A comparison of the associations of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Section II personality disorders and Section III personality domains with clinical dysfunction in a psychiatric patient sample.

In this study, we compare the incremental predictive capacities of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) Section II personality disorders (SII-PDs) with Section III trait domains of the Alternative Model of Personality Disorders (AMPD) in a psychiatric outpatient sample (N = 185). To this end, a series of hierarchical regression analyses was conducted in which the 10 SII-PDs and the five AMPD trait domains served as the predictor variables and five areas of clinical dysfunction as the criterion variables. Two models for each criterion were tested. In Model A, the 10 PDs were entered as a block, followed by the block entry of trait domains; in Model B, the block entry of these predictors was reversed. As the AMPD was designed to address the shortcomings of the SII-PDs, it was hypothesized that the AMPD trait domains would show greater predictive capacity vis-à-vis the latter by (a) explaining more overall variance for each criterion variables when entered first into the model versus when SII-PDs was entered first and (b) explaining more incremental variance than SII-PDs when block was entered second. These hypotheses were partially supported. Overall, the AMPD trait domains predicted more variance than SII-PDs and demonstrated better model fit and more predictive power for three of the criterion variables. Similarly, the AMPD domains predicted a significant but modest incremental increase in variance over that of the SII-PDs for three of the criterion variables. We conclude that more work needs to be done to improve the AMPD, particularly in the assessment of externalizing psychopathology as it relates to clinical dysfunction. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perception of stigma across diagnostic models of personality pathology.

Stigmatizing views surrounding mental illness are widespread. Personality disorders (PDs) are among the most stigmatized mental illnesses, as individuals with PDs are often described using pejorative terms, which might impact clinicians' a priori expectations and increase the likelihood of stigmatization, discrimination, or early termination from treatment. The degree to which the terms used in any diagnostic classification systems are stigmatizing has never been examined. The current study aims to explore the level of stigma perceived in diagnostic terms used and to compare which systems of classification (the Diagnostic and Statistical Manual of Mental Disorders, fifth edition [DSM-5] Section II, DSM-5 Alternative Model of Personality Disorder, and Hierarchical Taxonomy of Psychopathology [HiTOP]) are reported as less stigmatizing. The current study consisted of three samples. Individuals with lived experience of personality pathology (n = 218) completed an online survey examining the level of stigma perceived in diagnostic terms; mental health care providers (n = 75) and undergraduate psychology students (n = 732) also completed online surveys examining their perceptions of stigma within diagnostic terms. We examined differences in perceived stigma between the three classification systems across the three samples. Among mental health care providers, the HiTOP was rated as the least stigmatizing while DSM-5 categorical labels were rated as the most stigmatizing. There were no significant differences found among individuals with lived experience or undergraduate students. Understanding the degree to which the terms used to describe personality pathology contributes to reducing stigma has potentially important repercussions for research and clinical practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Head-to-head comparisons of Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Section II and Section III personality disorder in predicting clinical outcomes.

In 2022, PDs: Theory, Research, and Treatment published a 10-year retrospective on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), Section III, Alternative Model for PDs (AMPD; American Psychiatric Association, 2013). The articles of the 10-year retrospective provided evidence in support of the validity, reliability, and clinical utility of the AMPD. Specifically, it provided evidence in support of the unidimensional factor structure of the LPF and the five-dimensional structure of the pathological trait domains. In addition, evidence in support of the construct validity of the LPF in its association with psychiatric severity, functional outcomes, traditional PDs, cognitive, emotional, and contextual correlates, and other indices of maladaptive self- and interpersonal functioning was provided. Despite this evidence, a significant gap has since been identified related to how the American Psychiatric Association (APA) decides to accept proposed revisions to diagnostic criteria. The goal of the current special issue is to address this gap. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring personality correlates of psychiatric hospitalization: A cross-sectional comparison of section ii personality disorder model and alternative model for personality disorders.

Our cross-sectional study provides a head-to-head comparison of Section II and Section III of Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic models of personality disorders (PDs) in identifying significant personality correlates of psychiatric hospitalization (PH). PH is an indicator of a breakdown in one's existing ability to manage mental crisis. The sample was recruited from psychiatric clinical services (N = 60) as well as universities and the local community (N = 49). We used the Structured Clinical Interview for DSM-5 PD (SCID-5-PD) for Section II DSM-5 diagnosis, the Self and Interpersonal Functioning Scale (SIFS) for Criterion A and the Personality Inventory for DSM-5 (PID-5) for Criterion B. Separate logistic regressions analyses showed high discriminative utility for all diagnostic models: the number of Section II diagnosis, level of personality functioning, and five maladaptive traits (AUC between .89 and .97). Binomial logistic regression with a forward stepwise procedure showed that Section II number of diagnoses revealed incremental utility over Criteria A and B in distinguishing between individuals experiencing a mental health crisis requiring PH and those not requiring immediate intervention. We conclude that each diagnostic model, when considered individually, exhibits a high degree of discriminatory performance. However, employing all these models concurrently for identifying personality correlates of PH proves impractical. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Update on Antisocial Personality Disorder.

PURPOSE OF REVIEW: Antisocial personality disorder (ASPD) is a characterized by lifelong or recurrent behavioral problems that begin in childhood or early adolescence. This communication provides an overview on ASPD including findings from recent reviews and new research. RECENT FINDINGS: With regard to DSM-5's Section III Alternative Model of Personality Disorder criteria for ASPD, advocates point to the broader symptom coverage and harmonization with ICD-11; yet critics point to the lack of evidence for improved outcomes. A new report shows that antisocial individuals age faster than non-antisocial peers. ASPD has high heritability and newer molecular studies have found intriguing linkages to genes associated with crucial brain regions. A mentalization-based therapy model has been developed and early work shows promise. ASPD is common, widespread, and disruptive to individuals, families, and society. Chronic and lifelong, ASPD typically lessens in severity with advancing age. Assessment rests on the individual's history because there are no diagnostic tests. ASPD likely results from an interplay of genetic and environmental factors. Brain imaging studies have linked cortical dysfunction to antisocial behavior in crucial brain regions. Medication is sometimes targeted at the individual's aggression and irritability, but a more rational approach is to target co-occurring disorders. Cognitive-behavioral therapy and mentalization-based therapy models have been developed and are being studied.

Evaluation of Catatonia with Different Assessment Scales in Psychiatry and Neurology. / Psikiyatri ve Nörolojide Katatoninin Farkli Ölçeklerle Degerlendirilmesi.

OBJECTIVE: Catatonia is a syndrome that can be missed in clinical settings. Diagnosis of catatonia is important because the condition can be reversible and is associated with severe complications. This study aims to screen patients with catatonia admitted to a university hospital's psychiatry and neurology services, examine their characteristics, and compare the coverage of different catatonia scales. METHOD: During a consecutive 20 months study period, the Turkish adaptations of the Bush-Francis Catatonia Rating and the KANNER scales were administered in psychiatry and neurology inpatient units and patients on the waiting list for psychiatric hospitalization. The participants were also evaluated with DSM-5 criteria. In addition, the sociodemographic and clinical characteristics of the patients in the psychiatric group were compared. RESULTS: A total of 214 patients were evaluated. Twenty-eight (13.1%) screened positive for catatonia, and 23 (82.1%) were diagnosed with catatonia according to DSM-5 criteria. KANNER and Bush- Francis identified the same patients as having catatonia. In addition to schizophrenia and mood disorders; neurodevelopmental disorder, encephalitis, postpartum psychosis, obsessive-compulsive disorder, delirium, cerebrovascular disease, functional neurological symptom disorder have also been found to be associated with catatonia. The most common complication was urinary tract infection. Life-threatening complications were also observed. CONCLUSION: Overlooking catatonia may have dire consequences. Adhering solely to the DSM-5 criteria may miss some patients with catatonia. Widely and efficiently using standardized catatonia scales can improve detection capacity and enhance the management of morbidity and mortality.

Reliability and Validity of Turkish version of DSM-5 Substance Use Scale. / DSM-5 Madde Kullanimi Ölçegi'nin Türkçe Formunun Geçerligi ve Güvenilirligi.

OBJECTIVE: This study aims to evaluate the severity of substance use disorders according to the DSM-5 criteria and to show the reliability and validity of the Turkish version of the DSM-5 Substance Use Scale that improved to learn what kind of substances are used. METHODS: In this study,54 in or out-patients who met the criteria for any substance use disorder according to DSM-5 and who are receiving treatment in Psychiatry Department of Celal Bayar University Faculty of Medicine and AMATEM department of Bakirköy Prof. Dr. Mahzar Osman Mental Health and Neurology Training and Research Hospital, were included. One hundred volunteers without any mental or physical disease were also recruited as the control group. Beside the DSM-5 Level 2 substance use scale, Addiction Profile Index was used for concurrent validity. Internal consistency coefficient and item-total correlation analysis were performed for reliability analysis. ROC Analysis was used in the validity analysis. RESULTS: Mean age was 26.97±10.20 years in the study group and 39% of the sample (n=60) were female. 5.6% (n=3) of the patient group were female and 94.4% (n=51) were male. In the control group, 57% (n=57) were female and 43% (n=43) were male. Of the patients diagnosed with substance use disorder (n=54), 88.7% had opiate use disorder, 5.6% had polysubstance use disorder, 5.6% had other (unknown) substance (synthetic cannabinoid) use disorder and 1.8% of patients have cannabis use disorder. The internal consistency of the substance use scale was 0.80 and itemtotal correlation coefficients were between 0,196- 0,643 (p<0.0001). Coefficient of correlation analysis with API was calculated as r=0.806 (p<0.0001). CONCLUSION: The results showed that DSM-5 Substance Use Scale is a valid and reliable questionnaire that can be used to measure the progress of different dimensions of alcohol and substance use.

Comparing the DSM-5 Dimensional Trait and Triarchic Model Conceptions of Psychopathy: An External Validity Analysis.

In the DSM-5 Alternative Model of Personality Disorders (AMPD), psychopathy is marked by the presence of attention seeking, low anxiousness, and lack of social withdrawal, along with traits from the domains of Antagonism and Disinhibition. The triarchic model of psychopathy (TriPM) posits three biobehaviorally based traits underlying it: disinhibition, meanness, and boldness. The current study directly compared relations for measures of the two models with the broad dimensions of externalizing, internalizing, and positive adjustment. Participants (1,678 adults) were surveyed regarding maladaptive personality traits, clinical symptoms, and positive adjustment features. The TriPM model explained more variance than the AMPD in substance use, positive adjustment, and empathy, whereas the AMPD model explained more variance in internalizing symptoms. In addition, AMPD Antagonism and the Psychopathy Specifier diverged from TriPM Meanness and Boldness in their associations with some specific outcomes. Overall, our study provides evidence for complementarity of the two models in characterizing the multifaceted nature of psychopathy.

Association patterns of antisocial personality disorder across substance use disorders.

There is a high prevalence of antisocial personality disorder (ASPD) in individuals affected by substance use disorders (SUD). However, there is limited information on the specific patterns of association of ASPD with SUD severity and specific SUD diagnostic criteria. We investigated the association of alcohol, cannabis, cocaine, opioid, and tobacco use disorders (AUD, CanUD, CocUD, OUD, and TUD, respectively) in 1660 individuals with ASPD and 6640 controls matched by sex (24% female), age, and racial/ethnic background in a sample ascertained for addiction-related traits. Generalized linear regressions were used to test ASPD with respect to the five DSM-5 SUD diagnoses, their severity (i.e., mild, moderate, severe), and their diagnostic criteria. We found that ASPD is associated with the diagnosis and severity of AUD (Odds Ratio, ORs = 1.89 and 1.25), CanUD (ORs = 2.13 and 1.32), and TUD (ORs = 1.50 and 1.21) (ps < 0.003). Of the specific diagnostic criteria, the "hazardous use" criterion showed the strongest association with ASPD across the five SUDs investigated (from ORTUD = 1.88 to ORCanUD = 1.37). However, when criteria of different SUDs were included in the same model, ASPD was independently associated only with TUD "hazardous use" and CocUD "attempts to quit". Attempting to quit cocaine was inversely related to the presence of ASPD and remained significant (OR = 0.57, 95% confidence interval = 0.36-0.89) after controlling for interactive effects with sex. The current work provides novel insights into ASPD-SUD comorbidity, supporting the existence of different SUD patterns among individuals affected by ASPD.

Validation of the delirium diagnostic tool-provisional (DDT-Pro) in geriatric medical inpatients with diagnostic permutations of the 3Ds with and without delirium.

OBJECTIVE: Validations of brief delirium tools have not included analysis of psychiatric disorders comorbidities or control groups. We validated the Delirium Diagnostic Tool-Provisional (DDT-Pro) in 422 geriatric inpatients with high incidence of depression and/or dementia. METHODS: Cross-sectional study using two delirium reference standards, DSM-5-TR and Delirium Rating Scale-Revised-98 (DRS-R98). We assessed concurrent and construct DDT-Pro validity too. RESULTS: There were 117 (27.7%) delirium cases using DDT-Pro, 104 (24.6%) per DSM-5-TR and 93 (22.0%) per DRS-R98; 133 patients (31.5%) had depression and 105 (24.9%) dementia, some comorbid with delirium. DDT-Pro accuracy (AUC under ROC curve) ranges were 88.3-95.9% vs DSM-5-TR and 92.7-95.0% vs DRS-R98 for whole sample and four diagnostic groups, without statistical differences. DDT-Pro ≤6 had the most balanced sensitivity-specificity for delirium diagnosis against both DSM-5-TR and DRS-R98 with similar specificity but higher sensitivity for DRS-R98 than DSM-5-TR delirium, with the highest values in patients with depression and dementia (≥92% sensitivity, ≥81% specificity). Positive and negative likelihood ratios support diagnostic strength. Concurrent validity was high reflected by significant correlations (p < 0.001) of DDT-Pro total and item scores with DRS-R98 and Delirium Frontal Index scores, highest in groups with comorbid depression and/or dementia. The DDT-Pro represented a single construct for delirium demonstrated by one factor with high item loadings and high internal consistency reliability of its items. CONCLUSIONS: The DDT-Pro demonstrated strong performance metrics in general hospital elderly inpatients with preexisting depression and/or dementia, which is unique among brief delirium tools. Its optimized cutoff score was the same as in other populations.

Controversies in Assessment, Diagnosis, and Treatment of Kratom Use Disorder.

PURPOSE OF REVIEW: We apply the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria for substance use disorders (SUDs) to the herbal product kratom. Similarities and differences between kratom use disorder (KUD) and other SUDs are explored, along with assessment, diagnostic, and therapeutic recommendations for KUD. RECENT FINDINGS: Literature reports of "kratom addiction" or KUD rarely specify the criteria by which patients were diagnosed. Individuals meeting DSM-5 KUD criteria typically do so via tolerance and withdrawal, using more than intended, and craving, not functional or ​psychosocial disruption, which occur rarely. Most clinicians who use medication to treat patients with isolated KUD select buprenorphine formulations, although there are no controlled studies showing that buprenorphine is safe or efficacious in this patient population. Diagnosis and treatment decisions for KUD should be systematic. We propose an algorithm that takes into consideration whether KUD occurs with comorbid opioid use disorder.

Diagnostic accuracy of large language models in psychiatry.

INTRODUCTION: Medical decision-making is crucial for effective treatment, especially in psychiatry where diagnosis often relies on subjective patient reports and a lack of high-specificity symptoms. Artificial intelligence (AI), particularly Large Language Models (LLMs) like GPT, has emerged as a promising tool to enhance diagnostic accuracy in psychiatry. This comparative study explores the diagnostic capabilities of several AI models, including Aya, GPT-3.5, GPT-4, GPT-3.5 clinical assistant (CA), Nemotron, and Nemotron CA, using clinical cases from the DSM-5. METHODS: We curated 20 clinical cases from the DSM-5 Clinical Cases book, covering a wide range of psychiatric diagnoses. Four advanced AI models (GPT-3.5 Turbo, GPT-4, Aya, Nemotron) were tested using prompts to elicit detailed diagnoses and reasoning. The models' performances were evaluated based on accuracy and quality of reasoning, with additional analysis using the Retrieval Augmented Generation (RAG) methodology for models accessing the DSM-5 text. RESULTS: The AI models showed varied diagnostic accuracy, with GPT-3.5 and GPT-4 performing notably better than Aya and Nemotron in terms of both accuracy and reasoning quality. While models struggled with specific disorders such as cyclothymic and disruptive mood dysregulation disorders, others excelled, particularly in diagnosing psychotic and bipolar disorders. Statistical analysis highlighted significant differences in accuracy and reasoning, emphasizing the superiority of the GPT models. DISCUSSION: The application of AI in psychiatry offers potential improvements in diagnostic accuracy. The superior performance of the GPT models can be attributed to their advanced natural language processing capabilities and extensive training on diverse text data, enabling more effective interpretation of psychiatric language. However, models like Aya and Nemotron showed limitations in reasoning, indicating a need for further refinement in their training and application. CONCLUSION: AI holds significant promise for enhancing psychiatric diagnostics, with certain models demonstrating high potential in interpreting complex clinical descriptions accurately. Future research should focus on expanding the dataset and integrating multimodal data to further enhance the diagnostic capabilities of AI in psychiatry.

Improving posttraumatic stress disorder assessment in young children: comparing measures and identifying clinically-relevant symptoms in children ages six and under.

Young children exposed to trauma are vulnerable to developing posttraumatic stress disorder (PTSD). Although experts agree on the importance of tailoring PTSD assessments to be developmentally-appropriate for young children, there is little research on which assessment methods best identify clinically significant symptomatology in this difficult-to-assess population. Two competing models for assessing PTSD have been proposed by the DSM-5 and ICD-11. This study compared a DSM-5 measure to an ICD-11 measure in young children (ages 1-6) exposed to a natural disaster. The measures identified similar rates of PTSD in children; however, diagnostic agreement between the measures was low (31-36%). Both PTSD measures were associated with actual and perceived life threat, functional impairment, and comorbid psychopathology. PTSD symptom and cluster endorsement rates were also binned by age and compared to functional impairment to identify commonly-reported and highly impairing symptoms in trauma-exposed young children, as potential candidates for inclusion in future revisions of diagnostic criteria. Across age ranges, increased clinginess post-trauma was the most commonly reported symptom and was associated with functional impairment. Arousal symptoms (startle, hypervigilance) and Re-experiencing symptoms (nightmares) also emerged as relevant for young children. Findings may contribute to efforts to improve assessment for PTSD in young children.

Revisiting Rorschach test and Minnesota Multiphasic Personality Inventory-II patterns in Kraepelinian vs. DSM-wise Schizophrenia: How They Differ and What It Means for Diagnosis.

OBJECTIVE: This retrospective chart review study aimed to investigate the differences in the Rorschach test and Minnesota Multiphasic Personality Inventory (MMPI)-II profiles among patients with Kraepelinian schizophrenia, those with DSM-wise schizophrenia, and controls. Kraepelinian schizophrenia is characterised by a chronic, deteriorative disease course and a predominance of negative symptoms. METHODS: Patients with Kraepelinian schizophrenia were selected based on medical record reviews. We then compared their Rorschach test and MMPI-II results with those of the DSM-wise schizophrenia group and the control group. RESULTS: The Rorschach test revealed a significant increase in DV2 score and a decrease in D score in patients with Kraepelinian schizophrenia compared to those with DSM-wise schizophrenia. In the MMPI-II profiles, patients with Kraepelinian schizophrenia exhibited an elevated L relative to those with DSM-wise schizophrenia. CONCLUSION: Our results suggested the value of revisiting psychological tests in clinically delineated subgroups, such as Kraepelinian schizophrenia. Although patients fall under the same diagnostic category of schizophrenia, considering different phenotypes is important when interpreting psychological test outcomes. Additionally, our study indicated that both schizophrenia groups did not show as many abnormalities as expected compared to controls. This highlights the potential value of revisiting established profiles of certain psychological tests and calls for further research on other psychological tests.

Psychiatric Diagnosis: A Clinical Guide to Navigating Diagnostic Pluralism.

ABSTRACT: The controversies surrounding the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases have generated significant debate across the psy-sciences. This debate has been further fueled by the launch of the Research Domain Criteria as a framework to facilitate advances in neuroscientific research, a renewed emphasis on dimensional models of psychopathology, currently exemplified by the Hierarchical Taxonomy of Psychopathology, and development of the Psychodynamic Diagnostic Manual by the psychodynamic community. In this article, we provide a clinical overview of recent debates surrounding categorical and dimensional approaches to psychiatric diagnosis, offer a critical assessment of proposed alternatives, and discuss how clinicians can navigate a plurality of diagnostic frameworks. Our discussion emphasizes that diagnostic frameworks need to be contextualized within the process of a comprehensive clinical evaluation, and their advantages and disadvantages should be understood in relationship to the theoretical orientations and practical needs of clinicians.

The Grief Debate, the DSM, and Clinical Practice.

There has been an ongoing debate regarding grief, whether it may be at times pathological, and whether it is different from depression. This article addresses those questions by tracking the changing course of the Diagnostic and Statistical Manuals of Mental Disorders (DSMs) since DSM-III and by reviewing the debate concerning grief and depression. At the time when DSM-III was being prepared in the late 1970s (it was published in 1980), there was a concern that normal bereavement (or grief) was being diagnosed as major depression. To address this concern, the editors of DSM-III added a category of "uncomplicated bereavement." The fourth edition of the DSM (DSM-IV), published in 1994, then followed by a minor change. However, the editors of DSM-5 decided to eliminate the bereavement exclusion entirely. Their concern was simply whether the individual did or did not suffer from major depression. Since an individual might not warrant a diagnosis of major depression but might still be experiencing grief, the DSM discussion leads directly into the question of whether grief-later called prolonged grief disorder-and depression are separate conditions. Advocates for prolonged grief disorder maintained that grief is different from depression but that patients may present with a mix of grief and depressive symptoms that are clinically difficult to distinguish. Advocates of separate conditions have in fact developed an inventory of symptoms that identify prolonged grief disorder. However, inasmuch as a typical grief presentation will include depressive symptoms, the clinical challenge is to distinguish prolonged grief disorder and major depression, as well as to distinguish both from normal grief. Given the temporal limits of an average consultation, this article argues that making the required distinctions is an unrealistic expectation. Finally, researchers have developed specific treatment programs for prolonged grief disorder, but a conflict between the 2 primary researchers involved and the generalities in which the programs are phrased have led to the suggestion of a different approach to treatment that replaces generalities with a person-centered approach.

Depression prevalence of the Geriatric Depression Scale-15 was compared to Structured Clinical Interview for DSM using individual participant data meta-analysis.

Depression questionnaire cutoffs are calibrated for screening accuracy and not to assess prevalence, but the Geriatric Depression Scale (GDS-15) is often used to estimate diagnostic prevalence among older adults, most commonly with scores of ≥ 5. We conducted an individual participant data meta-analysis to compare depression prevalence based on GDS-15 ≥ 5 to Structured Clinical Interview for Diagnostic and Statistical Manual (SCID) diagnoses and assessed whether an alternative cutoff could be more accurate. We used generalized linear mixed models to estimate prevalence. Data from 14 studies (3602 participants, 434 SCID major depression) were included. Pooled GDS-15 ≥ 5 prevalence was 34.2% (95% confidence interval [CI] 27.5-41.6%), and pooled SCID prevalence was 14.8% (95% CI 10.0-21.5%; difference of 17.6%, 95% CI 11.6-23.6%). GDS-15 ≥ 8 provided the closest estimate to SCID with mean difference of - 0.3% (95% prediction interval - 17.0-16.5%). Prevalence estimate differences were not associated with study or participant characteristics. In sum, GDS-15 ≥ 5 substantially overestimated depression prevalence. A cutoff of ≥ 8 was accurate overall, but heterogeneity was too high for implementation in practice. Validated diagnostic interviews should be used to estimate major depression prevalence among older adults.

Correlates of treatment-seeking in DSM-5 generalized anxiety disorder: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III.

Generalized Anxiety Disorder (GAD) presents a significant personal and societal burden and is associated with chronic medical comorbidities and markedly lower quality of life. Effective treatments exist, less than half of individuals with lifetime GAD will ever seek psychotherapeutic or pharmacological treatment. A thorough understanding of the factors that influence treatment seeking for GAD is warranted. The present study investigates the correlates of GAD treatment seeking, using data from the National Epidemiological Survey on Alcohol and Related Disorders-III (NESARC-III), which assessed for psychiatric disorders using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version (AUDADIS-5). A series of logistic regressions were run to identify demographic, diagnostic, and symptom-level correlates of treatment seeking in those meeting DSM-5 diagnostic criteria for GAD. Comorbid depression, panic disorder, and PTSD were all uniquely associated with higher rates of GAD-related treatment seeking. Additionally, several accompanying anxiety symptoms were also uniquely predicted treatment seeking, including fatigue, panic attacks, reassurance-seeking, and interpersonal avoidance. Findings underscore the multi-factorial nature of treatment seeking behavior in GAD and highlight the need for further research to fully understand these relationships and devise effective strategies to improve treatment seeking in this population.

Diagnostic and Statistical Manual of Mental Disorders, fifth edition, personality disorders and the alternative model: Prediction of naturalistically observed behavior, interpersonal functioning, and psychiatric symptoms, 1 year later.

Traditional personality disorders (PDs; e.g., Diagnostic and Statistical Manual of Mental Disorders, fifth edition [DSM-5] Section II PDs), as well as dimensional traits (e.g., alternative model for PD [AMPD]), offer unique advantages in personality pathology assessment. However, very little is known about how these systems compare in predicting observable behavior. This study compares self-report ratings of PD symptoms (i.e., Structured Clinical Interview for DSM-IV PD) with self-reports of AMPD traits (i.e., Personality Inventory for DSM-5) in predicting clinical outcomes, 1 year later, via three different methods: (a) naturalistically observed psychosocial functioning (i.e., electronically activated recorder [EAR]), (b) informant-reported interpersonal functioning (i.e., Inventory of Interpersonal Problems-32), and (c) self-reported suicidality (SI), depression, anxiety, and substance use symptoms (i.e., Psychiatric Diagnostic Screening Questionnaire). Data were analyzed from 72 individuals in current or recent psychiatric treatment meeting diagnosis for at least one PD. Results showed that DSM Section II PD and AMPD ratings yielded meaningful and comparable predictions of naturalistically observed EAR variables and informant-rated interpersonal functioning. The AMPD appeared to offer slight advantages in the prediction of EAR-observed negative affect, hostile words, and informant-rated interpersonal functioning, with clearer advantages at the facet level. Overall, these results provide tentative evidence that both DSM Section II PD and AMPD systems show meaningful links with clinical outcomes measured via multiple methods 1 year later, but with clearer advantages for the AMPD at the facet level. Moreover, results show that the EAR is a viable method for capturing naturalistically observed clinically meaningful, in vivo behavior of individuals exhibiting maladaptive personality patterns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Different routes to the same destination? Comparing Diagnostic and Statistical Manual of Mental Disorders, fifth edition Section II- and alternative model of personality disorder-defined borderline personality disorder.

Borderline personality disorder (BPD) is defined by the presence of at least five of nine symptoms in Section II of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Section III Alternative Model of Personality Disorders (AMPD), BPD is defined by deficits in self and/or interpersonal functioning (Criterion A), elevated negative affectivity, and elevated antagonism and/or disinhibition (Criterion B). However, it is unclear if these definitions describe the same people and if the AMPD criteria explain unique variability in treatment outcomes in this population. In a treatment-seeking sample of adult participants diagnosed with BPD according to Section II criteria (n = 65, Mage = 27.60, 70.8% female, 76.9% White), we found a majority (66.2%) would have also received the diagnosis based on AMPD criteria. Those meeting AMPD criteria reported more severe Section II BPD symptoms than those who did not, ps < .02, ds > 0.60, and the presence or severity of Section II fears of abandonment and inappropriate anger uniquely predicted AMPD BPD diagnoses, ps < .03, ORs ≥ 2.31. Changes in AMPD dimensions explained 34% of the variability in change in work/social adjustment (p = .13) and quality of life (p = .22), respectively, over and above changes in Section II symptoms during a novel cognitive-behavioral treatment for BPD. These results suggest that AMPD criteria capture a more severe subset of BPD than Section II criteria and may be important predictors of treatment outcomes. We discuss the potential trade-offs of this shift in diagnosis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).