The Historical context of mental health- Categorising mental disorders

what is the DSM?
The Diagnostic and Statistical Manual of Mental disorders (DSM); currently in its 5th edition is perhaps the most common method of categorising dysfunctional behaviour, and is particularly favoured in the USA.
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who publishes the dsm?
American Psychiatric Association (APA), a body of professional psychologists, publish it. They posit that there are medical explanations for dysfunctional behaviour, and that there are categorical disorders that can be diagnosed by a list of criteria
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what are the first 2 axis of the dsm?
the clinician had to consider whether the condition was from Axis I: clinical disorders (e.g. affective, psychotic etc...) and/or Axis II: Personality and developmental disorders.
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whats the third and fourth axis?
clinician had to consider Axis III: Physical conditions (medical/neurological problems relevant to the current psychiatric problems), and Axis IV: Psychosocial stressors (life events such as divorce, death of spouse etc...).
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what is the fith axis?
Finally Axis V: Level of functioning was coded on a 0-100 scale, with 100 being nearly ‘perfect’ functioning.
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what is the multi axis system there for?
the multi-axial system was to encourage clinicians to diagnose holistically, considering biological, social, and cognitive factors which may be affecting behaviour.
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what happend to the dsm in 2013?
The DSM- V however, released in 2013, combined the first three axes, and removed the fifth axis due to issues with reliability and validity of measures of functioning.
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what was axis IV replaced by?
Axis-IV was replaced by a recommendation to consider situational factors, although a standardised way of measuring and recording these factors was not outlined.
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what were revisions in the DSM carried out in reponse to?
to research and changes in social attitudes
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what were the feilds in the DSM?
160 researchers from a variety of fields: social and behavioural science, neuroscience, genetics, etc…
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what disorders were revised in the new additions?
This meant many disorders were also revised in the new edition of the DSM, such as Schizophrenia: the sub-types, such as paranoid, catatonic, etc… were removed because of issues with the reliability and validity of categorising symptoms.
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how was asbergers and autism combined with?
disorders such as Aspergers, Autism, etc… were combined as ‘Autism Spectrum Disorder’, as research indicated these disorders reflected differences in the severity of symptoms rather than different etiologies (causes)
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what was changed in the mental retardation?
the diagnosis of ‘mental retardation’ was replaced by ‘intellectual disability’, in response to changes in social attitudes.
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how are disorders organised into chapters?
Each specific disorder is organised under major categories or chapters, such as neurodevelopmental disorders; disruptive, impulse control, and conduct disorders; and trauma- and stressor- related disorders.
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how are the disorders organised in the chapters?
For each disorder, a sub-set of characteristics is outlined, providing a broad spectrum (range) of symptoms, some of which are necessary for a diagnosis and some of which are optional. This accounts for individual differences.
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how has the DSM been revised to resemble ICD?
The DSM-V has been revised to resemble the ICD-10, and upcoming ICD-11, more closely, with ICD codes referenced in the DSM so a diagnosis can be checked against both manuals.
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what is the ICD?
The ICD (International Classification of Diseases) is in its 10th edition, and is the most common method of classifying disease and dysfunctional behaviour in Europe.
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who published the ICD?
. It is published by the WHO (World Health Organisation), whose aim is to relieve the world-wide disease burden (which is measured by loss of quality of life, number of fatalities, and economic cost)
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how is the ICD more cultrally exceptable?
It is more cross-culturally applicable than the DSM as it is targeted at diagnosing disorders globally, and it is potentially less biased, as it is created by an independent, charitable organisation
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how is the ICD more cultrally exceptable? 2
who consult with professionals from around the world and distribute the manual at low-cost, whereas the DSM is created by the APA, a body of American Psychology professionals, who receive much of their revenue from sales of the manual
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what does the ICD consist of?
The ICD consists of 10 main groups of disorders, from F0 to F9; these categories include, for example: Mood disorders (i.e. depression), Mental retardation, and Disorders of Psychological development (i.e. Autism Spectrum Disorder).
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Which diagnostic manual is more cross-culturally valid, and why?
The ICD is more cross-culturally applicable than the DSM as it is targeted at diagnosing disorders globally, and it is potentially less biased.
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‘Axis-IV was replaced by a recommendation to consider situational factors, although a standardised way of measuring and recording these factors was not outlined.’ Why is this an issue?
Reliability, if the way in which clinicians consider situational factors differs then there may be inconsistencies in diagnoses.
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‘the current DSM involved around 160 researchers from a variety of fields: social and behavioural science, neuroscience, genetics, etc.’ What debate could this be linked to?
Holism because it takes into account a variety of areas of psychology.
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‘The DSM-V has been revised to resemble the ICD-10, and upcoming ICD-11, more closely, with ICD codes referenced in the DSM so a diagnosis can be checked against both manuals.’ Why is it better that the two most widely used diagnostic manuals similar
To improve reliability, so that regardless of which manual is used – the same diagnosis will be made. –
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Consider what the implications of a diagnosis of mental illness may be (both positive and negative), considering ethics and usefulness.
Labelling, stigma, treatment, understanding, support, helplessness/ lack of control
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Outline an issue with the reliability of categorising mental disorders using statistical manuals, with reference to research.
Spitzer & Fleiss (1974) found an average Kappa score (the likelihood of two clinicians giving the same diagnosis) of 0.52 for diagnosing disorders.
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Outline an issue with gender bias when categorising mental disorders using the DSM.
Ford & Widiger (1989) found gender bias in diagnosing personality disorders using the DSM. Females were more significantly more likely to be misdiagnosed with Histrionic personality disorder- females are stereotyped as being emotional.
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Outline a different issue with bias when categorising mental disorders using the DSM.
Krimsky & Cosgrove (2012) 69% of practitioners were tied with the pharmaceutical industry (biological explanations)
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Card 2

Front

who publishes the dsm?

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American Psychiatric Association (APA), a body of professional psychologists, publish it. They posit that there are medical explanations for dysfunctional behaviour, and that there are categorical disorders that can be diagnosed by a list of criteria

Card 3

Front

what are the first 2 axis of the dsm?

Back

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Card 4

Front

whats the third and fourth axis?

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Card 5

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what is the fith axis?

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