Psychometric perspectives on diagnostic systems

The author identifies four conceptualizations of the relation between symptoms and disorders as utilized in diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV; American Psychiatric Association, 1994): A constructivist perspective, which holds that disorders are conveniently grouped sets of symptoms; a diagnostic perspective, which holds that disorders are latent classes underlying the symptoms; a dimensional perspective, which holds that symptoms measure latent continua; and a causal systems perspective, which holds that disorders are causal networks consisting of symptoms and direct causal relations between them. Advantages and disadvantages of these conceptualizations are discussed. The author concludes that the psychometric analysis of diagnostic systems is not settled, and that these systems require deeper psychometric analysis than they currently receive. © 2008 Wiley Periodicals, Inc. J Clin Psychol 64: 1089–1108, 2008.