50 shades of anxious: Is it time to Consider a Dimensional Approach to Diagnosis?
As humans we innately categorize everything, it’s in our genes to do so and it inevitably seeps into our system of beliefs and behaviours- we can’t help it. To some extent we’ve even come to categorize clusters of symptoms, perhaps to the exclusion of other not-so-present ones, in order to label, package and seal it under the guise of ADHD or anxiety. While it adds a dimension of realness (per se) to the experience of symptoms and for the patient, I’d say it’s just as real, title or not. It is precisely this human characteristic in testing that leads me to believe why, in both theory and practice, psychology among other domains, has been so adamant on the idea of categorization.
The ongoing debate on categorization vs. dimensionality of psychopathology has led me to wonder if our neural wiring has something to do with this approach to psychological disorders, and the possibility that these things like “anxiety” we are just as real and concrete despite the strict categorization we feel compelled to use. Is it possible that we all have the ability to experience feelings, emotions, states of being anxious on some dimension, and it still be as real without so narrowly fencing it in (and maybe missing individual differences in symptoms)? Just to clarify, this is not to dismiss the very real existence of mental illnesses but just the opposite that the way we’ve come to diagnose and test them is problematic- these illnesses exist without the strict categorization we feel necessary in order to validate them.
Though without a label it becomes difficult to communicate an illness like anxiety, understanding it in terms of a dimension could lead to greater public awareness, acceptance and outreach. In my personal experiences with anxiety diagnosis,I’ve noticed that categorizing and getting the label of “generalized anxiety”, for example, seems only to feed into feelings of further victimization, otherness, separateness and alienation- a feeling of “me” and “them” only leading to further despair. If we come to view mental illness as highly prevalent, which it is, and something we differ on by degree rather than all-or-none, it removes the barriers and separation between us and could help those suffering to feel comfortable talking about it. If the reality is closer to a dimension, why not treat it like that? The more you box something in and isolate it in a strict category, you only push it further into itself, and that is no way to go.
