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The Frontiers of Society, Science and Technology, 2023, 5(15); doi: 10.25236/FSST.2023.051507.

The Categorical and Dimensional Approaches of Anxiety Disorders: A Discussion of Discrete Entities with Overlapping Features

Author(s)

Chenyang Xiao

Corresponding Author:
Chenyang Xiao
Affiliation(s)

The University of Melbourne, Melbourne, Victoria, Australia

Abstract

There has been a long debate about whether mental disorders should be classified in the categorical or dimensional approaches. This article aims to provide a new perspective on the different classification approaches of one common mental health disorder — anxiety disorder. The essay reflects on both empirical evidence and theoretical models that discuss reliability, utility, and validity as well as various classical treatments of the different classification models. More specifically, this essay analyses several sorts of commonly used psychological models like cognitive models, emotion dysregulation models, and clinical staging models to discuss whether there are discrete entities with overlapping features of anxiety disorder. The results reflect that the categorical approach is sometimes untenable in clinical treatment due to drawbacks like time limitation, lack of experience, and less knowledge of the cut-off points. Moreover, this article suggested that although anxiety disorders are somewhat discrete when doing clinical diagnoses, they share overlapping features and characteristics with other disorders and other anxiety disorders. In conclusion, a more advanced and well-established system is needed to characterize mental disorders such as anxiety disorders in the future.

Keywords

Anxiety disorders, Categorical approach, Dimensional approach

Cite This Paper

Chenyang Xiao. The Categorical and Dimensional Approaches of Anxiety Disorders: A Discussion of Discrete Entities with Overlapping Features. The Frontiers of Society, Science and Technology (2023) Vol. 5, Issue 15: 35-41. https://doi.org/10.25236/FSST.2023.051507.

References

[1] Streefkerk, R. (2022) APA format for Academic Papers and essays, Scribbr. Available at: https://www.scribbr.com/apa-style/format/ (Accessed: 31 August 2023). 

[2] Mayou, R. (1976) ‘The role of diagnosis in psychiatry: R.E. Kendell. Blackwell Scientific, Oxford, 1975. pp. 176. 3.50’, British Journal of Psychiatry, 128(2), pp. 200–200. doi:10.1192/s000712500010 4076. 

[3] Potuzak, M. et al. (2012) ‘Categorical vs dimensional classifications of psychotic disorders’, Comprehensive Psychiatry, 53(8), pp. 1118–1129. doi:10.1016/j.comppsych.2012.04.010. 

[4] Stier, M. (2013) ‘Normative preconditions for the assessment of mental disorder’, Frontiers in Psychology, 4. doi:10.3389/fpsyg.2013.00611. 

[5] Brown, T.A. and Barlow, D.H. (2009) ‘A proposal for a Dimensional Classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment.’ Psychological Assessment, 21(3), pp. 256–271. doi:10.1037/a0016608. 

[6] Widiger, T.A. and Samuel, D.B. (2005) ‘Evidence-based assessment of personality disorders.’ Psychological Assessment, 17(3), pp. 278–287. doi:10.1037/1040-3590.17.3.278. 

[7] Dell’Osso, L. and Pini, S. (2012) ‘What did we learn from research on comorbidity in psychiatry? advantages and limitations in the forthcoming DSM-V Era’, Clinical Practice & Epidemiology in Mental Health, 8(1), pp. 180–184. doi:10.2174/1745017901208010180. 

[8] Brown, T.A. et al. (2001) ‘Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders.’ Journal of Abnormal Psychology, 110(1), pp. 49–58. doi:10.1037/0021-843x.110.1.49. 

[9] Widiger, T.A. and Gore, W.L. (2015) ‘Dimensional versus categorical models of psychopathology’, The Encyclopedia of Clinical Psychology, pp. 1–12. doi:10.1002/9781118625392.wbecp108. 

[10] Meehl, P.E. (1995) ‘Bootstraps taxometrics: Solving the classification problem in psychopathology.’ American Psychologist, 50(4), pp. 266–275. doi:10.1037/0003-066x.50.4.266. 

[11] Ruscio, J. and Ruscio, A.M. (2004) ‘Clarifying boundary issues in psychopathology: The role of Taxometrics in a comprehensive program of structural research.’ Journal of Abnormal Psychology, 113(1), pp. 24–38. doi:10.1037/0021-843x.113.1.24. 

[12] Trull, T.J. and Durrett, C.A. (2005) ‘Categorical and dimensional models of personality disorder’. Annual Review of Clinical Psychology, 1(1), pp. 355–380. doi:10.1146/annurev.clinpsy.1.102803. 144009. 

[13] Flett, G.L., Vredenburg, K. and Krames, L. (1997) ‘The continuity of depression in clinical and nonclinical samples.’ Psychological Bulletin, 121(3), pp. 395–416. doi:10.1037/0033-2909.121.3.395. 

[14] Kanner, A.M. (2011a) ‘Anxiety disorders in epilepsy: The Forgotten Psychiatric Comorbidity’, Epilepsy Currents, 11(3), pp. 90–91. doi:10.5698/1535-7511-11.3.90. 

[15] Kendell, R. and Jablensky, A. (2003) ‘Distinguishing between the validity and utility of psychiatric diagnoses’, American Journal of Psychiatry, 160(1), pp. 4–12. doi:10.1176/appi.ajp.160.1.4. 

[16] Barlow, D.H., Rapee, R.M. and Brown, T.A. (1992) ‘Behavioral treatment of generalized anxiety disorder’, Behavior Therapy, 23(4), pp. 551–570. doi:10.1016/s0005-7894(05)80221-7. 

[17] Brown, T.A., Chorpita, B.F. and Barlow, D.H. (1998) ‘Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal.’ Journal of Abnormal Psychology, 107(2), pp. 179–192. doi:10.1037/0021- 843x.107.2.179. 

[18] Gordon, D. and Heimberg, R.G. (2011) ‘Reliability and validity of DSM-IV generalized anxiety disorder features’, Journal of Anxiety Disorders, 25(6), pp. 813–821. doi:10.1016/j.janxdis.2011. 04.001. 

[19] Eaton, N.R. et al. (2013) ‘The structure and predictive validity of the internalizing disorders.’ Journal of Abnormal Psychology, 122(1), pp. 86–92. doi:10.1037/a0029598. 

[20] Mannuzza, S. (1989) ‘Reliability of Anxiety Assessment’, Archives of General Psychiatry, 46(12), p. 1093. doi:10.1001/archpsyc.1989.01810120035007. 

[21] Heimberg, R.G. (2002) ‘Cognitive-behavioral therapy for Social Anxiety Disorder: Current status and Future Directions’, Biological Psychiatry, 51(1), pp. 101–108. doi:10.1016/s0006-3223(01)01183-0. 

[22] Rutter, L.A. and Brown, T.A. (2015) ‘Reliability and validity of the dimensional features of generalized anxiety disorder’, Journal of Anxiety Disorders, 29, pp. 1–6. doi:10.1016/j.janxdis.2014.10.003. 

[23] Bossuyt, P.M. et al. (2012) ‘Beyond diagnostic accuracy: The clinical utility of diagnostic tests’, Clinical Chemistry, 58(12), pp. 1636–1643. doi:10.1373/clinchem.2012.182576. 

[24] Luyten, J., Naci, H. and Knapp, M. (2016) ‘Economic Evaluation of Mental Health Interventions: An introduction to cost-utility analysis’, Evidence Based Mental Health, 19(2), pp. 49–53. doi:10.1136/eb-2016-102354. 

[25] Widiger, T.A. and Samuel, D.B. (2005) ‘Diagnostic categories or dimensions? A question for the Diagnostic and statistical manual of mental disorders--fifth edition.’ Journal of Abnormal Psychology, 114(4), pp. 494–504. doi:10.1037/0021-843x.114.4.494. 

[26] Tanriverdi, D. et al. (2019) ‘The comparison of internalized stigmatization levels of patients with different mental disorders’, Journal of Substance Use, 25(3), pp. 251–257. doi:10.1080/14659891.2019.1675790. 

[27] Verheul, R. (2005) ‘Clinical utility of dimensional models for personality pathology’, Journal of Personality Disorders, 19(3), pp. 283–302. doi:10.1521/pedi.2005.19.3.283. 

[28] First, M.B. (2005) ‘Clinical utility: A prerequisite for the adoption of a dimensional approach in DSM.’ Journal of Abnormal Psychology, 114(4), pp. 560–564. doi:10.1037/0021-843x.114.4.560. 

[29] Norton, P.J. and Price, E.C. (2007) ‘A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders’, Journal of Nervous & Mental Disease, 195(6), pp. 521–531. doi:10.1097/01.nmd.0000253843.70149.9a. 

[30] Barlow, D.H. et al. (2000) ‘Cognitive-behavioral therapy, imipramine, or their combination for panic disorder’, JAMA, 283(19), p. 2529. doi:10.1001/jama.283.19.2529. 

[31] Covin, R. et al. (2008) ‘A meta-analysis of CBT for pathological worry among clients with gad’, Journal of Anxiety Disorders, 22(1), pp. 108–116. doi:10.1016/j.janxdis.2007.01.002. 

[32] Shafran, R. et al. (2009) ‘Mind the gap: Improving the dissemination of CBT’, Behaviour Research and Therapy, 47(11), pp. 902–909. doi:10.1016/j.brat.2009.07.003. 

[33] Clark, D.A. (2009) ‘Cognitive behavioral therapy for anxiety and depression: Possibilities and limitations of a transdiagnostic perspective’, Cognitive Behaviour Therapy, 38(sup1), pp. 29–34. doi:10.1080/16506070902980745. 

[34] Talkovsky, A.M. and Norton, P.J. (2014) ‘Mediators of Transdiagnostic Group Cognitive Behavior therapy’, Journal of Anxiety Disorders, 28(8), pp. 919–924. doi:10.1016/j.janxdis.2014. 09.017. 

[35] Watson, D. (2005) ‘Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V.’, Journal of Abnormal Psychology, 114(4), pp. 522–536. doi:10.1037/0021-843x.114.4. 522. 

[36] Campbell-Sills, L. et al. (2006) ‘Acceptability and suppression of negative emotion in anxiety and mood disorders.’ Emotion, 6(4), pp. 587–595. doi:10.1037/1528-3542.6.4.587. 

[37] Hofmann, S.G. et al. (2012) ‘Emotion dysregulation model of mood and anxiety disorders’, Depression and Anxiety, 29(5), pp. 409–416. doi:10.1002/da.21888. 

[38] Hofmann, S.G. et al. (2010) ‘The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review.’ Journal of Consulting and Clinical Psychology, 78(2), pp. 169–183. doi:10.1037/a0018555. 

[39] Bokma, W.A. et al. (2019) ‘A clinical staging approach to improving diagnostics in anxiety disorders: Is it the way to go?’ Australian & New Zealand Journal of Psychiatry, 54(2), pp. 173–184. doi:10.1177/0004867419887804. 

[40] Batelaan, N.M. et al. (2014) ‘Two-year course trajectories of Anxiety Disorders’, The Journal of Clinical Psychiatry, 75(09), pp. 985–993. doi:10.4088/jcp.13m08837. 

[41] Cosci, F. and Fava, G.A. (2012) ‘Staging of mental disorders: Systematic review’, Psychotherapy and Psychosomatics, 82(1), pp. 20–34. doi:10.1159/000342243. 

[42] Scott, J. et al. (2013) ‘Clinical staging in psychiatry: A cross-cutting model of diagnosis with heuristic and practical value’, British Journal of Psychiatry, 202(4), pp. 243–245. doi:10.1192/bjp.bp.112.110858. 

[43] Bokma, Wicher A. et al. (2019) ‘Aligning the many definitions of treatment resistance in anxiety disorders: A systematic review’, Depression and Anxiety, 36(9), pp. 801–812. doi:10.1002/da.22895. 

[44] Andersson, G. and Ghaderi, A. (2006) ‘Overview and analysis of the behaviourist criticism of the<I>diagnostic and Statistical Manual of Mental disorders</i>(dsm)’, Clinical Psychologist, 10(2), pp. 67–77. doi:10.1080/13284200600690461. 

[45] Rottman, B.M. et al. (2009) ‘Can clinicians recognize DSM-IV personality disorders from five-factor model descriptions of patient cases?’, American Journal of Psychiatry, 166(4), pp. 427–433. doi:10.1176/appi.ajp.2008.08070972. 

[46] Westen, D., Shedler, J. and Bradley, R. (2006) ‘A prototype approach to personality disorder diagnosis’, American Journal of Psychiatry, 163(5), pp. 846–856. doi:10.1176/ajp.2006.163.5.846. 

[47] Nakash, O., Nagar, M. and Kanat-Maymon, Y. (2015) ‘Clinical use of the <em>dsm</em> categorical diagnostic system during the Mental Health Intake session’, The Journal of Clinical Psychiatry, 76(07). doi:10.4088/jcp.14m09214. 

[48] Iniesta, R., Stahl, D. and McGuffin, P. (2016) ‘Machine Learning, statistical learning and the future of Biological Research in Psychiatry’, Psychological Medicine, 46(12), pp. 2455–2465. doi:10.1017/s0033291716001367. 

[49] Borsboom, D. and Cramer, A.O.J. (2013) ‘Network analysis: An integrative approach to the structure of Psychopathology’, Annual Review of Clinical Psychology, 9(1), pp. 91–121. doi:10.1146/annurev-clinpsy-050212-185608.