Criteria for Assessing a Classification in Psychiatry

Abstract

The diagnostic rubrics of ICD-10 and DSM-IV aim to provide a framework for organising and explaining clinical experience in order to derive predictions about outcome and to guide treatment. However, the term ‘disorder’, as a generic unit of classification, has no clear correspondence with either the concept of disease or the concept of syndrome in medical classifications. Its ambiguous status may hinder the advancement of knowledge through the ‘reification fallacy’ (the tendency to view the ‘disorders’ as quasi-disease entities) and the fragmentation of psychopathology that leads to a proliferation of comorbid diagnoses. Although there is a mounting assumption that most currently recognised psychiatric disorders are not disease entities, this has never been properly demonstrated because studies of the appropriate kind are yet to be designed and conducted. Molecular genetics and neuroscience will play an increasing role in long-range research targeting aetiology and pathogenesis. In the shorter term, there is a strong rationale for reinstating the syndrome as the basic unit of psychiatric classifications. In contemplating future revisions, a set of pragmatic criteria need to be considered, including: validity (in terms of clinical utility and relevance), cognitive ease of use, reliability, applicability across cultures and settings, as well as specific needs of clinicians, users of mental health services, and researchers. It would be premature simply to discard the current categorical entities. Categorical and dimensional models need not be mutually exclusive and mixed or class-quantitative models, which combine qualitative categories with quantitative trait measurements, are becoming increasingly feasible.

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