Relationship problems and the DSM:needed improvements and suggested solutions

Richard E. Heyman · Amy M. Smith Slep · Steven R. H. Beach · Marianne Z. Wamboldt · Nadine J. Kaslow · David Reiss

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Mental Health and Psychiatry Attachment and Relationship Dynamics Psychology and Mental Health

Abstract

The DSM-IV-TR limits mental disorders, by definition, to problems within a person: "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom" (1).Clinically significant behavioral or psychological syndromes or patterns that occur between or among individuals and that are associated with present distress or disability or with a significant increased risk of suffering death, pain, disability, or an important loss of freedom, receive little attention in the DSM-IV.This article focuses on eleven such syndromes/patterns occurring within families -partner relational problems, parenting problems, parent-child relational problems, partner maltreatment (physical, emotional, and sexual abuse; neglect) and child maltreatment (physical, emotional, and sexual abuse; neglect) -which we will refer to as "relational problems".We briefly review how relational problems are handled in DSM-IV.We sketch the scientific body of research that supports the importance of relational processes to individual's functioning and well-being.We provide several examples of the way criteria could be presented in a clear, structured manner.We present the series of studies that provide evidence of content validity and inter-rater agreement for criteria to determine presence versus absence of relational problems.We discuss the development of screening and diagnostic interviews for relational problems.We present recom-Relationship problems and the DSM: needed improvements and suggested solutions

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References

2000Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)2002Risky families: Family social environments and the mental and physical health of offspring.1995Content validity in psychological assessment: A functional approach to concepts and methods.2003Life Event Dimensions of Loss, Humiliation, Entrapment, and Danger in the Prediction of Onsets of Major Depression and Generalized Anxiety 1999Developmental Health and the Wealth of Nations: Social, Biological, and Educational Dynamics.2002A Research Agenda for DSM-V 2000Methods to Improve Diagnostic Accuracy in a Community Mental Health Setting 1999Marital dissatisfaction and incidence of major depressive episode in a community sample.

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