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An alternative hierarchical organization of the mental disorders of the DSM-IV.

With the approaching publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), alternative organizations of the DSM (4th ed.; DSM-IV; American Psychiatric Association, 1994) categories have been proposed. This article compares several published alternative organizations to clinicians' organization of the DSM-IV categories. As demonstrations of their organization of DSM-IV categories, psychologists and psychiatrists sorted 66 DSM-IV diagnostic categories into groups of similar diagnoses and then made progressively larger and smaller groups of diagnoses or placed similar groups next to each other on a table. Hierarchical agglomerative data analysis of clinicians' individual sortings showed that clinicians retained many lower level DSM-IV categories (e.g., anxiety disorders, mood disorders), but not the higher level DSM-IV categories (e.g., Axis I vs. Axis II). Instead, at the highest hierarchical level, clinicians' categories resembled the structure of the first edition of the DSM (American Psychiatric Association, 1952), which followed clinicians' diagnostic decision-making scheme, dividing mental disorders into organic versus nonorganic and then psychotic versus neurotic disorders. At minimum, these data suggest a DSM organization that makes sense to clinicians.