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Critical evaluation of classifactory model of psychopathology

1. Brief overview of model (demo and organisation)

2. Critical analysis (strengths and limitations)

3. Research evidence

4. Conclusion (suitable for clinical purposes or not) (practical implications and

utility)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181189/

https://egyankosh.ac.in/bitstream/123456789/21119/1/Unit-2.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375295/#:~:text=A%20categorical%2

0approach%20to%20assessment,continuum%20of%20frequency%20and%2For

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375295/#R11

https://www.sciencedirect.com/topics/psychology/categorical-model

https://people.bu.edu/tabrown/Manuscripts/Brown%20Barlow%202005.pdf

https://psycnet-apa-org.ncrlibrary.remotexs.in/search/display?id=bc3b27ad-1dc9-79b6-2af1-3

0951d0b8a38&recordId=5&tab=PA&page=1&display=25&sort=PublicationYearMSSort%20

desc,AuthorSort%20asc&sr=1
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https://web-s-ebscohost-com.ncrlibrary.remotexs.in/ehost/pdfviewer/pdfviewer?vid=1&

sid=66ded054-520d-4bf3-9710-f079f0bbb109%40redis

https://web-s-ebscohost-com.ncrlibrary.remotexs.in/ehost/pdfviewer/pdfviewer?vid=3&

sid=085fa788-7d44-4de4-8fca-6920c8b0650f%40redis
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CATEGORICAL MODEL

Overview

Background - It would be interesting to look at the development of nosology and the

functions it serves before critically analysing the various approaches to mental nosology (a

categorization or list of disorders). Over time, the nosology of psychiatric diseases has

changed. Attempts to classify and define diverse psychiatric diseases have been tried since

the era of Hippocrates and Aristotle.The classification system developed by S. Emil

Kraepelin (1856–1926) was based on the cause, course, and results of clinically diagnosed

diseases. His main classifications were dementia praecox and manic-depressive psychosis.

Kraepelin was combined by Eugen Bleuler and Meyerian methodologies, which based their

classification of mental diseases on psychopathological processes.

Communication between clinicians and researchers, etiologic understanding, treatment

efficacy testing, awareness of the prevalence of issues and disorders, healthcare planning,

service organisation, and reimbursement purposes all require knowledge of psychiatric

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nosology. For psychiatric nosology, a variety of methods have been employed, including

categorical, dimensional, hybrid, and etiological methods. Following the Renaissance and

Enlightenment, the usage of categories significantly increased in popularityThe first

psychiatrist to categorise psychological diseases from a biological or medical perspective was

Kraepelin. We have a collection of causative factors for Kraepelin's physical diseases that do

not

overlap with other disorders Every member of the category or group must satisfy one

defining criterion, such as schizophrenia. An object either belongs to a category after it has

been specified, or it does not. A categorical approach to classification makes the qualitative

assumption that differences between members of various categories exist. A categorical

approach to classification assumes that distinctions among members of different categories

are qualitative.

According to the categorical approach, views illness as either present or absent. The

disorder is classified as either present or absent depending on how closely the description of a

typical instance matches the prototype description. There are no "in between" diagnoses for a

given combination of symptoms; they either indicate a problem or they do not. Depending on

the prototypes and descriptions, this technique could lead to a wide range of illnesses. When

two conditions coexist, or have comorbid disorders, their symptoms are said to be present

(e.g., generalised anxiety disorder and depressive disorder existing as comorbid disorders).

The categorical approach claims that disorder is different from normalcy (i.e., either one is ill

or not ill).
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The DSM and ICD classification systems are also used in this method. The DSM identifies

the disorders and provides detailed descriptions of each. The ICD defines signs of disorders

and their symptoms. The underlying tenets and presumptions of categorical approaches

include the following:

● During a mental health assessment, some symptoms might be used to diagnose a

mental condition.

● It is possible to classify thoughts, feelings, and behaviour into groups that correspond

to various illnesses.

● The system used to define and diagnose mental illnesses is valid and trustworthy

because it follows the all-or-nothing concept (i.e., a person either has a diagnosable

mental disorder or they do not).

The categorical DSM system makes an effort to define "caseness" within certain parameters.

This has several flaws, especially since nature tends to detest defined borders (especially for

Axis II personality disorders).although for Axis I situations as well). Due to the constraints of

the categorical approach, boundary patients are common, boundary categories are necessary,

and the rate of definitional comorbidity is artificially exaggerated. Adopting a dimensional

system of continuous variables could be a potential option. When the DSM-IV was being

developed, this was suggested, particularly for the Axis II personality disorders. However, it

should be highlighted that no dimensional systems (for Axis I or Axis II illnesses) have

attained widespread recognition.It is evident that dimensional systems continue to be very

appealing while categorical systems, despite their flaws, continue to be quite useful in clinical

and scientific practise.The DSM-IV (TR) is a categorical classification system. The

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categories are prototypes, and a patient with a close approximation to the prototype is said to

have that disorder with qualifiers, for example mild, moderate or severe forms of a disorder.

Demo

sample scenario for examining the different approaches. For over a month now, Mr. P, a

44-year-old businessman, has been experiencing symptoms of persistent and pervasive grief.

In comparison to his former self, he gets tired easily and shows less enthusiasm in activities.

His sleep quality has declined, and his appetite has decreased. Though he denies having any

suicidal thoughts, he does express feelings of shame and pessimism about the future. He

makes it to work, but he works inefficiently. He doesn't have any serious medical conditions.

According to the current nosological systems, this is a case of what psychiatrists would often

classify as a depressed disorder.

Mr. P suffers from a depressive condition, which is different from "normal" functioning, in

accordance with the categorical approach. It is a distinct condition from dysthymia,

generalised anxiety disorder, and unspecified forms of depression. If he receives treatment

and makes enough progress, he won't experience depression (i.e., depression will either be

present or absent).

DSM-III was 494 pages long and listed 265 diagnostic categories. It rapidly came into

widespread international use. DSM-III was published with 93% changes in nomenclature

from the earlier version of DSM with diagnostic Classification of Psychopathology: DSM IV

TR Foundations of Psychopathology 2 8 criteria for each of the disorders mentioned. There

was a multi-axial classification with five axes. DSM-III provided a vast increase in

background information about each disorder, adding diagnostic features, associated features,

cultural and gender features; prevalence, course, familiar patterns, differential diagnosis,

decision trees and glossary. However, DSM-III was later criticized on the ground that 20-30

percent of the population would have been diagnosed as having behavioural disorders without
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having any serious mental problems. DSM-III-R (1987): The DSM-III-R was published as a

revision of DSM-III in 1987. Categories were renamed, reorganised, and significant changes

in criteria were made. Six categories were deleted, while some new categories were added.

Controversial diagnoses such as pre-menstrual dysphoric disorder and Masochistic

Personality Disorder were discarded. “Sexual orientation disturbance” was also removed and

was largely subsumed under “sexual disorder not otherwise specified” which can include

“persistent and marked distress about one’s sexual orientation.”

Critical evaluation

limitation

The categorical approach runs into a lot of issues. Identifying the threshold of

symptoms that leads to a diagnosis is one of the key problems. The conceptualization and

sensitivity of the particular assessor to certain symptoms determine the threshold at which a

diagnosis is made.s (Wakefield, Schmitz, First, & Horwitz, 2007). Should depression be

identified in our situation if the patient is depressed for eight, fourteen, or twenty hours per

day? When a patient is somewhat depressed, moderately depressed, or severely depressed,

should depression be diagnosed?

The categorical approach also has issues with sub-syndromal symptoms. A disorder's

symptoms typically show up in a range of degrees of severity. Sub-syndromal symptoms have

been linked to dysfunction and disability, and their treatment promotes

improvement.However, if they are below a diagnostic cutoff, no diagnosis would be made

using a categorical approach, and as a result, no treatment would be provided or paid for.

While separating from other disorders, there may be difficulties encountered. Are two

different syndromes (such as depressive disorder and generalised anxiety disorder) to be

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regarded when two sets of symptoms (of two illnesses) are present, or should the combination

be (such as schizoaffective)? When psychiatric diseases coexist with other conditions, the

question of whether classification into pigeonholes is the best course of action arises.

The DSM is criticised for lacking validity since it has no connection to a recognised

scientific model of mental disorder, and as a result, the judgements made on its categories (or

even the debate over categories vs. dimensions) were not made in a scientifically sound

manne. Ones; that lack dependability in part because different diagnoses share similar

criteria, and what may appear to be different criteria are frequently merely different wordings

of the same idea, meaning that the choice of which diagnosis to give a patient is partially

based on personal prejudice (McLaren, 2007).

Unjustified Categorical Distinctions - Despite warnings in the DSM's inception, it has long

been contended that its system of classification makes arbitrary cut-offs between disorders

and unwarranted categorical distinctions between them both typical and unusual. Some

suggest that a fully dimensional, spectrum-based, or complaint-oriented approach would

more accurately reflect the facts than a categorical one (Bentall, 2006). (Horwitz,2007). Once

a person is identified as having a specific disorder, Axis IV of the DSM-IV (TR) contains a

step for describing "Psychosocial and environmental elements contributing to the condition."

The DSM's criteria of distress or disability can frequently result in false positives because a

person's level of impairment is frequently not associated with symptom counts and can result

from many individual and social causes (Spitzer & Wakefield, 1999).

When both the definitive pathophysiology and aetiology of a functional mental condition are

unclear or absent, a disease entity is defined syndromatically by the statistical relationships

between the signs, symptoms, features, tests, and other data. Comorbidity as a concept

becomes troublesome, and applying it to specific patients is challenging (Meehl, Paul E.,
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2001). Although category data suggest that early disruptive behaviour problems are stable,

comparisons between research are challenging for a number of reasons. First, different

research defines these issues differently. For instance, Campbell (1994) exclusively used

categorical evaluations of ADHD, Gadow et al. (2001) used categorical ratings of ADHD and

ODD separately, and Campbell and Ewing (1990) used categorical ratings of ADHD and

dimensional ratings of externalising issues.

Diagnostic Overlap/Comorbidity Problem

The significant levels of diagnostic overlap utilising the DSM-III and later categories have

been validated by a vast number of different empirical research. These studies are covered in

great detail in Clark, Watson, and Reynolds' review (1995) .One of the model's principles was

expressed when the categorical model of classification was being discussed: "In the

borderline areas where categories may overlap, the number of overlapping patients should be

very minimal." Diagnostic overlap is the proportion of patients who have one diagnosis but

also fit the bill for a different one. As stated in the tenet above, some diagnostic overlap is

anticipated.Blanchard (1986).

Despite concern regarding its theoretical foundation (1), utility (2-4), and perfectibility,

diagnosis by classification into categories predominates in the medical approach to psychoses

(5, 6). It might not be best to use a categorical diagnosis a base for development, particularly

for the many diagnostic functions. Limitations in highlighting factors like disability or need

are likely to be struck by categorical diagnosis.

Many decisions concerning therapy, clinical care, and even service design are influenced by

disability and social functioning. This outcome would The suspicion that category diagnoses

are poor predictors in these areas seems to be supported by these findings.

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Additionally, categorical categorization may obscure significant symptom information that is

disregarded or necessitates concomitant diagnoses

Strengths

The ability of categorical techniques to distinguish between who are referred for clinical

treatment due to disruptive behaviour problems and their counterparts who are not has also

been the subject of several research. In general, both methods can accomplish this

successfully. For instance, researchers have employed a range of study tools, including as the

SNAP (Campbell, 1994) (Gadow et al., 2001), in a categorical manner to show that referred

children can be discriminated from non-referred peers (Pierce et al., 1999)

This approach has a long history in psychology and psychiatry and has a number of benefits:

A disease-based approach is appropriate to the extent that personal factors are taken into

account, such as

(a) clinicians are generally familiar with the descriptive and clinical terminology and can

apply it easily

(b) predictions can be made about a person based on the description of the category; for

example, if a person is classified as sociopathic, we may assume that rule violation or

criminal activity is likely;

(c) personality types have clear and vivid descriptions that facilitate communication;

(d) Given that personality abnormalities are distinct, homogenous diagnostic entities with

little overlap between categories, a disease-based approach is suitable.

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Strengths of employing this strategy include:

facilitates conversation

permits diagnosis

This strategy has a number of drawbacks, including:

low interdependence

Several symptoms may overlap, which can make diagnosis difficult.

Shaming and tagging

limitations of the categorical model

heterogeneity within diagnoses, inadequate coverage, lack of consistent diagnostic

thresholds, excessive diagnostic co-occurrence, and inadequate scientific base

Conclusion / implications

● The Categorical Approach is a way of categorising mental disorders that involves

determining if a person has a disorder based on symptoms and traits that are

considered typical of the disorder.

● By categorical diagnosis, only the usage of support services and the course of the

illness were better predicted. When added to category diagnoses, dimensional ratings

significantly increased the amount of variance explained.

Conclusion: Functional psychotic behaviour, impairment, and outcome are better

understood when categorical measures of psychopathology are used. Dimensions with

categories provide considerable additional information that a diagnosis did not,

making them a more practical foundation for therapeutic care.(, M. Evans,2003)

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● Only the usage of assistance services and a worsening course were better described by

categorical diagnosis. This Health care regulations that restrict access to many

publicly funded clinical services to those with documented categorical mental

diagnoses and other factors contributed to the reason in part support using services. A

specific requirement for DSM-III and DSM-IIIR diagnoses is the course of the illness,

particularly its duration and deterioration. As a result, the association between these

category diagnoses and a gauge of worsening is strengthened.

categorical diagnosis is favoured because it seems to provide all the information required for

categorization and planning, categorical diagnosis is preferred and the management of mental

disease. The weight of medical tradition, which views categorical disease diagnosis as the

key to understanding the etiology and treatment of sickness, would ensure categorical

diagnosis' persistence even if that favouritism were revealed to be unwarranted.

Some people have criticised categorical approaches, claiming that they fail to adequately

address a number of important aspects of disorders in their diagnoses, such as individual

differences in severity, the variability of contributing factors, variations in how different

disorders appear, and comorbidity with other disorders.

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The use of categorical diagnosis has the risk of reducing the precision of symptom

recognition and depleting descriptive inadequate data for the revision, much alone the

overhaul, of categorical or syndromal diagnosis due to psychopathology

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