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Psychoanalytic Patients in the U.S., Canada, and Australia: II. A DSM-III-R Validation Study

Canadian Institute of Psychoanalysis, Toronto Branch, Columbia University Center for Psychoanalytic Training and Research, Department of Psychiatry, University of Toronto, Norman.doidge{at}utoronto.ca

Barry Simon

Department of Psychiatry, University of Toronto

William J. Lancee

Department of Psychiatry, Mount Sinai Hospital, Department of Psychiatry, University of Toronto

Michael First

Biometrics Research Department, New York State Psychiatric Institute, Columbia University

Jacqueline Brunshaw

Clinical Psychology Program, York University, Toronto

Lee Brauer

Committee on Psychoanalytic Practice, American Psychoanalytic Association

Donald C. Grant

Australian Psychoanalytical Society

Annette Stevens

Division of Community Mental Health, Department of Psychiatry, University of British Columbia

John M. Oldham

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina

Paul Mosher

Psychoanalytic Electronic Publishing

A study was conducted to validate our previous work on the DSM-III-R disorders diagnosed in patients in psychoanalysis in the U.S., Canada, and Australia and to determine which specific mood, anxiety, and personality disorders were the most common in these patients. The earlier study consisted of three surveys of psychoanalytic practice that together obtained data on 1,718 patients, through extensive mail surveys to analysts in the three countries. In the validation study, 206 patients were diagnosed using a different technique. Analysts similar in important respects to those who participated in the original surveys rated patients diagnostically before and after DSM-III-R training. After training, no significant changes appeared in the rates for any of the specific mood disorders. For the thirty disorders examined, training effects decreased the identification of the generalized anxiety disorder, and increased the identification of three personality disorders: avoidant, dependent, and personality disorder not otherwise specified. Thus, analysts slightly underdiagnosed the number of personality disorders, and some "anxious" patients appear to have qualified for personality disorders. Some limitations of the DSM-III-R notion of narcissistic personality are discussed, as are the importance and stability of the self-defeating (masochistic) personality disorder. The most common Axis I disorder in psychoanalytic patients was dysthymia, followed by major depression, recurrent. This study reinforces the findings of the original three surveys. Minor corrections were developed to adjust the original three surveys.

Journal of the American Psychoanalytic Association, Vol. 50, No. 2, 615-627 (2002)
DOI: 10.1177/00030651020500021101


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