DSM-IV Self-Report and Subjective Evaluation by Psychiatrists in Israel
Strous, Rael D., Stryjer, Rafael, Weiss, Mordechai, Ofir, Dana, et al., The Israel Journal of Psychiatry and Related Sciences
Abstract: Background: Psychiatric disorder, with the range of both subsyndromal and syndromal manifestation, is an important, yet often unrecognized and unacknowledged, problem among physicians. It is a subject that remains understudied, particularly among psychiatrists. The purpose of this study was to explore the subjective perception of mental illness among members of the psychiatric profession. Method: Psychiatrists attending an educational symposium completed, anonymously, a self-evaluation questionnaire in which they were asked to self-diagnose the presence of DSM-IV disorders. Results: 110 responses were received (response rate: 52.1%); 90% of respondents indicated the presence of at least one syndrome or trait. The most common disorders on axis I and axis II were "mood disorder" and "narcissistic traits" respectively, with the least common being "psychotic disorder" and "schizotypal traits." Female psychiatrists reported more impairment, particularly among axis I disorders. The reported number of axis I and II conditions decreased with subjects' age. Conclusions: Manifestations of psychiatric conditions including the range of subthreshold phenomena, as self-diagnosed according to DSM-IV criteria, appear to be prominently reported, albeit with low severity, in a subjective manner by psychiatrists. Our findings may be of importance in encouraging the implementation of special programs in training and ongoing occupational support.
The psychiatry profession has long been "plagued" by the stereotype that members of the field themselves exhibit manifestations of mental illness. While much of this stereotype remains unproven and prejudiced, the subject of mental illness among psychiatrists remains surprisingly understudied, especially since psychiatric disorder is an important, yet often unrecognized and unacknowledged, problem among physicians.
Several studies have investigated mental illness in residents and general physicians. Alcohol related disorders, substance abuse and affective disorder have been reported to be the most common disorders found in the medical profession (1). Other studies have demonstrated a particularly high incidence of suicide in psychiatrists (2, 3). While several studies have investigated psychopathology specifically in residents training in the field of psychiatry (4-8), few have explored the phenomenon of mental illness in members of the psychiatric profession who have been in clinical practice for several years. This is a subject that remains surprisingly understudied despite the few studies demonstrating mood disorder, for example, to be as high as 60-90% (9-12). Many of these reports remain anecdotal with study methods [including for example self-report on medical licensure applications (13), retrospective review of physician deaths, second hand reports by psychiatric educators regarding their trainees (e.g., 14), self-report on occupational stress levels (10), personality inventories (15)] often constrained and limited due to difficulties in obtaining unbiased responses and evaluations. For obvious reasons these include especially assessments which entail evaluation by potential colleagues.
Although limited research has been carried out in this subpopulation of physicians, it arguably remains an issue of major importance especially in the subspecialty of psychiatry considering the relatively higher incidence of suicide and the fact that these issues may or may not affect patient management. While the investigation of mental illness or distress in physicians is not an easy task considering the sensitivities involved, it becomes important at least as a first step to attempt to characterize the subjective experience of practicing psychiatrists who are well versed in psychiatric phenomenology. Many have noted that while mental distress even to the extent of suicidal behavior may be of considerable concern to the profession, it may not necessarily be heralded by impairment of professional function (9). …