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Epidemic modeling suggests that a major scale-up in HIV treatment could have a dramatic impact on HIV incidence. This has led both researchers and policymakers to set a goal of an "AIDS-Free Generation." One of the greatest obstacles to achieving this objective is the number of people with undiagnosed HIV infection. Despite recent innovations, new research strategies are needed to identify, engage, and successfully treat people who are unaware of their infection.

One improvement from the second to the third edition of the Diagnostic and Statistical Manual of Mental Disorders was to replace clinicians' subjective interpretations of mental disorders with objective descriptions of signs and symptoms that could be rated reliably across investigators. Along with clinicians' subjective impressions, however, the subjective experiences of the person with the mental disorder were minimized. This information could be valuable, as people's subjective experiences of disorders may indicate major underlying processes and be different from how characteristics of disorders appear objectively to outside observers. The authors suggest that empirically derived, patient-subjective characteristics of mental disorders be incorporated into future editions of the DSM and the ICD. Not only will these data offer important information that will help to enhance the accuracy of the diagnostic categories of the DSM and ICD, but such data also may serve to enhance clinicians' abilities to conceptualize accurately and empathically treat these disorders in their patients. Examples of patient-subjective criteria and their relationship to current DSM criteria are examined for borderline personality disorder and schizophrenia and suggestions for DSM-V and ICD-11 are offered. Diagnostic criteria that accurately reflect patients' subjective experience could also increase clinicians' ability to empathize with patients, one of the most important variables in treatment alliances.

Clinicians are trained to conceptualize and diagnose mental disorders according to their depiction in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). But to what extent do the DSM and ICD truly represent the way that clinicians think about mental disorders? We outline the history of studies examining how clinicians think about mental disorders and discuss our current research on clinicians' natural taxonomies of mental disorders, which compares clinicians' conceptualization of mental disorders with their depiction in the DSM and the ICD. We make practical suggestions for how to make the DSM and ICD more like the way clinicians think about mental disorders to improve its clinical utility. We argue that the DSM and ICD would be more useful to clinicians if it had fewer categories, fewer diagnostic levels, removed the Axis I-II distinction used in the DSM, and included practical considerations such as treatment access (and the role of insurance companies in the United States or the local economy in developing countries), stigma, and clinicians' emotional reactions. Another way the DSM and ICD could be more useful to clinicians is if they more accurately represented the way that mental illness is experienced by the person who has the mental illness. Continued research of clinicians' conceptualization of mental disorders is necessary to make the DSM and ICD as useful to clinicians as possible. Keywords: clinical utility, ICD, DSM, clinicians, classification DOI: 10.1037/a0021603

The current experiments examine mental health clinicians' beliefs about biological, psychological, and environmental bases of the DSM-IV-TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians' beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by having clinicians list what they thought were the specific causes of nine familiar mental disorders and rate their bio-psycho-environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena. Keywords: Concept; Clinical reasoning; Causal explanation; Dualism

With the approaching publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), alternative organizations of the DSM (4th ed.; DSM-IV; American Psychiatric Association, 1994) categories have been proposed. This article compares several published alternative organizations to clinicians' organization of the DSM-IV categories. As demonstrations of their organization of DSM-IV categories, psychologists and psychiatrists sorted 66 DSM IV diagnostic categories into groups of similar diagnoses and then made progressively larger and smaller groups of diagnoses or placed similar groups next to each other on a table. Hierarchical agglomerative data analysis of clinicians' individual sortings showed that clinicians retained many lower level DSM-IV categories (e.g., anxiety disorders, mood disorders), but not the higher level DSM-IV categories (e.g., Axis I vs. Axis II). Instead, at the highest hierarchical level, clinicians' categories resembled the structure of the first edition of the DSM (American Psychiatric Association, 1952), which followed clinicians' diagnostic decision-making scheme, dividing mental disorders into organic versus nonorganic and then psychotic versus neurotic disorders. At minimum, these data suggest a DSM organization that makes sense to clinicians. Keywords: DSM, taxonomy, hierarchy, clinicians

Since 1980, a caveat in the introduction to the DSM has stated that the DSM classifies mental disorders and not people. Whether the DSM classifies disorders or people has important human rights implications: if people are being classified rather than disorders, then a person is defined by his/her disorder and cannot recover. Given the ethical implications of this issue, whether the prescriptions of the DSM are followed by researchers and the general public should be investigated. A MEDLINE keyword search found that phrases classifying people by researchers have steadily declined since 1975 but are still used approximately 50% of the time. In the general public, phrases classifying people are currently used equally as often as phrases classifying disorders. Reasons why classification systems must classify disorders instead of people, possible sources for the misconception that people are being classified, and the clinical implications of this issue are discussed.

This study used a unique methodology to determine the aspects of case vignettes that elicited an effect of case gender on diagnosis. A total of 99 psychiatrists and psychologists were shown cases representing a man or a woman that contained varying numbers of histrionic and antisocial criteria. The cases were presented by computer a few sentences at a time. Clinicians were asked to offer a diagnosis for the case after each group of sentences was presented. Results indicated that case gender tended to affect clinicians' diagnostic decisions when criteria related to that diagnosis were shown, suggesting that case gender was acting as a context in which diagnostic criteria were interpreted. Keywords: gender bias; diagnosis; clinicians; personality disorders; case vignettes

Background: "Recovery supports", often provided by persons in recovery themselves, have emerged over the last decade as important components of recovery-oriented systems of care for persons with substance use disorders. Aims: This study assesses the benefit of adding peer recovery supports to the care of adults with co-occurring psychosis and substance use. Method: 137 adults with both disorders who had at least one prior admission within the past year were recruited during an index hospitalization into a randomized trial of standard care vs skills training with and without a peer-led social engagement program. Participants were assessed at admission and at three and nine months post-discharge on symptoms, functioning, substance use, and other factors. Results: At three months, skills training was effective in reducing alcohol use and symptoms, with the addition of peer-led support resulting in higher levels of relatedness, self-criticism, and outpatient service use. At nine months, skills training was effective in decreasing symptoms and inpatient readmissions and increasing functioning, with the addition of peer support resulting in reduced alcohol use. Conclusions: Adding peer-led support may increase engagement in care over the short term and reduce substance use over the longer-term for adults with co-occurring disorders. [ABSTRACT FROM AUTHOR]

Do people believe mental disorders are real and possess underlying essences? The current study found that both novices and practicing clinicians held weaker essentialist beliefs about mental disorders than about medical disorders. They were also unwilling to endorse the idea that mental disorders are real and natural. Furthermore, compared with novices, mental health clinicians were less likely to endorse the view that there is a shared cause underlying a mental disorder and that one needs to remove the cause to get rid of the mental disorder. Clinicians were polarized on their views about whether mental disorders are categorical or dimensional. These findings reflect current controversies about mental disorders in the field at large.

An introduction is presented in which articles in the issue are discussed on topics including measurement of change in psychotherapy, alternatives to psychiatric diagnosis, and disease model approaches to schizophrenia.

An introduction is presented in which the editor discusses articles in the issue on topics including the contemporary diagnostic mental disorder, the metacognition of persons with schizophrenia and the reappropriation of agency and personal narratives about self-experience in the face of stigma.

The advent of a dimensional model of personality disorder included in DSM-5 has necessitated the development of a new measurement scheme, specifically a self-report questionnaire termed the Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012). However, there are many threats to the validity of a self-report measure, including response inconsistency. This study outlines the development of an inconsistency scale for the PID-5. Across both college student and clinical samples, the inconsistency scale was able to reliably differentiate real from random responding. Random responses led to increased scores on the PID-5 facets, indicating the importance of detecting inconsistent responding prior to test interpretation. Thus, this inconsistency scale could be of use to researchers and clinicians in detecting inconsistent responses to this new personality disorder measure. [ABSTRACT FROM AUTHOR]

The DSM-5 has included for further research a new dimensional measure of personality disorder, operationalized in the Personality Inventory for DSM-5 (PID5). It is important to investigate if extreme variants of these traits are associated with functional impairment, because functional impairment is a key aspect of the definition of personality disorder. The current study investigated this relationship in 989 college students and 91 clinical patients. The PID5 facets were meaningfully associated with measures of functional impairment in both samples, although the clinical sample evidenced more pathological levels of most traits, as might be expected. Overall, the PID5 appears to be a useful measure for the new DSM-5 system of personality disorder diagnosis. [ABSTRACT FROM AUTHOR]