Evidence-based Cognitive Behavioral Therapy Research Articles

Clinical factors contributing to the differential diagnosis of primary insomnia and insomnia related to mental disorders.

Primary insomnia and insomnia related to mental disorders are the two most common DSM-IV insomnia diagnoses, but distinguishing between them is difficult in clinical practice. This analysis was performed to identify clinical factors used by sleep specialists to distinguish primary insomnia from insomnia related to mental disorders. Clinicians evaluated 216 patients referred for insomnia at five clinical sites, rated a list of clinical factors judged to contribute to each patient's presentation, and assigned diagnoses. Analysis of variance was performed, with contributing factors as the dependent variable and diagnostic group and clinic location as independent variables. Sleep specialists rated a psychiatric disorder as a stronger factor for insomnia related to mental disorders and rated negative conditioning and sleep hygiene as stronger factors for primary insomnia. However, a psychiatric disorder was rated as a contributing factor for 77% of patients who received a first diagnosis of primary insomnia. While neither sleep hygiene nor negative conditioning is a diagnostic criterion in DSM-IV, these results support the face validity of these clinical factors distinguishing between primary insomnia and insomnia related to mental disorders. The use of a psychiatric disorder as an inclusion criterion for insomnia related to mental disorders and an exclusion criterion for primary insomnia reinforces a categorical distinction between the two diagnoses, but the contribution of psychiatric symptoms in primary insomnia appears to be a clinically relevant one. These findings suggest the need for studies on the validity of negative conditioning and sleep hygiene in the etiology of primary insomnia, as well as on the significance of psychiatric disorders, especially depression, in primary insomnia.

Dr. Kellner and Dr. Steele Reply

Back to table of contents Previous article Next article ArticleNo AccessDr. Kellner and Dr. Steele ReplyCHARLES H. KELLNER, and THOMAS E. STEELECHARLES H. KELLNERSearch for more papers by this author, and THOMAS E. STEELESearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.149.9.1278AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Dr. Kellner and Dr. Steele Reply." American Journal of Psychiatry, 149(9), p. 1278 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByJournal of Aggression, Maltreatment & Trauma, Vol. 20, No. 8Behavioral Sleep Medicine, Vol. 7, No. 2Psychotherapy and Psychosomatics, Vol. 76, No. 1Habituelle Stressverarbeitung, Befindlichkeit und Verhalten nach AlpträumenZeitschrift für Klinische Psychologie und Psychotherapie, Vol. 35, No. 4Journal of Sleep Research, Vol. 15, No. 2Journal of Applied Research in Intellectual Disabilities, Vol. 19, No. 1Behavioral Sleep Medicine, Vol. 4, No. 1Journal of Psychiatric Practice, Vol. 10, No. 2Perceptual and Motor Skills, Vol. 99, No. 7Behavioral Sleep Medicine, Vol. 1, No. 3An Open-Label Trial of Evidence-Based Cognitive Behavior Therapy for Nightmares and Insomnia in Crime Victims With PTSDBarry Krakow, M.D., Lisa Johnston, M.A., M.P.H., Dominic Melendrez, PSGT, Michael Hollifield, M.D., Teddy D. Warner, Ph.D., Debie Chavez-Kennedy, and Margaret J. Herlan, M.A.1 December 2001 | American Journal of Psychiatry, Vol. 158, No. 12Journal of Traumatic Stress, Vol. 13, No. 4Annals of the New York Academy of Sciences, Vol. 821, No. 1 PsychobiologyJournal of Traumatic Stress, Vol. 9, No. 1Counselling Psychology Quarterly, Vol. 9, No. 3American Journal of Clinical Hypnosis, Vol. 35, No. 3 Volume 149Issue 9 September 1992Pages 1278-1278 Metrics PDF download History Published online 1 April 2006 Published in print 1 September 1992