The likely success of functional analysis tied to the DSM

Abstract

Nelson-Gray and Farmer argue that behavioral assessment and functional analysis may be bene®cially applied to personality disorders (PDs). While this is a reasonable response to the largely nonbehaviorally derived Diagnostic and Statistical Manual (DSM), it is not yet clear that grafting such theoretically incongruent elements will be viable. In essence, they argue that a syndromal classi®cation system could serve a nomothetic role of guiding a functional, idiographic analysis. This is possible, but it seems unlikely that this process would remain in equilibrium, with no interactive eect of the functional analysis on the syndromes themselves. Yet the DSM system has shown itself to be surprisingly closed to a more functional approach, so the relationship between the DSM and functional analysis is not open in both directions. What is needed is a nomothetic level of analysis that is also functionally derived. The primary bene®t of functional over syndromal categories is one of treatment utility, a concept that is itself surprisingly absent from the authors' otherwise comprehensive discussion of behavioral assessment. # 1999 Elsevier Science Ltd. All rights reserved.Keywords: Behavioral assessment; Treatment utility; Functional analysis The likely success of functional analysis tied to the DSMNelson-Gray and Farmer argue that there is a synergistic bene®t in augmenting the DSM syndromal classi®cation of PDs with behavioral, functional assessment, and argue that a nomothetic categorization system is valuable in providing a place to begin a functional analysis. In eect, the authors describe how many behavioral clinicians currently cope with a syndromal classi®cation paradigm that is often incongruent with behavioral theory. While we agree that the DSM can and often does serve this initial role, we are not sure that this is the best place to start, nor that the relationship is ultimately sustainable and mutual.

Overview and analysis of the behaviourist criticism of theDiagnostic and Statistical Manual of Mental Disorders(DSM)

“…Although such a system covering both the classification and treatment utility aspect for psychiatric problems is not currently available, the alternative approaches (e.g., functional diagnostic categories and expert system: see Hayes & Follette, 1992) seem to have the potential to become a useful alternative. Expert system or logical algorithm approach (Hayes & Follette, 1992) would allow for a systematisation of the analytical process, which is the basis for the development of functional diagnostic categories (Bissett & Hayes, 1999). Such categories would naturally emerge from the repetition of individual functional analyses, all conducted in accordance with a standard analytic process (Bissett & Hayes, 1999).…”

“…The DSM can be described as a nomothetic system (Bissett & Hayes, 1999;Scotti et al, 1996). Nomothetic is defined as the opposite of the ideographic and is the way for finding general laws (Bem & de Jong, 1997).…”

“…In other words, a diagnosis should say something not only about which treatment to use, but also how the treatment should be implemented. Functional analysis has failed to progress as a system of case formulation, classification and treatment guidance primarily because of lack of replicability and unclear rules about how it should be conducted (Bissett & Hayes, 1999).…”

“…The issue has been brought up by many authors in the behaviour therapy literature (e.g., Haynes & O'Brian, 1988;Hickey, 1998). However, the field is not unified, and different standpoints have been expressed, from the view that functional analysis and the DSM are difficult to reconcile (Bissett & Hayes, 1999;Follette & Houts, 1996) to recommending peaceful coexistence (Hersen, 1988;Nelson & Maser, 1988;Nelson-Gray & Farmer, 1999).…”

“…The second critique was the lack of proper empirical support for many of the assumptions in the DSM, for example diagnostic specificity. One most recurring example is the extreme case of individuals receiving the same diagnosis, but not sharing a single diagnostic characteristic (Bissett & Hayes, 1999), and the lack of internal consistency of symptoms within the personality disorders diagnoses (e.g., Morey, 1988), although the most recent version of the DSM shows a slight improvement in the internal consistency of the most of the diagnoses. Admittedly, there are strong empirical validations of some of the DSM categories (Nathan & Langenbucher, 1999), but it is well known that the DSM to a large extent still is a consensus-based system.…”