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The diagnostic quagmire: Philosophical issues 

The diagnostic quagmire: Philosophical issues
Chapter:
The diagnostic quagmire: Philosophical issues
Author(s):

Patricia Casey

DOI:
10.1093/med/9780198786214.003.0003
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date: 26 June 2019

As currently defined, adjustment disorder (AD) lies in the hinterland between non-pathological behaviour/distress on one side and full-blown common mental disorders (CMDs) on the other. However, considerable symptom overlap exists, such that AD is frequently misdiagnosed as one of the other CMDs, and vice versa. Given the universality of life events which are stressful, clearly delineating AD from normal adaptive responses is particularly prescient if all human experience is not to be medicalized. DSM-III attempted to deal with this by requiring that the symptoms be ‘clinically significant’, yet this construct is a subjective one. It is not used in ICD-10 but it requires both symptoms and dysfunction, unlike DSM. The heterogeneity of symptoms that constitute a specific diagnosis where no one symptom is essential and all are given equal weight (the polythetic approach) can add to diagnostic uncertainty. The National Institute of Mental Health has made a suggestion for approaching this diagnostic maelstrom.

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