The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index; 1 of the 10 sources its claims cite were checked for support.
The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria.
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How should DSM criteria relate to the disorders they are designed to assess? To address this question empirically, the author examines how well DSM-5 symptomatic criteria for major depression capture the descriptions of clinical depression in the post-Kraepelin Western psychiatric tradition as described in textbooks published between 1900 and 1960. Eighteen symptoms and signs of depression were described, 10 of which are covered by the DSM criteria for major depression or melancholia. For two symptoms (mood and cognitive content), DSM criteria are considerably narrower than those described in the textbooks. Five symptoms and signs (changes in volition/motivation, slowing of speech, anxiety, other physical symptoms, and depersonalization/derealization) are not present in the DSM criteria. Compared with the DSM criteria, these authors gave greater emphasis to cognitive, physical, and psychomotor changes, and less to neurovegetative symptoms. These results suggest that important features of major depression are not captured by DSM criteria. This is unproblematic as long as DSM criteria are understood to index rather than constitute psychiatric disorders. However, since DSM-III, our field has moved toward a reification of DSM that implicitly assumes that psychiatric disorders are actually just the DSM criteria. That is, we have taken an index of something for the thing itself. For example, good diagnostic criteria should be succinct and require minimal inference, but some critical clinical phenomena are subtle, difficult to assess, and experienced in widely varying ways. This conceptual error has contributed to the impoverishment of psychopathology and has affected our research, clinical work, and teaching in some undesirable ways.
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“Eighteen symptoms and signs of depression were described, 10 of which are covered by the DSM criteria for major depression or melancholia.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Abstract
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“For two symptoms (mood and cognitive content), DSM criteria are considerably narrower than those described in the textbooks.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Abstract
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“Second, the descriptive literature placed greater relative emphasis on the cognitive and attitudinal changes associated with depression than do the DSM criteria, where these features constitute only one criterion, characterized solely by worthlessness and guilt.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Empirical Conclusions
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“However, none of the authors noted increased appetite and weight gain, which are also described in this DSM criterion.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Textbooks' Descriptions of Symptoms and Signs
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“Fatigue, exhaustion, and feelings of being tired out, symptoms well captured by DSM criterion A6, were described by only eight authors.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Textbooks' Descriptions of Symptoms and Signs
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“Sixth, consistent with recent work (30), these authors gave greater prominence to changes in psychomotor functioning, especially psychomotor retardation, than is our current practice.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Empirical Conclusions
What the sources say
- Not checked — no full text of the sourcecites [30] source
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“Depression-related changes in volition and motivation were described by 15 authors and were typically distinguished both from the more physical feelings of fatigue and the difficulty in decision making.Most commonly, this was described as lack of initiative, loss of will, or inability to work.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Textbooks' Descriptions of Symptoms and Signs
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“Of note, only one author described neurovegetative changes in sleep, appetite, or weight as a central symptom of depression.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Prominent Symptoms and Signs
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“Third, second to mood changes, the most frequently noted key symptom of major depression was changes in cognitive Am J Psychiatry 173:8, August 2016 ajp.psychiatryonline.org773 functioning, typically characterized by difficulties in thinking and concentrating.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Empirical Conclusions
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“Mood disturbances in the course of major depression were described by all 19 textbook authors (Table 1).”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Textbooks' Descriptions of Symptoms and Signs
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“Second, it does not explain the diminution in psychopathological expertise and interest since the advent of DSM-III (4).”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Potential Limitations
What the sources say
- Supportedcites [4] source
The Abstract says that since DSM-III’s publication in 1980, teaching careful clinical evaluation informed by psychopathology has steadily declined. The section ‘To improve communication between clinicians’ adds that classics in psychopathology are largely ignored and research in psychopathology is a dying enterprise. Together, these support the claimed diminution in expertise and interest. (LLM, conf=0.93)
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- Supported
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“Compared with the DSM criteria, these authors gave greater emphasis to cognitive, physical, and psychomotor changes, and less to neurovegetative symptoms.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Abstract
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“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Textbooks' Descriptions of Symptoms and Signs
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In the paper
“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).”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Lewis's Monograph
What the sources say
- Not checked — no full text of the sourcecites [7] source
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In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Textbooks' Descriptions of Symptoms and Signs
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In the paper
“Speech that was slow, hesitant, indistinct, and/ or monosyllabic was described by all but two authors.This symptom is not included in DSM-5.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Textbooks' Descriptions of Symptoms and Signs
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In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Textbooks' Descriptions of Symptoms and Signs
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In the paper
“All three of these are well reflected in the DSM criteria for major depression.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Prominent Symptoms and Signs
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In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Criteria for Depression Proposed by Muncie
What the sources say
- Not checked — no full text of the sourcecites [22] Muncie W, 1939 source
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In the paper
“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 Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Prominent Symptoms and Signs
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“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Textbooks' Descriptions of Symptoms and Signs
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“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Quantitative Analysis
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In the paper
“Poor appetite and weight loss were described by, respectively, 10 and nine textbook authors, consistent with DSM criterion A3.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Textbooks' Descriptions of Symptoms and Signs
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“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Empirical Conclusions
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In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Empirical Conclusions
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“First, the nature of psychiatric practice changed during the 20th century, with outpatient care constituting a larger proportion of our work, especially after 1960.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Potential Limitations
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“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Potential Limitations
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“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Illustrations of the Problems Associated With Our Category Mistake
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- Rests on an assumption: The 19 textbooks examined are representative of the Western post-Kraepelinian psychiatric tradition.
- Also stated in: § Illustrations of the Problems Associated With Our Category Mistake · plain
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In the paper
“For the key major depression criteria A1 and A7, DSM-5 lists three and two descriptors, respectively.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Illustrations of the Problems Associated With Our Category Mistake
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“Most of our textbook writers considered anxiety to be a prominent and clinically important part of the presentation of major depression.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Illustrations of the Problems Associated With Our Category Mistake
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- Rests on an assumption: The 19 textbooks examined are representative of the Western post-Kraepelinian psychiatric tradition.
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In the paper
“Many of the classical textbook writers were seeing severely depressed patients in hospitals.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Potential Limitations
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“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Potential Limitations
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In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Conceptual Issues With Our Current Approach to DSM Criteria
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In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Empirical Conclusions
What the sources say
- Not matchedcites [35] Spitzer RL, 1975
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In the paper
“This conceptual error has contributed to the impoverishment of psychopathology and has affected our research, clinical work, and teaching in some undesirable ways.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Abstract
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“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Potential Limitations
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“Second, developers of diagnostic criteria are also appropriately concerned about specificity.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Illustrations of the Problems Associated With Our Category Mistake
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In the paper
“Many of us have become diagnostic literalists with respect to DSM, stymied by an excessive respect for own creation.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Consequences of Our Category Mistake
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“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > CONCLUSIONS
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In the paper
“But it is problematic when we focus our teaching, our clinical work, and our research solely around DSM criteria.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > CONCLUSIONS
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“The presence of such validators helps illustrate the difference between indexing and constituting a disorder.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Consequences of Our Category Mistake
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In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Consequences of Our Category Mistake
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“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Potential Limitations
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In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Illustrations of the Problems Associated With Our Category Mistake
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In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Potential Limitations
What the sources say
- Not checked — no full text of the sourcecites [37] source
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In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Consequences of Our Category Mistake
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In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Illustrations of the Problems Associated With Our Category Mistake
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In the paper
“Given our pride in our diagnosis and our lack of definitive validators, it is understandable that our field has had undergone a”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Consequences of Our Category Mistake
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“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Illustrations of the Problems Associated With Our Category Mistake
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“Third, to be practical, diagnostic criteria need to be succinct.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Illustrations of the Problems Associated With Our Category Mistake
Strength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Phenomenology of Major Depression and the Representativeness and Nature of DSM Criteria > Consequences of Our Category Mistake
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
The paper relies on this without support.
Textbooks are the best place to obtain expert opinion about the important symptoms and signs of depression.
“I focus initially on textbooks as the best place to obtain expert opinion about the important symptoms and signs of depression.”
The paper relies on this without support.
The 19 selected textbooks are representative of the post-Kraepelinian Western psychiatric tradition circa 1900-1960.
“In total, 19 textbooks, published from 1899 to 1956 from five countries (nine from the United States, seven from the United Kingdom, and one each from Germany, France, and Switzerland), met inclusion criteria.”
The paper relies on this without support.
The textbook descriptions and Lewis's cases accurately reflect the phenomenology of depressive illness or major depression.
“I next review the phenomenology of depression described by Aubrey Lewis in what is the most detailed survey of the phenomenology of depression written in the 20th century (7).”
The paper relies on this without support.
Lewis's monograph is the most detailed survey of the phenomenology of depression written in the 20th century.
“I next review the phenomenology of depression described by Aubrey Lewis in what is the most detailed survey of the phenomenology of depression written in the 20th century (7).”
The paper relies on this without support.
The 19 textbooks examined are representative of the Western post-Kraepelinian psychiatric tradition.
“The DSM symptomatic criteria for major depression do a reasonable but incomplete job of assessing the prominent clinical symptoms and signs of depressive illness as described in the Western post-Kraepelinian psychiatric tradition.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Abstract understates the number of symptoms covered by DSM criteria
MinorThe abstract says 10 symptoms or signs are covered by criteria for major depression or melancholia. The quantitative analysis counts 10 well covered by major-depression criteria plus one covered by a melancholia criterion, for a total of 11.
“Eighteen symptoms and signs of depression were described, 10 of which are covered by the DSM criteria for major depression or melancholia.”
“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.”
Dana textbook has two publication years
MinorTable 1 dates Dana's textbook to 1907, while its bibliography entry gives 1904.
“| Dana, 1907 (11) | Mental |”
“11. Dana CL: Text-Book of Nervous Diseases and Psychiatry: For the Use of Students and Practitioners of Medicine, 6th rev and enlarged ed. New York, William Wood, 1904”
Conflicting counts of central neurovegetative symptoms
MinorOne section says one author considered a sleep, appetite, or weight change central to depression; a later section says no author considered those changes key symptoms.
“Of note, only one author described neurovegetative changes in sleep, appetite, or weight as a central symptom of depression.”
“No author noted them as key depressive symptoms.”
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Di, Y., Rahmani, E., Mefford, J., Wang, J., Ravi, V., Gorla, A., Alwan, A. A., Kendler, K. S., Zhu, T., & Flint, J. (2024) · Molecular Psychiatry · doi:10.1038/s41380-024-02877-y · Cited by 16
“Changes in human pitch and tone of speech have been noted as an important sign of depression for over a century [1, 2].”
InfluentialSelf-citationKendler, K. S. (2017) · Psychological Medicine · doi:10.1017/s0033291717002768 · Cited by 10
Self-citationPeterson, E. C., Snyder, H. R., Neilson, C., Rosenberg, B. M., Hough, C. M., Sandman, C. F., Ohanian, L., Garcia, S., Kotz, J. E., Finegan, J. L., et al. (2022) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2022.838645 · Cited by 14
“While anxious arousal is commonly associated with anxiety disorders (e.g., panic disorder) we note that altered physiological arousal and heightened anxiety have historically been considered central features of mood pathology (Kendler, 2016, 2017).”
BackgroundA call for renewed attention to construct validity and measurement in psychopathology research
Hayden, E. P. (2022) · Psychological Medicine · doi:10.1017/s0033291722003221 · Cited by 12
“Even widely studied disorder constructs such as depression are subject to ongoing debate regarding their validity (Fried, Flake, & Robinaugh, 2022; Kendler, 2016, 2017).”
BackgroundThe Dimensionality of Proposed DSM-5 PTSD Symptoms in Trauma-Exposed Young Children
McKinnon, A., Scheeringa, M. S., Meiser‐Stedman, R., Watson, P., Young, A. D., & Dalgleish, T. (2019) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-019-00561-2 · Cited by 9
“A final possibility is that the range of PTSD symptoms enshrined in the DSM for young children is too narrow and detailed qualitative investigations of young children’s clinical presentations are indicated, in line with similar endeavors in adults (e.g., Kendler 2016).”
ResultTest-retest & familial concordance of MDD symptoms
Kaiser, A. J. E., Funkhouser, C. J., Mittal, V. A., Walther, S., & Shankman, S. A. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113313 · Cited by 9
“Kendler (2016) argues that diagnostic criteria are designed to index rather than describe the complete syndrome and aggregating disparate symptoms (as explored in this study) likely further impacts the reliability and validity of diagnosis.”
BackgroundQuestionable Agreement: The Experience of Depression and DSM-5 Major Depressive Disorder Criteria
Nussbaum, A. M. (2020) · The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine · doi:10.1093/jmp/jhaa025 · Cited by 9
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“Items were excluded if they were outside the domains of interest (as defined by published psychopathological reviews), 25–27 if they had low minor endorsement rates, or if they had high degrees of missingness, all issues that make factor analysis computationally unstable.”
BackgroundCarlson, G. A. (2018) · Child and Adolescent Mental Health · doi:10.1111/camh.12243 · Cited by 9
Characterizing depression after traumatic brain injury using a symptom-oriented approach
Carmichael, J. J., Ponsford, J. L., Gould, K. R., & Spitz, G. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.130 · Cited by 9
Objectivity, standardization, and epistemic injustice in psychiatry
Ballesteros, V. (2025) · Synthese · doi:10.1007/s11229-025-05016-4 · Cited by 9
“…self-accusation, self-derogation, feelings of inadequacy and of being a failure, and a specific focus on prior moral shortcomings, often of a sexual nature”, (Kendler, 2016 , p. 6) which is notably broader than the DSM-5 criterion “Feelings of worth - lessness or excessive or inappropriate guilt.””
Butelman, E. R., Baynard, C., McElroy, B. D., Prisinzano, T. E., & Kreek, M. J. (2021) · Journal of Psychopharmacology · doi:10.1177/0269881121996883 · Cited by 8
“These mechanisms are thought to include dysphoria and anhedonia, which are two of the main features observed in clinical depression (Fried et al., 2016; Kendler, 2016).”
BackgroundBeyond pathology: women’s lived experiences of melancholy and mourning in infertility treatment
de Boer, M. L., Bondevik, H., & Solbrække, K. N. (2019) · Medical Humanities · doi:10.1136/medhum-2018-011586 · Cited by 8
A procedural overview of why, when and how to use machine learning for psychiatry
Lucasius, C., Ali, M., Patel, T., Kundur, D., Szatmári, P., Strauss, J., & Battaglia, M. (2025) · Nature Mental Health · doi:10.1038/s44220-024-00367-2 · Cited by 7
“While the adoption of such functioning criteria has resulted in greater replicability and reliability of psychiatric diagnoses, it has done so by disadvantaging many classical, long-standing clinical descriptors, and at the price of the pheno-menology of psycho pathology 1 .”
A revisionist model for treatment-resistant and difficult-to-treat depression
Parker, G. B. (2024) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674241240600 · Cited by 8
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“According to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders V) criteria, the main MDD symptoms include depressed mood, insomnia, psychomotor agitation, fatigue, and recurrent suicidal thoughts [5].”
MethodFried, E. I., & Haslbeck, J. M. B. (2019) · doi:10.31234/osf.io/5mvz4 · Cited by 6
van Oosterzee, A. (2024) · AI & Society · doi:10.1007/s00146-024-02012-z · Cited by 8
“The patients’ clinical realities are poorly reflected in the symptoms selected by the DSM classification system (Kendler 2016).”
Impaired reward sensitivity in Parkinson's depression is unresponsive to dopamine treatment
Costello, H., Yamamori, Y., Kieslich, K., Murphy, M., Bobyreva, K., Schrag, A. E., Howard, R. J., & Roiser, J. P. (2025) · Brain · doi:10.1093/brain/awaf098 · Cited by 11
“9,10 There are at least 256 possible unique symptom profiles that meet Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V) criteria for a diagnosis of major depressive disorder.”
Martínez-Líbano, J., Yeomans‐Cabrera, M., Serey, A. K., Lara, R. I., & Fincias, P. T. (2025) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe15070130 · Cited by 12
“…demands they endure and their ability to meet them (Kent, 2003), and (iii) depression, established as a persistent mood state of excessive sadness and/or a significantly reduced experience of pleasure (Kendler, 2016) which significantly affect the well-being of different groups of the poulation (G.”
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A crise do diagnóstico em psiquiatria e os manuais diagnósticos
Pondé, M. P. (2018) · Revista Latinoamericana de Psicopatologia Fundamental · doi:10.1590/1415-4714.2018v21n1p145.10 · Cited by 9
“Kendler (2016) nega que as doenças psiquiátricas tenham essências, mas nascem de uma rede de causas, sintomas e signos.”
BackgroundKendler, K. S. (2020) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaa039 · Cited by 6
Self-citationHøstmælingen, A., Ulvenes, P., Nissen‐Lie, H. A., Eielsen, M., & Wampold, B. E. (2021) · Journal of Counseling Psychology · doi:10.1037/cou0000572 · Cited by 5
Kraepelin's final views on manic-depressive Illness
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Phenomenology and psychiatry: Shaping the diagnosis
Jerotić, S., & Nešić, J. (2023) · Theoria Beograd · doi:10.2298/theo2301089j · Cited by 5
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Historical precedents for the DSM-III bereavement exclusion criteria for major depression
Kendler, K. S. (2018) · Psychological Medicine · doi:10.1017/s0033291718000533 · Cited by 5
“I began with texts I had assembled for two prior projects: psychiatric textbooks written in 1900–1960 (Kendler, 2016) and textbooks and review articles on MD published from 1880 to 1900 (Kendler, 2017).”
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Self-citationChild and adolescent psychiatry: challenges, solutions, opportunities, and future directions
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“Their categorical structure, based on stable cross- sectional diagnostic entities with clearly defined symptom clusters 45 , fails to accommodate the dynamic syndromic shifts typical in child and adolescent psychiatric presentations 46 .”
Gao, F., Jia, S., Yin, S., Yin, Z., Guan, W., Ding, F., Wang, X., & Wan, P. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07310-4 · Cited by 5
Symptom network connectivity indices as predictors of relapse in major depressive disorder
Nunes, A., Pavlová, B., Nuñez, J.-J., Quilty, L. C., Foster, J. A., Harkness, K. L., Ho, K. T., Lam, R. W. M., Li, Q. S., Milev, R. V., et al. (2025) · Psychiatry Research · doi:10.1016/j.psychres.2025.116562 · Cited by 6
“…each other, resulting in a single symptom cascading into a full syndromic depression (Baez and Heller, 2020; Madhoo and Levine, 2016; Pe et al., 2015; Santos Jr. et al., 2017; van Borkulo et al., 2015; van de Leemput et al., 2014; Vos et al., 2017; Wichers et al., 2020, 2016; Wigman et al., 2015).”
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“Depressive symptoms, including persistent sadness, hopelessness, anhedonia, appetite changes, and sleep disturbances, often compromise self-care and social interactions (Kendler, 2016).”
On the Origins of MAOI Misconceptions: Reaffirming their Role in Melancholic Depression
den Eynde, V. V., Parker, G. B., Ruhé, H. G., Birkenhäger, T. K., Godet, L., Shorter, E., & Gillman, P. K. (2025) · Psychopharmacology Bulletin · doi:10.64719/pb.4466 · Cited by 4
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“This results not only in heterogeneity in the literature, but serves to reify the diagnostic criteria for depression, which are intended only to be an indicator of the syndrome of depression, and resultantly restricts the field and its impact (Kendler, 2016).”
Lam, M. I., Bai, W., Feng, Y., Zhang, Q., Zhang, Y., Jackson, T., Rao, S.-Y., Ho, T.-I., Su, Z., Cheung, T. C. C., et al. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111910 · Cited by 3
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Self-citationBiomarkers of Depression: Potential Diagnostic Tools
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Predictors of Depressive Symptoms Among Parents of Children With Cancer in Ethiopia
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“As a screening tool, the DASS21 is not intended to address the greater symptomatology of depression: changes in cognitive function, low energy, insomnia, changes in weight and appetite, and suicidal ideation and behavior (Kendler, 2016).”
MethodA Comparative Study on Mental Disorder Conceptualization: A Cross-Disciplinary Analysis
Jerotić, S., Ignjatović, N., Marić, N. P., Nešić, J., Jovandić, Ž., Latas, M. B., Nestorović, M., Jevtovic, M., & Aftab, A. (2024) · Community Mental Health Journal · doi:10.1007/s10597-024-01240-3 · Cited by 3
Penanganan Depresi melalui Dimensi Rohani di Kota Bandung
Omega, Y. P., & Herman, S. (2024) · Fidei Jurnal Teologi Sistematika dan Praktika · doi:10.34081/fidei.v7i1.488 · Cited by 3
Spagna, A., Wang, J., Rosario, I. E., Zhang, L., Zu, M., Wang, K., & Tian, Y. (2022) · Brain Sciences · doi:10.3390/brainsci12030350 · Cited by 3
“Cognitive deficits [8] play a critical role in the life of an individual living with depression.”
BackgroundThe Cross-National Epidemiology of Mental Disorders
Stein, D. J., de Jonge, P., Kessler, R. C., & Scott, K. M. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316336168.002 · Cited by 3
“Indeed it is unlikely that the next editions of DSM and ICD will represent a paradigm shift; it is much more likely that they will represent iterative improvement (Kendler & First 2010).”
BackgroundClinical depression: the fault not in our stars?
Parker, G. B. (2021) · Australasian Psychiatry · doi:10.1177/10398562211022750 · Cited by 3
Kendler, K. S. (2020) · Psychological Medicine · doi:10.1017/s003329172000118x · Cited by 3
“Kraepelin’s diagnostic views on mania and depression can be placed into their historical context by two prior reviews of textbook descriptions of the symptoms and signs of mania and depression from 1900 till 1960 (Kendler, 2016, 2017).”
BackgroundResultSelf-citationFrom syndromes to symptoms: Advancing our understanding of mental disorders
Clack, S. (2020) · Open Access Victoria University of Wellington | Te Herenga Waka (Figshare) · doi:10.26686/wgtn.17151110.v1 · Cited by 3
Major Depressive Disorder: From Accurate Diagnosis to Effective Treatment
Sofocleous, A. (2025) · Journal of Humanistic Psychology · doi:10.1177/00221678251385600 · Cited by 2
Hou, X., Zhang, J., Duan, J., Song, Y., Tang, X., Gong, Z., Li, Z., Kang, Z., Huang, Y., He, J., et al. (2026) · NeuroImage · doi:10.1016/j.neuroimage.2026.121706 · Cited by 2
Bilder, R. M. (2017) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2017.03.012 · Cited by 2
“Can we start with CAT approaches to define “legacy” constructs (like the diagnoses that have been the basis of virtually all case-control studies so far, and key dimensions such as internalizing and externalizing behavior), and augment these with items that will flesh out the phenotypic space that may be missed? Can w…”
MethodLimenih, G., MacDougall, A. G., Smith, M. W. J., & Nouvet, É. (2024) · International Journal of Social Psychiatry · doi:10.1177/00207640241280620 · Cited by 2
Hayasaka, T., Nagashima, I., Hoshino, M., Teruya, K., Matumoto, Y., Murao, M., Maruki, T., Watanabe, M., Katagiri, T., Imamura, Y., et al. (2024) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.70038 · Cited by 2
Contemporary GWAS studies of depression: the critical role of phenotyping
Kasyanov, E. D., Rakitko, A., Rukavishnikov, G. V., Голимбет, В. Е., Shmukler, A. B., Ilinsky, V. V., Незнанов, Н. Г., Kibitov, A. O., & Mazo, G. E. (2022) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202212201150 · Cited by 2
ECT is evidence-based – a commentary on depression: why drugs and electricity are not the answer
Meechan, C., Laws, K. R., Young, A. H., McLoughlin, D. M., & Jauhar, S. (2022) · Psychological Medicine · doi:10.1017/s003329172200085x · Cited by 2
“Regarding their concept of depression, as “misery and sadness”, they ignore historical psychopathological descriptions of depression, presenting with features such as impaired cognition, psychomotor disturbance and psychosis (Kendler, 2016).”
BackgroundClinical Features of Depressive Disorders
Anderson, I. M., & Williams, K. (2024) · Cambridge University Press eBooks · doi:10.1017/9781911623861.004 · Cited by 4
Do enteric glial cells play a role in the pathophysiology of major depression?
Rajkumar, R. P. (2024) · Exploration of neuroscience · doi:10.37349/en.2024.00042 · Cited by 2
van Loo, H. M., & Romeijn, J. (2017) · Psychological Medicine · doi:10.1017/s0033291717001799 · Cited by 2
Jonathan Flint, C., Di, Y., Rahmani, E., Mefford, J., Wang, J., Ravi, V., Gorla, A., Alwan, A. A., Kendler, K. S., & Zhu, T. (2024) · Research Square · doi:10.21203/rs.3.rs-4135145/v1 · Cited by 2
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“9,10 There are at least 256 possible unique symptom profiles that meet DSM-V criteria for a diagnosis of major depressive disorder.”
BackgroundBednarek, L., Harrison, B. J., Davey, C. G., Steward, T., & Jamieson, A. J. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-026-02201-5 · Cited by 1
“Although somatic complaints are not core symptoms within DSM diagnostic criteria, they are emphasized in historic criteria and in phenomenological psychiatry [57, 58].”
The psychedelic experience: a new perspective, a new attitude towards the world
Ballesteros, V. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780192898371.003.0009 · Cited by 1
Some Further Considerations: A Critique of Quaternary Prevention in Mental Health
González‐Blanch, C. (2025) · Papeles del Psicólogo - Psychologist Papers · doi:10.70478/pap.psicol.2025.46.15 · Cited by 2
The characteristics of modern-type depression and its relevance in clinical practice
Volpe, U., Orsolini, L., & Kato, T. A. (2025) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000001050 · Cited by 2
No precision psychiatry without clinical precision
Amad, A., D’Hondt, F., Daoudi, M., & Fovet, T. (2025) · Molecular Psychiatry · doi:10.1038/s41380-025-03363-9 · Cited by 1
“As comparative analyses have shown, many symptoms carefully elaborated in classical psychiatric literature are simply absent from diagnostic systems like the DSM [7].”
From thoughts to symptoms: The temporal and dimensional dynamics of rumination in depression
Kresinszky, L., Kheirkhah, M., Alizadeh, S., Shariatpanahi, B., Savić, V., & Jamalabadi, H. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120968 · Cited by 2
Singh, S., Cunningham, J. E. A., Uher, R., Becker, S., & Nunes, A. (2026) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2026.106652 · Cited by 3
Foster, S., & Mohler‐Kuo, M. (2020) · PLoS ONE · doi:10.1371/journal.pone.0235272 · Cited by 1
Contemporary Genome-Wide Association Studies in Depression: The Critical Role of Phenotyping
Kasyanov, E. D., Rakitko, A., Rukavishnikov, G. V., Голимбет, В. Е., Shmukler, A. B., Ilinsky, V. V., Незнанов, Н. Г., Kibitov, A. O., & Mazo, G. E. (2022) · Neuroscience and Behavioral Physiology · doi:10.1007/s11055-022-01306-3 · Cited by 1
Conceptualizando la depresión: dos miradas
Enrique Jadresic, M. (2022) · Revista médica de Chile · doi:10.4067/s0034-98872022001101419 · Cited by 1
Transtorno do Déficit de Atenção e Hiperatividade (TDAH) na perspectiva transdiagnóstica
Fernandes, M. F., Zys, D. C., Paola, F. F. D., & Menegatti, C. L. (2023) · Psicologia Argumento · doi:10.7213/psicolargum.41.113.ao012 · Cited by 1
Too sad to be true: hypo- and hyperreality in experiences of depression
Lopes, M. (2023) · Philosophical Psychology · doi:10.1080/09515089.2023.2252448 · Cited by 1
“The point is that DSM criteria for depression, while a good place to start a diagnostic evaluation (as an index), by its very nature, cannot capture or represent all the relevant symptoms and signs that merit evaluation in such experiences (the “thing” itself) (Kendler, 2016).”
BackgroundInfluentialPhenomenology and making sense of the DSM: situatedness in melancholic and atypical depression
Kavosh, A. (2024) · Phenomenology and the Cognitive Sciences · doi:10.1007/s11097-024-10014-x · Cited by 1
Schmahl, C. G., Priebe, K., Stiglmayr, C., et al. (2024) · Springer eBooks · doi:10.1007/978-3-662-67687-5_11 · Cited by 1
Opportunities and Challenges of Biomaterials in Brain Disease
Zheng, W., Jiang, M., Dong, N., Fang, H., Tian, H., & Chen, X. (2025) · Advanced Healthcare Materials · doi:10.1002/adhm.202500746 · Cited by 2
Targeting and transforming major depression
Parker, G. B., Paterson, A., McCraw, S., & Hadzi‐Pavlovic, D. (2016) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12681 · Cited by 1
“In reframing it as capturing a domain of clinical depression, we echo Kendler’s model (5) and the concern expressed by Fawcett (4): ‘We know enough to know that the traditional DSM approach is obsolete, but we do not know enough to articulate the paradigm shift we know will be necessary’.”
BackgroundMethodResultInfluentialThe SVARAD Scale for Rapid Dimensional Assessment: Development and Applications in Research
Biondi, M., Gaetano, P., Pasquini, M., & Picardi, A. (2018) · Springer eBooks · doi:10.1007/978-3-319-78202-7_1 · Cited by 1
When Checklists Were New: The Prototype of DSM’s Operational Criteria
Justman, S. (2018) · Ethical Human Psychology and Psychiatry · doi:10.1891/1559-4343.20.1.17 · Cited by 1
“(Hyman, 2010, p. 156) Unlike a list of diagnostic criteria so venerated that it’s taken as a one-for-one representation of the disorder itself (Kendler, 2016), the Cassidy checklist was simply an expedient for the conduct of a study.”
BackgroundThe one and the many: a case highlighting comorbidity and complexity in psychiatry
Williams, J. H., Cain, R., Arnone, D., & Kyratsous, M. (2020) · BJPsych Bulletin · doi:10.1192/bjb.2020.23 · Cited by 1
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Bukh, J., Fabrazzo, M., Christensen, E. M., et al. (2022) · Psychopathology · doi:10.1159/000522505 · Cited by 1
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Jiménez, J. P., Botto, A., & Fonagy, P. (2021) · Depression and personality · doi:10.1007/978-3-030-77329-8_1 · Cited by 2
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Nunes, A., Singh, S., Allman, J., et al. (2022) · doi:10.31234/osf.io/zqcjd · Cited by 1
Clarke, J. C. (2018) · Psychoanalytic Psychotherapy · doi:10.1080/02668734.2018.1462036 · Cited by 3
Screening for Depression Through a Glass Darkly—Reply
Olfson, M., Blanco, C., & Marcus, S. C. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.9287
Bolton, P. A., & Haroz, E. E. (2018) · Social Science & Medicine · doi:10.1016/j.socscimed.2018.01.002
“This is actually very consistent with how the DSM was designed – as an index of disorders to simplify interpretation, while acknowledging the existence of substantial variation in the disorder experience (Kendler, 2016, 2017).”
Crocq, M. A., Guelfi, J. D., Pull, C. B., et al. (2000) · Time to knit · doi:10.1016/s0246-1072(17)63127-4
Treating depression with activation
Nyström, M. B. T. (2018) · KTH Publication Database DiVA (KTH Royal Institute of Technology)
Sadness/Demoralisation and Apathy
Picardi, A., Gaetano, P., & Fabi, E. (2018) · Springer eBooks · doi:10.1007/978-3-319-78202-7_6
Signes et symptômes en psychiatrie au xxie siècle : une nouvelle frontière… ?
Demazeux, S., Falissard, B., & Swendsen, J. D. (2018) · French Journal of Psychiatry · doi:10.1016/s2590-2415(19)30052-2
Changing perspectives: Towards detailed phenotyping in geneticsPreprint
Nagel, M. (2020) · Thesis Commons (OSF Preprints) · doi:10.31237/osf.io/a4nz2 · Cited by 1
Chatterjee, D. (2019) · TSpace (University of Toronto)
Perception, Action, and DepressionPreprint
Tate, M., & James, A. P. (2020) · PhilSci-Archive (University of Pittsburgh)
Delusional Depression and Melancholia
Quagliato, L. A., Freire, R. C. R., & Nardi, A. E. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-68309-8.00006-0
Epistemically Adrift: Mood Disorders and Navigating Responsibility
Jackson, J. (2020) · TUScholarShare (Temple University)
Stein, D. J. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-90239-7.00008-0
How can we know what is true, then?
Stein, D. J. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-90239-7.00010-9
Stein, D. J. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-90239-7.00004-3
Metadata
- Authors
- Kendler, K. S.
- Affiliations
- Virginia Commonwealth University (US)
- Corresponding author
- Kendler, Kenneth S.
- ORCID
- Kendler, Kenneth S.
- Venue
- American Journal of Psychiatry
- Published
- 2016-08-01
- Volume
- 173
- Issue
- 8
- Pages
- 771-780
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2346168897
- Cited by
- 255
- References
- 42
- Citations by year
- 2026: 25 · 2025: 32 · 2024: 32 · 2023: 20 · 2022: 27 · 2021: 19 · 2020: 24 · 2019: 15 · 2018: 27 · 2017: 27 · 2016: 5
- FWCI
- 153.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- major depressive disorder, DSM-5 diagnostic criteria, melancholia, history of psychiatry, psychomotor symptoms, neurovegetative symptoms, depersonalization/derealization
- MeSH terms
- Attitude of Health Personnel, Curriculum, Major Depressive Disorder, Diagnosis, Differential, Education, Medical, Humans, Psychopathology, Research, Textbooks as Topic, United States, Diagnostic and Statistical Manual of Mental Disorders
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