Week 2: DSM Reactions

I want to discuss two issues in this blog. The first is whether researchers should focus on psychological phenomena or psychiatric diagnoses and the second is whether clinicians should use categorical or dimensional diagnoses. For both issues, I believe BOTH aspects are equally important and BOTH need to be researched/used.

When few empirical studies have been done on a specific psychological phenomenon, I agree with Persons’ (1986) view that researchers should attempt to focus their research on the phenomenon rather than psychiatric diagnoses. However, I believe that this should only be the first step in a two step process. Once a solid foundation of empirical studies has accumulated on the phenomenon and multiple theories have been formulated and tested, the logical next step would be to study the theories created IN specific psychiatric disorders. As Persons’ noted, it is much easier to develop theories about specific psychological processes of symptoms rather than develop theories to explain the psychological processes that lead to psychiatric disorders. As a result, it makes sense to study the symptom specifically as a first step. However, is it valid to generalize theories focusing on only one symptom to people with diagnosed disorders? For instance, if a researcher is looking at loosening of associations, the researcher may have subjects who would fall in many different diagnostic categories. Although the researcher will be more likely to learn about possible etiological aspects of the loosening of associations, there will be no evidence to show that what is found will generalize to subjects who suffer from loosening of associations AND have been diagnosed with schizophrenia. It is possible that the loosening of associations common to schizophrenics might actually be very different from the loosening of associations common to other disorders. It is integral for researchers to look at the symptoms within specific diagnostic categories once theories have been tested on the symptoms alone.

Although I planned to only discuss the Persons' article, I decided I wanted to mention a quick thought on categorical vs. dimensional diagnoses. In both Widiger and Clark's (2000) and Allen's (1998) articles, the proposal to use dimensional diagnoses instead of categorical diagnoses was proposed. If this proposal was taken seriously, I think it would be a ridiculous loss (or perhaps waste) of solid past research on categorical diagnoses. I think the idea of using dimensional diagnoses has a lot to offer (it lacks arbitrary cutoffs and it has the possibility of giving more information than categorical diagnoses), but I do not think it should completely replace the use of categorical diagnoses. In my opinion, psychologists should use both dimensional and categorical diagnoses. Otto Kernberg proposed a dimensional model in which people are rated on a scale of Range I to Range V (I is normal, II is neurotic, III is upper level borderline, IV is lower level borderline, and V is psychotic). This scale takes a more universal approach to diagnosis (similar to Axis V of the multiaxial diagnoses) and it provides useful information about people than cannot be obtained from a categorical diagnosis alone. A Range IV anorexic patient is qualitatively different from a Range V anorexic patient: a Range V would have poorer reality testing and worse social reality testing, among other issues. However, if only the categorical diagnosis was used, the two anorexics would seem deceivingly similar. I believe it is important to integrate new methods of diagnosis into current methods, rather than simply choosing one or the other.