Why the clinical utility of diagnostic categories in psychiatry is intrinsically limited and how we can use new approaches to complement them

Maj, Mario

doi:10.1002/wps.20512

Cited by 79 publications

(74 citation statements)

References 9 publications

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“…It is grounded more in rediscoveries than true innovations, and it is demonstrably affected by conceptual biases. Medicine has always worked by a gradual evolutionary evidence‐based process and, before rejecting time‐tested and progressively refined concepts that are rooted in clinical tradition, a reliable and valid alternative is needed.…”

Section: Discussionmentioning

confidence: 99%

“…To date, transdiagnostic approaches have not delivered the substantial empirical clinical “meat” required for them to represent a credible paradigm shift. The risk of an acritical endorsement of transdiagnostic approaches would be to throw the baby out with the bathwater and be lost in a controversial mare magnum of diagnostic uncertainty that may be deleterious for patients and clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…Since its inception, psychiatric nosology has always been under fire. This is documented by several lines of evidence, including two recent issues of this journal. Although current diagnostic categories have demonstrated moderate to almost perfect reliability, their usefulness has remained questionable.…”

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confidence: 99%

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Transdiagnostic psychiatry: a systematic review

et al. 2019

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The usefulness of current psychiatric classification, which is based on ICD/DSM categorical diagnoses, remains questionable. A promising alternative has been put forward as the "transdiagnostic" approach. This is expected to cut across existing categorical diagnoses and go beyond them, to improve the way we classify and treat mental disorders. This systematic review explores whether self-defining transdiagnostic research meets such high expectations. A multi-step Web of Science literature search was performed according to an a priori protocol, to identify all studies that used the word "transdiagnostic" in their title, up to May 5, 2018. Empirical variables which indexed core characteristics were extracted, complemented by a bibliometric and conceptual analysis. A total of 111 studies were included. Most studies were investigating interventions, followed by cognition and psychological processes, and neuroscientific topics. Their samples ranged from 15 to 91,199 (median 148) participants, with a mean age from 10 to more than 60 (median 33) years. There were several methodological inconsistencies relating to the definition of the gold standard (DSM/ICD diagnoses), of the outcome measures and of the transdiagnostic approach. The quality of the studies was generally low and only a few findings were externally replicated. The majority of studies tested transdiagnostic features cutting across different diagnoses, and only a few tested new classification systems beyond the existing diagnoses. About one fifth of the studies were not transdiagnostic at all, because they investigated symptoms and not disorders, a single disorder, or because there was no diagnostic information. The bibliometric analysis revealed that transdiagnostic research largely restricted its focus to anxiety and depressive disorders. The conceptual analysis showed that transdiagnostic research is grounded more on rediscoveries than on true innovations, and that it is affected by some conceptual biases. To date, transdiagnostic approaches have not delivered a credible paradigm shift that can impact classification and clinical care. Practical "TRANSD"iagnostic recommendations are proposed here to guide future research in this field.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Transdiagnostic psychiatry: a systematic review

et al. 2019

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“…Krueger & Eaton [4]). Despite the existing criticism of practical issues related to a dimensional approach [5], based on growing evidence, the HiTOP model assumes a recent and scientifically prominent position when investigating PD measures, although empirical evidence is scant [6,7]. With this study, we intend to operationalize the subfactors and respective maladaptive traits proposed by the HiTOP to assessing borderline personality disorder (BPD), while adding data on the utility and adequacy of the HiTOP system.…”

Section: Introductionmentioning

confidence: 99%

Assessing borderline personality disorder based on the Hierarchical Taxonomy of Psychopathology (HiTOP): Dimensional Clinical Personality Inventory 2 – BPD

Carvalho¹,

Pianowski²,

Bacciotti³

et al. 2018

Arch Psych Psych

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A new approach to mental disorder taxonomy was recently proposed, the Hierarchical Taxonomy of Psychopathology (HiTOP). The aim of this study was to develop a specific version of the Dimensional Clinical Personality Inventory 2 (IDCP-2), a self-reported measure developed in Brazil for use in pathological personality traits assessment, focused on the assessment of traits related to BPD in accordance with the HiTOP model. In step 1 we developed new factors to cover all traits of BPD according to HiTOP. In step 2, data were collected from 207 adults from the community (N = 207; M age = 35.9). Participants completed the developed measure (IDCP Borderline Personality Disorder Scale; IDCP-BPD), and selected factors from IDCP-2, PID-5, FFBI and FFHI. Exploratory structural equation modeling (E-SEM) suggested a 3-factors solution for the grouping of the fifteen factors of the IDCP-BPD.Factors and total score reliability was good. Correlations between IDCP-BPD factors and external measures were coherent, corroborating our expectations. The bootstrap two-sample t-test comparing the healthy and pathological groups suggested good discrimination capacity of the IDCP-BPD factors, mainly the Fragility and Impotence feelings factors. Favorable evidence was found for the use of IDCP-BPD to BPD traits measurement. The new factors extend the coverage of IDCP-2 in measuring BPD symptoms. Correlations suggest that IDCP-BPD factors measure the traits considered as relevant according to HiTOP. Discriminant capacity of the factors also supports the use of the measure, although future studies must replicate this in samples composed of BPD patients. personality disorders, differential diagnosis, emotional instability, psychological assessment

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“…During the last few decades, psychiatry has developed considerably, also owing to neuroscientific advances. These developments, however, have uncovered a multitude of complexities, reflected for example in current controversies over psychiatric classification. The bar for conceptual sophistication by which psychiatry has to account for these complexities theoretically and clinically has consequently raised.…”

mentioning

confidence: 99%