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DSM disorders and their criteria: how should they inter-relate?

Published online by Cambridge University Press:  04 April 2017

K. S. Kendler
K. S. Kendler*
Affiliation:
Departments of Psychiatry, and Human and Molecular Genetics, Virginia Institute of Psychiatric and Behavioral Genetics, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA
*
*Address for correspondence: K. S. Kendler, M.D., Departments of Psychiatry, and Human and Molecular Genetics, Virginia Institute of Psychiatric and Behavioral Genetics Medical College of Virginia/Virginia Commonwealth University, Box 980126, Richmond, VA 23298-0126, USA. (Email: kenneth.kendler@vcuhealth.org)
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Abstract

While the changes in psychiatric diagnosis introduced by Diagnostic and Statistical Manual third edition (DSM-III) have had major benefits to the field of psychiatry, the reification of its diagnostic criteria and the widespread adoption of diagnostic literalism have been problematic. I argue that, at root, these developments can be best understood by contrasting two approaches to the relationship between DSM disorders and their criteria. In a constitutive relationship, criteria definitively define the disorder. Having a disorder is nothing more than meeting the criteria. In an indexical relationship, the criteria are fallible indices of a disorder understood as a hypothetical, tentative diagnostic construct. I trace the origins of the constitutive model to the philosophical theory of operationalism. I then examine a range of historical and empirical results that favor the indexical over the constitutive position including (i) evidence that individual criteria for DSM-III were selected from a broader pool of possible symptoms/signs, (ii) revisions of DSM have implicitly assumed an indexical criteria-disorder relationship, (iii) the indexical position allows DSM criteria to be wrong and misdiagnose patients while such a result is incoherent for a constitutive model, an implausible position, (iv) we assume an indexical criteria-scale relationships for many personality and symptom measures commonly used in psychiatric practice and research, and (v) empirical studies suggesting similar performance for DSM and non-DSM symptoms for major depression. I then review four reasons for the rise of the constitutive position: (i) the ‘official’ nature of the DSM criteria, (ii) the strong investment psychiatry has had in the DSM manual and its widespread use and success, iii) lack of a clear pathophysiology for our disorders, and (iv) the absence of informative diagnostic signs of minimal clinical importance. I conclude that the constitutive position is premature and reflects a conceptual error. It assumes a definitiveness and a literalism about the nature of our criteria that is far beyond our current knowledge. The indexical position with its tentativeness and modesty accurately reflects the current state of our field.

Keywords

Diagnostic and Statistical Manualoperationalismphilosophypsychiatric diagnosispsychometrics
Type
Review Article
Information
Psychological Medicine , Volume 47 , Issue 12 , September 2017 , pp. 2054 - 2060
Copyright
Copyright © Cambridge University Press 2017 

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References

Abel, JL, Borkovec, TD (1995). Generalizability of DSM-III-R generalized anxiety disorders to proposed DSM-IV criteria and cross-validation of proposed changes. Journal of Anxiety Disorders 9, 303–315.CrossRefGoogle Scholar
Anonymous (2013). DSM-5: By the Book. The Economist, May 18, 2013.Google Scholar
Bridgman, PW (1927). The Logic of Modern Physics. Macmillan: New York.Google Scholar
Cassidy, WL, Flanagan, NB, Spellman, M, Cohen, ME (1957). Clinical observations in manic-depressive disease: a quantitative study of one hundred manic-depressive patients and fifty medically sick controls. Journal of the American Medical Association 164, 1535–1546.CrossRefGoogle ScholarPubMed
Chang, H (2009). Operationalism. In Stanford Encyclopedia of Philosophy (ed. Zalta, E (Principal ed.) Nodelman, U (Senior ed.), Allen, C (Assoc. ed.), Oppenheimer, P, Alama, J, Pease, E, Magnani, M, Kim, H (All Assit. eds)), pp. 1–43. The Metaphysics Research Lab, Center for the Study of Language and Information, Stanford University: Stanford, CA.Google Scholar
Clayton, P, Desmarais, L, Winokur, G (1968). A study of normal bereavement. American Journal of Psychiatry 125, 168–178.CrossRefGoogle ScholarPubMed
Clayton, PJ, Herjanic, M, Murphy, GE, Woodruff, R (1974). Mourning and depression – their similarities and differences. Canadian Psychiatric Association Journal 19, 309–312.CrossRefGoogle ScholarPubMed
CONVERGE Consortium (2015). Sparse whole-genome sequencing identifies two loci for major depressive disorder. Nature 523, 588–591.CrossRefGoogle Scholar
Decker, HS (2013). The Making of DSM-III: A Diagnostic Manual's Conquest of American Psychiatry, 1st edn. Oxford University Press: Oxford, UK.Google Scholar
Eysenck, SBG, Eysenck, HJ, Barrett, P (1985). A revised version of the psychoticism scale. Personality and Individual Differences 6, 21–29.CrossRefGoogle Scholar
Fava, M, Rush, AJ, Trivedi, MH, Nierenberg, AA, Thase, ME, Sackeim, HA, Quitkin, FM, Wisniewski, S, Lavori, PW, Rosenbaum, JF, Kupfer, DJ (2003). Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study. Psychiatry Clinics of North America 26, 457–494.CrossRefGoogle ScholarPubMed
Feighner, JP, Robins, E, Guze, SB, Woodruff, RA Jr., Winokur, G, Munoz, R (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 57–63.CrossRefGoogle ScholarPubMed
Fried, EI (2016). The 52 symptoms of major depression: lack of content overlap among seven common depression scales. Journal of Affective Disorders 208, 191–197.CrossRefGoogle ScholarPubMed
Hempel, CG (1965). Fundamentals of taxonomy. In Aspects of Scientific Explanation: And Other Essays in the Philosophy of Science (ed. Hempel, CG), pp. 137–154. The Free Press: New York, Collier-Macmillan Limited: London.Google Scholar
Hyman, SE (2010). The diagnosis of mental disorders: the problem of reification. Annual Review of Clinical Psychology 6, 155–179.CrossRefGoogle ScholarPubMed
John, OP, Donahue, EM, Kentle, RL (1991). The Big Five Inventory-Versions 4a and 54. University of California Berkeley, Institute of Personality and Social Research: Berkeley, CA.Google Scholar
Jones, TD (1944). The diagnosis of rheumatic fever. Journal of the American Medical Association 126, 481–484.CrossRefGoogle Scholar
Kendler, KS (2016 a). Phenomenology of schizophrenia and the representativeness of modern diagnostic criteria. JAMA Psychiatry 73, 1082–1092.CrossRefGoogle ScholarPubMed
Kendler, KS (2016 b). The phenomenology of major depression and the representativeness and nature of DSM criteria. American Journal of Psychiatry 173, 771–780.CrossRefGoogle ScholarPubMed
Kendler, KS, Munoz, RA, Murphy, G (2010). The development of the Feighner criteria: an historical perspective. American Journal of Psychiatry 167, 134–142.CrossRefGoogle ScholarPubMed
Locke, J (1979). An Essay Concerning Human Understanding. Oxford University Press: London.Google Scholar
Meehl, PE (2006). Construct validity in psychological tests. In A Paul Meehl Reader: Essays on the Practice of Scientific Psychology (ed. Waller, NG, Yonce, LJ, Grove, WM, Faust, D and Lezenweger, MF), pp. 9–30. Lawrence Erlbaum Associates, Inc.: Mahwah, NJ.Google Scholar
Mill, JS (1843). A System of Logic, Ratiocinative and Inductive, Being a Connected View of the Principles of Evidence and the Methods of Scientific Investigation, vol. 2. John W. Parker: London.Google Scholar
Robins, E, Guze, SB (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry 126, 983–987.CrossRefGoogle ScholarPubMed
Ropes, MW, Bennett, GA, Cobb, S, Jacox, R, Jessar, RA (1957). Proposed diagnostic criteria for rheumatoid arthritis: report of a study conducted by a committee of the American rheumatism association. Annals of the Rheumatic Diseases 16, 118–125.CrossRefGoogle Scholar
Rush, AJ, Gullion, CM, Basco, MR, Jarrett, RB, Trivedi, MH (1996). The inventory of depressive symptomatology (IDS): psychometric properties. Psychological Medicine 26, 477–486.CrossRefGoogle ScholarPubMed
Skimina, E, Strus, W, Topolewska, A, Rowinski, T, Cieciuch, J (2014). The short IPIP-BFM-20 questionnaire for measuring the Big Five. Roczniki Psychologiczne 17, 385–402.Google Scholar
Spitzer, RL, Endicott, J, Robins, E (1975). Research Diagnostic Criteria for a Selected Group of Functional Disorders, 2 edn. New York Psychiatric Institute: New York.Google Scholar
Stone, TT, BURRIS, BC (1950). Melancholia; clinical study of 50 selected cases. Journal of the American Medical Association 142, 165–168.CrossRefGoogle ScholarPubMed
Whitehead, AN (1925). Science and the Modern World. Free Press (Simon & Schuster): New York, NY.Google Scholar
Wilson Disease Association (2016). Kayser-Fleischer Rings. The Wilson Disease Association (WDA): Milwaukee, WI. 11-4-2016. Online Source.Google Scholar
Zachar, P (2014). A Metaphysics of Psychopathology, 1 edn. Massachusetts Institute of Technology: Cambridge, MA.CrossRefGoogle Scholar