The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria.

Probably not a substantial claim: may not pass S3 (load-bearing).

There has been a diminution in psychopathological expertise and interest since the advent of DSM-III.

“Second, it does not explain the diminution in psychopathological expertise and interest since the advent of DSM-III (4).”

• cites [4] sourceSupported

May combine two claims.

Compared with the DSM criteria, the textbook authors gave greater emphasis to cognitive, physical, and psychomotor changes, and less to neurovegetative symptoms.

“Compared with the DSM criteria, these authors gave greater emphasis to cognitive, physical, and psychomotor changes, and less to neurovegetative symptoms.”

May combine two claims.

Depression-associated depersonalization and derealization were noted in 12 textbooks, and no DSM-5 criteria for major depression describe this kind of depressive symptomatology.

“Depression-associated depersonalization and derealization were noted in 12 of the textbooks.A number of descriptions were provided, including everything feeling changed or unreal, seeing the world through a mist, and perplexity.No DSM-5 criteria for major depression describe this kind of depressive symptomatology.”

May combine two claims.

Lewis commented on all but two of the symptoms and signs developed from the textbook review, indicating a high degree of consilience between the two sources.

“First, Lewis comments on all but two of the symptoms and signs that I developed from the textbook review, so there is a high degree of consilience between these two sources of information (Table 3).”

• cites [7] sourceNot checked — no full text of the source

May combine two claims.

Psychomotor changes were reported by all but one textbook author; 12 described only psychomotor retardation and six also commented on agitation; these signs are well presented in DSM-5 criterion A5.

“Psychomotor changes were reported by all but one author, 12 of whom described only aspects of psychomotor retardation and six of whom also commented on agitation.These signs are well presented in DSM-5 criterion A5.”

May combine two claims.

Speech that was slow, hesitant, indistinct, and/or monosyllabic was described by all but two textbook authors and is not included in DSM-5.

“Speech that was slow, hesitant, indistinct, and/ or monosyllabic was described by all but two authors.This symptom is not included in DSM-5.”

May combine two claims.

Various aspects of anxiety, including panic attacks and obsessive fears, were noted by 14 textbook authors, but anxiety is not included in the DSM criteria for major depression.

“Various aspects of anxiety, including panic attacks and obsessive fears, were noted by 14 authors, but anxiety is not included in the DSM criteria for major depression.”

May combine two claims.

Lowered mood, impairment in cognitive function, and psychomotor changes are all well reflected in the DSM criteria for major depression.

“All three of these are well reflected in the DSM criteria for major depression.”

May combine two claims.

Compared with DSM-5 criteria, Muncie's 1939 criteria included symptoms of depersonalization and derealization and gave greater emphasis to physiological symptoms and changes in facial expression and posture.

“Compared with the DSM-5 criteria, Muncie's criteria included symptoms of depersonalization and derealization and gave greater emphasis to physiological symptoms and changes in facial expression and posture.”

• cites [22] Muncie W, 1939 sourceNot checked — no full text of the source

May combine two claims.

The next most common central symptom, volitional changes, was noted by only 20% of these authors and is not described in DSM-5 criteria.

“The next most common central symptom, volitional changes, was noted by only 20% of these authors and is not described in DSM-5 criteria.”

May combine two claims.

Other physical symptoms and signs were noted by 17 textbook authors, most commonly gastrointestinal complaints, diminished libido, amenorrhea, headaches, and changes in facial expression and posture; these are not captured by any part of the DSM-5 A criterion for major depression.

“Other physical symptoms and signs, noted by 17 authors, was the most difficult symptom category to summarize.Most commonly described were gastrointestinal complaints, but diminished libido, amenorrhea, and headaches were also often noted.Also frequently described were changes in facial expression and posture.These phenomena are not captured by any part of the A criterion in DSM-5 major depression.”

May combine two claims.

Ten of the 18 symptoms and signs were well described by the DSM A criteria for major depression and one by a criterion for melancholia.

“As seen in Table 4, ten of the 18 symptoms and signs were well described by the DSM A criteria for major depression and one by a criterion for melancholia.”

May combine two claims.

Poor appetite and weight loss were described by 10 and nine textbook authors respectively, consistent with DSM criterion A3.

“Poor appetite and weight loss were described by, respectively, 10 and nine textbook authors, consistent with DSM criterion A3.”

May combine two claims.

Nearly all textbook authors commented on changes in the speech of depressed patients, most typically describing it as slow, low in volume, with long pauses; this sign is not in DSM-5.

“Eighth, nearly all authors commented on changes in the speech of depressed patients, most typically describing it as slow, low in volume, with long pauses.This sign is not in DSM-5.”

May combine two claims.

The textbook authors gave less importance to the neurovegetative features of depression-changes in sleep, appetite, and weight-than the DSM criteria do, and no author noted them as key depressive symptoms.

“Fifth, the textbook authors gave less importance to the neurovegetative features of depression-changes in sleep, appetite, and weight-than the DSM criteria do.No author noted them as key depressive symptoms.”

Probably not a substantial claim: may not pass S4 (based).

The nature of psychiatric practice changed during the 20th century, with outpatient care constituting a larger proportion of our work, especially after 1960.

“First, the nature of psychiatric practice changed during the 20th century, with outpatient care constituting a larger proportion of our work, especially after 1960.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

By the time DSM-III was published in 1980, the majority of depressed patients were being seen in ambulatory settings and were often more mildly ill.

“By the time DSM-III was published in 1980, the majority of depressed patients were being seen in ambulatory settings and were often more mildly ill.”

Probably not a substantial claim: may not pass S4 (based).

Many classical textbook authors believed that derealization was an important clinical feature of major depression.

“But many of our classical textbook authors believed that derealization was an important clinical feature of major depression.”

• Also stated in: § Illustrations of the Problems Associated With Our Category Mistake · plain

  “Yet, senior clinicians of earlier generations thought it was a critical feature of the depressive syndrome that reflected their patients' lived experiences.”

• AssumptionRests on an assumption: The 19 textbooks examined are representative of the Western post-Kraepelinian psychiatric tradition.

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

For the key major depression criteria A1 and A7, DSM-5 lists three and two descriptors, respectively.

“For the key major depression criteria A1 and A7, DSM-5 lists three and two descriptors, respectively.”

Probably not a substantial claim: may not pass S4 (based).

Most textbook writers considered anxiety to be a prominent and clinically important part of the presentation of major depression.

“Most of our textbook writers considered anxiety to be a prominent and clinically important part of the presentation of major depression.”

• AssumptionRests on an assumption: The 19 textbooks examined are representative of the Western post-Kraepelinian psychiatric tradition.

Classified as probably not a substantial claim.

Many classical textbook writers were seeing severely depressed patients in hospitals.

“Many of the classical textbook writers were seeing severely depressed patients in hospitals.”

Probably not a substantial claim: may not pass S4 (based).

Many mental health clinicians have conflated clinical evaluation and assessment of DSM criteria in clinical work, research, and teaching.

“First, it fails to recognize the degree to which many mental health clinicians have conflated clinical evaluation and assessment of DSM criteria in our clinical work, research, and teaching.”

May combine two claims.

Meeting the DSM criteria for major depression is not the same thing as having major depression, and the DSM criteria do not constitute clinically significant depression.

“But meeting the DSM criteria for major depression is not the same thing as having major depression.The DSM criteria do not constitute clinically significant depression.”

May combine two claims.

Increased eating and weight gain were introduced into the Research Diagnostic Criteria for major depression and carried over into all subsequent editions of DSM.

“Increased eating and weight gain were introduced into the Research Diagnostic Criteria (35) for major depression and carried over into all subsequent editions of DSM.”

• cites [35] Spitzer RL, 1975Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

This conceptual error has contributed to the impoverishment of psychopathology and has affected research, clinical work, and teaching in undesirable ways.

“This conceptual error has contributed to the impoverishment of psychopathology and has affected our research, clinical work, and teaching in some undesirable ways.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

The critique does not address the underlying conceptual problems of diagnostic literalism and reification that arise directly from our category mistake of confusing our fallible diagnostic criteria with the categories they are designed to assess.

“Third and most importantly, the critique does not address the underlying conceptual problems of diagnostic literalism and reification that arise directly from our category mistake of confusing our fallible diagnostic criteria with the categories they are designed to assess.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Developers of diagnostic criteria are appropriately concerned about specificity.

“Second, developers of diagnostic criteria are also appropriately concerned about specificity.”

Probably not a substantial claim: may not pass S2 (checkable).

Many of us have become diagnostic literalists with respect to DSM, stymied by an excessive respect for our own creation.

“Many of us have become diagnostic literalists with respect to DSM, stymied by an excessive respect for own creation.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Diagnostic criteria need only to identify true cases with sufficient sensitivity and specificity, and not to reflect complete catalogs of important symptoms and signs.

“That is, criteria need only to identify true cases with sufficient sensitivity and specificity, and not to reflect complete catalogs of important symptoms and signs.”

Probably not a substantial claim: may not pass S2 (checkable).

It is problematic when we focus our teaching, our clinical work, and our research solely around DSM criteria.

“But it is problematic when we focus our teaching, our clinical work, and our research solely around DSM criteria.”

Probably not a substantial claim: may not pass S2 (checkable).

The presence of such validators helps illustrate the difference between indexing and constituting a disorder.

“The presence of such validators helps illustrate the difference between indexing and constituting a disorder.”

Probably not a substantial claim: may not pass S2 (checkable).

By losing sight of the indexical function of diagnostic criteria and confounding the criteria with the disorders themselves, we open the door to reification.

“By losing sight of the indexical function of our diagnostic criteria and confounding the criteria with the disorders themselves, we open the door to reification.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

The goals of those who develop diagnostic criteria are not the same as those of the textbook writers, with the former being much more concerned with brevity, reliability (and hence low inferential content), and specificity.

“Third, as noted above, the goals of those who develop diagnostic criteria are not the same as those of the textbook writers, with the former being much more concerned with brevity, reliability (and hence low inferential content), and specificity.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Derealization did not make it into DSM because it is a subtle concept, time-consuming to evaluate, and perhaps of limited reliability.

“We can understand why this did not make it into DSM: It is a subtle concept, time-consuming to evaluate, and perhaps of limited reliability.”

Probably not a substantial claim: may not pass S3 (load-bearing).

It is possible, although unlikely given modest symptomatic differences seen for depression in major depression as compared with bipolar illness, that some of the differences between the symptoms described and those listed in the DSM-5 criteria result from admixture of patients with bipolar illness.

“It is possible, although unlikely given modest symptomatic differences seen for depression in major depression as compared with bipolar illness (37), that some of the differences between the symptoms described and those listed in the DSM-5 criteria result from admixture of patients with bipolar illness.”

• cites [37] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

DSM criteria are imperfect approximations created by a very human process that, although scientifically informed, could not be claimed by any knowledgeable individual to be infallible.

“DSM criteria are imperfect approximations created by a very human process that, although scientifically informed, could not be claimed by any knowledgeable individual to be infallible.”

Classified as probably not a substantial claim. May combine two claims.

The DSM-5 descriptor lists for criteria A1 and A7 are too short to capture adequately the range of human experience of the mood state of depression and the range of self-derogatory/pessimistic depressive cognitions.

“As illustrated by our textbook writers, these lists are too short to capture adequately the range of human experience of the mood state of depression and the range of self-derogatory/pessimistic depressive cognitions.”

May combine two claims.

Given our pride in diagnosis and lack of definitive validators, our field has undergone a conceptual creep in which our criteria have mistakenly become our disorder.

“Given our pride in our diagnosis and our lack of definitive validators, it is understandable that our field has had undergone a”

Probably not a substantial claim: may not pass S2 (checkable).

A symptom could be clinically important, but if it is shared by many other syndromes, it would likely not make a good diagnostic criterion.

“A symptom could be quite clinically important, but if it is shared by many other syndromes, it would likely not make a good diagnostic criterion.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

To be practical, diagnostic criteria need to be succinct.

“Third, to be practical, diagnostic criteria need to be succinct.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

DSM criteria have been enshrined in diagnostic algorithms and structured interviews, and are so often required by journal and grant reviewers that they approach the tokens of an orthodox faith.

“These criteria have been enshrined in our diagnostic algorithms and structured interviews, and are so often required by journal and grant reviewers that they approach the tokens of an orthodox faith.”