What is the difference between categorical and dimensional diagnosis in DSM
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P-960 - Dimensional approach vs. categorical approach in psychiatric diagnosis: historical and epistemological aspects
Author links open overlay panelC.WidakowichP.HubainP.F.JurystaP.P.Linkowski Show
ShareShare Cited ByCite https://doi.org/10.1016/S0924-9338(12)75127-1Get rights and content BackgroundThe methodological opposition between the categorical approach and the dimensional approach appears as the main issue for the reorganization of current psychiatric knowledge. After a period exclusively marked by the categorical approach, the dimensional method comes back today complementarily with spectral models, anticipating the development of the future DSM V, scheduled for 2013. MethodologyIn this abstract, we browse the interaction between these two approaches in the construction of our nosographic from Pinel and Kraepelin to nowadays spectral classifications. Both approaches are compared in an epistemological way, with its pros and cons. ResultsHistorical perspective shows how psychiatry begins with categorical classification, which is later replace by dimension taxonomy, since second decade of XX century. Most symptoms are dimensional in nature, and can be transformed into a category by setting a cutoff point. Now, after excessive classification and clinical reductionism applied since DSM III, dimensional approach is emerging to propose a more sensible description about mental disorders. Dimensional approach advantages are a certain facility to explore interpersonal differences without artificial cut-offs, and clinical flexibility. A principal disadvantage is the multiplicity of proposed dimensions, without consensus between different theories. In the other hand, categorical method is familiar to us, and is based on solid clinical empirical data. By the way, clinicians say “the more they know their patients, the more they find it difficult to insert them into a category”, the map is not the territory. ConclusionBoth approaches must coexist, being each one complementary to each order. References (0)
Research article Comprehensive Psychiatry, Volume 65, 2016, pp. 57-62 Show abstractNavigate Down Published data suggest that cannabis use is associated with several negative consequences for individuals with bipolar disorder (BD), including new manic episode onset, psychosis, and functional disability. Yet much less is known about cannabis use disorders (CUDs) in this population, especially in more acutely symptomatic groups. To evaluate correlates of CUD comorbidity in BD, a retrospective chart review was conducted for 230 adult patients with bipolar I disorder (BDI) who were admitted to a university-affiliated private psychiatric hospital. Using a computer algorithm, a hospital administrator extracted relevant demographic and clinical data from the electronic medical record for analysis. Thirty-six (16%) had a comorbid CUD. CUD comorbidity was significantly associated with younger age, manic/mixed episode polarity, presence of psychotic features, and comorbid nicotine dependence, alcohol use disorder (AUD), and other substance use disorders, but was associated with decreased likelihood of anxiety disorder comorbidity. With the exception of manic/mixed polarity and AUD comorbidity, results from multivariate analyses controlling for the presence of other SUDs were consistent with univariate findings. Patients with BD and comorbid CUDs appear to be a complex population with need for enhanced clinical monitoring. Given increasing public acceptance of cannabis use, and the limited availability of evidenced-based interventions targeted toward CUDs in BD, psychoeducation and other treatment development efforts appear to be warranted. Research article Journal of Psychosomatic Research, Volume 75, Issue 2, 2013, pp. 167-172 Show abstractNavigate Down Several authors proposed a shortened version of the State scale of the State-Trait Anxiety Inventory (S-STAI) to obtain a more efficient measurement instrument. Psychometric theory shows that test shortening makes a total score more vulnerable to measurement error, and this may result in inaccurate and biased research results and an increased risk of making incorrect decisions about individuals. This study investigated whether the reliability and the measurement precision of shortened versions of the S-STAI are adequate for psychological research and making decisions about individuals in clinical practice. Secondary data analysis was used to compare reliability and measurement precision between twelve shortened S-STAI versions and the full-length 20-item S-STAI version. Data for the 20-item version came from a longitudinal study performed previously in the Netherlands and included 377 patients and 375 of their family members. This was our master data set. A literature study was conducted to identify shortened S-STAI versions that are used in research and clinical practice. Data for each shortened version were obtained from the master data set by selecting the relevant items from the 20-item version. All analyses were done by means of classical test theory statistics. The effect of test shortening on total-score reliability was small, the effect on measurement precision was large, and the effect on individual diagnosis and assessment of individual change was ambiguous. We conclude that shortened versions of the S-STAI seem to be acceptable for research purposes, but may be problematic in clinical practice. Research article Surgery for Obesity and Related Diseases, Volume 15, Issue 7, 2019, pp. 1182-1188 Show abstractNavigate Down Bariatric surgery continues to be the most effective long-term treatment for obesity and its associated co-morbidities. Despite the benefits, not all patients may repeat the decision to undergo bariatric surgery based on their postoperative experience (postdecision dissonance). In this study, we explore the predictors of postdecision dissonance following bariatric surgery. Accredited bariatric center at an academic medical center. Patients at an accredited Bariatric Center who underwent bariatric surgery between 2011 and 2017 were surveyed to determine factors predictive of postdecision dissonance, as well as expectations, well-being, and overall satisfaction. A total of 591 patients were sent surveys, of whom 184 (31.1%) responded. Of the 184 responders, 20 (10.9%) patients would not choose to undergo bariatric surgery if they had it do to over again (postdecision dissonance). There was no difference in the time since surgery, age, sex, or type of bariatric surgery among groups. Dissonant patients were less likely to be married and privately insured. Dissonant patients were more likely to feel they had inadequate preoperative education on postoperative expectations (P < .001). These patients also had significantly greater postoperative weight regain, failed weight loss expectations, depression, and dissatisfied body image. Postdecision dissonance is driven in part by a patient’s perceived inadequacy of preoperative preparation for postoperative outcomes coupled with postoperative weight regain, depression, dissatisfied body image, and failed weight loss expectations. This highlights the importance of preoperative counseling on managing expectations and outcomes after surgery, as well as the need for continued postoperative engagement with a bariatric program to address weight regain and provide mental health support. Research article Journal of the American Academy of Child & Adolescent Psychiatry, Volume 54, Issue 8, 2015, pp. 626-634 Show abstractNavigate Down The importance of dimensional approaches is widely recognized, but an empirical base for clinical application is lacking. This is particularly true for irritability, a dimensional phenotype that cuts across many areas of psychopathology and manifests early in life. We examine longitudinal, dimensional patterns of irritability and their clinical import in early childhood. Irritability was assessed longitudinally over an average of 16 months in a clinically enriched, diverse community sample of preschoolers (N = 497; mean = 4.2 years; SD = 0.8). Using the Temper Loss scale of the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) as a developmentally sensitive indicator of early childhood irritability, we examined its convergent/divergent, clinical, and incremental predictive validity, and modeled its linear and nonlinear associations with clinical risk. The Temper Loss scale demonstrated convergent and divergent validity to child and maternal factors. In multivariate analyses, Temper Loss predicted mood (separation anxiety disorder [SAD], generalized anxiety disorder [GAD], and depression/dysthymia), disruptive (oppositional defiant disorder [ODD], attention-deficit/hyperactivity disorder [ADHD], and conduct disorder [CD]) symptoms. Preschoolers with even mildly elevated Temper Loss scale scores showed substantially increased risk of symptoms and disorders. For ODD, GAD, SAD, and depression, increases in Temper Loss scale scores at the higher end of the dimension had a greater impact on symptoms relative to increases at the lower end. Temper Loss scale scores also showed incremental validity over DSM-IV disorders in predicting subsequent impairment. Finally, accounting for the substantial heterogeneity in longitudinal patterns of Temper Loss significantly improved prediction of mood and disruptive symptoms. Dimensional, longitudinal characterization of irritability informs clinical prediction. A vital next step will be empirically generating parameters for the incorporation of dimensional information into clinical decision-making with reasonable certainty. Research article Depression, posttraumatic stress disorder (PTSD) and their comorbidity: Implications of adversity amongst young women living in informal settlements in Durban, South AfricaJournal of Affective Disorders Reports, Volume 1, 2020, Article 100022 Show abstractNavigate Down Informal settlements have high rates of poor mental health, yet little research has looked at PTSD-depression co-occurrence in these settings. We investigated the prevalence of depression, PTSD, and comorbid PTSD-depression amongst a non-clinical sample of 18–30 year old women, in informal settlements in South Africa. Cross-sectional analysis of self-selecting young women, enrolled at baseline of an intervention trial. We assessed the occurrence of depression, PTSD and co-occurring PTSD and depression, and used multinomial and logistic regressions to assess risk factors for these. Depression, PTSD and comorbid PTSD-depression were reported by 45.2%, 21.0% and 18.6% of the women respectively. Depression was associated with social group membership (ß -0.74, p = 0.022), food insecurity (ß. 0.97, p = 0.001), stress related to lack of work (ß 0.61, p = 0.022), childhood traumas (ß 0.07, p = 0.004), IPV (ß 0.58, p = 0.007), other lifetime traumas (ß 0.51, p = 0.021) and alcohol misuse (ß 0.04, p = 0.002). Comorbid PTSD-depression was associated with social group membership (ß -0.73, p = 0.008), lack of work stress (ß 1.13, p = 0.009), disability (ß 0.99, p = 0.002), childhood traumas (ß 0.19, p <0.001), alcohol misuse (ß 0.05, p = 0.036) and other lifetime traumas (ß 1.32, p <0.001). Differentiating depression and comorbid PTSD-depression were disability (adj.OR 2.20, p = 0.013), childhood traumas (adj.OR 1.13, p <0.001) and other lifetime traumas (adj.OR 2.44, p = 0.012). This was a cross-sectional study, limiting delineation of the direction of associations. Findings cannot be generalised as the study was non-representative. Findings motivate for trauma informed mental health interventions. Potential for group-based interventions is indicated. Research article Child and adolescent changes to DSM-5Asian Journal of Psychiatry, Volume 11, 2014, pp. 87-92 Show abstractNavigate Down To describe child and adolescent changes to the DSM-5 and discuss controversial changes. Relevant changes to the structure and categorization of DSM-5 childhood conditions are examined, and controversial issues noted. Important overlaps between a number of new conditions are described, and questions raised in relation to underlying assumptions about some new categories. Further research is required to determine the validity of new conditions, and the clinical and service effects of structural changes, particularly in respect of overlapping disorders, and categorical vs severity descriptors. Is the DSM categorical or dimensional?To ensure DSM-5 is not overly disruptive to clinical practice, its spectrum measures are compatible with categorical definitions. The new edition combines the best of both categorical and dimensional ap- proaches to provide better guidance to clinicians and, as a consequence better treatment to patients.
Is DSM 4 categorical or dimensional?Results: The DSM-IV 3-point dimensional convention was more strongly associated with measures of psychosocial morbidity than was categorical diagnosis.
Does the DSM think of disorders using a categorical or dimensional model?The DSM-5, in a section on “Emerging Measures and Models,” also includes an alternative model of personality disorders that takes a hybrid, dimensional-categorical approach [2] and addresses many of these problems.
What is the categorical approach to diagnosis?The categorical approach is essentially how we approach physical illness. Each possible diagnosis represents a category of illness, and clinicians try to figure out which one the symptoms belong to.
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