Psychiatric Diagnosis and Classification - ResearchGate

60 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION
concerned with the amount and type of research underlying the diagnoses
[71]. The revision process of DSM-IV was explicitly guided by the empirical
database available for each disorder, and was accomplished through comprehensive
literature reviews, secondary data analyses and field trials. Still,
it has been argued that the DSM-IV workgroups, comprised overwhelmingly
of psychiatrists, neglected the potential value of basic behavioral and
social sciences in reaching their decisions. This argument has been particularly
pointed in the child and adolescent field, in which the discipline of
developmental psychopathology has sought an increased role [72]. Higher
visibility and increased participation of researchers in neuroscience, genetics,
epidemiology, anthropology, and sociology in future revisions of the
DSM have also been advocated.
Ideally, a research base for mental disorder nosology and classification
should include studies representing epidemiology, genetics, clinical research,
basic brain research, social and behavioral science, and psychometrics. The
current research base varies widely from this ideal, both in quality and
quantity. For example, in the child and adolescent field, research on disability
and its relationship to symptoms has outpaced the same research for adult
populations [73, 74]. There is a fast-growing body of work in basic child
development and its relationship to psychopathology. Yet treatment research
has lagged for children, and there is still no widely generalizable epidemiological
study of mental disorders for this population in the United States [75,
76]. A relative lack of data has prevented a needed overhaul of the personality
disorder diagnoses which are universally agreed to be unsatisfactory, and
there are virtually no data on the ``not otherwise specified'' diagnoses. A weak
database undermines confidence in the reliability and validity of a diagnosis
among clinicians and scientists. Among other users of the DSMÐsuch as the
legal system, insurers, government officials, and the public at largeÐdiagnoses
can be assigned an uncritical equivalence in validity, leading to inappropriate
usage.
Gaps in Classification
The DSM-IV diagnostic categories, as mentioned above, were set up with
varying degrees of research to support them. As the research base grows,
and as the classification is used and scrutinized by clinicians, limitations
inevitably emerge, as well as opportunities for modification. Personality
disorders have received considerable attention [77]. Although in DSM-IV
they are categorical entities and their criteria are generally met by symptom
counts, the DSM-IV ``general diagnostic criteria for a personality disorder''
seem to lend themselves to a scalar or dimensional approach. For example, a
person with a personality disorder must have inner experiences and behav-