about robins and guze, who added an extra criterion?
Waldman, lilienfeld, and hahey 1995
diagnosis should be able to predict response to treatment
although this has been considered an error in logic (cannot determine etiology from response to treatment--headache remedied by opiate agonist, although may not have been caused by a lack of opiates)
Meehl 77, 90
all dx are open concepts, fallible
unclear inner nature
list of indicators that are extendable, modifiable
misconceptions about dx
mental illness is a mythi (szasz, 1960)
dx is pigeon holing
dx is unreliable
dx stigmatize--rosenhan 1973 study
criticisms of the classification system
comorbidity: lilienfeld et al, 1994, pincus 2004
Drake et al 2007 says it is premature to assume comorbidity is actually overlap
Explanations for comorbidity: dx mutually influence each other, predispose to each other
clinical selection bias, seeking tx
proliferation of dx: means not improving science
neglect of attenuation paradox: improve reliability reduces validity (loevinger, 1957)
Evidence for a dimensional model: except schizo-spectrum disorders (Lenzenweger & Korfine, 1994)
AxisI and AxisII distinction: Harkness & Lilienfeld, 1997: no evidence of qualitative difference
Dimensional approach to DSM
evidence of dimensionality of disorders, especially PDs
Widiger and Clark: 5 factor model Costa & McCrae, 1992
Accomodates for variations in normal and abnormal personality
Obstacles: FFM is not universally accepted
there are competing models that aree also well supported like Telegen's 30D model of personality AKA "Big 3" which is: positive emotionality, negative emotionality, and constraint.
Harkness and Lilienfeld argue that there is a difference between basic tendencies and character adaptations.
Basic tendencies: core traits
Character adaptations: b manifestations of traits
eg. some BT can be expressed (CA) in socially constructive or destructive ways, depends on moderating influences. The implication is that personality dimensions may not be sufficient to capture the full variance of personality disorders.
This is in response largely to heterogeneity: for example, not all schizotypes or even schizophrenics have same symptome profile or perform deviantly on all laboratory tasks--maybe we need to be OK with heterogeneity if we want to understand true psychopathology--there really may be different subtypes with various etiologies (Lenzenweger, 2010).
When talking about switching to the dimensional system what is something that is good to talk about?
NID PCS: nomenclature, information retrieval, description, prediction, concept formation, sociopolitical (Blashfield and Livesly, 1999)
Then say: How will switching improve these things?
conducted research on psychotherapy and made claims that it was useless
only reviewed 11 studies (eliminated hundreds of articles b/c were dissertations, theses, project studies, or not published in peer reviewed, file drawer phenomenon)
also eliminated studies without untreated controls
only if .05 significance did he count it
discounted if significant using subjective measures like TAT or rorschach
if sig differences were found using objective measures like GPA but not subjective, discounted study b/c outcome differences were inconsistent.
mean difference between two groups divided by standard deviations of control (Standardized mean difference)
smith and glass 1977
compared psychotherapies to untreated groups
found no differences between different types of therapies although therapy was better than no therapy
Studies to cite for 5httlpr
Risch et al. 2009: serotonin transporter linked polymorphic region
numerous prior association studies of the same polymorphism (without looking at envi risk factors) had not consistently shown strong or replicated association w/ depression
caspi et al 2003 finding of interaction sounded intuitive b/c of known association between stressful life events and depression (Brown et al. 1973) as well as the general efficacy of ssris on depression
Risch et al. looked at: interaction btwn genotype (ss, sl, ll) and number of stressful life events (0, 1, 2, >=3) and DSM IV or ICD-10 categorical description of depression or not.
total of 14 studies included
used logistic regression
1769 had depression of total
genotype alone didn't predict depression
number of stressful life events did predict depression
no significant interaction
highlights difficulty in finding effects, especially meta analyses, and difficulty in interpreting replications because all divergent definitions and measures
must be careful because those who report significant effect might only find it for one genotype (SL) vs. the aggregate genotype originally reported by Casp . This is a big difference and one worth investigating since it doesn't necessarily consistute a replication.
MUNAFO et al. 2009 meta-analysis found no support for interaction either.
definition personality disorder
oltsmann and emery (2007)
enduring pattern of inner eperience and behavior that deviates markedly from the expectations of the individual's culture.
Notice cultural component. Is this different from axis I?
characteristics of bpd
says 75% women, but lenz 2007 say prob equal just women present for tx more
depression and ptsd
adolescence, peaks young adulthood, burns out by middle age
some criteria predict continuation of bpd from adolescence to adulthood, namely anger, suicidal threats, identity disturbances, emptiness
biopsychosocialmodel/diathesis-stress model of bpd
no biological markers specific to bpd
basid dimensions of BPD (impulsivity, affective instability, cognitive symptoms) show heritability
Siever & Davis 1991: neurotransmitter systems to personality traits and disorders
each of four systems (mood-affect, impulse-action, attention-cognition, anxiety) associated w/ biological and genetic markers
Linehan's emotional vulnerability: excessive sensitivity to invalidating envi and emotional stimuli, vicious cycle
shared social and cultural characteristics that have a bearing on psychological functioning (sue, 1991)
tends to be associated with more of a psychological perspective. A subset of risk factors that are endogenous to the individual that may serve as mechanisms in the development of the disorder.
Can be genetically or environmentally based.
Thought of as stable and enduring.
Juxtaposed with the notion of resilience.
Vulnerability model: essential to note that the emergence of psychopathology is the result of stressors overwhelming one's level of resilience.
BPD: Linehan's biosocial model: client's emotional and behavioral dysregulation are elicited and reinforced by the transaction between an invalidating rearing environment and biological tendency toward emotional vulnerability.
OCD: Salkovskis 1996: exaggeration of risk, negative automatic thoughts, avoidant behavior, neutralizing behavior maintain obsessions. Person's appraisal of intrusions predictive of OCD. Excessive tendency for self-blame, overestimation of responsibility, intolerance for uncertainty, excessive morality. Then stress increases presence of intrusions to make perfect storm.