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(Notice the three key facets and the relative prominence and ordering, reflective of American but not all of western neuropsychiatry): (1) neuroadaptation, (2) disturbances of behavior (compulsion-like ‘inability to abstain consistently, dysfunction of behavioral control), and (3) disturbances of the mental life (obsession-like ‘craving’ and ‘dysfunctional emotional response’). Also disengaged from non-American western traditions of theoretical psychopathology (as a science), the interdependent facets of socially maladaptative behavior have been moved into the foreground. An alternative is multi-axial thinking within theories of (1) how things break down and go against life form viability and successful survival of the species and of the individual (survivorship of the individual, to the extent it can be usefully separated from reactions of other players in the individual’s social fields, as well as the social context) and the (2) the separable but interdependent responses of natural raters in social fields (e.g., interpersonal strife when the individual does not live up to expectations of the natural raters in these social fields). The theory that these facets are exchangeable manifestations of one another, with an underlying single latent dimensional structure, has influenced the measurement model such that diagnosis now requires little more than counting up what is thought to be exchangeable. Alternative theoretcal models specify value in maintaining a distinction between the ‘disease’ or ‘disorder’ as can be observed with social field/context held constant (which requires a separable measurement), versus manifestations that are interdependent but conceptually kept separate despite the interdependence and shared origins.
To think about a clear example in medicine where we have another strong independendence but a compelling rationale to maintain separation, consider systolic versus diastolic blood pressure, where the inter-correlaion often shows up with correlation coefficients well above 0.65, and shared variance components due to common origins. Irrespective of the biometrical correlation and covariance structure, the conceptual theory of modern medicine leads us to specify a measurement model for hypertenion diagnosis that separates the systolic dimension of arterial stiffness (change in SBP with DBP dimension held constant) from the diastolic dimension of arterial compliace (change in DBP with SBP dimension held constant).
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