Affective - Bipolar
Edited DSM-IV criteria for a major depressive episode:
5 or more of the following symptoms have been present during the same 2 week period and represent a change from previous functioning:
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (feels sad or empty) or observation made by others (appears tearful).
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
- Significantly weight loss when not dieting or weight gain (change of more than 5% of body weight in a month, or a decrease or increase in appetite nearly every day.
- Insomnia or hypersomnia nearly everyday.
- Psychomotor agitation or retardation nearly everyday (observable by others, not merely subjective feelings of restlessness or being slowed down).
Affective - Bipolar
- Fatigue or loss of energy nearly everyday.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly everyday (either by subjective account or as observed by others).
- Recurrent thoughts of deaath (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
In addition, the symptomss cause clinically significant distress or impairment in social, occupational or other important areas of functioning and are not due to taking drugs of a physical illness or a recent bereavement. The symptoms must persist for longer than two months or are characterised by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms or psychomotor retardation.
Anxiety - Phobia
Edited DSM-IV criteria for phobias:
- Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g. flying , heights, animals, receiving an injection, seeing blood).
- Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a panic attack.
- The person recognises that the fear is excessive or unreasonable.
- The phobic situation is avoided or else is endured with intense anxiety or distess. The avoidance, anxious anticipation or distresss in the feared situation interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
Anxiety - Phobia
- In individuals under age 18, the duration is at least 6 months.
- The anxiety, panic attacks or phobic avoidence associated with the specific object or situation are not better accounted for by another mental disorder, such as OCD (fear of dirt in someone with an obsession about contamintion), PTSD (avoidance of stimuli associated with a severe stressor), seperation anxiety disorder (avoidance of school), social phobia (avoidance of social situations because of fear of embarrassment), panic disorder with agoraphobia or agoraphobia without history of panic disorder.
Psychotic - Schizophrenia
Edited by DSM-IV criteria for schizophrenia:
Criterion A: Characteristic symptoms: Two or more of the following,each present for a significant portion of time during a one-month period (or less if successfully treated):
- Disorganised speech
- Grossly disorganised or catatonic behaviour
- Negative symptoms, i.e. affective flattening, alogia or avolition
(Only one Criterion A symptom is required if delusions are bizarre or hallucinstions consist of a voice keeping up a running commentary on the person's beahviour or thoughts, or two or more voices conversing with each other.)
Criterion B: Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic or occupational achievement).
Psychotic - Schizophrenia
Criterion C: Duration: Continuous signs of the disturbance persist for at least 6 months. This 6 month period must include at least one month of symptoms (or less if successfully treated) that meet Criterion A (i.e. active-phase symptoms) and may include periods of prodroma or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g. odd beliefs, unusual perceptual expriences).
Criterion D: No other explanation: No other disorder is identified at the same time, no drug abuse or medication could explain the behaviour and there was no other developmental disorder.
Characteristics of disorders - Evaluation
The DSM criteria are criticised for lacking validity and being vague. It is possible for a misdiagnosis to occur because people do not need to show all the symptoms for a disorder and for only short periods of time. Symptoms overlap, e.g. the negative symptoms of schizophrenia are very similar to those of depression. Similarly, mania in bipolar disorder could be confused with positve symptoms of schizophrenia. The use of the criteria is affected by what a therapist might consider 'normal' life, which is bound to be affected by cultural norms and stereotypes about what men and women are like. The therapist has only observation, the patients word or the views of relatives to go on in the clinic and a patient may appear very different in a clinical setting to how they appear at home. Some people have argued that mental illness is a myth and disorders are just general variations of people along a continuum (Szasz). Rosenhan and Seligmans research also showed difficulties in diagnosis and the unreliablity of clinical practice. Labelling someone as a depressive or phobic has negative associations.
Characteristics of disorders - Debates
Ethnocentrism- is mental illness culturally determined? Are the values we place on a healthy lifestyle baised towards a western perspective?
Nature/Nurture - does some mental illness run in families? Or is the Diasthesis-stress model more accurate by explaining behaviour as a result of both biological and genetic vulnerablity and stress from life experiences?
Usefulness - diagnosing disorders can give people relief from wondering why they do not enjoy life and can give them the treatment that they need to help them over come their problems. Having a diagnosis can have legal uses too.