Discrete categorical classifications of mental illness

Question 1

Classification

Answer 1

organising items into groups based on their shared characteristics.

Question 2

DSM-IV general

Answer 2

· The DSM (Diagnostic and Statistical Manual of Mental Disorders) is the system most widely used by mental health professionals throughout the world to identify and classify mental illnesses for the purposes of diagnosis.
· 365 mental disorders are described, and organised in 16 categories and 1 ‘other’ section.
· Published by the American Psychiatric Association, primarily used in Australia and USA.
· It does not suggest causes or treatment of specific disorders but rather simply names the disorders and describes them in specific terms, more specifically:
o How the disorder will progress (typical course of the disorder)
o The age at which a person is most likely to develop the disorder
o The degree of impairment
o How common it occurs
o Whether the disorder is likely to affect others in the family
o The relationship of the disorder to gender, age and culture

Question 3

DSM - diagnostic criteria

Answer 3

symptoms that are characteristic of the disorder

Question 4

DSM - inclusion criteria

Answer 4

symptoms that must be present in order for the disorder to be diagnosed.

Question 5

DSM - exclusion criteria

Answer 5

symptoms that must not be present for a disorder to be diagnosed.

Question 6

DSM - polythetic criteria

Answer 6

a list of diagnostic criteria in which only some symptoms need to be present in order for the disorder to be diagnosed.

Question 7

DSM - Axis 1, clinical disorders

Answer 7

Any major psychological disorder. It includes symptoms that cause distress or significantly impair social or occupational functioning (e.g. anxiety disorders, mood disorders, schizophrenia). These disorders are typically present of part of the patient’s life.

Question 8

DSM - Axis 2, personality and disorders and mental retardation

Answer 8

Personality disorders involve socially unacceptable behaviour, maladaptive thinking. Intellectual disorders describe an individual who is significantly below the average level of intelligence (e.g. paranoid / antisocial / borderline / obsessive-compulsive personality disorder). These disorders are typically present for all of the patient’s life.

Question 9

DSM - Axis 3 - general medical conditions

Answer 9

Physical disorders that may be relevant to understanding or treating a psychological disorder from Axis I and II (e.g. diabetes, cancer, hypertension, heart disease).

Question 10

DSM - Axis 4 - psycho-social and environmental problems

Answer 10

Problems (such as interpersonal stressors and negative life events) that may affect the diagnosis, treatment and prognosis of psychological disorders (e.g. isolation, family break-up, unemployment).

Question 11

DSM - Axis 5 - global assessment of functioning (GAF)

Answer 11

The individual’s overall level of functioning in social, occupational and leisure activities in which the patient is given a score out of 100 (a high score means good functioning in all areas and minimal symptoms).

Question 12

DSM - criticisms

Answer 12

· Cultural variation: the DSM is based on American culture, tradition and mores, and thus may not always be appropriate.
· Validity of the categories: It is possible that a very precise and specific description may not truly reflect the disorder (e.g. homosexuality was considered a mental disorder).
· Writing by committee: Committee members may have a disproportionate influence on the committee listing the diagnostic criteria for a particular disorder.
· Subjectivity: People may not disclose subjective feelings (these feelings are the symptoms that classification is based on), such as intense anxiety, unhappiness or distress.
· Health insurance: ‘Disorders’ such as alcohol addiction can be paid for by the health insurance company.

Question 13

ICD (International Classification of Diseases and Related Health Problems)

Answer 13

· The ICD (International Classification of Diseases and Related Health Problems) is a categorical system that diagnoses and classifies mental disorders based on recognised symptoms.
· Published by the World Health Organisation, primarily used in Europe
· It includes a detailed description of each disorder listed and identifies symptoms that indicate the presence of a disorder.
· It doesn’t provide guidelines on the prognosis or prevalence of disorders (unlike the DSM).
· The original text covered the whole of medical practice in 21 chapters with one chapter on mental disorders (Chapter V).

Chapter V is now printed as a separate book and is less detailed than the DSM-IV.

Question 14

Strengths of categorical approach

Answer 14

· Based on ongoing scientific research and regularly revised.
· Very comprehensive in terms of the number of disorders included and amount of information.
· Useful for planning treatment.
· Provides user-friendly guidelines that help in the diagnosis of disorders with the ‘yes/no’ approach, thus assisting the decision making process, i.e. if treatment is needed.
· Assists communication between mental health professionals and their peers.

Question 15

Limitations of categorical approach

Answer 15

· Only looks at whether the patient has a disorder or not—does not address the severity or provide an evaluation of the symptoms present.
· Some disorders have low inter-rater reliability (e.g. personality disorders).
· High degree of overlap between symptoms for various disorders.
· Stigmatisation (e.g. shame due to labelling).

Substantial loss of information (e.g. overlooks unique combinations of symptoms for each individual).