The development of the feighner criteria: a historical perspective
Kendler, Muñoz & Murphy (2010)

Abstract

The team that developed the Feighner criteria made three key contributions to psychiatry

• The systematic use of operationalized diagnostic criteria
• The reintroduction of an emphasis on illness course and outcome
• An emphasis on the need, whenever possible, to base diagnostic criteria on empirical evidence

The historical context

At the time of psychoanalysis, psychoanalysis had a negative view of psychiatric diagnosis, arguing that diagnosis in the conventional sense could be injurious to patients.
Early empirical investigations of psychiatric diagnosis showed that the probability of agreement of two psychiatrists in diagnosis mental disorders in patients hardly exceeded chance.

The development of the criteria

John Feighner came with a proposal that a paper should be published citing and reviewing those papers that clearly outlined the scientific and diagnostic bases for research in psychiatry.
He was responsible for doing ‘comprehensive literature review.. and a working outline of diagnostic criteria’ for each disorder.

Depression

The criteria for depression outlined in the Cassidy et al. article were:

• The patient has made at least one statement of mood change
• The patient had any six of the ten following special symptoms
  • Slow thinking
  • Poor appetite
  • Constipation
  • Insomnia
  • Feels tired
  • Loss of concentration
  • Suicidal ideas
  • Weight loss
  • Decreased sex interest
  • Wringing hands
  • Pacing
  • Over-talkativeness
  • Press of complatins

The threshold of six out of ten criteria was made because ‘it sounded about right’.

The proposed Feighner criteria were very similar to those by Cassidy et al.
Four significant changes were made

• Constipation was dropped
• Feelings of self-reproach or guilt were added
• Insomnia was expanded to sleep difficulties
• Anorexia and weight loss were combined into one item

Antisocial personality disorder

The starting point for the development of the Feighner criteria for antisocial personality disorder was the 19 criteria developed for sociopathic personality by Lee Robins.
Eight of the nine Feighner criteria for antisocial personality disorder had close parallels with these criteria.
Discussions in the group about the criteria were particularly concerned about avoiding confounds with poverty and drug abuse.

Alcoholism

The criteria for alcoholism were especially influenced by Guze.

Criteria were organized in five groups, symptoms from at least three of which were required for a diagnosis.

Other diagnoses

The Feighner criteria for schizophrenia required ‘at least 6 months of symptoms… without return to the premorbid level of psychosocial adjustment.’
Only delusions, hallucinations, or thought disorder was required.

The influence of the Feighner criteria

The research diagnostic criteria and toward DSM-III

Drs Spitzer and Endicott learned three major lessons from their interactons with Robins and the Feighner criteria that deeply shaped their subsequent efforts with the RDC and DSM-III.

• The use of operationalized criteria
• Before, the focus of the diagnostic work had been on presenting symptoms and signs
  After, there was also focus on the prognosis
• The number of diagnosis expanded
  It was a research program that developed diagnosis based on empirical data