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Classifying Abnormal Behavior

Classifying Abnormal Behavior

Objective:  At the end of this lesson, students will be able to demonstrate an understanding of the history, uses, and structure of the DSM-IV-TR, apply it to various case Examples, and expand on the criticism of classifying abnormal behavior.

The DSM-IV-TR is revered in today’s psychiatric community as the “Bible” of mental disorders.  This manual identifies every recognized mental disorder, the symptomology that constitutes these disorders, and the prevalence of these disorders in society.   The DSM was first published in 1952 and has been revised numerous times.   Some disorders have been removed, others have been added, and some have been renamed.  For example, multiple personality disorder was redefined and renamed when the DSM-IV was created.  This disorder is now referred to as dissociative identity disorder.  These continuous changes to the DSM have brought criticism to the system of classifying and defining mental disorders.   The diagnosis of dissociative identity disorder is one that has brought great controversy among the psychiatric community.  The study, conducted by Gigante et al.  (2001), revealed that “Canadians harbored significantly more skepticism about the diagnostic legitimacy and scientific validity of dissociative identity disorder and were less accepting than were their American counterparts of the inclusion of dissociative amnesia in the DSM-IV without reservations.”  As a result, Gigante et al. suggested:

Groups responsible for subsequent editions of the International Classification of Diseases and the DSM should consider the current lack of professional consensus when deciding whether to include dissociative amnesia or dissociative identity disorder as official diagnoses.

In addition to this criticism of the DSM, some question how much insurance companies and various lobbyist groups affect the changes to the DSM.  Cooper contended, “The fact that third-party payers only reimburse treatment of patients with a DSM diagnosis provides an incentive for psychiatrists and patients to lobby for new disorders to be included in the DSM.”  Family therapists have been lobbying since 1970 to have diagnosing suitable to family problems included in the DSM strictly so that therapists can obtain third-party payment for the treatment of such problems.  Finally, as insurance companies have increasingly demanded DSM diagnoses for reimbursement for treatment, the diagnosis of neurotic disorders has increased to 70.6%, whereas therapists confidentially report that these diagnoses make up only 28.4% of diagnoses in reality.  Fifty-nine percent of social workers admitted to giving a disorder diagnosis for insurance purposes, even though the diagnosis was unwarranted (Cooper, 2004).  Even with all the controversy that surrounds the DSM,  it remains the authority for the treatment and diagnosing of mental disorders.  The DSM-IV-TR classifies mental disorders using a multiaxial system.  Each axis is used to note specific things relevant to diagnosing and treating each patient.  Information to include on each axis is as follows: 

Axis I - Clinical Disorders and Substance-Related Disorders, Other Condition That May Be a Focus of Clinical Attention (V-codes)
  Axis II - Personality Disorders, Mental Retardation
  Axis III - General Medical Conditions
  Axis IV - Psychological or Environmental Problems
Axis V - Global Assessment of Functioning

Axis I consists of most mental disorders and significant life situations referred to as V-codes.  Axis II consists of personality disorders and mental retardation.  Though the therapist may not be “treating” the mental retardation, it is important for the therapist to know of this condition because it will affect treatment as well as determine if the behaviors constitute a mental disorder are a part of the mental retardation.  Axis III consists of significant medical conditions that may affect a person’s behavior, cause great stress to the client, or may be of importance when prescribing medications for psychiatric reasons.

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