Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2012

Open Access 01-12-2012 | Opinion

Towards a genuinely medical model for psychiatric nosology

Authors: Randolph M Nesse, Dan J Stein

Published in: BMC Medicine | Issue 1/2012

Login to get access

Abstract

Psychiatric nosology is widely criticized, but solutions are proving elusive. Planned revisions of diagnostic criteria will not resolve heterogeneity, comorbidity, fuzzy boundaries between normal and pathological, and lack of specific biomarkers. Concern about these difficulties reflects a narrow model that assumes most mental disorders should be defined by their etiologies. A more genuinely medical model uses understanding of normal function to categorize pathologies. For instance, understanding the function of a cough guides the search for problems causing it, and decisions about when it is expressed abnormally. Understanding the functions of emotions is a foundation missing from decisions about emotional disorders. The broader medical model used by the rest of medicine also recognizes syndromes defined by failures of functional systems or failures of feedback control. Such medical syndromes are similar to many mental diagnoses in their multiple causes, blurry boundaries, and nonspecific biomarkers. Dissatisfaction with psychiatric nosology may best be alleviated, not by new diagnostic criteria and categories, but by more realistic acknowledgment of the untidy landscape of mental and other medical disorders.
Literature
1.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 2000, Washington, DC: American Psychiatric Association, 4
2.
Akil H, Brenner S, Kandel E, Kendler KS, King MC, Scolnick E, Watson JD, Zoghbi HY: Medicine. The future of psychiatric research: genomes and neural circuits. Science. 2010, 327: 1580-1581. 10.1126/science.1188654.CrossRefPubMedPubMedCentral
3.
Hyman SE: The diagnosis of mental disorders: the problem of reification. Annu Rev Clin Psychol. 2010, 6: 155-179. 10.1146/annurev.clinpsy.3.022806.091532.CrossRefPubMed
4.
Wakefield JC: Diagnosing DSM-IV--Part I: DSM-IV and the concept of disorder. Behav Res Ther. 1997, 35: 633-649. 10.1016/S0005-7967(97)00018-1.CrossRefPubMed
5.
Phillips KA, First MB, Pincus HA: Advancing DSM: Dilemmas in Psychiatric Diagnosis. 2003, Washington, D.C.: American Psychiatric Association
6.
Nesse RM, Jackson ED: Evolutionary foundations for psychiatric diagnosis: making DSM-V valid. Maladapting Minds: Philosophy, Psychiatry, and Evolutionary Theory. Edited by: De Block A, Adriaens P. 2011, Oxford: Oxford University Press, 167-191.
7.
Stein D, Phillips K, Bolton D, Fulford K, Sadler J, Kendler K: What is a mental/psychiatric disorder? From DSM-IV to DSM-V. Psychol Med. 2010, 40: 1759-1765. 10.1017/S0033291709992261.CrossRefPubMedPubMedCentral
8.
Grebb JA, Carlsson A: Introduction and considerations for a brain-basd diagnostic system in psychiatry. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Edited by: Sadock BJ, Sadock VA, Ruiz P, Kaplan HI. 2009, Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 1-4. 9
9.
Luhrmann TM: Of Two Minds: An Anthropologist Looks at American Psychiatry. 2000, New York: Alfred A. Knopf
10.
Hyman SE: Can neuroscience be integrated into the DSM-V?. Nat Rev Neurosci. 2007, 8: 725-732. 10.1038/nrn2218.CrossRefPubMed
11.
12.
Klein D: Delineation of two drug-responsive anxiety syndromes. Psychopharmacology. 1964, 5: 397-408. 10.1007/BF02193476.CrossRef
13.
Kety SS, Rosenthal D, Wender PH, Schulsinger F, Jacobsen B: Mental illness in the biological and adoptive families of adopted individuals who have become schizophrenic. Behav Genet. 1976, 6: 219-225. 10.1007/BF01065721.CrossRefPubMed
14.
Feighner J, Robins E, Guze S, Woodruff R, Winokur G, Munoz R: Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry. 1972, 26: 57-10.1001/archpsyc.1972.01750190059011.CrossRefPubMed
15.
American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders. 1968, Washington: American Psychiatric Association, 2
16.
American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders. 1980, Washington, D.C.: American Psychiatric Association, 3
17.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 2000, Washington, DC: American Psychiatric Association, 4
18.
Wilson M: DSM-III and the transformation of American psychiatry: a history. Am J Psychiatry. 1993, 150: 399-410.CrossRefPubMed
19.
Spitzer RL, Williams JB, Gibbon M, First MB: The structured clinical interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry. 1992, 49: 624-629. 10.1001/archpsyc.1992.01820080032005.CrossRefPubMed
20.
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshelman S, Willchen HU, Kendler KS: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the national comorbidity survey. Arch Gen Psychiatry. 1994, 51: 8-19. 10.1001/archpsyc.1994.03950010008002.CrossRefPubMed
21.
Kessler RC, Chiu WT, Demler O, Merikangas K, Walters EE: Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry. 2005, 62: 617-627. 10.1001/archpsyc.62.6.617.CrossRefPubMedPubMedCentral
22.
Kendell R, Jablensky A: Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry. 2003, 160: 4-12. 10.1176/appi.ajp.160.1.4.CrossRefPubMed
23.
Andreasen NC: DSM and the death of phenomenology in america: an example of unintended consequences. Schizophr Bull. 2007, 33: 108-112.CrossRefPubMed
24.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 1994, Washington, DC: American Psychiatric Association, 4
25.
Adriaens PR, De Block A: Why we essentialize mental disorders. J Med Philo. 2012, (forthcoming)
26.
Schwartz MA, Wiggins OP: Diagnosis and ideal types: a contribution to psychiatric classification. Compr Psychiatry. 1987, 28: 277-291. 10.1016/0010-440X(87)90064-2.CrossRefPubMed
27.
28.
Frances A: A warning sign on the road to DSM-V: beware of its unintended consequences. Psychiat Times. 2010, 26.
29.
30.
Helzer JE: A proposal for incorporating clinically relevant dimensions into DSM-5. The Conceptual Evolution of DSM-5. Edited by: Regier DA, Narrow WE, Kuhl EA. 2010, Washington DC: American Psychiatric Publisher, 81-96.
31.
Kraemer HC: DSM categories and dimensions in clinical and research contexts. Int J Meth Psychiat Res. 2007, 16: S8-S15. 10.1002/mpr.211.CrossRef
32.
Westen D, Heim A, Morrison K, Patterson M, Campbell L: Simplifying diagnosis using a prototype-matching approach: Implications for the next edition of the DSM. Rethinking the DSM: A Psychological Perspective (Decade of Behavior). 2002, Washington, DC: American Psychological Association, 221-250.CrossRef
33.
Stein DJ: Philosophy of Psychopharmacology: Smart Pills, Happy Pills, and Pep Pills. 2008, Cambridge, UK; New York: Cambridge University PressCrossRef
34.
Kendler KS, First MB: Alternative futures for the DSM revision process: iteration v. paradigm shift. Br J Psychiatry. 2010, 197: 263-265. 10.1192/bjp.bp.109.076794.CrossRefPubMed
35.
Wakefield J: Evolutionary versus prototype analyses of the concept of disorder. J Abnorm Psychol. 1999, 108: 374-399.CrossRefPubMed
36.
Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, Sanislow C, Wang P: Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010, 167: 748-751. 10.1176/appi.ajp.2010.09091379.CrossRefPubMed
37.
Kupfer DJ, Regier DA: Why all of medicine should care about DSM-5. JAMA. 2010, 303: 1974-1975. 10.1001/jama.2010.646.CrossRefPubMed
38.
39.
40.
Murphy D, Stich S: Darwin in the madhouse: evolutionary psychology and the classification of mental disorders. Evolution and the Human Mind: Modularity, Language and Meta-Cognition. Edited by: Carruthers P, Chamberlain A. 2000, Cambridge: Cambridge University Press, 62-92.CrossRef
41.
Kennair LEO: Evolutionary psychology and psychopathology. Curr Opin Psychiatry. 2003, 16: 691-699. 10.1097/00001504-200311000-00015.CrossRef
42.
Nesse RM: Natural selection and the regulation of defenses: a signal detection analysis of the smoke detector principle. Evol Hum Behav. 2005, 26: 88-105. 10.1016/j.evolhumbehav.2004.08.002.CrossRef
43.
Nesse RM, Williams GC: Why We Get Sick: the New Science of Darwinian Medicine. 1996, New York: Vintage Books
44.
Nesse RM: Evolutionary origins and functions of emotions. The Oxford Companion to Emotion and the Affective Sciences. Edited by: Scherer K, Sander D. 2009, Oxford: Oxford University Press, 159-164.
45.
Nesse RM: Proximate and evolutionary studies of anxiety, stress, and depression: synergy at the interface. Neurosci Biobehav Rev. 1999, 23: 895-903. 10.1016/S0149-7634(99)00023-8.CrossRefPubMed
46.
Stein DJ, Nesse RM: Threat detection, precautionary responses, and anxiety disorders. Neurosci Biobehav Rev. 2011, 35: 1075-1079. 10.1016/j.neubiorev.2010.11.012.CrossRefPubMed
47.
Plutchik R: Emotions and Life: Perspectives from Psychology, Biology, and Evolution. 2003, Washington DC: American Psychological Association
48.
49.
Nesse RM: Explaining depression: neuroscience is not enough, evolution is essential. Understanding Depression: A Translational Approach. Edited by: Pariente CM, Nesse RM, Nutt DJ, Wolpert L. 2009, Oxford, UK: Oxford University Press, 17-35.CrossRef
50.
Wakefield J, Baer J, Schmitz M: Differential diagnosis of depressive illness versus intense normal sadness: how significant is the'clinical significance criterion'for major depression?. Expert Rev Neurother. 2010, 10: 1015-1018. 10.1586/ern.10.67.CrossRefPubMed
51.
Wakefield JC, Schmitz MF, Baer JC: Did narrowing the major depression bereavement exclusion from DSM-III-R to DSM-IV increase validity? Evidence from the national comorbidity survey. J Nerv Ment Dis. 2011, 199: 66-73. 10.1097/NMD.0b013e31820840c5.CrossRefPubMed
52.
Zisook S, Kendler KS: Is bereavement-related depression different than non-bereavement-related depression?. Psychol Med. 2007, 37: 779-794. 10.1017/S0033291707009865.CrossRefPubMed
53.
54.
Wakefield JC, First MB: Placing symptoms in context: the role of contextual criteria in reducing false positives in Diagnostic and Statistical Manual of Mental Disorders diagnoses. Compr Psychiatry. 2011.
55.
Krebs J, Davies N: Behavioral Ecology: An Evolutionary Approach. 1991, Oxford: Blackwell, 3
56.
Belsky J: Attachment, mating, and parenting: an evolutionary interpretation. Hum Nat. 1997, 8: 361-381. 10.1007/BF02913039.CrossRefPubMed
57.
Westneat DF, Fox CW: Evolutionary Behavioral Ecology. 2010, Oxford; New York: Oxford University Press
58.
Kardum I: Evolutionary explanations of eating disorders. Psychol Topics. 2008, 17: 247-263.
59.
Power ML, Schulkin J: The Evolution of Obesity. 2009, Baltimore: Johns Hopkins University Press
60.
Kirkpatrick LA, Ellis BJ: An evolutionary-psychological approach to self-esteem: multiple domains and multiple functions. Blackwell Handbook of Social Psychology: Interpersonal Processes. Edited by: Fletcher GJO, Clark MS. 2001, Oxford, UK: Blackwell, 411-436.
61.
McGuire MT, Troisi A, Raleigh MM: Depression in evolutionary context. The Maladapted Mind. Edited by: Baron-Cohen S. Erlbaum. 1997, East Sussex: Psychology Press, 255-282.
62.
Troisi A: Sexual disorders in the context of Darwinian psychiatry. J Endocrinol Invest. 2003, 26: 54-57.PubMed
63.
Buss DM: The Evolution of Desire: Strategies of Human Mating. 2003, New York: BasicBooks, Revised
64.
Troisi A, McGuire M: Darwinian psychiatry and the concept of mental disorder. Neuro Endocrinol Lett. 2002, 23 (Suppl 4): 31-38.PubMed
65.
Brüne M: Textbook of Evolutionary Psychiatry: the Origins of Psychopathology. 2008, Oxford; New York: Oxford University Press
66.
Powers WT: Behavior: The Control of Perception. 1973, Chicago: Aldine
67.
68.
Abelson JL, Nesse RM, Weg JG, Curtis GC: Respiratory psychophysiology and anxiety: ognitive intervention in the doxapram model of panic. Psychosom Med. 1996, 58: 302-313.CrossRefPubMed
69.
Klein DF: Cybernetics, activation, and drug effects. Acta Psychiatr Scand Suppl. 1988, 341: 126-137.CrossRefPubMed
Metadata
Title
Towards a genuinely medical model for psychiatric nosology
Authors
Randolph M Nesse
Dan J Stein
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2012
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-10-5

Other articles of this Issue 1/2012

BMC Medicine 1/2012 Go to the issue

Minireview

Clinical application of stem cell therapy in Parkinson's disease

Technical advance

The Transeurope Footrace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486km transcontinental ultramarathon

Commentary

Cost-effectiveness analysis for clinicians

Research article

Autophagy in periodontitis patients and gingival fibroblasts: unraveling the link between chronic diseases and inflammation

Review

Novel therapeutic strategies targeting HIV integrase

Review

Notch signaling in pediatric soft tissue sarcomas