Psychosocial functioning in the context of diagnosis: Assessment and theoretical issues.

Abstract

Psychosocial functioning is an important focus of attention in the revision of the Diagnostic and Statistical Manual of Mental Disorders. Researchers and clinicians are converging upon the opinion that psychometrically strong, comprehensive assessment of individuals' functioning is needed to characterize disorder fully. Also shared is the realization that existing theory and research in this domain have critical shortcomings. The authors urge that the field reexamine the empirical evidence and address theoretical issues to guide future development of the construct and its measurement. The authors first discuss several theoretical issues relevant to the conceptualization and assessment of functioning: (a) definitions of functioning, (b) the role of functioning in defining disorder, and (c) understanding functioning within environmental contexts. The authors then present data regarding empirical domains of psychosocial functioning and their interrelations. Self-reported data on multiple domains of psychosocial functioning were collected from 429 participants. Factor-analytic results (promax rotation) suggest a 4-factor structure of psychosocial functioning: Well-Being, Basic Functioning, Self-Mastery, and Interpersonal and Social Relationships. Finally, the authors propose an integration of theory and empirical findings, which they believe will better incorporate psychosocial functioning into future diagnostic systems.

Stability of Eating Disorder Diagnostic Classifications in Adolescents: Five-Year Longitudinal Findings From a Population-Based Study

“…Furthermore, because subthreshold classifications have been found to have similar levels of psychopathology compared to threshold diagnoses (Ackard, Fulkerson, & Neumark-Sztainer, 2011;Chamay-Weber, Narring, & Michaud, 2005;Thomas, Vartanian, & Brownell, 2009), it is critically important to detect the early development of disordered eating behaviors and body image disturbances and intervene as soon as possible to reduce the risk of maintaining subthreshold symptoms or developing a threshold eating disorder. Future research should evaluate the associations between psychological and behavioral health and diagnostic stability, as awareness of an individuals' functioning is integral to understanding and evaluating more fully the severity of a range of eating disorder diagnostic classifications (Ro & Clark, 2009). …”

Do DSM-5 Personality Disorder Proposals Meet Criteria for Clinical Utility?

“…Several have noted the need for a rating of severity of personality dysfunction as part of improving the assessment and classification of personality pathology (e.g., Bornstein, 1998Bornstein, , 2007Trull, 2005). In a recent study, Ro and Clark (2009) reviewed some of the extant measures of psychosocial functioning, which included measures of general functioning along with measures of impaired functioning specific to personality pathology (Parker et al, 2004;Verheul et al, 2008). Using a factor analytic strategy, they found that existing instruments cluster into four factors: (1) well being (subjective well being and general social functioning), (2) basic functioning, (3) self-mastery (internal self-control, self-direction, irresponsibility and impulsivity, ineffectiveness, failure to learn from experience, and (4) interpersonal and social relationships (uncaring for others, disagreeableness, lack of empathy, poor social concordance).…”

Living under threat: psychosocial effects on victims of terrorism

“…Within 'Social interactions', the role played by the neighbours have been noted through the indifference and blaming to the victims (Basque Youth Observatory, 2011; De la Cuesta Arzamendi, Varona, Mayordomo, & San Juan, 2011;Larizgoitia, Izarzugaza, & Markez, 2009). This shows the relevance of individuals' functioning as is inseparable from their surrounding context in the sense that environmental factors influence one's functional level (Ro & Clark, 2009). In addition, it has been related to an active role for the collaboration in the violence, for instance, through passing information needed for the terrorist group to commit a murder (Pereira, 2004).…”

“…Ro and Clark (2009) noted that though there is little clarity regarding the boundaries of the construct of psychosocial functioning, it involves the specific daily behaviours and the subjective evaluation of normally functioning as satisfaction and quality-of-life on the different domains (e.g. relationships) of the daily life.…”