CHapter 4: Classification and Diagnosis
-a disorder must be classified correctly before its causes or best treatments can be found.
the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its 5th edition.
published by APA
History of Classification:
-in 1948 (WHO) International Statistical Classification of diseases, injuries, and causes of death
(ICD), a comprehensive listing of all diseases with the inclusion of some abnormal behaviours.
-not really accepted and the APA published DSM in 1952.
-1980 DSM III emerged which was big because it entailed the use of multiaxial classification,
whereby each individual is rated on 5 seperate dimensions or axes.
-5 axes were 1: All diagnostic categories except personality disorders
2: Personally disorders and mental retardation
3.General Medical conditions
4.psychosocial and envrionmental problems
5.Current level of functioning
Axis i & ii made up the diagnoses of abnormal behaviour.
DSM IV and Allen Frances, 1994, changes to diagnostic categories and criteria.
all version of DSM are criticized because they are believed to be developed by physicians who
applied a medical model of diagnosis of presumed phychiatric illnesses and assumed that
acategorical diagnosis was best.
The Diagnostic System of the American Psychiatric Association:
DSM 5 was meant to intiate a renewed focus on the validity of diagnosis, and eliminate
disparities between DSm and the WHO ICD.
DSM 5-PC for normal practitioner 32 disorders most commonly witnessed.
Criteria for ADHD DSM5 :
1. Inattention: 6 or more of the
following symptoms or
2. Hyper activity and Impulsivity:
B. Several inattentive or hyperactive implusive systems were present prior to age 12
C. Several inaatentive of ....are present in two or more settings
D. there is clear eviden that the symptoms interfere with, or reduce the quality of social,
academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia or another
psychotic disorder and are not better explained by another mental disorder.
OVERVIEW OF CHANGES IN DSM5
-first ADHD was seperated from conduct disorder and oppositional defiant disorder. Also it was
decided to remove ADHD subtypes, also plan to remove autism as an exclusion criterion.
-Scientific review commmittee Kendler, criterion of exclusion removed, subtypes removed, ex of
adult adhd put in, and prior to age 7 was changed to 12. 5 instead of 6 symptoms for adult adhd.
Overview of revisions in dsm5
1.New disorders (binge eating disorder, hoarding disorder, )
2. New criteria for existing disorders (eg. PTSD criteria more clearly spell out what
qualifies as a `traumatic experience'
3.New superordinate categories combining previous categories (eg autism spectrum
disorder; substance abuse and substance dependence combined into substance use
4. New conceptualizations of current disorders (eg, gender dysphoria to cross gender
indentification, OCD no longer anxiety disorder, seperation anxiety disorder taken out of
anxiety section and taken into acct adult cases aswell
5. New names for existing disorderss (eg depersonalization disorder becomes
depersonalization/derealization disorder; somatoform disorder become somatic
symptom and related disorders)
6. New dimensional ratings within disorders (eg. schizophrenia subtypes have been
replaced with a dimensional rating of the severity of core symptoms known as symptoms
7. New emphasis of suicidality (suicide risk associated with many disorders now
discussed and highlighted) 8. New Manual format reflecting the age span with chapters for childhood disorders at
the beginning and chapters for disorders found more often among older adults
appearing later in the manual.
COntroversial changes in DSM 5
-Creation of Autism spectrum disorder category , which does away with asbergers syndrom
-The creation of Disruptiuve mood dysregulation disorder (DMDD). the temper tantrum
disorder under depressive disorders.
Epidemiology: study of the frequency and distribution of a disorder in a population
Comorbidity: or co-occurrence of different disorders, has been called ``the premier challenge
facing mental health professionals``.
-Bereavement exclusion to depression...
-4.personality disorder remain under categorical not dimensional approach
5. issue of removing or not including non-suicidal self -injury as a disorder.
-said the changes will take normal behaviour and typify it as abnormal.
-the prevalence of 3 disorder adhd, autism, and bipolar depression is over diagnosed in order
for doctors and pharma companies to make money.
Mental Disorder defined by DSM: a syndrome characterized by clinically significant
disturbances in individuals cognition, emotion, or behaviour that reflects a dysfunction in the
psychological , biological, or developmental processes underlying mental functioning. Mental
disorders are usually associated with significant distress or disability in social, occupational, or
other important activities.
Neurodevelopmental disorders: onset in developmental peroid
-ADHD, intellectual disability Autism spectrum disorder, communication disorders.
Neurocognitive disorders: deficits in cognitive functioning, brain injury or illness
-major cognitve disorder is dementia
Substance related and Addictive disorders.
-Pathological gambling. gambling as a way to escape from problem
-gambling is its own disorder now. Schizophrenia Spectrum and other Psychotic Disorder:
-For individuals lose contact with reality is faulty. language problems communication is distorted.
OCD- trichotillomania- ripping out or pulling of hair.
Somatic Symptom and related disorders:
-people with somatic symptom disorder have a long history of multiple physical complaints for
which they have taken medicine