In this article, we examine how symptoms are conceptualized in theories of psychopathology. We identify five questions that need to be asked about symptoms, including what kind of constructs they are, how we should describe them, and what causal explanations they support. We then examine how three different theoretical frameworks address these questions: the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the symptom-network-modeling approach, and the Cambridge model of symptom formation. We show that the assumptions these frameworks make affect the kinds of theoretical models they support and the research approaches they advocate. When symptoms are viewed as empirical observations, the focus of inquiry is directed elsewhere. However, when symptoms are understood as complex constructs in their own right, that are themselves built on certain theoretical assumptions, then understanding them becomes crucial to theoretical progress. We conclude by calling for greater focus on research that unpacks the constructs underlying symptoms.
Clinical reasoning is one of the central components of psychological assessment. The identification of a client's psychological difficulties and the subsequent depiction of their onset, development, and interrelationships enables clinicians to plan treatment in a systematic and effective manner. In an article (Ward, Vertue, & Haig, 1999), we outlined the abductive theory of method (ATOM) and argued that it offered a useful framework for highlighting and integrating the major phases of psychological assessment. These phases involve detecting clinical phenomena, postulating psychological mechanisms, developing a case formulation, and evaluating a case formulation. In this article we present a revised version of the adaptation of ATOM and elaborate on the related clinical dimensions of assessment.
In the field of psychopathology there is still a lack of consensus on how mental disorders, such as depression, should be classified and explained. Many of our current classifications suffer from disorder heterogeneity and are conceptually vague. While some researchers have argued that mental disorders are better explained from a biological perspective, others have made the case for pluralistic and integrative explanations. Using depression as an extended example, we explore the challenges in classifying and explaining psychopathology. We begin by evaluating the current approaches to classification, including frameworks for what we consider a mental disorder. This is followed by a detailed summary of current explanatory perspectives in psychiatry. The relationship between classification and explanation presents unique theoretical challenges in understanding mental disorders. We suggest that by adjusting our focus from understanding syndromes to clinical phenomena we can advance our understanding of mental disorders.
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