Mental disorder can be classified in many ways. Earliest attempts can be traced back to the ancient Greece. In 5 B. C. Hippocrates tried to establish a classification system for mental disorder. He used words such as mania, hysteria to classify mental illness. In the course of time the vocabulary had been enhanced by word such as circular madness, paranoia etc. However, the first classification system with real scientific profile was provided by Emil Kreapelin (1856-1926). Nowadays, the World Health Organization? International Classification of Diseases 10 ( ICD -10) and the American Psychiatric Association? s Diagnostic and Statistical Manual (of Mental disorders) IV (DSM – IV TR) (2000) are the most commonly used classification systems in the world. They two have gone through several revisions before the most recent versions could be published. The ICD is an international classification system for all diseases, which did not include any diagnostic criteria for mental disorder before the 6th version of ICD have been published. DSM IV TR is the primary system used in the USA to classify and diagnose people.
The first two manuals were published in 1952 and 1968. The two were criticized for their low reliability/validity and bad utility of syndromal diagnosis. The third edition (1972) was an important development, as it was the first empirical based nomenclature of the DSMs. It improved the reliability, validity and utility of syndromal diagnosis substantially. It introduced the multiaxial approach of five scales, which is characteristic for the 4th edition of DSM. Professionals are using those five axes to asset the patient`s presenting complaint.
It is quite common that patients are classified as having two different disorders from Axis I or Axis II respectively. The new edition DSM IV (1994), chaired by the psychiatrist Allen Frances, should provide a better documentation of the empirical support. The purpose was to improve the utility of the manual and the congruency with ICD -10. DSM IV TR (2000) is the most current version of the Diagnostic and Statistical Manual. The difference between DSM IV TR and his predecessors it, that DSM IV TR is based on data analysis and re-analysis, literature reviews and field trials.
The predecessors were generally focused on descriptive rather than etiological factors. Also, all version of DSM including the last one still do not suggest treatment approaches. The following list illustrates the five axes and what they represent, with an example for each axes. Axis I Mental disorder 300. 4 Dysthymic Disorder 315. 00 Reading Disorder Axis II Personality disorders and mental retardation V71. 09 No diagnosis Axis III Physical conditions and disorders 382. 9 Otitis media, recurrent Axis IV Psychosocial and Environmental Stressors/Problems
Victim of child neglect Axis V Global Assessment of Function using the GAF scale GAF = 53 (current)” The Code of DSM IV match with some codes in ICD -10. The ‘diagnostic criteria’ for a particular condition is represented by those codes. The Diagnostic criteria for 295. 90 is an example of criteria used by DSMIV to diagnose a person’s present complaint “Diagnostic criteria for 295. 90 Undifferentiated Type: A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type. According to’ this diagnostic criteria’, it is also necessary to look up for the criteria of Schizophrenia. In 1996 the study: “Prevalence of DSM IV Diagnostic Criteria of Insomnia: Distinguishing Insomnia Related to Mental Disorders from Sleep Disorders” (Maurice M. Ohayon) was aimed to examine whether DSM IV Diagnostic criteria is a necessary tool to determine whether a person suffering from a sleep disorder or whether the insomnia constitutes a symptom of a mental disorder.
Thereby 5622 people from the French population were interviewed over the telephone by some persons, which had no experiences in psychiatric diagnosis. The persons had been trained to use the Sleep-Eval knowledge- based system (Ohayon, 1994), which is a diagnostic tool for administration and management of telephone surveys. The results illustrated the need and importance of standardized classification systems to distinguishing between sleep disorder and insomnia constitutes a symptom of a mental disorder. Nowadays, it is also possible to distinguish between schizophrenia and mood disorder with psychotic symptoms.
This is important as diagnosis and the therapeutic approach change. Patient’s, which have been described in the past as having “hysteria” achieve appropriate treatments, rather than shut away for protection of others. National/international consultation and empirical studies enable a new partnership between clinical psychiatry and the cognitive-behavioral, interpersonal, behavioral psychotherapies. The relationship enable to come up with a combined treatment. For some mental disorders the use of combined treatments has been written down in specialized literature.
For examplePatient suffering with social phobia are mostly treated with antidepressants as well as cognitive-behavioral therapy (CBT). It is possible to eliminate the physical symptoms resulting from anxiety with antidepressants drugs, but the decreased sociability, bad assertiveness etc. need to be treated with other therapies as CBT. Blashfield and Draguns (1976) described the utility the manuals as a helpful scientific tool. They see them as a consensual language, which enable the professionals to communicate. Also, “a means for organizing and retrieving information, because an item? name is a key to its literature and knowledge accrues to the type”. He sees it as a template to describe the differences and similarities between patients or to make predictions about course and results. Further, standardized classification systems enable and promote empirical research in psychopathology. Besides, the DSM IV and the ICD-10 do not provide any causes of mental disorder. But as the individuals are assigned to groups that share the same signs and symptoms, it is a helpful as well as necessary tool to indicate what causes some mental disorder.
However, it is important to remember that diagnoses are not mad by the criteria; diagnoses are made by clinicians, who use those criteria as a guideline. DSM IV “cannot simply be applied in a cookbook fashion” . A person needs to be trained in the use of DSM IV before assessing another person’s present complaint. Thus, the DSM IV is just a guideline for professionals, which aim it is to confirm a diagnosis, but do not replace the clinical diagnosis itself. But the clinical diagnosis based on perception, intuition, and feelings that arise from the unique relation between the patient and the therapist.
Each therapist may interpret the unique relation in a different way, so that the diagnosis would differ among different professionals. Besides, DSM IV included different diagnoses, which share many criteria. Therefore, it makes it more difficult for professionals to come up with the right diagnoses. The predecessors of DSM IV showed low reliability. Beck (1962) examined that two psychiatrist agreed only 54 % of time while diagnosing the present complaints of 153 patients. The most data of Reliability and validity of DSM IV categories are coming from field trial reports.
Those studies show a higher reliability compares to the predecessors, as DSM IV provides more clearly stated criteria and symptoms. Also, structured interviews schedules helped to improve the diagnostic reliability. However, according to Nathan and Langenbucher (1999) reliability has been improved just on few categories, but the most categories still tend to provide unreliable diagnostic. Westen agrues, especially diagnosing Axis II (personal disorder) provide unreliable outcomes, as no operational criteria is been given.
Also, The DSM IV Definition of Mental Disorder makes it more complicated for the clinicians to distinguish between uncommon or unusual behaviour and psychopathological behaviour. The definition is too spread out and included behavior with is not necessarily pathological. When using the diagnostic criteria, it can produce false positives, because of failure of symptom criteria to indicate an underlying dysfunction. For example extreme sadness and associated symptoms of depression can be a result of a normal reaction to extreme loss or to a mental disorder.
The “concept of comorbidity” is the “occurrence of two or more mental disorders or other medical conditions in the same individual”. In the mental health area it represents the inability to come up with a single diagnosis, rather than multiple diagnoses. The problem is due to diagnostic criteria, which had been tripled since the development of DSM I. Critics argue that many diagnostic labels can be seen as one diagnosis, rather than subdivide them (e. g. Marzuk, 1996) When assessing a patient’s present complaint only present symptoms has to be considered.
Diagnostics should not show cultural or gender bias. Recent research argues that the last edition of DSM IV is gender biased (Adler, Drake, & Teague, 1990). Some claim that DSM IV is biased against females. Also, it has been found that DSM IV is cultural biased (Garb, 1997). There are many other problems of DSM IV, but it would need an own essay.