Chapter 3

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 th been through several revisions and the current one is the 4 edition (DSM-IV) A Brief History of Classification Early Efforts at Classification - during 19 and early 20 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 werent 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 revision of 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 andor 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 www.notesolution.comparticular 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 persons 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 persons symptoms should be considered in an assessment so that the persons 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 persons 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-deficithyperactivity 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 www.notesolution.com