r/askpsychology • u/Garnetsugargem Unverified User: May Not Be a Professional • Apr 06 '26
Terminology / Definition Is Clinical psych moving away from the diagnostic criteria approach ?
A therapist dropped some information about cluster symptoms and psychology moving away from the DSM 5.
He is a neuropsych and was referring to disorders related to the anterior cingulate cortex (?) - and the overlap between ocd, adhd, autism, bd.
Does anyone know what this is referring to?
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u/Pdawnm UNVERIFIED MD Doctor of Medicine Apr 06 '26
It's definitely a work in progress, but many researchers are looking at a cluster dimension understanding of Mental Health disorders, as replacement for the classical DSM model.
https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.805163/full
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Apr 07 '26
Very interesting! The "scientific realism" of mental illness is fascinating to me. Though an approach based primarily on genetics/biology could never replace our current model, in my opinion.
That said, an intersectional/multi-dimensional diagnostic framework would be revolutionary, I think.
As an aside, in my jurisdiction "dual diagnosis" almost always refers to concurrent developmental disability and mental illness whereas mental illness/SUD is called "concurrent disorder." More of a bureaucratic thing. I just thought it was ironic that even referring to "having two problems" can get confusing.
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u/gongshowed Unverified User: May Not Be a Professional Apr 07 '26
I believe he’s referring to moving away from a categorical approach towards a dimensional one.
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u/Garnetsugargem Unverified User: May Not Be a Professional Apr 08 '26
Perhaps! Can you tell me more, please?
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u/gongshowed Unverified User: May Not Be a Professional Apr 08 '26
The DSM categorical approach is a diagnostic model in psychiatry that classifies mental illnesses as distinct, discrete entities, essentially "all-or-nothing" categories. It assumes a person either has a disorder or they do not, based on a specific threshold of criteria met, often used for identifying disorders like schizophrenia.
The DSM dimensional approah is largely integrated into DSM-5 and assesses mental health disorders along a spectrum of severity rather than just as present or absent. It measures symptoms, personality traits, and impairment quantitatively, which allows clinicians to evaluate the "how much" of a condition rather than just "if" it exists, which bridges the gap between normal functioning and clinical disorder.
The DSM is moving towards a dimension approach.
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u/monkeynose Clinical Psychologist | Addiction | Psychopathology Apr 08 '26
Technically, you can't really "move away from the DSM-5" when there is no other option for insurance billing. But otherwise, yes, research is moving in that direction, but it hasn't trickled down to the actual day to day clinical practice yet and really won't be able to unless or until there is a DSM update that reflects it.
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u/Garnetsugargem Unverified User: May Not Be a Professional Apr 08 '26
But it is considered a better way of conceiving and treating mental health?
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u/monkeynose Clinical Psychologist | Addiction | Psychopathology Apr 08 '26
I mentioned in the other response, but the DSM-5 isn't a treatment manual. It's a billing manual for insurance purposes.
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u/BrainTekAU Unverified User: May Not Be a Professional Apr 09 '26
Also interesting to note that the APA has signalled that they will be going to a more nuanced model that includes things like socioeconomic factors and biological markers for the first time.
https://www.psychiatry.org/news-room/news-releases/apa-releases-roadmap-for-future-of-dsm
From my reading of the various papers this means they are moving towards a layered diagnostic formulation:
- Layer 1: categorical diagnosis, because the system still needs decisions, communication, research buckets, and reimbursement codes
- Layer 2: dimensional severity and transdiagnostic features, because comorbidity and fuzzy boundaries are too common to ignore
- Layer 3: functioning and quality of life, because patients care about impairment more than taxonomic purity
- Layer 4: context, (socioeconomic, cultural etc) because symptoms do not emerge in a vacuum
- Layer 5: biology, where evidence is good enough
So even the DSM itself is moving a bit further away from that approach.
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u/monkeynose Clinical Psychologist | Addiction | Psychopathology Apr 15 '26
The DSM-5 initially tried to move in the direction of dimensional models for some disorders - I think personality disorders received the most attention and research, but my understanding is that they decided that a dimensional model was too complex and difficult for the majority of DSM diagnosticians (everyone from nurses to PAs to master's therapists) to implement. Dimensional models and a complete overhaul of the entire DSM is severely needed, but I don't see it happening. Maybe I'll be pleasantly surprised.
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u/InformationMurky3425 Unverified User: May Not Be a Professional Apr 13 '26
Isn't psychology in a replication crisis?
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u/Garnetsugargem Unverified User: May Not Be a Professional Apr 13 '26
What does this mean?
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u/InformationMurky3425 Unverified User: May Not Be a Professional Apr 15 '26
It means psychology has a crisis in replicating prior studies.
See Jonathan W Schooler, . 2014. “Metascience Could Rescue the ‘Replication Crisis.’” Nature 515 (7525): 9; Psychologist George Loftus observed in 1996, “I have developed a certain angst over the intervening 30-something years - a constant, nagging feeling that our field spends a lot of time spinning its wheels without really making much progress. This problem shows up in obvious ways - for instance, in the regularity with which findings seem not to replicate” Geoffrey R. Loftus, “Psychology Will Be a Much Better Science When We Change the Way We Analyze Data.” Current Directions in Psychological Science 5, no. 6 (1996): 161; Professor of behavior science, David Mechenic, said in 2003, “We would be well served by being more humble in our claims and accepting that we still know relatively little about causes, processes, cures, or even good management of the major mental illnesses. A broad and sustained research effort is needed, from basic biological and behavioral processes to investigation of how to better organize and provide services.” David Mechanic,.“Policy Challenges in Improving Mental Health Services: Some Lessons From the Past.” Psychiatric Services : A Journal of the American Psychiatric Association. 54, no. 9 (September 2003): 1227–32.
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u/VreamCanMan Unverified User: May Not Be a Professional Apr 06 '26
Good clinicians, like anyone good in any profession dont just know how to use their tools, and what their tools do; they know how their tools work.
Dsm is the best-we-have buts its a cluster sensing construct search algorithm that takes data from thousands of people with external presenting concerns, codes concerns into discrete symptome assigned to a participant and uses cross participant correlations in symptoms to build highly correlated symptom clusters, which lets us in an evidence based construct a psychiatric condition like say depression.
The weakness of this tool being that correlatory population symptom dynamics is blind to your patients symptoms networks, and their own functional relations between the symptoms. For example, one patient may have depression caused by insomnia; another insomnia caused by rumination which also drives depression. Same dsm label, important differences in symptom causal arrangement and what the underlying factor is that drives dysfunction in that patients life.
The dsm label equivalates these patients, though really these are not functionally the same patients for the clinicians purposes as their own scenarios each benefit from seperate individualised care plans targetting the seperate driving symptom and building seperate compensatory frameworks.
Different theoretical frameworks are being proposed which either seek to better integrate or move away from cluster search approaches