Mad Science by Stuart A. Kirk
Author:Stuart A. Kirk [Kirk, Stuart A.; Gomory, Tomi; Cohen, David ]
Language: eng
Format: epub
ISBN: 9781412849319
Publisher: Transaction Publishers
Comorbidity among Categories
In addition to heterogeneity within categories, there is comorbidity across DSM categories. Comorbidity refers to people having more than one “disease,” more than one morbid condition. Since some DSM categories share diagnostic criteria (behaviors asserted to be representative “symptoms”), some people either meet the required criteria for more than one category or have some but not enough symptoms to “qualify” for any one DSM disease category. In short, many people don’t fit neatly into the DSM categories. This is not merely the case of the occasional person having more than one “independent” illness at the same time. This is a much more extensive and common problem, undermining the DSM assumption of discrete categories of illness. In fact, studies (Kessler, Chiu, Kemler, & Walters, 2005) have found comorbidity in about half of people diagnosed, suggesting, as one researcher said, that “there is no empirical evidence” for “natural boundaries between major syndromes,” and that “the categorical approach is fundamentally flawed” (Cloninger, 1999, as cited in Rounsaville et al., 2002, p. 12).
DSM provides various tactics for categorizing messy cases. One is a catchall option within most categories: NOS “Not Otherwise Specified.” If a person doesn’t meet the required specific criteria demanded by DSM, clinicians can use NOS. Another tactic, added in DSM-IV (p. xxiii) allows clinicians to use a category even if the problem “falls just short” of the full criteria. In these ways, the entire effort of the modern DSM to specify required diagnostic criteria can be ignored at any time by any clinician by using NOS or the “just falls short” options.
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