Reinstating the concept of ‘syndrome’ in psychiatric nosology: a strategic step back for moving the field ahead

Abstract

Lately, reification of psychiatric diagnostic categories has been the rule, both in clinical practice and research. In everyday clinics, reification can be seen in the disorder-centered approach often adopted by clinicians and also in the cultural assimilation of psychiatric nomenclature by patients; the result being a rather superficial and naive diagnostic assessment process. Regarding research, the problem is that diagnostic categories are part of the background used in empirical studies, but are seldom put to test themselves. This has become critical now that these categories clearly did not live up to the expectations they generated. Arguably, the very issue of comorbidity is also dependent on reification: as long as the presence of multiple diagnoses is taken simply as multiple foci of clinical attention, there is no harm done; confusion arises when they are treated instead as if they were multiple co-occurring diseases. This trend is so widespread that reversing it represents a great challenge for psychiatry. In this paper, we put forth reasons for reinstating into the psychiatric realm the time-honored medical concept of ‘syndrome’. The adoption of a syndromic approach, with syndromes taken as grouping higher-order categories, could not only contribute to a desirable simplification of diagnostic classifications, but also lead to an increase of the validity of the diagnoses. Syndromes may have better defined boundaries than current categories of mental disorders. In order to advance the field, we suggest that this move should be coupled with the adoption of both a cross-sectional assessment of multiple psychopathological domains and a longitudinal framework, which could allow us to put into play the medical construct of 'clinical staging', still largely underutilized in psychiatry.