DSM-5 - an overlooked but consequential change!

I must admit that I never used to wait on pins and needles for previous revisions to the Big Book of Maladies (aka Diagnostic and Statistical Manual of Mental Disorders) the way I have been anxiously waiting for this one. Perhaps it's because I'm writing an abnormal psychology textbook and the prooooooooooo-traaaaaaaaaaac-teeeeeeeeeeeed release of the DSM-5 has added at least a headache per week to that process.

The buildup to the DSM-5's release has been met with every kind of reaction, from political protests to editorial warfare to a variety of unprecedented statements by major professional and governmental agencies that, somehow, they're going to ignore whatever the DSM-5 says. The eventual level of acceptance of the DSM-5 seems pretty up in the air. I have my own thoughts on the major alternative to the DSM, the International Classification of Diseases, but I'll save those for later. And I don't know what efforts to fund, say, depression treatment research will look like without referring to DSM criteria. From time to time, though, I'm going to weigh in with my thoughts on the changes that have been made from the previous version to this new one.

Much attention has been paid to changes to criteria for personality disorders, autism spectrum disorders, and a childhood precursor to psychotic disorders. However, I think that one change that will be more consequential than any of those has been almost completely neglected.

There were a couple of changes to Posttraumatic Stress Disorder (PTSD). The first change is mainly organizational. PTSD is now included among a new category of Trama- and Stressor-Related Disorders. It has been moved from the Anxiety Disorders chapter into a new one, where it joins its cousins Acute Stress Disorder and Adjustment Disorder, along with Reactive Attachment Disorder and Disinhibited Social Engagement Disorder (both of which focus on the damage that trauma and neglect can do to a child's ability to form secure attachments).

The second change is a bigger deal, in my opinion. The definition of a trauma has been changed to--for the first time--include sexual victimization. Previously, the DSM defined trauma as an event in which a person experienced, witnessed, or was confronted with actual or threatened death, serious injury, or a threat to the physical integrity of the self or others. Whatever that means. The revised criteria define a trauma to include exposure to actual or threatened death, serious injury, or sexual violence.

Seems like  little thing but I think it has at least two implications that could affect all of us. First, it recognizes the vile and toxic nature of sexual violence and reduces the need for a sexual violence survivor to try to demonstrate that she or he thought death or serious injury were imminent. The perpetration of sexual violence is enough! This could assist witnesses in sexual crime prosecution, and could also make it easier to conceptualize some of the problems faced by those targeted with childhood sexual victimization.

Second, it has direct implications for our military. Two disturbing stories come to mind. There have been numerous reports that military management has sought to reduce costs by putting pressure on Veterans Affairs clinicians to underdiagnose PTSD (for example, this story). Also, there have been awful reports about the nauseatingly high rates of sexual victimization of female soldiers in the military and the further victimization of these soldiers by the military brass (for example, this story). I think that the implications of redefining trauma to include sexual violence will--and should--put the spotlight on rape in our military and enable greater levels of diagnosis, recognition, service connection, and ultimately prevention. That benefits all of us, including those who fight and serve in our name.

Reading Student Evaluations is One of My Favorite Things To Do!

I may well be a masochist (I am an academic after all), but the two times of year I look forward to most in my job come after each semester has ended and the results of the most recent student evaluations are revealed. At my university, the evaluation sheets are scanned, average ratings are computed (and in some ways used to determine whether I get a raise), and then I get to download a giant PDF.

The average ratings are my first stop. I put them on a spreadsheet and graph them so that I can track their rise and occasional fall. I am eagerly anticipating the day when i will have enough observations to calculate meaningful estimates of variance! Ooh boy! I am a researcher after all!

I'm grateful to enjoy nice numbers, but I always suspect that students might just be polite, or have either ridiculously low standards or ridiculously high anchoring for their ratings. Because of this, I read through every comment.

It is truly inspiring to read them. Sure, I wish more students would note my dashing good looks and suggest I start a second career as a singer-songwriter because of the evocative timbre of my voice (actually, I wish even one students would say something like that...instead I get students guessing I'm 10 years older than I truly am and giving me blank stares when I drop cultural references. Doesn't anyone remember M*A*S*H!?!?), but I am most excited when a student takes the time to *hand-write* that something about my class touched or changed his or her life. I live for it.

I also like reading the criticism, and here is another way in which I find myself impressed and inspired by this crop of students. I occasionally get the "Your tests are too hard and it sucked" feedback, but it is much more common for me to read critiques grounded in students' reflections on their learning styles. I read that some students like video case studies because it helps them personalize the content, and some other students characterize those supplementary strategies as "filler" because they favor consuming raw data, not stories. Some students persuasively argue I should make my lecture slides available online because they are auditory learners and writing too much interferes with their information encoding. Students almost uniformly appreciate an open, respectful environment, and some explain this is so because it helps them consider alternative points of view. Pretty amazing! When I was a student, I remember mostly trying not to fall asleep, hoping that if I talked long enough that the instructor would either (a) forget the question I was supposed to be answering or (b) never call on me again, and desperately wracking my brains for something, anything to write in the comments box.

I have noticed two new kinds of comments popping up in the past year or so, and though I am somewhat of a skeptic about the whole "generational differences" thing, I think it might be a generational difference. (hypocrite) If you haven't heard, the children of the Baby Boomers have been called the Me Generation. This is because one way to briefly characterize cohort effects psychologist Jean Twenge has found in certain datasets is that they are kind of narcissistic. A summary of her research is here, but it is not without controversy.

Regardless, as teachers, we have been told to expect a results-oriented student who sees higher education as an economic transaction. I think my students have been reading these same warnings, because I am starting to see comments like "Dr. Steger made the class worth my time!" I'm happy to hear this, because I teach a class of about 180 students and that is my philosophy, too. Class should be worth their time. I don't take attendance but I'm still disappointed on those days when there are some noticeably empty seats. I am less happy to hear comments like, "Reading the book was worth my time," or even worse, "Reading the book was a waste of my time." There seems to be a calculus at work whereby if minutes spent reading don't convert at a high, fixed rate to better grades on tests, then it's a waste. I took all sorts of wacky classes during college and especially loved the ones that had nothing to do with my future career because there was so much to learn. I even enjoyed economics class for crying out loud! Learning seems to be losing a little ground to time maximization for this busy generation of students.

The second kind of comment I started to see for the first time this past year was of the "Steger needs to be better at time management. He should limit how much students share and respond in class" variety. Gosh, we're exhorted to create student engagement, and in a big class, it's a small point of pride that I can create an environment wherein students feel at liberty to share their battles with addiction, their parent's schizophrenia, questions about fetishes, and vote on whether sex offenders should ever be released from prison. Creating a small classroom feel in a big classroom is something I strive for, but there, too, there is an apparent calculus at work.

I can't blame students for their thoughts on such things, they are, after all, paying my salary and I want to be responsive to what helps them learn best. So, these two trends are on my radar. I'd love to hear if anyone else has seen these shifts in student feedback. Until then, enjoy summer!