B32: Abnormal Behaviour
Chapter 3: Classification and Diagnosis
Diagnostic system widely employed by mental health professions: Diagnostic and Statistical Manual of Mental
Disorder (DSM IV).
BRIEF HISTORY OF CLASSIFICATION
Early Efforts of Classification
By the end of the 19th c, medicine had progressed far beyond its practice during the Middle Ages; people started
to recognize that different illnesses required different treatments.
During 19th c. and early 20th c. there was great inconsistency in classification of abnormal behaviour.
•By end of 1900 the diversity of classification recognized as serious problem that impeded communication
among people in the field and several attempts were made to produce a system of classification that would
be widely adopted.
Development of the WHO and DSM Systems
More recent efforts at achieving uniformity of classification have not been totally successful either.
•1939: World Health Organization(WHO) added mental disorders to the International List of Causes of
1948: list expanded to become International Statistical Classification of Diseases, Injuries
and Causes of Death (ICD): list of all diseases including classification of abnormal
WHO adopted it, but the mental disorder section was not widely accepted.
1952: the American Psychiatric Association published its own Diagnostic and Statistical
Manual (DSM) not long after.
•1969: WHO published a new classification system that was more widely accepted; a 2nd version of the
APA’s DSM was similar to the WHO system
the WHO classification simply a listing of diagnostic categories; actual behaviour or
symptoms that were the bases of diagnoses were not specified
•DSM-II and the British Glossary of Mental Disorders provided some of the crucial info but did not specify
the same symptoms for a given disorder; the diagnostic practices still varied widely
•An important change in the DSM-IV-R was the adoption of a conservative approach to making changes in
the diagnostic criteria – reasons for changes in diagnoses would be explicitly stated and clearly supported
•DSM-IV used throughout USA and Canada and accepted around much of the world
THE DIAGNOSTIC SYSTEM OF THE AMERICAN PSYCHIATRIC ASSOCIATION
(DSM-IV & DSM-IV-TR)
Definition of Mental Disorder
A clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that
is associated with present distress (painful symptom) or disability (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. – DSM-IV-TR
•Syndrome or pattern must not be an expectable and culturally sanctioned response to a particular event
(death of a loved one); it must be a manifestation of a behavioural, psychological or biological dysfunction
in the individual
Five Dimensions of Classification
Multiaxial Classification (MAC): each individual is rated on five separate dimensions or axes
1.Axis I: All diagnostic categories except personality disorder and mental retardation
2.Axis II: Personality disorders and mental retardation
3.Axis III: general medical conditions
i.e. the existence of a heart condition who is diagnosed with depression
4.Axis IV: psychosocial and environmental problems
Occupational problems, economic problems, interpersonal difficulties with family members and a variety
of problems in other life areas that may influence psychological functioning
5.Axis V: current levels of adaptive functioning
Life areas considered are social relationships, occupational functioning and use of leisure time
Give info about need of treatment
•The MAC forces diagnostician to consider broad range of info
•Axis I and II are separated to ensure that the presence of long-term disturbances is not overlooked
•Axis III-V are not needed to make actual diagnosis but they are invaded to indicate that factors other than a
person’s symptoms should be considered in an assessment so that person’s overall life situation can be
Focus on Discovery 3.1 Issues & Possible Categories in Need of Further Study (pg 81)
Possible New Syndromes:
Caffeine Withdrawal; results in significant distress or impairment in occupational or social functioning.
Premenstrual Dysphoric Disorder; occurs 1 week before menstruation and is marked by depression, anxiety,
anger, mood swings, and decreased interest in activities usually engaged in with pleasure.
Mixed Anxiety-Depressive Disorder; the person would have been depressed for at least a month and have had at
the same time at least four of the following symptoms: concentration/memory problems, sleep disturbances,
fatigue or low energy…
Passive-Aggressive Personality Disorder; person is angry or resentful; often feel mistreated, cheated or
underappreciated; symptoms are: resenting, opposing demands, forgetfulness, procrastination.
Depressive Personality Disorder; applied to people whose general lifestyle is characterized by chronic
gloominess, lack of cheer, and a tendency to worry a lot.
Proposed Axes in Need of Further Study:
professionals are being encouraged to consider whether a future axis should include defense mechanisms
defined as “automatic psychological processes that protect the individual against anxiety and from the
awareness of internal or external dangers of stressors.”
There are several defence levels, each with a set of defence mechanisms:
High Adaptive level
- healthy defence level, containing coping efforts to handling stress i.e. channelling or sublimination
- characterized by defences that keep troubling stressors or ideas out of conscious awareness i.e. denial or
Level of Defensive Dysregulation
- lowest level is marked by failure to deal with stress, leading to a break with reality i.e. psychotic denial
DSM indicates that disorder for axis I and II may be due to medical conditions or substance abuse
•Thus, clinicians must be sensitive not only to the symptoms of their patients, but also to the possible
medical causes of their patient’s conditions
Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence
Separation anxiety disorder: excessive anxiety about being away from home or patents
Conduct disorder: repeatedly violate social norms and rules
Attention-deficit/hyperactivity disorder: difficulty sustaining attention and are unable to control their activity
when the situation calls for it
Mental retardation: subnormal intellectual functioning and deficits in adaptive functioning
Pervasive developmental disorders: autistic disorder, severe condition in which individual has problems in
acquiring communication skills and deficits in relating to other people
Diagnostic system widely employed by mental health professions: diagnostic and statistical manual of mental. By the end of the 19th c, medicine had progressed far beyond its practice during the middle ages; people started to recognize that different illnesses required different treatments. More recent efforts at achieving uniformity of classification have not been totally successful either. 1939: world health organization(who) added mental disorders to the international list of causes of. 1948: list expanded to become international statistical classification of diseases, injuries and causes of death (icd): list of all diseases including classification of abnormal behaviour. who adopted it, but the mental disorder section was not widely accepted. 1952: the american psychiatric association published its own diagnostic and statistical. 1969: who published a new classification system that was more widely accepted; a 2nd version of the. Apa"s dsm was similar to the who system.