Twelve-Month Prevalence of DSM-5 Gambling Disorder and Associated Gambling Behaviors Among Those Receiving Methadone Maintenance

This study sought to: (1) determine the prevalence of gambling disorder using the Diagnostic and Statistical Manual of Mental Disorders Version 5 (DSM-5; American Psychiatric Association in Diagnostic and statistical manual of mental disorders, American Psychiatric Publishing, Arlington, 2013) criteria; (2) identify the frequency and amount of money spent on gambling behaviors; and (3) determine demographic and treatment related predictors associated with gambling disorder in a substance using population. People receiving methadone maintenance treatment (N = 185) in an urban medical center consented to participate in the study. We used DSM-5 criteria to assess the 12-month prevalence of gambling disorder. Questions adapted from a previously developed measure were used to identify, describe and quantify the frequency of use and amount of money spent on gambling behaviors. Most participants were African-American (71.4 %), male (54.1 %), unmarried (76.8 %), unemployed (88.1 %) and had an income of <$20,000 (88.5 %). On average, participants were receiving 81.0 mg of methadone (SD: 22.8) daily. Nearly half (46.2 %) of participants met DSM-5 criteria for gambling disorder. Compared to those without gambling disorder, those with gambling disorder did not differ significantly with respect to demographic characteristics nor methadone dose. However, those with gambling disorder had been in methadone maintenance treatment for significantly less time. Those with gambling disorder were significantly more likely to report engaging in a variety of gambling behaviors. Given that the 12-month prevalence of DSM-5 defined gambling disorder was nearly 50 % future efforts to screen and treat gambling disorder in the context of methadone maintenance treatment are clearly warranted.     

Schizotypal Personality Disorder: A Clinical Social Work Perspective

Schizotypal personality disorder (SPD) is considered to be a “schizophrenia spectrum disorder” as evidenced in part by its cross-listing in that chapter of the DSM-5. SPD is considered to be a condition with limited potential for positive change because one of its major features is the presence of a biologically based cognitive deficit. This assumption, however, is an example of the medical model’s creating a bias against psychosocial features that are always involved in character development. The social work profession’s bio-psycho-social perspectives focus more comprehensively on all features of the condition and promote a more optimistic view of clients’ change potentials. The purposes of this paper are to examine SPD from a social work perspective and to demonstrate, with a case example, how effective intervention can be organized and delivered.     

Biological Underpinnings of Borderline Personality Disorder

SUMMARY

Biological understanding of a personality disorder is best achieved by examining the disorder's component dimensions, which for borderline personality disorder include impulsive aggression and affective instability. Current biological research into BPD aims to identify the neurotransmitters and brain regions implicated in each of these key domains. Because of advancing technologies and analytic strategies, structural and functional neuroimaging are at the forefront of such efforts. Structural neuroimaging, primarily in the form of magnetic resonance imaging (MRI) scans, gives information about the anatomy of the brain, while functional neuroimaging, primarily functional MRI (fMRI) and positron emission tomography (PET) scans, gives information about brain activity and neurotransmitter systems at the molecular level. BPD neuroimaging studies to date have implied the involvement of several neurotransmitter systems, principally serotonin, along with dysfunction of select brain regions, including the prefrontal cortex and amygdala, suggesting a “dualbrain pathology”: “hyperarousal-dyscontrol syndrome.” However, the exact mechanisms of all these putative etiologies remain unknown.     

Do the DSM-5 diagnostic revisions affect the psychometric properties of the Brief Biosocial Gambling Screen?

Several significant changes in the diagnostic criteria for gambling disorder occurred with the newest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The changes aim to simplify and streamline the diagnosis without compromising its validity. Yet many of the tools used to screen and diagnose the disorder are based upon the prior fourth edition of the DSM, and it is unclear how they perform with the revised diagnostic criteria. The aim of this study is to examine the psychometric properties of a common pathological gambling screen, the Brief Biosocial Gambling Screen (BBGS; Gebauer, LaBrie, & Shaffer, 2010), in the context of DSM-5 criteria within a help-seeking sample. Gamblers calling a helpline (N = 2750) completed a semi-structured interview assessing DSM-IV past-year pathological gambling criteria with a trained clinician. Sensitivity, specificity, positive predictive value, negative predictive value and differences by sex were examined. The BBGS had high sensitivity as well as positive and negative predictive values. In light of the revisions made to the diagnostic criteria in DSM-5, the BBGS remains a psychometrically supported instrument for gambling disorder.     

Commentary: Problems with the Sexual Disorders Sections of DSM-5

There are a number of problems with the sexual disorders sections of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. These problems must be understood in a historical context, namely the evolution of criteria for psychosexual disorders from DSM-II (1968) to DSM-5 (2013). There are many inconsistencies in the DSM-5 criteria for different sexual disorders. Given these inconsistencies—and the history of diagnostic criteria for homosexuality and gender identity disorder from DSM-II to DSM-5—it is possible that, like homosexuality, DSM-5 gender dysphoria could disappear from future editions of the manual. Even if that does not happen, there are numerous problems with the DSM-5 sexual disorders that require attention.     

Body Dysmorphic Disorder and Its Significance to Social Work

Body dysmorphic disorder (BDD) is a relatively common and often severe psychiatric disorder in which an individual has an excessive preoccupation with an imagined or slight defect in his or her appearance (American Psychiatric Association in Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, 2000). Despite its prevalence in the United States and worldwide, many health care and mental health professionals, including social workers, are unfamiliar with BDD. In fact, BDD is virtually absent from the social work literature and no authors or researchers have considered BDD from a social work perspective. The purpose of this article is to inform social workers about the seriousness, prevalence and treatment challenges of BDD, and to highlight its significance to social work practice and research. A clinical case presentation illustrates an example of how BDD may present in practice and the value of addressing it from a biopsychosocial perspective.     

The DSM-5’s Proposed New Categories of Sexual Disorder: The Problem of False Positives in Sexual Diagnosis

The proposals that have emerged from the DSM-5 revision process have triggered considerable controversy, especially regarding potential invalid inflation of diagnostic categories. To illustrate the kinds of issues that have emerged, I closely examine the proposed new categories of sexual disorder. The DSM-5 Sexual and Gender Identity Disorders Work Group is proposing the addition of three categories of disorder to the DSM-5??hypersexuality, hebephilia (as part of a revised pedophilia category that would become pedohebephilia), and coercive paraphilic disorder (basically a ??nonconsent?? or rape paraphilia). These proposals are driven by perceived clinical or forensic needs. I argue, however, that their conceptual soundness remains problematic; each could lead to large numbers of false positive diagnoses (i.e., diagnoses that mistakenly label a normal variant of behavior as a mental disorder), with potential for serious forensic abuse in ??sexually violent predator?? civil commitment proceedings.     

Viewing psychopathology through a trauma lens

Many symptoms and behaviors associated with a range of psychiatric disorders, including those not designated as trauma- or stressor-related, result from unprocessed and unintegrated traumatic experiences, requiring therapeutic assessments and interventions that consider the complex dynamics brought on by trauma. While the focus on symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM) may lead practitioners away from a consideration of etiology when choosing interventions, the exclusions of “disorders of extreme stress not otherwise specified” in DSM-IV and “developmental trauma disorder” from DSM-5 may further predispose practitioners to disregard traumatic etiology and symptoms when assessing, diagnosing, and treating clients. Because a majority of recipients of public mental health services suffer deleterious effects from trauma exposure, social work and other mental health professionals have an ethical responsibility to incorporate trauma-based screenings, assessments, and interventions with clients. Thus, trauma-informed evaluation and treatment approaches must be included in graduate curricula, practitioners must seek continuing education to supplement their knowledge and practice skills, and agency administrators must provide inservice training to professional staff.     

The Neurosequential Model of Therapeutics: An Interview with Bruce Perry

In this interview with Bruce Perry, MD, PhD, Senior Fellow of The Child Trauma Academy, Laurie MacKinnon discusses with Dr Perry developmental trauma and the Neurosequential Model of Therapeutics, an approach to clinical problem solving that utilises a developmental lens and incorporates advances in neurobiological development. Dr Perry gives his perspective on the causal connection between childhood abuse and later psychiatric diagnosis, the child's contact with a violent parent post‐separation, the importance of interventions that address the organisation and functioning of lower parts of the brain and his perspective on the use and limitations of psychotropic medications, cognitive behaviour therapy and family therapy.     

Reliability,Validity, and Classification Accuracy of the DSM-5 Diagnostic Criteria for Gambling Disorder and Comparison to DSM-IV

The DSM-5 was published in 2013 and it included two substantive revisions for gambling disorder (GD). These changes are the reduction in the threshold from five to four criteria and elimination of the illegal activities criterion. The purpose of this study was to twofold. First, to assess the reliability, validity and classification accuracy of the DSM-5 diagnostic criteria for GD. Second, to compare the DSM-5–DSM-IV on reliability, validity, and classification accuracy, including an examination of the effect of the elimination of the illegal acts criterion on diagnostic accuracy. To compare DSM-5 and DSM-IV, eight datasets from three different countries (Canada, USA, and Spain; total N = 3247) were used. All datasets were based on similar research methods. Participants were recruited from outpatient gambling treatment services to represent the group with a GD and from the community to represent the group without a GD. All participants were administered a standardized measure of diagnostic criteria. The DSM-5 yielded satisfactory reliability, validity and classification accuracy. In comparing the DSM-5 to the DSM-IV, most comparisons of reliability, validity and classification accuracy showed more similarities than differences. There was evidence of modest improvements in classification accuracy for DSM-5 over DSM-IV, particularly in reduction of false negative errors. This reduction in false negative errors was largely a function of lowering the cut score from five to four and this revision is an improvement over DSM-IV. From a statistical standpoint, eliminating the illegal acts criterion did not make a significant impact on diagnostic accuracy. From a clinical standpoint, illegal acts can still be addressed in the context of the DSM-5 criterion of lying to others.     

Structural Discontinuity and the Development of Anorexia Nervosa

Abstract

Anorexia nervosa is a complex disorder in which emotional, physiological, and interpersonal processes are altered. Various studies have indicated that the disorder occurs disproportionately among females, with adolescents and young women particularly vulnerable. While explanations for this distribution have traditionally focused on medical or psychological phenomena, it is my contention that anorexia nervosa can only be understood in a sociocultural context. It is suggested that the following conditions are necessary for the disorder to occur: (1) individuals must be biologically predisposed; (2) they must be exposed to cultural pressures for slimness; (3) they must lack meaningful peer attachments; and (4) they must be embedded in a social structure regulated by universalism and achievement. The position taken here is that the co-occurrence of these variables is a relatively recent historical development and may account for the disorder's apparent increase during the past 15 to 20 years.     

AN EXAMINATION OF LINEAR AND NONLINEAR CAUSAL RELATIONSHIPS BETWEEN COMMODITY PRICES AND U.S. INFLATION

This article uses both linear and nonlinear causality tests to examine the causal relationships between changes in commodity prices and U.S. inflation. Prior to the Great Moderation, there is evidence that changes in commodity price indices linearly lead inflation. The stability of the causal relationship appears to vary over time with a stronger bivariate link established before the Great Moderation. Further, there is evidence of significant nonlinear causality from raw industrials and metals indices to inflation with most of this detected nonlinear relationship being captured using the Baba, Engle, Kraft, and Kroner asymmetric generalized autoregressive conditional heteroskedasticity model. This implies that the observed nonlinear Granger causality is largely driven by unanticipated shocks and volatility spillovers in the run‐up of commodity prices in late 2000. (JEL C18, C22, E31)     

Remittances and Calorie Consumption Nexus in Algeria

This study investigates the cointegration and causal relationships between remittances and calorie consumption as an indicator of food security in Algeria. We estimate the calorie demand function for the period 1970‐2008, using two different cointegration tests Johansen and Juselius ( 1990 ) and autoregressive distributed lag (ARDL) bounds testing approach proposed by Pesaran et al. ( 2001 ) and Granger causality test based on Vector Error Correction Model. We find that: (1) GDP per capita affects calorie consumption positively and significantly; (2) income elasticity of calorie consumption is 0.16 in the short run and 0.60 in the long run; (3) remittances positively and significantly influence calorie consumption in the long run; (4) remittance elasticity of calorie consumption is 0.05 in the long run; (5) based on the causality test remittances influence calorie consumption directly and indirectly via GDP per capita in the long run.     

An Integrative Group Treatment Model for Women with Binge Eating Disorder: Mind,Body and Self in Connection

Binge eating disorder (BED) is the most prevalent eating disorder reported among women, and its recent diagnostic recognition in the DSM-5 (APA 2013) calls for further discussion on effective treatment. Women with BED commonly report a diet/binge cycle that can exacerbate a disconnection between mind and body and reinforce feelings of shame and isolation. This article presents an integrative group treatment model for women with BED that has shown positive outcomes in clinical practice. The group model addresses key biopsychosocial factors associated with BED and incorporates mindfulness principles tailored to problems of the disorder. A core foundation of the group model is the relational context that fosters connections between women members and promotes self-efficacy. The discussion includes etiology of BED and current empirical support for integrating mindfulness skills in treatment for binge eating problems, as well as the author’s clinical experience in formulating a short-term group model. The eight-session semi-structured group format integrates evidence-based treatments in resonance with treatment-based evidence that reflects the distinct clinical needs of women with BED. Clinical vignettes illustrate how the group model can provide an anchoring therapeutic support to women with BED for linking experiences of mind, body, and self.     

Evaluation of Lehman's Brief Quality of Life Interview in Assessing Outcome in Psychiatric Rehabilitation in People with Severe and Persistent Mental Disorder

Abstract

Lehman's Brief Quality of Life Interview (QOLI) was administered to psychiatric rehabilitation program clients 6 times at 6-month intervals. Participants were individuals with predominantly psychotic-type diagnoses. Results showed no change over time and few gender differences. No change over time indicates no improvement but also no deterioration in this chronic population. Correlations between test times indicated that the subjective scales were relatively stable in comparison to the objective scales. Results indicate that the QOLI has poor sensitivity, and therefore limited utility, for assessing change in psychiatric rehabilitation of individuals with severe and persistent mental disorders. However, the QOLI does have an important use: It provides a good indication of the clients' perspectives on the quality of their lives and services received.     

Response to Ross’s “Commentary: Problems with the Sexual Disorders Sections of DSM-5”

The recent commentary by Ross (2015) addresses concerns regarding the newly created Paraphilic Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, and “inconsistencies.” The author’s statements reflect notable confusion regarding issues related to human sexuality and the categories thereof in the DSM-5 (e.g., gender dysphoria and pedophilic disorder). This is a response to Ross’s commentary.     

The Interactional Community: Emergent Fields of Collective Agency*

Social interaction is generally regarded as elemental to the notion of community. Within the broader discourse on community, the field‐interactional perspective is distinctive in its explicit focus on emergent social processes and community change dynamics. Wilkinson (1970) extended Kaufman’s (1959) early work on the interactional approach through an application of the social field concept to community action. In doing so, Wilkinson (1991) outlined several key linkages between social–symbolic interaction and community agency. Despite these promising beginnings, only a modicum of research has examined the theoretical or philosophical underpinnings of the interactional conception of community. This article explores the symbolic‐interactionist tenets undergirding the field‐interactional approach, most notably Mead’s (1934, 1938) discussion of generalized social attitudes and Blumer’s (1969a, 1969b) work on joint or collective action.     

DSM-5 substance use disorders among college-age young adults in the United States: Prevalence,remission and treatment

Abstract

Objective: To determine the prevalence, remission, and treatment associated with DSM-5 substance use disorders (SUDs) among young adults based on college attendance. Participants: The population-based sample included 2,057 young adults aged 19–23 in college/school and 1,213 not currently attending college/school who participated from April 2012 through June 2013. Methods: Face-to-face interviews were conducted as part of a cross-sectional national survey. Results: The prevalence of any past-year DSM-5 SUD was 39.6% among young adults in college and 44.5% among those not attending college. Past-year tobacco use disorder and multiple DSM-5 SUDs were more prevalent among those not attending college. Among those with prior-to-past-year SUDs, abstinent remission was low among college (1.0%) and noncollege (1.9%) young adults. Conclusions: Approximately two in five U.S. college students had at least one past-year DSM-5 SUD. Sustained abstinent remission from SUDs is extremely rare (1–2%) and the majority of those with SUDs do not receive treatment.     

Understanding Sheng Nu (“Leftover Women”): the Phenomenon of Late Marriage among Chinese Professional Women

In the past few decades, there has been a rise in the number of single, unmarried Chinese professional women, which is known as the sheng nu or “leftover women” phenomenon. Through an interactionist grounded theory method, this study has located the interactional constraints faced by 50 single Chinese professional women that were issued by their male romantic partners and parents, respectively. “Discriminatory” and “controlling” gendered constraints issued by the women's male suitors and partners reflected the persistence of the Chinese patriarchal structure, and this was found to be the leading cause of the women being “leftover” in the marriage market. Parents' traditional views continued to exert strong influences on the women's marital choices, but this was seen to conflict with their more “modern” views toward advocating and supporting the women's strong economic achievements. The four different types of Chinese professional women that were constructed based on their different partner choice strategies not only gave rise to an in‐depth and nuanced understanding of the sheng nu phenomenon in China, but could also be generalized toward understanding the marital choices of single professional women in other patriarchal societies who faced similar dilemmas in reconciling interactional constraints imposed by men and parents alike.