An Operationalized Multisymptomatic Model of Neuroses (OMMON): toward a reintegration of diagnosis and treatment in behaviour therapy.

Abstract

Experimental results from a sample of 216 patients with four different "symptom-neuroses" show that 65% to 90% of these patients have different combinations of multiple symptomatology. With a background of these data, we present an Operationalized Multisymptomatic Model of Neuroses (OMMON), based on self-rating assessment of these patients on 4 symptom scales. Individual ratings on each scale are dichotomized into (+) or (-) results with regard to defined cut-off points and the model is derived from their 16 mathematically possible combinations. Subsequent analysis of these data (from a single test application) with our Varying Cut-Off Point Assessment (VACOPA) leads to hypotheses regarding causal symptom interactions and prediction of symptom changes over time, easily evaluated by repeated test application. In treatment research the model seems suitable to: (a) build more homogeneous diagnostic groups; (b) operationalize varying degrees of "neurotic" disturbance, from "normal" via "client" to "patient"--independently of existing illness theories; (c) support prognoses of individual developments within and without treatment; (d) specify treatment aims and optimal sequences of interventions; (e) monitor predicted outcome; (f) reconsider earlier apparently contradictory outcome studies; (g) evaluate theoretical concepts regarding "neurotic" symptom formations in neuroses, psychoses, and psychosomatic disturbances. For treatment purposes, OMMON should only be used together with "clinical" hypotheses; its prognostic potential can be increased by additional application of our Operationalized Multivariate Model of Motivation (OMMOM). All three diagnostic approaches may be used for mutual evaluation.