7 Key excerpts on "Categories of Disorders"

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  eBook - ePub

  Creating Mental Illness

  • Allan V. Horwitz(Author)
  • 2020(Publication Date)
  • University of Chicago Press

    (Publisher)

  Chapter Five THE STRUCTURING OF MENTAL DISORDERS

  At the end of the twentieth century, the profession of psychiatry adopted a symptom-based, categorical system of mental disorders both to become more medically minded and to maintain its scientific authority over a broad range of human behavior. This categorical system requires the discipline to think about and treat human problems as discrete diseases. Community studies further justify this classificatory system by showing that these conditions are pervasive in untreated populations. The precise definition, high reliability, and refined measurement of each of these categorical mental disorders seemingly proves their reality. Many of these disorders, however, are products of the classification system that defines them rather than natural entities.

  The bedrock assumption of diagnostic psychiatry is that overt symptoms indicate discrete underlying mental diseases. Whenever enough symptoms are present to meet the criteria for a diagnosis, a particular mental disorder exists. An anxiety disorder, for example, involves intense fear and dread accompanied by physical sensations such as rapid heartbeat, shortness of breath, and perspiration (USDHHS 1999, 40). A mood disorder features sustained feelings of sadness or elation with disturbances in sleep or appetite, energy level, or concentration (USDHHS 1999, 42). Symptom-based, categorical diagnoses are used to classify a wide range of heterogeneous behaviors including psychoses, neuroses, expectable responses to stressors, and social deviance. The categories of diagnostic psychiatry, however, are not equally useful ways of looking at the variety of behaviors that they try to encompass.

  A useful diagnostic system must fulfill certain goals. The self-defined goals of diagnostic psychiatry are the conventional scientific ones of ordering, explaining, predicting, and treating the phenomena so classified (Kendell 1989; Klerman 1977; Goodwin and Guze 1996; Skodol 2000). Ordering is the most basic goal because etiology, prognosis, and treatment all depend on adequate classification (Robins and Helzer 1986). Symptoms that cluster together in predictable ways are used to indicate the presence of a discrete underlying disease. Distinguishing one disease from another also helps differentiate the causes of the different conditions. In addition, knowing what phenomenon is under consideration ought to enable us predict the course of the severity, duration, and frequency of symptoms. Indeed, one prominent psychiatric text states that “Diagnosis is prognosis

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  eBook - ePub

  Foundations of Clinical Psychiatry Third Edition

  • Sidney Bloch, Bruce S. Singh(Authors)
  • 2013(Publication Date)
  • Melbourne University Press Digital

    (Publisher)

  It has been recommended that the ‘somatoform disorders categories’ in DSM-IV and ICD-10 should be abolished since (a) the terminology is unacceptable to patients; (b) the category is inherently dualistic (i.e. it promotes a mind–body dichotomy); (c) they do not form a coherent category; (d) they are incompatible with certain cultures; (e) the exclusion criteria are ambiguous; (f) subcategories are unreliable; (g) clearly defined thresholds are lacking; and (h) confusion arises in disputes over medico-legal and insurance entitlements. Instead, the disorders should be ‘redistributed’ to other parts of the classification. For example, ‘hypochondriasis’ would be renamed as ‘health anxiety disorder’ and shifted to the anxiety disorders.

  A dimensional classification of personality disorder, consisting of a limited number of broad domains of personality functioning, has been proposed. The suggested domains are (a) emotional dysregulation vs emotional stability; (b) constraint vs impulsivity; (c) extraversion vs introversion; and (d) antagonism vs compliance. The current diagnostic criteria would be incorporated into a new structure and current personality disorder constructs (e.g. antisocial or borderline) detected through diagnostic algorithms (i.e. decision trees) using personality trait scales. (See Chapter 14 .)

  Conclusion

  Familiarity with the two classifications requires knowledge of clinical psychiatry, as well as awareness of the types of emotional distress (not necessarily due to a mental disorder) that may lead a person to seek professional help. Classification is a requisite for clinicians and researchers alike. The process of diagnosis forces the former to focus on symptoms, to decide which are dominant, and to plan therapy accordingly.

  Some diagnoses continue to be problematic. Biological advances, as well as studies of syndrome patterns using statistical techniques, will, however, lead to greater precision, and this will be reflected in future editions of ICD and DSM.

  Further reading

  American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. 4th edn—text revision (DSM-IV-TR), American Psychiatric Association, Washington DC.

  This remains the most detailed and widely used system of psychiatric diagnosis and classification currently available.

  Berrios, G. (1996). The History of Mental Symptoms. Descriptive Psychopathology since the Nineteenth Century. Cambridge University Press, Cambridge.

  A magisterial account of the development of clinical psychiatry, with a particular emphasis on the delineation of symptoms of mental illness, the basis of classification.

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  Personality and Psychological Disorders

  • Gordon Claridge, Caroline Davis(Authors)
  • 2013(Publication Date)
  • Routledge

    (Publisher)

  Chapter 2Description, Classification, and Models of Disorder

  The Medical Classification

  Whenever natural variations are seen in some phenomenon there is always a need to classify them – to arrive at what in biology is termed a taxonomy, an orderly descriptive system for bringing together subsets of examples that share similar features. In the case of psychological disorders, attempts to construct such a taxonomy – in this case called a nosology – has traditionally been in the hands of psychiatrists. Consequently, as will be evident from our introductory chapter, the form and thinking behind psychiatric nosologies have been very much dictated by a medical model, a belief in the need to identify distinct psychological diseases. This has often attracted criticism. But it should not blind us to the fact that, irrespective of how it is done, som e way of systematically distinguishing between the various psychological disorders is required. Why is this? There are three main reasons.

  First, it provides clinicians and others involved in the management of the mentally ill with a language in which to communicate with one another about individual cases with whom they are dealing. It obviously helps, when exchanging information about a patient or client, if some commonly agreed terminology is available and if a label can be assigned, which differentiates one person’s disorder from another’s. Second, classification helps in the choice of treatment. Indeed, if it did not do so, the nosology would be of limited use, since one of the main purposes of the labelling process is to match the client to a suitable form of therapy. Third, classification serves a scientific need, by defining the guidelines for studying different types of disorder; it allows researchers interested in a particular disorder to select for investigation only those cases that share defined features of the condition they wish to study. Of course, since such research has to be done in order to help to establish the nosology in the first place, there is an element here of what is often called ‘bootstrapping’, that is, gradually refining the classification on the strength of new knowledge that accumulates from its use.

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  Classification and Diagnosis of Psychological Abnormality

  • Susan Cave(Author)
  • 2005(Publication Date)
  • Routledge

    (Publisher)

  2

  Classification, assessment and diagnosis

  BackgroundDiagnostic and Statistical Manual of Mental Disorders (DSM)Axes I and II: Major categoriesInternational Classification of Diseases (ICD)Clinical assessment proceduresEvaluation of classification and diagnosis

  Background

  One of the key features of the scientific approach to any subject is that it is systematic. The subject matter is grouped into categories of items that share similar features, or subjected to some other form of logical organisation that makes it easier to see patterns or consistencies in what is observed. The natural sciences have long employed classification systems of various sorts, such as the periodic table of the elements used in chemistry or the phylogenetic systems of the biological sciences. In the 19th century, medical science began to make progress by identifying different illnesses and providing different forms of treatment for them. By comparison, there was very little consistency in the approach to abnormal behaviour. In Britain, a classification scheme was produced by the Statistical Committee of the Royal Medico-Psychological Association, but never utilised by the members. In Paris and America similar schemes also failed to gain acceptance.

  One of these early schemes was that produced by Kraepelin (1883), who is often regarded as the founder of modern psychiatry. His system identified symptom groups or syndromes, which he considered to have organic causes, i.e. they were physically based. For example, severe mental illnesses were divided into dementia praecox (now known as schizophrenia), which was thought to result from a chemical imbalance, and manic-depressive psychosis, which was thought to result from metabolic irregularities. Kraepelin’s system was the basis from which modern diagnostic schemes developed.

  There are two major schemes in use at present. These are: the Diagnostic and Statistical Manual of Mental Disorders

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  The Origins and Course of Common Mental Disorders

  • Prof David Goldberg, Ian M Goodyer(Authors)
  • 2014(Publication Date)
  • Routledge

    (Publisher)

  Part I The nature and distribution of common mental disorders Passage contains an image

  Chapter 1 Competing models for common mental disorders

  DOI: 10.4324/9781315820149-1

  Categorical models of common mental disorders

  The conventional taxonomy of mental disorders is that set out in the fifth chapter of the World Health Organisation's International Classification of Disease, tenth edition (WHO 1988 : ICD-10). This is broadly comparable to the fourth edition of the American Psychiatric Association's (1994) Diagnostic and Statistical Manual, fourth edition (DSM-4).

  These classifications are arrived at by consensus meetings of distinguished psychiatrists, either in Geneva or in Washington. They are essentially arbitrary, ‘top-down’ classifications — and they are necessarily revised at regular intervals, as new treatments become available, as new mental disorders emerge, or as research findings indicate heterogeneity within diagnostic entities.

  Inevitably, it is easier to reach consensus about major, severe disorders that are worldwide in their distribution — like dementia, mental retardation, schizophrenia and bipolar disorder. It is far more difficult to achieve consensus about the common mental disorders, where cultural factors and differing diagnostic habits dictate different patterns of common symptoms of mental distress.

  Thus, ‘brain fag’ (Africa), ‘kidney weakness’ (China), ‘Jibyo’ (Japan), ‘burn-out’ (USA), ‘chronic fatigue’ (UK) or ‘neurasthenia’ (Asia) are all ways of referring to syndromes of disordered function in various parts of the world that have no known organic pathology. One solution to this otherwise intractable problem is to impose the diagnostic concepts that have been agreed by senior psychiatrists upon general physicians in the rest of the world. These concepts are heavily influenced by American and European psychiatrists, and may do less than justice to the forms of disorder in other parts of the world.

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  The Wiley Encyclopedia of Personality and Individual Differences, Set

  • (Author)
  • 2020(Publication Date)
  • Wiley

    (Publisher)

  Diagnostic and Statistical Manual of Mental Disorders, 5th Ed.: DSM‐5

  Catalina Sarmiento and Chloe Lau

  University of Western Ontario, London, Ontario

  What is the Diagnostic and Statistical Manual of Mental Disorders?

  Published by the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders (DSM ) is an authoritative guide to the diagnosis and classification of mental disorders for clinical practice and research. The DSM standardizes diagnoses, thereby providing a common terminology to discuss psychopathology. Its influence is seen in an array of settings and systems, including public health policies, education, reimbursement systems, research, and forensic science.

  Historical Overview

  In 1949, the World Health Organization released the sixth edition of the International Classification of Diseases and Related Health Problems (ICD ). This was the first edition to include a chapter on mental disorders. In response to the ICD‐6, the American Psychiatric Association developed its own classification system, the DSM, which was first published in 1952.

  The DSM‐I was the earliest formal manual of mental disorders to focus on clinical use. It was influenced by the psychobiological approach of Adolf Meyer, which conceptualized mental disorders as stress reactions, and the psychoanalytic approach of Sigmund Freud, which emphasized unconscious forces. In 1968, the next edition was released. It introduced new disorders and increased compatibility with the ICD. The DSM‐II was more influenced by a psychoanalytic approach than its predecessor, and no longer referred to disorders as “reactions” (e.g. schizophrenic reaction). The diagnostic definitions of the DSM‐I and DSM‐II were brief, vague, and did not include specific criteria.

  There were several challenges that psychiatry encountered in the late 1960s and 1970s. These included the advent of other mental health professionals that had different theoretical orientations, polemics regarding asylum conditions, research that uncovered unreliability in diagnoses, and criticism of unproven etiological assumptions of the DSM. These events contributed to a paradigm shift in psychiatry, away from a psychoanalytic approach and toward a biomedical model.

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  The SAGE Encyclopedia of Educational Research, Measurement, and Evaluation

  • Bruce B. Frey(Author)
  • 2018(Publication Date)
  • SAGE Publications, Inc

    (Publisher)

  Diana Joyce-Beaulieu Diana Joyce-Beaulieu Joyce-Beaulieu, Diana

  Diagnostic and Statistical Manual of Mental Disorders Diagnostic and statistical manual of mental disorders

  503 507

  Diagnostic and Statistical Manual of Mental Disorders

  The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is considered the authoritative source within the United States for mental health diagnoses. The manual offers detailed guidance on mental health concerns across the life span from early childhood neurodevelopmental disorders to adult personality disorders and later geriatric neurocognitive disorders. Clinicians and researchers utilized this resource across multiple disciplines, including counseling, education, medicine, psychology, psychiatry, rehabilitation, and social work fields. Therefore, the DSM offers a common theoretical framework for understanding mental health issues and a recognized nomenclature to facilitate cross-discipline collaboration. In addition, the DSM coded diagnoses data collected through hospitals and treatment providers, yielding important national information on diagnoses trends, which then informs policy decisions for service provision, research funding, and educational initiatives. This entry begins by reviewing the history of the editions of the DSM and how the fifth edition of DSM (DSM-5) is organized. Next, the importance of the International Classification of Diseases (ICD) is considered, followed by a look at how symptoms and measures in the DSM assist in diagnoses. Finally, the entry provides a warning about using the DSM without proper qualifications and considers changes that may be made to future revisions of the DSM.

  History of the DSM

  The first edition of the DSM (i.e., DSM-I) was published in 1952 and focused primarily on adult mental health needs across three classifications (i.e., organic brain disorders, functional disorders, and mental deficiency disorders). The manual also offered brief diagnostic descriptions of 106 subcategories from a psychobiological perspective often using the term “reactions” rather than symptoms. In 1968, the second edition of the DSM (i.e., DSM-II) shifted to a psychoanalytic approach to understanding mental health, and disorders were described in more detailed narratives. Although an important manual, the early editions of the DSM

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