Dimensional diagnosis and the medical student's grasp of psychiatry

Two problems that interfere with the student's understanding and acceptance of psychiatric knowledge result largely from the use of a categorical model for psychiatric diagnosis. These two problems are: (1) the apparent inapplicability of the standard system of psychiatric diagnosis to real patients; and (2) the apparent irrelevance for general medical practice of psychiatric diagnosis and theory. Both problems may be avoided by presenting psychiatry in the framework of a multidimensional diagnostic schema that used familiar terms but treats them as dimensions with severe, moderate, and mild degrees of impairment rather than as categories of mutually exclusive psychiatric diseases. A teaching program is described in which detailed review of student interviews with psychiatric and especially nonpsychiatric patients is employed to demonstrate the usefulness of multidimensional psychiatric diagnosis.