Background: Many authors have highlighted that a classificatory system such as the ICD-10 or the DSM-IV should attempt to integrate categorical as well as dimensional aspects rather than relying only on a categorical distinction. Methods: In the current study, a method is presented that allows both perspectives to be considered. Based on their clinical experience, 20 therapists were asked to rate a selection of ICD-10 mental disorders in terms of their similarity. The resulting data were processed by nonmetric multidimensional scaling on individual basis as well as mean basis and a cluster analysis. Results: From a categorical point of view, the resulting mean cognitive map and the cluster analytic groups showed a good concordance with the ICD-10 F groups. Additionally, analogies to the critical observations with regard to the classification systems could be observed. From the dimensional point of view, there were two dimensions found (cognition and psychosis) which showed high correlations in the mean map. Conclusions: The method presented in this study offers an opportunity to account for dimensional as well as categorical aspects of classification by exploring the structure of the ICD-10 mental disorders directly from the point of view of therapists and thus creating the basis for an expert model.

Background: In an earlier study, our research group presented an alternative approach to measuring knowledge about mental disorders by constructing a structure-based expert model of the ICD-10 mental disorders. This article presents a validation of this expert model by measuring the emergence of such knowledge structures in psychotherapy students. Sampling and Methods: The participants of a continuing education program in cognitive behavioral psychotherapy rated a selection of mental disorders based on their phenomenological similarity. The similarity judgments of each student were translated by nonmetric multidimensional scaling (NMDS) into a cognitive map. In a quasi-longitudinal section design, the maps of the students of the first to the fourth year of training were compared with each other and with an expert map (the expert model) of experienced therapists. Results: The discrepancies of the trainee maps compared with each other and with the expert map significantly decreased with increasing training level. Conclusions: The convergence of the students’ maps towards the expert model indicates that the structural knowledge about mental disorders of experienced therapists can also be found to be emerging in psychotherapy students. This finding supports the validity of the expert model and may reflect a general knowledge-structuring principle of the mental disorders. In spite of the statistical significance found, in view of the small number of participants in the third and fourth years of training, the results should be treated with caution and should be regarded as first indicators which need further confirmation.

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