Descriptive Psychopathology: The Signs and Symptoms of ...

6 Section 1: Present, past, and futureTable 1.1. Problems in present classificationProblemReliability is weakEncourages false positives and falsenegatives with over-inclusivediagnostic criteriaOffers false choicesOmits or marginalizes establishedsyndromesDiagnostic criteria are poorlydefinedChecklist format limits meaningfulexaminationOmits important discriminatingpsychopathologyClaiming theory neutrality,it avoids neuroscience andlaboratory criteriaLongitudinal criteria are not usedEffectThe “claim to fame” of recent DSM iterations is highreliability. Weak reliability insures idiosyncraticdiagnosisSome conditions are over-diagnosed (e.g. depression)resulting in false positives, research sampleheterogeneity, and unneeded or dangerous treatmentfor patients. Some conditions are not recognized(e.g. catatonia), resulting in false negatives andinappropriate treatmentFalse choices lead to the prescription of inappropriatetreatments. Conditions such as schizophreniformhave no validity. Dissociation, a symptom, is treatedas a disease. Abnormal bereavement and puerperaldepressions are given separate statusCatatonia is incorrectly linked to psychotic disorders,melancholia is reduced to a modifying term, thedifferent frontal lobe syndromes are not includedTerms such as “disorganized speech” encouragemisdiagnosis (e.g. misidentifying a fluent aphasia asflight-of-ideas or formal thought disorder)Items are incorrectly given equal weight. Type of illnessonset, sequence of symptom emergence, and patternsof features are mostly ignored, resulting in misdiagnosisPsychopathology associated with neurologic syndromes(e.g. psychosensory features and seizure disorder)are not mentioned, resulting in illnesses goingunrecognizedPatterns of features that indicate the involvement ofa specific brain region or system are not included(e.g. features indicating right hemisphere disease).Laboratory assessments are not included as helpfulcriteria (e.g. hypothalamic pituitary functioning indepressive illness, CPK levels and response tolorazepam in catatonia)The pre-psychosis findings in schizophrenia are ignored,resulting in the over-diagnosis of the condition andresearch sample heterogeneity. The dimensional traitsof personality are ignored, resulting in poor reliabilityand validity for the personality disorders