Current Medical Diagnosis & Treatment in Psychiatry

CATEGORIES PLUS DIMENSIONS

Current Concepts in AnxietyAug 01, 06

There is still much abstract (and, I think, pointless) debate about the relative merits of dimensional rather than categorical description. Torgerson (1967) argued that there are two major mathematical approaches: those which seek to identify classes (or clusters) with a data matrix and those which seek to identify dimensions of variation (or factors) within the data. Each approach has underlying assumptions that increase the likelihood of detecting patterns conforming to the method. For example, assuming a set of variables measured in a sample of patients with anxiety disorders, both dimensional factors and clusters could be imposed on even random data by the assumptions of the particular analytic procedure used. Further, multiple discrete neurobiologic abnormalities might produce a continuum of behavioral manifestations.

Thus, mathematical detection of dimensions of pathology does not rule out the presence of discrete pathophysiology.

A more inclusive model of the anxiety disorders involves a mix of both concepts: “a set of classes (either exclusive or nonexclusive) representing specific disorders, with one or more quantitative dimensions superimposed” (Torgerson, 1967). The overall objective is to determine the model best suited to the purposes for which the nosology is intended, but that depends on substantive, testable hypotheses. These are in short supply.

This heated disagreement about abstractions is probably secondary to opposing etiological frameworks. Those who believe in major determining variables underlying discrete syndromes are largely of a neurobiological frame of mind and emphasize categories. Those who believe that multiple mislearnings are essential for psychopathology emphasize continuity with normality and differences of degree across multiple dimensions.

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