Skip to main content Accessibility help
×
×
Home

Information:

  • Access

Actions:

      • Send article to Kindle

        To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

        Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

        Find out more about the Kindle Personal Document Service.

        Classification
        Available formats
        ×

        Send article to Dropbox

        To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

        Classification
        Available formats
        ×

        Send article to Google Drive

        To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

        Classification
        Available formats
        ×
Export citation

The science of psychiatric diagnosis and classification has its critics. Seligman (2005), the father of positive psychology, has even suggested that we ‘develop a nosology of human strengths – the “unDSM–1”, the opposite of DSM–IV’. Nevertheless, as ‘diagnosis is intended to be one of the strongest assets of a psychiatrist’ (Tyrer 2009), clinicians need to think about and be involved in the forthcoming revisions and harmonisation of the two major classifications ICD and DSM. Sartorius (pp. 2–9) gives a behind-the-scenes view of the revision process. There are many vested interests: not just clinicians, but governments and NGOs, lawyers, researchers, public health practitioners, Big Pharma and patient groups. Vast sums are at stake – everything from welfare benefits and compensation claims to research budgets. Concerns include the use of national classifications to facilitate political abuse and of diagnostic labels that are seen as stigmatising or are used to stigmatise. Like Sartorius, Thornicroft (pp. 53–59) singles out chronic fatigue syndrome, ‘bitterly contested in terms of its status as a physical, psychiatric or psychosomatic condition’ and viewed by healthcare staff as a ‘less deserving’ category.

Should the classifications use categories or dimensions? A dimensional approach seems impractical, although dimensions could be used to augment categorical definitions, as with severity of depression in ICD–10. If categories, should revision involve lumping or splitting and on what basis? Goldberg (pp. 14–19) is critical of the proliferation of diagnoses necessitating ‘a diagnostic paella’ of multiple comorbidities. He tantalises us with his proposal of a small number of large groups of disorders, each group based on aetiologically related criteria. But there are difficulties. For example, should bipolar disorder be considered a mood disorder, a psychotic disorder or separate from both? Craddock (pp. 20–22) is not convinced that there is (yet) sufficient evidence for Goldberg's categories, believing that it will take at least 5–10 years before our understanding of brain dysfunctions will justify major change in classification. The complexities involved in clarifying neurobiological mechanisms are well illustrated in a robust exchange in our Correspondence (pp. 76–80). Gillman stresses the importance of understanding the pharmacodynamics and pharmacokinetics of interactions of antidepressants. Palanniyappan et al agree, but reach an only too familiar conclusion: insufficient clinical data and a lack of biological markers of pharmacological mechanisms.

CBT with children and families

For the clinician, ‘a diagnosis is no substitute for a full formulation, where cause should be addressed’ (Scott 2002). Dummett (pp. 23–36) explores the use of a collaborative therapeutic approach to formulation in her article, which is my Editor's Pick. Causative and maintaining factors, present and past life contexts, and systemic and developmental factors are all considered and thoughtfully illustrated in a series of clinical vignettes. Her article should be read not just by CBT practitioners and those working with children.

Seligman, M (2005) Positive psychology, positive prevention and positive therapy. In Handbook of Positive Psychology (eds Snyder, CR, Lopez, SJ) 39. Oxford University Press.
Scott, S (2002) Classification of psychiatric disorders in children and adolescents: building castles in the sand. Advances in Psychiatric Treatment, 8: 205–13.
Tyrer, P (2009) From the Editor's desk. British Journal of Psychiatry, 195: 470.