Problems and perspectives in psychiatric diagnosis

Abstract

Diagnosis in psychiatry is a complex and difficult issue. A great many considerations have been made about the debatable ontological status of mental disorders and the difficulties in providing flawless definitions for them. While these considerations help appreciate the subtleties and difficulties of the topic, they do not imply that mental disorders do not exist or that nosological classification is unnecessary or useless. Although classifications have some inherent flaws and limitations, they can nevertheless be useful. The current psychiatric nosology, however, is based on a categorical approach that has been the object of much criticism. Alternatives include the prototype approach, which has some strong points but also a number of potential disadvantages, and the dimensional approach. The latter approach, though not solving all problems, has recently attracted increasing interest and has received substantial empirical support. There are several ways of conceptualising dimensions and using them in the context of assessment and diagnosis. One of these ways is represented by the SVARAD (Scala per la VAlutazione RApida Dimensionale, i.e., "rapid dimensional assessment scale"), which is an observer-rated scale that covers 10 psychopathological dimensions. Two decades of clinical and research experience have supported its reliability, validity, and ease of use. Dimensional approaches of this kind could easily integrate and enrich the traditional DSM or ICD assessment and may help optimize personalised psychiatric treatment.