
Contents
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The Diagnostic Threshold Approach The Diagnostic Threshold Approach
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Differentiating Normality from Illness Differentiating Normality from Illness
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Differentiating Illnesses from Each Other Differentiating Illnesses from Each Other
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The Comorbidity Problem The Comorbidity Problem
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The Diagnostic Hierarchy Approach The Diagnostic Hierarchy Approach
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Conceptual Basis for Diagnostic Hierarchies: Not Limited to Etiology Conceptual Basis for Diagnostic Hierarchies: Not Limited to Etiology
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Can Diagnostic Hierarchies Be Validated? Can Diagnostic Hierarchies Be Validated?
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An Empirically Based Diagnostic Hierarchy An Empirically Based Diagnostic Hierarchy
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The Concept of a Diagnosis of Exclusion The Concept of a Diagnosis of Exclusion
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Summary Summary
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Selected Reference Selected Reference
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18 C18The Concept of a Diagnostic Hierarchy
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Published:December 2018
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Abstract
The concept of a diagnostic hierarchy implies that certain diagnoses should not be made when other are present. This approach contrasts with the DSM-based approach of making multiple diagnoses at the same time, which leads to the problem of comorbidity. A central aspect of taking a non-DSM approach to clinical psychopharmacology is the importance of tackling this “comorbidity” problem. In the DSM system, all diagnoses are created equal, and clinicians are encouraged to diagnose as many disorders as possible. In practice, multiple drugs are given for multiple “disorders,” thus comorbidities lead to polypharmacy. As discussed previously, since many DSM diagnoses are created for social/professional purposes, and thus overlap in content, the apparent comorbidity can lead to unnecessary treatment.
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