111-413: The Beck Depression Inventory ( BDI , BDI-1A , BDI-II ), created by Aaron T. Beck , is a 21-question multiple-choice self-report inventory , one of the most widely used psychometric tests for measuring the severity of depression . Its development marked a shift among mental health professionals, who had until then, viewed depression from a psychodynamic perspective, instead of it being rooted in
222-469: A United States Army manual. Revisions since its first publication in 1952 have incrementally added to the total number of mental disorders , while removing those no longer considered to be mental disorders. Recent editions of the DSM have received praise for standardizing psychiatric diagnosis grounded in empirical evidence, as opposed to the theory-bound nosology (the branch of medical science that deals with
333-476: A fellow in psychiatry at the Austen Riggs Center , a private mental hospital in the mountains of Stockbridge, Massachusetts , until 1952. At that time, it was a center of ego psychology with an unusual degree of collaboration between psychiatrists and psychologists, including David Rapaport . Beck then completed military service as assistant chief of neuropsychiatry at Valley Forge Army Hospital in
444-438: A category reflected a particular underlying pathology (an approach described as " neo-Kraepelinian "). The psychodynamic view was marginalised, although still influential, in favor of a regulatory or legislative model that emphasised observable symptoms. A new "multiaxial" system attempted to yield a picture more amenable to a statistical population census, rather than a simple diagnosis . Spitzer argued "mental disorders are
555-453: A clinical-significance criterion to almost half of all the categories, which required symptoms causing "clinically significant distress or impairment in social, occupational, or other important areas of functioning". Some personality-disorder diagnoses were deleted or moved to the appendix. The DSM-IV characterizes a mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that
666-925: A congress of the International Statistical Institute (ISI) in Chicago. (The ISI had commissioned him to create it in 1891). A number of countries adopted the ISI's system. In 1898, the American Public Health Association (APHA) recommended that United States registrars also adopt the system. In 1900, an ISI conference in Paris reformed the Bertillion Classification, and created the International List of Causes of Death (ILCD) . Another conference would be held every ten years, and
777-821: A continuation of the Statistical Manual for the Use of Hospitals of Mental Diseases. Each item was given an ICD-6 equivalent code, where applicable. The DSM-I centers on three classes of symptoms: psychotic, neurotic, and behavioral. Within each class of mental disorder, classifying information is provided to differentiate conditions with similar symptoms. Under each broad class of disorder (e.g. "Psychoneurotic Disorders" or "Personality Disorders"), all possible diagnoses are listed, generally from least to most severe. The 1952 DSM version also includes sections detailing how to record patients' disorders along with their demographic details. The form includes information like
888-445: A different response compared to administration via a postal survey. In participants with concomitant physical illness the BDI's reliance on physical symptoms such as fatigue may artificially inflate scores due to symptoms of the illness, rather than of depression. In an effort to deal with this concern Beck and his colleagues developed the "Beck Depression Inventory for Primary Care" (BDI-PC),
999-542: A disorder. For nearly half the disorders, symptoms must be sufficient to cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning", although DSM-IV-TR removed the distress criterion from tic disorders and several of the paraphilias due to their egosyntonic nature. Each category of disorder has a numeric code taken from the ICD coding system , used for health service (including insurance) administrative purposes. The DSM-IV
1110-504: A distinction between neurosis and psychosis (roughly, anxiety/depression broadly in touch with reality, as opposed to hallucinations or delusions disconnected from reality). Sociological and biological knowledge was incorporated, under a model that did not emphasize a clear boundary between normality and abnormality. The idea that personality disorders did not involve emotional distress was discarded. A study published in Science in 1973,
1221-509: A far wider mandate under the influence and control of Spitzer and his chosen committee members. One added goal was to improve the uniformity and validity of psychiatric diagnosis in the wake of a number of critiques, including the famous Rosenhan experiment . There was also felt a need to standardize diagnostic practices within the United States and with other countries, after research showed that psychiatric diagnoses differed between Europe and
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#17328479929441332-419: A high one-week test–retest reliability (Pearson's r = 0.93), suggesting that it was not overly sensitive to day-to-day variations in mood. The test also has high internal consistency ( α = .91). The development of the BDI was an important event in psychiatry and psychology ; it represented a shift in health care professionals' view of depression from a Freudian , psychodynamic perspective, to one guided by
1443-518: A negative effect on a person's behavior no matter what type of disorder they had, he found. Beck explained that successful interventions will educate a person to understand and become aware of their distorted thinking, and how to challenge its effects. He discovered that frequent negative automatic thoughts reveal a person's core beliefs. He explained that core beliefs are formed over lifelong experiences; we "feel" these beliefs to be true. Since that time, Beck and his colleagues worldwide have researched
1554-612: A new edition of the ILCD would be released. Five were ultimately issued. Non-fatal conditions were not included. In 1903, New York's Bellevue Hospital published "The Bellevue Hospital nomenclature of diseases and conditions", which included a section on "Diseases of the Mind". Revisions were released in 1909 and 1911. It was produced with the assistance of the AMA and Bureau of the Census. In 1917, together with
1665-505: A patient he had been listening to for a year at the Penn clinic. When he suggested she was anxious due to her ego being confronted by her sexual impulses, and asked her whether she believed this when she did not seem convinced, she said she was actually worried that she was being boring, and that she thought this often and with everyone. In 1962, Beck requested a sabbatical and would go into private practice for five years. In that same year, he
1776-415: A patient with a close approximation to the prototype is said to have that disorder. DSM-IV states, "there is no assumption each category of mental disorder is a completely discrete entity with absolute boundaries" but isolated, low-grade, and non-criterion (unlisted for a given disorder) symptoms are not given importance. Qualifiers are sometimes used: for example, to specify mild, moderate, or severe forms of
1887-509: A patient's area of residence, admission status, discharge date/condition, and severity of disorder. See Figure 1. for the form that psychiatrists were asked to utilize for recording preliminary diagnostic information. Furthermore, the APA listed homosexuality in the DSM as a sociopathic personality disturbance. Homosexuality: A Psychoanalytic Study of Male Homosexuals , a large-scale 1962 study of homosexuality by Irving Bieber and other authors,
1998-600: A relatively "neutral" space and a bridge to psychology. With a monograph on depression that Beck published in 1967, according to historian Rachael Rosner: "Cognitive Therapy entered the marketplace as a corrective experimentalist psychological framework both for himself and his patients and for his fellow psychiatrists." Working with depressed patients, Beck found that they experienced streams of negative thoughts that seemed to arise spontaneously. He termed these cognitions "automatic thoughts", and discovered that their content fell into three categories: negative ideas about oneself,
2109-683: A revision of the DSM, which was published in 1968. DSM-II was similar to DSM-I, listed 182 disorders, and was 134 pages long. The term "reaction" was dropped, but the term " neurosis " was retained. Both the DSM-I and the DSM-II reflected the predominant psychodynamic psychiatry, although both manuals also included biological perspectives and concepts from Kraepelin 's system of classification. Symptoms were not specified in detail for specific disorders. Many were seen as reflections of broad underlying conflicts or maladaptive reactions to life problems that were rooted in
2220-517: A short screening scale consisting of seven items from the BDI-II considered to be independent of physical function. Unlike the standard BDI, the BDI-PC produces only a binary outcome of "not depressed" or "depressed" for patients above a cutoff score of 4. Although designed as a screening device rather than a diagnostic tool, the BDI is sometimes used by health care providers to reach a quick diagnosis. The BDI
2331-628: A six-month junior residency in pathology at Rhode Island Hospital and a three-year residency in neurology at Cushing Veterans Administration Hospital in Framingham, Massachusetts . During this time, Beck began to specialize in neurology, reportedly liking the precision of its procedures. However, due to a shortage of psychiatry residents , he was instructed to do a six-month rotation in that field, and he became absorbed in psychoanalysis , despite initial wariness. After completing his medical internships and residencies from 1946 to 1950, Beck became
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#17328479929442442-528: A subset of medical disorders", but the task force decided on this statement for the DSM: "Each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome." Personality disorders were placed on axis II along with "mental retardation". The first draft of DSM-III was ready within a year. It introduced many new categories of disorder, while deleting or changing others. A number of unpublished documents discussing and justifying
2553-399: A three-step process: first, each group conducted an extensive literature review of their diagnoses; then, they requested data from researchers, conducting analyses to determine which criteria required change, with instructions to be conservative; finally, they conducted multi-center field trials relating diagnoses to clinical practice. A major change from previous versions was the inclusion of
2664-509: A version of Medical 203 specifically for use in the United States, to standardize the diverse and confused usage of different documents. In 1950, the APA committee undertook a review and consultation. It circulated an adaptation of Medical 203, the Standard ' s nomenclature, and the VA system's modifications of the Standard to approximately 10% of APA members. 46% of members replied, with 93% approving
2775-527: Is copyrighted ; a fee must be paid for each copy used. There is no evidence that the BDI-II is more valid or reliable than other depression scales, and public domain scales such as the Patient Health Questionnaire – Nine Item ( PHQ-9 ) have been studied as a useful tool. Aaron T. Beck Aaron Temkin Beck (July 18, 1921 – November 1, 2021) was an American psychiatrist who
2886-966: Is a co-founder of the non-profit Beck Institute . He turned 100 on July 18, 2021, and died later in the year on November 1 in his sleep at his home in Philadelphia. Along with the Beck Depression Inventory (BDI), Beck developed the Beck Hopelessness Scale , Beck Scale for Suicidal Ideation (BSS), Beck Anxiety Inventory (BAI), Beck Youth Inventories, Clark-Beck Obsessive-Compulsive Inventory (CBOCI), Personality Belief Questionnaire (PBQ), Dysfunctional Attitude Scale (DAS), Suicide Intent Scale (SIS), Sociotropy-Autonomy Scale (SAS), Cognitive Therapy Rating Scale (CTRS), Beck Cognitive Insight Scale (BCIS), Satisfaction with Therapy Questionnaire (STQ) and BDI–Fast Screen for Medical Patients. Beck collaborated with psychologist Maria Kovacs in
2997-622: Is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria. It is an internationally accepted manual on the diagnosis and treatment of mental disorders, though it may be used in conjunction with other documents. Other commonly used principal guides of psychiatry include the International Classification of Diseases (ICD), Chinese Classification of Mental Disorders (CCMD), and
3108-452: Is associated with present distress or disability or with a significant increased risk of suffering death, pain, disability, or an important loss of freedom". It also notes that "although this manual provides a classification of mental disorders it must be admitted that no definition adequately specifies precise boundaries for the concept of 'mental disorder." The DSM-IV is a categorical classification system. The categories are prototypes, and
3219-442: Is designed to reflect the depth of depression, it can monitor changes over time and provide an objective measure for judging improvement and the effectiveness or otherwise of treatment methods. The instrument remains widely used in research; in 1998, it had been used in over 2000 empirical studies . It has been translated into multiple European languages as well as Arabic , Chinese , Japanese , Persian , and Xhosa . The BDI has
3330-712: Is low for many disorders in the DSM-5, including major depressive disorder and generalized anxiety disorder . An alternate, widely used classification publication is the International Classification of Diseases (ICD), produced by the World Health Organization (WHO). The ICD has a broader scope than the DSM, covering overall health as well as mental health; chapter 6 of the ICD specifically covers mental, behavioral and neurodevelopmental disorders. Moreover, while
3441-399: Is there any credible evidence that any version of the manual has greatly increased its reliability beyond the previous version. There are important methodological problems that limit the generalizability of most reliability studies. Each reliability study is constrained by the training and supervision of the interviewers, their motivation and commitment to diagnostic accuracy, their prior skill,
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3552-416: Is uniformly high. Reliability appears to be only satisfactory for three categories: mental deficiency, organic brain syndrome (but not its subtypes), and alcoholism. The level of reliability is no better than fair for psychosis and schizophrenia and is poor for the remaining categories". As described by Ronald Bayer, a psychiatrist and gay rights activist, specific protests by gay rights activists against
3663-545: The Psychodynamic Diagnostic Manual . However, not all providers rely on the DSM-5 as a guide, since the ICD's mental disorder diagnoses are used around the world, and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. It is used by researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies ,
3774-639: The Beck Depression Inventory , which he published in 1961 and soon started to market, unsupported by Appel. In another experiment, he found that depressed patients sought encouragement or improvement following disapproval, rather than seeking out suffering and failure as predicted by the Freudian anger-turned-inwards theory. Through the 1950s, Beck adhered to the department's psychoanalytic theories while pursuing experimentation and harboring private doubts. In 1961, however, controversy over whom to appoint
3885-654: The New York State Psychiatric Institute . However, the influence of clinical psychiatrists, themselves often working with psychoanalytic ideas, were still strong. Other criteria, and potential new categories of disorder, were established by debate, argument and consensus during meetings of the committee chaired by Spitzer. A key aim was to base categorization on colloquial English (which would be easier to use by federal administrative offices), rather than by assumption of cause, although its categorical approach still assumed each particular pattern of symptoms in
3996-629: The Rosenhan experiment , received much publicity and was viewed as an attack on the efficacy of psychiatric diagnosis. An influential 1974 paper by Robert Spitzer and Joseph L. Fleiss demonstrated that the second edition of the DSM (DSM-II) was an unreliable diagnostic tool. Spitzer and Fleiss found that different practitioners using the DSM-II rarely agreed when diagnosing patients with similar problems. In reviewing previous studies of eighteen major diagnostic categories, Spitzer and Fleiss concluded that "there are no diagnostic categories for which reliability
4107-712: The Standard), was released. Along with the New York Academy of Medicine , the APA provided the psychiatric nomenclature subsection. It became well adopted in the US within two years. A major revision of the Statistical Manual was made in 1934, to bring it in line with the new Standard. A number of revisions of the Standard were produced, with the last in 1961. World War II saw the large-scale involvement of U.S. psychiatrists in
4218-436: The U.S. House of Representatives , stating that "the most glaring and remarkable errors are found in the statements respecting nosology , prevalence of insanity, blindness, deafness, and dumbness, among the people of this nation", pointing out that in many towns African Americans were all marked as insane, and calling the statistics essentially useless. The Association of Medical Superintendents of American Institutions for
4329-593: The United States Military . Beck then joined the Department of Psychiatry at the University of Pennsylvania in 1954. The department chair was Kenneth Ellmaker Appel, a psychoanalyst who was president of the American Psychiatric Association , whose efforts to expand the presence and relatedness of psychiatry had a big influence on Beck's career. At the same time, Beck began formal training in psychoanalysis at
4440-467: The classification of diseases ) used in DSM-III. However, it has also generated controversy and criticism , including ongoing questions concerning the reliability and validity of many diagnoses; the use of arbitrary dividing lines between mental illness and " normality "; possible cultural bias ; and the medicalization of human distress. The APA itself has published that the inter-rater reliability
4551-535: The manifest content of dreams (that which can be directly reported by the dreamer). Beck and a graduate student developed a new inventory they used to assess "masochistic" hostility in manifest dreams, published in 1959. This study found themes of loss and rejection related to depression, rather than inverted hostility as predicted by psychoanalysis. Developing the work with funding from the National Institute of Mental Health , Beck came up with what he would call
Beck Depression Inventory - Misplaced Pages Continue
4662-475: The " a and b statements" described above were removed, and respondents were instructed to endorse how they had been feeling during the preceding two weeks. The internal consistency for the BDI-IA was good, with a Cronbach's alpha coefficient of around 0.85, meaning that the items on the inventory are highly correlated with each other. However, this version retained some flaws; the BDI-IA only addressed six out of
4773-494: The 1950s, the prevailing psychoanalytic theory attributed the syndrome to inverted hostility against the self.' By contrast, the BDI was developed in a novel way for its time; by collating patients' verbatim descriptions of their symptoms and then using these to structure a scale which could reflect the intensity or severity of a given symptom. Beck drew attention to the importance of "negative cognitions" described as sustained, inaccurate, and often intrusive negative thoughts about
4884-481: The 1950s. He had begun presenting his "rational therapy" by the mid-1950s. Beck recalled that Ellis contacted him in the mid-1960s after his two articles in the Archives of General Psychiatry , and therefore he discovered Ellis had developed a rich theory and pragmatic therapy that he was able to use to some extent as a framework blended with his own, though he disliked Ellis's technique of telling patients what he thought
4995-532: The APA began in 1970, when the organization held its convention in San Francisco . The activists disrupted the conference by interrupting speakers and shouting down and ridiculing psychiatrists who viewed homosexuality as a mental disorder. In 1971, gay rights activist Frank Kameny worked with the Gay Liberation Front collective to demonstrate at the APA's convention. At the 1971 conference, Kameny grabbed
5106-474: The Armed Forces nomenclature [were] introduced into many clinics and hospitals by psychiatrists returning from military duty." The Veterans Administration also adopted a slightly modified version of the standard in 1947. The further developed Joint Armed Forces Nomenclature and Method of Recording Psychiatric Conditions was released in 1949. In 1948, the newly formed World Health Organization took over
5217-499: The BDI-1A, and the BDI-II, published in 1996. The BDI is widely used as an assessment tool by health care professionals and researchers in a variety of settings. The BDI was used as a model for the development of the Children's Depression Inventory (CDI), first published in 1979 by clinical psychologist Maria Kovacs . According to Beck's publisher, 'When Beck began studying depression in
5328-498: The DSM and the ICD manuals, which may not systematically match because revisions are not simultaneously coordinated. Though recent editions of the DSM and ICD have become more similar due to collaborative agreements, each one contains information absent from the other. For instance, the two manuals contain overlapping but substantially different lists of recognized culture-bound syndromes . The ICD also tends to focus more on primary-care and low and middle-income countries, as opposed to
5439-525: The DSM is the most popular diagnostic system for mental disorders in the US, the ICD is used more widely in Europe and other parts of the world, giving it a far larger reach than the DSM. An international survey of psychiatrists in sixty-six countries compared the use of the ICD-10 and DSM-IV. It found the former was more often used for clinical diagnosis while the latter was more valued for research. This may be because
5550-616: The DSM tends to put more emphasis on clear diagnostic criteria, while the ICD tends to put more emphasis on clinician judgement and avoiding diagnostic criteria unless they are independently validated. That is, the ICD descriptions of psychiatric disorders tend to be more qualitative information, such as general descriptions of what various disorders tend to look like. The DSM focuses more on quantitative and operationalized criteria; e.g., to be diagnosed with X disorder, one must fulfill 5 of 9 criteria for at least 6 months. The DSM-IV-TR (4th ed.) contains specific codes allowing comparisons between
5661-479: The DSM's focus on secondary psychiatric care in high-income countries. The initial impetus for developing a classification of mental disorders in the United States was the need to collect statistical information. The first official attempt was the 1840 census , which used a single category: " idiocy / insanity ". Three years later, the American Statistical Association made an official protest to
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#17328479929445772-595: The Insane ("The Superintendents' Association") was formed in 1844. In 1860, during the international statistical congress held in London, Florence Nightingale made a proposal that was to result in the development of the first international model of systematic collection of hospital data. In 1872, the American Medical Association (AMA) published its Nomenclature of Diseases , which included various "Disorders of
5883-757: The Intellect". Its use was short-lived however. Edward Jarvis and later Francis Amasa Walker helped expand the census, from two volumes in 1870 to twenty-five volumes in 1880. In 1888, the Census Office published Frederick H. Wines' 582-page volume called Report on the Defective, Dependent, and Delinquent Classes of the Population of the United States, As Returned at the Tenth Census (June 1, 1880) . Wines used seven categories of mental illness, which were also adopted by
5994-602: The National Commission on Mental Hygiene (now Mental Health America ), the American Medico-Psychological Association developed a new guide for mental hospitals called the Statistical Manual for the Use of Institutions for the Insane . This guide included twenty-two diagnoses. It would be revised several times by the Association, and by the tenth edition in 1942, was titled Statistical Manual for
6105-638: The Philadelphia Institute of the American Psychoanalytic Association . Beck's closest colleague was Marvin Stein, a friend since their army hospital days to whom Beck looked up to for his scientific rigor in psychoneuroimmunology . Beck's first research was with Leon J. Saul, a psychoanalyst known for unusual methods such as therapy by telephone or setting homework, who had developed inventory questionnaires to quantify ego processes in
6216-709: The Superintendents: dementia , dipsomania (uncontrollable craving for alcohol), epilepsy , mania , melancholia , monomania , and paresis . In 1892, the Superintendents' Association expanded its membership to include other mental health workers, and renamed to the American Medico-Psychological Association (AMPA). In 1893, a French physician, Jacques Bertillon , introduced the Bertillon Classification of Causes of Death at
6327-483: The United States. The establishment of consistent criteria was an attempt to facilitate the pharmaceutical regulatory process. The criteria adopted for many of the mental disorders were influenced by the Research Diagnostic Criteria (RDC) and Feighner Criteria , which had just been developed by a group of research-orientated psychiatrists based primarily at Washington University School of Medicine and
6438-580: The Use of Hospitals of Mental Diseases . In 1921, the AMPA became the present American Psychiatric Association (APA). The first edition of the DSM notes in its foreword: "In the late twenties, each large teaching center employed a system of its own origination, no one of which met more than the immediate needs of the local institution." In 1933, the AMA's general medical guide the Standard Classified Nomenclature of Disease , (referred to as
6549-443: The ancient philosophical system of Stoicism as a forerunner of their ideas. Beck cited Epictetus as an influence from Stoicism. In 1967, becoming active again at University of Pennsylvania , Beck still described himself and his new therapy (as he always would quietly) as neo-Freudian in the ego psychology school, albeit focused on interactions with the environment rather than internal drives. He offered cognitive therapy work as
6660-602: The basic outline of the Standard and attempting to express present-day concepts of mental disturbance." Under the direction of James Forrestal , a committee headed by psychiatrist Brigadier General William C. Menninger , with the assistance of the Mental Hospital Service, developed a new classification scheme in 1944 and 1945. Issued in War Department Technical Bulletin, Medical, 203 (TB MED 203); Nomenclature and Method of Recording Diagnoses
6771-433: The changes have recently come to light. Field trials sponsored by the U.S. National Institute of Mental Health (NIMH) were conducted between 1977 and 1979 to test the reliability of the new diagnoses. A controversy emerged regarding deletion of the concept of neurosis, a mainstream of psychoanalytic theory and therapy but seen as vague and unscientific by the DSM task force. Faced with enormous political opposition, DSM-III
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#17328479929446882-619: The changes. After some further revisions, the Diagnostic and Statistical Manual of Mental Disorders was approved in 1951 and published in 1952. The structure and conceptual framework were the same as in Medical 203, and many passages of text were identical. The manual was 130 pages long and listed 106 mental disorders. These included several categories of "personality disturbance", generally distinguished from "neurosis" (nervousness, egodystonic ). The foreword to this edition describes itself as being
6993-579: The decisions that led to the production of DSM-IV, and the scientific credibility of contemporary psychiatric classification. A text revision of DSM-IV, titled DSM-IV-TR, was published in 2000. The diagnostic categories were unchanged as were the diagnostic criteria for all but nine diagnoses. The majority of the text was unchanged; however, the text of two disorders, pervasive developmental disorder not otherwise specified and Asperger's disorder, had significant and/or multiple changes made. The definition of pervasive developmental disorder not otherwise specified
7104-607: The development of the Children's Depression Inventory , which used the BDI as a template. Beck received honorary degrees from Yale University , University of Pennsylvania, Brown University, Assumption College , and Philadelphia College of Osteopathic Medicine . In 2017, Medscape named Beck the fourth most influential physician in the past century. Diagnostic and Statistical Manual of Mental Disorders The Diagnostic and Statistical Manual of Mental Disorders ( DSM ; latest edition: DSM-5-TR , published in March 2022 )
7215-704: The effectiveness of CBT—relatively easy because of the narrow, time-limited and manual-based nature of the treatment—there has been much less focus on experimentally proving the supposedly active mechanisms; in some cases the predicted causal relationships have not been found, such as between dysfunctional attitudes and outcomes. Beck was involved in research studies at the University of Pennsylvania, and conducted biweekly Case Conferences at Beck Institute for area psychiatric residents, graduate students, and mental health professionals. He met every two weeks with conference participants and generally did two to three role plays. He
7326-539: The efficacy of this form of psychotherapy in treating a wide variety of disorders including depression, bipolar disorder , eating disorders , drug abuse , anxiety disorders , personality disorders , and many other medical conditions with psychological components. Cognitive therapy has also been applied with success to individuals with schizophrenia . He also focused on cognitive therapy for schizophrenia, borderline personality disorder , and for patients who have had recurrent suicide attempts. Beck's recent research on
7437-542: The homogeneity of the clinical setting in regard to patient mix and base rates, and the methodological rigor achieved by the investigator ... In 1987, DSM-III-R was published as a revision of the DSM-III, under the direction of Spitzer. Categories were renamed and reorganized, with significant changes in criteria. Six categories were deleted while others were added. Controversial diagnoses, such as Premenstrual Dysphoric Disorder and Masochistic Personality Disorder , were considered and discarded. (Premenstrual Dysphoric Disorder
7548-666: The importance of a warm and encouraging therapeutic relationship and tailoring treatment to the specific challenges of each individual. Beck's work was presented as a far more scientific and experimentally-based development than psychoanalysis (while being less reductive than behaviorism), Beck's key principles were not necessarily based on the general findings and models of cognitive psychology or neuroscience developing at that time but were derived from personal clinical observations and interpretations in his therapy office. And although there have been many cognitive models developed for different mental disorders and hundreds of outcome studies on
7659-625: The introductory text stated for at least some disorders, "particularly the Personality Disorders, the criteria require much more inference on the part of the observer"[page xxiii]. In 1994, DSM-IV was published, listing 410 disorders in 886 pages. The task force was chaired by Allen Frances and was overseen by a steering committee of twenty-seven people, including four psychologists. The steering committee created thirteen work groups of five to sixteen members, each work group having about twenty advisers in addition. The work groups conducted
7770-505: The items were reworded; only the items dealing with feelings of being punished, thoughts about suicide, and interest in sex remained the same. Finally, participants were asked to rate how they have been feeling for the past two weeks, as opposed to the past week as in the original BDI. Like the BDI, the BDI-II also contains about 21 questions, each answer being scored on a scale value of 0 to 3. Higher total scores indicate more severe depressive symptoms. The standardized cutoffs used differ from
7881-484: The legal system, and policymakers. Some mental health professionals use the manual to determine and help communicate a patient's diagnosis after an evaluation. Hospitals, clinics, and insurance companies in the United States may require a DSM diagnosis for all patients with mental disorders. Health-care researchers use the DSM to categorize patients for research purposes. The DSM evolved from systems for collecting census and psychiatric hospital statistics, as well as from
7992-529: The maintenance of the ILCD. They greatly expanded it, included non-fatal conditions for the first time, and renamed it the International Statistical Classification of Diseases (ICD). The foreword to the DSM-I states the ICD-6 "categorized mental disorders in rubrics similar to those of the Armed Forces nomenclature." The APA Committee on Nomenclature and Statistics was empowered to develop
8103-417: The medical community and made her a heroine to many gay men and lesbians, but homosexuality remained in the DSM until May 1974. In the 1960s, there were many challenges to the concept of mental illness itself. These challenges came from psychiatrists like Thomas Szasz , who argued mental illness was a myth used to disguise moral conflicts; from sociologists such as Erving Goffman , who said mental illness
8214-409: The microphone and yelled: "Psychiatry is the enemy incarnate. Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you." This gay activism occurred in the context of a broader anti-psychiatry movement that had come to the fore in the 1960s and was challenging the legitimacy of psychiatric diagnosis. Anti-psychiatry activists protested at
8325-407: The more advanced or termination phases of a case, and again in 1961 when he had not done so but outlined his clinical and research work. Such deferments were a tactic used by the institute to maintain the orthodoxy in teaching, but Beck did not know this at the time and has described the decision as stupid and dumb. Beck usually explained his increasing belief in his cognitive model by reference to
8436-553: The most widely used instruments for measuring the severity of depression. In 1994 he and his daughter, psychologist Judith S. Beck , founded the nonprofit Beck Institute for Cognitive Behavior Therapy , which provides CBT treatment and training, as well as research. Beck served as President Emeritus of the organization up until his death. Beck was noted for his writings on psychotherapy , psychopathology , suicide , and psychometrics . He published more than 600 professional journal articles, and authored or co-authored 25 books. He
8547-439: The new chair of psychiatry—specifically, fierce psychoanalytic opposition to the favored choice of biomedical researcher Eli Robins —brought matters to a head, an early skirmish in a power shift away from psychoanalysis nationally. Beck tried to remain neutral and, with Albert J. Stunkard , opposed a petition to block Robins. Stunkard, a behaviorist who specialized in obesity and who had dropped out of psychoanalytic training,
8658-616: The nine DSM-III criteria for depression. This and other criticisms were addressed in the BDI-II. The BDI-II was a 1996 revision of the BDI, developed in response to the American Psychiatric Association's publication of the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, which changed many of the diagnostic criteria for Major Depressive Disorder. Items involving changes in body image , hypochondriasis , and difficulty working were replaced. Also, sleep loss and appetite loss items were revised to assess both increases and decreases in sleep and appetite. All but three of
8769-461: The original BDI had more than one statement marked with the same score. For instance, there are two responses under the Mood heading that score a 2: (2a) "I am blue or sad all the time and I can't snap out of it" and (2b) "I am so sad or unhappy that it is very painful". The BDI-IA was a revision of the original instrument developed by Beck during the 1970s, and copyrighted in 1978. To improve ease of use ,
8880-483: The original: One measure of an instrument's usefulness is to see how closely it agrees with another similar instrument that has been validated against information from a clinical interview by a trained clinician. In this respect, the BDI-II is positively correlated with the Hamilton Depression Rating Scale with a Pearson r of 0.71, showing good convergent validity . The test was also shown to have
8991-406: The patient's own thoughts or "cognitions". It also established the principle that instead of attempting to develop a psychometric tool based on a possibly invalid theory, self-report questionnaires when analysed using techniques such as factor analysis can suggest theoretical constructs. The BDI was originally developed to provide a quantitative assessment of the intensity of depression. Because it
9102-514: The patient's own thoughts. In its current version, the BDI-II is designed for individuals aged 13 and over, and is composed of items relating to symptoms of depression such as hopelessness and irritability, cognitions such as guilt or feelings of being punished, as well as physical symptoms such as fatigue, weight loss , and lack of interest in sex. There are three versions of the BDI—the original BDI, first published in 1961 and later revised in 1978 as
9213-506: The process of putting down roots on Providence's East Side . In 1923, when Aaron was two years old, the family purchased a house at 43/41 Sessions Street in the city's Blackstone neighborhood. Beck attended John Howland Grammar School, Nathan Bishop Junior High, and Hope Street High School , where he graduated as valedictorian in 1938. As an adolescent, Beck dreamed of becoming a journalist. Beck matriculated at Brown University , where he graduated magna cum laude in 1942. At Brown, he
9324-414: The reliability of the radically new diagnostic system they had devised, which relied on data from special field trials. However, according to a 1994 article by Stuart A. Kirk : Twenty years after the reliability problem became the central focus of DSM-III, there is still not a single multi-site study showing that DSM (any version) is routinely used with high reliably by regular mental health clinicians. Nor
9435-399: The same APA conventions, with some shared slogans and intellectual foundations as gay activists. Taking into account data from researchers such as Alfred Kinsey and Evelyn Hooker , the seventh printing of the DSM-II, in 1974, no longer listed homosexuality as a category of disorder. After a vote by the APA trustees in 1973, and confirmed by the wider APA membership in 1974, the diagnosis
9546-399: The same limitations as other self-report inventories , in that scores can be easily exaggerated or minimized by the person completing them. Like all questionnaires, the way the instrument is administered can have an effect on the final score. If a patient is asked to fill out the form in front of other people in a clinical environment, for instance, social expectations have been shown to elicit
9657-465: The selection, processing, assessment, and treatment of soldiers. This moved the focus away from mental institutions and traditional clinical perspectives. The U.S. armed forces initially used the Standard, but found it lacked appropriate categories for many common conditions that troubled troops. The United States Navy made some minor revisions but "the Army established a much more sweeping revision, abandoning
9768-508: The self. In his view, it was the case that these cognitions caused depression, rather than being generated by depression. Beck developed a triad of negative cognitions about the world, the future, and the self, which play a major role in depression. An example of the triad in action taken from Brown (1995) is the case of a student obtaining poor exam results: The development of the BDI reflects that in its structure, with items such as "I have lost all of my interest in other people" to reflect
9879-427: The subject has been feeling in the last week. Each question had a set of at least four possible responses, ranging in intensity. For example: When the test is scored, a value of 0 to 3 is assigned for each answer and then the total score is compared to a key to determine the depression's severity. The standard cut-off scores were as follows: Higher total scores indicate more severe depressive symptoms. Some items on
9990-445: The terms of the new cognitive psychology, extended to become a therapeutic need. Beck's notebooks were also filled with self-analysis, where at least twice a day for several years he wrote out his own "negative" (later "automatic") thoughts, rated with a percentile belief score, classified and restructured. The psychologist who would become most important for Beck was Albert Ellis , whose own faith in psychoanalysis had crumbled by
10101-502: The treatment of schizophrenia has suggested that patients once believed to be non-responsive to treatment are amenable to positive change. Even the most severe presentations of the illness, such as those involving long periods of hospitalization, bizarre behavior, poor personal hygiene, self-injury, and aggressiveness, can respond positively to a modified version of cognitive behavioral treatment. Although Beck's approach has sometimes been criticized as too mechanistic, modern CBT stresses
10212-473: The world, "I feel discouraged about the future" to reflect the future, and "I blame myself for everything bad that happens" to reflect the self. The view of depression as sustained by intrusive negative cognitions has had particular application in cognitive behavioral therapy (CBT), which aims to challenge and neutralize them through techniques such as cognitive restructuring . The original BDI, first published in 1961, consisted of twenty-one questions about how
10323-614: The world, and the future. He stated that such cognitions were interrelated as the cognitive triad . Limited time spent reflecting on automatic thoughts would lead patients to treat them as valid. Beck began helping patients identify and evaluate these thoughts and found that by doing so, patients were able to think more realistically, which led them to feel better emotionally and behave more functionally. He developed key ideas in CBT, explaining that different disorders were associated with different types of distorted thinking. Distorted thinking has
10434-442: Was a professor in the department of psychiatry at the University of Pennsylvania . He is regarded as the father of cognitive therapy and cognitive behavioral therapy (CBT). His pioneering methods are widely used in the treatment of clinical depression and various anxiety disorders . Beck also developed self-report measures for depression and anxiety , notably the Beck Depression Inventory (BDI), which became one of
10545-452: Was a visiting scientist at Oxford University . He was a professor emeritus at Penn since 1992, and an adjunct professor at both Temple University and University of Medicine and Dentistry of New Jersey . During his time at Penn, he pioneered the development of Recovery-Oriented Cognitive Therapy. While the Center for CT-R was created at Penn, it was later absorbed by Beck Institute. Beck
10656-488: Was already making notes about patterns of thoughts in depression, emphasizing what can be observed and tested by anyone and treated in the present. He was engaged by George Kelly 's personal construct theory and Jean Piaget 's schemas . Beck's first articles on the cognitive theory of depression, in 1963 and 1964 in the Archives of General Psychiatry , maintained the psychiatric context of ego psychology but then turned to concepts of realistic and scientific thinking in
10767-437: Was another example of how society labels and controls non-conformists; from behavioural psychologists who challenged psychiatry's fundamental reliance on unobservable phenomena; and from gay rights activists who criticised the APA's listing of homosexuality as a mental disorder. The APA was closely involved in the next significant revision of the mental disorder section of the ICD (version 8 in 1968). It decided to go ahead with
10878-701: Was elected a Fellow of the American Academy of Arts and Sciences in 2007. Beck was the founder and President Emeritus of the non-profit Beck Institute for Cognitive Behavior Therapy , and the director of the Aaron T. Beck Psychopathology Research Center, which was the parent organization of the Center for the Treatment and Prevention of Suicide, which is now known as the Penn Center for the Prevention of Suicide. In 1986, he
10989-698: Was elected a member of the Phi Beta Kappa Society , was an associate editor of The Brown Daily Herald , and received the Francis Wayland Scholarship, William Gaston Prize for Excellence in Oratory, and Philo Sherman Bennett Essay Award. Beck attended Yale Medical School , planning to become an internist and work in private practice in Providence. He graduated from Yale with a Doctor of Medicine in 1946. After receiving his M.D., Beck completed
11100-521: Was eventually appointed department head in the face of sustained opposition which again Beck would not engage in, putting him at bitter odds with his friend Stein. On top of this, despite having graduated from his Philadelphia training, the American Psychoanalytic Institute rejected Beck's membership application in 1960, skeptical of his claims of success from relatively brief therapy and advising he conduct further supervised therapy on
11211-492: Was going on rather than helping the client to learn for themselves empirically . Psychoanalyst Gerald E. Kochansky remarked in 1975 in a review of one of Beck's books that he could no longer tell if Beck was a psychoanalyst or a devotee of Ellis. Beck highlighted the classical philosophical Socratic method as an inspiration, while Ellis highlighted disputation which he stated was not anti-empirical and taught people how to dispute internally. Both Beck and Ellis cited aspects of
11322-454: Was in serious danger of not being approved by the APA Board of Trustees unless "neurosis" was included in some form; a political compromise reinserted the term in parentheses after the word "disorder" in some cases. Additionally, the diagnosis of ego-dystonic homosexuality replaced the DSM-II category of "sexual orientation disturbance". The gender identity disorder in children (GIDC) diagnosis
11433-420: Was introduced in the DSM-III; prior to the DSM-III's publication in 1980, there was no diagnostic criteria for gender dysphoria . Finally published in 1980, DSM-III listed 265 diagnostic categories and was 494 pages long. It rapidly came into widespread international use and has been termed a revolution, or transformation, in psychiatry. When DSM-III was published, the developers made extensive claims about
11544-471: Was later reincorporated in the DSM-5, published in 2013). "Ego-dystonic homosexuality" was also removed and was largely subsumed under "sexual disorder not otherwise specified", which could include "persistent and marked distress about one's sexual orientation." Altogether, the DSM-III-R contained 292 diagnoses and was 567 pages long. Further efforts were made for the diagnoses to be purely descriptive, although
11655-464: Was married in 1950 to Honorable Phyllis W. Beck (ret.), and they had four children together: Roy, Judy, Dan, and Alice. Phyllis was the first woman judge on the appellate court of the Commonwealth of Pennsylvania . Her youngest daughter, Alice Beck Dubow, is a judge on the same court, while the older daughter Judith is a prominent CBT educator and clinician, who wrote the basic text in the field and
11766-588: Was named one of the "Americans in history who shaped the face of American psychiatry", and one of the "five most influential psychotherapists of all time" by The American Psychologist in July 1989. His work at the University of Pennsylvania inspired Martin Seligman to refine his own cognitive techniques and later work on learned helplessness . Aaron Temkin Beck was born in Providence , Rhode Island , on July 18, 1921. He
11877-401: Was organized into a five-part axial system: The DSM-IV does not specifically cite its sources, but there are four volumes of "sourcebooks" intended to be APA's documentation of the guideline development process and supporting evidence, including literature reviews, data analyses, and field trials. The sourcebooks have been said to provide important insights into the character and quality of
11988-623: Was released shortly after the war in October 1945 under the auspices of the Office of the Surgeon General . It was reprinted in the Journal of Clinical Psychology for civilian use in July 1946 with the new title Nomenclature of Psychiatric Disorders and Reactions . This system came to be known as "Medical 203". This nomenclature eventually was adopted by all the armed forces, and "assorted modifications of
12099-451: Was replaced with the category of "sexual orientation disturbance". The emergence of DSM-III represented a "quantum leap" in terms of the scale and reach of the manual. In 1974, the decision to revise the DSM was made, and psychiatrist Robert Spitzer was selected as chair of the task force. The initial impetus was to make the DSM nomenclature consistent with that of the International Classification of Diseases (ICD). The revision took on
12210-488: Was the youngest of four children born to Elizabeth Temkin and Harry Beck, Jewish immigrants from Ukraine . Harry worked as a printer and Elizabeth's family found financial success in tobacco wholesaling; the family belonged to the upwardly-mobile vanguard of Providence's Eastern European-Jewish immigrant community. At the time of Aaron's birth, the Temkin-Becks lived a "comfortable, lower-middle class lifestyle" and were in
12321-424: Was used to justify inclusion of the disorder as a supposed pathological hidden fear of the opposite sex caused by traumatic parent–child relationships. This view was influential in the medical profession. In 1956, however, the psychologist Evelyn Hooker performed a study comparing the happiness and well-adjusted nature of self-identified homosexual men with heterosexual men and found no difference. Her study stunned
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