Order of psychiatric diagnoses may influence how clinicians identify symptoms

November 28, 2012

The diagnostic system used by many mental health practitioners in the United States—known as the Diagnostic and Statistical Manual of Mental Disorders—assumes that symptoms of two disorders that occur at the same time are additive and that the order in which the disorders are presented doesn't matter. But new research suggests that order actually plays a significant role in determining how clinicians think about psychiatric disorders.

In an article published in Clinical , a journal of the Association for Psychological Science, researchers Jared Keeley, Chafen DeLao, and Claire Kirk of Mississippi State University draw from existing research on conceptual combination to investigate how clinicians diagnose that occur together.

They predicted that for disorders with overlapping symptoms—such as (MDD) and generalized anxiety disorder (GAD)—clinicians would describe the disorders pretty much the same way, regardless of which disorder was presented first.

But for two disorders that are quite different—such as (GAD) and (ASPD)—the researchers predicted that the order in which symptoms are presented would significantly influence clinicians' descriptions of the disorders.

Keeley and colleagues also predicted that the features of one disorder would overshadow the features of another, providing evidence for a "dominance" effect.

In two different studies, the researchers asked clinicians to identify the symptoms that would describe each of three disorders individually (MDD, GAD, ASPD) and the symptoms that would describe paired combinations of the three disorders.

In both studies, the clinicians were inconsistent in their descriptions of disorder pairs—for example, the symptoms they identified for a combination of MDD + ASPD were not necessarily the same as those identified for a combination of ASPD + MDD.

And in one of the two studies, the researchers found that the order of symptoms mattered more for clinicians' descriptions of disorders that were different than for disorders that overlapped, partially confirming their original hypothesis.

Together, these results seem to contradict the assumption that order doesn't matter in psychiatric diagnoses. Findings from a third study indicated that clinicians' descriptions of the symptoms involved in GAD were dominated by their descriptions of both MDD and ASPD, while symptoms of ASPD and MDD had equal weight.

Keeley and colleagues offer several possible explanations for their findings. Clinicians could be straying from the additive guidelines of the . Alternatively, their clinical experiences may have led to "rater drift," such that the criteria that they use to evaluate symptoms have drifted over time.

But it's also possible that practitioners are actually ahead of the curve. Keeley, DeLao, and Kirk argue that clinicians could be "accurately modeling an aspect of psychopathology that our current has yet to accommodate."

While it remains to be seen whether these findings have implications for the actual treatment of psychiatric disorders, Keeley and colleagues believe that these three studies may help researchers and practitioners in trying to bring the classification of psychiatric disorders and actual clinical practice closer together.

Explore further: DSM-5 proposed criteria for autism spectrum disorder diagnosis

More information: "The Commutative Property in Comorbid Diagnosis: Does A + B = B + A?" Clinical Psychological Science, 2012.

Related Stories

DSM-5 proposed criteria for autism spectrum disorder diagnosis

January 23, 2012

(Medical Xpress) -- The American Psychiatric Association (APA) has proposed new diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for autism. While final decisions ...

Study finds faults in proposed mental disorder diagnosis

October 3, 2012

A much anticipated addition to the revised Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) is questionable according to research findings. The newly revised DSM-5, the first alterations since it ...

Psychiatric group: Parental alienation no disorder

September 21, 2012

(AP)—Rebuffing an intensive lobbying campaign, a task force of the American Psychiatric Association has decided not to list the disputed concept of parental alienation in the updated version of its catalog of mental disorders.

The dark path to antisocial personality disorder

February 7, 2012

With no lab tests to guide the clinician, psychiatric diagnostics is challenging and controversial. Antisocial personality disorder is defined as "a pervasive pattern of disregard for, and violation of, the rights of others ...

Recommended for you

Who needs stress? We all do. Here's why

January 17, 2017

If you could do something to decrease your risk of memory failure, to increase your self-confidence, to be a better public speaker, to improve your brain, to help you deal with back pain, to bust out of your comfort zone, ...

Teens unlikely to be harmed by moderate digital screen use

January 13, 2017

Parents and pediatricians alike may worry about the effects of teens' screen time, but new findings from over 120,000 adolescents in the UK indicate that the relationship between screen time and well-being is weak at best, ...

Schizophrenia could directly increase risk of diabetes

January 12, 2017

People with early schizophrenia are at an increased risk of developing diabetes, even when the effects of antipsychotic drugs, diet and exercise are taken out of the equation, according to an analysis by researchers from ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.