June Sprock

Neuropsychological functioning in patients with borderline personality disorder

Although results have been variable, studies suggest that individuals with borderline personality disorder (BPD) exhibit cognitive deficits suggestive of frontal- and temporal-lobe dysfunction. Patients diagnosed with BPD (n = 18) using two structured interviews, and who were carefully screened for neurological and substance-use disorders, were compared to depressed patients (n = 18) and a nonpsychiatric control group (n = 18) on a series of neuropsychological tasks. The role of emotion on cognitive functioning was assessed by including emotional stimuli and interference on several of the tasks. Little support was found for the neurobehavioral hypothesis of BPD. The BPD group performance did not differ from the normal group on most tasks of executive functioning or memory, and the introduction of emotional stimuli did not impair performance. The depressed group performed less effectively than the other groups. Reasons for variable findings and factors affecting the cognitive functioning of patients with BPD are discussed. There may be considerable heterogeneity in the cognitive functioning of BPD patients, with those exhibiting significant cognitive deficits comprising only a subgroup.

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.

Exemplar prototypes of personality disorder diagnoses

Abstract The applicability of the prototype model to the DSM-III personality disorders was examined by attempting to isolate prototype cases (both high interclinician agreement and fast diagnostic reaction time). Twenty clinicians assigned diagnoses to 30 cases selected to represent the 11 personality disorders. Prototype cases were located for seven of the personality disorders. Also examined were differences among the clinicians according to profession (psychology/psychiatry) and level of experience (student/faculty). No difference was found according to profession using reaction time or agreement data, but interprofessional diagnostic differences were noted on individual cases. Experience had a significant effect on diagnostic speed, but not on agreement. A multidimensional scaling solution yielded a circumplex ordering of the personality disorders.

Women and depression: An update on the report of the APA task force

This article reviews selected research on gender differences in depression in order to update the status of the literature and address concerns raised by the APA Task Force on women and depression. Recent research continues to provide considerable evidence that women experience higher rates of depression and that a variety of biological and psychological factors and their interactions must be considered to understand gender differences. Methodological issues including the need to define homogeneous subgroups, the effect of demographic variables, and sex bias in the diagnosis and measurement of depression are discussed. Conclusions are drawn that have implications for the prevention, identification and treatment of depression, and suggestions are made for research strategies.

The effect of mental retardation and schizophrenia on information processing.

Research Diagnostic Criteria-diagnosed schizophrenic persons with average intelligence and dual diagnosis mentally retarded schizophrenic persons were tested in a forced-choice letter discrimination task in order to examine the relationship between schizophrenia and retardation from the standpoint of information-processing theory. The subjects consisted of eight schizophrenic persons of average or better intelligence, eight mentally retarded schizophrenic persons, and a control group of eight Research Diagnostic Criteria-diagnosed minor depressive individuals who were matched with the nonretarded schizophrenic group for intelligence. The groups did not differ significantly on the minimum exposure duration needed to identify an unmasked target stimulus at criterion levels of accuracy. When masked stimuli were employed, however, the depressive group obtained significantly more correct detections than both schizophrenic groups. More importantly, the performance of the two schizophrenic groups did not differ significantly. Our data indicated that schizophrenic deficits in information processing are independent of intellectual factors. Thus, vulnerability to a masking stimulus in schizophrenic persons can be attributed to the pathology of schizophrenia. This vulnerability indicates that schizophrenic patients are slow information processors.

Classification of schizoaffective disorder.

Abstract Two studies were conducted to examine the viability of the major alternative models of the classification of schizoaffective disorder: that it is a subtype of schizophrenia, a type of affective disorder, on a continuum between schizophrenia and affective disorder, a totally independent disorder, or a heterogeneous category. The methodologies, taken from the prototype view of classification in cognitive psychology, study the behavior of the classifiers, in this case, clinicians assigning psychiatric diagnoses. These paradigms are especially useful in the study of schizoaffective disorder since different definitions of this diagnosis have resulted in widely discrepant findings. Therefore, finding the concept of schizoaffective disorder with the highest consensus is a reasonable first step before conducting empirical studies of patients. The first study attempted to locate exemplars or typical schizoaffective cases based on high diagnostic agreement and fast diagnostic decision time. Twenty clinicians assigned diagnoses to 30 cases, including 15 schizoaffective cases from the literature. While 11 exemplars were found for other diagnoses, only one was found for schizoaffective disorder. Schizoaffective cases were most often diagnosed as schizophrenia, particularly by more experienced clinicians. In the second study, 20 clinicians listed the essential clinical features of schizoaffective disorder and other major psychoses. The schizoaffective list shared as many features with schizophrenia as did the schizophrenic subtypes, but shared only one feature with the affective disorders. Overall, the results suggested that these clinicians perceive schizoaffective disorder as a variant of schizophrenia; however, this view of schizoaffective disorder may be changing in newer clinicians. Implications for defining schizoaffective disorder, suggestions for diagnosis, the generalizability of these findings and directions for future research are discussed.

Classification of depression.

Abstract Recently, there has been increased recognition of the importance of classification in the study of depression. Despite the popularity of the RDC and Feighner criteria to define groups for research, there have been few systematic evaluations and comparisons between these nosologies and DSM-III. These three classifications of depression were evaluated according to a series of criteria considered important for classifications in order to provide diagnosticians with a checklist for choosing between them. The research literature was reviewed to determine whether each classification satisfied these criteria. Overall, DSM-III fared best, largely because of structural improvements over earlier nosologies. A major problem with all three was within group heterogeneity and lack of cross-cultural generalizability. Situations in which each classification may be preferable are discussed.

The schizophrenia spectrum: a study of the relationship among the Rorschach, MMPI, and visual backward masking

Compared 20 Ss within the schizophrenia spectrum and 20 non-schizophrenia spectrum controls in terms of their MMPI and Rorschach performance. Ss also were studied in terms of their ability to identify a briefly exposed visual stimulus when it was followed by a noninformational mask stimulus and when it was not. Ss did not differ on the MMPI or on their ability to identify an unmasked target stimulus. They differed significantly in the number of deviant verbalizations, a special scoring category of the Rorschach. Ss also differed in their ability to identify the briefly exposed stimulus when it was followed by the noninformational mask. Results indicated a relationship among the deviant verbalization, the masking procedure, and the schizophrenia spectrum.

The Family Resemblance Hypothesis Applied to Psychiatric Classification

The prototype model, an alternative to the classical view of classification theory, has recently been advocated for the study of the personality disorders. A central assumption of the prototype model is the family resemblance hypothesis. This hypothesis states that the more features of a category that a patient possesses, the more prototypical the patient is of the category. In previous research, results from applying this hypothesis to psychiatric classification have been mixed. The present study investigates the family resemblance hypothesis by examining the relationship between diagnostic agreement and the number of features in personality disorder cases.

Gender-Typed Behavioral Examples of Histrionic Personality Disorder

Findings that clinicians diagnose Histrionic Personality Disorder more frequently in women may be due to the feminine gender weighting of the criteria or because the diagnostic label elicits a feminine stereotype. Using a method derived from the act-frequency approach, undergraduates generated behavioral examples of the DSM-IIIR and DSM-IV Histrionic criteria without regard to sex or according to sex role instructions that elicited masculine or feminine sex roles. A national sample of psychologists and psychiatrists rated the representativeness of the symptoms for the Histrionic criteria or for Histrionic Personality Disorder. Feminine behaviors were rated more representative of Histrionic Personality Disorder and somewhat more representative of the Histrionic criteria than masculine behaviors suggesting that the feminine sex role is more strongly associated with the label than the criteria. Masculine behaviors were also rated less representative than sex-unspecified examples. Results provide a possible explanation for the higher rates of diagnosis of Histrionic Personality Disorder in women.