TY - JOUR
T1 - Three Approaches to Understanding and Classifying Mental Disorder
T2 - ICD-11, DSM-5, and the National Institute of Mental Health’s Research Domain Criteria (RDoC)
AU - Clark, Lee Anna
AU - Cuthbert, Bruce
AU - Lewis-Fernández, Roberto
AU - Narrow, William E.
AU - Reed, Geoffrey M.
N1 - Funding Information:
DSM-III diagnoses quickly became the standard for research funded by U.S. federal agencies, particularly NIMH, and for use in testing new drugs for approval and regulation by the U.S. Food and Drug Administration. Starting in the early 1980s, research based on DSM-III diagnoses led to a proliferation of new findings on multiple aspects of mental disorders including prevalence, course of illness, genetics, and many others. In addition to providing considerable evidence supporting the new approach to diagnosis, this research also revealed a number of inconsistencies and unclear or invalid criteria in the manual, so work on a fairly extensive revision began within a few years, resulting in the publication of the volume’s revised third edition, the DSM-III-R (APA, 1987).
Publisher Copyright:
© 2017, © The Author(s) 2017.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - The diagnosis of mental disorder initially appears relatively straightforward: Patients present with symptoms or visible signs of illness; health professionals make diagnoses based primarily on these symptoms and signs; and they prescribe medication, psychotherapy, or both, accordingly. However, despite a dramatic expansion of knowledge about mental disorders during the past half century, understanding of their components and processes remains rudimentary. We provide histories and descriptions of three systems with different purposes relevant to understanding and classifying mental disorder. Two major diagnostic manuals—the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders—provide classification systems relevant to public health, clinical diagnosis, service provision, and specific research applications, the former internationally and the latter primarily for the United States. In contrast, the National Institute of Mental Health’s Research Domain Criteria provides a framework that emphasizes integration of basic behavioral and neuroscience research to deepen the understanding of mental disorder. We identify four key issues that present challenges to understanding and classifying mental disorder: etiology, including the multiple causality of mental disorder; whether the relevant phenomena are discrete categories or dimensions; thresholds, which set the boundaries between disorder and nondisorder; and comorbidity, the fact that individuals with mental illness often meet diagnostic requirements for multiple conditions. We discuss how the three systems’ approaches to these key issues correspond or diverge as a result of their different histories, purposes, and constituencies. Although the systems have varying degrees of overlap and distinguishing features, they share the goal of reducing the burden of suffering due to mental disorder.
AB - The diagnosis of mental disorder initially appears relatively straightforward: Patients present with symptoms or visible signs of illness; health professionals make diagnoses based primarily on these symptoms and signs; and they prescribe medication, psychotherapy, or both, accordingly. However, despite a dramatic expansion of knowledge about mental disorders during the past half century, understanding of their components and processes remains rudimentary. We provide histories and descriptions of three systems with different purposes relevant to understanding and classifying mental disorder. Two major diagnostic manuals—the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders—provide classification systems relevant to public health, clinical diagnosis, service provision, and specific research applications, the former internationally and the latter primarily for the United States. In contrast, the National Institute of Mental Health’s Research Domain Criteria provides a framework that emphasizes integration of basic behavioral and neuroscience research to deepen the understanding of mental disorder. We identify four key issues that present challenges to understanding and classifying mental disorder: etiology, including the multiple causality of mental disorder; whether the relevant phenomena are discrete categories or dimensions; thresholds, which set the boundaries between disorder and nondisorder; and comorbidity, the fact that individuals with mental illness often meet diagnostic requirements for multiple conditions. We discuss how the three systems’ approaches to these key issues correspond or diverge as a result of their different histories, purposes, and constituencies. Although the systems have varying degrees of overlap and distinguishing features, they share the goal of reducing the burden of suffering due to mental disorder.
KW - DSM
KW - Diagnostic and Statistical Manual of Mental Disorders
KW - ICD
KW - International Classification of Diseases
KW - RDoC
KW - Research Domain Criteria
KW - classification
KW - diagnosis
KW - mental disorder
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U2 - 10.1177/1529100617727266
DO - 10.1177/1529100617727266
M3 - Article
C2 - 29211974
AN - SCOPUS:85037975442
SN - 1529-1006
VL - 18
SP - 72
EP - 145
JO - Psychological Science in the Public Interest
JF - Psychological Science in the Public Interest
IS - 2
ER -