Evaluate one classification system: DSM (16 Marks).
The DSM is produced by the APA which covers symptoms of over 300 disorders. The current version was
published in 2013, called the DSM-V. It has three sections. Section 1 includes guidance to the new
system, Section 2 details the disorders and categorises based on current understanding of underlying
causes and similarities between symptoms, and Section 3 it also includes suggestions of new disorders. It
also includes information about the impact of culture in terms of the way symptoms are presented and
communicated, especially when there is a cultural difference between the clinician and the patient.
One strength of the DSM-V is it has a good level of agreement between clinicians. For example, Reiger et
al (2013) report that disorders like PTSD have a very good kappa value of 0.60 to 0.79, while severe
diagnoses like schizophrenia have a 'good' kappa value of 0.40 to 0.59. This shows that clinicians had
adapted to the changes in terms of the numbers and specific symptoms required to make a diagnosis for
PTSD, for example, showing a good reliability of the DSM.
However, there is a weakness in terms of what counts as an acceptable level of agreement over the last
35 years. For example, Cooper (2014) explains that the DSM-V classified values as low as 0.2-0.4 as
acceptable, when one of the least reliable diagnoses of major depressive disorder is reported at 0.28 by
Reiger (2013). This shows that the DSM-V may not be as reliable since there were possible errors and
misses that they have overlooked. Despite that, Kupfer and Kraemer (2012) explain that in terms of the
changes in DSM-V clinicians were asked to work as they should be mirroring normal practice, while in
previous versions, like the DSM-III, clinicians were given detailed training and screened test clients. This
shows why DSM-V may have lower levels of reliability due to its natural and field trials.
In making a diagnosis using the DSM-V, clinicians gather information about an individual through
observation, but most likely through clinical interviews. Usually, they are unstructured, but some
symptoms may require a structured interview, such as the Beck Depression Inventory, which lists 21
questions. The process involves matching symptoms to what is written in the DSM to find the best-fit
diagnosis for the individual.
One strength is that there is evidence that supports the DSM-IV-TR. For example, Kim-Cohen (2005)
interviewed children and mothers, as well as performing observations and questionnaires in terms of the
children's anti-social behaviour, studying their conduct disorder (CD), which increases the concurrent
validity of the system. There is also good aetiological validity showing that factors like male, low income
and parental psychological disorders may have caused CD. Lastly, a good predictive validity of 5-year-old
children with CD would display more educational difficulties at age 7. This is important as it highlights that
an accurate diagnosis can help reduce adult mental health.
However, for some psychologists the DSM-V may lack validity. For example, the psychiatric diagnosis
does not tell the cause of a disorder. They argue that the classification system only puts label on
individuals and has nothing useful to answer reasons why. Therefore, the DSM may lack validity in terms
of understanding a disorder and symptoms.
In conclusion, the DSM-V has good reliability in terms of the level of agreement between clinicians;
however, the change over the years undermines the reliability of the classification system since kappa
values as low as 0.2-0.4 are deemed to be acceptable. Furthermore, it has good validity in terms of
Kim-Cohen, which can help predict and reduce adult mental health disorders, however the DSM lacks
explanation or real answers towards the cause of a disorder, decreasing its validity.
The DSM is produced by the APA which covers symptoms of over 300 disorders. The current version was
published in 2013, called the DSM-V. It has three sections. Section 1 includes guidance to the new
system, Section 2 details the disorders and categorises based on current understanding of underlying
causes and similarities between symptoms, and Section 3 it also includes suggestions of new disorders. It
also includes information about the impact of culture in terms of the way symptoms are presented and
communicated, especially when there is a cultural difference between the clinician and the patient.
One strength of the DSM-V is it has a good level of agreement between clinicians. For example, Reiger et
al (2013) report that disorders like PTSD have a very good kappa value of 0.60 to 0.79, while severe
diagnoses like schizophrenia have a 'good' kappa value of 0.40 to 0.59. This shows that clinicians had
adapted to the changes in terms of the numbers and specific symptoms required to make a diagnosis for
PTSD, for example, showing a good reliability of the DSM.
However, there is a weakness in terms of what counts as an acceptable level of agreement over the last
35 years. For example, Cooper (2014) explains that the DSM-V classified values as low as 0.2-0.4 as
acceptable, when one of the least reliable diagnoses of major depressive disorder is reported at 0.28 by
Reiger (2013). This shows that the DSM-V may not be as reliable since there were possible errors and
misses that they have overlooked. Despite that, Kupfer and Kraemer (2012) explain that in terms of the
changes in DSM-V clinicians were asked to work as they should be mirroring normal practice, while in
previous versions, like the DSM-III, clinicians were given detailed training and screened test clients. This
shows why DSM-V may have lower levels of reliability due to its natural and field trials.
In making a diagnosis using the DSM-V, clinicians gather information about an individual through
observation, but most likely through clinical interviews. Usually, they are unstructured, but some
symptoms may require a structured interview, such as the Beck Depression Inventory, which lists 21
questions. The process involves matching symptoms to what is written in the DSM to find the best-fit
diagnosis for the individual.
One strength is that there is evidence that supports the DSM-IV-TR. For example, Kim-Cohen (2005)
interviewed children and mothers, as well as performing observations and questionnaires in terms of the
children's anti-social behaviour, studying their conduct disorder (CD), which increases the concurrent
validity of the system. There is also good aetiological validity showing that factors like male, low income
and parental psychological disorders may have caused CD. Lastly, a good predictive validity of 5-year-old
children with CD would display more educational difficulties at age 7. This is important as it highlights that
an accurate diagnosis can help reduce adult mental health.
However, for some psychologists the DSM-V may lack validity. For example, the psychiatric diagnosis
does not tell the cause of a disorder. They argue that the classification system only puts label on
individuals and has nothing useful to answer reasons why. Therefore, the DSM may lack validity in terms
of understanding a disorder and symptoms.
In conclusion, the DSM-V has good reliability in terms of the level of agreement between clinicians;
however, the change over the years undermines the reliability of the classification system since kappa
values as low as 0.2-0.4 are deemed to be acceptable. Furthermore, it has good validity in terms of
Kim-Cohen, which can help predict and reduce adult mental health disorders, however the DSM lacks
explanation or real answers towards the cause of a disorder, decreasing its validity.
