Psychological Medicine

Thematic section: A proposal for a meta-structure for DSM-V and ICD-11

Emotional disorders: Cluster 4 of the proposed meta-structure for DSM-V and ICD-11

Paper 5 of 7 of the thematic section: ‘A proposal for a meta-structure for DSM-V and ICD-11’

D. P. Goldberga1 c1, R. F. Kruegera2, G. Andrewsa3 and M. J. Hobbsa3

a1 Institute of Psychiatry, King's College, London, UK

a2 Departments of Psychology and Psychiatry, Washington University in St Louis, USA

a3 School of Psychiatry, University of New South Wales, Sydney, Australia


Background The extant major psychiatric classifications DSM-IV, and ICD-10, are atheoretical and largely descriptive. Although this achieves good reliability, the validity of a medical diagnosis would be greatly enhanced by an understanding of risk factors and clinical manifestations. In an effort to group mental disorders on the basis of aetiology, five clusters have been proposed. This paper considers the validity of the fourth cluster, emotional disorders, within that proposal.

Method We reviewed the literature in relation to 11 validating criteria proposed by a Study Group of the DSM-V Task Force, as applied to the cluster of emotional disorders.

Results An emotional cluster of disorders identified using the 11 validators is feasible. Negative affectivity is the defining feature of the emotional cluster. Although there are differences between disorders in the remaining validating criteria, there are similarities that support the feasibility of an emotional cluster. Strong intra-cluster co-morbidity may reflect the action of common risk factors and also shared higher-order symptom dimensions in these emotional disorders.

Conclusion Emotional disorders meet many of the salient criteria proposed by the Study Group of the DSM-V Task Force to suggest a classification cluster.

(Received May 22 2008)

(Revised July 07 2008)

(Accepted May 12 2009)

(Online publication October 01 2009)


c1 Address for correspondence: Professor Sir David Goldberg, Institute of Psychiatry, de Crespigny Park, London SE5 8AF, UK. (Email: