Do Clinicians Conceptualize DSM-IV Disorders Hierarchically?
All classification systems of psychopathology use hierarchical categories. The purpose of the two studies in this article was to test whether clinicians think hierarchically about mental disorders.
Seventy six clinicians were asked to sort 67 diagnostic categories into groups using different instruction sets, either to make progressively larger and smaller groups of diagnoses (Study 1) or to place similar groups next to each other (Study 1 and Study 2).
Clinicians' sortings of mental disorders had a hierarchical structure regardless of the methodology, profession, expertise, and instructional set used.
Given that all modern diagnostic systems have been hierarchical, it is important to know that clinicians' thinking is also hierarchical.
Available from: Rebeca Robles García
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ABSTRACT: To examine the conceptualizations held by psychiatrists and psychologists around the world of the relationships among mental disorders in order to inform decisions about the structure of the classification of mental and behavioral disorders in World Health Organization's International Classification of Diseases and Related Health Problems 11th Revision (ICD-11).
517 mental health professionals in 8 countries sorted 60 cards containing the names of mental disorders into groups of similar disorders, and then formed a hierarchical structure by aggregating and disaggregating these groupings. Distance matrices were created from the sorting data and used in cluster and correlation analyses.
Clinicians' taxonomies were rational, interpretable, and extremely stable across countries, diagnostic system used, and profession. Clinicians' consensus classification structure was different from ICD-10 and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV), but in many respects consistent with ICD-11 proposals.
The clinical utility of the ICD-11 may be improved by making its structure more compatible with the common conceptual organization of mental disorders observed across diverse global clinicians.
Journal of Clinical Psychology 12/2013; 69(12). DOI:10.1002/jclp.22031 · 2.12 Impact Factor
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ABSTRACT: The Diagnostic and Statistical Manual of Mental Disorders (DSM) was created in 1952 by the American Psychiatric Association so that mental health professionals in the United States would have a common language to use when diagnosing individuals with mental disorders. Since the initial publication of the DSM, there have been five subsequent editions of this manual published (including the DSM-III-R). This review discusses the structural changes in the six editions and the research that influenced those changes. Research is classified into three domains: (a) issues related to the DSMs as measurement systems, (b) studies of clinicians and how clinicians form diagnoses, and (c) taxonomic issues involving the philosophy of science and metatheoretical ideas about how classification systems function. The review ends with recommendations about future efforts to revise the DSMs.
Annual Review of Clinical Psychology 03/2014; 10(1):25-51. DOI:10.1146/annurev-clinpsy-032813-153639 · 12.67 Impact Factor
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