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To the Editor: In his Commentary, Dr McHugh¹ argues that it is time for psychiatric classification to go beyond the descriptive approach that began with Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III),² which defined and grouped disorders based on shared symptomatology, and instead move toward a system that "helps distinguish causes from symptoms." He proposes that the next edition of the DSM group the disorders into 4 "etiopathic clusters" according to "what patients have, what they are, what they do, or what they encounter."

The introduction to DSM-III explained the need for a descriptive approach because "for most of the DSM-III disorders, the etiology is unknown."² Twenty five years later, that statement is still true. Despite the considerable advances in psychiatric research, disappointingly, little progress has been made toward understanding the pathophysiological processes and etiology of mental disorders. If anything, the research has shown that . . . [Full Text of this Article]

Robert L. Spitzer, MD
rls8@columbia.edu

Michael B. First, MD
Department of Psychiatry
Columbia University
New York, NY

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