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Classifying mental conditions and disorders can be done through categorical or dimensional approach or hybrid. What are the similarities and differences of these models of classification? From their differences, would it be considered a complementary or competing approaches? And finally which approach has the most appropriate classification?
The psychiatric syndromes and symptoms are both complex phenomena which can potentially be assessed and conceptualized either using the categorical or the dimensional approach. Although the Diagnostic and Statistical Manual of Mental Disorder (DSM) as well as the Classification of Disease (ICD) systems both rely extensively on the categorical approach, they also take note the dimensional nature of syndromes and symptoms.
It is in clinical practice that the categorical approach to psychiatric disorders is frequently adopted although psychiatric epidemiologists and intervention researchers may find this approach useful. The presence or absence of a specific condition gives the clinicians an information as to the treatment decisions. The categorical cut points are what is used to make the determination about the treatment although dimensional approach is used when symptoms are measured (Kessler, 2009).
This kind of approach has several limitations which must be taken into account. The first limitation is the likelihood of under appreciation of the importance of variations of different symptoms and the variations of underlying mechanisms from individual to individual. The provision of categories such as “ major depression”. Since this is define in terms of operationalized criteria, it means that such entities may be reified and then viewed as natural kinds. An underlying result to this would be a significant negative impact in clinical context as well as research. Another limitation of the categorical approach is that when the DSM system was used, a lot of individuals have been found to have more than one disorder. The extensive comorbidity seems artifactual. Diagnosing individuals with two comorbid disorders, say, major depression and generalized anxiety, would seem to suggest that each would involve different mechanisms ad treatments.
The drawbacks of this clinical approach would seem to make the analyses of dimensional approach more accurate as it offers greater statistical power. In fact many clinicians and researchers advocate the use of dimensional approach. This approach can be used to record not only symptom profiles but also etiological contributors including the types and extents. However, just as categorical approach, the dimensional approach also has potential limitations. The analyses in this approach is only relevant when the association of predictors with the dimensional scores is constant in the entire dimensional severity range. Also, this approach may not have reification of a single entity, there can be a potential reification of causal dimension or some particular symptoms. Another thing is the potential problem of how to easily understand the complex pattern of overt symptoms and its underlying mechanisms. This is a challenge to many clinicians and the issues of user acceptability arises.
It can be gleaned from the above information that no approach seem to best fit it all. This is the reason why the concept of a hybrid approach came. Just as hybrid cars having engines that use both electricity as well as gasoline become common, hybrid models of psychiatric diagnoses also became popular. Here, researches have agreed to keep the categorical disorders but add dimensional measures along with DSM categories. The biggest challenge is the funding and sustainability (Ahmed, 2012).
While many clinicians and researchers advocate different approach in their field of work, at the end of the day, there must be something useful in every approach that enticed them to use it. After all, no matter how good the system is, if it not use, it would just be a waste. These diverse classification has their own use and purpose.
Ahmed, A. (2012, September 11). Coming Along With the DSM-5: Hybrid Models of Psychiatric Diagnosis . July 09, 2015 Psychiatric Times: http://www.psychiatrictimes.com/articles/coming-along-dsm-5-hybrid-models-psychiatric-diagnosis
Kessler, R. C. (2009). The Categorical versus Dimensional Assessment Controversy in the Sociology of Mental Illness. Journal of Health and Social Behavior , 2-15.