Diagnosis and the DSM

Vanheule, Stijn

doi:10.1057/9781137404688

Cited by 21 publications

(13 citation statements)

References 71 publications

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“…Psychiatry has been criticized at multiple levels, including its difficulties with its diagnostic manuals and their assumptions. It embraces mostly the medical model of disorder and diagnosis, the biocentric model of the causality of disorder, or etiology, and the psychopharmacological model of disorder treatment and management ( 6 – 9 ). Even the basic concept of what constitutes a mental disorder has been disputed.…”

Section: Issuesmentioning

confidence: 99%

“…Similarly, the DSM-5 is a psychiatric classificatory system that aims to include reliable and valid categories of mental disorder with clear causes (etiology), an aspiration that, if realized, would facilitate effective treatment; however, its critics maintain that it fails to achieve its objective [e.g., Ref. ( 6 – 9 )]. Also, in terms of causal explanations, they maintain that it is still steeped in the biocentric model.…”

Section: Issuesmentioning

confidence: 99%

“…According to Vanheule ( 9 ), a diagnostic category needs to be both reliable and valid. For reliability, he noted that the range of kappa results in reliability studies of DSM categories has shifted in the qualitative attribute given to the best results, the next best, and so on.…”

Section: Issuesmentioning

confidence: 99%

“…As for validity, Vanheule ( 9 ) queried whether the DSM-5 accounts well for context and whether its categories apply well to individual cases. He concluded that, rather than symptoms being signs or indices, they should be conceived as personal constructions.…”

Section: Issuesmentioning

confidence: 99%

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Causality in Psychiatry: A Hybrid Symptom Network Construct Model

Young

2015

Front. Psychiatry

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Causality or etiology in psychiatry is marked by standard biomedical, reductionistic models (symptoms reflect the construct involved) that inform approaches to nosology, or classification, such as in the DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; (1)]. However, network approaches to symptom interaction [i.e., symptoms are formative of the construct; e.g., (2), for posttraumatic stress disorder (PTSD)] are being developed that speak to bottom-up processes in mental disorder, in contrast to the typical top-down psychological construct approach. The present article presents a hybrid top-down, bottom-up model of the relationship between symptoms and mental disorder, viewing symptom expression and their causal complex as a reciprocally dynamic system with multiple levels, from lower-order symptoms in interaction to higher-order constructs affecting them. The hybrid model hinges on good understanding of systems theory in which it is embedded, so that the article reviews in depth non-linear dynamical systems theory (NLDST). The article applies the concept of emergent circular causality (3) to symptom development, as well. Conclusions consider that symptoms vary over several dimensions, including: subjectivity; objectivity; conscious motivation effort; and unconscious influences, and the degree to which individual (e.g., meaning) and universal (e.g., causal) processes are involved. The opposition between science and skepticism is a complex one that the article addresses in final comments.

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Section: Issuesmentioning

confidence: 99%

Section: Issuesmentioning

confidence: 99%

Section: Issuesmentioning

confidence: 99%

Section: Issuesmentioning

confidence: 99%

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Causality in Psychiatry: A Hybrid Symptom Network Construct Model

Young

2015

Front. Psychiatry

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“…The term MUS has received a lot of criticism, yet, recent diagnostic ‘improvements’ such as ‘functional somatic syndromes’ or ‘somatic symptom disorder’ in DSM-V still fail to offer a better etiological understanding and framework for therapy. This is especially the case for DSM-V ( Frances, 2014 ; Vanheule, 2014 ; Vanheule et al, 2014 ). Therapeutic tools are not really based on a sound pathophysiological understanding and both pharmacological and non-pharmacological treatment outcomes are often disappointing ( Kleinstäuber et al, 2014 ; Van Dessel et al, 2014 ).…”

Section: Introductionmentioning

confidence: 96%

Touching the Lived Body in Patients with Medically Unexplained Symptoms. How an Integration of Hands-on Bodywork and Body Awareness in Psychotherapy may Help People with Alexithymia

et al. 2016

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Medically unexplained symptoms (MUS) are a considerable presenting problem in general practice. Alexithymia and difficulties with mental elaboration of bodily arousal are hypothesized as a key mechanism in MUS. In turn, this inability influences the embodied being and participating of these patients in the world, which is coined as ‘the lived body’ and underlies what is mostly referred to as body awareness (BA). The present article explores a more innovative hypothesis how hands-on bodywork can influence BA and serve as a rationale for a body integrated psychotherapeutic approach of MUS. Research not only shows that BA is a bottom-up ‘bodily’ affair but is anchored in a interoceptive-insular pathway (IIP) which in turn is deeply connected with autonomic and emotional brain areas as well as verbal and non-verbal memory. Moreover, it is emphasized how skin and myofascial tissues should be seen as an interoceptive generator, if approached in the proper manual way. This article offers supportive evidence explaining why a ‘haptic’ touch activates this IIP, restores the myofascial armored body, helps patients rebalancing their window of tolerance and facilitates BA by contacting their bodily inner-world. From a trans-disciplinary angle this article reflects on how the integration of bodywork with non-directive verbal guidance can be deeply healing and resourcing for the lived body experience in MUS. In particular for alexithymic patients this approach can be of significance regarding their representational failure of bodily arousal.

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Differential diagnosis and current polythetic classification

Parnas

2015

World Psychiatry

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Diagnosis and the DSM

Cited by 21 publications

References 71 publications

Causality in Psychiatry: A Hybrid Symptom Network Construct Model

Causality in Psychiatry: A Hybrid Symptom Network Construct Model

Touching the Lived Body in Patients with Medically Unexplained Symptoms. How an Integration of Hands-on Bodywork and Body Awareness in Psychotherapy may Help People with Alexithymia

Differential diagnosis and current polythetic classification

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