Reading §
- Describe why we need a classification system for mental disorders.
- A diagnostic system for mental disorders serves a number of important functions, such as providing a description of mental disorders, distinguishing among different types of mental disorders, providing a vocabulary for communicating about mental disorders, and facilitating research in psychopathology. Furthermore, accurate assessment and diagnosis, as well as effective treatment of mental disorders, rely on a system of classification. Diagnostic systems are also needed for surveying population health and for understanding the prevalence and etiology of particular mental health problems.
- Outline what criteria can be used to evaluate a system of classification.
- Every science includes a system for categorizing information. In abnormal psychology, the perfect diagnostic system would be based on etiology, presenting symptoms, prognosis, and response to treatment. This diagnostic system would also enhance the organization of clinical factors and provide a shorthand to help professionals communicate easily.
- Describe the history of classification of mental disorders.
- Although attempts to classify mental disorders date back to at least the Middle Ages, modern efforts at classification owe much to Kraepelin’s work in the nineteenth century. A milestone in the modern development of a comprehensive diagnostic scheme was the World Health Organization’s decision to add mental health disorders to the International List of the Causes of Death. In 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 abnormal behaviour. In response to limitations of the ICD system, the American Psychiatric Association published its own classification system, the Diagnostic and Statistical Manual (DSM), in 1952. Both of these systems of classification (ICD and DSM) have undergone numerous revisions, in efforts to address inadequacies of previous editions (e.g., poor reliability) and to ensure that research evidence informs 62 our classification of mental disorders. Currently, the system of classification used most commonly in North America is the DSM-5.
- Describe the system of classification of mental disorders.
- The editions of the DSM have progressed considerably in arriving at DSM-5 and recognize the importance of psychosocial features in the development and maintenance of psychological problems.
- Identify the key reasons why the system of classification was revised to create the DSM-5.
- To address some of the limitations of the diagnostic system, the DSM is periodically revised. The guiding principles behind the revisions are to update the diagnostic system, based on the most current available scientific evidence, and to enhance the clinical utility of the diagnostic system.
- Describe the benefits of going beyond the DSM by using a new classification framework for research that examines psychopathology.
- Many professionals feel that current and past versions of the DSM remain too closely aligned with the medical model, and that this leads to excessive stigmatization and loss of information about individuals. The whole enterprise of diagnosis of mental disorders is also criticized for using categories that do not do justice to the complexity of human behaviour and for displaying gender and cultural biases.
- Outline the major criticisms of the current and past systems of classification of mental disorders.
- As we have seen, the DSM-5 is far from perfect. However, as the history of classification in the natural sciences has demonstrated, the development of a diagnostic classification system is an ongoing process that requires continual refinement. Classification is an accepted procedure in all sciences, and it is very likely that the field of mental health will continue to use it. It is encouraging to note that the field of mental health is continually looking to efforts to improve and validate the diagnostic system using empirical evidence. This scientific attitude should allow the detection of flaws in the present system and lead to an improved diagnostic system in the future. An example of this is the NIMH’s adoption of RDoC as a way of encouraging researchers to examine underlying processes across domains of functioning and at various levels of analysis to better understand psychopathology, and eventually, to develop a more biologically valid classification system and better treatments. Gradually, diagnostic categories in any mental health taxonomy should be refined as we fill in the present gaps in our knowledge and come to recognize how culture, politics, and social norms have influenced professional concepts of mental health. This refinement process is well under way.
Lecture §
- Describe why we need a classification system for mental disorders?
- A vocabulary for communicating about mental disorders with others
- Outline what criteria of “perfect” diagnostic system ^46def1
- Symptoms (clusters): symptom mapping to disorder
- Etiology (cause): history leading to disorder
- Prognosis (natural course): phases
- Response to treatment
- No overlap
- Perfect cure
- Describes the characteristics of strong diagnostic systems
- Describe the history of classification of mental disorders.
- Add mental health disorders to ICD
- DSM I & DSM II
- DSM III & DSM-III-R
- More atheoretical
- More polythetic
- DSM-5 (2013)
- Outline the major criticisms of the current and past systems of classification of mental disorders.
- Against classification
- Medical model
- Stigmatization: unfairly labels an individual
- Loss of Information: information is lost through the use of labels
- Criticisms
- Gender bias: diagnosis more likely for women
- Cultural Bias: normality vs abnormality; culture-based syndromes