Abnormal Psychology in a
Changing World
Jeffrey S. Nevid / Spencer A. Rathus / Beverly Greene
Chapter 3
(Pp 69-77)
Classification and
Assessment of
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.
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
The DSM system, like the medical model, treats abnormal
behaviors as signs or symptoms of underlying disorders or
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.
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
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)
The End!