College Women Eating Disorder Diagnostic Profile and DSM-5

Abstract

A consistent diagnostic profile describing college women with eating disorders has been well established in the college health and mental health literature. This diagnostic framework traditionally has been associated with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision¹ Eating Disorders Not Otherwise Specified category. In this article, the authors discuss implications of the recently revised Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition² eating disorder diagnostic categories for the existing college women eating disorder profile.     

Endorsement of Criminal Behavior Amongst Offenders: Implications for DSM-5 Gambling Disorder

The fifth edition of the diagnostic and statistical manual (DSM) has changed the scoring threshold for a gambling disorder (GD) from five criteria to four and eliminated the illegal acts criterion. The impact of these changes was examined with data from a correctional population (N = 676) in Ontario, Canada. The offenders completed a self-report survey that included the Canadian problem gambling index, the South Oaks Gambling Screen and the DSM-IV criteria. Changing the threshold from 5 to 4 improved the convergent validity for GD and resulted in an increase in the percentage of offenders diagnosed with a GD from 7.4 to 10.2 %. The results also indicate that the illegal acts criterion contributes to the convergent validity of GD. The evidence supports the change in the threshold from five to four, but also reinforces the importance of examining illegal acts when dealing with an offender population. The incorporation of illegal acts into the “lying to others” criteria appears to make up, to some extent, for the removal of the illegal acts criterion.     

DSM-5: An Overview of Changes and Controversies

The DSM-5 offers many changes in the criteria and categories used in clinical diagnosis. The provocative and sometimes controversial nature of the changes has enlivened debate in the mental health field about how we should best understand our clients. I selectively survey what is new in DSM-5, why changes were made, and what about them is so controversial. First, I summarize the main metastructural and organizational changes, including elimination of the multiaxial system and changed chapter groupings. Second, I survey the most important new categories of disorder and the most important changes to the diagnostic criteria for existing categories of disorder. I focus on particularly controversial changes, such as those to substance use and addictive disorders, autism spectrum disorders, and posttraumatic stress disorder. Pros and cons are provided for changes in criteria as well as for the addition of new disorder categories, such as hoarding disorder and binge eating disorder. Finally, I offer a more in-depth review and analysis of the changes to the depressive disorders chapter, which was subject to some of the most intense controversies and had some of the most extensive changes.     

An Overview of and Rationale for Changes Proposed for Pathological Gambling in DSM-5

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for publication in 2013. It will include several changes to the diagnosis of pathological gambling: the name of the disorder will be altered, the threshold for diagnosis will decrease, and one criterion will be removed. This paper reviews the rationale for these changes and addresses how they may impact diagnosis and treatment of the disorder, as well as potential for future research in the field.     

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.     

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.     

The Desomatizing Selfobject Transference: Analysis of an Eating Disorder

This article documents the manner in which psychological treatment, with its attentiveness to the vicissitudes of the unfolding selfobject transference, gradually enabled a patient to contain and articulate painful affect states. The patient's passionate relationship with food, strikingly illustrated in the clinical material, including her dreams, endowed eating with the functions of an idealized selfobject. Over the course of treatment, she seemed to traverse a psychic bridge that took her from an isolated reliance on food through a more focal awareness of her body and her feelings, to an investment in, and capacity for, deepened relationships with other people.     

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.     

An Exploratory Study of Clinical Measures Associated with Subsyndromal Pathological Gambling in Patients with Binge Eating Disorder

Both binge eating disorder (BED) and pathological gambling (PG) are characterized by impairments in impulse control. Subsyndromal levels of PG have been associated with measures of adverse health. The nature and significance of PG features in individuals with BED is unknown. Ninety-four patients with BED (28 men and 66 women) were classified by gambling group based on inclusionary criteria for Diagnostic and Statistical Manual-IV (DSM-IV) PG and compared on a range of behavioral, psychological and eating disorder (ED) psychopathology variables. One individual (1.1% of the sample) met criteria for PG, although 18.7% of patients with BED displayed one or more DSM-IV criteria for PG, hereafter referred to as problem gambling features. Men were more likely than women to have problem gambling features. BED patients with problem gambling features were distinguished by lower self-esteem and greater substance problem use. After controlling for gender, findings of reduced self-esteem and increased substance problem use among patients with problem gambling features remained significant. In patients with BED, problem gambling features are associated with a number of heightened clinical problems.     

Autism Spectrum Disorder: The Impact of Stressful and Traumatic Life Events and Implications for Clinical Practice

Research findings suggest that behavioral interventions are effective in improving educational outcomes and fostering skill development in people with autism spectrum disorder (ASD). However, high rates of comorbidity between ASD and other psychological disorders, including depression and anxiety, indicate that standard behavioral approaches are not adequately addressing issues related to mental health in this population. Research emerging since the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is advancing our understanding of the nature of childhood stress and trauma in people with ASD and its subsequent impact on mental health and wellbeing. Mounting evidence for stress and trauma as a risk factor for comorbidity and the worsening of core ASD symptoms may intimate a shift in the way clinical social workers and other clinical practitioners conceptualize and approach work with this population to include trauma-focused assessment strategies and clinical interventions. Future directions for research to better understand the nature of childhood stress and trauma and improve mental health in this population are also discussed.     

Cultural Factors in Collegiate Eating Disorder Pathology: When Family Culture Clashes With Individual Culture

Objective: The authors evaluated the validity of familial enmeshment (extreme proximity in family relationships) as a risk factor for eating disorders across cultural value orientations. They tested the hypothesis that although familial enmeshment may be a risk factor for eating disorder pathology for (1) participants of non-Asian descent or (2) culturally independent participants, enmeshment will not be a risk factor for (1) participants of Asian descent or (2) culturally interdependent participants. Participants: 255 undergraduate women participated. Methods: Participants completed questionnaires on cultural value orientations, enmeshment, and eating disorder pathology. Results: As hypothesized, enmeshment was related to eating disorder pathology in non-Asian American and culturally independent participants, but not in Asian American and culturally interdependent participants. Conclusions: Depending on cultural values, enmeshment may or may not be a risk factor for eating disorders. This study highlights the importance of examining risk factors in the appropriate cultural framework when considering college student mental health.     

Narcissistic Implications in Gambling Disorder: The Mediating Role of Emotion Dysregulation

Gambling Disorder (GD) is a complex psychopathology involving a numbers of cognitive, behavioral, emotional and neurobiological determinants. Previous research suggests that GD may frequently co-occur with Narcissistic Personality Disorder. However, there is still a lack of study investigating Pathological Narcissism (PN) in both its vulnerable and grandiose facets among clinical population. Moreover, emotional dysregulation is commonly thought to underlie GD albeit research on this topic remains poor. The present study aims to investigate the role of both vulnerable and grandiose narcissism in relation to GD as well as the mediator role played by emotion dysregulation in such link. We administered to a sample of addicted gamblers (n = 74) and a sample of heathy controls (n = 105), the South Oaks Gambling Screen (SOGS), the Pathological Narcissism Inventory (PNI) and the Difficulties in Emotion Regulation Scale (DERS). Differences across groups emerged on the scores obtained on the PNI and DERS. Moreover, we found positive associations between SOGS scores and both PNI and DERS. Also, strategic addicted gamblers showed higher levels of vulnerable narcissism compared to others. Finally, emotion dysregulation difficulties appeared to fully mediate the relationship between grandiose narcissism and GD severity. Grandiose and vulnerable narcissism appear important variables involved in GD. Also, emotion regulation deficits seem to account for GD and to explain the pathways by which grandiose narcissism leads to GD. Clinical implications and future directions are discussed.     

The utility of the DSM-5 Z-codes for clinical social work diagnosis

ABSTRACT

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard reference text used by social workers for diagnosing mental disorders. The social work profession has always had an uneasy relationship with the DSM, but for 33 years there was an opportunity to note a client’s psychosocial stressors on Axis IV. With the publication of the DSM-5, however, the multiaxial diagnostic system was abandoned, and many social workers are concerned that this change limits their ability to provide comprehensive diagnoses. The purpose of this article is to consider an expanded use of Z-codes as one way to continue including social work’s psychosocial perspective on human functioning in the diagnostic process.     

Living Together and Eating Together: Changes in Food Choice and Eating Habits during the Transition from Single to Married/Cohabiting

In 1995 we recruited twenty-two heterosexual couples from Edinburgh and Glasgow to examine the changes which took place in their eating habits and food related activities when they began to live together. Semi-structured interviews were carried out three months before and after moving-in dates and on each occasion both men and women were interviewed separately. Both felt that eating together had a symbolic importance when they set up home together and most couples made efforts to eat a main meal together most evenings, while shopping and eating patterns tended to become more regular and formalised than they were at the pre-marriage/cohabitation stage. In a small majority of cases the women were mainly responsible for buying and preparing food. A significant difference between these women and those of other, earlier studies is that they tended to be less deferential to their husbands' food choices. However, associations between women, food and nurturing were evident in the efforts women made to improve their husbands' diets. Where food purchase and preparation were shared, so was choice of food. The goal of enjoying food together was achieved by learning, influence and compromise but no significant gendering of power in food choice was identified.     

Gambling Disorder in Veterans: A Review of the Literature and Implications for Future Research

To review the scientific literature examining gambling behavior in military veterans in order to summarize factors associated with gambling behavior in this population. Database searches were employed to identify articles specifically examining gambling behavior in military veterans. Cumulative search results identified 52 articles (1983–2017) examining gambling behavior in veteran populations. Articles generally fell into one or more of the following categories: prevalence, psychological profiles and psychiatric comorbidities, treatment evaluations, measurement, and genetic contributions to gambling disorder. Results from reviewed articles are presented and implications for future research discussed. Research to date has provided an excellent foundation to inform potential screening, intervention and research activities going forward. The authors suggest that a public health approach to future research endeavors would strengthen the evidence base regarding gambling in veteran populations and better inform strategies for screening, prevention and treatment.     

A DSM-5-Based Online Mental Health Referral Inventory: A Large-Scale Validation Study

In 2007, a comprehensive mental health referral inventory based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was posted online as an alternative to the informal tests the public now uses to self-diagnose mental health problems. A validation study was published in 2011 (Epstein &; Muzzatti, 2011 Epstein, R., &; Muzzatti, L. (2011). Preliminary validation of an online DSM-based mental health referral inventory. Journal of Technology in Human Services, 29, 284–295. doi:10.1080/15228835.2011.638421[Taylor &; Francis Online] , [Google Scholar]). In 2013, a revision of that inventory that was consistent with the DSM-5 was posted. The present study evaluates the new inventory with a diverse sample of 201,625 people from 184 countries (mainly the United States, Canada, and the United Kingdom). The 63-item inventory screens for 21 common problems and typically takes about 5?min to complete. Test scores proved to be good predictors of a variety of self-reported criterion measures, including happiness, personal and professional success, history of hospitalization, history of therapy, current participation in therapy, and employment. Females were found to have slightly more mental health problems than males, and effects were also found for education and race/ethnicity. The revised test is more accessible than the original, reducing the reading level from grade 10.2 to 6.6. It is not designed to diagnose; rather, its primary purpose is to refer people to mental health professionals for further evaluation. It can also be used in clinical settings for quick screening purposes.