The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

Abstract

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

Improving patient-centered communication of the borderline personality disorder diagnosis

“…First, some patients responded critically, not by disagreeing with whether or not they met the criteria, but rather by questioning the meaning of the criteria. These were literate critiques of psychiatry that clinicians too debate (Phillips et al 2012a, Phillips et al 2012b, Phillips et al 2012c, Phillips et al 2012d). “To categorize someone in great distress as having a ‘disordered personality’ is fundamentally stigmatizing and flawed in concept.…”

Le jardinier et le botaniste. Proposition d’une organisation minimale de la sémiologie psychiatrique pour l’étudiant en médecine

“…Cette logique de botaniste à l'oeuvre dans le projet des RDoC a été créée avec la volonté d'augmenter la validité scientifique des diagnostics psychiatriques [12], en attribuant un fondement neurobiologique unique à chaque trouble psychiatrique diagnostiqué et de réaliser ainsi une classification à proprement parler « taxinomique » [26,55]. Cependant, les discussions nombreuses sur la validité et la précision scientifique des entités diagnostiques en psychiatrie [8,12,23,[40][41][42][43] ne doivent pas faire sous-estimer la pertinence et l'utilité clinique des approches épidémiologiques pragmatiques pour définir une maladie [20,26,33].…”

“…»). En psychiatrie, les discussions portant sur les classifications semblent s'être focalisées principalement sur les aspects nosographiques [8,12,23,[40][41][42][43]. Les aspects sémiologiques semblent étonnamment laissés de côté.…”

The six most essential questions in psychiatric diagnosis: a pluralogue part 3: issues of utility and alternative approaches in psychiatric diagnosis

“…Part 1 [1] of this article covered the first two questions, and Part 2 [32] the second two questions. This text, Part 3, covers the fifth and six questions.…”