You only need SOME of the material on this page. The Exam will expect you to know about EITHER DSM-5 OR DSM-IV; you need to be aware of some of the things that are in the DSM and some research into this as well as arguments about whether this is a good or bad way to classify mental disorders. You also need to be aware of ICD-10. The history of the DSM is NOT needed for the Exam, but it's here to help you evaluate earlier studies like Rosenhan (1973).
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DIAGNOSTIC CLASSIFICATION SYSTEMS
Diagnostic manuals contain the information needed for clinicians to make objective, reliable diagnoses. They contain:
What most diagnostic manuals don't do is speculate about the causes of disorder. They're based on observed statistical patterns, not common causes. For example, having hallucinations and having delusions tend to occur together, which is why diagnostic manuals will put them both under the heading "psychosis". It's got nothing to do with them both being caused by the same thing in the brain.
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THE DIAGNOSTIC & STATISTICAL MANUAL (DSM)
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1
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Abolishing the 5 "axes"
The axes from DSM-IV are gone. Critics said these were artificial and made it hard to draw links between different symptoms. The whole thrust of DSM-5 is the links between different symptoms and conditions.
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2
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Removing unnecessary (and over-used) diagnoses
Austistic spectrum disorder has become just one category. The old categories of autism, Asperger’s, childhood disintegrative disorder, and pervasive developmental disorder have been merged together.
The same has been done with schizophrenia spectrum disorder, which is just one category. The old sub-types of paranoid, catatonic, disorganised, undifferentiated and residual schizophrenia have been merged together. Similarly, Childhood Bipolar Disorder has been replaced by a more general Disruptive Mood Dysregulation Disorder (DMDD). Getting rid of these separate diagnoses is a good thing if they were being over-used (a lot of people felt Childhood Bipolar Disorder was being applied too quickly to kids who were just having tantrums). Having just a single diagnosis that can be applied to a lot of people definitely makes diagnosis easier. But does it make it less valid?
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3
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Reflecting social change
Some changes to DSM-5 reflect changes in society.
These are good examples of the DSM keeping pace with social change - the way DSM-I and II failed to do with homosexuality. The reclassification of dementia could be a useful point for your Cognitive Key Question.
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4
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Reflecting tolerant attitudes
The offensive phrase "mental retardation” is finally out of the DSM. The new phrase is “intellectual disability” or Intellectual Development Disorder. (IDD). The importance of IQ scores has been downplayed in diagnosing IDD. The DSM-IV identified an IQ of less than 70 as "retarded" but DSM-5 diagnosis is based more on failure to function appropriately.
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THE INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASE (ICD)
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APPLYING DIAGNOSTIC MANUALS
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EVALUATING DIAGNOSTIC MANUALS
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Frances' criticisms amount to the warning that DSM-5 will create a lot of Type I Errors (False Positives).
Not only does this lead to people thinking they're sick when they're not, it leads to the unnecessary prescribing of medical drugs. This is expensive (but great news for "Big Pharma") and could be dangerous, because these drugs have side-effects.
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Of course, Frances is ignoring the danger of False Negatives. Some people who throw tantrums, grieve excessively or can't stop playing Pokemon Go really DO have a mental disorder and need help.
Differences
There are two diagnostic manuals in use worldwide: DSM and ICD. DSM is American and only describes mental disorders. ICD is international and describes all known diseases and disorders, so it's much bigger.
ICD-10 is distributed freely by the WHO and can be viewed online. DSM must be paid for and generates a huge income for the American Psychological Association (APA).
ICD-10 and DSM-5 are similar in many ways, describing the same disorders and often using the same wording. Unlike DSM-IV, DSM-5 uses the symptom-based approach that ICD has always followed.
There has been found to be only a 68% agreement (Andrews et al, 1999) between the ICD-10 and DSM-IV on an assessment of 1500 patients. However, Andrews found agreement on diagnosis for depression, substance dependence and generalised anxiety.
Hoffman et al. (2015) compared DSM-5 and ICD-10 in a study of alcoholism among over 7000 prisoners. The two systems agreed in diagnosing healthy individuals and those with severe alcoholism. However, the diagnoses differed when it came to mild-to-moderate alcohol disorders. About a third of those with mild alcohol disorder according to DSM-5 received no diagnosis from ICD-10.
There are two diagnostic manuals in use worldwide: DSM and ICD. DSM is American and only describes mental disorders. ICD is international and describes all known diseases and disorders, so it's much bigger.
ICD-10 is distributed freely by the WHO and can be viewed online. DSM must be paid for and generates a huge income for the American Psychological Association (APA).
ICD-10 and DSM-5 are similar in many ways, describing the same disorders and often using the same wording. Unlike DSM-IV, DSM-5 uses the symptom-based approach that ICD has always followed.
There has been found to be only a 68% agreement (Andrews et al, 1999) between the ICD-10 and DSM-IV on an assessment of 1500 patients. However, Andrews found agreement on diagnosis for depression, substance dependence and generalised anxiety.
Hoffman et al. (2015) compared DSM-5 and ICD-10 in a study of alcoholism among over 7000 prisoners. The two systems agreed in diagnosing healthy individuals and those with severe alcoholism. However, the diagnoses differed when it came to mild-to-moderate alcohol disorders. About a third of those with mild alcohol disorder according to DSM-5 received no diagnosis from ICD-10.
The Simpsons' 3rd season episode "Stark Raving Dad" pokes fun at misdiagnosis
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The studies by Andrews and Hoffman both suggest there is inter-rater reliability and concurrent validity with the DSM and ICD, but the reliability and validity could be a lot higher, especially with mild-to-moderate conditions.
Critics of the two diagnostic manuals argue that we should be classifying diagnoses in different ways. Other proposed systems have included:
- Systems based purely on neurology (brain biology), such as assessing unusual levels of neurotransmitters. The problem with this is that it is a very reductive way of looking at mental health.
- Systems based on measuring the psychological dimensions of personality (such as extraversion). This is supported by many humanist psychologists who criticised DSM-5 but it involves relying on psychometric tests.
- Systems based on the development of the mind, such as Freud's psychodynamic theory. The DSM started out this way but was criticised by being unreliable and subjective.
Applications
Although the NHS uses ICD-10, the DSM-5 has a big influence on how mental health is thought about and treated in this country. It helps set research agendas, brings conditions into the public eye and influences clinical guidelines.
ICD-10 is currently being updated and DSM-5 may have an influence on the mental health section of the ICD-11. The two classification systems are becoming more and more similar.
Although the NHS uses ICD-10, the DSM-5 has a big influence on how mental health is thought about and treated in this country. It helps set research agendas, brings conditions into the public eye and influences clinical guidelines.
- British research tends to use the DSM in order to fit in with American research, as most psychological research that is published and widely known is conduced in the US.
- Previous versions of the DSM made new conditions better known in the UK, such as ADHD and Borderline Personality Disorder.
- Patients increasingly self-diagnose using medical websites which are based on DSM-5; this puts pressure on doctors to know about these diagnoses and offer treatments for them, even if they don't agree with them
ICD-10 is currently being updated and DSM-5 may have an influence on the mental health section of the ICD-11. The two classification systems are becoming more and more similar.
EXEMPLAR ESSAY
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