Classificatory Models Essay

315 WordsMay 23, 20152 Pages
Defenders of the strict categorical model argue that mental disorders can be divided into a set of separate disorders that are mutually exclusive yet jointly exhaustive. Unfortunately, this apparently simple requirement is impossible to achieve, since there is great overlap between the various syndromes of disorder (see, for example, Kessler 1996, 2005). There are three possible solutions to this problem: hierarchical categories, multiple ‘comorbid’ categories and dimensions of disorder. The first model arranges disorders in a hierarchy, with organic disorders at the top, then the major psychoses, with ‘neuroses’ and personality disorders at the bottom, and assigns a sick individual to the highest level achieved. At each higher level it is possible for lower-order diagnoses to be present – thus bipolar disorder and schizophrenia trump disorders such as depressive episode and panic disorder, whereas organic symptoms trump the psychoses (Wing 1974; Foulds 1976). This model depends on a clear distinction between psychoses and neuroses, and cannot deal with the fact that lower-order symptoms are not always present. The hierarchical system began to be modified in the revised version of DSM–III (DSM–III–R, 1987) and was largely abandoned in DSM–IV (1994), where the prevailing conventional wisdom is to make multiple categorical diagnoses. The DSM system is arranged in 16 chapters (Box 1⇓), and the ICD system in 10 (Box 2⇓), with symptom similarity being the main criterion for each chapter. The downside of this model is that there is no upper limit to the number of possible categories: sometimes an additional symptom triggers the new concept – so flashbacks following a traumatic event distinguish post-traumatic stress disorder (PTSD) from anxious depression, despite the fact that they also share the same basic set of symptoms. Separate categories can also be justified

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