Chapter 3: Classification and Diagnosis
Chapter 3 – Classification and Diagnosis
Chapter Overview
Classification and diagnosis is the heart of what most clinical psychologists do.
Without accurate diagnosis, one is unable to provide proper treatment, and the
patient is unable to assume an active role in their recovery. However,
classification of mental illness may contribute to stigma, helplessness, and in
some cases, secondary gain. Formal diagnostic criteria dates back to 1952
when the first DSM was published. While the fourth edition of the DSM has
come a long way, critics debate the rigidity and overemphasis on criteria. With
the release the DSM-5 in May 2013, many clinicians and researchers are divided
on the benefits and utility of this latest edition. Additionally, we must keep in mind
that the field of mental health continues to evolve and involves not just clinicians
and researchers, but patients, families, communities, and government. While
many may argue if we are better off with the DSM, without a classification system
to aid in diagnosis, we would have to rely on assessing individuals on important
dimensions of functioning, in particular internalizing and externalizing problems.
This chapter explores the positives and negatives of the DSM, diagnostic
reliability and validity, and other classification systems.
DSM Timeline

DSM-I: Diagnostic and Statistical Manual: Mental Disorders (1952)

DSM-I Special Supplement: on plans for revision to better align with the
International Classification of Diseases (1965)

DSM-II: Diagnostic and Statistical Manual of Mental Disorders, 2nd
Edition (1968)

DSM-II 6th printing change: Elimination of Homosexuality as a mental
disorder and substitution of the new category Sexual Orientation
Disturbance (1973)

DSM-III: Diagnostic and Statistical Manual of Mental Disorders, 3rd
Edition (1980)

DSM-III-R: Diagnostic and Statistical Manual of Mental Disorders, 3rd
Edition—Revised (1987)
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Chapter 3: Classification and Diagnosis

DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th
Edition (1994)

DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, 4th
Edition, Text Revision (2000)

DSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th
Edition (2013)
Chapter Contents

Introduction

Defining Abnormal Behavior and Mental Disorders


Developmental Psychopathology

Diagnosis

Defining Disorder

Prevalence of Mental Disorders

Understanding the Development of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
System


The Evolution of the DSM

The DSM-5
The International Statistical Classification of Diseases and Related
Health Problems (ICD) System

Limitations of Diagnostic Systems

Heterogeneity of Symptom Profiles

Summary and Conclusions
Learning Objectives
1. What is the difference between a categorical versus a dimensional
approach?
2. What are the uses of a diagnostic system?
3. How do we define abnormal behavior?
4. Why is developmental psychopathology important?
5. Discuss what is meant by diagnosis. Why is it based on a cluster of
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Chapter 3: Classification and Diagnosis
symptoms?
6. How do we define disorder? How does culture play a part in the definition?
7. What is the prevalence of mental disorders?
8. How do mental disorders develop?
9. Discuss the effects of PTSD on the patient and on loved ones.
10. What is the DSM approach to diagnosis?
11. How has the DSM evolved?
12. What are the differences between the DSM-IV-TR and the DSM-5?
13. What are the benefits and limitations of the DSM-5?
14. Discuss the use of the ICD system?
15. Why is diagnostic reliability important for assessment?
16. Why is diagnostic validity important for assessment?
17. How does comorbidity impact diagnosis and prognosis?
18. Are dimensions a better way to describe and understand mental
disorders?
Up for Discussion
1. What makes a person’s behavior abnormal?
2. Does society set the standard for abnormality? Why?
3. Is it better to have a formal diagnosis or would you prefer not to know?
4. Is ADHD overdiagnosed?
5. Does a diagnosis of ADHD limit or help a child?
6. Referring to Table 3.1 on the Prevalence of Selected Mental Disorders,
what explanations can you give for the high rates of anxiety, mood,
impulse-control, and substance abuse in the various countries?
7. Why would immigrating to another country exacerbate mental illness?
8. How is the biopsychosocial model a more thorough model as compared to
the medical or biological model?
9. Should the DSM include actual diagnostic categories for such disorders as
childhood depression and bipolar disorder? Why or why not?
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Chapter 3: Classification and Diagnosis
10. Role play with one of your students and have one of your students
conduct a mock interview of you presenting as either a depressed or
anxious patient. Have the student take notes and write up a brief psych
assessment. Share with the class and discuss the interview skills, the
questions, and the brief psych assessment.
11. Break students up into groups of 4-6 persons per group to form
“assessment teams” and have them review 1-2 cases per group. The
cases are included in the appendix of this Instructor’s Manual, or you may
have them review your own cases. Go over the cases with each group
after the 30 minutes of review. Discuss the findings and rationale for
diagnosis.
12. Are the limitations of the DSM-5 problematic? Why or why not?
13. How does resilience play a critical role in one’s prognosis for recovery?
14. Discuss the issue of social desirability and how this may impact
diagnosis?
Out-of-Class Activities
1. Encourage students to visit a mall, park, or another public place and
observe the people around them. They should note what they see, the
verbal and non-verbal interactions, and the thoughts and reactions that
may occur to them. Have students discuss how their own feelings and
reactions could affect diagnosis.
2. Ask students to write up their own ideas to replace or enhance the DSM.
Ask them to provide rationales and justifications for the omission or
additions.
3. Divide students into two teams. Team 1 would research the pros of the
DSM, and team 2 would research the cons of the DSM. The following
week have the team debate the issues of the DSM with the instructor
serving as the moderator.
4. Have students watch a movie or television program and write up an
assessment of the main characters. Students should provide clinical
terminology, demonstrate a clear understanding of the limitations of their
assessment, and formulate questions they would ask the character in a
real interview.
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Chapter 3: Classification and Diagnosis
5. Have students practice their interviewing skills on a friend or family
member, noting both their reactions and the reactions of the “patient”. Ask
students to discuss why treating a family member or friend is not advised.
Discuss the boundaries and limitations as well as social desirability of the
friend or family member. Also, discuss the impact this would have on
therapy.
Web Links
Information on the DSM-5, including its history and use, can be found at this
American Psychiatric Association site:
http://www.psychiatry.org/practice/dsm
Information on the development of the DSM-5 can be found on this American
Psychiatric Association site:
http://www.dsm5.org/about/Pages/DSMVOverview.aspx
For information on the World Health Organization’s International Classification of
Diseases, go to:
http://www.who.int/classifications/icd/en/
The National Institute of Mental Health provides a wealth of data on the
prevalence of mental disorders:
http://www.nimh.nih.gov/index.shtml
This is the home page of the American Psychiatric Association, the publishers of
the DSM-5. You will find links to the various sections, journals, and online
resources about education, practice, and self-help resources. Most psychiatrists
belong to this organization.
http://www.psych.org/
Video Suggestions
Primal Fear (DVD, color, 130 min.) A high-powered attorney takes the case of an
alter boy found running away from the scene of the murder of a Catholic bishop
who had taken him in. This is a courtroom thriller with twists and turns and a
surprise ending. The highlight is the diagnostic challenges throughout the movie.
1996 Paramount
Copycat (DVD, color, 123 min.) An excellent thriller about a copycat murderer
and a reclusive criminal psychologist battling PTSD and panic disorder with
agoraphobia. 1995 Warner Brothers
First Break (Video, color, 51 min) First break is the first episode of mental illness
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Chapter 3: Classification and Diagnosis
in a person's life. Three young adults and their families discuss the challenge of
living with a diagnosis of mental illness, and its impact on their self-identities and
family relationships. 1997, Fanlight Productions, Boston, MA.
Disorders Due to Psychoactive Substance Abuse (Video, color, 34 min)
Psychiatric diagnosis can be classified into several main categories. This
program focuses on alcoholism and the five main areas involving psychoactive
substance abuse: dependence syndrome, withdrawal state, withdrawal state with
delirium, psychotic disorder, and amnestic syndrome. Interviews with several
alcoholics illustrate the various mental disorders associated with the illness, their
symptoms, and the differential diagnoses associated with each, including
Korsakov's psychosis. 1998, Films for the Humanities and Sciences, Princeton,
NJ.
What Is Normal? (30 min., Insight Media). Explores the question of what
distinguishes normal from abnormal and the classification of abnormal behavior
using the DSM.
Madness: To Define True Madness (60 min., PBS Video). Examines attitudes
toward mental illness throughout the history of Western culture.
Suggested Readings
Barnett, J. E., & Johnson, W. B. (2008). Ethics desk reference for psychologists.
Washington, DC: American Psychological Association.
American Psychiatric Association. (2000). Diagnostic and statistical manual of
mental disorders (4th ed., text revision). Washington, DC: Author.
First, M. B., & Tasman, A. (Eds.). (2004). DSM-IV mental disorders: Diagnosis,
etiology, & treatment. Hoboken, NJ: John Wiley & Sons.
Journal of Abnormal Psychology
Journal of Abnormal Child Psychology Archives of General Psychiatry
American Journal of Psychiatry
Childhood Mental Health Disorders. 2008. Brown, R.T., Antonuccio, D.O.,
DuPaul, G.J., et al. American Psychological Association.
On the Stigma of Mental Illness – Practical Strategies for Research and Social
Change. 2005. Corrigan, P. W. American Psychological Association.
Thesaurus of Psychological Index Terms: 30th Anniversary 10th Edition. 2005.
American Psychological Association.
Assessment and Treatment of Childhood Problems: 2nd Edition: A Clinician’s
Guide 2002. Schroeder, C. S. & Gordon, B. N. The Guilford Press.
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Chapter 3: Classification and Diagnosis
Assessment in Behavioral Medicine. 2001. Vingerhoets, A. Brunner/Routledge.
Classification and Diagnosis of Psychological Abnormality. 2002. Cave, S.
Routledge Publishers.
Rethinking the DSM: A Psychological Perspective. Beutler, L.E. & Malik, M.L.
2002. American Psychological Association
A Pocket Reference for Psychiatrists: Third Edition. Jankins, S.C., Tinsley, J.A.,
& Van Loon, J.A., 2001, American Psychiatric Press.
How to Identify Suicidal People: A Systematic Approach to Risk Assessment,
White, 1999, Charles Press Publishers
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