Progressive validation of psychiatric syndromes: The example of panic disorder

Prior validation approaches for psychiatric disorders, as used in DSM-IV and DSM-5, have been synchronic—snapshots of results typically taken out of temporal context. This chapter explores the advantages of a diachronic approach to validation. The discovery of juvenile-onset and adult-onset diabetes is explored as an example of a successful division of a broad biomedical syndrome into subtypes. This division has yielded fruitful insights into etiology and treatment. A psychiatric example, reviewed in detail, is the division of anxiety neurosis into panic disorder and generalized anxiety disorder. A range of etiologic and treatment studies have supported the distinction between these two forms of anxiety. These findings are interpreted in the context of Lakatos’s conceptual framework of a progressive versus degenerative scientific paradigm. The conclusion is that considering a diachronic or historical view of validity of psychiatric disorders adds a valuable perspective to the discipline and its nosology.