Clinicians' sortings of mental disorders had a hierarchical structure regardless of the methodology, profession, expertise, and instructional set used. CONCLUSIONS: Given that all modern diagnostic systems have been hierarchical, it is important to know that clinicians' thinking is also hierarchical.

An invisible college view of the DSM-5 personality disorder classification.

The DSM-5 Personality and Personality Disorders Work Group released the final proposed changes for the upcoming manual in May 2012. The proposal, located at www.dsm5.org , included a hybrid dimensional/categorical method of diagnosing personality disorders. This brief article examines the reference section of the DSM-5 personality disorder proposal rationale (American Psychiatric Association, 2012). The authors counted the number of authors and the coauthorships; coauthorship patterns were then examined and diagramed. The data suggested that a group of researchers involved with the Collaborative Longitudinal Personality Disorders Study (CLPS) were central to the hybrid classification created by the DSM-5 work group.

Clinicians' conceptualizations of comorbid cases: a test of additive versus nonadditive models.

Comorbidity in psychopathology is a common phenomenon. However, little is known about the way in which clinicians think about comorbid cases. The Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) implies an additive model of concept combination, but studies of human cognition find that individuals often combine concepts in nonadditive ways. In this study, 70 clinicians listed symptoms for three disorders and their combinations. Participants produced nonadditive descriptions, termed overextensions, at significant rates. These results challenge the utility of the implicit additive model of the current DSM.

An alternative hierarchical organization of the mental disorders of the DSM-IV.

With the approaching publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), alternative organizations of the DSM (4th ed.; DSM-IV; American Psychiatric Association, 1994) categories have been proposed. This article compares several published alternative organizations to clinicians' organization of the DSM-IV categories. As demonstrations of their organization of DSM-IV categories, psychologists and psychiatrists sorted 66 DSM-IV diagnostic categories into groups of similar diagnoses and then made progressively larger and smaller groups of diagnoses or placed similar groups next to each other on a table. Hierarchical agglomerative data analysis of clinicians' individual sortings showed that clinicians retained many lower level DSM-IV categories (e.g., anxiety disorders, mood disorders), but not the higher level DSM-IV categories (e.g., Axis I vs. Axis II). Instead, at the highest hierarchical level, clinicians' categories resembled the structure of the first edition of the DSM (American Psychiatric Association, 1952), which followed clinicians' diagnostic decision-making scheme, dividing mental disorders into organic versus nonorganic and then psychotic versus neurotic disorders. At minimum, these data suggest a DSM organization that makes sense to clinicians.

Do clinicians see Axis I and Axis II as different kinds of disorders?

Since 1980, personality disorders have been conceptualized as a qualitatively different kind of mental disorder and placed on their own "axis." In this study, clinicians were given 67 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses and were asked to discard unfamiliar diagnoses, make groups of similar diagnoses, place the most similar groups next to each other, and describe the overall structure of their taxonomies. Results showed that clinicians were more familiar with the personality disorders than with some kinds of Axis I disorders (eg, sleep disorders). Clinicians tended not to keep the personality disorders in one group, although they often kept the cluster groupings together. Cluster groupings were often placed with comorbid Axis I disorders. These data suggest that clinicians did not see the personality disorders as qualitatively different from the Axis I disorders.

Gender acts as a context for interpreting diagnostic criteria.

This study used a unique methodology to determine the aspects of case vignettes that elicited an effect of case gender on diagnosis. A total of 99 psychiatrists and psychologists were shown cases representing a man or a woman that contained varying numbers of histrionic and antisocial criteria. The cases were presented by computer a few sentences at a time. Clinicians were asked to offer a diagnosis for the case after each group of sentences was presented. Results indicated that case gender tended to affect clinicians' diagnostic decisions when criteria related to that diagnosis were shown, suggesting that case gender was acting as a context in which diagnostic criteria were interpreted.

Voices of the five doctoral training councils in psychology: seeking common ground on Combined-Integrated doctoral training in psychology.

Doctoral training programs in psychology are accredited by the American Psychological Association in four areas: Clinical, Counseling, School, and Combined-Integrated (C-I) psychology. Each area of doctoral preparation in psychology has its own council, which represents its interests within the field and to external constituents. Despite the fact that Combined-Integrated training programs have existed since the mid-1970s, the Consortium representing this area's interests only formed in the past two years. The purpose of this article was to obtain input from representatives of all five training councils regarding the role of the newly formed council in relation to the other councils and the role of Combined-Integrated training. We begin with a brief description of each of the five councils. We then summarize the representatives' responses to narrative questions regarding advantages and disadvantages associated with meeting to discuss the combined model. Finally, common and divergent themes across the councils in training psychologists are presented, and the future role for Combined-Integrated programs is discussed.

Gender bias in the diagnosis of personality disorders: the roles of base rates and social stereotypes.

In all three studies described in this article, novices were trained to associate traits from the DSM-IV Cluster B personality disorder categories with four letters of the alphabet. Novices were also taught various gender associations (i.e., "base rate" information) with the categories (none, stereotype-consistent, or stereotype-inconsistent). Results showed that when no gender associations were taught (Study I), case gender did not affect ratings of case vignettes. When associations were consistent with social stereotypes (Study II), case gender influenced ratings in the expected direction. When associations were the opposite of social stereotypes (Study III), only the ratings for narcissistic and histrionic were affected. Across the three studies, these results suggested that subjects rated cases in accordance with known "base rates," but that the correspondence between base rates and stereotypic associations affected the consistency and magnitude of this base rate effect.