DSM and ICD - Edexcel A level Psychology

DSM

Diagnostic and Statistical Manual of Mental Disorders

What does the DSM do?

Groups disorders into families with linked disorders grouped together, allowing clinicians to go from general to specific diagnosis

What versions of the DSM are currently being used?

DSM-5 and DSM-IV-TR

Strengths of the DSM

Allows for a common diagnosis by clinicians

Weaknesses of the DSM

Medicalises people, seeing them as patients that need treatment, Laing calls schizophrenia another way of living

Social norms are reflecting in judgement as it requires subjective judgement on symptoms

What does reliability mean for the DSM?

Whether one person's symptoms would receive a different diagnosis from a different physician

System diagnosis needs inter rater reliability where 2 or more clinicians are shown the details, diagnosis is made if there's a high % of agreement

What would happen if the DSM had low reliability?

Clinicians may prescribe different treatments which could lead to unnecessary side effects

Goldstein (1988) DSM concurrent validity

Using DSM III, re diagnosed patients diagnosed with DSM II and found a lot of similarities

Weakness of DSM reliability

Patients may give clinicians different info about their symptoms, due to shame, denial or memory issues or manipulation and deceit due to mental illness

Unstructured interviews could cause clinicians to focus on certain symptoms so different info could be collected

Ward et al (1962) DSM low reliability

Two psychiatrists diagnosing the same patient, found disagreement because of inconsistency by the patient (5%); inconsistency in the interpretation from the clinicians of the symptoms (33%) and inadequacy of classification system (63%)

Validity of the DSM

Means treatments are more likely to work

If the DSM is not reliable then it would not be valid either

Concurrent validity in the DSM

Comparing the symptoms and diagnosis with other classification systems like the ICD

Predictive validity in the DSM

To see whether the predictions about the course of the disorder and the symptoms can be seen in the life of the patient and if medical effects can be predicted

Strengths of DSM validity

Includes info about how disorders relate to each other and cultural guidance on diagnosing

Weaknesses of DSM validity

Does not suit well with people that have multiple conditions, focuses on one diagnosis

Andrews et al (1999) concurrent validity of the DSM

Found only a 68% agreement between the ICD-10 and the DSM-IV on an assessment of 1500 patients, but did find an agreement on depression and substance dependence

What is the ICD?

International Statistical Classification of Diseases and Related Health Problems

What is included in the ICD?

The ICD-10 has up to 22 categories with mental/behavioural disorders being number 5 diseases of the nervous system being number 6

Weakness of the ICD

Breaking a mental disorder down into features and symptoms could be reductionist, an approach looking at aspects of a persons life may be more valid

Jansson et al (2002) validity in the DSM and ICD

ICD-10 and DSM-IV gave best agreement in regard to diagnosis (0.82)

Jansson et al (2002) weakness of ICD validity

ICD-9 and ICD-10 focused on different features and symptoms of schizophrenia