'A rose is a rose is a rose'?

摘要

To the Editor: Dr. Barglow's commentary on the Freedman et al. editorial (1) regarding publication of the DSM-5 field trial results (2) addresses the distinction between the validity and the reliability of mental disorder diagnoses now contained in the DSM-5 revision. Dr. Barglow is correct in noting the additional requirements for validity in the Robins and Guze criteria, which include distinct boundaries, family history, laboratory tests, and clinical course, modified by Kendler to include treatment response (3). However, the original Kraepelinian and the Robins and Guze neo-Kraepelinian conceptualization of categorical diagnoses with distinct boundaries between disorders has been called into question by the failure to find "zones of rarity" between diagnoses based on symptomatic overlap and epidemiologic findings in the historic paper of Kendell and Jablensky (4). More recently, the molecular genetic findings of the Cross-Disorder Group of the Psychiatric Genomics Consortium (5) put to rest the distinct genetic vulnerability theory for many mental disorders by showing common genetic vulnerabilities for neuro-developmental disorders (autism spectrum disorder and attention deficit hyperactivity disorder), schizophrenia, bipolar disorder, and major depressive disorder—the first four chapters of DSM-5. Even Kraepelin in his later years dropped the concept of a strict separation of schizophrenia and the affective psychoses in favor of a spectrum approach that would include schizotypal personality disorder, schizophrenia, schizoaffective disorder, and bipolar disorder in today's classification (6).