Classifying Psychopathology

Question 1

The development of Classification Systems

Answer 1

First person to create a classification system for psychopathology was Emil Kraeplin. He believed psychopathology could be classified into different and separate pathologies, each of which had a different cause and described by a distinct set of symptoms that he called a syndrome. He identified three types of psychoses; manic depression, dementia praecox (schizophrenia), and paranoia.

DSM was first primarily based on clinical experiences in asylums. the problem with the first DSM emerged in use of soldiers returning from war experiencing stress reaction, psychosomatic problems and personality problems that the DSM did not cover.

Although the two most influential systems were further developed by:
- American Psychiatric Association then published the first Diagnostic and Statistical Manual (DSM-I).
- the World Health Organisation (WHO) which added psychological disorders to the International List of Causes of Death (ICD) in 1939. However, the mental disorders section in the ICD was not widely accepted.
(specifically DSM-II - but has two problems, reliability of diagnosis and outdated diagnosis (homosexuality)).
- since then there has been a series of developments, and now the most recent version is DSM-5 published in 2013. it acknowledges that the science underlying disorders is still developing

Question 2

Defining and Diagnosing Psychopathology

Answer 2

what is the DSM classification system primarly designed to do?

The DSM has 4 basic objectives:

• must provide necessary and sufficient criteria for correct differential diagnosis
• must provide a means of distinguishing ‘true’ psychopathology (in the medical/dysfunctional sense) from non-disordered human conditions that are often labelled as everyday ‘problems in living’
• must provide diagnostic criteria in a way that allows them to be applied systemically by different clinicians in different settings.
• the diagnostic criteria it provides should be theoretically neutral; do not favour one theoretical approach to psychopathology.

Question 3

General Problems with Classification

Answer 3

• DSM does not classify psychopathology according to it’s causes, but on the basis of symptoms
• DSM criteria to label people with a disorder can be stigmatising and harmful
• DSM tends to define disorders as discrete entities rather than dimensional
• DSM conceptualises psychopathology as a collection of hundreds of distinct categories of disorders, but this is not the case; combordity is the co-occurrence of two or more distinct disorders and hybrid disorders are disorders that contain elements of a number of different disorders.
• it can be conceived as a ‘hodgepodge’ collection of disorders, that have been developed and refined in a piecemeal way across a number of revisions.

an example of a hybrid disorder is mixed anxiety-depressive disorder whereby people exhibit symptoms of both anxiety and depression, yet do not meet the threshold for either an anxiety or a depressive diagnosis.

Question 4

what are the main changes that were implemented in DSM-5?

Answer 4

• new chapters for OCD and Trauma and Stress-Related Disorders
• ASD will incorporate many previously separate labels
• New Disruptive Mood Dysregulation Disorder
• Binge Eating Disorder, Hoarding Disorder and Skin-Picking Disorder included
• Personality Disorders retained with added dimensional scales
• PTSD included in new chapter on stress
• Removal of bereavement exclusion in Major Depression
• Substance use disorder combines substance abuse and substance dependence.