Diagnostic issues of depressive disorders from kraepelinian dualism to the diagnostic and statistical manual of mental disorders, fifth edition

Seon Cheol Park, Yong Ku Kim

    Research output: Contribution to journalReview articlepeer-review

    12 Citations (Scopus)


    Because the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) was mainly influenced by the neo-Kraepelinian approach, its categorical approach to defining mental disorders has been criticized from the viewpoint of etiological neutrality. In the context of bridging the gap between “presumed etiologies-based symptomatology” and “identifiable pathophysiological etiologies,” the content in 5th edition, the DSM-5, has been revised to incorporate a combination of categorical and dimensional approaches. The most remarkable change of note regarding the diagnostic classification of depressive disorders in the DSM-5 is the splitting of mood disorders into bipolar disorders and depressive disorders, which is in accordance with the deconstruction of the Kraepelinian dualism for psychoses. The transdiagnostic specifiers “with mixed features,” “with psychotic features,” and “with anxious distress” are introduced to describe the relationships of depressive disorders with bipolar disorders, schizophrenia, and generalized anxiety disorder, respectively, in a dimensional manner. The lowering of the diagnostic threshold for major depressive disorder (MDD) may be caused by the addition of “hopelessness” to the subjective descriptors of depressive mood and the elimination of “bereavement exclusion” from the definition of MDD. Since the heterogeneity of MDD is equivalent to the Wittgensteinian “games” analogy, the different types of MDD are related not by a single essential feature but rather by “family resemblance.” Network analyses of MDD symptoms may therefore need further review to elucidate the connections among interrelated symptoms and other clinical elements.

    Original languageEnglish
    Pages (from-to)636-644
    Number of pages9
    JournalPsychiatry Investigation
    Issue number9
    Publication statusPublished - 2019 Sept

    Bibliographical note

    Funding Information:
    This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (2019R1A2C1090146).

    Publisher Copyright:
    © 2019 Korean Neuropsychiatric Association.


    • Categorical approach
    • Diagnostic and statistical manual of mental disorders
    • Dimensional approach
    • Major depressive disorder
    • Network analysis

    ASJC Scopus subject areas

    • Psychiatry and Mental health
    • Biological Psychiatry


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