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