Given the heterogeneity of symptoms allowed in the diagnosis of psychotic disorders, as well as other challenges of categorical diagnosis (e.g., First et al., 2002; Krueger, 1999), the increased specificity brought by dimensional ratings of underlying features is often important. Models using the factorial structure of psychotic symptoms perform as good as or better than traditional categorical models (Allardyce, Suppes, & Van Os, 2007). DSM-5 has provided such a system of ratings to aid clinicians, the Clinician Rated Dimensions of Psychosis Symptom Severity Scale (PSS; APA, 2013). In this approach, the clinician rates symptom severity in eight domains which emphasize traditional psychotic symptomatology, cognition, and mood. Given its accessibility and the support of the DSM-5, it is possible that the measure could achieve wide use. However, little is known about the measure and the challenges of applying it in clinical settings. This study is a conceptual analysis of the conceptual foundation of the PSS, including its psychometric properties, applications, and demonstrated validity. It is also compared to the widely used Brief Psychiatric Rating Scale – Revised (BPRS-R). The PSS is more concise that other measures, and five of the PSS domains parallel the DSM-5's "Key Features That Define the Psychotic Disorders" (p. 87-88) (although the brief instructions of the PSS differ at times from DSM-5 definitions, and little in the way of definition is offered in the PSS itself). In contrast, no rationale is given for adding the remaining three domains. The dimensional model of the PSS has similarities to the factor structure typically found for symptomatology in psychotic disorder, but a number of important differences are noted. The data required for making ratings is never defined, although the only mention of data that might be helpful for rating one of the domains depends upon extensive testing. Although anchors for the ratings might, at first glance, appear to be given in the PSS, in fact, they offer almost nothing beyond the adjectives of "equivocal," "mild," "moderate," and "severe." Finally, we found that very little research exists on the PSS, no field trial was done, psychometric properties are largely unknown, and normative data is unavailable. The PSS is brief and provides a quick way to rate the severity of the five key features of psychosis required by DSM-5 diagnoses. Thus, it can work as a quick quantification of these features. Beyond this its utility is unknown, and it appears to lack the specificity of other rating scales, such as the BPRS-R.



College and Department

Family, Home, and Social Sciences; Psychology



Date Submitted


Document Type





PSS, psychosis, inpatient, SMI, dimensionality, conceptual analysis

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Psychology Commons