Page 105 - Anales RADE vol I n 1
P. 105
1. INTRODUCTION
There is still a debate on the nature of the symptoms of mental disorders, a
confusion about their classification and diagnosis and a preoccupation with the
growing inflation of diagnostic categories. And this is probably due because
psychiatry does not have a clear definition of mental disorder that covers all
situations, and it is difficult to establish a precise distinction between normality
and psychopathology (López-Ibor et al, 2013 ).
Current models for classifying clinical depression are dimensional and
therefore out-dated and descriptions of depressive disorders do not always
distinguish depressive disorders from non-pathological mood states. If depressive
symptomatology appears as a response to a life event such as bereavement, a
diagnosis of depression may not be clear since these reactions represent normal
and presumably adaptive reactions to such life circumstances.
The challenge to face is the delimitation of normal emotional reactions to
everyday events and a set of psychiatric illnesses characterised by the presence of
sadness accompanied by other phenomena, which, incidentally, may also be
unchained by negative experiences.
DSM 5 (American Psychiatric Association, 2013), and eventually the
International Classification of Disorders will follow the same path, putting forward
old and important problems of psychiatric classification. DSM 5 proposes that the
word "criteria" is substituted by the word "symptoms" to avoid confusion between
number of symptoms and number of criteria necessary for diagnosis. This seems
reasonable because it underlines the fact that DSM, and by correspondence ICD-10
(International Classification of Mental Disorders, 1992), are not treaties of
psychiatry but just instruments to classify diseases and to elaborate statistical
documents. Nevertheless, a clear definition of what symptoms are is lacking in
both systems.
As Maj (Maj, 2011) pointed out recently it is not always easy to establish
when a depression becomes a mental disorder and he proposed three approaches,
the first one is the need to take into account the context in which depression
occurs, the second is that there is a qualitative difference between sadness and
depression, in depression anhedonia is one of the main diagnostic criteria but it
does not appear in sadness and the third one is a pragmatic approach that
considers a continuum for sadness to clinical depression .
More recently Wakefield et al (Wakefield et al., 2013) have proposed to take
into consideration the recurrence rates of major depression in order to evaluate
the validity of diagnosis; uncomplicated symptoms, transient duration, and lack of
elevated recurrence suggested that generally it may represent just a non-
pathological sadness so to say, not a depressive disorder.
105| Sadness versus depression: everyday feelings versus mood disorders: the adaptative
value of sadness
There is still a debate on the nature of the symptoms of mental disorders, a
confusion about their classification and diagnosis and a preoccupation with the
growing inflation of diagnostic categories. And this is probably due because
psychiatry does not have a clear definition of mental disorder that covers all
situations, and it is difficult to establish a precise distinction between normality
and psychopathology (López-Ibor et al, 2013 ).
Current models for classifying clinical depression are dimensional and
therefore out-dated and descriptions of depressive disorders do not always
distinguish depressive disorders from non-pathological mood states. If depressive
symptomatology appears as a response to a life event such as bereavement, a
diagnosis of depression may not be clear since these reactions represent normal
and presumably adaptive reactions to such life circumstances.
The challenge to face is the delimitation of normal emotional reactions to
everyday events and a set of psychiatric illnesses characterised by the presence of
sadness accompanied by other phenomena, which, incidentally, may also be
unchained by negative experiences.
DSM 5 (American Psychiatric Association, 2013), and eventually the
International Classification of Disorders will follow the same path, putting forward
old and important problems of psychiatric classification. DSM 5 proposes that the
word "criteria" is substituted by the word "symptoms" to avoid confusion between
number of symptoms and number of criteria necessary for diagnosis. This seems
reasonable because it underlines the fact that DSM, and by correspondence ICD-10
(International Classification of Mental Disorders, 1992), are not treaties of
psychiatry but just instruments to classify diseases and to elaborate statistical
documents. Nevertheless, a clear definition of what symptoms are is lacking in
both systems.
As Maj (Maj, 2011) pointed out recently it is not always easy to establish
when a depression becomes a mental disorder and he proposed three approaches,
the first one is the need to take into account the context in which depression
occurs, the second is that there is a qualitative difference between sadness and
depression, in depression anhedonia is one of the main diagnostic criteria but it
does not appear in sadness and the third one is a pragmatic approach that
considers a continuum for sadness to clinical depression .
More recently Wakefield et al (Wakefield et al., 2013) have proposed to take
into consideration the recurrence rates of major depression in order to evaluate
the validity of diagnosis; uncomplicated symptoms, transient duration, and lack of
elevated recurrence suggested that generally it may represent just a non-
pathological sadness so to say, not a depressive disorder.
105| Sadness versus depression: everyday feelings versus mood disorders: the adaptative
value of sadness
