A Classification System DSMIV
461 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 462 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.