Clinical Diagnosis at the Crossroads

David Watson, University of Iowa
Lee Anna Clark

Abstract

There is widespread dissatisfaction with the existing diagnostic system articulated in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The current DSM system is atheoretical, cumbersome to use, and plagued by the problems of comorbidity and heterogeneity. We explore two possible alternative approaches: (a) reorganizing the diagnostic classes and (b) the implementation of fully dimensional schemes. We then discuss the possibility that DSM-V will be a hybrid system, with Axis I remaining categorical and Axis II becoming dimensional. We conclude with a discussion of the merits—as well as the disadvantages—of creating two different taxonomic systems, one designed for psychopathology researchers and the other for practicing clinicians