Psychiatric Classification

1
Psychiatric Classification

• By Drew Bradlyn, Ph.D.
• West Virginia University

2
Weston State HospitalProblems at Admission 1864
- 1889

• Moral insanity
• Laziness
• Asthma
• Chronic Masturbation
• Epileptic Fits
• Vicious Vices
• Uterine Derangement
• Small Pox

• Spinal Irritation
• Grief
• Sunstroke
• Immoral Life
• Foolishness of Intellect
• Seduction and Disappointment
• Moul (1998)

3
What is abnormal?

• Moral definitions
• Statistical definitions
• Current psychiatric definition

4
DSM-IV

• Diagnostic and Statistical Manual of Mental
  Disorders. Fourth Edition, by the American
  Psychiatric Association (1994).

5
DSM-I and DSM-II Systems

• Essentially only lists of names, many of which
  were thought to be explanations for psychiatric
  phenomena
• Psychoanalytic overemphasis
• No operational criteria--poor reliability
• Little consideration of course of illness
• Little formal conceptual structure

6
Benefits of Classification

• Standardized vocabulary that permits effective
  communication
• Communication structure that places named
  phenomena into some conceptual order
• Context for providing causal understanding of
  phenomena
• Context for developing expectations about effects
  and interventions

7
DSM-IVA mental disorder is.

• conceptualized as a clinically significant
  behavioral/psychological distressdisabilityor
  with significant risk of death, pain, disability,
  or important loss of freedommust not be merely
  an expectable or culturally sanctioned response
  to a particular event (e.g., death of a loved
  one).
• neither deviant behavior (e.g., political,
  religious, or sexual) nor conflicts that are
  primarily between the individual and society are
  mental d/o unless the symptom is dysfunctional
  (in the individual).

8
DSM-IV Multiaxial Classification

• Axis I Psychiatric Syndromal Diagnoses
• Axis II Personality Disorders and
• Mental Retardation
• Axis III Medical Conditions
• Axis IV Psychosocial Stresses
• Axis V Level of Functioning

9
DSM-IV General Categories

• Disorders seen first in infancy or childhood
• Delirium, dementia, cognitive, or other amnestic
• Disorders due to other medical conditions
• Substance-related disorders
• Affective (mood) disorders
• Anxiety disorders
• Somatoform disorders
• Factitious disorders
• Dissociative disorders
• Sexual and gender identity disorders
• Sleep disorders
• Adjustment disorders
• Personality disorders