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Chapter 3

PSYC3460 chapter 3

Course Code
PSYC 3460
Stephen Kosempel

of 5
Chapter 3
Classification & Diagnosis
May 20, 2008
Diagnostic and Statistical Manual of Mental Disorders: DSM – IV
The 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
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 but the actual behaviour or
symptoms that were the basis for the diagnoses were not specified
DSM 11 provided some crucial information, but did not specify symptoms
1988 DSM IV – the reasons for diagnostic changes were in it; published in 1994
The Diagnostic System of the American Psychiatric Association (DSM-IV and DSM-IV-TR)
Definition of Mental Disorder
It recognizes that no definition adequately specifies precise boundaries for the concept
But is conceptualized as a significant behavioural or psychological syndrome or pattern that
occurs in an individual and that is associated with present distress, disability or increased risk of
suffering death, pain, disability or loss of freedom
It can’t be an expectable and culturally sanctioned response to an event (like death of a loved
It can’t be deviant behaviour nor conflicts that are primarily between the individual and society
Five dimensions of classification
Multiaxial classification
Axis 1: all diagnostic categories except personality disorders and mental retardation
Axis 2: Personality disorders and mental retardation
Axis 3: General medical condition
Axis 4: Psychosocial and environmental problems (occupational, economic, interpersonal and
family problems)
Axis 5: Current level of functioning (social relationships, occupational function and use of leisure
Diagnostic Categories
Intellectual, emotional and physical disorders usually begin in infancy, childhood or adolescence
Separation anxiety, conduct disorder (violate social norms repeatedly), ADHD, mental retardation,
pervasive developmental disorders (problems in acquiring communication skills and deficits in
relating to other people), and learning disorders (speech, reading, arithmetic, and writing skills)
Substance-related disorders: ingesting some substance that impairs social or occupational
functioning. They may not be able to stop ingestion and have withdrawal symptoms. It may
contribute to other Axis 1 disorders (mood or anxiety disorder)
Schizophrenia: language and communication are disordered, delusions, hallucinations, their
emotions are blunted, flattened or inappropriate, and their social relationships and ability to work
show marked deterioration
Mood disorders: moods that is extremely high or low.
oMajor depressive disorder: deeply sad and discouraged (lose weight and energy), and
have suicidal thoughts and feeling of self-reproach
oMania: exceedingly euphoric, irritable, more active than usual, distractible, and
possessed of unrealistically high self esteem
oBipolar disorder: both mania and depression
Anxiety disorders: some form of irrational or overblown fear of the central disturbance
oPhobia: fear an object or situation so intensely that they must avoid it, even when they
know it’s unreasonable. It disrupts their lives
oPanic disorder: sudden but brief attacks of intense apprehension. They will tremble and
shake, feel dizzy and have trouble breathing
Agoraphobia: when person is fearful of leaving familiar surroundings
oGeneralized anxiety disorder: fear and apprehension are pervasive, persistent and
uncontrollable. Feel on the edge and easily tired.
oObsessive-compulsive disorder: obsessions or compulsions. Recurrent thought, idea,
or image that dominates their consciousness
oPosttraumatic 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
oAcute stress disorder: like 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
oSomatisation disorder: long history of multiple physical complains for which they have
taken medicine or consulted doctors
oConversion disorder: loss of motor or sensory function, such as paralysis, an
anaesthesia or blindness
oPain disorder: suffer from severe and prolonged pain
oHypochondriasis: misinterpretation of minor physical sensations as serious illness
oDysmorphic disorder: preoccupied with an imagined defect in their appearance
Dissociative Disorder: psychological dissociation is sudden alteration in consciousness that
affects memory and identity
oDissociative amnesia: may forget their entire past or lose their memory for a particular
time period
oDissociative fugue: individual suddenly and unexpectedly travels to a new locale, starts
a new life, and cannot remember his or her previous identity
oDissociative identity disorder: possess two or more distinct personalities, each
complex and dominant one at a time
oDepersonalization disorder: a severe and disruptive feeling of self-estrangement or
Sexual and Gender Identity disorders
oParaphilias: sources of sexual gratification (exhibitionist, voyeurism, sadism)
oSexual dysfunctions; unable to complete usual response cycle, inability to maintain
erection ,premature ejaculation, and inhibition of orgasm
oGender identity disorder: extreme discomfort with the anatomical sex and identity
themselves as members of the opposite sex
Sleep disorders
oDyssomnias: sleep is disturbed in amount, quality or timing
oParasomnias: unusual events occur during sleep (nightmare, sleepwalking)
Eating disorders
oAnorexia nervosa: person avoids eating and emaciated, because they fear of becoming
oBulimia nervosa: binge eating and self induced vomiting and heavy use of laxatives
Factitious disorder: people who intentionally complain of physical or psychological symptoms,
apparently because of a psychological need to assume the role of a sick person
Adjustment disorder: development of emotional or behavioural symptoms following the
occurrence of a major life stressor (do not meet diagnostic criteria for any other Axis 1 diagnosis)
Impulse-Control Disorder: persons behaviour is inappropriate and seemingly out of control
oIntermittent explosive disorder: episodes of violent behaviour that result in destruction
of property or injury to another person
oKleptomania: person steals repeatedly, but not for monetary value or use of the object
oPyromania: purposefully sets fires and derives pleasure from it
oPathological gambling: person is preoccupied with gambling, unable to stop, a way to
escape from problems
oTrichotillomania: person cannot resist urge to pluck out his or her hair
Personality disorder: enduring, inflexible, and maladaptive patterns of behaviour and inner
experience (Axis 2)
oSchizoid personality disorder: person is a loner, few friends, and indifferent to praise
and criticism
oNarcissistic personality disorder: overblown sense of self-importance, fantasize about
great successes, requires constant attention and likely to exploit others
oAntisocial personality disorder: surfaces as conduct disorder before age 15 (running
away from home, delinquency, and general belligerence), indifferent about holding a job,
being responsible or a partner, planning for the future, and staying on the right side of the
law. They don’t feel guilt or shame for transgressing social mores.
Malingering: faking physical or psychological symptoms to achieve a goal such as avoiding work
Delirium, Dementia, Amnestic and other cognitive disorders: cognition is disturbed
oDelirium: clouding of consciousness, incoherent stream of thought, maybe caused by
malnutrition or substance abuse
oDementia: deterioration of mental capacities, especially memory (Alzheimer’s disease,
stroke, others)
oAmnesic syndrome: an impairment in memory when there is no delirium or dementia
Issues in the Classification of Abnormal Behaviour
General Criticism of Classification
Some say that labelling one into a category loses their own individual uniqueness
Sometimes we may be ignoring extremely important differences
But the fact is that in categorizing some information must be lost
Classification may have negative effects on the patient and how others treat them
The value of Classification and Diagnosis
Forming categories furthers knowledge, additional information may be ascertained
Only after categories are formed that we can study people who fit its definition and uncover
Specific criticism of classification
Are the classification valid and reliable?
Discrete diagnostic foster a false impression of discontinuity
There is question of where the exact cut off should be for diagnosing as a disorder
The DSM presents a discrete entity classification (that is it yes or no) there is no middle
between the normal or abnormal
Continuum supporters say that the difference in normal and abnormal is not in kind but in degree
or intensity, and that using the discrete method fosters a false impression and discontinuity
Dimensional classification: objects must be classified by ranking on quantitative dimension (1-
10 scale)
Possible new Syndromes
Caffeine withdrawal: significant distress or impairment in occupational or social functioning
(headache, fatigue, anxiety, depression, nausea, and impaired thinking)
Premenstrual Dysphoric Disorder: a week or so before menstruation is marked by depression,
anxiety, anger, mood swings, decreased interest in activities with pleasure