Nav: Home

Researchers propose new diagnostic model for psychiatric disorders

March 23, 2017

A consortium of 50 psychologists and psychiatrists from around the world has outlined a new diagnostic model for mental illness, in what researchers hope will be a paradigm shift in how these illnesses are classified and diagnosed.

Lee Anna Clark, William J. and Dorothy K. O'Neill Professor and Chair of Psychology, and David Watson, Andrew J. McKenna Family Professor of Psychology at the University of Notre Dame, who both are members of the consortium, say that the current model of diagnosis and classification -- the DSM-5 -- is fundamentally flawed.

"The Diagnostic and Statistical Manual of Mental Disorders (DSM) -- which is overseen and published by the American Psychiatric Association -- currently is the dominant diagnostic model in North America; it also is highly influential around the world," Watson said. Although he and Clark were involved in the revisions for the DSM's fifth edition, he said, "Quite frankly, we were not satisfied with the revisions that were made. We felt that DSM-5 was far too conservative and failed to recognize and incorporate important scientific evidence regarding the nature of psychopathology."

The model the consortium proposes, called the Hierarchical Taxonomy of Psychopathology (HiTOP), addresses these concerns, which are shared by many psychologists and psychiatrists.

The HiTOP model differs from the DSM in two fundamental ways, Watson said. First, although the DSM's categorical nature means that a specific diagnosis is given only if someone meets a specific number of criteria, the HiTOP model allows for not only a diagnosis but also an assessment of its severity.

"If you meet the DSM's diagnostic criteria for major depression, you are diagnosed as being depressed. If you do not meet these criteria, however, then you simply are classified as not depressed," Watson said. "In contrast, HiTOP conceives of psychopathology as being continuous, that is, dimensional in nature."

The advantages of such classification include more personalized and specific treatment, as well as allowing researchers and clinicians to recognize and acknowledge the existence of significant problems that don't currently meet full DSM diagnostic thresholds.

A second major advantage of the HiTOP model is its use of empirical evidence to classify disorders, a change from the DSM's tendency to group disorders based partly on clinical assumptions about which disorders seem to go together. "For example, generalized anxiety disorder, panic disorder and specific phobia all are classified as 'anxiety disorders' in the DSM because they all involve symptoms related to fear and anxiety," Watson said. "In contrast, most people who are diagnosed with general anxiety disorder also meet the criteria for major depression. Consequently, in HiTOP, generalized anxiety disorder is classified as being more similar to major depression than to specific phobia.

"One major advantage of this approach is that it helps to clarify underlying causes and mechanisms. For instance, many of the same vulnerabilities and risk factors have been linked to both major depression and generalized anxiety disorder. So, this model will help us identify the underlying causes of problems more quickly."

Lesser known conditions, such as sleep and bipolar disorders, still need to be classified within the HiTOP model. "Certain aspects of the system are ready to be developed into clinical applications," said Clark, who is a member of a workgroup within the consortium that developed HiTOP exploring its clinical use. "With sufficient background knowledge, it can be used clinically immediately, but it's clear from our discussions that it will take some time to develop HiTOP to the point that it can be widely used clinically -- that is, by clinicians in the community who do not have a research background."

Clark and Watson played a significant role in developing this model. Researchers used several large epidemiological surveys in the United States, Australia, the Netherlands and other countries to gather data about how the most common forms of psychopathology -- such as depression, anxiety, substance abuse and personality disorder -- are related.
-end-
The consortium's paper, "The Hierarchical Taxonomy of Psychopathology (HiTOP): A Dimensional Alternative to Traditional Nosologies," published March 23 in the Journal of Abnormal Psychology, is available online at http://www.apa.org/pubs/journals/features/abn-abn0000258.pdf.

University of Notre Dame

Related Depression Articles:

Tackling depression by changing the way you think
A thought is a thought. It does not reflect reality.
How depression can muddle thinking
Depression is associated with sadness, fatigue and a lack of motivation.
Neuroimaging categorizes 4 depression subtypes
Patients with depression can be categorized into four unique subtypes defined by distinct patterns of abnormal connectivity in the brain, according to new research from Weill Cornell Medicine.
Studies suggest inflammatory cytokines are associated with depression and psychosis, and that anti-cytokine treatment can reduce depression symptoms
Studies presented at this year's International Early Psychosis Association meeting in Milan, Italy, (Oct.
Is depression in parents, grandparents linked to grandchildren's depression?
Having both parents and grandparents with major depressive disorder was associated with higher risk of MDD for grandchildren, which could help identify those who may benefit from early intervention, according to a study published online by JAMA Psychiatry.
Postpartum depression least severe form of depression in mothers
Postpartum depression -- a household term since actress Brooke Shields went public in 2005 about her struggle with it -- is indeed serious.
Tropical Depression 1E dissipates
Tropical Depression 1E or TD1E didn't get far from the time it was born to the time it weakened to a remnant low pressure area along the southwestern coast of Mexico.
Diagnosing depression before it starts
MIT researchers have found that brain scans may identify children who are vulnerable to depression, before symptoms appear.
Men actually recommend getting help for depression
Participants in a national survey read a scenario describing someone who had depressed symptoms.
Depression too often reduced to a checklist of symptoms
How can you tell if someone is depressed? The Diagnostic and Statistical Manual of Mental Disorders (DSM) -- the 'bible' of psychiatry -- diagnoses depression when patients tick off a certain number of symptoms on the DSM checklist.

Related Depression Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...