Abnormal Psychology in a Changing World SEVENTH EDITION Jeffrey S. Nevid / Spencer A. Rathus / Beverly Greene Chapter 3 (Pp 69-77) Classification and Assessment of Abnormal Behavior HOW ARE ABNORMAL BEHAVIOR PATTERNS CLASSIFIED? The DSM was introduced in 1952. The latest version, published in 2013, is the DSM-5. Another common system of classification, published by the World Health Organization, is used mainly for compiling statistics on the worldwide occurrence of disorders: the International Statistical Classification of Diseases and Related Health Problems (ICD), which is now in its tenth revision (the ICD-10). The DSM-V is compatible with the ICD, so that DSM diagnoses could be coded in the ICD system as well. HOW ARE ABNORMAL BEHAVIOR PATTERNS CLASSIFIED? In its third edition, the CCMD (Chinese Classification of Mental Disorders) maintains a focus on issues that are of interest to Chinese culture. Some disorders identified in the ICD-10 and the DSM-5 that are not common in China (ie, anorexia nervosa) are left out; others are included that appear to be culture-bound disorders (ie, ego-dystonic homosexuality). The DSM and Models of Abnormal Behavior The DSM system, like the medical model, treats abnormal behaviors as signs or symptoms of underlying disorders or pathologies. However, the DSM does not assume that abnormal behaviors necessarily reflect biological causes or defects. The authors of the DSM recognize that their use of the term mental disorder is problematic because it perpetuates a long-standing but dubious distinction between mental and physical disorders. Features of the DSM The DSM is descriptive, not explanatory. It describes the diagnostic features—or, in medical terms, symptoms—of abnormal behaviors. It does not attempt to explain their origins or adopt any particular theoretical framework, such as psychodynamic or learning theory. Features of the DSM The DSM IV recommended that clinicians assess an individual’s mental state according to five factors, or axes. Together the five axes provide a broad range of information about the individual’s functioning, not just a diagnosis. The system contained the following axes (see textbook): Axis I Axis II Axis III Axis IV Axis V Clinical Disorders and Other Conditions That May Be a Focus of Clinical Attention. Personality Disorders and Mental Retardation. General Medical Conditions. Psychosocial and Environmental Problems. Global Assessment of Functioning. THE DSM-5 HAS MOVED TO A NONAXIAL DCUMENTATION OF DIAGNOSIS Features of the DSM Features of the DSM Culture-Bound Syndromes Culture-bound syndromes - Patterns of abnormal behavior found within only one or a few cultures. Culture-bound syndromes may reflect exaggerated forms of common folk superstitions and belief patterns within a particular culture. Culture-bound syndromes in the United States include anorexia nervosa and dissociative identity disorder (formerly called multiple personality disorder). Culture and Psychology • If all abnormal behaviors were entirely etic in their expression and presentation, then creating reliable and valid diagnostic categories would not be a problem • DSM-5 does not require an assessment of cultural elements that may be necessary to recognize and classify a culture-bound syndrome • Local diagnostic systems (CCMD) have been created to address the problem of the lack of cultural considerations in the assessment of mental disorders Culture and Psychology • It can be difficult to use a psychological assessment from one culture to another • Overpathologizing and underpathologizing can be problems if a clinician does not understand a person’s culture Evaluating the DSM System To be useful, a diagnostic system such as the DSM must demonstrate reliability and validity. Reliability - In psychological assessment, the consistency of a measure or diagnostic instrument or system. Validity - The degree to which a test or diagnostic system measures the traits or constructs it purports to measure. Advantages and Disadvantages of the DSM System The major advantage of the DSM may be its designation of specific diagnostic criteria. Critics challenge the utility of particular symptoms or features associated with particular syndromes or of specified diagnostic criteria. Another concern is that the medical model focuses on categorizing psychological (or mental) disorders rather than describing people’s behavioral strengths and weaknesses. Advantages and Disadvantages of the DSM System Critics also complain that the DSM system might stigmatize people by labeling them with psychiatric diagnoses. Sanism - The negative stereotyping of people who are identified as mentally ill. The DSM system, despite its critics, has become part and parcel of the everyday practice of most U.S. mental health professionals. What are some possible consequences of being labeled with a “mental illness”? A Continuum of Mental Illness (Dr. Tom Burish, 1977) Normal Neurotic Psychotic The End!