Unit 4 Section A Clinical Psychology
D efinitions and Debates in diagnosis
8.1.1 DEFINITIONS OF ABNORMALITY
Thomas Szasz: “There is no such thing as abnormality, only problems with living. Abnormality is
a sane reaction to an insane world and psychiatry is a tool to control difficult people”.
Statistical Infrequency
A person's trait, thinking or behaviour is classified as abnormal if it is rare or statistically
unusual. With this definition it is necessary to be clear about how rare a trait or behaviour needs to
be before we class it as abnormal. For instance, one may say that an individual who has an IQ
below or above the average level of IQ in society is abnormal.
Statistical norms are established using a normal
distribution curve which illustrates the fact the most people
(approx. 95%) score between one and two standard
deviations above or below the mean. This leaves just over
5% of people who score usually high/low (more than/less
than 2SDs from the mean) and these people would be
classed as abnormal because they are not typical of most
people. Schizophrenia is suffered by 1% of people, 99% do
not have the condition and therefore by statistical
standards it is rare and thus abnormal.
Strengths Weaknesses
The statistical approach helps to address what Fails to distinguish between desirable and
is meant by normal in a statistical context. It undesirable behaviour, e.g. obesity is
helps us objectively make cut – off points in statistically normal but not associated with
terms of diagnosis. healthy or desirable. Conversely, high IQ is
statistically abnormal, but may well be
regarded as highly desirable.
The decision of where to start the "abnormal"
classification is arbitrary. Who decides what is
statistically rare and how do they decide? For
example, if an IQ of 70 is the cut-off point, how
can we justify saying someone with 69 is
abnormal, and someone with 70 normal?
Some characteristics are regarded as abnormal
even though they are quite frequent.
Depression may affect 27% of elderly people
(NIMH, 2001). This would make it common
but that does not mean it isn’t a problem →
what is normal statistically may be also
abnormal and vice versa.
Ignores any individual experience
1
,Unit 4 Section A Clinical Psychology
Failure to Function Adequately
Failure to function adequately is a definition of abnormality where a person is considered
abnormal if they are unable to cope with the demands of everyday life, or experience personal
distress. They may be unable to perform the behaviours necessary for day-to-day living e.g. self-
care, hold down a job, interact meaningfully with others, make themselves understood etc.
Rosenhan & Seligman (1989) suggest the following characteristics that define failure to function
adequately:
Name of feature Meaning Example
1 Suffering Recognition of your own personal Depression
distress
2 Maladaptiveness Behaviour interferes with the ability to Substance abuse
lead a normal life
3 Vividness and Unusual behaviours OCD; Bipolar
unconventionality
4 Unpredictability and loss Behaviour is unpredictable, does not fit Psychosis - loosing
of control the situation, unexpected + sense of reality
uncontrolled
5 Irrationality and Behaviour that does not make sense to Psychosis; Phobia
incomprehensibility others
6 Causes observer An observer who watches mentally ill
discomfort person makes it uncomfortable
7 Violates moral/social Anything that goes against social norms Inappropriate
standards reaction, e.g. Laughing
at bad news
Strengths Weaknesses
Takes into account individual experience Subjective → who decides you’re not
functioning adequately
You can fail to function adequately but you are
not mentally ill → e.g. grieving
Vice versa → function adequately but being
mentally ill, e.g. psychopathy (a person does
not recognise a problem; it does not interfere
with day-to-day life)
Ethnocentric → cultural social situation is not
taken into account
2
, Unit 4 Section A Clinical Psychology
8.1.2 CLASSIFICATION SYSTEMS
ICD (ICD10,11) & DSM (DSM4,5)
International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental
Disorders DSM are systems that identify and classify diseases once the diagnosis is established.
ICD and DSM are identical in some ways and differ in others. However, both systems represent
codes and manual for diseases which provide medical informatics such as automated decision
support, claims process in medical billing, statistics on morbidity & mortality, surveying epidemic
outbreak, etc. as well as for clinical purposes such as treatment, and welfare of public health.
ICD:
• It is a globally accepted convention for classifying the illnesses and a complete system that covers
all illness documented in the world. ICD is used for health management, epidemiology, and for
various other clinical purposes. This system is maintained by World Health Organisation by
accounting all conditions, disorders, and diseases in the WHO member nations.
• Revision is a periodical process. Initially, the system was designated to be revised once in every
decade. However, it became clear that the time between two successive revisions was rather
short. ICD-10, updated in 1994, is the current version which provides classifications for more
than 155,000 codes. It was swiftly adopted across the world with resources readily accessible in
the form of manual and browser from the WHO. A customised version of ICD-10 was adopted by
Australia, New Zealand, and Canada.
• Currently, WHO is amidst revising ICD. The new version called ICD-11 is being authored using
iCAT (Collaborative authoring tool), an online workspace. After completing the review in 2015, a
final draft was planned for endorsement in 2017. However, it was deferred for approval from the
WHA (World Health Assembly) until 2018.
• ICD-11 contains codes and definitions in a language that is simple enough for humans to
understand. The new revisions permit computerisation of content which enhances its pliability
and applicability.
DSM:
• Diagnostic & Statistical Manual of Mental Disorder (DSM) is a handbook that provides criteria
for classifying clinical diagnosis, particularly ones associated with mental disorder. This system
offers a common language that helps medical professionals to make better healthcare decisions.
DSM is also useful in documenting and sharing patient diagnosis after successful evaluation.
• American Psychiatric Association (APA) is the organisation behind the publication of DSM
manual. DSM has a lesser recognition globally because this manual is only popular in the United
States and partially accepted across the world. The criteria included in the DSM manual are not
all-inclusive and therefore, its validity and reliability were’t bulletproof. However recently, the
system is somewhat believed to be accurate due to its practicality in general belief and research.
• Revision of the DSM is also a periodical process, and currently, the system is in the 5th edition
(DSM-5). It contains latest codes for all recognised mental disorders. The DSM publication helps
bring over $ 5 million annually to APA. The widespread use of DSM is still yet to become a reality
because the system is mostly considered bigoted and unscientific.
3
D efinitions and Debates in diagnosis
8.1.1 DEFINITIONS OF ABNORMALITY
Thomas Szasz: “There is no such thing as abnormality, only problems with living. Abnormality is
a sane reaction to an insane world and psychiatry is a tool to control difficult people”.
Statistical Infrequency
A person's trait, thinking or behaviour is classified as abnormal if it is rare or statistically
unusual. With this definition it is necessary to be clear about how rare a trait or behaviour needs to
be before we class it as abnormal. For instance, one may say that an individual who has an IQ
below or above the average level of IQ in society is abnormal.
Statistical norms are established using a normal
distribution curve which illustrates the fact the most people
(approx. 95%) score between one and two standard
deviations above or below the mean. This leaves just over
5% of people who score usually high/low (more than/less
than 2SDs from the mean) and these people would be
classed as abnormal because they are not typical of most
people. Schizophrenia is suffered by 1% of people, 99% do
not have the condition and therefore by statistical
standards it is rare and thus abnormal.
Strengths Weaknesses
The statistical approach helps to address what Fails to distinguish between desirable and
is meant by normal in a statistical context. It undesirable behaviour, e.g. obesity is
helps us objectively make cut – off points in statistically normal but not associated with
terms of diagnosis. healthy or desirable. Conversely, high IQ is
statistically abnormal, but may well be
regarded as highly desirable.
The decision of where to start the "abnormal"
classification is arbitrary. Who decides what is
statistically rare and how do they decide? For
example, if an IQ of 70 is the cut-off point, how
can we justify saying someone with 69 is
abnormal, and someone with 70 normal?
Some characteristics are regarded as abnormal
even though they are quite frequent.
Depression may affect 27% of elderly people
(NIMH, 2001). This would make it common
but that does not mean it isn’t a problem →
what is normal statistically may be also
abnormal and vice versa.
Ignores any individual experience
1
,Unit 4 Section A Clinical Psychology
Failure to Function Adequately
Failure to function adequately is a definition of abnormality where a person is considered
abnormal if they are unable to cope with the demands of everyday life, or experience personal
distress. They may be unable to perform the behaviours necessary for day-to-day living e.g. self-
care, hold down a job, interact meaningfully with others, make themselves understood etc.
Rosenhan & Seligman (1989) suggest the following characteristics that define failure to function
adequately:
Name of feature Meaning Example
1 Suffering Recognition of your own personal Depression
distress
2 Maladaptiveness Behaviour interferes with the ability to Substance abuse
lead a normal life
3 Vividness and Unusual behaviours OCD; Bipolar
unconventionality
4 Unpredictability and loss Behaviour is unpredictable, does not fit Psychosis - loosing
of control the situation, unexpected + sense of reality
uncontrolled
5 Irrationality and Behaviour that does not make sense to Psychosis; Phobia
incomprehensibility others
6 Causes observer An observer who watches mentally ill
discomfort person makes it uncomfortable
7 Violates moral/social Anything that goes against social norms Inappropriate
standards reaction, e.g. Laughing
at bad news
Strengths Weaknesses
Takes into account individual experience Subjective → who decides you’re not
functioning adequately
You can fail to function adequately but you are
not mentally ill → e.g. grieving
Vice versa → function adequately but being
mentally ill, e.g. psychopathy (a person does
not recognise a problem; it does not interfere
with day-to-day life)
Ethnocentric → cultural social situation is not
taken into account
2
, Unit 4 Section A Clinical Psychology
8.1.2 CLASSIFICATION SYSTEMS
ICD (ICD10,11) & DSM (DSM4,5)
International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental
Disorders DSM are systems that identify and classify diseases once the diagnosis is established.
ICD and DSM are identical in some ways and differ in others. However, both systems represent
codes and manual for diseases which provide medical informatics such as automated decision
support, claims process in medical billing, statistics on morbidity & mortality, surveying epidemic
outbreak, etc. as well as for clinical purposes such as treatment, and welfare of public health.
ICD:
• It is a globally accepted convention for classifying the illnesses and a complete system that covers
all illness documented in the world. ICD is used for health management, epidemiology, and for
various other clinical purposes. This system is maintained by World Health Organisation by
accounting all conditions, disorders, and diseases in the WHO member nations.
• Revision is a periodical process. Initially, the system was designated to be revised once in every
decade. However, it became clear that the time between two successive revisions was rather
short. ICD-10, updated in 1994, is the current version which provides classifications for more
than 155,000 codes. It was swiftly adopted across the world with resources readily accessible in
the form of manual and browser from the WHO. A customised version of ICD-10 was adopted by
Australia, New Zealand, and Canada.
• Currently, WHO is amidst revising ICD. The new version called ICD-11 is being authored using
iCAT (Collaborative authoring tool), an online workspace. After completing the review in 2015, a
final draft was planned for endorsement in 2017. However, it was deferred for approval from the
WHA (World Health Assembly) until 2018.
• ICD-11 contains codes and definitions in a language that is simple enough for humans to
understand. The new revisions permit computerisation of content which enhances its pliability
and applicability.
DSM:
• Diagnostic & Statistical Manual of Mental Disorder (DSM) is a handbook that provides criteria
for classifying clinical diagnosis, particularly ones associated with mental disorder. This system
offers a common language that helps medical professionals to make better healthcare decisions.
DSM is also useful in documenting and sharing patient diagnosis after successful evaluation.
• American Psychiatric Association (APA) is the organisation behind the publication of DSM
manual. DSM has a lesser recognition globally because this manual is only popular in the United
States and partially accepted across the world. The criteria included in the DSM manual are not
all-inclusive and therefore, its validity and reliability were’t bulletproof. However recently, the
system is somewhat believed to be accurate due to its practicality in general belief and research.
• Revision of the DSM is also a periodical process, and currently, the system is in the 5th edition
(DSM-5). It contains latest codes for all recognised mental disorders. The DSM publication helps
bring over $ 5 million annually to APA. The widespread use of DSM is still yet to become a reality
because the system is mostly considered bigoted and unscientific.
3
