Saturday in Chicago, Brain Overload

Still in the City of Chicago! The photo here at the top was taken just about half a block from the Sheraton, where the APS meeting is being held... and we are right beside the Chicago River. It really is very beautiful.

I'm taking a small break from the onslaught of great presentations; some amazing research is being done, and it is being presented to us at a very brisk clip; I have heard several speakers who were given 20 minutes, during which time they have managed to pack in a talk that really needed at least 45 minutes. So they use techniques such as: talking very fast! which drives me a bit into frustration mode.

One of the very popular symposia today was about the possible, and maybe likely, changes that will be made when the next psychiatric diagnostic manual comes out (DSM-V, it will be), in a few years. We have been hearing, for a while, that the big move will (finally!) be in the direction of a more dimensional approach, because our current polythetic and categorical approach has created what is essentially too large a crowd of diagnoses that are simply not realistic, and do not accurately correspond either with the clinical picture(s) of the real problems displayed by psychiatric patients, or the actual methods used in the diagnosis (and treatment) of their problems. Dr. Robert Krueger suggested that the 5 broad spectra that might be used in the new manual could be:

• Emotionality ("internalizing" experiences such as depression and anxiety)
• Externalizing (problems with disinhibition, e.g., antisocial personality disorder)
• Psychosis
• Neurocognitive (e.g., dementia)
• Neurodevelopmental (e.g., autism)

He also suggested that the "personality disorders," now coded on a different axis than most other disorders (such as depressive disorders, and schizophrenia) will be folded into the other diagnoses, by assessing patients along and according to five trait dimensions that exist within "normal" personality, as well as in people who merit psychiatric diagnoses:

• Neuroticism (tendency to have painful emotional experiences)
• Introversion vs. Extraversion
• Antagonism vs. Agreeableness
• Compulsivity (extreme Conscientiousness)
• Peculiarity

These five trait dimensions are very well-validated, and should prove to be a MUCH more reasonable and useful way to capture various aspects of personality functioning that contribute to what we call "mental disorders."