Advances in Personality Assessment - Vol. 6

By James N. Butcher; Charles D. Spielberger | Go to book overview

2
Identification of Dysthymia and Cyclothymia by the General Behavior Inventory

Richard A. Depue
Michael J. Fuhrman
University of Minnesota

Traditionally, psychopathologists have narrowly defined disorder in terms of its more severe, full syndromal forms. Clinically, of course, we see and treat mainly the patients at the extreme end of a severity continuum, so accordingly, the symptomatology and course of these patients form the basis of our illustrative descriptions of disorder. Moreover, these are the patients on whom diagnostic criteria are formulated, psychobiologic hypotheses tested, and the efficacy of treatments assessed. This narrow focus has often been fruitful in both clinical and research contexts, but as some researchers have emphasized ( Akiskal, 1981a; Turner & King, 1983), until recently diagnosis has focused on hospitalized patients to the extent that the milder forms of disorder existing in the premorbid histories of these patients have been ignored or given only slight attention.

Psychiatric genetics has led the way in broadening our conception of psychopathology to include milder forms of disorder. The repeated finding of an excess of subsyndromal forms of disorder in the relatives of ill probands or in the adoptees of psychiatrically ill biological parents necessitated a broadening of the definition of disorder ( Gershon, Bunney, & Leckman, 1976; Heston, 1966, 1970; Shields, Heston, & Gottesman, 1975; Wetzel, Cloninger, & Hong, 1980). This broadening has had an impact on several different areas of psychiatry. For instance, it has required modification of arbitrary concepts of disease dependent on sensitivity of measurement of gene expression, such as the geneticist's notion of penetrance ( Meehl, 1973; Vogel & Motulsky, 1982); the epidemiologist's prevalence, sensitivity, and specifity ( Weissman & Myers, 1978); and the psychologist's true and false positive and negative rates ( Meehl & Rosen, 1955). Definitional expansion has also meant that previous genetic estimates of morbidity risk and of modes of transmission of a disorder are plagued by the problem

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