If an Entrepreneur Founded the DSM-5 Alternative Model of Personality Disorder: When Axis II Meets Disruptive Innovation

Personality disorder (PD) researchers proposed a highly innovative “paradigm-shifting” revamp for the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5; APA, 2013). Yet, ten years later, Widiger and Hines (this issue) summarize a developmental process plagued by disagreement and stagnation, with little evidence of the field having reaped the desired benefits of this diagnostic revolution. In this commentary, we draw on principles from entrepreneurial creation, operation, and success—positioning the personality disorder scientists in the role of “disruptive innovator”—and summarize key principles from the entrepreneurial process that may be relevant in understanding the challenges and failures of the personality disorder revolution to date.

Sociocultural Context and the DSM-5 Alternative Model of Personality Disorder: Comment on Widiger & Hines

Widiger and Hines provide a brief overview of the development of the Alternative Model of Personality Disorder (AMPD) housed within Section 3 of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). They highlight eight issues and controversies related to the AMPD in need of resolution for improvement of both the AMPD model itself as well as the field of personality disorders more broadly. In this brief commentary, I add a ninth issue in need of attention both with respect to the AMPD but also within the field of personality disorders more broadly: 9) How is sociocultural context to be accommodated in AMPD—and more generally personality disorder—theory, research, and treatment? The historical intra-individual, deficit-based models for conceptualizing personality disorders linger in current personality disorder discourse. However, failure to appropriately consider sociocultural context that systematically predisposes wide swaths of the population to unequal access to resources and exposure to psychological stressors, which can impact the appearance of personality pathology, serves to stigmatize minoritized individuals. The personality disorder field, and the AMPD discourse, must appropriately contend with sociocultural context in its models otherwise it risks developing models with limited generalizability and which hold potential to adversely affect sexual and gender minoritized populations, among others.

Post-Traumatic Stress Disorder in People with Visual Impairment Compared with the General Population

Background: People with a visual impairment appear to have an increased risk of experiencing potentially traumatizing life events and possibly also subsequently developing post-traumatic stress disorder (PTSD). This study investigated the point prevalence of PTSD in people with a visual impairment compared with the general population of Norway and examined factors associated with PTSD among people with a visual impairment. Methods: A telephone-based survey was administered to a probability sample of 1216 adults with a visual impairment. Of these, 736 (61% response rate) participated. A probability sample from the general population served as a reference (n = 1792, 36% response rate). PTSD was measured with the PTSD Checklist for the DSM-5 (PCL-5), based on the currently most bothersome event reported from the Life Events Checklist for DSM-5 (LEC-5). We used the DSM-5 diagnostic guidelines to categorize participants as fulfilling the PTSD symptom criteria or not. Results: The prevalence of PTSD was higher among people with a visual impairment than in the general population, both for men (9.0% vs. 3.8%) and women (13.9% vs. 8.5%). The prevalence rates of PTSD from the illness or injury that had caused the vision loss (men 3.9%, women 2.2%) accounted for a considerable part of the difference between the populations. For women, PTSD related to sexual assaults also contributed significantly to a higher PTSD prevalence in the visually impaired versus the general population (5.2% vs. 2.2%), while for men there were no other event categories which resulted in significant differences. Among people with a visual impairment, the higher risk of PTSD was associated with lower age, female gender, having acquired the vision loss, and having other impairments in addition to the vision loss. Conclusion: The higher prevalence of PTSD in people with a visual impairment suggests that vulnerability to mental health problems is associated with serious life events. The higher incidence than in the general population is partly due to the illness or injury that had led to the vision loss and partly due to people with vision loss appearing to be more vulnerable through exposure to other types of potentially traumatizing events, such as sexual abuse.

Night Eating Syndrome in Patients With Obesity and Binge Eating Disorder: A Systematic Review

Night eating syndrome (NES) is currently classified as an Other Specified Feeding or Eating Disorder (OSFED) under the Diagnostic Statistical Manual−5 (DSM-5). This systematic review aims to consolidate the studies that describe the sociodemographic, clinical and psychological features of NES in a population of patients with eating disorders (ED), obesity, or those undergoing bariatric surgery, and were published after the publication of the DSM-5. A further aim was to compare, where possible, NES with BED on the aforementioned variables. Lastly, we aimed to appraise the quality of the studies being included in the review. We conducted a systematic search on three databases (MEDLINE, PubMed and Embase) which resulted in the selection of 22 studies for the review. We included the articles that studied patients with NES and their sociodemographic, clinical and psychological features in a clinical (i.e., ED, obese or bariatric surgery) population, through a quantitative study design. Articles were excluded if the NES patients included in the study had a comorbid psychological disorder, and/or the sample was collected from a university/non-clinical population, and/or the study design was qualitative, and/or NES features were compared with any other disorder, except BED. Our study found that no conclusions about the link between any sociodemographic feature (such as, age, gender, income, etc.) and an NES diagnosis could be made. Further, NES patients presented with elevated ED pathology (including emotional eating and loss of control eating) and higher occurrence of depressive symptoms than controls. Contrary to the literature suggesting that NES and Binge Eating Disorder (BED; an ED subtype which is also comorbid with obesity) patients often report overlapping features, questioning the validity of NES as an ED diagnosis, we found that BED can be differentiated from NES by the higher occurrence of emotional eating, body related concerns and abnormal eating episodes. The review also suggested an overlap between NES and Sleep-Related Eating Disorder. We recommend that it is essential to study NES as an independent disorder to further develop its diagnostic criteria and treatment options, thereby, increasing the quality of life of the patients suffering from this syndrome.

Diagnostic Contribution of the DSM-5 Criteria for Internet Gaming Disorder

Background: Internet gaming disorder (IGD) can have long-term severe consequences in affected individuals, especially adolescents and young people. Empirical studies of IGD using the DSM-5 criteria are still lacking. This study aimed to evaluate the contribution of specific criteria to the diagnosis of IGD based on the DSM-5 in the context of Chinese culture.Methods: The Chinese version of the Internet Gaming Disorder Scale–Short Form (IGDS9-SF) was applied to investigate the prevalence of IGD in a general sample of 28,689 middle school students aged 12–19 years from two cities in China.Results: The prevalence of IGD was 4.6% among this adolescent sample. The group of IGD students reported longer weekly gaming times and worse academic performance than the group of non-IGD students. Although “preoccupation” and “playing to escape” were the most frequently reported criteria, the conditional inference trees showed that “give up other activities,” ‘negative consequences,” and “continue despite problems” contributed most to the diagnosis of IGD based on the DSM-5.Conclusions: The prevalence of IGD among Chinese adolescents (ages 12–19) was 4.6%. This study provides evidence for retaining or deleting specific diagnostic criteria by the DSM framework in the future.

Combination of Clomipramine and Carbamazepine for Treatment of Patients with Methamphetamine Dependence

Objective: There are few new approaches to the pharmacotherapeutic treatment of methamphetamine dependence in the literature. The publications contain abundant data on various methods of pharmacotherapeutic treatment of methamphetamine dependence. However, no pharmacotherapeutic therapy for methamphetamine dependence is sufficient. Materials and Methods: This was a double-blind study in patients diagnosed with methamphetamine dependence according to DSM-5. A total of 100 patients who met the DSM-5 criteria for methamphetamine dependence were examined. All male patients from 18 to 60 years old. The patients were divided into two groups of 50 people: the first group received clomipramine (anafranil) 300 mg / day (100 mg 3 times a day) and carbamazepine 600 mg / day (200 mg 3 times a day) orally. The second group received an indifferent drug (placebo) Results: as shown by follow-up data (12 months), among 50 patients who received anaphrani and carbamazepine only, 10 had short-term breakdowns associated with exposure to microsocial causes. The rest of the patients were in remission. Among patients receiving placebo, only 5 patients experienced remission, all the rest had cases of relapse. Responder analysis was performed using chi-square (x2) and analysis of variance (ANOVA). Conclusion. Clinical statistics indicate the high efficiency of the use of anaphrani and carbamazepine in the treatment of methamphetamine dependence. The mechanisms of action of the drug are being discussed.