Symptom Descriptions in Psychopathology: How Well Are They Working for Us?

Abstract

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.

The Explanation of Disordered Eating: A Metatheoretical Approach

“…In some cases, they may be signs and symptoms as currently conceptualised, such as "anhedonia" or "binge eating". However, given the ambiguity and disagreement surrounding what exactly constitutes a "symptom" or a "sign" (see Wilshire et al, 2021), 14 these may in other cases be collections or "complexes" of these constructs that represent reliable patterns of behaviour, cognition, and emotion identified within psychopathology (such as the B-P cycle; Nielsen & Ward, 2020a). Such phenomena are more empirically valid and less heterogeneous than DSM syndromes.…”

“…At present, the phenomena that psychopathologists seek to understand are "thinly" described, most often consisting of sets of diagnostic criteria that invoke vaguely defined constructs, such as "body dissatisfaction". This lack of description has arguably contributed to our current poor understanding of psychopathological signs and symptoms (see Wilshire & Ward, 2021)…”

“…Several theorists argue that, to move forward, psychological explanation should, at least for now, focus on symptoms and signs (clinical phenomena) rather than syndromes (Berrios, 2013;Borsboom, 2017;Costello, 1992;Fried & Nesse, 2015;Mojtabai & Rieder, 1998;Ward & Clack, 2019;Wilshire et al, 2021). For instance, instead of trying to describe and explain the syndrome of BN, which comprises a cluster of diverse symptoms, one might instead focus on a single symptom of ED pathology, such as "binge eating".…”

“…However, they are generally agnostic about how the phenomenon should be taxonomically organised. Nevertheless, because of their informational value, compositional explanations are highly useful for those aiming to develop taxonomies of mental disorder (Wilshire et al, 2021). Their rich description of the constitution of a presentation or specific symptom may help to signal connections between certain disorder states or psychopathological phenomena, and thereby suggest novel ways of considering and grouping them.…”

“…• The philosophies of evidence-based practice (Howick, 2011;Spring & Neville, 2011) and science-informed practice (Ward & Wilshire, 2021).…”