Structural validity and the classification of mental disorders

Krueger, Robert F.; Eaton, Nicholas R.

doi:10.1093/med/9780199642205.003.0029

Cited by 8 publications

(19 citation statements)

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“…In contrast, DSM disorders have low construct and structural validity (Krueger & Eaton, 2012); while they are somewhat reliable, they are potentially invalid constructs, as they are neither distinct nor independent from one another (Rodriguez-Seijas, Eaton, & Krueger, 2015). DSM disorder diagnoses are particularly poor measurement indicators for psychopathology because they discard valuable information by collapsing signs and symptoms into dichotomous variables deemed present or absent (Krueger & DeYoung, in press).…”

Section: Part 1: the Case For Moving Beyond Comorbidity As A Focus Inmentioning

confidence: 99%

Beyond comorbidity: Toward a dimensional and hierarchical approach to understanding psychopathology across the life span

Tackett²,

et al. 2016

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In this review, we propose a novel developmentally informed framework to push research beyond a focus on comorbidity between discrete diagnostic categories, and to move towards research based on the well-validated dimensional and hierarchical structure of psychopathology. For example, a large body of research speaks to the validity and utility of the Internalizing and Externalizing (IE) spectra as organizing constructs for research on common forms of psychopathology. The IE spectra act as powerful explanatory variables that channel the psychopathological effects of genetic and environmental risk factors, predict adaptive functioning, and account for the likelihood of disorder-level manifestations of psychopathology. As such, our proposed theoretical framework uses the IE spectra as central constructs to guide future psychopathology research across the lifespan. The framework is particularly flexible, as any of the facets or factors from the dimensional and hierarchical structure of psychopathology can form the focus of research. We describe the utility and strengths of this framework for developmental psychopathology in particular, and explore avenues for future research.

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Section: Part 1: the Case For Moving Beyond Comorbidity As A Focus Inmentioning

confidence: 99%

Beyond comorbidity: Toward a dimensional and hierarchical approach to understanding psychopathology across the life span

Tackett²,

et al. 2016

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“…Therefore, approaches focusing only on the predictive validity of psychiatric disorders do not necessarily teach us much about the best way to parse psychopathological phenomena. We should nevertheless also be concerned with the latter if we strive for a scientifically valid psychiatric nosology …”

Section: Reliability and Validitymentioning

confidence: 87%

“…In recent work from the philosophy of psychiatry, this discussion of validity has broadened by incorporating ideas from the validity debate in psychology. As a consequence, different types of “validity” have been considered . Following the psychometric literature, the type of validity most often considered to evaluate psychiatric disorders is predictive (or external, or criterion‐related) validity: it represents the degree to which a test enables successful prediction of external variables.…”

Section: Reliability and Validitymentioning

confidence: 99%

“…This concept has had less influence on the assessment of psychiatric nosologies than on the assessment of psychological instruments. However, as Krueger and Eaton argue, critically thinking about the structural validity of psychiatric nosologies is important if we want to “carve psychopathology at its joints.” Structural validity precisely describes the correlation between a disease concept (eg, depression) and the empirical data that inform the concept. Stated differently, it concerns the question to what extent the diagnostic criteria or the broader organization of mental disorders into the DSM categories reflects how mental disorders and their symptoms occur in the world .…”

Section: Reliability and Validitymentioning

confidence: 99%

“…Note that structural validity also ascribes to realism, albeit a broader and weaker version than the realism underlying the DSM project, as no presuppositions about the organization or character of psychiatric disorders is made. It has been argued that the current psychiatric disease categories do not possess enough structural validity, and this also forms a basic concern of our article.…”

Section: Reliability and Validitymentioning

confidence: 99%

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What to expect from reliability and validity claims? A pragmatic conception of psychiatric nosology

Lefere

Rouck²,

Vreese

2016

Evaluation Clinical Practice

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The reliability and validity of psychiatric diagnoses have always been a major concern. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) reliability field trials yielded ambiguous results, with some diagnostic categories scoring well below par. We argue that the emphasis on the reliability of psychiatric diagnoses, which has dominated psychiatric nosology and guided the endeavor of improving the DSM in its consecutive editions, is misguided and lacks in structural validity. In this article, we defend a pragmatic view on psychiatric disease as the most fruitful approach to an understanding of what the categorical distinctions in the DSM (can) represent. Disorders in the DSM are descriptions of clinical pictures and do not necessarily correspond to an identified pathological substrate. Although this is a logical result of the nature of psychiatric disease, it bears important consequences. The various DSM disease categories are not uniform but should be regarded as representing different kinds of disorders, ranging from a separation from normal behavior based on practical grounds to the discrete kind of disorders envisioned by proponents of a strong realistic view. We argue that the explication of kinds of disorders outlined in this article provides interesting perspectives on the problems of reliability and validity that the DSM faces.

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Internalizing psychopathology and all‐cause mortality: a comparison of transdiagnostic vs. diagnosis‐based risk prediction

et al. 2021

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Previous studies have documented the utility of a transdiagnostic internalizing factor in predicting important future outcomes (e.g., subsequent mental disorder diagnoses). To date, however, no study has investigated whether an internalizing factor predicts mortality risk. Also, while previous studies of mortality risk have emphasized its associations with particular internalizing disorders, no study has assessed how the transdiagnostic internalizing factor vs. disorder‐specific variance differently predict that risk. The primary aims of this study were to explore: a) whether the internalizing factor predicts mortality risk, b) whether particular internalizing psychopathologies uniquely predict mortality risk over and beyond the transdiagnostic internalizing factor, and c) whether there is a significant interaction of internalizing with self‐reported health in the prediction of mortality risk. We utilized a large national sample of American adults from the Midlife in the United States (MIDUS), a longitudinal study that examined midlife development of individuals across multiple waves between 1995 and 2015. Data were analyzed for the 6,329 participants who completed the phone interview and self‐administered questionnaire in MIDUS 1 (1995‐1996) and were then followed up until October 31, 2015 or until death. To investigate the association between internalizing and mortality risk, we used the semi‐parametric proportional hazards Cox model, where survival time was regressed on a latent internalizing factor. Overall findings indicate that a transdiagnostic internalizing factor significantly predicts mortality risk over a 20‐year period (hazard ratio, HR=1.12, 95% CI: 1.05‐1.16, p<0.01) and that internalizing outperforms disorder‐specific variance (e.g., depression‐specific variance) in the prediction of that risk. Further, there was a significant interaction between transdiagnostic internalizing and self‐reported health, whereby internalizing psychopathology had a specific association with early death for individuals with excellent self‐reported health condition (HR=1.50, 95% CI: 1.17‐1.84, p<0.05). This highlights the clinical utility of using the transdiagnostic internalizing factor for prediction of an important future outcome, and supports the argument that internalizing psychopathology can be a meaningful liability to explore in public health practice.

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Structural validity and the classification of mental disorders

Cited by 8 publications

References 0 publications

Beyond comorbidity: Toward a dimensional and hierarchical approach to understanding psychopathology across the life span

Beyond comorbidity: Toward a dimensional and hierarchical approach to understanding psychopathology across the life span

What to expect from reliability and validity claims? A pragmatic conception of psychiatric nosology

Internalizing psychopathology and all‐cause mortality: a comparison of transdiagnostic vs. diagnosis‐based risk prediction

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