scholarly journals DSM-5, psychiatric epidemiology and the false positives problem

2015 ◽  
Vol 24 (3) ◽  
pp. 188-196 ◽  
Author(s):  
J. C. Wakefield
Keyword(s):  
Psychiatric Epidemiology ◽  
False Positives ◽  
Psychiatric Research ◽  
Intermittent Explosive Disorder ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Diagnostic Threshold ◽  
Public Record ◽  
Definition Of ◽  
Verbal Arguments

The revision effort leading to the publication of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was flawed in process, goals and outcome. The revision process suffered from lack of an adequate public record of the rationale for changes, thus shortchanging future scholarship. The goals, such as dimensionalising diagnosis, incorporating biomarkers and separating impairment from diagnosis, were ill-considered and mostly abandoned. However, DSM-5's greatest problem, and the target of the most vigorous and sustained criticism, was its failure to take seriously the false positives problem. By expanding diagnosis beyond plausible boundaries in ways inconsistent with DSM-5's own definition of disorder, DSM-5 threatened the validity of psychiatric research, including especially psychiatric epidemiology. I present four examples: increasing the symptom options while decreasing the diagnostic threshold for substance use disorder, elimination of the bereavement exclusion from major depression, allowing verbal arguments as evidence of intermittent explosive disorder and expanding attention-deficit/hyperactivity disorder to adults before addressing its manifest false positives problems.

To ID or Not to ID? Changes in Classification Rates of Intellectual Disability Using DSM-5

2014 ◽  
Vol 52 (3) ◽  
pp. 165-174 ◽  
Author(s):  
Aimilia Papazoglou ◽  
Lisa A. Jacobson ◽  
Marie McCabe ◽  
Walter Kaufmann ◽  
T. Andrew Zabel
Keyword(s):  
Intellectual Disability ◽  
Clinical Judgment ◽  
Assessment System ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Adaptive Behavior Assessment System ◽  
Dsm Iv ◽  
Definition Of ◽  
Adaptive Skill

Abstract The Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5) diagnostic criteria for intellectual disability (ID) include a change to the definition of adaptive impairment. New criteria require impairment in one adaptive domain rather than two or more skill areas. The authors examined the diagnostic implications of using a popular adaptive skill inventory, the Adaptive Behavior Assessment System–Second Edition, with 884 clinically referred children (ages 6–16). One hundred sixty-six children met DSM-IV-TR criteria for ID; significantly fewer (n  =  151, p  =  .001) met ID criteria under DSM-5 (9% decrease). Implementation of DSM-5 criteria for ID may substantively change the rate of ID diagnosis. These findings highlight the need for a combination of psychometric assessment and clinical judgment when implementing the adaptive deficits component of the DSM-5 criteria for ID diagnosis.

Evidence for the taxonic latent structure for DSM-5 intermittent explosive disorder in adults

2019 ◽  
pp. 1-8 ◽  
Author(s):  
Jennifer R. Fanning ◽  
David K. Marcus ◽  
Jonathan R. Preszler ◽  
Emil F. Coccaro
Keyword(s):  
Aggressive Behavior ◽  
Population Based ◽  
Latent Structure ◽  
Behavioral Disorder ◽  
Standardized Assessments ◽  
Intermittent Explosive Disorder ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Group Members ◽  
Clinically Significant

Abstract Background Identification of individuals with clinically significant aggressive behavior is critical for the prevention and management of human aggressive behavior. A previous population-based taxometric study reported that the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV) intermittent explosive disorder (IED) belongs to its own discrete class (taxon) rather than existing along a continuum. Methods This study sought to extend previous population-based findings in a clinical research sample of adults with DSM-5 IED (n = 346), adults with non-aggressive DSM-5 disorders (n = 293), and adults without any DSM-5 disorder (n = 174), using standardized assessments of DSM-5 diagnoses, aggression, and other related measures not available in past studies. Results Analyses revealed a taxonic latent structure that overlapped with the DSM-5 diagnosis of IED. Within the sample, taxon group members had higher scores on a variety of measures of psychopathology than did the complement members of the sample. Comorbidity of other diagnoses with IED did not affect these results. Conclusion These findings support the proposition that DSM-5 IED represents a distinct behavioral disorder rather than the severe end of an aggressive behavior continuum.

Future of Classification in Posttraumatic Stress Disorder

2012 ◽  
pp. 53-66
Author(s):  
Terence M. Keane ◽  
Mark W. Miller
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Mental Disorders ◽  
Stress Disorder ◽  
Future Directions ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
The Status ◽  
History Of ◽  
Definition Of

This chapter reviews the status of modifications to the definition of PTSD and proposed changes for DSM-5. We include a brief history of the diagnosis and trace its evolution in the Diagnostic and Statistical Manual of Mental Disorders (DSM). We discuss some of the current controversies related to the definition of PTSD including its location among the anxiety disorders, the utility of Criterion A and its subcomponents, and the factor structure of the symptoms. We review the rationale for the addition of new symptoms and modifications to existing criteria now and conclude with comments on future directions for research on PTSD.

Comparing Math LD Diagnostic Rates Obtained Using LDAC and DSM-5 Criteria: Implications for the Field

2020 ◽  
Vol 35 (3) ◽  
pp. 175-196
Author(s):  
Meadow Schroeder ◽  
Michelle A. Drefs ◽  
Michael Zwiers
Keyword(s):  
Learning Disabilities ◽  
Learning Disability ◽  
Classification Systems ◽  
Math Learning ◽  
Data Set ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Learning Disability Identification ◽  
Definition Of ◽  
Disability Identification

Within the Canadian context, the two major learning disability classification systems are arguably the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders and the Learning Disabilities Association (LDAC) of Canada’s Official Definition of Learning Disabilities. Several of the more recent changes to the fifth edition of the DSM contrast with the LDAC definition, which establishes them as competing diagnostic frameworks. We investigated the frequency of math learning disability identification when both the LDAC and DSM-5 criteria were modelled and applied to an archived data set (2011–2016). Results support generally similar percentages of math learning disability cases identified when employing LDAC or DSM-5 criteria; however, the two methods identified a different set of cases. Implications for using DSM-5 versus LDAC criteria in diagnosing learning disabilities are discussed, including the need to consider adopting a national diagnostic standard.

Impulse-control and its disorders, including pathological gambling

2020 ◽  
pp. 1257-1264
Author(s):  
Donald W. Black
Keyword(s):  
Impulse Control ◽  
Gambling Disorder ◽  
Self Regulation ◽  
Conduct Disorders ◽  
Statistical Manual ◽  
Intermittent Explosive Disorder ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Oppositional Defiant ◽  
Behavioural Addictions

Impulse-control disorders (ICDs) are conditions, the hallmark of which is difficulty with emotional and behavioural self-regulation. Acknowledged in Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) as ‘disorders of impulse control not elsewhere classified’, the category was reorganized in DSM-5 as ‘disruptive, impulse-control, and conduct disorders’. This chapter discusses oppositional defiant disorder (ODD), intermittent explosive disorder, kleptomania, pyromania, and gambling disorder. Several non-DSM conditions are also included: compulsive shopping, Internet addiction, and compulsive sexual behaviour. The latter conditions are often referred to as behavioural addictions, a category for disorders that appear to share commonalities with traditional substance use disorders but are not associated with the use of drugs or alcohol.

Exclusion of overlapping symptoms in DSM-5 mixed features specifier: heuristic diagnostic and treatment implications

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 126-133 ◽  
Author(s):  
Gin S Malhi ◽  
Yulisha Byrow ◽  
Tim Outhred ◽  
Kristina Fritz
Keyword(s):  
Future Research ◽  
Mixed States ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Mixed Features ◽  
Definition Of ◽  
Compare And Contrast ◽  
Current Classification System

This article focuses on the controversial decision to exclude the overlapping symptoms of distractibility, irritability, and psychomotor agitation (DIP) with the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) mixed features specifier. In order to understand the placement of mixed states within the current classification system, we first review the evolution of mixed states. Then, using Kraepelin’s original classification of mixed states, we compare and contrast his conceptualization with modern day definitions. The DSM-5 workgroup excluded DIP symptoms, arguing that they lack the ability to differentiate between manic and depressive states; however, accumulating evidence suggests that DIP symptoms may be core features of mixed states. We suggest a return to a Kraepelinian approach to classification—with mood, ideation, and activity as key axes—and reintegration of DIP symptoms as features that are expressed across presentations. An inclusive definition of mixed states is urgently needed to resolve confusion in clinical practice and to redirect future research efforts.

Conceptualization of psychosis in psychiatric nosology

2020 ◽  
pp. 3-11
Author(s):  
Matcheri S. Keshavan ◽  
John Torous ◽  
Rajiv Tandon
Keyword(s):  
Statistical Manual ◽  
Classification Schemes ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Digital Phenotyping ◽  
Novel Approaches ◽  
Spectrum Disorders ◽  
Definition Of ◽  
Research Domain ◽  
Current Standards

The definition of psychotic spectrum disorders such as schizophrenia has evolved with changing nosology and scientific advancements over the last 200 years. Understanding both the historical evolution of the concept and recent changes reflected in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) and the National Institute of Health’s (NIH) Research Domain Criteria (RDOC) framework is critical for informing current efforts to further update and refine the nosology of psychotic spectrum disorders. This chapter offers an overview of past classification schemes, current standards, and novel approaches to further improve the validity of these definitions through use of biomarkers, reverse nosologies, and digital phenotyping tools like smartphones and sensors.

Diagnostic and Statistical Manual (DSM)

2014 ◽  
Author(s):  
Thomas A. Widiger ◽  
Whitney L. Gore
Keyword(s):  
Empirical Support ◽  
Dimensional Model ◽  
Fourth Edition ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
History Of ◽  
Dsm Iv ◽  
Definition Of

This chapter provides a discussion of the American Psychiatric Association’s classification of mental disorders (DSM-I through DSM-5), with a particular emphasis on mood disorders and their classification and diagnosis. It begins with the rationale for having an official, authoritative diagnostic manual and then traces the history of the development of the first edition through the fourth edition (DSM-IV-TR, 2000). The authors then discuss fundamental issues concerning the fifth edition (DSM-5, 2013), including the definition of mental disorder, the empirical support for proposed revisions, the shift toward a dimensional model of classification, and the shift toward a neurobiologically-based classification.

The treatment of bipolar mixed states

2017 ◽  
Author(s):  
Sarah Kittel-Schneider
Keyword(s):  
Mixed States ◽  
Major Depressive ◽  
Randomized Controlled Clinical Trials ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Bipolar Ii ◽  
Definition Of ◽  
Bipolar Patients ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Definition of mixed episodes has changed in the Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5). A mixed feature specifier can be added not only to major depressive episodes and manic episodes in bipolar patients but also to hypomanic episodes in bipolar II patients and major depressive episode in major depressive disorder. Atypical antipsychotics seem to be effective in acute treatment as well as valproate and carbamazepine. Regarding prophylaxis of mixed states, monotherapy with valproate, olanzapine and quetiapine seems to prevent mixed episodes. Adjunctive therapy with valproate or lithium to quetiapine has also proven to be effective in prophylaxis of mixed episodes. In patients who suffer from pharmacotherapy-resistant mixed episodes electroconvulsive therapy can lead to response/remission. There is a lack of randomized controlled clinical trials investigating pharmacological and non-pharmacological treatments with focus on mixed states of bipolar patients, especially according to the DSM-5 definition.

Philosophical Issues in Psychiatry IV

2017 ◽  
Keyword(s):  
Steering Committee ◽  
Psychiatric Research ◽  
Psychiatric Diagnoses ◽  
Foreseeable Future ◽  
Philosophy Of Psychiatry ◽  
Psychiatric Nosology ◽  
Dsm 5 ◽  
Wide Range ◽  
Continuous Improvement Model ◽  
Definition Of

This book contains, in addition to an introduction, sixteen chapters, each with its own introduction and discussion, that review various issues within psychiatric nosology from clinical, historical and particularly philosophical perspectives. The contributors to this book include major psychiatric researchers, clinicians, historians and especially nosologists (including several leaders of the DSM-5 effort and the DSM Steering Committee that will be guiding future revisions in DSM for the foreseeable future), psychologists with a special interest in psychiatric nosology and philosophers with a wide range of orientations. The book is organized into four major sections. The first explores the nature of psychiatric illness and the ways in which define it including clinical and psychometric perspectives. The second section examines problems in the reification of psychiatric diagnostic criteria, the problem of psychiatric epidemics and the nature and definition of individual symptoms. The third session explores the concept of epistemic iteration as a possible governing conceptual framework for the revision efforts for official psychiatric nosologies such as DSM and ICD and the problems of validation of psychiatric diagnoses. The final session explores how we might move from the descriptive to the etiologic in psychiatric diagnoses, the nature of progress in psychiatric research and the possible benefits of moving to a living document (or continuous improvement) model for psychiatric nosologic systems. The organization of the book—with its introduction and comments—well captures the dynamic cross-disciplinary interactions that characterize the best work in the philosophy of psychiatry.

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