A Classification System DSMIV

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Classifying Psychological Disorders
TA B L E
12.1
Explanatory Domain
Possible Contributing Factors
Neurobiological/medical
José may have organic disorders (e.g., genetic tendency toward anxiety; brain tumor, endocrine dysfunction; neurotransmitter imbalance).
Psychological: psychodynamic
José has unconscious conflicts and desires. Instinctual impulses are breaking through ego defenses
into consciousness, causing panic.
Psychological: social-cognitive
Physical stress symptoms are interpreted as signs of
serious illness or impending death. Panic is rewarded by avoidance of work stress and the opportunity
to stay home.
Psychological: humanistic
José fails to recognize his genuine feelings about
work and his place in life, and he fears expressing
himself.
Sociocultural
A culturally based belief that “a man should not
show weakness” amplifies the intensity of stress
reactions and delays José’s decision to seek help.
Diathesis-stress summary
José has a biological (possibly genetic) predisposition to be overly responsive to stressors. The stress
of work and extra activity exceeds his capacity to
cope and triggers panic as a stress response.
Explaining Psychopathology
Here are the factors that would be highlighted by the biopsychosocial model in the
case of José, the man described at the
beginning of this chapter. At the bottom
is a summary of how these factors might
be combined within a diathesis-stress
framework.
features that differs from those shared by people in other categories could provide clues
about which features are related to the development of each disorder.
In 1952 the American Psychiatric Association published the first edition of what has
become the “official” North American diagnostic classification system, the Diagnostic
and Statistical Manual of Mental Disorders (DSM). Each edition of the DSM has
included more categories. The latest editions, DSM-IV and DSM-IV-TR (text revision),
include more than 300 specific diagnostic labels (American Psychiatric Association,
1994, 2000). Mental health professionals outside North America diagnose mental disorders using classification systems that appear in the tenth edition of the World Health
Organization’s International Classification of Diseases (ICD-10) and its companion volume, the second edition of the International Classification of Impairments, Disabilities
and Handicaps (ICIDH-2). To facilitate international communication about—and
cross-cultural research on—psychopathology, DSM-IV was designed to be compatible
with these manuals, and efforts are under way to remove inconsistencies existing
between the systems (DeAngelis, 2001; Ottosson et al., 2002).
A Classification System: DSM-IV
DSM-IV describes the patterns of thinking, emotion, and behavior that define various
mental disorders. For each disorder, DSM-IV provides specific criteria outlining the conditions that must be present before a person is given that diagnostic label. In keeping with
the biopsychosocial model, diagnosticians using DSM-IV can evaluate troubled people on
five dimensions, or axes (the plural of axis). Together, these axes provide a broad picture
of each person’s biological and psychological problems, as well as of any sociocultural
context factors that might contribute to them. As shown in Table 12.2, mental disorders
such as schizophrenia or major depressive disorder are recorded on Axis I, whereas evidence of personality disorders or mental retardation is noted on Axis II. Any medical conditions that might be important in understanding the person’s cognitive, emotional, or
behavioral problems are listed on Axis III. On Axis IV, the diagnostician notes any
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TA B L E
Chapter 12 Psychological Disorders
12.2
The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric
Association
Axis I of the fourth edition (DSM-IV ) lists the major categories of mental disorders. Personality disorders and mental retardation are listed
in Axis II.
Axis I (Clinical Syndromes)
1. Disorders usually first diagnosed in infancy, childhood, or
adolescence. Problems such as hyperactivity, childhood fears,
conduct disorders, frequent bed-wetting or soiling, and other
problems in normal social and behavioral development.
Autistic spectrum disorders (severe impairment in social,
behavioral, and language development), as well as learning
disorders.
2. Delirium, dementia, and amnesic and other cognitive disorders. Problems caused by physical deterioration of the
brain due to aging, disease, drugs or other chemicals, or other
possible unknown causes. These problems can appear as an
inability to “think straight” (delirium) or as loss of memory
and other intellectual functions (dementia).
3. Substance-related disorders. Psychological, behavioral,
physical, social, or legal problems caused by dependence on,
or abuse of, a variety of chemical substances, including alcohol, heroin, cocaine, amphetamines, hallucinogens, marijuana,
and tobacco.
4. Schizophrenia and other psychotic disorders. Severe conditions characterized by abnormalities in thinking, perception,
emotion, movement, and motivation that greatly interfere
with daily functioning. Problems involving false beliefs
(delusions).
5. Mood disorders (also called affective disorders). Severe
disturbances of mood, especially depression, overexcitement
(mania), or alternating episodes of each extreme (as in
bipolar disorder).
6. Anxiety disorders. Specific fears (phobias); panic attacks;
generalized feelings of dread; rituals of thought and action
(obsessive-compulsive disorder) aimed at controlling anxiety;
and problems caused by traumatic events, such as rape or
military combat (see the chapter on health, stress, and coping
for more on posttraumatic stress disorder).
7. Somatoform disorders. Physical symptoms, such as paralysis
and blindness, that have no physical cause. Unusual
preoccupation with physical health or with nonexistent
physical problems (hypochondriasis, somatization disorder,
pain disorder).
8. Factitious disorders. False mental disorders that are intentionally produced to satisfy some psychological need.
9. Dissociative disorders. Psychologically caused problems
of consciousness and self-identification—e.g., loss of memory (amnesia) or the development of more than one identity (multiple personality).
10. Sexual and gender identity disorders. Problems of (a) finding sexual arousal through unusual objects or situations
(like shoes or exposing oneself ), (b) unsatisfactory sexual
activity (sexual dysfunction; see the chapter on motivation
and emotion), or (c) identifying with the opposite gender.
11. Eating disorders. Problems associated with eating too little
(anorexia nervosa) or binge eating followed by self- induced
vomiting (bulimia nervosa). (See the chapter on motivation
and emotion.)
12. Sleep disorders. Severe problems involving the sleep-wake
cycle, especially an inability to sleep well at night or to stay
awake during the day. (See the chapter on consciousness.)
13. Impulse control disorders. Compulsive gambling, stealing,
or fire setting.
14. Adjustment disorders. Failure to adjust to, or deal well with,
such stressors as divorce, financial problems, family discord,
or other unhappy life events.
Axis II (Personality Disorders and Mental Retardation)
1. Personality disorders. Diagnostic labels given to individuals
who may or may not receive an Axis I diagnosis but who
show lifelong behavior patterns that are unsatisfactory to
them or that disturb other people. These patterns may
involve unusual suspiciousness, unusual ways of thinking,
self-centeredness, shyness, overdependency, excessive
concern with neatness and detail, or overemotionality,
among others.
2. Mental retardation. As described in the chapter on
thought, language, and intelligence, the label of “mental
retardation” is applied to individuals whose measured IQ is
less than about 70 and who fail to display the skills at daily
living, communication, and other tasks expected of people
their age.