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Diagnosis in the field of psychotherapy: a plea for an alternative to the DSM-5.x

Stijn Vanheule UGent (2012) PSYCHOLOGY AND PSYCHOTHERAPY-THEORY RESEARCH AND PRACTICE. 85(2). p.128-142
abstract
Purpose. This paper studies how diagnosis is currently conceptualized in the field of psychiatry, and examines whether this mode of diagnosis is relevant for psychotherapeutic intervention. Method. Narrative literature review was used in this study. Results. In the context of the DSM, diagnosis is equated with classification. Symptoms and complaints are approached in terms of a medical semiological model, and are seen as signs of underlying illness processes. In discussing this approach the author makes use of Gottlob Frege's theory, in which three aspects of a sign are discerned: the reference/referent or Bedeutung, the sense or Sinn, and the representation/idea or Vorstellung. Based on this distinction, it is argued that in the transition from the DSM-III to the DSM-5 much effort has been taken to disambiguate the sense attributed to symptoms and complaints, while person-specific ideas and representations have been excluded. This exclusion of the Vorstellung is criticized, both from a psychiatric and a psychotherapeutic perspective. Subsequently it is argued that whereas the DSM-III and DSM-IV avoided strong statements on etiology, the DSM-5 makes clear choices. The DSM-5, and more recently the RDoC group within the NIMH, aims at developing systems of classification that start from the assumption that psychiatric disorders are brain disorders. It is argued that by doing so a referent is classified that is different from the object of intervention that psychotherapeutic theories are concerned with. Conclusion. Such a view of diagnosis is not workable for psychotherapy. The exclusion of personal experiences associated with symptoms and complaints is problematic and the referent that recent psychiatric classification uses, that is, brain processes, is not compatible with the referent that psychotherapeutic theories use. Case formulation can be seen as an alternative to standard classification.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
MENTAL-DISORDER, PSYCHIATRIC-DIAGNOSIS, DSM-V, CLASSIFICATION, NEUROSCIENCE, CRITERIA, FUTURE
journal title
PSYCHOLOGY AND PSYCHOTHERAPY-THEORY RESEARCH AND PRACTICE
Psychol. Psychother.-Theory Res. Pract.
volume
85
issue
2
pages
128 - 142
Web of Science type
Article
Web of Science id
000304086700002
JCR category
PSYCHOLOGY, CLINICAL
JCR impact factor
1.69 (2012)
JCR rank
56/114 (2012)
JCR quartile
2 (2012)
ISSN
1476-0835
DOI
10.1111/j.2044-8341.2012.02069.x
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2110137
handle
http://hdl.handle.net/1854/LU-2110137
date created
2012-05-22 10:37:52
date last changed
2012-10-03 11:55:44
@article{2110137,
  abstract     = {Purpose. This paper studies how diagnosis is currently conceptualized in the field of psychiatry, and examines whether this mode of diagnosis is relevant for psychotherapeutic intervention. Method. Narrative literature review was used in this study. Results. In the context of the DSM, diagnosis is equated with classification. Symptoms and complaints are approached in terms of a medical semiological model, and are seen as signs of underlying illness processes. In discussing this approach the author makes use of Gottlob Frege's theory, in which three aspects of a sign are discerned: the reference/referent or Bedeutung, the sense or Sinn, and the representation/idea or Vorstellung. Based on this distinction, it is argued that in the transition from the DSM-III to the DSM-5 much effort has been taken to disambiguate the sense attributed to symptoms and complaints, while person-specific ideas and representations have been excluded. This exclusion of the Vorstellung is criticized, both from a psychiatric and a psychotherapeutic perspective. Subsequently it is argued that whereas the DSM-III and DSM-IV avoided strong statements on etiology, the DSM-5 makes clear choices. The DSM-5, and more recently the RDoC group within the NIMH, aims at developing systems of classification that start from the assumption that psychiatric disorders are brain disorders. It is argued that by doing so a referent is classified that is different from the object of intervention that psychotherapeutic theories are concerned with. Conclusion. Such a view of diagnosis is not workable for psychotherapy. The exclusion of personal experiences associated with symptoms and complaints is problematic and the referent that recent psychiatric classification uses, that is, brain processes, is not compatible with the referent that psychotherapeutic theories use. Case formulation can be seen as an alternative to standard classification.},
  author       = {Vanheule, Stijn},
  issn         = {1476-0835},
  journal      = {PSYCHOLOGY AND PSYCHOTHERAPY-THEORY RESEARCH AND PRACTICE},
  keyword      = {MENTAL-DISORDER,PSYCHIATRIC-DIAGNOSIS,DSM-V,CLASSIFICATION,NEUROSCIENCE,CRITERIA,FUTURE},
  language     = {eng},
  number       = {2},
  pages        = {128--142},
  title        = {Diagnosis in the field of psychotherapy: a plea for an alternative to the DSM-5.x},
  url          = {http://dx.doi.org/10.1111/j.2044-8341.2012.02069.x},
  volume       = {85},
  year         = {2012},
}

Chicago
Vanheule, Stijn. 2012. “Diagnosis in the Field of Psychotherapy: a Plea for an Alternative to the DSM-5.x.” Psychology and Psychotherapy-theory Research and Practice 85 (2): 128–142.
APA
Vanheule, S. (2012). Diagnosis in the field of psychotherapy: a plea for an alternative to the DSM-5.x. PSYCHOLOGY AND PSYCHOTHERAPY-THEORY RESEARCH AND PRACTICE, 85(2), 128–142.
Vancouver
1.
Vanheule S. Diagnosis in the field of psychotherapy: a plea for an alternative to the DSM-5.x. PSYCHOLOGY AND PSYCHOTHERAPY-THEORY RESEARCH AND PRACTICE. 2012;85(2):128–42.
MLA
Vanheule, Stijn. “Diagnosis in the Field of Psychotherapy: a Plea for an Alternative to the DSM-5.x.” PSYCHOLOGY AND PSYCHOTHERAPY-THEORY RESEARCH AND PRACTICE 85.2 (2012): 128–142. Print.