Limitations of the symptom-oriented approach to psychiatric research

We critically reviewed the arguments of the symptom-oriented researchers who propose to replace syndromes and diagnostic categories with symptoms as units of analysis in psychiatric research. Three central arguments were examined: (a) current diagnostic categories lack reliability and validity; (b) using diagnostic categories leads to misclassification and confounding; and (c) symptom-oriented theories are clearer, easier to test, and more likely to lead to an explanation of psychopathology. These arguments are based on three assumptions respectively: (a) symptoms have higher reliability and validity; (b) underlying pathological processes are symptom-specific; and (c) elucidation of the process of symptom development will lead to (and must precede) the discovery of the causes of syndromes. We found little evidence supporting these assumptions and arguments based on them. There are no clear advantages in replacing syndromes with symptoms as units of analysis for psychiatric research.