In order to understand the idea behind the use of the FFM, instead of the current diagnostic criteria, it helps to look at an illustration. Although the original journal article is viewable by registration only, it appears that the pop-up illustration can be viewed by anyone who has the URL. I think this will work. At least it works when I view it in Opera, which does not have access to my Firefox cookies, and should not know that I am registered.
Some of what I was going to add has already been added by a commenter, dreikin. In fact, dreikin went into greater detail than I would have, so that is done. I would, however, elaborate on the question of whether the scales used in the FFM are "biologically-based." How could anyone know this? They may "know" because of particular correlations in various studies. But I hardly think that I need to say, that such correlations are open to interpretation. Besides, to we really care if they have a basis in biology? If so, why?
One of the main themes of the article is that any changes to the diagnostic system should be based, at least partly, upon utility. That is a good idea. But the DSM serves multiple purposes, so the concept of utility can get muddled. It is important to ask: useful for what? and useful for whom?
The authors state:
However, one significant issue seldom examined is whether the FFM will be clinically useful. Clinical utility means the extent to which a diagnostic system assists clinicians in fulfilling key clinical functions, including making treatment plans and prognoses, communicating with patients or other clinicians, and describing a patient's global personality or important personality problems.
That is valid, as far as it goes. It does, howver, leave out the most important item: would the implementation of the FFM improve patient outcomes?
Back when I would occasionally host medicla student journal clubs, I
would let the student present the paper, then see what questions came
up, then, when the discussion seemed to be losing steam, ask the
question: How would you use this information in clinical practice?
Usually, several of the students would look surprised. I, in turn, would be surrised that they would be surprised. It seems like a fairly obvious quesiton. The whole point of reading the literature is to put it into use, and generate better outcomes.
The FFM could, if properly implemented, lead to some advantages. It could lead to greater standardization of the diagnostic process. This, in turn, could lead to higher interrater reliability. In research settings, it could lead to a more homogeneous patient population.
Of greater interest, though, is what the author mentioned about the treatment planning process. There always will be heterogeneity, even within a diagnostic category. Individuals often will have characteristics of more than one personality disorder. By looking at the individual scales, it would be possible to propose interventions for each of the areas where pathology may be present. This should, in theory, lead to greater individualization of the treatment plan. Again, in theory, this should lead to better outcomes. It may also lead to some degree of face validity, which in some cases might improve motivation and compliance. This realtes to another of the authors' points, that it could improve communication with patients.
So long as I am venturing into speculation, I'll go a bit farther. It is possible that the use of the FFM could destigmatize the diagnostic process. By having greater transparency in the process, it is possible that treaters and patients can focus more on the problem areas, and less on real, implied, or perceived value judgments.
The importance of the this is illustrated, perhaps inadvertently, by the first comment to the first part of this series. If the DSM is used as intended, there is nothing about it that is judgmental. The problem is, there does not appear to be any way to separate diagnosis from judgment, in most people's minds. Perhaps this is wishful thinking, but if the process is made more transparent, perhaps some of the implied value judgments would go away.
Usually, several of the students would look surprised. I, in turn, would be surrised that they would be surprised. It seems like a fairly obvious quesiton. The whole point of reading the literature is to put it into use, and generate better outcomes.
The FFM could, if properly implemented, lead to some advantages. It could lead to greater standardization of the diagnostic process. This, in turn, could lead to higher interrater reliability. In research settings, it could lead to a more homogeneous patient population.
Of greater interest, though, is what the author mentioned about the treatment planning process. There always will be heterogeneity, even within a diagnostic category. Individuals often will have characteristics of more than one personality disorder. By looking at the individual scales, it would be possible to propose interventions for each of the areas where pathology may be present. This should, in theory, lead to greater individualization of the treatment plan. Again, in theory, this should lead to better outcomes. It may also lead to some degree of face validity, which in some cases might improve motivation and compliance. This realtes to another of the authors' points, that it could improve communication with patients.
So long as I am venturing into speculation, I'll go a bit farther. It is possible that the use of the FFM could destigmatize the diagnostic process. By having greater transparency in the process, it is possible that treaters and patients can focus more on the problem areas, and less on real, implied, or perceived value judgments.
The importance of the this is illustrated, perhaps inadvertently, by the first comment to the first part of this series. If the DSM is used as intended, there is nothing about it that is judgmental. The problem is, there does not appear to be any way to separate diagnosis from judgment, in most people's minds. Perhaps this is wishful thinking, but if the process is made more transparent, perhaps some of the implied value judgments would go away.
Brain & Behavior
Comments
It seems obvious that Psychiatric diagnosis is not made arbitrarily and without consideration of patient prognosis. That being said, their are clearly huge elements of the population who feel quite the opposite. From mildly pseudoscientific criticism to blatantly conspiratorial accusations, it's clear that mistrust of the field has spread beyond just The Church of Scientology.
Psych is, like any science, and incomplete and evolving work in progress. If we are going to revise and update the field, than greater transparency and consistency are indeed great goals to endeavor towards. Science tends to be internally consistent and so it seems only natural that the DSM-V should jive with modern Biology & Neuroscience.
Posted by: Darwyn Jackson | April 9, 2009 11:40 PM
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Atheist? We can fix that...
Posted by: PZDUMMY | April 11, 2009 4:43 PM