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Chapter 3

Course Code
Konstantine Zakzanis

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Chapter 3 - Classification & Diagnosis
The official diagnostic system widely used by mental health professionals is the Diagnostic and Statistical
Manual of Mental Disorders (the DSM), which is currently on its 4th edition (the DSM-IV)
A Brief History of Classification
People realized different illnesses required different treatments
There was a lot of diversity of classification in the end of the 19th century, but no universal classification
Development of the WHO and DSM Systems
In 1969, the WHO published a new classification system that was more widely accepted
The WHO classifications were just lists of diagnostic categories; the actual behaviour or symptoms that were
the bases for the diagnoses were not specified
DSM II and the British Glossary of Mental Disorders provided some crucial information, but did not specify
the same symptoms for a given disorder
In 1988, work began to create the DSM IV, and in 1994 it was published
The Diagnostic System of the American Psychiatric Association (DSM-IV and DSM-IV-TR)
Definition of Mental Disorder
The DSM recognizes that WKHWHUP³mental disorder´ is problematic and that no definition adequately
specifies precise boundaries for the concept
A mental disorder, according to the DSM, is conceptualized as a significant behavioural or psychological
syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with
an increased risk of suffering death, pain, disability or loss of freedom
,WFDQ¶WEHDQH[SHFWDEOHand culturally sanctioned response to an event (ie. The death of a loved one)
,WFDQ¶WEHGHYLDQWEHKDYLRXU, nor conflicts that are primarily between the individual and society
Five dimensions of classification
Several major innovations distinguish the 3rd version from subsequent versions, perhaps the most sweeping
change being the use of multiaxial classification, whereby each individual is rated on 5 separate dimensions,
or axes
¾ Axis 1: All diagnostic categories except personality disorders and mental retardation
¾ Axis 2: Personality disorders and mental retardation
Axis I and II compose the classification of abnormal behaviour
¾ Axis 3: General medical condition(s)
This is important when considering medications for the patient
¾ Axis 4: Psychosocial and environmental problems (occupational, economic, interpersonal and family
¾ Axis 5: Current level of functioning (social relationships, occupational function and use of leisure time)
Diagnostic Categories
Disorders usually first diagnosed in infancy, childhood or adolescence: Intellectual, emotional and
physical disorders usually begin in infancy, childhood or adolescence.
¾ Separation anxiety, conduct disorder (violate social norms repeatedly), ADHD, mental retardation,
pervasive developmental disorders (include autistic disorders, a condition in which the individual has

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problems in acquiring communication skills and deficits in relating to other people), and learning disorders
(speech, reading, arithmetic, and writing skills)
Substance-related disorders: is diagnosed when ingesting some substance has changed behaviour enough to
impair social or occupational functioning. The individual may not be able to control/discontinue ingestion and
may develop withdrawal symptoms. The substances may contribute to other Axis 1 disorders (mood or anxiety
Schizophrenia: 7KHLQGLYLGXDO¶VFRQWDFWZLWKUHDOLW\LVIDXOW\/anguage and communication are disordered;
they commonly experience hallucinations; their emotions are blunted, flattened or inappropriate, and their
social relationships and ability to work show marked deterioration
Mood disorders: moods that are extremely high or low.
¾ Major depressive disorder: the person is deeply sad and discouraged (lose weight and energy), and have
suicidal thoughts and feeling of self-reproach
¾ Mania: The person is exceedingly euphoric, irritable, more active than usual, distractible, and possessed of
unrealistically high self esteem
¾ Bipolar disorder: The person experiences episodes of mania or both mania and depression
Anxiety disorders: Have some form of irrational or overblown fear of the central disturbance
unreasonable. It disrupts their lives.
¾ Panic disorder: Sudden but brief attacks of intense apprehension, so upsetting that they will tremble and
shake, feel dizzy and have trouble breathing. A panic attack may also be accompanied by agoraphobia.
Agoraphobia: when person is fearful of leaving familiar surroundings
¾ Generalized anxiety disorder: Fear and apprehension are pervasive, persistent and uncontrollable. People
feel on the edge and easily tired.
¾ Obsessive-compulsive disorder: Obsessions or compulsions. An obsession is a recurrent thought, idea, or
image that dominates their consciousness. A compulsion is an urge to perform a stereotyped act.
¾ Posttraumatic stress disorder: Anxiety and emotional numbness after a very traumatic event. They have
painful intrusive recollections by day and bad dreams at night, and feel detached from others.
¾ Acute stress disorder: Similar to posttraumatic stress disorders, but the symptoms do not last as long
Somatoform disorders: The physical symptoms have no physiological cause, but seem to serve a
psychological purpose
¾ Somatization disorder: Have a long history of multiple physical complains for which they have taken
medicine or consulted doctors
¾ Conversion disorder: A loss of motor or sensory function, such as paralysis, anaesthesia or blindness
¾ Pain disorder: Suffer from severe and prolonged pain
¾ Hypochondriasis: Misinterpretation of minor physical sensations as serious illness
¾ Dysmorphic disorder: People are preoccupied with an imagined defect in their appearance
Dissociative Disorder: psychological dissociation is sudden alteration in consciousness that affects memory
and identity
¾ Dissociative amnesia: May forget their entire past or lose their memory for a particular time period
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