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

ABSTRACT 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.

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Available from: Douglas B Samuel, Nov 24, 2014
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    • "Decision for medication or hospitalization is categorical—thus specific points of demarcation are needed to guide clinical decisions (Widiger and Samuel, 2005) + Internally valid to describe specific patient's psychopathology (Kass et al., 1985) − Inaccurate and misleading descriptions (Maser et al., 1991) + Less criteria to assess—i.e., smaller set of underlying dimensions of functioning (Haslam, 2002) − Thousands of valid categorical distinctions + Better able to recognize subthreshold conditions (Magruder and Calderone, 2000) − Frequent use of Not Otherwise Specified lacks clinical utility—inadequate diagnostic coverage (Verheul and Widiger, 2004) + Avoiding misleading, unstable, illusory effects (Widiger and Samuel, 2005) − Confusion—minor changes to a diagnostic criterion often create substantial changes in prevalence rates, further complicating scientific theory and public health policy (Narrow et al., 2002) + Potential to facilitate development of clear demarcations between normal and abnormal functioning (Kessler, 2002) within the new system. Within the field of psychology, this approach could aid development of a common international language to define symptoms, analogous to the field of psychiatry. "
    Frontiers in Psychology 08/2015; 6:1108. DOI:10.3389/fpsyg.2015.01108 · 2.80 Impact Factor
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    • "This information is critical to the generalizability of MTurk samples. Psychological symptoms and associated factors (e.g., cognitive vulnerabilities) are understood to be dimensionally distributed throughout the population (Widiger & Samuel, 2005). Whether the distribution in MTurk samples differs from the general population, however, remains unknown. "
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    ABSTRACT:'s Mechanical Turk (MTurk) website provides a data collection platform with quick and inexpensive access to diverse samples. Numerous reports have lauded MTurk as capturing high-quality data with an epidemiological sample that is more representative of the U.S. population than traditional in-person convenience samples (e.g., undergraduate subject pools). This benefit, in combination with the ease and low-cost of data collection, has led to a remarkable increase in studies using MTurk to investigate phenomena across a wide range of psychological disciplines. Multiple reports have now examined the demographic characteristics of MTurk samples. One key gap remains, however, in that relatively little is known about individual differences in clinical symptoms among MTurk participants. This paper discusses the importance of assessing clinical phenomena in MTurk samples and supports its assertions through an empirical investigation of a large sample (N = 1,098) of MTurk participants. Results revealed that MTurk participants endorse clinical symptoms to a substantially greater degree than traditional nonclinical samples. This distinction was most striking for depression and social anxiety symptoms, which were endorsed at levels comparable with individuals with clinically diagnosed mood and anxiety symptoms. Participants' symptoms of physiological anxiety, hoarding, and eating pathology fell within the subclinical range. Overall, the number of individuals exceeding validated clinical cutoffs was between 3 and 19 times the estimated 12-month prevalence rates. Based on the current findings, it is argued that MTurk participants differ from the general population in meaningful ways, and researchers should consider this when referring to this sample as truly representative. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Psychological Assessment 07/2015; DOI:10.1037/pas0000217 · 2.99 Impact Factor
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    • "In sum, seeking a diagnosis of any mental health disorder has pros and cons. On the one hand, it acts as a pathway for treatment access, validation and feelings of relief (Clarke and Winsor 2010); on the other, it may assume absolute boundaries where none exist, and promote categorical thinking (Widiger and Samuel 2005). Our results indicate that apprehension about the public's negative reactions to an ASD rather than an Asperger's label "
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    ABSTRACT: In the DSM-5, 'Asperger's Disorder' was incorporated into 'Autistic Spectrum Disorder' (ASD). One key concern in this change has been that the ASD label will increase negative attitudes relative to the Asperger's label. To test this, we asked 465 American adults to read a vignette describing a child with autistic symptoms that included an ASD label, an Asperger's label, or no label, and rate their stigma and treatment attitudes (help-seeking and perceived effectiveness). Contrary to predictions, label did not impact stigma. Label did impact treatment attitudes, with greater help-seeking and perceived treatment effectiveness for both Asperger's and ASD labels. In sum, concern that the ASD label will increase negative perceptions, at least amongst the general public, is not supported.
    Journal of Autism and Developmental Disorders 06/2015; 45(10). DOI:10.1007/s10803-015-2485-7 · 3.06 Impact Factor
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