Classification Systems

Question 1

DSM (diagnostic and statistic manual of mental disorders)

Answer 1

• american psychiatric association in 1952 (DSM I), now in its revised 5th edition
• each revision is done with the aim of making diagnosis more reliable
• disorders are added and removed over time, revision is done to reflect changing sociocultural and political norms

Question 2

DSM I 1952

Answer 2

• homosexuality was listed as a mental disorder
• heavily grounded on psycholanalytic abilities (lacks empirical evidence)
• assumed origins of behavior are from childhood trauma

Question 3

DSM II 1968

Answer 3

• behaviorists criticised the use of non-observable constructs (eg: trauma, motivation)
• anti-psychiatry movement emerged (Szasz 1960 said mental health was a myth)
• in 1974 homosexuality was removed as a mental illness because of gay-rights activists

Question 4

DSM III 1980

Answer 4

• 265 diagnostic categories organized in 5 groups (axes) - called multi-axial system
• shift from psychoanalytics - observing mental disorders rather than explaining them

Question 5

DSM IV 1994

Answer 5

Major change was clinical significance criteria: individual has to exhibit clinical impairment or significant distress in daily functioning to be diagnosed with a disorders
- done to reduce overmedicalisation
- gives an account of the broad range of information about the patient’s mental state through Medical Screening Examination
- 5 dimensions

Question 6

5 dimensions

Answer 6

1) Clinical disorders - patterns of behavior that impair function
2) Personality disorders - rigid patterns of maladaptive behavior that become a part of the person’s personality
3) General medical conditions
4) Psychosocial and environmental porblems
5) Global assessment of functioning

Question 7

DSM V 2013

Answer 7

• Roman to Arabic numerals
• multi axial system removed, said that groups were artificial, similar disorders said to be brought apart

Question 8

key criticisms of DSM V

Answer 8

• all task-form members involve din revision had to sign non-disclosure agreement so it was conducted in relative secrecy leading to suspicion of influence by pharmaceutical industry
• failure to take seriously the false positives problem

Question 9

Chinese classification of mental disorders (1979)

Answer 9

• has not generalized far outside Chinese territory - in its 3rd edition (1985)
• inclusion of culturally distinct categories - modified better to reflect cultural realities
• has over 40 unique culturally related disorders
• disorders identified in DSM and ICD can be left out and specific to China included
• written partially due to issues with translation from ICD

Question 10

key criticism of CCMD

Answer 10

• used as a tool to politicize psychiatry (psychiatric hospitals over looked by China’s Ministry of Public Security rather than health ministry)

Question 11

kleinman (1982)

Answer 11

aim - to investigate if neurasthania in China would be similar to depression is DSM-III

Method: Kleinman interviewed 100 patients diagnosed with neurasthania using structured interviews based off of DSM III diagnostic criteria

Results - 80% could be classified as having depression; 90% complained of headaches, 78% of insomnia, 73% of dizziness, 48% of various pains. Depressed mood was only a complaint in 9% of cases.

Evaluation - neurasthania could be Chinese way of expressing depression in somatic ways as patients majorly had physical symptoms
- difficult to compare to Western data because patients don’t make the same complaints, shows a concern of cross-cultural diagnosis. Somatization may be cultural mode of stress in China, while in West common mode of stress is psychologization

Strength - CCMD increases cultural validity by including terms like neurasthania, cultural context prevents stigmatization and labels in relation to DSM
Weakness - Lack of cross cultural validity as the disorder is classified differently in DSM