The neo-Kraepelinian paradigm has been the dominant paradigm in psychiatry since the introduction of DSM-III in 1980. Though successful in achieving reliability and in some other respects, it also has limitations. Lately, it has been argued that a paradigm shift is needed in psychiatric diagnosis. The aim of this paper is to review evidence of the limitations of DSM and to determine whether our classification system is in a phase of crisis in the Kuhnian sense.
The most important criticisms raised since the early eighties include: the psychodynamic objection, the descriptive approach criticism, the criticism of poor diagnostic validity, and Öztürks critique. The author concludes that these old objections are not a real threat. In particular, problems stemming from the descriptive approach and low diagnostic validity are not attributable to DSM but are due to under-achievements in psychiatry.
On the other hand, the new problems seem more serious and may be considered signs of crisis. These include high rates of false positives, high levels of pseudo-comorbidity, and other deficiencies attributed to the categorical approach. However, because of the advantages of this approach and the lack of a serious candidate available to replace it, a paradigm shift seems highly unlikely. The real source of the problem is not the categorical model but the low validity of some of our categories. If our etiopathological understanding of all the categories were to reach that of medical disorders, no paradigm shift would seem necessary.
