the different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism. the categories are also polythetic, because a constellation of symptoms is laid out and different patterns of them can qualify for the same diagnosis. the traumatic incident) and a spectrum of how people respond to trauma.
an obsessive–compulsive spectrum – this can include a wide range of disorders from tourette syndrome to the hypochondrias, as well as forms of eating disorder, itself a spectrum of related conditions. on the one hand, work on major depressive disorder has identified a spectrum of subcategories and sub-threshold symptoms that are prevalent, recurrent and associated with treatment needs. it is difficult to distinguish impulsivity from compulsivity: sometimes paraphilic behaviors are prone to achieve pleasure (desire or fantasy), in some other cases these attitudes are merely expressions of anxiety, and the behavioral perversion is an attempt to reduce anxiety. in this context the overall system of classification is to some extent arbitrary, and could be thought of as a user interface which may need to satisfy different purposes.
the stark fact is that no one has yet agreed on how best to define and diagnose mental illnesses. but the attempt to introduce this approach foundered, as other psychiatrists and psychologists protested that it was premature. the classic kraepelian theoretical division between schizophrenia and bipolar disorder, for example, has long been bridged by a pragmatic hybrid called schizoaffective disorder, which describes those with symptoms of both disorders and was recognized in dsmâiv. âwe are going to have to have a rethink.â at the same time that research and clinical practice are helping to undermine the dsm categories, the rival dimensional approach is gaining support.
it is a massively simplified approach, craddock says, but it does seem to chime with the symptoms that patients report. asperger’s syndrome is bundled together with a handful of related conditions into the new category called autism-spectrum disorder; and ocd, compulsive hair-pulling and other similar disorders are grouped together in an obsessiveâcompulsive and related disorders category. kupfer and regier say that much of the work on dimensionality that did not make the final cut is included in the section of the manual intended to provoke further discussion and research. here, researchers and physicians are starting to classify and treat cancers on the basis of a tumour’s detailed genetic profile rather than the part of the body in which it grows.
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