Notes on Psychopathology Classification and Diagnosis

Classification and Diagnosis of Psychopathology

Diagnostic and Statistical Manual of Mental Disorders (DSM)

  • DSM Overview: Most commonly used classification system in the U.S., created by the American Psychiatric Association (APA), currently in the fifth edition (DSM-5).
  • History of DSM Editions:
  • DSM I (1952): Emphasized psychodynamic factors, contained approximately 60 disorders based on abnormal psychology theories.
  • DSM II (1968): Shift to biological and neurological understandings; had 11 diagnostic categories and 185 total diagnoses.
  • DSM III (1980): Introduced atheoretical, explicit diagnostic criteria; involved field trials for validation; introduced multiaxial diagnostic system.
  • DSM III-R (1987): An update reflecting advances in psychopathology literature with 297 diagnoses.
  • DSM IV (1994) & IV-TR (2000): Collaborative development; the text revision updated scientific information without changing diagnostic criteria.
  • DSM V (2013): Groundwork began in 1999; released amidst significant criticism regarding development processes.
  • DSM V-TR (2022): Involved over 200 experts, updated almost all disorder texts, included societal impacts on mental disorders and risk factors such as racism.

Major Changes from DSM V to V-TR

  • Revisions:
  • Major revisions to texts, prevalence, development factors, and increased attention to culture.
  • Addition of the diagnosis for prolonged grief disorder.
  • Over 70 updated criteria sets with clarifications since DSM-5.
  • Introduction of new ICD-10-CM codes for suicidal behavior.

Elements of a Diagnosis in DSM-5

  1. Diagnostic Criteria and Descriptors: Guidelines for diagnosis; specifies severity and course specifiers when full criteria are met.
  2. Subtypes and Specifiers: Allows for individuality in manifestation of disorders, detailing phenomenological subgroupings.
  3. Principal Diagnosis: Determines main focus of treatment in cases of comorbidity.
  4. Provisional Diagnosis: Used when there's a presumption of a future full diagnosis based on available information.

International Classification of Diseases (ICD)

  • ICD Overview: Developed by the World Health Organization (WHO), now in its 11th edition (ICD-11).
  • Comparison with DSM: Unlike DSM, ICD does not mandate consideration of functional impairments; harmonizes time course criteria, and includes dimensional assessments.

Behavioral Assessment/Observation

  • Behavioral assessment uses direct observation to analyze an individual’s thoughts, feelings, and behaviors in specific contexts. Aims to identify target behaviors and understand the factors influencing them.

Intake Interview/Clinical Interview

  • Central to clinical practice for psychologists and psychiatrists.
  • Involves structured communication aimed at gathering comprehensive information about the individual’s history, problems, and background.
  • Includes data on past behaviors, emotions, interpersonal relationships, and life events (stress, trauma).
  • Focuses on establishing therapeutic rapport, trust, and promoting open communication from the patient.