Publication Type: Symposium Paper
Abstract: Antisocial Personality Disorder (APD) requires a retrospective diagnosis of conduct disorder before age 15; however, many adults with antisocial behavior do not meet these criteria, leaving these individuals in “diagnostic limbo.” Using data on 1353 juvenile detainees assessed at baseline and 6.8 years later, this study examines differences between those with APD, adult antisocial behavior without a retrospective conduct disorder diagnosis (AAB), and neither APD nor AAB (“None”). In general, significant differences between the groups were found for prevalence of mental and substance use disorders, functional impairment, and self-reported crimes. The findings argue for changes to APD in the DSM-V.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: A revolution occurred within the psychiatric profession in the early 1980s, which rapidly transformed the theory and practice of mental health in the United States. In a very short period of time, mental illnesses were transformed from broad, etiologically defined entities that were continuous with normality to symptom-based, categorical diseases. The third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III) was responsible for this change. The paradigm shift in mental health diagnosis in the DSM-III was neither a product of growing scientific knowledge nor of increasing medicalization. Instead, its symptom-based diagnoses reflect a growing standardization of psychiatric diagnoses. This standardization was the product of many factors including: (1) professional politics within the mental health community, (2) increased government involvement in mental health research and policymaking, (3) mounting pressure on psychiatrists from health insurers to demonstrate the effectiveness of their practices, and (4) the necessity of pharmaceutical companies to market their products to treat specific diseases. This paper endeavors to explain the origins of DSM-III, the political struggles that generated it, and its long-term consequences for clinical diagnosis and treatment of mental disorders in the U.S.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: In 1980, the American Psychiatric Association, radically revised the Diagnostic and Statistical Manual-III (DSM-III), redefining a psychiatrists’ expertise from a psychodynamic orientation to an approach based on the biomedical model. These revisions played a significant role in shoring up the profession’s jurisdiction (Abbott 1988) vis-à-vis other mental health professionals. In the process, they altered the professional reality for psychiatrists themselves, elevating the biomedical model of psychiatry over others. For this reason, the DSM has become an object around which interprofessional tensions revolve. This study uses in-depth interviews from psychiatrists to explore the use of the DSM in practice through a dual level analysis. 1) On the individual level, use is shaped largely by psychiatrists’ opinions of the DSM. These opinions reflect a generational effect depending on ones’ position within the context of the jurisdictional dispute. 2) At the institutional level, these opinions are filtered through the context in which psychiatrists practice. The DSM is employed in different institutions, which place constraints on the psychiatrists’ discretion. Consequently, the use of the DSM is highly contextual as psychiatrists negotiate these institutional constraints. This case reveals that intraprofessional jurisdictional disputes, once resolved, feedback into the profession and alter the interprofessional reality.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: Financial associations between DSM panel members and the pharmaceutical industry is an important public health issue for women because undisclosed conflicts of interest influence both the inclusion of new DSM disorders and influence prescribing practices that directly affect women. Suggestions for developing greater integrity in psychopharmacological and mental health research will be provided.