Oh G-d, A Borderline: Clinical Diagnostics As Fundamental Attribution Error Page: 7
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biological perspective (Follette & Houts, 1996); the DSM specifically endorses the medical
model and is presented as a means to reintegrating psychiatry into medicine (APA, 2000). There
are no grounds to claim that if the DSM was theoretically based then it would be inherently
flawed. A developed theoretical rationale might lend coherence to the system, though
simultaneously making it less palatable to professionals who do not share similar philosophical
groundings. In either case, it is clear that there is a materialist medical model at play that
implicates an etiological mechanism internal to the diagnosed individual.
Pragmatically, the DSM system attempts to address three purposes of diagnostic
taxonomy (Millon, 1991): 1) clinical utility, 2) research facilitation, and 3) scientific
understanding. Each of these goals is adversely affected by the high rates of comorbidity that
result from DSM diagnoses. Kendall and Clarkin (1992) describe the issue of comorbidity to be
the largest challenge faced by the professional mental health community. In community samples,
specific DSM disorders yield very high comorbidity rates. Over 90% of individuals diagnosed
with panic disorder or schizophrenia had lifetime comorbid disorders (see Clark, Watson &
Reynolds, 1995, for a review). That comorbidity is the norm and presentation of a clear single
disorder is the exception indicates that the DSM system fails to create meaningful diagnostic
distinctions that are accurate or of help in clarifying clinical approaches and communication,
bolstering research, or increasing scientific understanding of psychopathological behavior.
In fact, the myriad combinations of disorders lead to clinical cases for which practitioners
do not feel that empirically supported approaches are well-suited (Ruscio & Holohan, 2006). At
the very least, there is warranted uncertainty that the empirical studies of the efficacy of a given
treatment for a given disorder are applicable to clients with comorbid conditions. In an effort to
increase internal validity, studies used in the determination of empirically supported or validated
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Schmalz, Jonathan. Oh G-d, A Borderline: Clinical Diagnostics As Fundamental Attribution Error, thesis, December 2011; Denton, Texas. (digital.library.unt.edu/ark:/67531/metadc103389/m1/13/: accessed January 24, 2017), University of North Texas Libraries, Digital Library, digital.library.unt.edu; .