Semantic structures and psychiatric diagnosis

This study examines psychiatric diagnosis using the concepts and methods of cognitive anthropology. Clinicians are viewed as cultural experts whose knowledge is represented in semantic structures, which are arrangements of diagnostic categories based on similarity of meaning. A test of similarity judgments of diagnostic categories was administered to a group of clinicians to derive two semantic structures of the categories included in axis I and axis II, respectively, of DSM-III. These structures were then compared with actual clinical diagnoses of concurrent disorders, and with the expected incidence of such diagnoses, in order to determine the possible influence of semantic similarity on the diagnostic process. The results suggest that semantic meanings of diagnostic categories influence the use of rule-out diagnoses more than positive diagnoses, and that this influence is more pronounced with respect to axis II than axis I.