Abnormal Psychology. William J. Ray

all members of society. Thus, traditional neuroscience perspectives that reflect action on the level of genetics, the neuron, and neural networks are integrated with research perspectives related to more system-level cognitive, emotional, and behavioral processes. See LENS: Assessment, Classification, and Clinical Practice: The RDoC Alternative to the DSM later in this chapter for a discussion of the Research Domain Criteria (RDoC) approach that is being explored by NIMH.

      Concept Check

       Why is the reliability of diagnosis an important aspect of psychological treatment?

       What does it mean that mental disorders can be described in both a categorical and a dimensional manner?

       Why is comorbidity of psychological disorders an important consideration? Discuss some of the advantages of including underlying processes in the study of psychopathology.

       Identify three specific ways in which neuroscience approaches have been utilized to classify mental illness and inform its treatment.

      Classification Systems for Mental Disorders

      Classification is a way to name, organize, and categorize the diversity of symptoms seen in mental disorders. Blashfield and Draguns (1976; see also Blashfield, Flanagan, & Raley, 2010) suggest five different purposes of classification:

      1 As a nomenclature—The purpose here, in giving a name to a disorder, is to present a way for mental health professionals to describe and discuss the clients they see.

      2 As a basis of information retrieval—Classifying disorders allows for individuals who may not be professionals to search for information concerning mental disorders.

      3 As a descriptive system—The name of the disorder summarizes the behaviors, thoughts, and emotions of individuals with the disorder.

      4 As a predictive system—In this case, the classification allows one to know the course of the disorder if untreated and particular treatments that may be effective.

      5 As a basis for a theory of psychopathology—The focus in this case is to use classification to understand the disorder.

      classification: in psychopathology, a way to name, organize, and categorize the collections of symptoms seen in mental disorders

      Over the past 200 years, numerous systems have been developed concerning the diagnosis and classification of mental disorders. In the past 50 years, the emphasis has been on reliability of diagnosis such that mental health professionals in one location would diagnose the same individual in the same manner as professionals in another location. As part of this emphasis, there has been a push for observable characteristics that would define a specific disorder. These types of criteria make up the structure of the DSM and the ICD. In general, the criteria used in the DSM and ICD are signs and symptoms that are delineated through observation of, and conversation with, the individual. Since ICD codes are used by many health facilities in the United States, I will note the similarities and differences in ICD and DSM criteria of mental disorders throughout this book.

      International Statistical Classification of Diseases and Related Health Problems

      The ICD, currently used in over 100 countries worldwide to classify disorders, has an interesting history. It began with the intent of identifying causes of death.

      One of the factors that helped create the initial DSM was the search for consistency in diagnosis across clinicians throughout the country. Here, in the 1940s, an asylum committee assesses a patient’s mental health.

      JERRY COOKE/The LIFE Picture Collection/ Getty Images

      Based on earlier attempts, a system for recording the cause of death was developed by the French statistician Jacques Bertillon in the late 1800s. This came to be known as the International List of Causes of Death. In 1898, the American Public Health Association suggested that the United States, Canada, and Mexico use this system and support its revision every 10 years. In 1948, the World Health Organization took over the ICD. The WHO collected health-related data worldwide. The sixth edition of the ICD published in 1949 included a section related to mental disorders. Currently, the ICD includes two sections, one for medical disorders and the other for mental and behavioral disorders. Because of the ICD inclusion of medical disorders, it is used for Health Insurance Portability and Accountability Act (HIPAA) purposes such as insurance in the United States.

      ICD-10 is currently in use but is being updated for the eleventh edition in 2018. Mental disorders in the ICD-10 are more of a short narrative describing the condition, rather than specific criteria as seen in the DSM–5.

      Diagnostic and Statistical Manual of Mental Disorders

      The DSM was created by a group of psychiatrists in the 1940s who had been involved in directing mental hospitals and directing the mental health services for the U.S. Army and Navy during World War II, and others who were part of the American Psychiatric Association. The first version of the DSM (DSM–I) was published in 1952 (see Grob, 1991).

      Origins of the DSM

      A number of factors helped to create the initial DSM. One was the search for consistency in diagnosis across clinicians throughout the country. In this sense, DSM–I sought to bring together and standardize the classifications used in state and private mental hospitals, those classifications developed during World War II, and those used by professionals in private practice. Another factor that gained emphasis during World War II was the realization that environmental stress associated with combat was related to the expression of mental disorders. A related understanding was that these disorders could be treated without prolonged institutionalization. In addition, treatment worked best if begun early in the course of the disorder. This required that professionals be able to differentiate those who could be treated and sent back to battle and those who needed long-term care.

      Early Versions of the DSM and the Eventual Focus on Diagnostic Criteria

      The classification system used by DSM–I divided disorders into two broad categories. The first category was those disorders such as Huntington’s chorea or neurocognitive disorders (then called dementias) resulting from brain pathophysiologies. These were disorders that resulted from hereditary origins, infections, long-term drug addictions, tumors of the brain, and other such factors. The second category was those disorders that included an environmental component in which the individual found it difficult to cope with his or her world. This second category was further divided into three different types of disorders. The first was psychosis, including schizophrenia and other psychotic disorders. The second was neurosis, such as anxiety disorders. The third was referred to as character disorders such as psychopathy, which were involved in forensic decisions. As you will see later, those individuals who demonstrate psychopathic tendencies often find themselves accused of crimes such as cheating others. In general, it was assumed that the neurotic disorders would be more amenable to psychological treatment.

      During World War II, mental health professionals realized that environmental stress associated with combat was related to the expression of mental disorders.

      H. Armstrong Roberts/ClassicStock/Archive Photos/Getty Images

      DSM–II was released in 1968. Although it did not differ greatly from DSM–I, it did offer an opportunity for the mental disorder categories of ICD-8 and DSM–II to be almost identical. This allowed for a worldwide classification system, which increased the ability to collect statistics on particular mental disorders. One difference that did exist was that