Title: Are the Obsessive-Compulsive Related Disorders Related to Obsessive-Compulsive Disorder? A Critical Look at DSM-5's New Category
Presenter:Jonathan S. Abramowitz, Ph.D., University of North Carolina-Chapel Hill
Moderator: Michelle Craske, Ph.D., UCLA
The creators of DSM-5 have moved obsessive-compulsive disorder (OCD) from its previous designation as an Anxiety Disorder to a newly introduced category of "Obsessive-Compulsive and Related Disorders" (OCRDs). Along with OCD, the OCRDs include body dysmorphic disorder, hoarding disorder, hair-pulling disorder (trichotillomania), and excoriation (skin picking) disorder. The framers of DSM-5 assert that all of these conditions overlap in their symptom presentation, etiology, and treatment response. Although incorporating these problems within the same diagnostic class might raise awareness of the more underrecognized and understudied conditions, the new category's conceptual validity, scientific basis, and practical utility are a matter of sharp disagreement among clinicians and researchers alike. In this address I will consider the nature of the putative OCRDs, examine the empirical grounds for this new diagnostic class, and discuss treatment implications. Careful inspection indicates that the DSM-5's new OCRDs category has insufficient empirical support and might ultimately be a detriment to the clinical management of these problems. For example, apparent overlaps in "compulsive" behavior disappear at the functional level and family studies suggest OCD is more closely related to anxiety disorders than to the other OCRDs. Moreover, clinicians might incorrectly assume that comparable interventions can be applied to all conditions within the broader category. I therefore propose a more evidence-based and clinically useful nosology of obsessive-compulsive and putatively related problems.
Title: From Bench to Global Impact: Lessons Learned About Translating Research to Reach
Presenter:Carolyn Black Becker, Ph.D., Trinity University
The ABCT mission fosters the "advancement of scientific approaches to the understanding and improvement of human functioning through the investigation and application of behavioral, cognitive, and other evidence-based principles to the assessment, prevention, treatment of human problems, and the enhancement of health and well-being." Although ABCT members have made significant strides towards our collective goals, we routinely acknowledge that our ability to develop empirically supported treatments exceeds our success in improving dissemination and implementation of said interventions. Further, as noted by Kazdin and Blase (2011), even if we succeeded in having every clinician worldwide administer our best treatments with good competency, we still would fail to significantly reduce the global burden of mental illness because most treatments require intensive labor by expensive providers. To this end, Kazdin and Blase and others call for increased use of alternative strategies. Examples include: increased attention towards prevention; use of lower-cost, simplified interventions; task-shifting; train-the-trainer models; community participatory research methodology, and identification of novel funding sources. The Body Project is an empirically supported, cognitive-dissonance-based prevention program that targets body image, a well-established risk factor for eating disorders, negative affect, unhealthy weight control behaviors, smoking behavior, and decreased physical activity. Supported by a global village of researchers, community activists, and organizational partners, the Body Project and its sister programs are currently being implemented in 112 countries. In this talk I will share lessons our team has learned in taking a program from early testing to widespread implementation and connect these back to broader conversations occurring in our field regarding the importance of scalability and new directions in improving global mental health.
You will learn:
The importance of attending to scalability in both research and practice.
The benefits of adopting community participatory research methods.
Advantages of using social entrepreneurship to improve dissemination and implementation.
Why grant funding can sometimes hinder innovation by allowing you to escape real-world contingencies.
The benefits of attending to shorter, easier-to-implement interventions even if they have potentially smaller effect sizes per individual.
Becker, C. B., Bull, S., Schaumberg, K., Cauble, A., & Franco, A. (2008). Effectiveness of peer-led eating disorders prevention: A replication trial. Journal of Consulting and Clinical Psychology, 76(2), 347-354. Becker, C. B., Stice, E., Shaw, H., & Woda, S. (2009). Use of empirically supported interventions for psychopathology: Can the participatory approach move us beyond the research-to-practice gap? Behaviour Research and Therapy, 47(4), 265-274. Fairburn, C. G., & Patel, V. (2014). The global dissemination of psychological treatments: A road map for research and practice. The American Journal of Psychiatry, 171(5), 495-498. Kazdin, A. E., & Blase, S. L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6(1), 21-37. Kilpela, L. S., Hill, K., Kelly, M. C., Elmquist, J., Ottoson, P., Keith, D., Hildebrandt, T., & Becker, B. C. (2014). Reducing eating disorder risk factors: A controlled investigation of a blended task-shifting/train-the-trainer approach to dissemination and implementation. Behaviour Research and Therapy, 63, 70-82. Patel, V., Chowdhary, N., Rahman, A., & Verdeli, H. (2011). Improving access to psychological treatments: Lessons from developing countries. Behaviour Research and Therapy, 49(9), 523-528.
Title: The Diagnostic and Statistical Manuals of Mental Disorders as Instruments of Cultural Propaganda
Presenter:Arthur C. Houts, Ph.D., Vector Oncology and University of Memphis
This address uses Ellul's (1965) concept of propagandas to interpret the history and development of the DSMs from 1952 to the present. Emphasis is placed on the period between DSM-II and DSM-III where efforts were made to define mental disorders as medical disorders. DSM-III coincided with longstanding cultural developments toward physiological reductionism and the economic "opportunities" for profit in health care and prescription medication promotion. The expansion of the DSMs is shown. The general claim that mental disorders are manifestations of dysfunctions is examined and criticized. The expansion of the scope and number of mental disorders is attributed to social and cultural developments related to loose definitions of mental disorder, the need of mental health professionals for employment, promotion of disorders by pharmaceutical companies, and a frightened and troubled populace. Some suggestions are offered to reconfigure broad categories of problems along a continuum of relative fit (likely vs. unlikely) for broken physiological mechanisms. Finally, questions of ethics and values are raised regarding the current state of mental health care in light of the history of the DSMs.
You will learn:
The concept of propagandas as Ellul defined the phenomenon of multiple propagandas.
How philosophical anthropologies can affect concepts of mental disorders.
General trends of the DSMs from 1952 to the present in terms of the size of the manuals and the number of specific mental disorders named within the manuals.
Reasons for why the time between DSM-II and DSM-III was important in terms of the expansion of the DSM and its use in U.S. society.
Three broad cultural developments this author believes were influential in the expansion of the DSM scope and number of mental disorders.
Baldwin, S. A., Williams, D. C., & Houts, A. C. (2004). The creation, expansion, and embodiment of posttraumatic stress disorder: A case study in historical critical psychopathology. Scientific Review of Mental Health Practice, 3(1), 33-52. Decker, H. S. (2013). The making of DSM-III: A diagnostic manual's conquest of American psychiatry. New York: Oxford University Press. Ellul, J. (1965). Propaganda: The formation of men's attitudes. (1st American ed.). New York: Knopf. Houts, A. C. (2000). Fifty years of psychiatric nomenclature: reflections on the 1943 War Department Technical Bulletin, Medical 203. Journal of Clinical Psychology, 56(7), 935-967.
Title: The Brave New World of the Brain: Promises and Perils for Clinical Psychology
Presenter:Scott O. Lilienfeld, Ph.D., Emory University
In this talk, Dr. Lilienfeld will examine the increasing influence of neuroscience on psychology, especially clinical psychology. He will discuss the potential of neuroscientific discoveries to transform our classification and treatment of mental disorders as well as our understanding of their etiology. At the same time, he will express concerns regarding the dangers of focusing unduly on a single level of analysis in explaining psychopathology, and will delineate potential perils in the premature application of brain-based discoveries to mental disorders.
You will learn:
Recent advances in neuroimaging and other neuroscience-based techniques.
The rationale for the recent Research Domain Criteria (RDoC) initiative of the National Institute of Mental Health, and be able to describe its potential advantages and disadvantages relative to the prevailing DSM approach.
Inferential limitations and common methodological errors in neuroimaging research.
The importance of distinguishing among different levels of analysis in understanding the causes and treatment of mental illness.
The potential scientific and pragmatic advantages and disadvantages of conceptualizing mental disorders as brain diseases.
Deacon, B. J. (2013). The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review, 33, 846-861. Kendler, K.S. (2014). The structure of psychiatric science. American Journal of Psychiatry, 171, 931-938. Kvaale, E. P., Gottdiener, W. H., & Haslam, N. (2013). Biogenetic explanations and stigma: A meta-analytic review of associations among laypeople. Social Science & Medicine, 96, 95-103. Satel, S., & Lilienfeld, S.O. (2013). Brainwashed: The seductive appeal of mindless neuroscience. New York: Basic Books.
Title: Anatomy of an Epidemic: The History and Science of a Failed Paradigm of Care
Presenter:Robert Whitaker, Psy.D., Former Fellow of the Edmond J. Safra Center for Ethics at Harvard University
In 1980, the American Psychiatric Association published DSM-III, which conceptualized psychiatric disorders as illnesses. This naturally led to the use of psychiatric drugs as first-line therapies for most disorders. Thirty-five years later, history and science reveal quite clearly that this paradigm of care has failed. The burden of mental illness in the United States and other developed countries has risen markedly during this period; there is now compelling evidence that psychiatric drugs worsen the long-term course of major mental disorders, including schizophrenia, depression, and bipolar disorder; and the DSM stands revealed as a diagnostic manual that is neither reliable nor valid. Psychiatry's guild interests serve as a barrier to remaking this paradigm of care.
You will learn:
Rising numbers of disabled mentally ill in the U.S. and other countries that have adopted a DSM approach to diagnosing and treating psychiatric disorders.
Research on the effects of psychiatric drugs on long-term outcomes of major mental disorders.
Research documenting the lack of reliability in the DSM manuals, and acknowledgments that the DSM lacks validity.
APA's guild interests that have so biased the information it presents to the public, and its reporting on findings from NIMH-funded trials.
How this failed paradigm of care can be remade.
Whitaker, R. (2015). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. New York: Random House. Whitaker, R., & Cosgrove, L. (2015). Psychiatry under the influence: Institutional corruption, social injury, and prescriptions for reform. New York: MacMillan.