ABSTRACT
Across this chapter the basic arguments are made for why the convention of an IMD is necessary in order to identify and understand FDBP and PA. The limitations of the current diagnostic system will be discussed, and the nature of pathology will be further defined. For example, at this point in time in the current Diagnostic and Statistical Manual for Mental Disorders , “relational problems” are not considered to be diagnoses in their own right. Also, there has been confusion about the use of the term syndrome when associated with diagnoses, which has further mired diagnostic clarity. There has been a shift in how diagnoses are viewed of late as well, shifting from categorical, to dimensional, to hybrids, to even multidimensional considerations.
Diagnoses have faced increased scrutiny as well with the advent of what is generally referred to as the Daubert Standard, which is used as a basis for scientific proof within the legal system. It is a standard in which there are scientific requirements for proof such as if a theory has been or may be tested, has the theory been exposed to the peer review and publication process, is there a known error rate, and has the theory been accepted by the community of scientists from which it originates. Given the intersection of FDBP and PA in healthcare and legal systems, discussing the prior considerations about the Daubert Standard and these phenomena is a necessary step toward elaborating the robustness of an IMD as a diagnostic concept. These considerations are followed by a review of the concept of proofs at each dimensional level in describing the cumulative nature of an IMD and its utility in clarifying each phenomenon. Characteristics, symptoms, individuals, systems, subdynamics, interrelated dimensions, and variable criteria are all factors articulated as part of the holistic systems vantage point that an IMD is proposed to bring practitioners, professionals, and researchers.
These pathological dynamics have proven both confusing and powerful, and in order for the kinds of dimensional interrelated proof processes described above to be clarified cautionary remarks are provided about splitting and triangulation to warn those interacting with these systems of the potential hazards as a practitioner and professional. An emphasis is offered again on systems thinking when considering these dynamics and IMDs as the discussion moves to the proposal of a new diagnostic approach that involves a suspicion stage and a further study stage. Suspicions of an IMD are raised by certain characteristics and symptoms that are more evident than others, and it is suggested that the aggregated threshold of known symptoms be better than chance. This marker signifies a stage of informed concern about the pathological dynamic that calls for precautionary actions that protect the child or children in these cases. If there has been sufficient evidence, it is also proposed that the suspicion stage be followed by a period of further study to address less apparent characteristics and symptoms that require assessment and investigation. It is proposed that ultimately these findings collectively be considered against a more probable than not threshold and methods for making such determinations are offered.
