Diagnostic categories or dimension? A question for the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition

Department of Psychology, University of Kentucky, Lexington, KY 40506-0044, USA.
Journal of Abnormal Psychology (Impact Factor: 4.86). 12/2005; 114(4):494-504. DOI: 10.1037/0021-843X.114.4.494
Source: PubMed


The question of whether mental disorders are discrete clinical conditions or arbitrary distinctions along dimensions of functioning is a long-standing issue, but its importance is escalating with the growing recognition of the frustrations and limitations engendered by the categorical model. The authors provide an overview of some of the dilemmas of the categorical model, followed by a discussion of research that addresses whether mental disorders are accurately or optimally classified categorically or dimensionally. The authors' intention is to document the importance of this issue and to suggest that future editions of the Diagnostic and Statistical Manual of Mental Disorders give more recognition to dimensional models of classification. They conclude with a dimensional mental disorder classification that they suggest provides a useful model.


Available from: Douglas B Samuel, Nov 24, 2014
    • "Categorical models are often examined using latent profile analysis (LPA; i.e., latent class analysis using continuous variables), which groups individuals according to their observed symptom response patterns ; it explains patterns of co-occurrence with respect to a numberofmutuallyexclusiveunderlyingclasses(Krueger,Markon, Patrick, & Iacono, 2005). Dimensional relationships between disorders are typically investigated using factor analytic (FA) methods, which allow for the unique and shared aspects of disorders, and explains patterns with respect to underlying continuous dimensions (Widiger & Samuel, 2005). However, neither statistical method alone suits both the nature of psychopathology and the needs of clinicians, and both rely on statistical assumptions that do not hold for psychopathology. 1 As such, while these methods are helpful theoretically, they are flawed in their practical appli- cations. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sexual dysfunctions have not been included in research on the broad structure of psychopathology to date, despite their high prevalence and impact on quality of life. Preliminary research has shown that they may fit well in an internalizing spectrum, alongside depressive and anxiety disorders. This study compared dimensional and categorical models of the relationships between depression, anxiety, and sexual problems with "hybrid" models (i.e., factor mixture analyses), which combine dimensional and categorical components simultaneously. Participants (n = 1000) were selectively recruited to include a range of symptom levels, and completed a series of self-report measures online. A hybrid model that combined dimensional and categorical components fit best for men and women. Taken together, the results are consistent with a nosology that explicitly recognizes the relationships between the diagnostic chapters of depressive and anxiety disorders and sexual dysfunctions, but still maintains discrete diagnoses, which is compatible with the structure of the DSM-5 and upcoming ICD-11.
    Archives of Sexual Behavior 11/2015; DOI:10.1007/s10508-015-0613-2 · 3.53 Impact Factor
    • "However, although DSM-IV categories are of great use in clinical practice, they have arbitrary boundaries, and show much overlap and comorbidity. Moreover, high heterogeneity of symptoms and severity within one diagnostic category is possible [8]. Depression and anxiety severity scales based on selfreported questionnaires also have limitations: two similar scores may indicate different clinical subtypes due to the heterogeneity of the covered range of symptoms as multidimensionality of symptomatology is not taken into account. "

  • Source
    • "There is much discussion about dimensional (i.e. symptom-based) and diagnostic methods of measuring mental health (Widiger and Samuel, 2005), but symptom measurement provides some distinct advantages for this study. First, symptoms provide insights into the linear relationships between these variables and offer the opportunity to examine mediating effects of trauma on group differences in mental health symptoms. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Symptoms of post-traumatic stress disorder are common in fibromyalgia patients. This study compared post-traumatic stress disorder symptoms in fibromyalgia patients and healthy controls and determined whether patient-control differences in post-traumatic stress disorder symptoms mediated differences in mental health. In all, 30 patients and 30 healthy controls completed questionnaires assessing symptoms of post-traumatic stress disorder and mental health. Fibromyalgia patients had greater symptoms of post-traumatic stress disorder and mental health than controls. Patient-control differences in mental health symptoms were fully or partially mediated by differences in post-traumatic stress disorder symptoms. Healthcare providers should understand the role of trauma as management of trauma symptoms may be one strategy for improving mental health.
    Journal of Health Psychology 10/2015; DOI:10.1177/1359105315611957 · 1.88 Impact Factor
Show more