The Categorical Versus Dimensional Debate

Categorical versus dimensional classification first became a matter of concern when the DSM-III tripled the number of diagnoses described by its predecessors, thereby raising the question of boundaries between old and new diagnostic entities. As diagnoses proliferated, the frequency of comor-

bidity increased, causing clinicians to ask whether comorbidity represents the co-occurrence of two or more mental disorders or a single disorder that has simply been labeled in different ways. As a consequence, the advantages and disadvantages of dimensional and categorical approaches to personality and diagnosis are now being explored extensively (e.g., Widiger, 1997). The focus of these efforts is on the Personality Disorders, where symptom overlap is greatest.

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Blazer, D. G., Kessler, R. C., McGonagle, K. A., & Swartz, M. S. (1994). The prevalence and distribution of major depression in a national community sample: The National Comorbidity Survey. American Journal of Psychiatry, 151, 979-986. Caplan, P. J. (1991). How do they decide who is normal? The bizarre, but true, tale of the DSM process. Canadian Psychology, 32, 162-170. Feighner, J. R., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G., & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 57-63. Guze, S. B. (1995). Review of American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Journal of Psychiatry, 152, 1228. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic Stress Disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 10481060.

Kirk, S. A., & Kutchins, H. (1992). The selling of DSM. The rhetoric of science in psychiatry. Hawthorne, NY: Aldine de Gruyter. Klein, D. N., & Riso, L. P. (1993). Psychiatric disorders: Problems of boundaries and comorbidity. In C. G. Costello (Ed.), Basic issues inpsychopathology (pp. 19-66). New York: Guilford Press. Magee, W. J., Eaton, W. W., Wittchen, H.-U., McGonagle, K. A., & Kessler, R. C. (1996). Agoraphobia, simple phobia, and Social Phobia in the National Comorbidity Survey. Archives of General Psychiatry, 53, 159-168. Robins, E., & Guze, S. (1970). Establishment of diagnostic validity in psychiatric illnesses: Its application to Schizophrenia. American Journal of Psychiatry, 126, 983-987. Spitzer, R. L., Endicott, J., & Robins, E. (1975). Research diagnos tic criteria (RDC) for a selected group of functional disorders. New York: New York State Psychiatric Institute.

Spitzer, R. L., Fleiss, J. L., Endicott, J., & Cohen, J. (1967). Mental Status Schedule: Properties of a factor-analytically derived scale. Archives of General Psychiatry, 16, 479-493.

Widiger, T. A. (1997). Mental disorders as discrete clinical conditions: Dimensional versus categorical classification. In S. M. Turner & M. Hersen (Eds.), Adult psychopathology and diagnosis (pp. 3-23). New York: Wiley.

Widiger, T. A., & Trull, T. J. (1993). The scholarly development of DSM-IV. In J. A. C. de Silva & C. C. Nadelson (Eds.), International review of psychiatry (pp. 59-78). Washington, DC: American Psychiatric Press.

Peter E. Nathan University of Iowa, Iowa City

See also: Diagnosis; Reliability

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