DIAGNOSING PSYCHOLOGICAL DISORDERS | DR. GEETANJALI PAREEK

DIAGNOSING PSYCHOLOGICAL DISORDERS

In biology and the other sciences, classification creates order. In psychiatry and psychology, diagnostic classification aims not only to describe a disorder but also to predict its future course, imply appropriate treatment, and stimulate research into its causes. Indeed, to study a disorder we must first name and describe it.

The two dominant taxonomies for diagnosing mental disorders are the International Classification of Diseases, Injuries, and Causes of Death (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Diagnostics are based on:

a) Some core symptoms that need to be present;

b) Pre-specified periods of time for symptoms to be present; and sometimes

c) Symptoms that should not be present.

Classification is a necessary first step in understanding more about disorders:- of their nature, causes, and treatment. To be scientifically and practically useful, a classification system must meet standards of diagnostic reliability and validity.

Reliability means that clinicians using the system should show high levels of agreement in their diagnostic decisions. Because professionals with different types and amounts of training-including psychologists, psychiatrists, social workers, and physicians—make diagnostic decisions, the system should be couched in terms of observable behaviours that can be reliably detected in order to minimize subjective judgments (American Psychiatric Association, 2000).

Validity means that the diagnostic categories should accurately capture the essential features of the various disorders. Thus, if research and clinical observations show that a given disorder has four behavioural characteristics, the diagnostic category for that disorder should also have those four features. Moreover, the diagnostic categories should allow us to differentiate one psychological disorder from another.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-V; American Psychiatric Association, 2013), is the latest edition of DSM by American Psychiatric Association which was released in May 2013 and is most widely used diagnostic classification system. Unlike DSM IV TR it is not multi-axial. DSM-5 has moved to a nonaxial documentation of diagnosis (formerly Axes I, II, and III), with separate notations for important psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V). This revision is consistent with the DSM-IV text that states, "The multiaxial distinction among Axis I, Axis II, and Axis III disorders does not imply that there are fundamental differences in their conceptualization, that mental disorders are unrelated to physical or biological factors or processes, or that general medical conditions are unrelated to behavioral or psychosocial factors or processes." In DSM-5, Axis III has been combined with Axes I and II.

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