CHAPTER #3 – Classification and Diagnosis
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
American Psychiatric Association
There is nothing statistical about this, actually.
It is the text that psych professionals use to formulate diagnosis about disorders
Why is this book important? It has labels that cause stigma and discrimination.
Provides descriptions about disorders
Provides reliability: inter-relator reliability (allows health care professionals to
Treatment - However, it is good for diagnosis that can lead to treatment plans.
This provides a background for being able to render a diagnosis
Allows differentiation between disorders - a differential diagnosis is where they
measure all possibilities and decide which one it is more likely to be.
DSM-IV Definition of Mental Disorder
A clinically significant behavioral or psychological syndrome or pattern that occurs in an
Psychological syndrome: a construct that we cannot see (e.g. anxiety)
Behavioral disorder: a syndrome that is observable (e.g. head banging)
No one specific symptom equals a disorder. A collection of syndromes might add up to
includes present distress or disability, or
a significantly increased risk of suffering death, pain, disability, or an important
loss of freedom
o an expectable and culturally sanctioned response to a particular event-
o deviant behavior (e.g., political, religious, or sexual)
o conflicts that are primarily between the individual and society (unless the
deviance or conflict is a symptom of a dysfunction in the individual)-
Diagnostic System of the American Psychiatric Association (DSM-IV)
Five dimensions of classification Axis I – All diagnostic categories (Front inside cover of your Textbook)
Axis II – Personality disorders and retardation (Front inside cover of your
Axis III – General medical conditions
o Important because of prescribing medication. You don’t want to make
someone’s medical condition worse.
Axis IV – Psychosocial and environmental problems (Back inside cover of your
o Academic, home, family etc. issues
Axis V – Current level of functioning- (Back inside cover of your Textbook)
o Global Assessment of Functioning (GAF): numerical score of functioning
to measure the levels of symptoms. The disorder is more severe the lower
the numbers go.
Can have limitations:
Example: for depression you need 5 symptoms for 2 weeks, according to DSM.
What happens if you have 4 symptoms that are: I want to kill myself, I know how I
want to kill myself, I will kill myself, I have a plan to kill myself.
o This sounds like pretty straight-forward depression. However it is not the
definition in the DSM.
The fifth DSM is more about dimensional categorization – it’s less about how
many symptoms and more about what symptoms.
Comorbidity: having one or more disorders. Makes diagnosis/treatment more difficult.
Axis I Disorders
Disorders usually first diagnosed in infancy, childhood, or adolescence
Separation anxiety disorder
A disorder in which the child violates social norms and has problems with the
o A conduct disorder diagnosis is necessary for an Anti-Social Personality
disorder or Psychopathy disorder diagnosis.
Attention-deficit/hyperactivity disorder Mental retardation
Pervasive developmental disorders
This only becomes a formal diagnosis when the substance abuse or dependence
results in behavior that is severe enough to interfere with normal behavior.
People with schizophrenia are those that have lost touch of reality especially with their
positive symptoms (something in the personality that has been added and shouldn’t be
there – delusions, hallucinations).
Negative disorders are those that are the absence of a personality trait – catatonia, lack
of motivation, lack of pleasure in life etc.
Schizophrenics kind of swing between psychotic episodes (positive symptoms) and
periods of remission (negative symptoms)
Major depressive disorder
Suicidality, suicidal ideas/ attempts, lack of motivation/appetite, bizarre sleep
patterns, hopelessness, sadness/depression
People with depression may not say they are depressed but will agree that they
feel hopeless, worthless etc. They may be in denial or avoiding social stigma
Have a euphoric sense of ability, unrealistic expectations – they’re still within the
realms of reality but they still take it bit further than other people. Unlikely but no
Shift between states of depression to states of mania
Very prevalent, common type of disorder
Phobia A fear that causes avoidance of whatever causes the fear
Fear is grounded in rational belief – they may know that their fear is irrational but
they are still afraid
Heart-racing, tremors, perspiration
Come on when people feel they cannot control the situation
Agoraphobia: fear of leaving the home because they are afraid of having a panic
Generalized anxiety disorder
Overwhelming belief that something bad is going to happen
An obsession is a recurrent thought/idea/image that continuously dominates a
person’s consciousness. This causes anxiety.
This leads to the compulsion: the urge to perform a stereotyped act with the
purpose of stopping the anxiety from the obsession.
Post-traumatic stress disorder
Behaviour that is caused by a traumatic experience: depression; flashbacks; fear
of the event happening again; anxiety; nightmares of the event
o Motor vehicle accidents; combat
Acute stress disorder
The traumatic event just occurred and doesn’t last for a very long time (chronic)
The physical symptoms that the patient presents with have no known physiological
cause. Symptom may serve some sort of psychological issue.
Person has a lot of the unknown physiological complaints. Will visit professiona