Post Traumatic Stress Disorder
Diagnostic Integration
Diagnostic Taxonomy-Matrix Diagnosis
The conceptual difficulties of describing the functional and somatoform syndromes listed in the previous paragraph have also caused problems in arranging them in the disease taxonomies that are commonly in use. The DSM tries to integrate the somatic, psychological, and social dimensions at the price of creating comorbidity . I see only one way to reach integration, that is by constructing a matrix of dimensions that follows the natural development of the human species (phylogeny) and individuals (ontogeny).
All the observable aspects of an individual’s functioning should then be broken down into dimensions based on these developmental lines. It is a matrix constructed for the full integrity of the individual patient. Semantically, it corresponds to the meaning of a matrix in mathematics. The genetically determined, unchangeable biological properties are at the basis of this system. Imprinting and learning are processes directly based on the genetic make-up of an individual. Imprinting is the creation of read-only-memories (ROMs), a biological parallel of computer ‘‘firmware’’. Learning is the adaptation and neural plasticity of functional circuits in response to repeated activation. Associative memory is another aspect of learning. Associations are acquired and, then, automated programmes. Acquisition of this dimension starts during ontogeny as the first layer over Diagnostic Matrix of Dimensions
- Genetic floorplan
- Structural floorplan (embryology/anatomy)
- Homeostatic physiology
- Psychophysiology (inborn responses to adaptational challenges)
- Acquired automated mechanisms (neuromotor/neurohumoral output, sensory input)
- Organising effects
- Imprinting (Read Only Memory)
- Long-term potentiation/dendritic plasticity
- Association
- Declarative faculty
- Reflexive consciousness
- Emotional development
- Complex language dependent systems
- Cognition: science, logic, mathematics, philosophy
- Groups/systems: politics
the inborn properties. Intrusive memory of sensory input and imprinted or amplified physiological memory belong to this dimension, as well as impulsiveness or temperament. From a heuristic point of view, it seems logical to separate linguistic development from the second dimension, considering the phylogeny of homo sapiens sapiens.
Reflexive consciousness and the development of emotional expression are representations of the declarative faculty including relational behaviour, literature, etc. Alexithymia is a description of incomplete or inhibited emotional development at the declarative level. It is characteristic of somatoform disorders and functional or psychophysiological syndromes. Psycho-physiological syndromes as listed in the paragraph on somatic stress syndromes can thus be seen as phylogenic and ontogenic precursors of more differentiated psychiatric syndromes.
Complex language-dependent systems can be seen as the present ultimate development of phylogeny and ontogeny. They constitute what we use to call human‘‘civilisation’’ including all aspects of science, philosophy and political systems, structures that are based on semantically explicit cognition. Although scientific theory development requires economy in calling in assumptions or abstractions, it seems appropriate and efficacious to categorise this level of development in a separate dimension, making a link with sociology.
This diagnostic matrix is a dimensional analysis slightly different from Van Praag’s proposal for functionalisation, verticalisation or ‘‘two-tier’’ diagnosing and more extensive but permits inclusion of his idea. It allows us to break down pathology at the level of the genome or allostatic physiology and phenotypical expressions or changes by organising effects of hormones and stressors, long-term potentiation, imprinting, plasticity, apoptosis, learning in all its aspects, deviant behaviour and irresponsible use of scientific progress or political power, genocide, etc.