Increasing Diagnostic Emphasis on Negative Affective Dysfunction: Potentially Negative Consequences for Psychiatric Classification and Diagnosis

Abstract

Maladaptive experiences of negative mood states and difficulties regulating them, collectively referred to here as negative affective dysfunction, are linked robustly to many disorders. Despite negative affective dysfunction being a nonspecific psychopathology feature, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) introduced new (a) disorders and (b) features to existing disorders intended to capture manifestations of negative affective dysfunction. This theoretical article highlights why these additions may exacerbate issues concerning disorder overlap and differential diagnosis. Specific examples are provided to support this viewpoint, including potential consequences of emphasizing negative affective dysfunction within the diagnostic criteria for attention-deficit/hyperactivity disorder. Although researchers likely will continue to disagree about how to best classify negative affective dysfunction (e.g., using dimensions vs. categories), I argue that we can reach common ground as a field by recognizing that caution is needed when proposing new DSM–5 additions to capture nonspecific psychopathology features.