The Absurdity of Latent Disease Classification for Mental Illness

Latent disease classification is currently the accepted approach to mental illness diagnosis. In the United States this takes the form of the Diagnostic and Statistical Manual of Mental Disorders-V-Text Revision (DSM-V-TR). Despite widespread use, latent disease classification has been criticized for reliability and validity problems. Several authors have illustrated that heterogenous symptom profiles are inherent for most diagnoses, and that the heterogeneity can be extreme. Past reports have been limited to a few specific disorders. To date, no authors have calculated the scope of the heterogeneity problem of the entire DSM-V-TR. We addressed this issue by calculating the unique diagnostic profiles that might exist for every DSM-V-TR diagnosis. In total, there are 10,130,807 unique ways to be diagnosed with a mental illness using DSM-V-TR criteria when not considering specifiers. When specifiers are considered, this number balloons to over 74 septillion unique symptom profiles. In other words, there are more unique ways to be classified with a mental illness than there are living humans. Additionally, there are 1,951,067 ways to present with psychiatric symptoms, yet not meet diagnostic criteria for any disorder. We outline arguments for how diagnostic heterogeneity inherent within latent disease classification is problematic for psychiatric research. We provide suggestions for alternative approaches to mental illness conceptualization, and echo recommendations for a movement towards the Research Domain Criteria. notReviewed other