The release of DSM-5 and the preparations for the launch of the ICD-11 provoked a series of critiques of psychiatric classification, which continues to depend largely on clinical description. Among the immediate problems are those of arbitrary diagnostic thresholds, tendency to reification, rigid category boundaries, comorbidity, diagnostic ‘epidemics' and differential diagnostic dilemmas. We argue that many of those problems stem from the polythetic-operational definitions of psychiatric categories, which thereby come to lack an organizing prototype-directed or gestaltic intelligibility principle. We illustrate these issues by briefly examining the current operational diagnosis of schizophrenia, its demarcation from affective illness and the status of the spectrum concept and the prodrome of schizophrenia. We point out that European research on schizophrenia always allocated an important diagnostic weight to a certain prototypical trait core of the illness, phenomenologically indispensable for its demarcation from other, nonschizophrenic psychotic conditions. We believe that the notion of self-disorder (reflective of the structural alterations of subjectivity), itemized into its various aspects in the Examination of Anomalous Self-Experience scale, is an important step forward in a more precise psychopathological articulation of that core, strengthening its clinical and research utility.

1.
Kendler KS, Parnas J (eds): Philosophical Issues in Psychiatry. Oxford, Oxford University Press, 2012, vol II: Nosology.
2.
Kendler KS, Parnas J (eds): Philosophical Issues in Psychiatry. Oxford, Oxford University Press, 2015, vol III: The Nature and Sources of Historical Change.
3.
Zachar P: A Metaphysics of Psychopathology. Cambridge, MIT Press, 2014.
4.
Zachar P, Stoyanov DST, Aragona M, Jablensky A (eds): Alternative Perspectives on Psychiatric Validity. Oxford, Oxford University Press, 2015.
5.
Jablensky A: The nosological entity in psychiatry: a historical illusion or a moving target? In Kendler KS, Parnas J (eds): Philosophical Issues in Psychiatry. Oxford, Oxford University Press, 2012, vol II: Nosology, pp 77-94.
6.
Frances AJ, Widiger T: Psychiatric diagnosis: lessons from the DSM-IV past and cautions for the DSM-5 future. Annu Rev Clin Psychol 2012;8:109-130.
7.
Hyman SE: The diagnosis of mental disorders: the problem of reification. Annu Rev Clin Psychol 2010;6:155-179.
8.
Hyman SE: Diagnosing the DSM: diagnostic classification needs fundamental reform. Cerebrum, April 26, 2011. http://dana.org/news/cerebrum/detail.aspx?id=32066.
9.
Parnas J, Bovet P: Psychiatry made easy: operation(al)ism and some of its consequences; in Kendler KS, Parnas J (eds): Philosophical Issues in Psychiatry. Oxford, Oxford University Press, 2014, vol III: The Nature and Sources of Historical Change, pp 190-212.
10.
Parnas J, Bovet P: Negative/positive symptoms of schizophrenia: clinical and conceptual issues. Nordic J Psychiatry 1994;48(suppl 31):5-14.
11.
Parnas J: DSM-IV and the founding prototype of schizophrenia: are we regressing to pre-Kraepelian nosology?; in Kendler KS, Parnas J (eds): Philosophical Issues in Psychiatry. Oxford, Oxford University Press, 2012, vol II: Nosology, pp 237-259.
12.
Parnas J: The core gestalt of schizophrenia. World Psychiatry 2012;11:67-69.
13.
Berner P, Katschnig H, Lenz G: Poly-diagnostic approach: a method to clarify incongruences among the classification of the functional psychoses. Psychiatr J Univ Ott 1982;7:244-248.
14.
Jansson LB, Parnas J: Competing definitions of schizophrenia: what can be learned from polydiagnostic studies? Schizophr Bull 2007;33:1178-1200.
15.
Kendler KS: Toward a scientific psychiatric nosology: strengths and limitations. Arch Gen Psychiatry 1990;47:969-973.
16.
Maj M: A critique of DSM-IV operational criteria for schizophrenia. Br J Psychiatry 1998;172:458-460.
17.
Parnas J: Differential diagnosis and current polythetic classification. World Psychiatry, in press.
18.
Yee L, Korner AJ, McSwiggan S, Meares RA, Stevenson J: Persistent hallucinosis in borderline personality disorder. Compr Psychiatry 2005;46:147-154.
19.
Slotema CW, Daalman K, Blom JD, Diederen KM, Hoek HW, Sommer IEC: Auditory verbal hallucinations in patients with borderline personality disorder are similar to those in schizophrenia. Psychol Med 2012;42:1873-1878.
20.
Melle I: The Breivik case and what psychiatrists can learn from it. World Psychiatry 2013;12:16-21.
21.
Parnas J: The Breivik case and ‘conditio psychiatrica'. World Psychiatry 2013;12:21-22.
22.
Craddock N, Owen MJ: The beginning of the end for the Kraepelinian dichotomy. Br J Psychiatry 2005;186:364-366.
23.
Cross-Disorder Group of the Psychiatric Genomics Consortium: Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs. Nat Genet 2013;45:984-994.
24.
Pearlson GD: Etiologic, phenomenologic, and endophenotypic overlap of schizophrenia and bipolar disorder. Annu Rev Clin Psychol 2015;11:13.1-13.31.
25.
Bleuler E: Dementia Praecox or the Group of Schizophrenias. New York, International Universities Press, 1950, p 304.
26.
Lipton AA: Was the ‘nervous illness' of Schreber a case of affective disorder? Am J Psychiatry 1984;141:1236-1239.
27.
Schreber DP: Memoirs of My Nervous Illness (1903). New York, New York Review of Books, 2000.
28.
Kendler KS, Spitzer RL: A reevaluation of Schreber's case. Am J Psychiatry 1985;142:1121-1123.
29.
Meehl PE: Schizotaxia, schizotypy, schizophrenia. Am Psychol 1962;17:827-838.
30.
Meehl PE: Toward an integrated theory of schizotaxia, schizotypy, and schizophrenia. J Pers Disord 1990;4:1-99.
31.
Parnas J, Licht D, Bovet P: Cluster A personality disorders: a review; in Maj M, Akiskal HS, Mezzich JE, Okasha A (eds): Personality Disorders. WPA Series Evidence and Experience in Psychiatry. Chichester, Wiley & Sons, 2005, pp 1-74.
32.
Bigdeli TB, Bacanu SA, Webb BT, Walsh D, O'Neill FA, Fanous AH, Riley BP, Kendler KS: Molecular validation of the schizophrenia spectrum. Schizophr Bull 2014;40:60-65.
33.
Handest P: Subjective and Expressive Psychopathology in First-Admission Schizophrenia Spectrum Cases; doctoral thesis, University of Copenhagen, Faculty of Health and Medical Sciences, 2003.
34.
Vollmer-Larsen A: Diagnostic Stability and Outcome. The Follow-Up Investigation of the Copenhagen Prodromal Study; doctoral thesis, University of Copenhagen, Faculty of Health and Medical Sciences, 2009.
35.
Handest P, Parnas J: Clinical characteristics of first admitted patients with ICD-10 schizotypal disorder. Br J Psychiatry 2005;187:49-54.
36.
Nordgaard J, Sass LA, Parnas J: The psychiatric interview: validity, structure, and subjectivity. Eur Arch Psychiatry Clin Neurosci 2013;263:353-364.
37.
Nordgaard J, Parnas J: Self-disorders and the schizophrenia spectrum: a study of 100 first hospital admissions. Schizophr Bull 2014;40:1300-1307.
38.
McHugh PR: Rendering mental disorders intelligible: addressing psychiatry's urgent challenge; in Kendler KS, Parnas J (eds): Philosophical Issues in Psychiatry. Oxford, Oxford University Press, 2012, vol II: Nosology, pp 269-279.
39.
Conrad K: Die beginnende Schizophrenie. Versuch einer Gestaltanalyse des Wahns. Stuttgart, Thieme, 1958.
40.
Huber G, Gross G, Schüttler R: Schizophrenie: eine verlaufs- und sozialpsychiatrische Langzeitstudie. Berlin, Springer, 1979.
41.
Klosterkötter J: Basissymptome und Endphänomene der Schizophrenie. Berlin, Springer, 1988.
42.
Parnas J, Bovet P, Innocenti G: Schizophrenic trait features, binding and cortico-cortical connectivity: a neurodevelopmental pathogenetic hypothesis. Neurol Psychiatry Brain Res 1996;4:185-196.
43.
McGorry PD, Killackey E, Yung AR: Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry 2008;7:148-156.
44.
Yung AR, Phillips LJ, Yuen HP, Francey SM, McFarlane CA, Hallgren M, McGorry PD: Psychosis prediction: 12-month follow up of a high-risk (‘prodromal') group. Schizophr Res 2003;60:21-32.
45.
Kline E, Schiffman J: Psychosis risk screening: a systematic review. Schizophr Res 2014;158:11-18.
46.
Nordgaard J, Revsbech R, Sæbye D, Parnas J: Assessing the diagnostic validity of a structured psychiatric interview in a first-admission hospital sample. World Psychiatry 2012;11:181-185.
47.
Nordgaard J, Sass LA, Parnas J: The psychiatric interview: validity, structure, and subjectivity. Eur Arch Psychiatry Clin Neurosci 2013;263:353-364.
48.
Parnas J: A disappearing heritage: the clinical core of schizophrenia. Schizophr Bull 2011;37:1121-1130.
49.
Parnas J, Sass LA: Varieties of ‘phenomenology': on description, understanding, and explanation in psychiatry; in Kendler KS, Parnas J (eds): Philosophical Issues in Psychiatry. Explanation, Phenomenology, and Nosology. Baltimore, John Hopkins University Press, 2008, pp 239-278.
50.
Kraus A: The significance of intuition for the diagnosis of schizophrenia; in Maj M, Sartorius N (eds): Schizophrenia. Chichester, Wiley & Sons, 1999, pp 47-49.
51.
Sass LA, Parnas J: Schizophrenia, consciousness, and the self. Schizophr Bull 2003;29:427-444.
52.
Parnas J, Møller P, Kircher T, Thalbitzer J, Jansson L, Handest P, Zahavi D: EASE: Examination of Anomalous Self-Experience. Psychopathology 2005;38:236-258.
53.
Parnas J, Henriksen MG: Disordered self in the schizophrenia spectrum: a clinical and research perspective. Harv Rev Psychiatry 2014;22:251-265.
54.
Møller P, Haug E, Raballo A, Parnas J, Melle I: Examination of Anomalous Self-Experience in first-episode psychosis: interrater reliability. Psychopathology 2011;44:386-390.
55.
Nelson B, Parnas J, Sass LA: Disturbance of minimal self (ipseity) in schizophrenia: clarification and current status. Schizophr Bull 2014;40:479-482.
56.
Rosén Rasmussen A, Parnas J: Anomalies of imagination and disordered self in schizophrenia spectrum disorders. Psychopathology DOI: 10.1159/000431291.
57.
Nelson B, Whitford TJ, Lavoie S, Sass LA: What are the neurocognitive correlates of basic self-disturbance in schizophrenia? Integrating phenomenology and neurocognition. 2. Aberrant salience. Schizophr Res 2014;152:20-27.
58.
Nelson B, Whitford TJ, Lavoie S, Sass LA: What are the neurocognitive correlates of basic self-disturbance in schizophrenia? Integrating phenomenology and neurocognition. 1. Source monitoring deficits. Schizophr Res 2014;152:12-19.
59.
Jansson L, Handest P, Nielsen J, Sæbye D, Parnas J: Exploring boundaries of schizophrenia: comparing ICD-10 with other diagnostic systems in first-admitted patients. World Psychiatry 2002;1:109-114.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.