A. Kenneth Fuller

Suggested guidelines for including or excluding categories in the DSM-IV

A set of guidelines is proposed for the possible inclusion or exclusion of diagnostic categories in the DSM-IV. For possible inclusion, a new category should meet all of the following five guidelines: adequate literature, specified diagnostic criteria, acceptable interclinician reliability, evidence that the criteria forms a syndrome, and differentiation from other categories. For possible exclusion, a category should possess an inadequate literature, extremely low coverage, or evidence of diagnostic bias. None of the exclusionary guidelines would be invoked if the category refers to a demonstrable disease.

Sadistic and self-defeating personality disorder criteria in a rural clinic sample

A sample of 176 outpatients at a mental health clinic in rural southern Georgia were rated for the presence or absence of the DMS-III-R sadistic and self-defeating personality disorder criteria. On the basis of these ratings, 48 patients met the criteria for sadistic (n = 14) and self-defeating (n = 41). Surprisingly, half of the patients who met the sadistic criteria also fulfilled the self-defeating criteria. A factor analysis failed to divide the criteria cleanly into sadistic and self-defeating subsets.

Sexual Abuse and HIV Transmission

The acquired immunodeficiency syndrome (AIDS) and sexual abuse are major public health concerns. Despite an alarming increase in the incidence of these conditions and a well-developed literature, many clinicians ignore them. The issue of human immunodeficiency virus (HIV) transmission by sexual abuse has not been given the same direct attention as other modes of spreading HIV. Although an alarmist view may be unwarranted, the lethality of AIDS makes HIV transmission a dangerous behavior that may fall under the Tarasoff principle. When a clinician becomes aware of sexual abuse involving the potential transmission of HIV, a dilemma develops: What actions should the clinician take? What are the legal obligations of the clinician to the perpetrator of sexual abuse, the victim, and society? How does the clinician resolve the many ethical issues surrounding reporting suspected sexual abuse or possible HIV transmission to proper authorities, versus the confidentiality of the patient–doctor relationship? The poli...