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A Dimensional Model for Common Mental Disorders

Published online by Cambridge University Press:  06 August 2018

David Goldberg*
Affiliation:
Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF

Abstract

Although categorical diagnoses are valued by clinicians and those wishing to collect homogeneous groups of patients for research projects, in the field of non-psychotic mental disorders they correspond poorly to actual clinical syndromes. Indeed, patients often satisfy several sets of categorical criteria simultaneously. A more parsimonious representation of symptomatology can be obtained by using a dimensional model for symptoms – with two correlated axes corresponding to anxiety and depression for ratings derived from the Present State Examination. The Composite International Diagnostic Interview is likely to produce a third dimension – somatic symptoms – because of a radically different symptom content. Preliminary data analysis indicates that the somatic symptoms dimension correlates with both anxiety and depression. Symptomatic individuals in particular areas of dimensional space will satisfy several criteria for categorical diagnoses, and thus display comorbidity. However, evidence that these disorders are distinct is far from persuasive, as they appear to share several common causes.

Type
Research Article
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

Dean, C., Surtees, P. G. & Sashidharan, S. P. (1983) Comparison of research diagnostic systems in an Edinburgh Community Sample. British Journal of Psychiatry, 142, 247256.CrossRefGoogle Scholar
Duncan-Jones, P., Grayson, D. & Moran, P. (1986) The utility of latent trait models in psychiatric epidemiology. Psychological Medicine, 16, 391405.CrossRefGoogle ScholarPubMed
Finlay-Jones, P. & Brown, G. (1981) Types of stressful life event and the onset of anxiety and depressive disorders. Psychological Medicine, 11, 803816.CrossRefGoogle ScholarPubMed
Goldberg, D. & Blackwell, B. (1970) Psychiatric illness in general practice. A detailed study using a new method of case identification. British Medicial Journal, 2, 439443.CrossRefGoogle Scholar
Goldberg, D., Bridges, K., Duncan-Jones, P., et al (1987) Dimensions of neuroses seen in primary care settings. Psychological Medicine, 17, 461470.CrossRefGoogle ScholarPubMed
Goldberg, D. & Bridges, K. (1990) Epidemiological observations on the concept of dysthymic disorder. In Dysthymic Disorder (eds Burton, S. & Akiskal, H.), pp. 104111. London: Gaskell.Google Scholar
Goldberg, D., Bridges, K., Cook, D., et al (1990) The influence of social factors on common mental disorders: destabilisation and restitution. British Journal of Psychiatry, 156, 704713.CrossRefGoogle ScholarPubMed
Goldberg, D. & Bridges, K. (1991) Minor psychiatric disorders and neurasthenia in general practice. In Problems of Psychiatry in General Practice (eds Gastpar, M. & Kielholz, P.), pp. 7988. Bern: Hogrefe-Huber.Google Scholar
Grayson, D., Bridges, K., Duncan-Jones, P., et al (1987) The relationship between symptoms and diagnoses of minor psychiatric disorder in general practice. Psychological Medicine, 17, 933942.CrossRefGoogle ScholarPubMed
Jaspers, K. (1923) Allgemeine Psychopathologie. Berlin: Springer-Verlag.CrossRefGoogle Scholar
Kendell, R. (1975) The Role of Diagnosis in Psychiatry. Oxford: Blackwell Scientific.Google Scholar
Ormel, J., van den Brink, W., Koeter, M., et al (1990) Recognition, management and outcome of psychiatric disorder in primary care: a naturalistic follow-up study. Psychological Medicine, 20, 909923.CrossRefGoogle ScholarPubMed
Ormel, H., Oldehinkel, T., Goldberg, D., et al (1995) The structure of common psychiatric symptoms: how many dimensions of neurosis? Psychological Medicine, 25, 521530.CrossRefGoogle ScholarPubMed
Sartorius, N. & Üstün, B. (1994) Psychological Disorders in General Medical Settings: A WHO Collaborative Study. Chichester: John Wiley.Google Scholar
World Health Organization (1992) The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD–10). Geneva: WHO.Google Scholar
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