Daniel L Segal

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Verified

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• PhD
• Professor (Full) at University of Colorado Colorado Springs

Objectives: Anxiety is a significant problem for many individuals in various long-term care (LTC) settings and is often undetected and under-treated. This study examined the psychometric properties of a new quantitative anxiety screening measure specifically designed for use in long-term care settings, the Geriatric Anxiety Scale – Long Term Care V...

In this cross-sectional study, we examined age-related differences in anxiety sensitivity (AS), experiential avoidance (EA), and mindfulness among younger adult students (N = 426; M age = 20.1 years) and community-dwelling older adults (N = 85; M age = 71.8 years). Participants anonymously completed the Anxiety Sensitivity Index-3, Acceptance and A...

Background: The Geriatric Anxiety Scale (GAS; Segal et al. (Segal, D. L., June, A., Payne, M., Coolidge, F. L. and Yochim, B. (2010). Journal of Anxiety Disorders, 24, 709-714. doi:10.1016/j.janxdis.2010.05.002) is a self-report measure of anxiety that was designed to address unique issues associated with anxiety assessment in older adults. This s...

Personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are conceptualized as distinct clinical syndromes. However, debate persists about the clinical utility of this categorical model, with many researchers supporting a dimensional model that focuses on pathological personality traits and personality dysfun...

The limited understanding and literature concerning somatic symptom and related disorders (SSRDs), especially in older adults, further complicates accurate and sensitive diagnosis and assessment for this growing and specialized population. As the population of older adults is expected to grow exponentially, the purposes of this paper are to identif...

Elevated rates of suicide among older adults continue to be a major public health problem globally. Improving our understanding of the precursors and the underlying mechanisms that lead to an increased risk of suicide in older adults is key to preventing suicide in this high-risk group. This study examined relationships between known risk factors o...

This paper traces the evolution of the diagnostic formulations for personality disorders (PDs) through the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR; American Psychiatric Association, 2022) and in the International Classification of Diseases (ICD-11; World Health Organization, 2019). It outlines key arguments for and a...

A cornerstone of the professional therapeutic relationship and a vital prerequisite to effective treatment, the diagnostic interview sets the tone for interventions that follow. This welcome update to the authoritative textbook includes coverage of foundational and advanced skills and strategies for effective clinical and diagnostic interviewing. C...

The ability to conduct an effective clinical and diagnostic interview is arguably one of the most valued skills among mental health professionals. It is during the interview that the clinician learns about the difficulties and challenges experienced by the client and begins to form the foundations of a healing professional therapeutic relationship....

The alternative model of personality disorders (AMPD) contains two diagnostic criteria: personality functioning and pathological personality traits. This study examined the temporal stability and predictive validity of the AMPD’s key constructs among older adults. A sample of older adults (n = 172) completed AMPD and psychosocial functioning measur...

Anxiety is among the most common mental health problems experienced in later life (defined as 65 years and older) and is associated with reduced quality of life and other negative outcomes, such as increased disability, impaired cognitive functioning, and elevated health care costs. Common symptoms of anxiety include excessive worry, fear, restless...

For the most optimal reading experience we recommend using our website. A free-to-view version of this content is available by clicking on this link, which includes an easy-to-navigate-and-search-entry, and may also include videos, embedded datasets, downloadable datasets, interactive questions, audio content, and downloadable tables and resources.

For the most optimal reading experience we recommend using our website. A free-to-view version of this content is available by clicking on this link, which includes an easy-to-navigate-and-search-entry, and may also include videos, embedded datasets, downloadable datasets, interactive questions, audio content, and downloadable tables and resources.

Unconditional positive regard is a core concept related to counseling and psychotherapy that is derived from person-centered and humanistic approaches to psychological therapy. In brief, unconditional positive regard refers to a kind and gentle stance adopted by the mental health professional characterized by being fully non-judgmental and acceptin...

There are several specific types of anxiety disorders in the DSM 5, including generalized anxiety disorder, panic disorder, specific phobia, agoraphobia, and social anxiety disorder. Each anxiety disorder has specific symptoms and a threshold of symptoms needed for a formal diagnosis. However, many people with anxiety symptoms do not meet full crit...

The Alternative Model of Personality Disorders (AMPD) is a dimensional model of personality disorders that contains two main diagnostic constructs: personality functioning and five pathological personality traits domains. This study examined the temporal stability and predictive validity of the AMPD’s two diagnostic constructs among older adults. I...

Aging anxiety is a distinct form of fear characterized by negative feelings associated with growing older. This study directly compared two common measures of aging anxiety within an older adult sample. Participants completed the Anxiety about Aging Scale, the Personal Anxiety Toward Aging Scale and several related constructs including ageism, expe...

Introduction The Alternative Model of Personality Disorders (AMPD) is a dimensional model of personality disorder pathology focusing on pathological personality traits, with five trait domains. Limited knowledge exists about relationships between cumulative exposure to traumatic events and the AMPD, a gap particularly relevant for older adults who...

Introduction Previous research established substantial age bias on personality disorder (PD) diagnostic criteria for older adults. The Alternative Model of Personality Disorders (AMPD) is a new model of PDs proposed in DSM-5’s Section III that measures PDs dimensionally along two criteria: personality functioning with four domains (measured by the...

Social isolation and disruptive dementia-related behaviors are common concerns among older adults with cognitive impairment and their caregivers within residential long-term care settings. However, many interventions aiming to improve the quality of life of residents through the reduction of dementia-related behaviors and isolation rely on human co...

Objective Based on past research demonstrating increased worry among the oldest old compared to younger older adults, this study tested an existing cognitive model of worry to determine whether differences in executive functioning during aging contribute to increased worry among the oldest old. Method 97 community-dwelling older adults (M age = 74...

Previous research on self‐informant reports in assessing personality disorders (PDs) has been mainly focused on adults, leaving older adults under‐studied. We examined self‐informant agreement in PD screening among older adults (≥60 years) using the Gerontological Personality disorders Scale (GPS). Potential differences such as who reports more per...

This study assessed how clinical anxiety, anxiety about aging, and death anxiety related to one another and to intrapersonal functioning. Older adults completed the Geriatric Anxiety Scale, Anxiety About Aging Scale, Death Anxiety Scale-Extended, and Intrapersonal Problems Rating Scale. Clinical anxiety was strongly correlated with anxiety about ag...

Assessment of personality disorders (PDs) in older adults is a nuanced trade of its own. The aim of this practice guide is to illustrate gerontological assessment challenges using 3 case vignettes. We argue that it is important to pay extra attention to the influence of cognitive and medical (somatic) disorders on personality functioning in older a...

Aims To investigate the relationship between anxiety and quality of life among older adults with self‐reported polypharmacy living in the long‐term care setting. Design A cross‐sectional design was used. Methods Between July 2021 and August 2022, 92 older adults living in long‐term care completed an anonymous one‐time questionnaire packet. Polyph...

Background: This study developed a Japanese version of the Geriatric Anxiety Scale (GAS-J) and its short form (GAS-10-J) to evaluate anxiety in Japanese older adults and assess its psychometric properties using a cross-sectional design. Methods: A total of 331 community-dwelling older adult participants (208 men, 116 women, seven unknowns; mean...

Objectives: The Alternative Model of Personality Disorders (AMPD) is a classification system for personality disorders (PDs) proposed in Section III of DSM-5. The AMPD contains two diagnostic constructs: personality functioning and pathological personality traits. Previous research has suggested that the model performed differently among older adul...

Experiencing traumatic events across the lifespan has long been identified as an etiologic factor in the development or worsening of personality disorder (PD) symptoms. However, knowledge about relationships between trauma and PDs among older adults is limited. In particular, no research has been conducted examining these relationships in later lif...

The Alternative Model of Personality Disorders (AMPD) is a relatively new dimensional model of personality disorders (PDs) that assesses two diagnostic constructs: personality functioning and pathological personality traits. Thus far, research on the AMPD among older adults has been limited, but the research that does exist suggests limited general...

The prevalence of polypharmacy (≥5 medications per day) is rising among older adults. Multiple medications are increasingly prescribed to treat multiple comorbidities in this growing population. An increase in anxiety and a decline in quality of life are also seen with polypharmacy, although evidence is limited. This study investigated the relation...

Introduction Anxiety is a significant mental health problem among older adults and is commonly comorbid with personality disorders (PD). However, specific relationships between personality functioning (a proposed feature of PDs) and late-life anxiety remain unclear. This study examined relationships between two models of personality functioning wit...

The DSM-5 (American Psychiatric Association, 2013) combined all previous autism diagnoses into a single diagnostic category, autism spectrum disorder (ASD). The present study examined whether an 84-item measure of the ASD DSM-5 criteria, the Coolidge Autism Symptom Survey (CASS), could differentiate between children who were developing typically (D...

Objectives We developed a new Italian short version of the Geriatric Anxiety Scale (GAS-12) and evaluated its psychometric properties. The GAS-12 specifically screens for anxiety symptoms in the Italian older adult population by identifying items that best discriminate anxiety in this population. Methods In Study 1, we administered the full-length...

Introduction: This study examined relationships between personality disorder (PD) features, Big Five personality traits, and interpersonal problems with anxiety. Method: Older adults (N = 130) completed the Geriatric Anxiety Scale, Coolidge Axis Two Inventory, Big Five Inventory-2, and Circumplex Scales of Interpersonal Problems. Pearson correla...

Introduction Anxiety is a significant mental health problem among older adults and is associated with multiple other mental disorders, poor psychosocial functioning, and reduced quality of life. Personality traits and disorders, along with interpersonal problems, may play a significant role in anxiety, but these relationships are not well understoo...

Introduction The interpersonal circumplex model measures interpersonal dysfunction along two axes (communion and agency), resulting in eight unhealthy patterns: Domineering, Vindictive, Cold, Socially Avoidant, Nonassertive, Exploitable, Overly Nurturant, and Intrusive. It is unclear how the circumplex model applies to older adults and their unique...

There are few published studies of attention-deficit/hyperactivity disorder (ADHD) in adult inmates, and even fewer studies that have considered ADHD in adult inmates by gender. The present study examined the prevalence of ADHD, its subtypes, and associated psychological and neuropsychological comorbidity as a function of gender in a sample of 3,96...

Objectives: The perception of being a burden is a well-known risk factor for dying by suicide. Research on factors that precede the state of perceived burdensomeness, such as fearing being a burden, is necessary. We investigated the extent to which health status, elevated depressive symptoms, and elevated anxiety symptoms are associated with fear o...

The experience of clinically significant anxiety and anxiety disorders represent significant and often debilitating problems for many residents in long-term care (LTC) settings. However, anxiety problems often go undetected and untreated in this growing population. The purposes of this paper are to examine the prevalence and impact of anxiety probl...

The interpersonal circumplex is a model that places interpersonal problems along two axes (communion and agency), resulting in eight theoretically derived patterns. Application of the circumplex to older adults is poorly understood. Subsequently, this study examined relationships between the interpersonal circumplex and personality disorder (PD) fe...

Four personality disorders (PD) have become “lost” throughout the various editions of the DSM: Depressive, Passive-Aggressive, Sadistic, and Self-Defeating. The Alternative Model of Personality Disorders (AMPD) is a novel approach to PD classification, containing two diagnostic criteria: personality functioning and pathological personality traits....

Objectives: The Pathological Narcissism Inventory (PNI) is a measure of narcissism, with two domains of Vulnerability and Grandiosity, that has limited evidence of validity among older adults. Subsequently, the objective of the present study was to examine relationships between the PNI and measures of diverse pathological personality features. Meth...

The aims of this study were to examine age-differences regarding various worry components among younger and older adults and to characterize the relationships between worry domains and anxiety. A total of 311 younger adults (18 - 30 years) and 100 older adults (65+ years) completed seven worry and anxiety questionnaires, focusing on worry content,...

Research suggests meaningful relationships between self-esteem and various deleterious mental health outcomes. However, these relationships are less well understood in older adults, where age-specific models of self-esteem are lacking. In this study, older adult participants (N = 284, M age = 73.3 years) anonymously completed a series of questionna...

Introduction: The Personality Inventory for DSM-5 (PID-5) is a measure of the alternative model of personality disorders (PDs), proposed in Section III of the DSM-5, but the PID-5 has limited evidence of validity for use among older adults. This study examined the validity of the alternate model through associations with the 10 traditional PDs in D...

Introduction. This study examined the influence of age and gender on diverse worry constructs and overall anxiety among younger (age 18-30) and older (age 65+) adults. Methods. 411 participants (311 younger, 100 older adults; 77.1% female) completed the PSWQ, BMWS, WDQ, and GAS online. Results. Among a series of 2x2 between-subjects ANOVAs, signifi...

The Levels of Personality Functioning Scale—Brief Form 2.0 (LPFS-BF 2.0) is a new measure of personality functioning according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition’s, alternative model of personality disorders, containing a total personality functioning score and two subscales (Self and Interpersonal). The LPF...

The number of older adults in the United States and much of the world is rapidly increasing as individuals continue to live longer, healthier lives, and is expected to continue growing over the next several decades. As a result, healthcare settings are constantly adapting to meet the specialized needs of this aging population. One major adaptation...

The Severity Indices of Personality Problems (SIPP; Verheul et al., 2008 Verheul, R., Andrea, H., Berghout, C. C., Dolan, C., Busschbach, J. J. V., van der Kroft, P. J. A., … Fonagy, P. (2008). Severity indices of personality problems (SIPP-118): Development, factor structure, reliability, and validity. Psychological Assessment, 20(1), 23–34. doi:1...

Objectives Current guidelines recommend highly specialized care for patients with severe personality disorders (PDs). However, there is little knowledge about how to detect older patients with severe PDs. The aim of the current study was to develop an age-specific tool to detect older adults with severe PDs for highly specialized mental health care...

At the end of life, hospice patients frequently rely on surrogate decision makers (SDMs) for healthcare decisions, which creates anxiety among SDMs. This project evaluated whether an educational intervention to create a plan of care for hospice patients would reduce anxiety among SDMs. Before the intervention, immediately after the intervention, an...

Worry is a ubiquitous human experience and core symptom of anxiety. The present study examined the extent to which specific aspects of worry are related to perceived executive dysfunction in older adults. A total of 100 older adult participants ( M age = 68.82 years; range = 65–79 years) completed the Worry Behaviors Inventory, the Coolidge Axis II...

Older adults are generally happier, less likely to have depression or anxiety, and have better emotion regulation abilities than earlier in life (Thomas et al., 2016). While older age predicts more hostile beliefs about others, older adults report less hostile behavior and no difference in covert hostility, compared to other age groups (Barefoot, B...

Introduction: Anxiety is a prevalent problem that has been found to be associated with multiple other mental disorders, functional impairments, and poor quality of life. Specifically, it appears that personality may play a major role in anxiety based on preferred dispositional coping methods and presence of normal and dysfunctional personality trai...

Unmet mental health care needs of older people living in rural areas have been identified as a fundamental problem. This project engaged a rural consortium of service agencies to support recruitment through advertising, word of mouth, social media. So far, 100 rural participants aged 50 and older have completed our survey which includes the revised...

At the end of life, adults with advanced illness frequently rely on surrogate decision makers to make health care decisions. Surrogate decision makers often have anxiety related to the difficulty and complexity of making end of life decisions. This project evaluated whether an educational intervention focused on creating a specific plan of care for...

Introduction: The Personality Inventory for DSM-5 (PID-5) is a measure of the alternative model of personality disorders with limited evidence of validity among older adults. This study examined validity of the model through associations with the Horney-Coolidge Tridimensional Inventory (HCTI). Method: Older adults (N=125) completed the PID-5 and t...

Anxiety symptoms and anxiety disorders are highly prevalent among older adults, and are associated with considerable distress, functional impairment, and burden. Also, there is growing need for brief instruments to measure anxiety symptoms in primary care and geriatric medical settings. Therefore, the current study focuses on the development and ps...

Synonyms Aid in dying; Good death; Physician-assisted dying; Voluntary-assisted dying Definition Death with dignity refers to the idea that terminally ill individuals should have the right to make their own end-of-life decisions, such as determining how much pain and suffering they should endure and when to end their own life.

The ability to conduct an efficient and effective clinical and diagnostic interview is arguably one of the most valued skills among mental health professionals. It is during the interview that the clinician learns about the difficulties and challenges experienced by the client and begins to form the foundations of a healing professional therapeutic...

This study established the psychometric properties of a new measure to assess the behavior of adults who are highly dependent on their parent(s), particularly in light of their capacity to function independently and whose behavior appears deviant even when compared to cultural norms. In the present study, these adults were labeled Highly Dependent...

The objective of this study was to explore the role of personality and self-esteem in later life within two established risk factors for suicidal ideation (SI)—Thwarted Belongingness (TB) and Perceived Burdensomeness (PB). The data about personality (i.e., Five Factor Model [FFM] and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edit...

Introduction: This study examined the psychometric properties of the Geriatric Anxiety Scale (GAS) in a sample of medically ill older adults. Method: Data were collected from older adults (N = 38; M age = 69.9 years) with at least one chronic physical health condition, who completed the GAS, the Beck Anxiety Inventory (BAI), the Geriatric Anxiety I...

A cornerstone of the professional relationship and a vital prerequisite to treatment, the diagnostic interview sets the tone for the interventions to follow. This welcome update to the formative reference includes coverage of foundational and advanced skills and strategies for effective diagnostic interviewing. Completely revised and updated to cor...

Anxiety in later life is a major clinical problem, with notable barriers to accurate assessment. The Geriatric Anxiety Scale (GAS) and Geriatric Anxiety Inventory (GAI) represent two elder-specific assessment tools that have recently been developed and validated. This study aimed to examine the convergent validity of both measures as they relate to...

Suicide represent a serious public health problem among older adults. Joiner’s interpersonal-psychological theory of suicidal behavior suggests that perceived burdensomeness (PB) and thwarted belongingness (TB) are important risk factors for suicidal ideation (SI). This study tested whether TB and PB predict SI above and beyond well-known psycholog...

As the proportion and sheer number of older adults in the United States continues to increase, we need to plan for their behavioral health care. Access to accurate data about current workforce characteristics in psychology can provide essential information to inform workforce planning. In this paper, we present results of the American Psychological...

Objective: To compare Emergency Department (ED) care of suicidal patients with and without documented acute alcohol use. Methods: Retrospective chart review of randomly sampled patient visits (n = 800; January 2014 to December 2015) at an urban ED with universal screening for suicide risk. Eligible visits were by adults (18+ years) who screened...

The goal of this study was to evaluate the continuity across the Section II personality disorders (PDs) and the proposed Section III model of PDs in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013a American Psychiatric Association. (2013a). Diagnostic and statistical manual of menta...

Prior work from surveys and limited populations suggests many emergency department (ED) patients with suicide risk do not have documented lethal means assessments (e.g., being asked about home firearms). The specific objectives of this study were to, in an ED with universal screening for suicide risk: (1) estimate how often ED providers documented...

Statement of purpose To identify care differences between those with and without alcohol intoxication among emergency department (ED) patients who screened positive for suicide risk. Methods This was a retrospective, observational study of electronic medical records at an urban ED with universal suicide risk screening. Eligible patients had screen...

Background/objective: We described characteristics and treatment received for older (≥60 years) vs younger (<60 years) adult emergency department (ED) patients with suicide risk. Design: Retrospective chart review. Setting: An ED with universal screening for suicide risk. Participants: Eligible charts included a random sample of adults (≥18...

Background: The Italian older adult population is increasing and psychiatric problems, such as anxiety among older adults, represent major challenges for public welfare. A strong need exists for instruments specifically developed to assess anxiety among Italian older adults. The Geriatric Anxiety Scale (GAS) is a 30-item self-report questionnaire t...

Depression, suicide ideation (SI) and suicide attempts (SA) are common among older adults, representing serious public health problems. Individuals with multiple comorbidities and frequent contact with hospital–based emergency departments (ED) may have elevated – but unrecognized – risk. To inform future interventions, we describe the prevalence of...

The Geriatric Anxiety Scale (GAS) was developed as an international screening instrument for anxiety in older adults. The aims of the present study were to translate the GAS into Chinese and to subsequently evaluate the preliminary psychometric properties of the Chinese version of the GAS (GAS-C) among community-dwelling Chinese older adults. The t...