Class Notes (1,100,000)
CA (620,000)
UTSC (30,000)
Psychology (8,000)
PSYB32H3 (600)

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Course Code
Konstantine Zakzanis

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Chapter 3 Classification and Diagnosis
- a disorder must be classified correctly before its causes or best treatments can be found
- the DSM-IV is the official diagnostic system widely employed by mental health professionals
Diagnostic and Statistical Manual of Mental Disorders a publication of the American Psychiatric
Association that is an attempt to delineate specific and discrete syndromes or mental disorders; it has
been through several revisions and the current one is the 4th edition (DSM-IV)
A Brief History of Classification
Early Efforts at Classification
- during 19th and early 20th centuries, there was great inconsistency in the classification of abnormal
Development of the WHO and DSM Systems
- 1939, World Health Organization (WHO) added mental disorders to the International List of Causes of
- 1948, the list was expanded to become the International Statistical Classification of Diseases, Injuries,
and Causes of Death (ICD), a comprehensive listing of all diseases, including a classification of abnormal
- American Psychiatric Association published its own Diagnostic and Statistical Manual (DSM) in 1952
- 1969, WHO published a new classification system that was more widely accepted; DSM-II came in 1968
- the WHO classifications were simply a listing of diagnostic categories; the actual behavior or symptoms
that were the bases for the diagnoses weren’t specified
- DSM-II and the British Glossary of Mental Disorders provided some of this crucial information but did not
specify the same symptoms for a given disorder
- DSM-III-R appeared in 1987
- 1988, APA appointed a task force to begin working on DSM-IV; an important change in the process for
this edition was the adoption of a conservative approach to making changes in the diagnostic criteria
the reason for changes in the diagnoses would be explicitly stated and clearly supported by data
- DSM-IV was published in 1994 and the APA subsequently completed a “text revisionof DSM-IV (DSM-
The Diagnostic System of the American Psychiatric Association ( DSM-IV and DSM-IV-TR )
Definition of Mental Disorder
mental disorder a behavioral or psychological syndrome associated with current distress and/or
- DSM-IV-TR provides the following definition for mental disorder: a clinically significant behavioral or
psychological syndrome or pattern that occurs in an individual and that is associated with present distress
(eg: a painful symptom) or disability (eg: impairment in one or more important areas of functioning) or with
a significantly increased risk of suffering death, pain, disability, or an important loss of freedom
- a number of conditions are excluded from consideration
- also, this syndrome or pattern must not be merely an expectable culturally sanctioned response to a

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particular event, for example, the death of a loved one; whatever the cause, it must be currently
considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual
Five Dimensions of Classification
multiaxial classification classification having several dimensions, each of which is employed in
categorizing: DSM-IV is an example
- in multiaxial classification, each individual is rated on 5 separate dimensions, or axes
- the 5 axes are:
Axis I all diagnostic categories except personality disorders and mental retardation
Axis II personality disorders and mental retardation
Axis III general medical conditions
Axis IV psychosocial and environmental problems
Axis V current level of functioning
- axes I and II compose the classification of abnormal behavior
- axes I and II are separated to ensure that the presence of long-term disturbances is not overlooked
- most people consult a mental health professional for an axis I condition, such as depression or an
anxiety disorder, but prior to the onset of their axis I condition, they may have had an axis II condition,
such as dependent personality disorder
- the presence of an axis II disorder along with an axis I disorder generally means that the person’s
problems will be more difficult to treat
- although the remaining 3 axes are not needed to make the actual diagnosis, their inclusion in the DSM
indicates that factors other than a person’s symptoms should be considered in an assessment so that the
person’s overall life situation can be better understood
- axis IV may include occupational problems, economic problems, interpersonal difficulties with family
members, and a variety of problems in other life areas that may influence psychological functioning
- for axis V, the clinician indicates the person’s current level of adaptive functioning; life areas considered
are social relationships, occupational functioning, and use of leisure time
- ratings of current functioning are supposed to give information about the need for treatment
Diagnostic Categories
- for many of the diagnoses, the DSM indicates that the disorder may be due to a medical condition or
substance abuse
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
- child with separation anxiety disorder has excessive anxiety about being away from home or parents
- children with conduct disorder repeatedly violate social norms and rules
- individuals with attention-deficit/hyperactivity disorder have difficulty sustaining attention and are
unable to control their activity when the situation calls for it
- individuals with mental retardation show subnormal intellectual functioning and deficits in adaptive
- pervasive developmental disorders include autistic disorder, a severe condition in which the individual
has problems in acquiring communication skills and deficits in relating to other people

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- learning disorders refer to delays in the acquisition of speech, reading, arithmetic, and writing skills
Substance-Related Disorders
- a substance-related disorder is diagnosed when the ingestion of some substance alcohol, opiates,
cocaine, amphetamines has changed behavior enough to impair social or occupational functioning
- the individual may become unable to control or discontinue ingestion of the substance and may develop
withdrawal symptoms if he/she stops using it
- these substances may also cause or contribute to the development of other axis I disorders, such as
mood or anxiety disorders
- for people that have this, contact with reality is faulty
- their language and communication are disordered, and they may shift from one subject to another in
ways that make them difficult to understand
- they commonly experience delusions, such as believing that thoughts that are not their own have been
placed in their heads
- also, they are sometimes plagued by hallucinations, commonly hearing voices that come from outside
- their emotions are blunted, flattened, or inappropriate, and their social relationships are ability to work
show deterioration
Mood Disorders
- these diagnoses are applied to people whose moods are extremely high or low
- in major depressive disorder, the person is deeply sad and discouraged and is also likely to lose
weight and energy and to have suicidal thoughts and feelings of self-reproach
- the person with mania may be described as exceedingly euphoric, irritable, more active than usual,
distractible, and possessed of unrealistically high self-esteem
- bipolar disorder is diagnosed if the person experiences episodes of mania or of both mania and
Anxiety Disorders
- anxiety disorders have some form of irrational or overblown fear as the central disturbance
- individuals with a phobia fear an object or situation so intensely that they must avoid it, even though
they know that their fear is unwarranted and unreasonable and disrupts their lives
- in panic disorder, the person is subject to sudden but brief attacks of intense apprehension, so
upsetting that he/she is likely to tremble and shake, feel dizzy, and have trouble breathing
- panic disorder may be accompanied by agoraphobia when the person is also fearful of leaving
familiar surroundings
- people with generalized anxiety disorder, fear and apprehension are pervasive, persistent, and
uncontrollable; they worry constantly, feel generally on the edge, and are easily tired
- a person with obsessive-compulsive disorder is subject to persistent obsessions or compulsions
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