Psychopathological Problems and Disorders

Abstract

Modeling psychotherapy implies that we also have to deal with the reasons why treatment is demanded. Commonly, the client enters psychotherapy because of a psychopathological condition in need of cure and remediation. There are two major classification systems of psychopathology, the “International Classification of Diseases” (ICD) and the “Diagnostic and Statistical Manual of Mental Disorders” (DSM). These systems and their shortcomings are briefly presented. Both rely largely on the definition of disorders as categories. The categorical definition of all disorders, however, leads to a number of conceptual problems, which are increasingly discussed in psychiatry. Such problems are the heterogeneity inside a diagnostic category and artificial classificatory comorbidity, which both threaten the reliability and validity of diagnoses. This unfortunate state of the field has led to the Research Domain Criteria (RDoC) initiative in an attempt to reach a solid evidence base for psychopathology research. RDoC however is biased toward biological units of analysis. For the sake of our modeling approach in psychotherapy, psychological and physiological state variables have priority, and dimensional scaling is preferable because it allows depicting courses of psychopathology by time series. Stable states of pathology are considered as attractors. Therefore, we conceive of psychopathology as a hierarchy of dimensional variables, with signs and symptoms at the bottom level, disorders at the intermediate level, and spectra of psychopathology at the top level. The “Hierarchical Taxonomy of Psychopathology” (HiTOP) is an example of such a conception of psychopathology.