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Chapter 3

Chapter 3: Classification and Diagnosis

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Mark Schmuckler

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 19 c, medicine had progressed far beyond its practice during the Middle Ages; people started to recognize that different illnesses required different treatments. During 19 c. and early 20 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 Death 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 Manual (DSM) not long after. 1969: WHO published a new classification system that was more widely accepted; a 2 version of the APAs 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 by data. 1 www.notesolution.com 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 persons symptoms should be considered in an assessment so that persons overall life situation can be better understood 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. 2 www.notesolution.com
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