Diagnostic dimensionality and transdiagnostic clinical manifestations

Francisco R. de la Peña, Miriam Feria


For 50 years, a way has been sought to establish the parameters to have valid diagnoses in psychiatry using a scientific approach. Probably the first proposal was the one made for the description of schizophrenia (Robins & Guze, 1970). This diagnostic approach was based on five parameters: The clinical description not only of the symptoms but also of psychosocial characteristics; laboratory studies; the delimitation of the disorders among themselves; follow-up to determine evolution and family and genetic studies. Shortly thereafter the treatment response parameter was added (Feighner et al., 1972). These six criteria were a fundamental part of the classifying principles of the Diagnostic and Statistical Manual of Mental Disorders in its third edition (DSM-III) published by the American Psychiatric Association (APA) (APA, 1980), and have persisted up to the present in the DSM-5 (APA, 2013); however, today this model has several limitations. The clinical descriptions of the current diagnoses are complex and involve symptoms in cognition, affects, behaviors and social relationships; same that are present among the different categories, which generates shared clinical manifestations. This situation impedes an adequate categorical delimitation. Current detailed brain function and imaging approaches, laboratory or genetic studies are still not of complete diagnostic utility in day-to-day clinical work in psychiatry. Follow-up studies and long-term treatments have only partially helped to understand some aspects of the pathophysiology of disorders and their evolution over time.

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