Elemental psychopathology: distilling constituent symptoms and patterns of repetition in the diagnostic criteria of the DSM-5

The Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) features hundreds of diagnoses comprising a multitude of symptoms, and there is considerable repetition in the symptoms among diagnoses. This repetition undermines what we can learn from studying individual diagnostic constructs because it can obscure both disorder- and symptom-specific signals. However, these lost opportunities are currently veiled because symptom repetition in the DSM-5 has not been quantified. This descriptive study mapped the repetition among the 1,419 symptoms described in 202 diagnoses of adult psychopathology in Section II of the DSM-5. Over a million possible symptom comparisons needed to be conducted, for which we used both qualitative content coding and natural language processing. In total, we identified 628 distinct symptoms: 397 symptoms (63.2%) were unique to a single diagnosis, whereas 231 symptoms (36.8%) repeated across multiple diagnoses a total of 1022 times (median 3 times per symptom; range 2-22). Some chapters had more repetition than others: For example, every symptom of every diagnosis in the Bipolar and Related Disorders chapter was repeated in other chapters, but there was no repetition for any symptoms of any diagnoses in the Elimination Disorders, Gender Dysphoria, or Paraphilic Disorders. The most frequently repeated symptoms included insomnia, difficulty concentrating, and irritability—listed in 22, 17, and 16 diagnoses, respectively. Notably, the top 15 most frequently repeating diagnostic criteria were dominated by symptoms of major depressive disorder. Overall, our findings lay the foundation for a better understanding of the extent and potential consequences of symptom overlap.