Disorders without borders: current and future directions in the meta-structure of mental disorders

Purpose Classification is the cornerstone of clinical diagnostic practice and research. However, the extant psychiatric classification systems are not well supported by research evidence. In particular, extensive comorbidity among putatively distinct disorders flags an urgent need for fundamental ch...

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Bibliographic Details
Published in:Social Psychiatry and Psychiatric Epidemiology 2015-03, Vol.50 (3), p.339-350
Main Authors: Carragher, Natacha, Krueger, Robert F., Eaton, Nicholas R., Slade, Tim
Format: Article
Language:English
Subjects:
Comorbidity
Connective tissue diseases
Development and progression
Diagnostic equipment (Medical)
Epidemiology
Fear & phobias
Humans
Invited Reviews
Medicine
Medicine & Public Health
Mental disorders
Mental Disorders - classification
Mental Disorders - complications
Mental Disorders - diagnosis
Mental illness
Models, Psychological
Psychiatric Status Rating Scales
Psychiatry
Psychology, Pathological
Psychopathology
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Summary:Purpose Classification is the cornerstone of clinical diagnostic practice and research. However, the extant psychiatric classification systems are not well supported by research evidence. In particular, extensive comorbidity among putatively distinct disorders flags an urgent need for fundamental changes in how we conceptualize psychopathology. Over the past decade, research has coalesced on an empirically based model that suggests many common mental disorders are structured according to two correlated latent dimensions: internalizing and externalizing. Methods We review and discuss the development of a dimensional-spectrum model which organizes mental disorders in an empirically based manner. We also touch upon changes in the DSM-5 and put forward recommendations for future research endeavors. Results Our review highlights substantial empirical support for the empirically based internalizing–externalizing model of psychopathology, which provides a parsimonious means of addressing comorbidity. Conclusions As future research goals, we suggest that the field would benefit from: expanding the meta-structure of psychopathology to include additional disorders, development of empirically based thresholds, inclusion of a developmental perspective, and intertwining genomic and neuroscience dimensions with the empirical structure of psychopathology.
ISSN:0933-7954
1433-9285
DOI:10.1007/s00127-014-1004-z