Journal of Experimental Psychopathology

This paper reviews the evolution of the definition and diagnostic criteria of Autism Spectrum Disorder (ASD), the external validity of ASD subtypes, and the impacts of DSM-5 ASD on future studies of ASD epidemiology and genetics; on the treatments or interventions of individuals with ASD; and on the economy of health costs. Overall, it seems that the implementation of DSM-5 ASD may cause more negative results than provides positive influences.

The current study examined the latent factor structure of posttraumatic stress disorder (PTSD) based on DSM-5 criteria in a sample of participants (N = 374) recruited for studies on trauma and health. Confirmatory factor analyses (CFA) were used to compare the fit of the previous 3-factor DSM-IV model of PTSD to the 4-factor model specified in DSM-5 as well as to a competing 4-factor “dysphoria” model (Simms, Watson, & Doebbeling, 2002) and a 5-factor (Elhai et al., 2011) model of PTSD. Results indicated that the Elhai 5-factor model (re-experiencing, active avoidance, emotional numbing, dysphoric arousal, anxious arousal) provided the best fit to the data, although substantial support was demonstrated for the DSM-5 4-factor model. Low factor loadings were noted for two of the symptoms in the DSM-5 model (psychogenic amnesia and reckless/self-destructive behavior), which raises questions regarding the adequacy of fit of these symptoms with other core features of the disorder. Overall, the findings from the present research suggest the DSM-5 model of PTSD is a significant improvement over the previous DSM-IV model of PTSD.

Having passed the one-year anniversary of the initial DSM-5 publication, this paper presents a guiding summary of key areas of change—and lack thereof—across DSM definitions of disorders affecting anxious youth, and offers data-informed evaluations and commentaries clarifying the areas in which DSM-5 should be celebrated as a meaningful advancement in the assessment of child anxiety, diagnostic dilemmas in child anxiety assessment from previous DSM editions that remain unresolved in DSM-5, and areas in which DSM-5 may have actually introduced new problems into the assessment of child anxiety. We organize our review and commentary around five of the meaningful changes in DSM-5 with implications for the assessment of anxious youth: (1) the new classification of selective mutism as an anxiety disorder; (2) the removal of the social anxiety disorder “generalized” specifier and the new addition of a “performance-only” specifier; (3) the revised operationalization of agoraphobia and the decoupling of agoraphobia from panic disorder; (4) the creation of a new category—disruptive mood dysregulation disorder—for diagnosing youth presenting with chronic irritability and severe temper outbursts; and (5) the revised classification of anxiety disorders not otherwise specified in the DSM. We then turn our attention to discuss four areas of noted diagnostic dilemmas in the assessment of child anxiety from DSM-IV that remain unresolved in the new DSM-5: (1) the phenomenological overlap between the OCD and generalized anxiety disorder (GAD) definitions; (2) the phenomenological overlap between GAD and major depressive disorder (MDD) definitions; (3) differential diagnostic utility across the separation anxiety disorder symptoms; and (4) the extent to which youth presenting with multiple marked and persistent fears should be assigned multiple distinct diagnoses of specific phobia.

The alternative dimensional model for personality disorder (PD) in DSM-5, Section III (DSM-5–III) includes two main criteria: (A) personality-functioning impairment, and (B) personality-trait pathology; provides specific functioning-and-trait criteria for six PD-type diagnoses; and introduces PD-trait specified (PD-TS), which requires meeting the general PD criteria and not meeting criteria for any specific PD type. We termed this Simple PD-TS and developed two additional definitions: Mixed PD-TS, meeting criteria for one or two PD types and having five or more additional pathological traits; and Complex PD-TS, meeting criteria for three or more PD types. In a mixed sample of 165 outpatients and 215 community adults screened to be at highrisk for PD, we investigated the effect of these additional definitions on coverage, prevalence, comorbidity, and within-diagnosis heterogeneity, and conclude that eliminating the PD-type diagnoses and thus having PD-TS as the only PD diagnosis would be both more parsimonious and more useful clinically.

With DSM-5, the American Psychiatric Association (APA) strongly encourages clinicians and researchers to supplement traditional categorical diagnoses with dimensional ratings of severity. To that end, several scales have been created for or adopted by the APA that are brief, psychometrically sound, and easily accessible. Despite these scales' inclusion in the text and online, awareness of them remains low one year after DSM-5's publication. In the present paper, we review the APA's guidelines for dimensional assessment and examine several issues relevant to dimensional assessment including: persuading clinicians of the utility of dimensional assessment, raising awareness of the scales, establishing guidelines for interpretation, incorporating data from multiple informants, assessment across diverse groups, and the risks and benefits of scales accessible to the general public. These issues will be illustrated through the example of the anxiety disorders, due to the fact that this diagnostic category has made significant progress with regard to dimensional classification.

The fifth edition of the Diagnostic and Statistical Manual (DSM-5) has been criticized for using arbitrary criteria to define mental disorders based on subjective data. The Research Domain Criteria (RDoC) initiative offers an alternative system that also considers biological and behavioral data, but shares the DSM-5's reliance on the latent disease model. Moreover, neither the DSM-5 nor RDoC provides any concrete treatment guidelines. In contrast, the cognitive behavioral model offers an empirically-based framework for a treatment-relevant classification system by focusing on maintaining rather than initiating factors. In contrast to the latent disease model of the DSM-5 and RDoC, the cognitive-behavioral framework is consistent with a complex causal network system network approach, which assumes that maladaptive cognitions and behaviors settle into a pathological state causing emotional distress. This framework offers concrete treatment implications while avoiding many shortcomings of a latent disease model.

Although the emotional disorders (EDs) have achieved favorable reliability in the Diagnostic and Statistical Manual of Mental Disorders (DSM), accumulating evidence continues to underscore limitations in ED diagnostic validity. In particular, taxometric, comorbidity, and other descriptive psychopathology studies of transdiagnostic phenotypes suggest that the EDs may be best conceptualized as dimensional entities that are more similar than different. Despite optimism that the fifth edition of the DSM (DSM-5) would constitute a meaningful shift toward dimensional ED assessment and diagnosis, most changes contribute little movement in that direction. In the present report, we summarize past and anticipate persisting (i.e., in DSM-5) limitations of a purely categorical approach to ED diagnosis. We then review our alternative dimensional-categorical profile approach to ED assessment and classification, including preliminary evidence in support of its validity and presentation of two ED profile case examples using our newly developed Multidimensional Emotional Disorder Inventory. We end by discussing the transdiagnostic treatment implications of our profile approach to ED classification and directions for future research.

The field of psychopathology needs a paradigm shift to revitalise its research methodology and translational practice. We describe Darwin's transformation of biology and its implications for science and culture, and we infer the implications of an analogous approach to psychopathology. Darwin challenged the assumptions of the biological classification system with compelling evidence to support a quantifiable, mechanistic theory of change across all life. Specifically, he showed that species were changeable, that individuals showed substantial variation in their features, and that these features were functional adaptations to the environment. Similarly, there is substantial evidence of continuous change, shared symptoms and functionality across the categories of psychiatric classification. Our novel research methodology, inspired by perceptual control theory, include both qualitative and quantitative methods, and entail the study of universal processes within heterogeneous samples and studying dynamic processes prospectively within individual cases, drawing direct analogies with evolutionary dynamic systems (e.g. trade-offs, speciation).

The recent discussions over the reliability, validity, utility, humanity and epistemology of psychiatric diagnosis have had wider implications than might at first sight be apparent. Diagnosis is, for many people, both the entry-point to services and the starting-point for public debate. Challenges to the scientific and professional basis for diagnosis, therefore, can have profound implications. Such is the dominance of traditional diagnostic thinking about mental health care that it is often wrongly assumed that there is little alternative – or that any possible alternatives would require lengthy and expensive periods of development. In fact, there is no present impediment to the development of new ways of thinking and delivering services, and especially no impediment to practical and scientifically valid alternatives to diagnosis.

The third edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders was a highly successful revision in large part because it was tremendously innovative. The authors of the fifth edition intended their version to provide another paradigm shift. However, the process of its construction was riddled with problems and controversies. Discussed herein is the presence of the internet, confidentiality contracts, no gold standard, and the inadequate documentation of empirical support. Also discussed was the failed attempt to provide a paradigm shift. Recommendations for the construction of future editions of the diagnostic manual are provided.