Oh G-d, A Borderline: Clinical Diagnostics As Fundamental Attribution Error Page: 8
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status typically screen for the presence of a particular disorder (e.g., major depressive disorder)
and exclude participants with common co-occurring diagnoses and circumstances (e.g., prior
therapy, suicidal risk; Westen & Morrison, 2001). Although the volume of research has increased
as a result of having a unified taxonomy, the very taxonomy has become an "unintended
straitjacket," limiting researchers to particular clear symptom presentations at the expense of the
commonality of comorbidity (Clark, Watson, & Reynolds, 1996, p. 123).
Another problem that consistently results from the use of the DSM system is
heterogeneity (Clark, Watson, & Reynolds, 1996). Not only do clients often fully meet criteria
for multiple disorders (i.e., comorbidity), but their symptom presentations also often overlap
across multiple diagnoses in an unclear fashion that makes it hard to clearly differentiate one
diagnosis from another (Clark et al., 1996). The problem of heterogeneity is likely the result of a
topographical approach that attempts to peg observed symptoms to underlying material
etiologies without considering the context in which the symptom occurs and the function it
serves in that context (Hayes, et al., 1996).
Research and speculation to date indicates that the DSM system does not succeed in the
three domains its creators proposed it would. The problems of comorbidity and heterogeneity are
indicators of an inconsistent link between symptoms and physiological etiology that has left
psychiatric diagnoses in the realm of syndromal classification and not true disease (Hayes et al.,
1996). Clinical work, research, nor scientific understanding seems to be meaningfully moved
forward by its presence. It would seem that the DSM has some utility, or the system would have
been fully shunned long ago. As suggested at the beginning of this section, a diagnostic system is
inevitable, it appeals to the human desire for categories and order. But, if our system does not
meet the expectations set for it, something is wrong. If the DSM system is not leading the way
Here’s what’s next.
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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/m1/14/: accessed April 27, 2017), University of North Texas Libraries, Digital Library, digital.library.unt.edu; .