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The future of mental health diagnostics goes beyond guidelines


In contrast, in HiTOP, examining behaviors would only be seen as a symptom that reflects position on a larger inner spectrum — a general tendency to experience strong negative emotions that may include simultaneously the qualities of OCD, anxiety and depression. Depending on the patient’s specific experience, HiTOP can also provide additional insight: In this model, phobic symptoms and associated rituals may indicate an internal response to grief. fear, while depressive symptoms suggest an element of distress. Sexual problems, eating disorders, and post-traumatic stress disorder also fall within this range.

Along the HiTOP continuum also exists an external spectrum, including ADHD-like symptoms; somatoform disorders, including cases where psychological distress is translated into physical symptoms; thought disorders, including symptoms currently grouped together such as schizophrenia, bipolar and psychosis; and separation disorder. But HiTOP is more than just reconfiguring old diagnoses into new groups; In some cases, symptoms of a single DSM diagnosis can be present in multiple locations during the HiTOP continuum. For example, in the case of borderline personality disorder, an individual may be in the introvert or extraversion range, depending on their particular circumstances.

Evidence has been forming for the externalization and internalization spectrum since Thomas Achenbach, a child psychologist, first used the terms 1966 to describe people who have “conflicts with the environment” versus those who have “problems with themselves.” It’s not a perfect system: Some studies show comorbidities even between internal and external features, but the model generally seem reliable, and has won the support of clinicians, who find it easier to agree that patients are more inclined to internalize than whether they have depression, anxiety, or all of the above.

For HiTOP proponents, such changes are long overdue. Back in 1969, philosopher Willard Van Orman Quine, who wrote prominently on “natural types,” emphasized the need for more “functionally appropriate” categories, including in the mind. behavioral theory. Subsequent theorists have argued that the large tent approach, which can include dozens of other transient labels under a few broad spectrums, will eventually provide that endurance.

With a focus on children’s mental health, HiTOP also offers a bundle of older, softer theories about the inner life. Since the 1940s, many child psychologists and later child psychiatrists have deliberately avoided grouping children into diagnostic groups, instead evaluating children based on more general aspects, such as the ability to self-regulate emotions, respond to risks and themselves. value — commonly known as profile approach. In a way, HiTOP’s real innovation is giving adults the same benefits.

However, HiTOP and other DSM The alternatives face an uphill battle. Even when many people are deeply distressed under their diagnostic label, others are enthusiastic fashion individuality and entire communities among them.

These obstacles are even more apparent for a system like Framework of meaning on the threat of power, which aims to eliminate diagnostic categories altogether. Developed by therapists in the British Psychological Association, a longtime critic of the medical model of mental illness, PTMF is built on the premise that mental illness doesn’t really exist — at least. not in the way that psychiatrists would like. That’s why DSM never convincingly describes a natural and why, PTMF advocates argue, even HiTOP will eventually fail. But to subvert the hegemony of the diagnostic label, we need more than just more “realistic” definitions of pain and disorder so abundant in society — we need to see alternatives in reality.



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