Diagnostic heterogeneity in psychiatry: towards an empirical solution
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COMMENTARY
Open Access
Diagnostic heterogeneity in psychiatry: towards an empirical solution Klaas J Wardenaar and Peter de Jonge*
Abstract The launch of the 5th version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has sparked a debate about the current approach to psychiatric classification. The most basic and enduring problem of the DSM is that its classifications are heterogeneous clinical descriptions rather than valid diagnoses, which hampers scientific progress. Therefore, more homogeneous evidence-based diagnostic entities should be developed. To this end, data-driven techniques, such as latent class- and factor analyses, have already been widely applied. However, these techniques are insufficient to account for all relevant levels of heterogeneity, among real-life individuals. There is heterogeneity across persons (p:for example, subgroups), across symptoms (s:for example, symptom dimensions) and over time (t:for example, course-trajectories) and these cannot be regarded separately. Psychiatry should upgrade to techniques that can analyze multi-mode (p-by-s-by-t) data and can incorporate all of these levels at the same time to identify optimal homogeneous subgroups (for example, groups with similar profiles/connectivity of symptomatology and similar course). For these purposes, Multimode Principal Component Analysis and (Mixture)-Graphical Modeling may be promising techniques. Keywords: DSM-5, Heterogeneity, Data-driven techniques, Cattell’s cube
Introduction With the launch of the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the debate about current psychiatric diagnostics has come into the limelight again, focusing on specific alterations in the DSM-5, such as the deletion of pervasive developmental disorder not otherwise specified (PDD-NOS) and Asperger’s Disorder [1,2] and the inclusion of mourning in major depressive disorder (MDD). However, more fundamental topics,such as the medicalization of normal behavior [3] and the categorical approach to continuous phenomena, are also debated [4]. Perhaps the most important criticism of the DSM-5 regards the poor validity of its classification. Several researchers have even stressed that the DSM-5 hampers research into the underlying mechanisms in the etiology of psychopathology and that the current state of affairs is one of scientific stagnation [5]. We argue that the development of more valid psychiatric classifications is important in * Correspondence: [email protected] Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, Groningen 9713 GZ, The Netherlands
order to link mental states to specific causes in scientific research, and that this process should be evidence-based. Decreasing the amount of diagnostic heterogeneity is central in this process. The problem of diagnostic heterogeneity
Current psychopathological concepts are heterogeneous by def
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