2 Classification and Assessment in Clinical Psychology
LEARNING GOAL 5
Describe the Diagnostic and Statistical Manual of Mental Disorders, including its development and
its limitations
2.1 CLASSIFYING PSYCHOPATHOLOGY
Why classification?
1. Categorisation and classification is an important
first stage in the pursuit of knowledge about
causes and aetiology, → understand how
different causes relate to different symptoms.
2. classification systems provide a common language for reporting and monitoring different
mental health problems which allows the world to share and comparICDe data in a
consistent way
3. One important and objective way of determining whether an individual is responding to
treatment is to see if there has been any improvement in objectively defined and
measurable symptoms
‘why try to define and classify psychopathology at all?’
1. psychology will want to try to understand the causes of mental health problems. This is
important so that we can develop effective treatments that address the root causes of
psychopathology and also develop prevention strategies
What are 2 types of classification?
1) Categoric vs dimensional
2) Monothetic vs Polythetic
• Monothetic: list of symptoms that are both necessary and sufficient for diagnosis
• Polythetic: list of symptoms + the number of symptoms a person must have to be
diagnosed
DSM 5 is poythetic→ refers to the fact that in order to be diagnosed with a personality disorder, a
person must meet a certain number of symptom criteria from a defined criteria set.
2.1.1 The Development of Classification Systems
Kraepelin->Syndrome
Emil Kraepelin (1883–1923). →German psychiatrist, arguably the first person to develop a
comprehensive classification system for psychopathology
• He suggested that psychopathology, like physical illness, could be classified into different
and separate pathologies, each of which had a different cause and could be described by a
distinct set of symptoms that he called a syndrome.
• Kraepelin’s work provided some hope that mental illness could be described and
successfully treated in much the same way as other medical illnesses.
World Health Organization (WHO) (1939)
Following on from Kraepelin’s scheme, the first extensive system for classifying psychopathology
was developed by the World Health Organisation (WHO), which added psychological disorders to
the International List of Causes of Death (ICD)
, From ICD to DSM (1952)
the mental disorders section in the ICD was not widely
accepted, and the American Psychiatric Association
(APA) published its first Diagnostic and Statistical
Manual (DSM) -extended version pf ICD
Diagnostic and Statistical Manual (DSM)→First
published in 1952 by the American Psychiatric
Association (APA), the DSM extended the World Health
Organisation’s (WHO) International List of Causes of
Death (ICD) classification system to include a more
widely accepted section on mental disorders.
2.1.2 DSM-5 Defining and diagnosing psychopathology
How does DSM-5 define what it considers to be a mental disorder?
DSM does make some attempt to rule out behaviours that are simply socially deviant as examples
of psychopathology and puts the emphasis on distress and disability as important defining
characteristics
4 objectives that define what exactly the DSM system is designed to do?
1. it must provide necessary and sufficient criteria for correct differential diagnosis
2. it should provide a means of distinguishing ‘true’ psychopathology (in the medical or
dysfunctional sense) from non-disordered human conditions that are often labelled as
everyday ‘problems in living’
3. it should provide diagnostic criteria in a way that allows them to be applied systematically
by different clinicians in different settings
4. the diagnostic criteria it provides should be theoretically neutral, in the sense that they do
not favour one theoretical approach to psychopathology over another
Which 4 features are provided by the DSM classification
systems?
1. essential features of the disorder (those that
‘define’ the disorder and allow for consistent
diagnosis across clinicians
2. associated features (i.e. those that are usually,
but not always present)
3. diagnostic criteria (a list of symptoms that must
be present for the patient to be given this
diagnostic label),
4. information on differential diagnosis (i.e. information on how to differentiate this disorder
from other, similar disorders)
diagnosis is made almost entirely on the basis of observable behavioural symptoms rather than
any supposition about the underlying cause of the symptoms
• General problems with classification
What are 4 problems with the classification of symptoms?
, 1. DSM does not classify psychopathology
according to its causes, but does so merely on
the basis of symptoms
2. simply using DSM criteria to label people with a
disorder can be stigmatising and harmful
3. DSM diagnostic classification tends to define
disorders as discrete entities. However, much
recent evidence has begun to suggest that
psychopathology may be dimensional rather
than discrete
4. Comorbidity→The co-occurrence of two or more distinct psychological disorders.
How are disorders therefore defined as?
hybrid disorders→Disorders that contain elements of a
number of different disorders.
disorder spectrum→The frequency of comorbidity
suggests that most disorders as defined by DSM may
indeed not be independent discrete disorders, but may
represent symptoms of a disorder spectrum that
represents a higher-order categorical class of symptoms.
• psychopathology may occur in a spectrum that
has a hierarchical structure rather than
consisting merely of numerous discrete disorders
An example of a hybrid disorder
mixed anxiety-depressive disorder→ many people exhibit symptoms of both anxiety and
depression, yet do not meet the threshold for either an anxiety or a depression diagnosis
The ‘hodgepodge’ view
• The current list of mental disorders certainly constitutes a hodgepodge collection. Some describe short-term
states, others life-long personality. Some reflect inner misery, others bad behaviour. Some represent problems
rarely or never seen in normals, others are just slight accentuations of the everyday. Some reflect too little
self-control, others too much. Some are quite intrinsic to the individual; others are defined against varying and
changing cultural mores and stressors. Some begin in infancy, others in old age. Some affect primarily thought;
others emotions, behaviors, or interpersonal relations; and there are complex combinations of all these. Some
seem more biological, others more psychological.
• Egosyntonic (psychodynamic)= in harmony with personality
• Changes in DSM-5
What are the main changes between DSM-5 and its predecessor (DSM-IV-TR)?
LEARNING GOAL 5
Describe the Diagnostic and Statistical Manual of Mental Disorders, including its development and
its limitations
2.1 CLASSIFYING PSYCHOPATHOLOGY
Why classification?
1. Categorisation and classification is an important
first stage in the pursuit of knowledge about
causes and aetiology, → understand how
different causes relate to different symptoms.
2. classification systems provide a common language for reporting and monitoring different
mental health problems which allows the world to share and comparICDe data in a
consistent way
3. One important and objective way of determining whether an individual is responding to
treatment is to see if there has been any improvement in objectively defined and
measurable symptoms
‘why try to define and classify psychopathology at all?’
1. psychology will want to try to understand the causes of mental health problems. This is
important so that we can develop effective treatments that address the root causes of
psychopathology and also develop prevention strategies
What are 2 types of classification?
1) Categoric vs dimensional
2) Monothetic vs Polythetic
• Monothetic: list of symptoms that are both necessary and sufficient for diagnosis
• Polythetic: list of symptoms + the number of symptoms a person must have to be
diagnosed
DSM 5 is poythetic→ refers to the fact that in order to be diagnosed with a personality disorder, a
person must meet a certain number of symptom criteria from a defined criteria set.
2.1.1 The Development of Classification Systems
Kraepelin->Syndrome
Emil Kraepelin (1883–1923). →German psychiatrist, arguably the first person to develop a
comprehensive classification system for psychopathology
• He suggested that psychopathology, like physical illness, could be classified into different
and separate pathologies, each of which had a different cause and could be described by a
distinct set of symptoms that he called a syndrome.
• Kraepelin’s work provided some hope that mental illness could be described and
successfully treated in much the same way as other medical illnesses.
World Health Organization (WHO) (1939)
Following on from Kraepelin’s scheme, the first extensive system for classifying psychopathology
was developed by the World Health Organisation (WHO), which added psychological disorders to
the International List of Causes of Death (ICD)
, From ICD to DSM (1952)
the mental disorders section in the ICD was not widely
accepted, and the American Psychiatric Association
(APA) published its first Diagnostic and Statistical
Manual (DSM) -extended version pf ICD
Diagnostic and Statistical Manual (DSM)→First
published in 1952 by the American Psychiatric
Association (APA), the DSM extended the World Health
Organisation’s (WHO) International List of Causes of
Death (ICD) classification system to include a more
widely accepted section on mental disorders.
2.1.2 DSM-5 Defining and diagnosing psychopathology
How does DSM-5 define what it considers to be a mental disorder?
DSM does make some attempt to rule out behaviours that are simply socially deviant as examples
of psychopathology and puts the emphasis on distress and disability as important defining
characteristics
4 objectives that define what exactly the DSM system is designed to do?
1. it must provide necessary and sufficient criteria for correct differential diagnosis
2. it should provide a means of distinguishing ‘true’ psychopathology (in the medical or
dysfunctional sense) from non-disordered human conditions that are often labelled as
everyday ‘problems in living’
3. it should provide diagnostic criteria in a way that allows them to be applied systematically
by different clinicians in different settings
4. the diagnostic criteria it provides should be theoretically neutral, in the sense that they do
not favour one theoretical approach to psychopathology over another
Which 4 features are provided by the DSM classification
systems?
1. essential features of the disorder (those that
‘define’ the disorder and allow for consistent
diagnosis across clinicians
2. associated features (i.e. those that are usually,
but not always present)
3. diagnostic criteria (a list of symptoms that must
be present for the patient to be given this
diagnostic label),
4. information on differential diagnosis (i.e. information on how to differentiate this disorder
from other, similar disorders)
diagnosis is made almost entirely on the basis of observable behavioural symptoms rather than
any supposition about the underlying cause of the symptoms
• General problems with classification
What are 4 problems with the classification of symptoms?
, 1. DSM does not classify psychopathology
according to its causes, but does so merely on
the basis of symptoms
2. simply using DSM criteria to label people with a
disorder can be stigmatising and harmful
3. DSM diagnostic classification tends to define
disorders as discrete entities. However, much
recent evidence has begun to suggest that
psychopathology may be dimensional rather
than discrete
4. Comorbidity→The co-occurrence of two or more distinct psychological disorders.
How are disorders therefore defined as?
hybrid disorders→Disorders that contain elements of a
number of different disorders.
disorder spectrum→The frequency of comorbidity
suggests that most disorders as defined by DSM may
indeed not be independent discrete disorders, but may
represent symptoms of a disorder spectrum that
represents a higher-order categorical class of symptoms.
• psychopathology may occur in a spectrum that
has a hierarchical structure rather than
consisting merely of numerous discrete disorders
An example of a hybrid disorder
mixed anxiety-depressive disorder→ many people exhibit symptoms of both anxiety and
depression, yet do not meet the threshold for either an anxiety or a depression diagnosis
The ‘hodgepodge’ view
• The current list of mental disorders certainly constitutes a hodgepodge collection. Some describe short-term
states, others life-long personality. Some reflect inner misery, others bad behaviour. Some represent problems
rarely or never seen in normals, others are just slight accentuations of the everyday. Some reflect too little
self-control, others too much. Some are quite intrinsic to the individual; others are defined against varying and
changing cultural mores and stressors. Some begin in infancy, others in old age. Some affect primarily thought;
others emotions, behaviors, or interpersonal relations; and there are complex combinations of all these. Some
seem more biological, others more psychological.
• Egosyntonic (psychodynamic)= in harmony with personality
• Changes in DSM-5
What are the main changes between DSM-5 and its predecessor (DSM-IV-TR)?
