pp 1–17 | Cite as

The Ethical and Empirical Status of Dimensional Diagnosis: Implications for Public Mental Health?

  • Kelso CratsleyEmail author
Original Paper


The field of mental health continues to struggle with the question of how best to structure its diagnostic systems. This issue is of considerable ethical importance, but the implications for public health approaches to mental health have yet to be explored in any detail. In this article I offer a preliminary treatment, drawing out several core issues while sounding a note of caution. A central strand of the debates over diagnosis has been the contrast between categorical and dimensional models, with renewed attention due to recent publication of the DSM-5, launch of the RDoC, and ongoing work on the ICD-11. This dispute involves an interesting assortment of ethical and empirical considerations, many with direct relevance for public health. It has been proposed, for example, that dimensional diagnosis may be morally preferable because it can help reduce the stigma associated with mental disorder. This is a pressing concern, as preventive strategies are expanded in mental health, often operating under dimensional assumptions that target various risk factors. But this type of proposal relies upon an empirical claim and the scientific status of dimensionality remains unresolved, including its relation to stigma. I suggest, then, that the current state of the evidence does not yet warrant clear adjudication between competing frameworks, and thus any implications for public mental health remain highly provisional. More research is needed to help resolve these issues, including ethical analysis.


Mental health; psychiatry Dimensionality Diagnosis RDoC 



The author would like to thank Peter Zachar and two anonymous reviewers for helpful comments on earlier drafts of this article.

Compliance with Ethical Standards

Conflicts of Interest

The author declares that he has no conflicts of interest.


  1. 1.
    van Os, J., G. Kenis, and B.P.F. Rutten. 2010. The environment and schizophrenia. Nature 468: 203–212.CrossRefGoogle Scholar
  2. 2.
    Harkness, K.L., E.P. Hayden, and N.L. Lopez-Duran, eds. 2015. Special section: Stress sensitivity in psychopathology: Mechanisms and consequences. Journal of Abnormal Psychology 124 (1): 1–231.Google Scholar
  3. 3.
    Holz, N.E., M. Laucht, and A. Meyer-Lindenberg. 2015. Recent advances in understanding the neurobiology of childhood socioeconomic disadvantage. Current Opinion in Psychiatry 28: 365–370.CrossRefGoogle Scholar
  4. 4.
    Whiteford, H.A., L. Degenhardt, J. Rehm, A.J. Baxter, A.J. Ferrari, H.E. Erskine, F.J. Charlson, R.E. Norman, A.D. Flaxman, N. Johns, R. Burstein, C.J.L. Murray, and T. Vos. 2013. Global burden of disease attributable to mental and substance use disorders: Findings from the global burden of disease study 2010. Lancet 382: 1575–1586.CrossRefGoogle Scholar
  5. 5.
    Walker, E., R.E. McGee, and B.G. Druss. 2015. Mortality in mental disorders and global disease burden implications: A systematic review and meta-analysis. JAMA Psychiatry 72: 334–341.CrossRefGoogle Scholar
  6. 6.
    World Health Organization. 2015. Mental health ATLAS 2014. Geneva: World Health Organization.Google Scholar
  7. 7.
    Saxena, S., E. Jane-Llopis, and C. Hosman. 2006. Prevention of mental and behavioural disorders: Implications for policy and practice. World Psychiatry 5 (1): 5–14.Google Scholar
  8. 8.
    Prince, M., V. Patel, S. Saxena, M. Maj, J. Maselko, M.R. Phillips, and A. Rahman. 2007. No health without mental health. Lancet 370 (9590): 859–877.CrossRefGoogle Scholar
  9. 9.
    Patel, V. 2012. Global mental health: From science to action. Harvard Review of Psychiatry 20 (1): 6–12.CrossRefGoogle Scholar
  10. 10.
    Patel, V. 2015. Addressing social injustice: A key public mental health strategy. World Psychiatry 14 (1): 43–44.CrossRefGoogle Scholar
  11. 11.
    American Psychiatric Association. 2013. Diagnostic and statistical manual of mental disorders, 5th edition. American Psychiatric Publishing.Google Scholar
  12. 12.
    Insel, T., B. Cuthbert, M. Garvey, R. Heinssen, D.S. Pine, K. Quinn, C. Sanislow, and P. Wang. 2010. Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry 167: 748–751.CrossRefGoogle Scholar
  13. 13.
    National Institute of Mental Health. 2015. NIMH strategic plan. National Institute of Health.Google Scholar
  14. 14.
    World Health Organization. 2018. International Classification of Diseases-11.
  15. 15.
    Saxena, S., P. Esparza, D.A. Regier, B. Saraceno, and N. Sartorius. 2012. Public health aspects of diagnosis and classification of mental and behavioral disorders: Refining the research agenda for DSM-5 and ICD-11. Arlington: American Psychiatric Association and World Health Organization.Google Scholar
  16. 16.
    Ben-Zeev, D., M.A. Young, and P.W. Corrigan. 2010. DSM-V and the stigma of mental illness. Journal of Mental Health 19 (4): 318–327.CrossRefGoogle Scholar
  17. 17.
    Haslam, N. 2014. Natural kinds in psychiatry: Conceptually implausible, empirically questionable, and stigmatizing. In Classifying psychopathology: Mental kinds and natural kinds, ed. H. Kincaid and J.A. Sullivan. Cambridge: MIT Press.Google Scholar
  18. 18.
    Wahlbeck, K. 2015. Public mental health: The time is ripe for translation of evidence into practice. World Psychiatry 14 (1): 36–42.CrossRefGoogle Scholar
  19. 19.
    Radden, J. 2018. Public mental health and prevention. Public Health Ethics 11 (2): 126–138.CrossRefGoogle Scholar
  20. 20.
    Tekin, S. 2014. Psychiatric taxonomy: At the crossroads of science and ethics. Journal of Medical Ethics 40 (8): 513–514.CrossRefGoogle Scholar
  21. 21.
    Drew, N., M. Funk, S. Tang, J. Lamichhane, E. Chavez, S. Katonoka, S. Pathare, O. Lewis, L. Gostin, and B. Saraceno. 2011. Human rights violations of people with mental and psychosocial disabilities: An unresolved global crisis. Lancet 378: 1664–1675.CrossRefGoogle Scholar
  22. 22.
    Sadler, J. 2015. Developing psychiatric diagnostic classifications: Ethics and values. In Oxford handbook of psychiatric ethics, ed. J.Z. Sadler, W. Staden, and K.W.M. Fulford. Oxford: Oxford University Press.Google Scholar
  23. 23.
    Szmukler, G. 2016. Compulsion and ‘coercion’ in mental health care. World Psychiatry 14 (3): 259–261.CrossRefGoogle Scholar
  24. 24.
    McHugh, P.R. 2012. The perspectives of psychiatry: The public health approach. In Public mental health, ed. William W. Eaton, 31–40. New York: Oxford University Press.CrossRefGoogle Scholar
  25. 25.
    Frances, A. 2013. Saving normal. New York: William Morrow.Google Scholar
  26. 26.
    Haslam, N., E. Holland, and P. Kuppens. 2012. Categories versus dimensions in personality disorder and psychopathology: A quantitative review of taxometric research. Psychological Medicine 42: 903–920.CrossRefGoogle Scholar
  27. 27.
    Krueger, R.F. 1999. The structure of common mental disorders. Archives of General Psychiatry 56: 921–926.CrossRefGoogle Scholar
  28. 28.
    Zachar, P., and M.B. First. 2015. Transitioning to a dimensional model of personality disorder in DSM 5.1 and beyond. Current Opinion in Psychiatry 28: 6–72.CrossRefGoogle Scholar
  29. 29.
    Zachar, P., R.F. Krueger, and K.S. Kendler. 2016. Personality disorder in DSM-5: An oral history. Psychological Medicine 46: 1–10.CrossRefGoogle Scholar
  30. 30.
    Barch, D.M., J. Bustillo, W. Gaebel, R. Gur, S. Heckers, D. Malaspina, M.J. Owen, S. Schultz, R. Tandon, M. Tsuang, J. van Os, and W. Carpenter. 2013. Logic and justification for dimensional assessment of symptoms and related clinical phenomena in psychosis: Relevant to DSM-5. Schizophrenia Research 150: 15–20.CrossRefGoogle Scholar
  31. 31.
    Tsuang, M.T., J. van Os, R. Tandon, D.M. Barch, J. Bustillo, W. Gaebel, R.E. Gur, S. Heckers, D. Malaspina, M.J. Owen, S. Schultz, and W. Carpenter. 2013. Attenuated psychosis in DSM-5. Schizophrenia Research 150: 31–35.CrossRefGoogle Scholar
  32. 32.
    First, M.B., G.M. Reed, S.E. Hyman, and S. Saxena. 2015. The development of the ICD-11 clinical descriptions and diagnostic guidelines for mental and behavioural disorders. World Psychiatry 14 (1): 82–90.CrossRefGoogle Scholar
  33. 33.
    Keeley, J.W., and W. Gaebel. 2018. Symptom rating scales for schizophrenia and other primary psychotic disorders in ICD-11. Epidemiology and Psychiatric Sciences 27: 219–224.CrossRefGoogle Scholar
  34. 34.
    National Institute of Mental Health. 2008. NIMH strategic plan. National Institute of Health.Google Scholar
  35. 35.
    National Institute of Mental Health. 2018. Research domain criteria (RDoC). National Institute of Health.
  36. 36.
    Cuthbert, R. 2014. The RDoC framework: Facilitating transition from ICD/DSM to dimensional approaches that integrate neuroscience and psychopathology. World Psychiatry 13 (1): 28–35.CrossRefGoogle Scholar
  37. 37.
    Cratsley, K. 2017. The shift to mechanistic classification and explanation. In Extraordinary science and psychiatry: Responses to the crisis in mental Health Research, ed. Serife Tekin and Jeff Poland, 163–196. Cambridge, MA: MIT Press.Google Scholar
  38. 38.
    Cuthbert, B.N., and T.R. Insel. 2013. Toward the future of psychiatric diagnosis: The seven pillars of RDoC. BMC Medicine 11: 126.CrossRefGoogle Scholar
  39. 39.
    Sullivan, J.A. 2016. Stabilizing constructs through collaboration across different research fields as a way to foster the integrative approach of the RDOC project. Frontiers in Human Neuroscience 10: 309.Google Scholar
  40. 40.
    Howes, O.D., and R.M. Murray. 2014. Schizophrenia: An integrated sociodevelopmental-cognitive model. Lancet 383 (9929): 1677–1687.CrossRefGoogle Scholar
  41. 41.
    Owen, M.J., A. Sawa, and P.B. Mortensen. 2016. Schizophrenia. Lancet 388 (10039): 86–97.CrossRefGoogle Scholar
  42. 42.
    van Os, J., R.J. Linscott, I. Myin-Germeys, P. Delespaul, and L. Krabbendam. 2009. A systematic review and meta-analysis of the psychosis continuum: Evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine 39: 179–195.CrossRefGoogle Scholar
  43. 43.
    McGorry, P. 2015. Early intervention in psychosis. The Journal of Nervous and Mental Disease 203 (5): 310–318.CrossRefGoogle Scholar
  44. 44.
    Fusar-Poli, P., S. Borgwardt, A. Bechdolf, J. Addington, A. Riecher-Rossler, F. Schultze-Lutter, M. Keshavan, S. Wood, S. Ruhrmann, L.J. Seidman, L. Valmaggia, T. Cannon, E. Velthorst, L. De Haan, B. Cornblatt, I. Bonoldi, M. Birchwood, T. McGlashan, W. Carpenter, P. McGorry, J. Klosterkotter, P. McGuire, and A. Yung. 2013. The psychosis high-risk state: A comprehensive state-of-the-art review. JAMA Psychiatry 70 (1): 107–120.CrossRefGoogle Scholar
  45. 45.
    Fusar-Poli, P., P.D. McGorry, and J.M. Kane. 2017. Improving outcomes of first-episode psychosis: An overview. World Psychiatry 16 (3): 251–265.CrossRefGoogle Scholar
  46. 46.
    Fusar-Poli, P. 2017. Extending the benefits of indicated prevention to improve outcomes of first-episode psychosis. JAMA Psychiatry 74 (7): 667–668.CrossRefGoogle Scholar
  47. 47.
    Birchwood, M., C. Connor, H. Lester, P. Patterson, N. Freemantle, M. Marshall, D. Fowler, S. Lewis, P. Jones, T. Amos, L. Eveard, and S.P. Singh. 2013. Reducation duration of untreated psychosis: Care pathways to early intervention in psychosis services. British Journal of Psychiatry 203: 58–64.CrossRefGoogle Scholar
  48. 48.
    Bhui, K., S. Ullrich, and J.W. Cold. 2014. Which pathways to psychiatric care lead to earlier treatment and a shorter duration of first-episode psychosis? BMC Psychiatry 14: 72.CrossRefGoogle Scholar
  49. 49.
    Fusar-Poli, P., W.T. Carpenter, S.W. Woods, and T.H. McGlashan. 2014. Attenuated psychosis syndrome: Ready for DSM-5.1? Annual Review of Clinical Psychology 10: 155–192.CrossRefGoogle Scholar
  50. 50.
    Yung, A.R., H.P. Yuen, P.D. McGorry, L.J. Phillips, D. Kelly, M. Dell’Ollio, S.M. Francey, E.M. Cosgrave, E. Killackey, C. Stanford, K. Godfrey, and J. Buckby. 2005. Mapping the onset of psychosis: Comprehensive assessment of at risk mental states. Australian and New Zealand Journal of Psychiatry 39: 964–971.CrossRefGoogle Scholar
  51. 51.
    DeRenzo, E.G., and P.J. Candilis. 2015. Ethics and the paradigm shift in schizophrenia: The early intervention story. In Oxford handbook of psychiatric ethics, ed. J.Z. Sadler, W. Staden, and K.W.M. Fulford. Oxford: Oxford University Press.Google Scholar
  52. 52.
    Corcoran, C.M. 2016. Ethical and epidemiological dimensions of labeling psychosis risk. American Medical Journal of Ethics 18 (6): 633–642.Google Scholar
  53. 53.
    Sisti, D.A., and M.E. Calkins. 2016. Psychosis risk: What is it and how should we talk about it? American Medical Association Journal of Ethics 18 (6): 624–632.Google Scholar
  54. 54.
    McGorry, P.D., J.A. Hartmann, R. Spooner, and B. Nelson. 2018. Beyond the ‘at risk mental state’ concept: Transitioning to transdiagnostic psychiatry. World Psychiatry 17 (2): 133–142.CrossRefGoogle Scholar
  55. 55.
    Lawrie, S.M. 2016. Whether ‘psychosis’ is best conceptualized as a continuum or in categories is an empirical, practical and political question. World Psychiatry 15 (2): 125–126.CrossRefGoogle Scholar
  56. 56.
    Lawrie, S.M., J. Hall, A.M. McIntosh, G.C. Owens, and E.C. Johnstone. 2010. The ‘continuum of psychosis’: Scientifically unproven and clinically impractical. British Journal of Psychiatry 197: 423–425.CrossRefGoogle Scholar
  57. 57.
    Lawrie, S.M., M.C. O’Donovan, E. Saks, T. Burns, and J.A. Lieberman. 2016. Improving classification of psychoses. Lancet Psychiatry 3: 367–374.CrossRefGoogle Scholar
  58. 58.
    Phillips, J., A. Frances, M.A. Cerullo, J. Chardavoyne, H.S. Decker, M.B. First, N. Ghaemi, G. Greenberg, A.C. Hinderliter, W.A. Kinghorn, S.G. LoBello, E.B. Martin, A.L. Mishara, J. Paris, J.M. Pierre, R.W. Pies, H.A. Pincus, D. Porter, C. Pouncey, M.A. Schwartz, T. Szasz, J.C. Wakefield, G.S. Waterman, O. Whooley, and P. Zachar. 2012. The six most essential questions in psychiatric diagnosis: A Pluralogue part 3: Issues of utility and alternative approaches in psychiatric diagnosis. Philosophy, Ethics and Humanities in Medicine 7: 9.CrossRefGoogle Scholar
  59. 59.
    Casey, B.J., N. Craddock, B.N. Cuthbert, S.E. Hyman, F.S. Lee, and K.J. Ressler. 2013. DSM-5 and RDoC: Progress in psychiatry. Nature Reviews Neuroscience 14: 810–814.CrossRefGoogle Scholar
  60. 60.
    Nemeroff, C.B., D. Weinberger, M. Rutter, H.L. MacMillan, R.A. Bryant, S. Wessely, D.J. Stein, C.M. Pariante, F. Seemuller, M. Berk, G.S. Malhi, M. Preisig, M. Brune, and P. Lysaker. 2013. DSM-5: A collection of psychiatrist views on the changes, controversies, and future directions. BMC Medicine 11: 202.CrossRefGoogle Scholar
  61. 61.
    Jablensky, A. 2016. Psychiatric classifications: Validity and utility. World Psychiatry 15 (1): 26–30.CrossRefGoogle Scholar
  62. 62.
    Reed, G.M., J.M. Correia, P. Esparza, S. Saxena, and M. Maj. 2011. The WPA-WHO global survey of psychiatrists’ attitudes towards mental disorders classification. World Psychiatry 10: 118–131.CrossRefGoogle Scholar
  63. 63.
    Evans, S.C., G.M. Reed, M.C. Roberts, P. Esparza, A.D. Watt, J.M. Correia, P. Ritchie, M. Maj, and S. Saxena. 2013. Psychologists’ perspectives on the diagnostic classification of mental disorders: Results from the WHO-IUPsyS global survey. International Journal of Psychology 48 (3): 177–193.CrossRefGoogle Scholar
  64. 64.
    Morey, L.C., A.E. Skodol, and J.M. Oldham. 2014. Clinician judgments of clinical utility: A comparison on DSM-IV-TR personality disorders and the alternative model for DSM-5 personality disorders. Journal of Abnormal Psychology 123: 398–405.CrossRefGoogle Scholar
  65. 65.
    First, M.B. 2016. The importance of developmental field trials in the revision of psychiatric classifications. Lancet Psychiatry 3: 579–584.CrossRefGoogle Scholar
  66. 66.
    Steardo, L. 2017. The ICD-11 clinic-based field studies are about to be concluded. World Psychiatry 16 (3): 331–332.CrossRefGoogle Scholar
  67. 67.
    First, M.B., T.J. Rebello, J.W. Keeley, R. Bhargava, Y. Dai, M. Kulygina, C. Matsumoto, R. Robles, A.-C. Stona, and G.M. Reed. 2018. Do mental health professionals use diagnostic classifications the way we think they do? A global survey. World Psychiatry 17: 187–195.CrossRefGoogle Scholar
  68. 68.
    Keeley, J.W., Gaebel, W., First, M.B., Peterson, D.L., Rebello, T., Sharan, P. & Reed, G.M. 2018. Psychotic disorder symptom rating scales: Are dichotomous or multi-point scales more clinically useful? – An ICD-11 field study. Schizophrenia Research.
  69. 69.
    Ajnakina, O., C. Morgan, C. Gayer-Anderson, S. Oduola, F. Bourque, S. Bramley, J. Williamson, J.H. MacCabe, P. Dazzan, P. Murray, R.M. Murray, and A.S. David. 2017. Only a small proportion of patients with first episode psychosis come via prodromal services: A retrospective survey of a large UK mental health programme. BMC Psychiatry 17: 308.CrossRefGoogle Scholar
  70. 70.
    David, A.S., and O. Ajnakina. 2016. Psychosis as a continuous phenotype in the general population: The thin line between normality and pathology. World Psychiatry 15 (2): 129–130.CrossRefGoogle Scholar
  71. 71.
    Davies, C., A. Cipriani, J.P.A. Ioannidis, J. Radua, D. Stahl, U. Provenzani, and P. McGuire. 2018. Lack of evidence to favor specific preventive interventions in psychosis: A network meta-analysis. World Psychiatry 17 (2): 196–209.CrossRefGoogle Scholar
  72. 72.
    Guloksuz, S., and J. van Os. 2017. The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum. Psychological Medicine 48: 229–244.CrossRefGoogle Scholar
  73. 73.
    van Os, J., and S. Guloksuz. 2017. A critique of the ‘ultra-high risk’ and ‘transition’ paradigm. World Psychiatry 16: 200–206.CrossRefGoogle Scholar
  74. 74.
    Saxena, S., P. Sharan, M. Botbol, D. Hasin, H. Herrman, C. Hosman, E. Jane-Llopis, D. Reiss, and S. Sturgeon. 2012. Prevention of mental disorders: Implications for revision of psychiatric diagnosis and classification. In Public health aspects of diagnosis and classification of mental and behavioral disorders: Refining the research agenda for DSM-5 and ICD-11, ed. S. Saxena, P. Esparza, D.A. Regier, B. Saraceno, and N. Sartorius. Arlington: American Psychiatric Association and World Health Organization.Google Scholar
  75. 75.
    Yager, J., and J.S. McIntyre. 2014. DSM-5 clinical and public health committee: Challenges and considerations. American Journal of Psychiatry 171 (2): 142–144.CrossRefGoogle Scholar
  76. 76.
    Patel, V., S. Saxena, H. Frankish, and N. Boyce. 2016. Sustainable development and global mental health – A lancet commission. Lancet 387: 1143–1145.CrossRefGoogle Scholar
  77. 77.
    Lilienfeld, S.O. 2014. The research domain criteria (RDoC): An analysis of methodological and conceptual challenges. Behaviour Research and Therapy 62: 129–139.CrossRefGoogle Scholar
  78. 78.
    Wakefield, J. 2014. Wittgenstein’s nightmare: Why the RDoC grid needs a conceptual dimension. World Psychiatry 13 (1): 38–40.CrossRefGoogle Scholar
  79. 79.
    Phillips, M.R. 2014. Will RDoC hasten the decline of America’s global leadership role in mental health? World Psychiatry 13 (1): 40–41.CrossRefGoogle Scholar
  80. 80.
    Collins, P.Y., V. Patel, S.S. Joestl, D. March, T.R. Insel, and A.S. Daar. 2011. Grand challenges in global mental health. Nature 475: 27–30.CrossRefGoogle Scholar
  81. 81.
    Angermeyer, M.C., H. Matschinger, and G. Schomerus. 2013. Attitudes towards psychiatric treatment and people with mental illness: Changes over two decades. British Journal of Psychiatry 203: 146–151.CrossRefGoogle Scholar
  82. 82.
    Angermeyer, M.C., S. van der Auwera, M.G. Carta, and G. Schomerus. 2017. Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: A systematic review and meta-analysis. World Psychiatry 16 (1): 50–61.CrossRefGoogle Scholar
  83. 83.
    Griffiths, K.M., B. Carron-Arthur, A. Parsons, and R. Reid. 2014. Effectiveness of programs for reducing the stigma associated with mental disorder. A meta-analysis of randomized control trials. World Psychiatry 12: 161–175.CrossRefGoogle Scholar
  84. 84.
    Mehta, N., S. Clement, E. Marcus, A.-C. Stona, N. Bezborodov, S. Evans-Lacko, J. Palacios, M. Docherty, E. Barley, D. Rose, M. Koschorke, R. Shidhaye, C. Henderson, and G. Thornicroft. 2015. Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: Systematic review. British Journal of Psychiatry 207: 377–384.CrossRefGoogle Scholar
  85. 85.
    Thornicroft, G., N. Mehta, S. Clement, S. Evans-Lacko, M. Doherty, D. Rose, M. Koschorke, R. Shidhaye, C. O’Reilly, and C. Henderson. 2016. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet 387: 1123–1132.CrossRefGoogle Scholar
  86. 86.
    David, A.S. 2010. Why we need more debate on whether psychotic symptoms lie on a continuum. Psychological Medicine 40: 1935–1942.CrossRefGoogle Scholar
  87. 87.
    Gergel, T. 2014. Too similar, too different: The paradoxical dualism of psychiatric stigma. Psychiatric Bulletin 38: 148–151.CrossRefGoogle Scholar
  88. 88.
    Haslam, N., and E.P. Kvaale. 2015. Biogenetic explanations of mental disorder: The mixed-blessings model. Current Directions in Psychological Science 24 (5): 399–404.CrossRefGoogle Scholar
  89. 89.
    Angermeyer, M., and G. Schomerus. 2012. A stigma perspective on recovery. World Psychiatry 11: 163–164.CrossRefGoogle Scholar
  90. 90.
    Angermeyer, M.C., A. Holzinger, M.G. Carta, and G. Schomerus. 2011. Biogenetic explanations and public acceptance of mental illness: Systematic review of population studies. British Journal of Psychiatry 199: 367–372.CrossRefGoogle Scholar
  91. 91.
    Luty, L., J.M. Easow, and V. Mendes. 2011. Stigmatised attitudes towards the ‘stressd’ or ‘ill’ models of mental illness. The Psychiatrist 35: 370–373.CrossRefGoogle Scholar
  92. 92.
    Lebowitz, M.S., and W. Ahn. 2012. Combining biomedical accounts of mental disorders with treatability information to reduce mental illness stigma. Psychiatric Services 63 (5): 496–499.CrossRefGoogle Scholar
  93. 93.
    Corcoran, C.M., M.B. First, and B. Cornblatt. 2010. The psychosis risk syndrome and its proposed inclusion in the DSM-V: A risk-benefit analysis. Schizophrenia Research 120: 16–22.CrossRefGoogle Scholar
  94. 94.
    Yang, L.H., A.J. Wonpat-Borja, M.G. Opler, and C.M. Corcoran. 2010. Potential stigma associated with inclusion of the psychosis risk syndrome in the DSM-V: An empirical question. Schizophrenia Research 120: 42–48.CrossRefGoogle Scholar
  95. 95.
    Nieman, D.H., and P.D. McGorry. 2015. Detection and treatment of at-risk mental state for developing a first psychosis: Making up the balance. Lancet Psychiatry 2: 825–834.CrossRefGoogle Scholar
  96. 96.
    Clement, S., O. Schauman, T. Graham, S. Maggioni, S. Evans-Lacko, N. Bezborodovs, C. Morgan, N. Rusch, J.S.L. Brown, and G. Thornicroft. 2015. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine 45: 11–27.CrossRefGoogle Scholar
  97. 97.
    Schnyder, N., R. Panczak, N. Groth, and F. Schultze-Lutter. 2017. Association between mental health-related stigma and active help-seeking: Systematic review and meta-analysis. British Journal of Psychiatry 210: 261–268.CrossRefGoogle Scholar
  98. 98.
    Gronholm, P.C., G. Thornicroft, K.R. Laurens, and S. Evans-Lacko. 2017. Mental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: A systematic review. Psychological Medicine 47: 1867–1879.CrossRefGoogle Scholar
  99. 99.
    Yang, L.H., B.G. Link, S. Ben-David, K.E. Gill, R.R. Girgis, G. Brucato, A.J. Wonpat-Borja, and C.M. Corcoran. 2015. Stigma related to labels and symptoms in individuals at clinical high-risk for psychosis. Schizophrenia Research 168 (1–2): 9–15.CrossRefGoogle Scholar
  100. 100.
    Broome, M., and P. Fusar-Poli. 2012. Philosophical issues in the prodromal phase of psychosis. Current Pharmaceutical Design 18: 596–605.CrossRefGoogle Scholar
  101. 101.
    Bortolotti, L., and H. Widdows. 2011. The right not to know: The case of psychiatric disorders. Journal of Medical Ethics 37: 673–676.CrossRefGoogle Scholar
  102. 102.
    Lawrence, R.E., P. Friesen, G. Brucato, R.R. Girgis, and L. Dixon. 2016. Concerns about genetic testing for schizophrenia among young adults at clinical high risk for psychosis. American Journal of Bioethics: Empirical Bioethics 7 (3): 193–198.Google Scholar
  103. 103.
    Rusch, N., K. Heekeren, A. Theodoridou, A. Muller, P.W. Corrigan, B. Mayer, S. Metzler, D. Dvorsky, S. Walitza, and W. Rossler. 2015. Stigma as a stressor and transition to schizophrenia after one year among young people at risk of psychosis. Schizophrenia Research 116: 43–48.CrossRefGoogle Scholar
  104. 104.
    Farooq, S., F. Naeem, and S.P. Singh. 2016. Telling the patients about diagnosis and outcome of schizophrenia: What, when and how? Early Intervention in Psychiatry 10: 101–102.CrossRefGoogle Scholar
  105. 105.
    Mittal, V.A., D.J. Dean, J. Mittal, and E.R. Saks. 2015. Ethical, legal, and clinical considerations when disclosing a high-risk syndrome for psychosis. Bioethics 29 (8): 543–556.CrossRefGoogle Scholar
  106. 106.
    Howe, L., A. Tickle, and I. Brown. 2014. ‘Schizophrenia is a dirty word’: Service users’ experiences of receiving a diagnosis of schizophrenia. Psychiatric Bulletin 38: 154–158.CrossRefGoogle Scholar
  107. 107.
    Blessing, A., A. Studer, A. Gross, L.F. Gruss, R. Schneider, and G. Dammann. 2017. Disclosure of diagnosis in early recognition of psychosis. Journal of Nervous and Mental Disease 205: 757–761.CrossRefGoogle Scholar
  108. 108.
    Carpenter, W.T. 2018. Clinical high risk controversies and challenge for the experts. Schizophrenia Bulletin 44 (2): 223–225.CrossRefGoogle Scholar
  109. 109.
    Appelbaum, P.S. 2015. Ethical challenges in the primary prevention of schizophrenia. Schizophrenia Bulletin 41: 773–775.CrossRefGoogle Scholar
  110. 110.
    Demjaha, A., K. Morgan, C. Morgan, S. Landau, K. Dean, A. Reichenberg, P. Sham, P. Fearon, G. Hutchinson, P.B. Jones, R.M. Murray, and P. Dazzan. 2009. Combining dimensional and categorical representation of psychosis: The way forward for DSM-V and ICD-11? Psychological Medicine 39: 1943–1955.CrossRefGoogle Scholar
  111. 111.
    Poulton, R., A. Caspi, T.E. Moffitt, M. Cannon, R. Murray, and H. Harrington. 2000. Children’s self-reported psychotic symptoms and adult schizophreniform disorder: A 15-year longitudinal study. Archives of General Psychiatry 57: 1053–1058.CrossRefGoogle Scholar
  112. 112.
    McGrath, J., S. Saha, A. Al-Hamzawi, J. Alonso, E.J. Bromet, R. Bruffaerts, J.M. Caldas-de-Almeida, Wai Tat Chiu, P. de Jonge, J. Fayyad, S. Florescu, O. Gureje, J.M. Haro, C. Hu, V. Kovess-Masfety, J.P. Lepine, C.C.W. Lim, Maria Elena Medina Mora, F. Navarro-Mateu, S. Ochoa, N. Sampson, K. Scott, M.C. Viana, and R.C. Kessler. 2015. Psychotic experiences in the general population: A cross-national analysis based on 31,261 respondents from 18 countries. JAMA Psychiatry 72 (7): 697–705.CrossRefGoogle Scholar
  113. 113.
    Russo, M., S.Z. Levine, A. Demjaha, M. Di Forti, S. Bonaccorso, P. Fearon, P. Dazzan, C.M. Pariante, A.S. David, C. Morgan, R.M. Murray, and A. Reichenberg. 2014. Association between symptom dimensions and categorical diagnoses of psychosis: Cross-sectional and longitudinal investigation. Schizophrenia Bulletin 40 (1): 111–119.CrossRefGoogle Scholar
  114. 114.
    Shevlin, M., E. McElroy, R. Bentall, U. Reininghaus, and J. Murphy. 2017. The psychosis continuum: Testing a bifactor model of psychosis in a general population sample. Schizophrenia Bulletin 43 (1): 133–141.CrossRefGoogle Scholar
  115. 115.
    Demjaha, A., J.H. MacCabe, and R.M. Murray. 2012. How genes and environmental factors determine the different neurodevelopmental trajectories of schizophrenia and bipolar disorder. Schizophrenia Bulletin 38 (2): 209–214.CrossRefGoogle Scholar
  116. 116.
    Linscott, R.J., and J. van Os. 2010. Systematic reviews of categorical and continuum models of psychosis: Evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI and DSM-VII. Annual Review of Clinical Psychology 6: 14.1–14.29.CrossRefGoogle Scholar
  117. 117.
    Linscott, R.J., and J. van Os. 2013. An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: On the pathway from proneness to persistence to dimensional expression across mental disorders. Psychological Medicine 43: 1133–1149.CrossRefGoogle Scholar
  118. 118.
    Howes, O.D., and S. Kapur. 2009. The dopamine hypothesis of schizophrenia: Version III – The final pathway. Schizophrenia Bulletin 35: 549–562.CrossRefGoogle Scholar
  119. 119.
    Kaymaz, N., and J. van Os. 2010. Extended psychosis phenotype – Yes: Single continuum – Unlikely. Psychological Medicine 40: 1963–1966.CrossRefGoogle Scholar
  120. 120.
    van Os, J., and U. Reininghaus. 2016. Psychosis as a transdiagnostic and extended phenotype in the general population. World Psychiatry 15 (2): 118–124.CrossRefGoogle Scholar
  121. 121.
    Bentall, R. 2017. Six myths about schizophrenia: A paradigm well beyond its use-by date. In The Extraordinary Science and Psychiatry: Responses to the Crisis in Mental Health Research, ed. S. Tekin and J. Polan. Cambridge: MIT Press.Google Scholar
  122. 122.
    Zoghbi, A.W., and J.A. Lieberman. 2018. Alive but not well: The limited validity but continued utility of the concept of schizophrenia. Psychological Medicine 48: 245–246.CrossRefGoogle Scholar
  123. 123.
    Wakefield, J. 2016. Against utility. World Psychiatry 15 (1): 33–35.CrossRefGoogle Scholar
  124. 124.
    Mollon, J., A.S. David, C. Morgan, S. Frissa, D. Glahn, I. Pilecka, S.L. Hatch, M. Hotopf, and A. Reichnberg. 2016. Psychotic experiences and neuropsychological functioning in a population-based sample. JAMA Psychiatry 73 (2): 129–138.CrossRefGoogle Scholar
  125. 125.
    Machery, E. 2017. Kinds or tails? In Extraordinary science and psychiatry: Responses to the crisis in mental Health Research, ed. Serife Tekin and Jeff Poland, 15–36. Cambridge: MIT Press.Google Scholar
  126. 126.
    Turkheimer, E. 2017. The hard question in psychiatric nosology. In Philosophical issues in psychiatry IV: Classification of psychiatric illness, ed. Kenneth S. Kendler and Josef Parnas, 27–44. Oxford University Press.Google Scholar
  127. 127.
    van Os, J. 2009. A salience dysregulation syndrome. British Journal of Psychiatry 194: 101–103.CrossRefGoogle Scholar
  128. 128.
    van Os, J., and S. Kapur. 2009. Schizophrenia. Lancet 374: 635–645.CrossRefGoogle Scholar
  129. 129.
    Boorsboom, D., M. Rhemtulla, A.O.J. Cramer, H.L.J. van der Maas, M. Scheffer, and C.V. Dolan. 2016. Kinds versus continua: A review of psychometric approaches to uncover the structure of psychiatric constructs. Psychological Medicine 46: 1567–1579.CrossRefGoogle Scholar
  130. 130.
    Borsboom, D., and A.O.J. Cramer. 2013. Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology 9: 91–121.CrossRefGoogle Scholar
  131. 131.
    Blashfield, R.K., J.W. Keeley, E.H. Flanagan, and S.R. Miles. 2014. The cycle of classification: DSM-I through DSM-5. Annual Review of Clinical Psychology 10: 25–51.CrossRefGoogle Scholar
  132. 132.
    Krueger, R.F., and K.E. Markson. 2014. The role of the DSM-5 personality trait model in moving toward a quantitative and empirically based approach to classifying personality and psychopathology. Annual Review of Clinical Psychology 10: 477–501.CrossRefGoogle Scholar
  133. 133.
    van Loo, H.M., P. de Jonge, J.-W. Romeijn, R.C. Kessler, and R.A. Schoevers. 2012. Data-driven subtypes of major depressive disorder: A systematic review. BMC Medicine 10: 156.CrossRefGoogle Scholar
  134. 134.
    Wakefield, J., and M.F. Schmitz. 2014. Uncomplicated depression is normal sadness, not depressive disorder: Further evidence from the NESARC. World Psychiatry 13 (3): 317–319.CrossRefGoogle Scholar
  135. 135.
    Zachar, P., M.B. First, and K.S. Kendler. 2017. The bereavement exclusions debate in the DSM-5: A history. Clinical Psychological Science 5 (5): 890–906.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Kennedy Institute of EthicsGeorgetown UniversityWashingtonUSA

Personalised recommendations