Now that you've learned about different methods of therapy, this lesson will discuss how to classify mental disorders.
The specific areas of focus include:
When classifying mental disorders, there are a variety of systems that can be used. However, there are two major systems to know:
The first method of classification is the ICD-16, or International Classification of Diseases, specifically Chapter 5.
This is a manual that's released by the World Health Organization, and is more internationally recognized.
The second method is the one that specifically concerns psychology in the United States. This is the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV.
This manual is put out by the American Psychiatric Association (APA). The DSM was originally released in 1952 in its first form, DSM-I.
The DSM-IV was released in 1994; since then, there's been a slight revision, so the DSM-IV-TR was published in the year 2000.
The DSM-IV is what is referred to as a non-theoretical type of classification, meaning that it doesn't subscribe to a specific theory.
Rather, it's more of a clinical-based approach that looks at the actual research done surrounding people with mental disabilities.
The DSM-IV provides symptoms and statistics that are based on the prevalence of the different types of disorders being discussed.
In a lot of ways, it's informed by the research that other people are doing, particularly the research being done within a clinical setting, as a lot of the issues that the DSM-IV deals with are not necessarily as prevalent in wider society.
There are about 250 different mental disorders discussed inside the DSM-IV, and they're organized into different categories (i.e., all anxiety disorders are in a category together).
a. Five Axes
These different categories are then further organized into five different axes:
Axis I is comprised of clinical disorders, such as anxiety or mood disorders, like depression. This basically includes all of the mental disorders you can think of except those classified under Axis II.
Axis II is comprised of personality disorders and mental retardation, as these are different than the disorders classified under Axis I. These are disorders such as antisocial personality disorder, or specific issues of mental retardation.
Axis III is comprised of general medical conditions, which are physical conditions that can have some type of effect on one of the disorders that's classified under either Axis I or II.
This would include a condition like a brain injury that might exacerbate one of these other problems.
Axis IV is comprised of psychosocial and environmental problems, which are any social or environmental occurrences that might influence any of the other mental disorders.
These are issues such as unemployment or divorce. Or if somebody has limited social support, then that might further exacerbate some of these other issues. In this way, Axis IV is a bit like Axis III, but is looking outside of the body as opposed to within.
Finally, Axis V is comprised of a global assessment of functioning. This basically means the testing and rating of the different psychological and social functions so that the clinician, or mental health expert, can better understand what's going on with the individual.
In other words, Axis V is meant to help assess the workings of the other four axes.
b. Operational Definitions
The actual disorders and the way they're organized inside each one of these axes use what are called operational definitions.
Operational definitions mean the disorder is defined by how it's measured, using a specific process or a set of requirements to determine whether a person has the disorder or not.
This can involve a list of the different symptoms a particular disorder might have, and then the requirements in number or type of symptoms to be diagnosed with that disorder.
For a particular disorder, a person might need five out of seven symptoms to be considered as having that disorder. This number is just an example; we will discuss more about the specifics of these requirements in later lessons on clinical psychology.
While the DSM is the most accepted form of classifying mental disorders, it's definitely not without controversy.
One of the more important controversial points about the DSM is the effect that labeling can have on individuals with mental disorders.
Ideally, applying a label to somebody is meant to be a way to identify that he or she has a particular problem in the interest of treating the person more effectively.
It's not meant to be a way of 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.
Someone who's been labeled as depressive might, as a result of that label, start to consider him or herself to be an inherently bad or dysfunctional type of person, which could exacerbate some of the mental health issues already in existence.
Another issue to consider when diagnosing people is the fact that sometimes what was at once considered to be a disorder might not actually be a psychological problem.
A specific instance of this was in the DSM-III, where homosexuality was actually listed as a mental disorder. It wasn't until 1975 that it was finally removed.
Up until that point, a lot of mental health professionals considered homosexuality to be pathological, or a sort of disease. Thus it's important to recognize that this kind of misclassification has happened, and to understand what a mental disorder really is.
In this lesson, you learned about two major systems of classification of mental disorders: the ICD-16 and the DSM-IV. While the ICD is more internationally recognized, the DSM is the system used in the United States. You also learned how the DSM works: disorders are classified using five axes, and then are given operational definitions for diagnosis.
You now understand that while the DSM is a very accepted form of classification, there are some issues with the DSM. Namely, labeling groups of people with disorders can cause those groups to become stigmatized. There have also been instances in which things that were not psychological disorders were mislabeled as such. Both of these issues are important to keep in mind when diagnosing mental disorders.
Source: Adapted from Sophia tutorial by Erick Taggart.
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.