Dilemmas in the pathway of the DSM-IV

It is argued that the format for developing recent versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) taxonomy is constrained in ways that seriously impair the quality of the product. These constraints include inappropriate assumption of a categorical model, ensured persistence of traditional categories of disorder, excessive concern with interdiagnostician agreement, insufficient attention to the issue of construct validity, and excessive preoccupation with clinician acceptance. These problems and certain others are illustrated with an analysis of the nosologic status of the schizophrenia construct. There is a significant danger that the adequacy of DSM-IV will be compromised by continuing difficulties of this sort.