The Cycle of Classification: <scp>DSM-I</scp> Through <scp>DSM-5</scp>

Blashfield, Roger K.; Keeley, Jared W.; Flanagan, Elizabeth H.; Miles, Shannon R.

doi:10.1146/annurev-clinpsy-032813-153639

Cited by 158 publications

(107 citation statements)

References 108 publications

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“…From the early 1980s, with the introduction of diagnostic manuals based on descriptive and operational criteria [1,2,3,4,5,6,7], the reliability of psychiatric diagnosis has been the focus of much attention and has substantially improved [8]. Those nosographic systems, in fact, have been developed mainly for reliability and ‘objectivity' purposes, virtually excluding any subjective or apparently unmeasurable psychic element.…”

Section: Introductionmentioning

confidence: 99%

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Pallagrosi

Fonzi²,

Picardi³

et al. 2016

Psychopathology

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Background: Classical psychopathology greatly valued the interaction between clinician and patient, and assigned to the clinician's subjective experience a significant role in the diagnostic process. Psychoanalysis, too, ascribed a privileged position to the clinician's feelings and empathic participation in the assessment and deep understanding of the patient. This study aimed at testing the traditional, though still relatively unexplored empirically, tenet that particular diagnostic groups elicit distinct and diagnostically useful reactions from clinicians. Sampling and Methods: The study was performed in several psychiatric inpatient and outpatient units in Rome, Italy. The clinicians completed the Assessment of Clinician's Subjective Experience (ACSE) questionnaire and other standardized assessment instruments when they evaluated a previously unknown patient. All adult patients diagnosed with schizophrenia (n = 119), cluster B personality disorder (n = 114), manic or mixed bipolar I episode (n = 59), and unipolar depression or anxiety disorder (n = 130) were included in the study, for a total of 422 patients evaluated by 35 clinicians. Results: We found a significant and theoretically consistent relationship between the clinicians' pattern of subjective experience during the first visit and patients' clinical diagnoses. Patients with unipolar depression/anxiety showed significantly lower scores than the other groups on all ACSE scales except engagement; patients with schizophrenia displayed significantly higher scores than the other groups on difficulty in attunement, and significantly higher scores than patients with cluster B personality disorder on impotence. Compared with the other groups, the patients with cluster B personality disorder displayed significantly lower scores on engagement, and significantly higher scores on disconfirmation. In multivariate models controlling for patient's age and education, symptom severity, clinician's sex, duration of visit and setting, diagnosis remained a significant predictor of scores on all ACSE scales except for impotence. Conclusions: The main limitations of the study are its reliance on clinical diagnoses and the non-independence of assessments. Further studies based on diagnoses made by a third observer through standardized instruments are needed to provide a most stringent test of the hypothesis that different diagnoses are associated with distinct profiles of clinicians' subjective experience. This study provided intriguing, though preliminary, evidence that the clinician's subjective experience may play a useful role in the diagnostic process. Time may have come to reintroduce the concept of intersubjectivity at the core of the diagnostic process.

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Section: Introductionmentioning

confidence: 99%

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Pallagrosi

Fonzi²,

Picardi³

et al. 2016

Psychopathology

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“…Blashfield and Fuller ( The first author of the current article recently published a review of the DSM editions (Blashfield et al, 2014). Blashfield et al (2014) said that DSM-II had 193 categories (instead of the 159 categories claimed by Blashfield and Fuller).…”

Section: Wikipedia (2015)mentioning

confidence: 98%

“…Blashfield et al (2014) said that DSM-II had 193 categories (instead of the 159 categories claimed by Blashfield and Fuller). Why does this degree of unreliability occur in what seems like a simple task of counting diagnoses?…”

Section: Wikipedia (2015)mentioning

confidence: 99%

Predicting the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition)

Blashfield

Fuller

2016

J Nerv Ment Dis

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Twenty years ago, slightly after the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition was published, we predicted the characteristics of the future Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (). Included in our predictions were how many diagnoses it would contain, the physical size of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition), who its leader would be, how many professionals would be involved in creating it, the revenue generated, and the color of its cover. This article reports on the accuracy of our predictions. Our largest prediction error concerned financial revenue. The earnings growth of the DSM's has been remarkable. Drug company investments, insurance benefits, the financial need of the American Psychiatric Association, and the research grant process are factors that have stimulated the growth of the DSM's. Restoring order and simplicity to the classification of mental disorders will not be a trivial task.

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“…The American Psychological Association (APA) published the first edition of the DSM in 1952 as a standardized way for clinicians to diagnose mental disorders and to improve communication among mental health professionals (Blashfield et al, 2014). The most recent edition of the DSM was published in May 2013 and is the fifth edition (DSM-5).…”

Section: Manual Of Mental Disorders or Dsm This Is The Manual Most Cmentioning

confidence: 99%

A Paradigm Shift: From a Categorical to Dimensional Diagnostic Model of Personality Disorder

Green¹

2015

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This thesis discusses the possibility of a paradigm shift in the conceptualization of personality disorders (PDs), and eventually all psychological disorders, from categorical to dimensional. It examines the three main types of models utilized for diagnosing PDs. These main types are: the categorical model, where symptoms are organized in a check list based on categories; the dimensional model, where symptoms are organized on a spectrum rather than in a list; and the hybrid model, which is a combination of the two. It focuses on the strengths and weaknesses of each model and how they are used to define and diagnose PDs. In conclusion, there are significant gaps in the empirical evidence pertaining to the practical applications of the dimensional and hybrid models, therefore, a change in diagnostic criteria is not yet advised. Only when these gaps have been filled can a paradigmatic shift from a categorical to a dimensional conceptualization of PDs, and eventually all psychological disorders, occur.3

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The Cycle of Classification: DSM-I Through DSM-5

Cited by 158 publications

References 108 publications

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

Predicting the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition)

A Paradigm Shift: From a Categorical to Dimensional Diagnostic Model of Personality Disorder

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