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Classifying Mental Disorders

Classifying Mental Disorders

Author: Erick Taggart

This lesson will give an overview of the DSM-IV-TR, how it is utilized in diagnosis, and the breakdown of its contents to include the 5 Axis diagnostic system.

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Video Transcription

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Hello, class. So when we're talking about all of these mental disorders and the therapies to deal with them, how do we actually determine what is a mental disorder? So there are different systems around the world that are used to classify. But there are two major ones that you should know about.

And the first one is the ICD-16, or the International Classification of Diseases, specifically Chapter 5. And this is a manual that's put out by the World Health Organization. And this is something that's more recognized, particularly worldwide.

The other one to talk about, and the one that really concerns us the most particularly here om the US, is the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-IV, since it's in its fourth edition, which is put out by the APA or American Psychiatric Association. Now, the DSM was originally put out in 1952 in its first form DSM-I. In 1994, the DSM-IV came out. And since then, there's been a slight revision in this, the DSM-IV-TR, which was put out in the year 2000.

Now, particularly the DSM-IV is what we would refer to as a non-theoretical type of classification, which is to say it doesn't subscribe to a specific theory. It's more of a clinical-based approach. It's looking at the actual research that was done with people with mental disabilities.

Inside of it, it provides symptoms and statistics that are based on the prevalence of the different kinds of disorders they're talking about. In a lot of ways, it's informed by the research that other people are doing, but particularly the research that's done within a clinical setting, since a lot of the issues that it's dealing with are ones that are not necessarily as prevalent in the wider society.

So how does the DSM actually work? Well, there are about 250 different mental disorders that are inside of the DSM-IV. And they're organized into different categories. For example, anxiety disorders are all put together. And then these different categories are further organized into five different axes.

So let's look at each one individually. Axis I is what we call clinical disorders. And this is basically all of the mental disorders you can think of, things like anxiety disorders like I said, or mood disorders like depression. Basically everything except for the second category, which is personality disorders and mental retardation. And again, these are different types of disorders. Personality disorders are things like antisocial personality disorder. It could also be mental retardation issues that you might be dealing with specifically.

Axis III is what we call general medical conditions, which is to say they're physical conditions that can have some kind of an effect on one of the disorders that was talked about in either Axis I or II, something like some kind of brain injury that might exacerbate one of these other problems. Axis IV is psychosocial and environmental problems, which is to say anything that's social or environmental that might influence any of the other mental disorders, things like if there's unemployment or divorce. Or if somebody has a limited social support, then that might further exacerbate some of these other issues, kind of like what category III was talking but, but instead we're looking outside of the body as opposed to in.

And finally Axis V is what we call global assessment of functioning. And that seems like a large term. It basically means we're testing and rating the different psychological and social functionings so that the clinician, the mental health expert, can better understand what's going on with the individual. So this is kind to help to assess what's going on with all of the other different categories.

Now, the actual disorders and the way they're organized inside of each one of these axes uses a sort of operational definition. And that means that the disorder is defined by how it's measured, using some kind of process or a set of requirements to tell you when a person does or doesn't have this. For example, it might list the different kinds of symptoms that a different disorder might have, and then what are the requirements for that. Like you might need five out of seven of the list of disorders, the listed symptoms, to actually be considered to have that kind of disorder. And we'll talk more about the specifics of each of these a little bit later on in the course when we get to clinical psychology.

The DSM is the most accepted form of classifying mental disorders. It's definitely not without its controversy. So let's talk a bit about that.

One of the more important controversial points about the DSM is the effect that labeling can have on individuals with mental disorders. Now ideally, applying a label to somebody is meant to be a way to identify that they have a particular problem and to treat them more effectively. It's not meant to be a way of grouping individuals and marginalizing groups that have particular disorders.

However, once you apply a label to somebody or to a group of people, oftentimes there's a stigma attached to that group or that label. So somebody who has depression, someone who's been labeled as depressive, might start to consider themselves as a result of that label to be a different, inherently bad or dysfunctional type of person, which could further some of their mental health issues. So that's something to consider when we diagnose people.

Another issue to consider is the fact that sometimes what we consider to be a disorder might not necessarily be as much of a problem as we originally thought. An example of this is that in the DSM-III, homosexuality was actually considered to be a mental disorder. It was listed inside of it. It wasn't until 1975 when it was finally removed. But up until that point, a lot of mental health professionals considered homosexuality to be pathological, to be a sort of disease. So it's important to recognize this and to realize what a mental disorder really is.

Terms to Know
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)- Fourth Edition, Text Revision

Published by the APA as the major system of classification of mental disorders; provides a standardized criteria for identification, diagnosis and classification based on cumulative research within the field.