DSM-5 cross-cutting symptom measures: a step towards the future of psychiatric care?

Abstract

The notion that psychiatric disorders occur along dimensional continua rather than as categorical entities has long been debated. Research and clinical evidence have illustrated that a categorical diagnostic schema does not accurately reflect the full realms of clinical concerns in many patients, such as the presence of subthreshold anxiety or psychotic symptoms in individuals with major depressive disorder that cause or exacerbate impairment and distress (1,2). In some instances, clinicians are forced to diagnose two or three separate disorders, typically using the “not otherwise specified” label, in order to facilitate treatment for their patients (3). In the absence of a fully dimensional diagnostic schema, the integration of dimensional assessments of psychiatric symptomatology may be clinically useful in providing valuable information for our current understanding of mental disorders and the issue of co-occurring symptoms and conditions (1). In addition, the integration of categorical diagnoses and dimensional assessments of psychiatric symptoms may also facilitate the identification and fine-tuning of psychiatric endophenotypes, as emphasized in the Research Domain Criteria, for the various mental disorders (4). The DSM-5 Task Force and Work Groups developed and proposed the incorporation of dimensional measures – i.e., self-(i.e., adult and child/adolescent) and informant-report (i.e., parent/guardian) versions of the DSM-5 Cross-Cutting (CC) Symptom measures – to help address the issue of co-occurring symptoms across mental disorders (5–8). This paper discusses the benefits of the DSM-5 CC Symptom measures and identifies areas for further research and development.