Classification of Abnormal Behaviour

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Classification of Abnormal Behaviour
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What Is Classification?

• An integral part of the medical model (where
  mental disorders are regarded as illness) is
  the classification of mental disorder
• The diagnosis of mental disorders represents a
  way of classifying abnormal behaviour on the
  basis of common features or symptoms
• All systems stem from the work of a 19th century
  German psychiatrist called Emil Kraeplin

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Background

• Hippocrates (an ancient Greek ) classified
  abnormal behaviours according to his theory of
  humours (body fluids)
• An excess of black bile made a person pessimistic
  and unsociable
• Too much yellow bile made a person excitable and
  aggressive
• Too much phlegm made a person phlegmatic (calm
  and unresponsive)
• Too much blood made a person sanguine (easy-going
  and cheerful)

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• In the middle ages abnormal behaviours were
  divided into two groups. Those caused by demonic
  possession, and those due to natural causes
• In the 19th century Emil Kraeplin was the first
  to develop a comprehensive model of
  classification based on distinctive features, or
  symptoms, associated with abnormal behaviour.

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Why is it important to classify?

• Classification is the core of science, without
  labelling and organising patterns of abnormal
  behaviour researchers could not communicate
  findings

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• Psychologists need to develop a shared vocabulary
• If a psychologist in one part of the
  country/world wishes to talk about schizophrenia
  for example with a psychologist from another part
  of the country/world, both need to have a common
  understanding of what is meant by the disorder

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Kraeplins System

• Defined two major groups of mental disorders,
  manic depressive psychosis and dementia praecox
  (schizophrenia). These were further divided into
  18 specific mental disorders.
• Extensions of Kraeplins work are the -

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• Diagnostic and Statistical Manual (DSM) published
  by the American Psychiatric association
  (currently DSM-5)
• International Classification of Diseases (ICD)
  (currently ICD 10)

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Problems

• However there were problems with these systems of
  -
• Reliability Are diagnosis consistent?
• Overlapping categories
• Validity Are diagnosis based on reality?
• Cultural relativism

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DSM ICD

• In 1950s the American Psychiatric Association
  attempted to address these problems by devising
  DSM 1
• In 1968 they published DSM II which tried to be
  compatible with the World Health Organisations
  International Classification of Diseases (ICD)
  which covers physical and psychological disorders
• Both have undergone revision, DSM now being on
  version 5, ICD on version 10

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DSM-IV categories

1. Delirium, dementia , cognitive disorders
2. Schizophrenia
3. Substance-related disorders
4. Mood disorders
5. Anxiety disorders
6. Somatoform disorders
7. Dissociative disorders
8. Adjustment disorders
9. Disorders of infancy, childhood, adolescence
10. Personality disorders
11. Sexual and gender identity disorders
12. Impulse-control disorders
13. Factitious disorders
14. Sleep disorders

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• 15.Eating disorders
• 16.Mental disorders due to a general mental
  condidition
• 17.Others

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ICD-10 Categories

1. Organic
2. Schizophrenia
3. Disorders due to substance abuse
4. Mood (affective) disorders
5. Neurotic disorders
6. Disorders of infancy, childhood, adolescence
7. Mental retardation
8. Personality disorders
9. Eating sleeping disorders
10. Behavioural syndromes associated with
    physiological disturbance
11. Unspecified mental disorder

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• http//www.who.int/classifications/icd/icdonlineve
  rsions/en/

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Multi-Axial Classification of DSM IV

• A major change with DSM III (1980) was the
  multi-axial system which allowed the patient to
  be assessed in different areas of functioning.
• Axis I Clinical Syndromes
• Axis II Personality disorders mental
  retardation
• Axis III General medical conditions
• Axis IV Psychosocial and environmental problems
• Axis IV Global assessment of functioning

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Example

• Axis I Autism
• Axis II Patient may also have a learning
  disability
• Axis III Any condition such as heart disease,
  cancer, diabetes that could affect mood
• Axis IV A stressful event which could be a
  contributory factor, such as divorce or death or
  housing problems
• Axis V A score between 1-100 for social,
  psychological and occupational well-being.
• A score of 90 would indicate superior
  functioning, below 10 would indicate patient was
  in danger of severely hurting others.

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Class Exercise

• Gary is 35 and became an alcoholic after the
  death of his only child ten years ago, he has
  recently been diagnosed with cirrhosis of the
  liver due to alcoholism. At 18 he was diagnosed
  with anti social personality disorder and as a
  consequence of this has been arrested and
  imprisoned several times over the years.

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• According to the DSM IV multi axial diagnosis
  (Axis 5) Garys current level of functioning is
  42 which suggests serious symptoms or serious
  impairment in social, occupational or school
  functioning. Complete the multi axial system for
  Gary -

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• Axis 1 -
• Axis 2 -
• Axis 3 -
• Axis 4 -
• Axis 5 Current level of functioning 42

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Neurosis Psychosis making the distinction

• Neurosis
• Only part of personality is affected
• Contact with reality maintained
• Neurotics have insight
• Symptoms/behaviour an exaggeration of normal
• Often in response to a stressor
• Disturbance is related to previous (premorbid)
  personality
• Treated mainly with psychological methods

• Psychosis
• Whole of personality affected
• Contact with reality lost
• Psychotics lack insight
• Symptoms/behaviour discontinuous with normal
• Usually no obvious cause
• Disturbance not related to premorbid personality
• Treated mainly by physical (somatic) methods

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Cultural Influences

• Symptoms and behaviour tolerated in one culture
  may cause severe social problems in another.
• Therefore definitions of normality/abnormality
  are culturally relative.
• Physical illness is the same world-wide,
  biologically orientated psychiatrists argue
  organic psychoses ( due to a physical cause
  e.g.head injury/brain tumour) are also culture
  free, but is it?
• Several studies have found that in non-western
  cultures there are unique ways of being mad,
  and that these are not easily accommodated by ICD
  or DSM

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Problems with Classification

• Both ICD and DSM require the assessor to make
  yes no decisions in a closed questionnaire.
  Pilgrim (2000) argued that the difference between
  mental health and abnormality was a matter of
  degree (i.e.the extent of concern about it)
• Judgements can be affected by interpersonal
  issues such as labelling, stereotyping, and the
  roles and expectations of both patient and
  doctor.
• Studies have highlighted problems with diagnostic
  reliability
• Studies on predictive validity and the effect on
  treatment has shown only a 50 chance of
  correctly predicting treatment on the basis of
  diagnosis (Heather, 1976)
• There is an issue of overlap between symptoms of
  different disorders

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Evidence

• Rosenhan (1971) provided a powerful example of
  the effect of labelling on mental health
  patients.
• Faulkner and Layzell (2000) provided evidence of
  stereotyping experiences of those suffering
  mental health problems
• Lewis et al (1990) found that mental health
  professionals judgements are affected by the
  race of the patient
• Brown and Harris (1978) found that mental health
  practitioners can also respond differently to men
  and women

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Any Questions?