Genetic strategies for clarifying a nosology of relational distress

Marital quality moderates genetic and environmental influences on the internalizing spectrum

Poor marital quality is a reliable correlate of internalizing problems, but the etiology of this association has yet to be examined. Marital distress may exert its influence by acting as a stressor that enables the expression of latent genetic risk for internalizing psychopathology. The authors examined this question using 379 twin pairs, assessed for marital quality, symptoms of major depression (MD), generalized anxiety disorder (GAD), panic attacks (PA), and neuroticism (N). A phenotypic factor analysis confirmed that one factor best accounted for the variance shared between MD, GAD, PA, and N. After accounting for genetic influences on the general Internalizing factor, there were residual genetic influences on N but no specific genetic influences on any other individual internalizing syndrome. The authors found overlap between the genetic influences on marital quality and the internalizing spectrum. Finally, biometrical moderation models revealed that genetic effects on the Internalizing factor increased as the marital quality deteriorated (marital quality high: h(2) = 0.05; marital quality low: h(2) = 0.29), suggesting that those with a genetic predisposition to internalizing syndromes may be more likely to express this predisposition in the context of a dissatisfying marriage.

Relational processes in the DSM-V revision process: comment on the special section

With the aim of stimulating research in advance of the revision process of the Diagnostic and Statistical Manual of Mental Disorders, "A Research Agenda for DSM-V" (D. A. Kupfer, M. B. First, and D. A. Regier, 2002) was published, highlighting areas for further study. A white paper included in the research agenda (M. B. First et al., 2002) identified the limited provision for the diagnosis of relational disorders as one of the most important gaps in the current DSM-IV (American Psychiatric Association, 1994). Specific recommendations in the research agenda included developing assessment modules, determining the clinical utility of relational disorders, determining the role of relational disorders in the etiology and maintenance of individual mental disorders, and considering aspects of relational disorders that might be modulated by individual mental disorders. In parallel with the 11 research planning conferences organized by the American Psychiatric Association from 2004 to 2007 under the title "The Future of Psychiatric Diagnosis: Refining the Research Agenda," a research planning conference sponsored by the Fetzer Institute was convened to promote research necessary for more empirically informed deliberations about the role of relational disorders in DSM-V. The current special section summarizes the conference proceedings and should serve as a valuable resource for the DSM-V revision process.

Relational disorders and relational processes in diagnostic practice: introduction to the special section

The special section addresses a number of salient issues that will arise as the revision process for the Diagnostic and Statistical Manual of Mental Disorders (DSM) unfolds and the role of relational processes in mental health is considered. This collection of articles, which emphasize historical, conceptual, and empirical contributions to the discussion, is intended to stimulate debate in the field and to serve as a resource for individuals charged with proposing new diagnostic guidelines. Jointly, the articles make it clear that the authors can improve on the current treatment of relational processes in the DSM and that there is a solid foundation of family research that can inform any discussion on this topic.

You cannot choose what is not on the menu--obstacles to and reasons for the inclusion of relational processes in the DSM-V: comment on the special section

Relational diagnosis has crucial importance in clinical treatment, but its development and inclusion in systems of classification such as the Diagnostic and Statistical Manual has been constrained by a number of factors. First, there is little consensus about what relational assessment and/or diagnosis entails. A second obstacle is the innate complexity of relational assessment and diagnosis, which results in a lack of definitive, well-accepted, evidence-based operational definitions of difficulties. Third, empirical testing of relational issues has lagged well behind the development of elegant theory. A fourth significant block to including relational disorders in the DSM is the discomfort engendered in some quarters about labeling social difficulties as disorders. Finally, the political process that is part of the evolution of diagnostic systems poses difficulties in the acceptance of new disorders or dimensions. This comment on the articles in the special section on relational disorders of the Journal of Family Psychology addresses how each of these articles contributes to overcoming these constraints.