Limitations of the symptom-oriented approach to psychiatric research

Author(s): Rieder, R. O.

Journal/Book: Br J Psychiatry. 1998; 173: British Journal of Psychiatry, 17 Belgrave Square, London SW1X 8PG, England. Royal College of Psychiatrists. 198-202.

Abstract: Background We critically reviewed the arguments of the symptom-oriented researchers who propose to replace syndromes and diagnostic categories with symptoms as units of analysis in psychiatric research. Method Three central arguments were examined: (a) current diagnostic categories lack reliability and validity; (b) using diagnostic categories leads to misclassification and confounding; and (c) symptom - oriented theories are clearer, easier to test, and more likely to lead to an explanation of psychopathology. These arguments are based on three assumptions respectively: (a) symptoms have higher reliability and validity; (b) underlying pathological processes are symptom-specific; and (c) elucidation of the process of symptom development will lead to (and must precede) the discovery of the causes of syndromes. Results We found little evidence supporting these assumptions and arguments based on them. Conclusion There are no clear advantages in replacing syndromes with symptoms as units of analysis for psychiatric research.

Note: Review Mojtabai R, 200 Haven Ave, Apt 6P, New York,NY 10033 USA

Keyword(s): DIAGNOSTIC-CRITERIA; SCHIZOPHRENIA; PAIRS

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