Diagnostic Categories Or Dimensions

Thought Paper Two
After reading the article titled, “Diagnostic Categories or Dimensions? A Question for the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition, ” by Thomas A. Widiger and Douglas B. Samuel of the University of Kentucky, I realized that the categorical approach does have some flaws, but the dimensional approach is not perfect either. Authors Widiger and Samuel believe that the dimensional approach, which classifies by disorders by differing in degrees. An example of this would be saying a person is mildly depressed, moderately depressed, or severely depressed instead of just diagnosing this person with depression, which represents the categorical approach. Agreeing with Widiger and Samuel, I believe there
are flaws in the categorical approach for many reasons. Disagreeing with the authors I also believe there are many benefits by using the categorical model. Starting with the flaws, having a categorical approach may be leaving patients who would benefit from treatment, or patients who should be diagnosed with a disorder undiagnosed; for example they may only meet criteria for six symptoms of this disorder instead of seven which would qualify them to be diagnosed.
The categorical model, which is currently used now in the DSM-V and was used in the DSM-IV, helps clinicians decide if their patient has a disorder and then tries to clarify which disorder that may be.
However, like Widiger and Samuel state, “It is evident, however, that DSM–IV routinely fails in the goal of guiding the clinician to the presence of one specific disorder”. Too often today we see patients diagnosed with multiple disorders when in fact they may only need one diagnosis. Comorbidity is a huge problem with the DSM. I believe we still have a lot of flaws in the system but that over time and with a few adjustments we will be giving patients the best care possible. Seeing patients diagnosed with a disorder with the words “not otherwise specified” following is a huge flaw that I see. I do understand why some clinicians may do this. They believe that their patient would benefit from treatment but do not meet the full diagnostic criteria. I do understand that and I agree that patients should be given treatment if treatment will help. However, we have certain diagnostic criteria for a reason, and if that criteria is not allowing patients who would benefit from treatment to receive it then there is a problem with the system. This is where the dimensional approach could help patients by using a
continuum.
The dimensional approach also has flaws. Using a dimensional approach, it may be difficult to see validity among clinicians. One clinician may diagnosis a patient with minor anxiety, where another clinician may believe that this same patient has moderate anxiety. Nevertheless, this patient has anxiety. It can be black or white. The patient either has a disorder or doesn’t; the intensity does not have to be labeled as long as the patient is receiving proper care. The dimensional approach may also be misdiagnosing patients who do not need treatment as having a minor disorder.
Neither classification approach is perfect and each has flaws, but using the approach that will insure the most validity and reliability is key. I am not convinced that the DSM should be categorized in a dimensional model but I do believe that we still have flaws in the categorical model. In my opinion, Widiger and Samuel made a good argument, however I believe we should put our energy into fixing the flaws we have now in the categorical model and not switch to a completely different model which is bound to have multiple flaws simply because we have to start fresh.