Chapter 3

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Published on 7 Jun 2011
School
UTSC
Department
Psychology
Course
PSYB32H3
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
behavior
Development of the WHO and DSM Systems
- 1939, World Health Organization (WHO) added mental disorders to the International List of Causes of
Death
- 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
behavior
- 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-
IV-TR)
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
disability
- 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
functioning
- 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
Schizophrenia
- 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
themselves
- 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
depression
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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Document Summary

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) During 19th and early 20th centuries, there was great inconsistency in the classification of abnormal behavior. 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 behavior. American psychiatric association published its own diagnostic and statistical manual (dsm) in 1952.