Beyond Clinical Utility: Broadening the DSM-V Research Appendix to Include Alternative Diagnostic Constructs

摘要

Over the past 15 years, researchers have argued that DSM-IV criteria are hindering investigation into the etiology, pathophysiology, and genetics of mental disorders (1-3) and have proposed changes to DSM-V to make it more useful for research. These include moving from a categorical to a dimensional approach more friendly to research (4-14) and adopting a "genetic nosology" that seeks to classify patients into categories that correspond to distinct genetic entities (15). However, because DSM must serve many masters (16), the prospect of including diagnostic constructs useful for researchers but unfamiliar, burdensome, or of unknown utility to clinicians creates a dilemma: how can DSM-V maintain its role as a common diagnostic language facilitating research efforts without seriously compromising its clinical utility?