Diagnostic threshold considerations for DSM-5

Darrel A. Regier

in Philosophical Issues in Psychiatry II

Published on behalf of Oxford University Press

Published in print April 2012 | ISBN: 9780199642205
Published online February 2013 | e-ISBN: 9780191754777 | DOI:

Series: International Perspectives in Philosophy & Psychiatry

Diagnostic threshold considerations for DSM-5

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In summary, members of the DSM-5 Task Force are acutely aware of the broader social impact of mental disorder definitions—beyond their use for clinical decision-making and for facilitating research studies. However, we are also aware that advances in our understanding of these disorders will only occur if the definitions and diagnostic criteria for these disorders are constructed to facilitate their testing as scientific hypotheses. Since the broad definition in DSM-IV and in the Stein revision (Stein et al. 2010) are almost impossible to test, most of our efforts will focus on the individual diagnostic criteria and dimensional measurements that permit better assessments of the thresholds between normal and pathological states. As Jablensky has so aptly pointed out in his remarkable history of “the nosological entity in psychiatry,” even Kraepelin in his later publications moved decisively from a strict categorical to a dimensional approach to comprehend the essential nature of psychopathology (Jablensky, Chapter 5, this volume). Although we are guided by current diagnostic boundaries, we are deliberately collecting information from 12 psychological domains that will allow us to characterize patient presentations better than the current criteria—where “Not Otherwise Specified” is often the norm. In collecting such information, we will see if new syndromes emerge from this “bottom-up” empirical approach. Hence, both the syndrome categories and more quantitative thresholds can be tested to determine whether they can differentiate between normal and pathological functioning, thereby suggesting revisions for DSM-5.1.

Chapter.  6398 words. 

Subjects: Psychiatry

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