Am J Psychiatry 160:4-12, January 2003
© 2003 American Psychiatric Association
Distinguishing Between the Validity and Utility of Psychiatric Diagnoses
Robert Kendell, M.D., and
Assen Jablensky, M.D.
OBJECTIVE: The meaning of the terms "validity" and "utility" as they apply to psychiatric diagnoses is examined. METHOD: The authors discuss the concepts of validity, utility, and disease; review assumptions that have been made about mental disorders as disease entities; and examine the evidence that mental disorders are separated from one another and from normality by natural boundaries (zones of rarity). RESULTS: Despite historical and recent assumptions to the contrary, there is little evidence that most currently recognized mental disorders are separated by natural boundaries. Researchers are increasingly assuming that variation in symptoms is continuous and are therefore questioning the validity of contemporary classifications. CONCLUSIONS: It is important to distinguish between validity and utility in considering psychiatric diagnoses. Diagnostic categories defined by their syndromes should be regarded as valid only if they have been shown to be discrete entities with natural boundaries that separate them from other disorders. Although most diagnostic concepts have not been shown to be valid in this sense, many possess high utility by virtue of the information about outcome, treatment response, and etiology that they convey. They are therefore invaluable working concepts for clinicians.
This article has been cited by other articles:
|
|
|
|
 
A. Jablensky
Towards ICD-11 and DSM-V: issues beyond 'harmonisation'
The British Journal of Psychiatry,
November 1, 2009;
195(5):
379 - 381.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Tyrer
From the Editor's desk
The British Journal of Psychiatry,
November 1, 2009;
195(5):
470 - 470.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Grove, O. McBride, and T. Slade
Towards DSM-V: Exploring Diagnostic Thresholds for Alcohol Dependence and Abuse
Alcohol Alcohol.,
October 6, 2009;
(2009)
agp069v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Kanaan, D. Armstrong, P. Barnes, and S. Wessely
In the psychiatrist's chair: how neurologists understand conversion disorder
Brain,
October 1, 2009;
132(10):
2889 - 2896.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Abi-Rached
Post-War Mental Health,Wealth, and Justice
Traumatology,
September 1, 2009;
15(3):
13 - 22.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. Kivimaki, G. D. Batty, A. Singh-Manoux, H. Nabi, S. Sabia, A. G. Tabak, T. N. Akbaraly, J. Vahtera, M. G. Marmot, and M. Jokela
Association between common mental disorder and obesity over the adult life course
The British Journal of Psychiatry,
August 1, 2009;
195(2):
149 - 155.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. E. Copeland, L. Shanahan, E. J. Costello, and A. Angold
Childhood and Adolescent Psychiatric Disorders as Predictors of Young Adult Disorders
Arch Gen Psychiatry,
July 1, 2009;
66(7):
764 - 772.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. A. Regier, W. E. Narrow, E. A. Kuhl, and D. J. Kupfer
The Conceptual Development of DSM-V
Am J Psychiatry,
June 1, 2009;
166(6):
645 - 650.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Fraguas and C.S. Breathnach
Problems with retrospective studies of the presence of schizophrenia
History of Psychiatry,
March 1, 2009;
20(1):
61 - 71.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. van Os
A salience dysregulation syndrome
The British Journal of Psychiatry,
February 1, 2009;
194(2):
101 - 103.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. R. Lake
Hypothesis: Grandiosity and Guilt Cause Paranoia; Paranoid Schizophrenia is a Psychotic Mood Disorder; a Review
Schizophr Bull,
November 1, 2008;
34(6):
1151 - 1162.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Cuesta and V. Peralta
Current Psychopathological Issues in Psychosis: Towards a Phenome-wide Scanning Approach
Schizophr Bull,
July 1, 2008;
34(4):
587 - 590.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Reeve, M Lloyd-Williams, and C Dowrick
Revisiting depression in palliative care settings: the need to focus on clinical utility over validity
Palliative Medicine,
June 1, 2008;
22(4):
383 - 391.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. Summerfield
How scientifically valid is the knowledge base of global mental health?
BMJ,
May 3, 2008;
336(7651):
992 - 994.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. A. Leiknes, A. Finset, T. Moum, and I. Sandanger
Overlap, Comorbidity, and Stability of Somatoform Disorders and the Use of Current Versus Lifetime Criteria
Psychosomatics,
April 1, 2008;
49(2):
152 - 162.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Noyes Jr., S. P. Stuart, and D. B. Watson
A Reconceptualization of the Somatoform Disorders
Psychosomatics,
February 1, 2008;
49(1):
14 - 22.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Raymond Lake
Disorders of Thought Are Severe Mood Disorders: the Selective Attention Defect in Mania Challenges the Kraepelinian Dichotomy A Review
Schizophr Bull,
January 1, 2008;
34(1):
109 - 117.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Rief and G. Rojas
Stability of Somatoform Symptoms Implications for Classification
Psychosom Med,
November 1, 2007;
69(9):
864 - 869.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Allardyce, W. Gaebel, J. Zielasek, and J. van Os
Deconstructing Psychosis Conference February 2006: The Validity of Schizophrenia and Alternative Approaches to the Classification of Psychosis
Schizophr Bull,
July 1, 2007;
33(4):
863 - 867.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Owen, N. Craddock, and A. Jablensky
The Genetic Deconstruction of Psychosis
Schizophr Bull,
July 1, 2007;
33(4):
905 - 911.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Dutta, T. Greene, J. Addington, K. McKenzie, M. Phillips, and R. M. Murray
Biological, Life Course, and Cross-Cultural Studies All point Toward the Value of Dimensional and Developmental Ratings in the Classification of Psychosis
Schizophr Bull,
July 1, 2007;
33(4):
868 - 876.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. S. E. Keefe and W. S. Fenton
How Should DSM-V Criteria for Schizophrenia Include Cognitive Impairment?
Schizophr Bull,
July 1, 2007;
33(4):
912 - 920.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Buchanan
Georges Canguilhem and the Diagnosis of Personality Disorder
J Am Acad Psychiatry Law,
June 1, 2007;
35(2):
148 - 151.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Zachar and K. S. Kendler
Psychiatric Disorders: A Conceptual Taxonomy
Am J Psychiatry,
April 1, 2007;
164(4):
557 - 565.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Baca-Garcia, M. M. Perez-Rodriguez, I. Basurte-Villamor, A. L. F. Del Moral, M. A. Jimenez-Arriero, J. L. G. De Rivera, J. Saiz-Ruiz, and M. A. Oquendo
Diagnostic stability of psychiatric disorders in clinical practice
The British Journal of Psychiatry,
March 1, 2007;
190(3):
210 - 216.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A Lieberman and M. B First
Renaming schizophrenia
BMJ,
January 20, 2007;
334(7585):
108 - 108.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Fink, T. Toft, M. S. Hansen, E. Ornbol, and F. Olesen
Symptoms and Syndromes of Bodily Distress: An Exploratory Study of 978 Internal Medical, Neurological, and Primary Care Patients
Psychosom Med,
January 1, 2007;
69(1):
30 - 39.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. B. First
Beyond Clinical Utility: Broadening the DSM-V Research Appendix to Include Alternative Diagnostic Constructs
Am J Psychiatry,
October 1, 2006;
163(10):
1679 - 1681.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Smart
A multi-dimensional model of clinical utility
Int. J. Qual. Health Care,
October 1, 2006;
18(5):
377 - 382.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. S. Kendler
Reflections on the Relationship Between Psychiatric Genetics and Psychiatric Nosology
Am J Psychiatry,
July 1, 2006;
163(7):
1138 - 1146.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. WEICH, L. TWIGG, and G. LEWIS
Rural/non-rural differences in rates of common mental disorders in Britain: Prospective multilevel cohort study
The British Journal of Psychiatry,
January 1, 2006;
188(1):
51 - 57.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. WEICH, L. TWIGG, G. LEWIS, and K. JONES
Geographical variation in rates of common mental disorders in Britain: prospective cohort study
The British Journal of Psychiatry,
July 1, 2005;
187(1):
29 - 34.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. N. Osser, R. D. Patterson, and J. J. Levitt
Guidelines, Algorithms, and Evidence-Based Psychopharmacology Training for Psychiatric Residents
Acad Psychiatry,
June 1, 2005;
29(2):
180 - 186.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Weich
Absence of spatial variation in rates of the common mental disorders
J Epidemiol Community Health,
April 1, 2005;
59(4):
254 - 257.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Bhui, S. Stansfeld, K. McKenzie, S. Karlsen, J. Nazroo, and S. Weich
Racial/Ethnic Discrimination and Common Mental Disorders Among Workers: Findings From the EMPIRIC Study of Ethnic Minority Groups in the United Kingdom
Am J Public Health,
March 1, 2005;
95(3):
496 - 501.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. N. Robins
Using Survey Results to Improve the Validity of the Standard Psychiatric Nomenclature
Arch Gen Psychiatry,
December 1, 2004;
61(12):
1188 - 1194.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. N. Robins and L. B. Cottler
Making a Structured Psychiatric Diagnostic Interview Faithful to the Nomenclature
Am. J. Epidemiol.,
October 15, 2004;
160(8):
808 - 813.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. B. First, H. A. Pincus, J. B. Levine, J. B.W. Williams, B. Ustun, and R. Peele
Clinical Utility as a Criterion for Revising Psychiatric Diagnoses
Am J Psychiatry,
June 1, 2004;
161(6):
946 - 954.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Sharpe and R. Mayou
Somatoform disorders: a help or hindrance to good patient care?
The British Journal of Psychiatry,
June 1, 2004;
184(6):
465 - 467.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Mayou, J. Levenson, and M. Sharpe
Somatoform Disorders in DSM-V
Psychosomatics,
December 1, 2003;
44(6):
449 - 451.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Shorter and P. Tyrer
Separation of anxiety and depressive disorders: blind alley in psychopharmacology and classification of disease
BMJ,
July 17, 2003;
327(7407):
158 - 160.
[Full Text]
[PDF]
|
|
|
Get information about faster international access.
Privacy Policy
Copyright © 2003
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
