PSY333: Abnormal Psychology - Classification & Diagnosis: DSM and ICD

Session Details

  • Course: PSY333 Abnormal Psychology
  • Session: 6
  • Topic: Classification & Diagnosis: DSM and ICD
  • Instructor: Dr. Saya Karavadra

Aims of the Session

  • Diagnosis
  • Classifications
  • DSM-5
  • The DSM Debate
  • ICD-11
  • Example of Psychosis
  • Resources

Diagnosis

  • Definition:
    • The process through which professionals determine whether a patient's psychological state exhibits characteristics of a disorder or pathology.
  • Objective:
    • Identifying and labeling a cluster of symptoms related to specific disorders.
  • Importance of Diagnosis:
    • Facilitates a systematic organization of psychological disorders.
    • Enables shared understanding and communication among professionals and clients.
    • Dictates treatment approaches, influencing both therapeutic outcomes and standard care protocols.

Classification Systems

ICD (International Classification of Diseases)

  • Origin:
    • Developed by the World Health Organization (WHO) in 1939, initially focused on both physical and mental health.
  • Adoption:
    • The first comprehensive system of classification for psychological disorders; however, initial acceptance was limited.
  • Current Versions:
    • ICD-11, published in 2018.
  • Philosophy:
    • Influenced by Emil Kraeplin’s view that mental illness could be classified and treated similarly to physical illnesses.
  • Approach:
    • Utilizes a multi-axial system (see Multi-Axial Presentation below).
    • Widely adopted for clinical diagnostic purposes and global health problem examination.
  • Usage:
    • Global classification and diagnosis, while DSM criteria are predominantly used in mental health research.

ICD Multi-Axial Presentation (ICD-10)

  • Axis I: Clinical diagnoses (e.g., mental disorders)
  • Axis II:
    • Disability assessment (including personal care, occupation, family and household context, and broader social functioning)
  • Axis III: Contextual factors
    • Relevant environmental and lifestyle factors that influence disease progression and patient illnesses.

DSM (Diagnostic and Statistical Manual of Mental Disorders)

  • Origin:
    • Published by the American Psychiatric Association (APA) in 1952, based on a classification system developed by the U.S. Army during WWII.
  • Current Version:
    • DSM-5, published in 2013.
  • Functionality:
    • Each disorder in the DSM-5 is standardized with detailed descriptions which include diagnostic features, required symptoms, prevalence, risk factors, and co-morbidity.
  • Development:
    • Revised continuously to reflect ongoing research; categories adapt over time.
  • Number of Diagnoses:
    • DSM-I included 106 diagnoses; DSM-V includes nearly 300.

Diagnostic Categories in DSM-5

  1. Neurodevelopmental Disorders
  2. Schizophrenia Spectrum and Other Psychotic Disorders
  3. Bipolar and Related Disorders
  4. Depressive Disorders
  5. Anxiety Disorders
  6. Obsessive-Compulsive and Related Disorders
  7. Trauma and Stressor-Related Disorders
  8. Dissociative Disorders
  9. Somatic Symptom and Related Disorders
  10. Feeding and Eating Disorders
  11. Elimination Disorders
  12. Sleep-Wake Disorders
  13. Sexual Dysfunctions
  14. Gender Dysphoria
  15. Disruptive, Impulse Control, and Conduct Disorders
  16. Substance Related and Addictive Disorders
  17. Neurocognitive Disorders
  18. Personality Disorders
  19. Paraphilic Disorders
  20. Other Disorders

*Note: Adapted from American Psychiatric Association (2013).

Depressive Disorders in DSM-V

  • Categories:
    • Disruptive Mood Dysregulation Disorder (for individuals under 18)
    • Major Depressive Disorder
    • Persistent Depressive Disorder (Dysthymia)
    • Premenstrual Dysphoric Disorder
    • Substance/Medication Induced Depressive Disorder
    • Depressive Disorder Due to Another Medical Condition
    • Other Specified Depressive Disorder
    • Unspecified Depressive Disorder

Example of Schizophrenia

  • DSM-5 Criteria for Diagnosis:
    • Presence of two or more of the following symptoms for at least one month (at least one must be a core symptom):
    1. Delusions
    2. Hallucinations (can be auditory, visual, tactile, or olfactory)
    3. Disorganized speech
    4. Grossly disorganized or catatonic behavior
  • Impact:
    • There must be impaired functioning in work, social relations, or self-care.

The DSM Debate

  • Critiques of the DSM:
    • Diagnoses focus on symptoms rather than underlying causes, potentially leading to stereotypical explanations.
    • The stigma associated with psychiatric labels, which may discourage individuals from seeking help.
    • Conversely, a diagnosis can enable access to care, insurance benefits, and necessary support.
  • Viewpoints on Classifications:
    • Traditional classifications treat disorders as discrete entities, while psychopathology is often multi-dimensional.
    • Highlights the relevance of biopsychosocial approaches and the 4P's (Predisposing, Precipitating, Perpetuating, and Protective factors) framework.
    • Co-morbidity is viewed as a normative aspect rather than an exception.

Influence Factors in DSM Development

  • Political Dynamics:
    • Money, politics, cultural pressures, historical contexts, and stigma play critical roles in shaping DSM decisions.
  • Key Organizational Influences:
    • Consider the influence of major organizations like the APA (American Psychiatric Association), FDA (Food and Drug Administration), and Big Pharma.

Resources and Next Session

  • Available Resources:
    • Lecture slides on Canvas.
    • Required reading: https://www.psychiatrictimes.com/couch-crisis/conversations-critical-psychiatry-allen-frances-md
    • Aftab, A. (2019, May 23). "Conversations in Critical Psychiatry: Allen Frances, MD." Retrieved February 2, 2020, from https://www.psychiatrictimes.com/couch-crisis/conversations-critical-psychiatry-allen-frances-md
  • Next Session:
    • Topic: Stress & Anxiety Disorders.