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Chapter 3

Chapter 3

Course Code
Konstantine Zakzanis

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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
Development of the WHO and DSM Systems
- 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
- 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
- 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
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
- 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
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

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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 perVRQV
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
- 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
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
- 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
- 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

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- these substances may also cause or contribute to the development of other axis I disorders, such as
mood or anxiety disorders
- 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
- 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
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
- a compulsion is an urge to perform a stereotyped act, with the usually impossible purpose of
warding off an impeding feared situation
- attempts to resist a compulsion create so much tension that the individual usually yields to it
- experiencing anxiety and emotional numbness in the aftermath of a very traumatic event is called post-
traumatic stress disorder
- individuals have painful, intrusive recollections by day and bad dreams at night
- they find it hard to concentrate and feel detached from others and from ongoing affairs
- acute stress disorder is similar to post-traumatic stress disorder, but the symptoms do not last long
Somatoform Disorders
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