Module 1: Introduction

1) Definition of abnormality
2) History of Abnormal Psychology
3) Causes of Abnormality
4) Classification of mental disorders – DSM, ICD-10
 1 - Definition of Abnormality
Abnormal behavior

[Behavior that is atypical or statistically uncommon within a particular culture

or that is maladaptive or detrimental to an individual or to those around that
individual. Such behavior is often regarded as evidence of a mental or
emotional disturbance, ranging from minor adjustment problems to severe
mental disorder]

– APA Dictionary
● DSM-5, Mental disorder is defined as a,

“clinically significant disturbance" in “cognitive, emptiness regulation or

behavior" that indicate a “dysfunction" in “mental functioning" that are
“usually associated with significant distress or disability" in work, relationships,
or other areas of functioning (American Psychiatric Association, 2013).

In addition, the definition states that expectable reactions to common stressors

are not mental disorders.
Defining Normality & Abnormality:-

▪ Most practice & research by clinical psychologists focus on abnormality = mental disorders,
psychiatric diagnosis, or psychopathology.

▪ Through training & professional activities - they become familiar with various forms of
abnormal behavior & the ways it differs from normal behavior.

▪ Before diagnostic categories are put to use by clinicians & scholars, they must be defined:-

- Personal distress to the individual (severe depression or panic disorder),

- Deviance from cultural norms (in many cases of schizophrenia),

- Statistical infrequency (rarer disorders = dissociative identity disorder),

- Impaired social functioning (social phobia, antisocial personality disorder).

 What Is Normal and Abnormal?

A woman
A man A woman making a shrine
kissing slapping a and offerings to
another child her dead
man
husband

A woman
A man A man
refusing to
barking driving a
eat for
like a dog nail through
several days
his hand
Standards For What Is Normal & Abnormal
● Cultural relativism
● Unusualness of behavior
● Discomfort of the person exhibiting the behavior
● Mental illness
● Maladaptiveness
 Standard 1: Cultural Relativism

Eg:- In many cultures, family members sleep together in one

room, often in the same bed. In the U.S., it is considered normal
for babies to sleep in their own bed in their own room.
● No universal standards or rules for labeling a behavior as
abnormal.
● Instead, behaviors can only be abnormal relative to cultural norms.
Gender Role Expectations
● How are men expected to act? What types of behaviors are
discouraged?
● How are women encouraged to act? What types of behaviors are
discouraged?
 Standard 2: Unusualness
● Is the behavior rare?
(Depends in part on the norms for that behavior in a culture.)
Eg:- Slurping while eating, spitting in public, PDA, Arranged marriages etc

Standard 3: Discomfort
● A behavior is only abnormal if the individual suffers as a result of the
behavior(s) and wishes to be rid of them.
● Some therapists object to the subjective discomfort criterion because
people are not always aware of problems that their behavior may
create for themselves or others.
Standard 4: Mental Illness
● Is the behavior caused by an identifiable disease?
● There is no medical test that identifies this process if it does exist.

Standard 5: Maladaptiveness
• Dysfunction- Does the behavior prevent normal daily
functioning?

• Distress- Does the person suffer distress?

• Deviance- Is the behavior highly unusual?

 Abnormal Psychology?
● Branch of science that deals with
○ Essential nature of mental disorders.
○ Structural and functional changes
○ The manifestations
 What is abnormality?
Criteria for defining abnormality
● The cultural situational model
○ Cultural deviances
● The statistical model
○ Frequency (Eg:- If IQ below or above = abnormal - Deviance from Average score)
● Experiential model
○ Personal discomfort (Eg:- avoiding situations that might trigger anxiety, using drugs or
alcohol to escape painful feelings, or engaging in ritual behaviors to try to prevent bad things from happening )

● Legal model
○ Violation of law
 Definition
●The 4 Ds

○ Deviance – Different, unusual, bizzare, extreme

○ Distressful – Unpleasant and upsetting to the individual

○ Dysfunction – Disruption in daily activities

○ Dangerous – To oneself and others.

 Study of abnormal behaviour
● 4 major components

○ Description – Diagnosis and classification of symptoms

○ Explanation – Causes – medical/ disease, psychological.

○ Experience – Feelings and emotions

○ Treatment/cure.
 2- History of Abnormal Psychology
● No documentation

● Incomplete data.

● Modern ideas influenced by early beliefs

○ Hippocrates’ belief-> disorders in brain-> abnormal

behaviours-> contemporary belief.

○ Physical assault in exorcism-> electroconvulsive

therapy.
 Mental illness - Pre-historic/ stone age
● Belief in supernatural forces

● Disorders attributed to evil spirits, possession, sorcery etc.

● Scholars, theologians, and philosophers believed a troubled mind was the

result of displeased Gods or possession.

People also believed in:-

● Lycanthropy – evil spirit changing man into a wolf on full moon days

● Vampirism – evil spirit causing people to suck blood

● Tarantism– people bitten by spiders dance out of control

Demonology: “the Devil made me do it!”
● Abnormal behavior (hallucinations, delusions, paranoia)
resulted from demonic possession.

● Treatment: drive the evil spirits out of the body.

- Stone-age: Trephination [surgical procedure in which a hole
is created in the skull by the removal of circular piece of bone]

- Exorcism: Prayers, Flogging, Starvation, etc.

Greco- Roman thought(500 B.C – 500 A.D)
● Naturalistic explanations by Hippocrates, Plato & Galen.

● By 5th century B.C., mental illness = Thought to be result of biological

problem in the brain.

-Hippocrates- argued that deviant behavior was result of physical causes.

-Deviant behavior occurs because of disease in the body is called

“Somatogenesis”
 Hippocrates
● Father of medicine.
● Relied on observations and explanations for mental disorders.
● Believed = Brain is the central organ for intellectual activity.
Deviant behaviour caused by brain pathology.
● Considered heredity and environment important.

● Classified mental illnesses into – mania, melancholia [profound sadness and despair] &
phrenitis [inflammation of brain - delirium, fever, nausea, drowsiness etc].
● Described Paranoia, Alcoholic delirium, Epilepsy etc.
● Thought cognitive functioning could be restored by balancing the four humors in
body(Body fluids): (Blood, Earth =Black bile, Fire = Yellow bile & Water =
Phlegm).
 Plato and Galen (Claudius Galenus)
● Contributed to the Organic explanation of behaviour.

● Plato = Insisted - Mentally disturbed people to be the responsibility of

the family & not be punished for their behaviour.

● Galen = Through the Scientific examination of the nervous system and

explaining the role of the brain in mental functioning.

- He was also the first person to say that arteries contain blood.
 Treatments The Dark Ages
● Tranquility ● With decline of Roman & Greek
● Moderate exercise civilizations/ rise of Church as
dominant power in Europe,
● Careful healthy diet
demonology makes a
come-back!!

● Treatment- Exorcisms
 Mental illness: witchcraft (1300s)

● Hallucinations & delusions = Evidence of witchcraft.

● Most accused = were not mentally ill, but forced to confess
crimes they didn’t commit.
● Treatment: beatings/death by hanging or burning.
 Mentally ill housed in Asylums (1500s+)
Mentally ill were confined to asylums.
● Most famous: St. Mary’s of Bethlehem in London (founded in 1243). Called
“Bedlam”
● Deplorable conditions- little food, little patient care, bloodletting practices, &
spread of diseases.

● Bethlehem- became hot tourist spot, where people gawked at London’s mentally ill.
● Treatment- patients were drained of blood & purposely “frightened.”
 Rise of Humanism - Emil Kraeplin
Renaissance
● Observed syndromes – a cluster
● New methods for treating the of symptoms representing a mental
illness.
mentally ill.
● Attributed all disorders to 4 causes.
● Johann Weyer = Witches are ○ Metabolic disturbance
mentally ill and not possessed. ○ Endocrine difficulty
- Moral treatment movement. ○ Brain disease
- Suitable mental hospitals and ○ Heredity
asylums - Gave a system to classify mental
disorders.
- Expanded inquiry into the - DSM is based on that system.
causes of mental disorders.
 3- Causes of Abnormality
● Difficult to properly explain psychopathology
● Take into account several theoretical perspectives while explaining
behavioural abnormality.
● Multiple causality – combination of theoretical perspectives.

Three major causes

● Biological Causes
● Psycho-social Causes
● Socio-cultural causes
● Genetic disorders
Biological Causes
○ Chromosomal disorders
■ Affect 7 out of 1000 infants
■ Result of too many or too less chromosomes
■ Change in structure of chromosomes
■ Error in separation, recombination or distribution of
chromosomes. Eg:- Down’s syndrome,
Turner’s syndrome in women, —

— Huntington’s corea,

Taysachs disease. —-
● Constitutional liabilities
○ Body types – Endomorphic, Ectomorphic, Mesomorphic
● Physical handicaps
○ Deformities – before or after birth
○ Pre-natal conditions – nutritional deficiencies, diseases.
● Physical deprivation
○ Malnutrition – impairs development, lowers resistance, stunts brain growth.
● Brain pathology – affects the CNS
○ Temporary – delirium, drug intoxication
○ Permanent – syphillitic infection to the brain.
 Psycho-social Causes
● Refer to interpersonal events that give rise to abnormal behaviour
later in life.
● Psychological influences – stressful life events, gender differences,
faulty thought patterns.
● Social influences – parents, socio-economic status, racial, cultural and
religious backgrounds, interpersonal relationships.
 Maternal Deprivation

1) Institutionalization – orphanage – less warmth, intellectual,

emotional and social stimulation.
2) Masked deprivation at home – neglect, indifference retards
intellectual, social and emotional development.
3) Pathogenic Interpersonal Relationships
4) Severe Stress

[2nd Point Cont…next slides]

2. (a) Pathogenic family patterns
● Faulty parent child relationship
○ Rejection – denial of love and affection, abuse-> fear, aggression,
insecurity, low self esteem.
○ Over protection – constant watch-> lack of essential competencies,
feelings of inadequacy.
○ Restrictiveness – rigid rules, no autonomy-> dependency,
submission, repressed hostility.
○ Over permissiveness and indulgence – surrender to the child->
selfishness, inconsiderate and demanding.
○ Unrealistic demands-> self-devaluation
○ Excessive discipline-> rebellion
○ Communication failure-> confusion, low self-confidence
○ Undesirable parent models-lie, cheat->delinquency, crime.
2.(b) Maladaptive family structure
● Inadequate family- lack of physical or psychological resources.

● Disturbed family – personal instability in parents.

● Anti-social family – unacceptable values-> dishonesty, deceit.

● Disrupted family-death, divorce-> insecurity, rejection,

delinquency.
3. Pathogenic Interpersonal 4. Severe stress
Relationships ● Repeated failure – devaluating, frustrating
● Marital instability ● Losses – objects, resources, individuals
● Fraudulent interpersonal ● Personal limitations or lack of resources
contracts – exploitative ● Guilt – mental suffering
● Collusion – partners follow ● Value conflicts
maladaptive norms not accepted
○ Integrity vs. self advantage
by society
● Pressure of modern living
● Discordant interpersonal
patterns – constant conflicts, ○ Competition
disagreements etc. ○ Educational, occupational, family
demands.
 Socio-cultural causes
● Are the larger forces within cultures and societies that affect the thoughts,
feelings and behaviour of individuals.

● War and violence – mutilation, death, grief.

● Prejudice and discrimination based on race, gender.

● Economic and employment problems – inflation, unemployment.

● Technological acceleration and social change – confusion, new

adjustments, anxiety.
 Biopsychosocial Model
● Genetic factors preordain the nature of the disaster
● Psychological and social factors modify expression and outcome of the
disorder.
● Biological, psychological and social factors vary across individuals, and
stages of life.
○ Eg:- Depression – a result of stressful life events.
○ Depression – genetic.
 Modern Era DSM
● Two widely established systems ● The standard abnormal
for classifying mental illnesses. psychology and psychiatry
reference book in North
○ International Classification
America.
of Diseases – ICD 10
● The current version is DSM V
○ Diagnostic and Statistical
manual of Mental Disorders ● Provides descriptions on what
– DSM V of the American constitutes a disorder
Psychological Association ● Gives general descriptions of
frequency, diagnostic criteria.
 History of DSM
● DSM I – 1952 – 130 pages – 106 mental disorders
● DSM II – 1968 – 182 disorders – 134 pages
● DSM III – 1980 – 494 pages – 264 disorders
● DSM IV – 1994 – 297 disorders – 886 pages long
● DSM IV TR – 2000 – diagnostic codes updated to maintain consistency with
the ICD, Text sections giving extra information updated.
● DSM V – 2013 - 1000 pages – ICD codes provided for all disorders.
DSM 5
● Classification of mental disorders with associated criteria designed
to facilitate more reliable diagnoses of these disorders.
● Standard reference for clinical practice in the mental health field.
● Practical, functional, and flexible guide for organizing information
that can aid in the accurate diagnosis and treatment of mental
disorders.
● Tool for clinicians, an essential educational resource for students
and practitioners, and a reference for researchers in the field.
 Changes from DSM IV to DSM V

● Classification of disorders is harmonized with the World Health Organization's

International Classification of Diseases (ICD)
● ICD-9-CM and ICD-IO-CM codes are attached to the relevant disorders in the
classification.
● Changes in the terminology used
● Changes in the order of presenting the disorders
● Chapter organization better reflects a lifespan approach – childhood to old age.
● Deletion of some disorders
● Addition of certain conditions and identifying as specific disorders
 Examples
● Restructuring of substance use disorders for consistency and clarity.

● Enhanced specificity for major and mild neuro-cognitive disorders.

● Transition in conceptualizing personality disorders.

● Consolidation of autistic disorder, Asperger's disorder, and pervasive

developmental disorder into autism spectrum disorder.

● Streamlined classification of bipolar and depressive disorders.

● Non-axial diagnosis

( www.psychiatry.org/dsm5)
 Changes in terminology
● Mental retardation = intellectual disability
● Language disorder - combines DSM-IV expressive and mixed
receptive-expressive language disorders
● Phonological disorder = speech sound disorder
● Stuttering = Childhood-onset fluency disorder
● Depersonalization disorder = Now called depersonalization/derealization
disorder
● Somatoform disorders = Somatic symptom and related disorders
● Feeding disorder of infancy or early childhood = Avoidant/restrictive food
intake disorder
 New conditions listed Deleted Disorders
● Hypochondriasis has been
● Social (pragmatic)
eliminated as a disorder
communication disorder, a new
condition for persistent difficulties ● Sleep disorders related to
in the social uses of verbal and another mental disorder and
nonverbal communication. sleep disorder related to a
general medical condition have
● Hoarding disorder is a new
been removed
diagnosis in DSM-5.
● Excoriation (skin-picking)
disorder is newly added to DSM-5
 Re-structured Disorders
● Autism Spectrum Disorder encompasses = Previous DSM-IV autistic disorder (autism),
Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder
not otherwise specified.
● Specific learning disorder = combines DSM-IV diagnoses of reading disorder, mathematics
disorder, disorder of written expression, and learning disorder not otherwise specified.
● Subtypes of schizophrenia-paranoid, disorganized, catatonic, undifferentiated, and
residual are eliminated
● Mood Disorders now divided into 2 separate units – Bi-polar and related disorders and
Depressive Disorders
● DSM-5 chapter on anxiety disorders no longer includes obsessive-compulsive disorder or
posttraumatic stress disorder and acute stress disorder
● Panic disorder and agoraphobia are unlinked in DSM-5. Instead to panic disorder with or
without agoraphobia – separate diagnoses.
 Sections
● Section 1: Intro to updates, how to use.

● Section II: The diagnoses (22 chapters)

● Section III: Conditions requiring further research; cultural

formulations; glossary.
 22 Chapters:
1. Neurodevelopmental Disorders 13. Sexual Dysfunctions
2. Schizophrenia Spectrum & Other 14. Gender Dysphoria
Psychotic Disorders 15. Disruptive, Impulse-Control &
3. Bipolar & Related Disorders Conduct Disorders
4. Depressive Disorders 16. Substance Related & Addictive
5. Anxiety Disorders Disorders
6. Obs-Compulsive & Related 17. Neurocognitive Disorders
7. Trauma- & Stressor-Related 18. Personality Disorders
8. Dissociative Disorders 19. Paraphilic Disorders
9. Somatic Symptom Disorders 20. Other Mental Disorders
10. Feeding & Eating Disorders 21. Medication-induced Movement…Med
11. Elimination Disorders Effects
12. Sleep/Wake Disorders 22. Other Conditions (v codes)

R
 DSM-5 ➔ DSM-5 is now in effect. DSM-IV should
not be used after 12/31/13.
● Mainly incremental changes from
DSM-IV ➔ DSM-5 is fully compatible with ICD-9
system now in use by insurance
● No more Roman numerals
companies.
● May have online updates in the
➔ DSM-5 also includes ICD-10 codes to be
future (e.g. DSM-5.1) to make it a
implemented 10/1/14.
“living document”

DSM Editors
● DSM-III: Robert Spitzer
● DSM-IV: Allen Francis
● DSM-5: David Kupfer
Problems with DSM-IV Goals for Improving the
Addressed by DSM-5 DSM
● Changes should be based on
empirical research rather than
● High rates of co-morbidity
clinical consensus.
● High use of (Not Otherwise
○ Behavioral science
Specified) NOS category
○ Neuroscience
● Concerns about reliability
○ Molecular genetics
and validity
● Move toward a classification based
on etiology.
DSM-5 Structure
● Section I: Basics
● Section II: Diagnostic Criteria and Codes
● Section III: Emerging Measures and Models
● Appendix
Section I: Basics
● Introduction
● Use of the Manual
● Cautionary Statement for Forensic Use
 Section I: Basics: Introduction
● DSM-5 has better reliability than DSM-IV.
● Research to validate diagnoses continues.
● The boundaries between many disorder categories are fluid over the life course.
● Symptoms assigned to one disorder may occur in many other disorders.
● DSM-5 accommodates dimensional approaches to mental disorders.
●DSM-5 provides explicit diagnostic criteria for each mental disorder, supplemented by
dimensional measures when appropriate.

●Many mental disorders are on a spectrum with related disorders that have shared
symptoms.

●The boundaries between disorders are porous.

● Disorder categories in earlier DSMs were overly narrow, resulting in the
widespread use of Not Otherwise Specified (NOS) diagnoses.
● DSM-5 removes the NOS diagnosis. It adds
Other Specified Disorder (criteria vary by disorder)
Unspecified Disorder (for use when there is insufficient information to be
more specific)
● Eg:- Suppose a client has significant depressive symptoms but does not
meet all the criteria for a major depressive episode.
- Diagnosis would be “Other specified depressive disorder, depressive
episode with insufficient symptoms.”
 Two Clusters of Disorders Organization of Disorders
● Internalizing group
● Disorders are organized on
Disorders with prominent
developmental & lifespan
anxiety, depressive, & somatic
considerations.
symptoms
● DSM-5 begins with = diagnoses
● Externalizing group
that manifest early in life, then
Disorders with prominent
adolescence & young adulthood,
impulsive, disruptive conduct,
then adulthood and later life.
and substance use symptoms
★ Disorders within these clusters
are adjacent in the DSM-5.
Cultural Issues
● Culture shapes the experience and expression of the symptoms, signs, and behaviors
that are criteria for diagnosis.
● Section III contains a Cultural Formulation.
● The Appendix contains a Glossary of Cultural Concepts of Distress.
● More information on culture and diagnosis is online at www.psychiatry.org/dsm5
● DSM-5 replaces the construct of the culture-bound syndrome in DSM-IV with 3
concepts:-

1) Cultural syndrome: a cluster of invariant symptoms in a specific cultural group

2) Cultural idiom of distress: a way of talking about suffering among people in a cultural
group
3) Cultural explanation or perceived cause for symptoms, illness, or distress
 DSM-5 is Non-Axial
● DSM-IV axes I, II, and III have been combined.

● Continue to list relevant medical conditions.

● The Global Assessment of Functioning (GAF) in DSM-IV has been

eliminated. Instead, use the World Health Organization Disability
Assessment Schedule (WHODAS).

● The WHODAS-2.0 is on page 747 of the DSM-5 and is also available

online.
Chart Entry Example of a Diagnosis
● Major depressive disorder, recurrent, severe; borderline personality
disorder; Chronic obstructive pulmonary disease (COPD)

● Anxiety; Insomnia

● Recent divorce; financial insecurity

● Function seriously impaired

 Major DSM-5 Changes
● Elimination of the only age-based section:
- Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence.
- Diagnoses from this section have been distributed to other sections based on
disorder categories.

● Creation of new sections:

- Neurodevelopmental Disorders; Obsessive-Compulsive and Related Disorders;
Trauma- and Stressor-Related Disorders.
● Sections renamed to better reflect disorders in the section
● Change in the name of diagnoses (with minimal change in individual diagnosis)
Major DSM-5 Changes (continued)
● Change in conceptual approach to a set of diagnoses, specifically Autism
Spectrum Disorder

● Changes in definition, criteria for diagnosis, and/or specifiers of the disorder

● The term “General medical condition” has been replaced throughout DSM-5
with “Another medical condition”

● Diagnoses are no longer placed on the multi-axial system of Axes I-V

● The Global Assessment of Functioning Scale (GAF) has been eliminated

➢ Disorders Usually First Diagnosed in Infancy, Childhood,
or Adolescence
● This category has been eliminated

● Disorders formerly in the section have been distributed in other

sections

● Neurodevelopmental Disorders is a new section that contains many

of the diagnoses from this old section
 Intellectual Disability
● Mental Retardation (MR) diagnosis has been replaced with Intellectual
Disability

● Both cognitive capacity (IQ) and adaptive functioning are assessed with
severity based on adaptive functioning rather than IQ
Communication Disorders is a category in
Neurodevelopmental Disorders that includes:
1. Language Disorder (combines Expressive and Mixed
Receptive-Expressive Disorder)

2. Speech Sound Disorder (replaces Phonological Disorder)

3. Childhood Onset Fluency Disorder (formerly Stuttering)

4. Social Pragmatic Disorder (New)

 Autism Spectrum Disorder
● A conceptual change defines Autism Spectrum Disorder as a single
condition with different levels of symptom severity – 2 symptom
categories are: social communication & interaction; and repetitive,
behavior, interests, & activities

● Encompasses previous diagnosis of Autistic Disorder, Asperger’s

Disorder, Childhood Disintegrative Disorder, and Pervasive
Developmental Disorder NOS
Additional Neurodevelopmental Disorder Diagnoses

● Attention Deficit/Hyperactivity Disorder (ADD, ADHD)

● Specific Learning Disorder (includes former reading, math, written

expression, and NOS diagnosis)

● Motor Disorders (includes Developmental Coordination Disorder,

Stereotypic Movement Disorder, Tourette’s Disorder, and other vocal

and motor tics, & unspecified disorders)
Schizophrenia Spectrum and other Psychotic Disorders

● Elimination of paranoid, undifferentiated, disorganized, and

residual subtypes

● Delusional Disorder – can now include bizarre delusion(s)

● Schizoaffective Disorder – major mood episode must be present for

a majority of the total duration of disorder
 Bipolar and Related Disorders
● Criteria for mania and hypomania now include changes in activity
and energy as well as mood changes

● Changes in diagnosis of Bipolar Disorder in children

Depressive Disorders
● Disruptive Mood Dysregulation Disorder – for children under age 18
who have persistent irritability and frequent extreme out of control
behavior (to address concerns about potential overdiagnosis of Bipolar
Disorder)

● Persistent Depressive Disorder (replaces Dysthymic Disorder)

● Bereavement no longer excluded from depression diagnosis

 Anxiety Disorders
● PTSD moved to new section called Trauma and Stressor Related
Disorders
● OCD moved to new section called Obsessive-Compulsive and
Related Disorders
● Social Anxiety Disorder (replaces Social Phobia)
● Panic Disorder with Agoraphobia – now 2 diagnoses, no longer one
diagnosis
● Separation Anxiety Disorder – moved from the old First Diagnosed
in Infancy…section
 Obsessive-Compulsive and Related Disorders
● Obsessive-Compulsive Disorder – moved from Anxiety Disorder section
● New Diagnosis: Hoarding Disorder
● Body Dysmorphic Disorder – moved from old Somatoform Disorder
section
● Trichotillomania
● Skin-picking Disorder
● Substance-induced OCD and OCD due to another medical condition
 Trauma and Stressor-Related Disorders
● Reactive Attachment Disorder – moved from the old First Diagnosed in
Infancy…section

● Disinhibited Social Engagement Disorder

● PTSD – moved from Anxiety Disorders section

● Acute Stress Disorder – moved from Anxiety Disorder Section

● Adjustment Disorders – old section of Adjustment Disorders eliminated

Dissociative Disorders
● Depersonalization/Derealization Disorder – concepts of
depersonalization and derealization combined to replace former
Depersonalization Disorder

● Dissociative Fugue – now a specifier under Dissociative Amnesia

instead of a stand-alone diagnosis
 Somatic Symptom and Related Disorders
● Formerly called Somatoform Disorders

● Somatic Symptom Disorder (replaces Somatization Disorder)

● Illness Anxiety Disorder (replaces Hypochondirasis)

● Conversion Disorder – also called Functional Neurological Symptom

Disorder

● Factitious Disorder: Imposed on self or Imposed on other colloquially known

as Munchausen’s Syndrome and Munchausen’s by proxy)
Feeding and Eating Disorders
● Adult diagnosis of Anorexia Nervosa and Bulimia Nervosa are
essentially unchanged

● New Diagnosis: Binge Eating Disorder

● New Diagnosis: Avoidant/Restrictive Food Intake Disorder

● Pica and Rumination Disorder - moved from former First Diagnosed in

Infancy…section
Disruptive, Impulse-Control, and Conduct Disorders

● Conduct Disorder and Oppositional Defiant Disorder – moved from

former First Diagnosed in Infancy…section

● Intermittent Explosive Disorder, Kleptomania, & Pyromania –

moved from former Impulse-Control Disorder section
 Substance-Related and Addictive Disorders
● Gambling – moved from former Impulse-Control Disorder section

● No longer a separation of substance abuse and dependence

● Categories reduced by combining amphetamine and cocaine into

stimulants; phencyclidine included in hallucinogens; and nicotine
expanded to tobacco
 Neurocognitive Disorders
● Formerly Delirium, Dementia, and Amnestic and other Cognitive
Disorders section
● Delirium remains in section
● Amnestic Disorder and Dementia are now in a new category called
Mild or Major Neurocognitive Disorder specified according to etiology
(vascular, HIV Infection, Traumatic Brain Injury, Alzheimer’s
Parkinson’s Huntington’s, Prion, other medical condition, multiple
etiologies), location (Frontotemporal), or characteristics (with Lewy
Bodies)
 Personality Disorders
● Personality Disorder diagnoses remain unchanged in Section II

● Another alternative approach is proposed in Section III to be used for

further study; it contains changes proposed in drafts of DSM-5 which
were not ultimately accepted

● The alternate section has 6 rather than 10 diagnoses with criteria

focusing on personality traits and personality functioning
 ICD -10
● The ICD is the global health information standard for mortality and morbidity
statistics.
● ICD is increasingly used in clinical care and research to define diseases and study
disease patterns, as well as manage health care, monitor outcomes and allocate
resources.
● More than 100 countries use the system to report mortality data, a primary indicator
of health status. This system helps to monitor death and disease rates worldwide and
measure progress towards the Millennium Development Goals.
● About 70% of the world’s health expenditures (USD $ 3.5 billion) are allocated using
ICD for reimbursement and resource allocation
● ICD has been translated into 43 languages.
● The 11th revision process is underway and the final ICD-11 will be released in 2018.
ICD purpose and uses
The ICD is the foundation for the identification of health trends and statistics globally.
It is the international standard for defining and reporting diseases and health
conditions. It allows the world to compare and share health information using a
common language.
The ICD defines the universe of diseases, disorders, injuries and other related health
conditions. These entities are listed in a comprehensive way so that everything is
covered. It organizes information into standard groupings of diseases, which allows
for:

● easy storage, retrieval and analysis of health information for evidenced-based

decision-making;
● sharing and comparing health information between hospitals, regions, settings and
countries; and
● data comparisons in the same location across different time periods.
It is the diagnostic classification standard for all clinical and research purposes.
These include monitoring of the incidence and prevalence of diseases, observing
reimbursements and resource allocation trends, and keeping track of safety and
quality guidelines.
● ICD allows the counting of deaths as well as diseases, injuries, symptoms,
reasons for encounter, factors that influence health status, and external causes
of disease.
● Primary users
● Users include physicians, nurses, health workers, researchers, health
information managers, policy-makers, insurers and national health programme
managers, among others.
History
● The first international classification edition, known as the International List of
Causes of Death, was adopted by the International Statistical Institute in 1893.
● The ICD has been revised and published in a series of editions to reflect
advances in health and medical science over time.
● WHO was entrusted with the ICD at its creation in 1948 and published the 6th
version, ICD-6, that incorporated morbidity for the first time. The WHO
Nomenclature Regulations, adopted in 1967, stipulated that Member States use
the most current ICD revision for mortality and morbidity statistics.
● ICD-10 was endorsed in May 1990 by the Forty-third World Health Assembly. It
is cited in more than 20,000 scientific articles and used by more than 100
countries around the world (117).
ICD-11 development underway
The 11th version, ICD-11, is now being developed through a continuous revision
process. ICD-11 will be finalized in 2018.

For the first time, through advances in information technology, public health users,
stakeholders and others interested can provide input to the beta version of ICD-11
using an online revision process. Peer-reviewed comments and input will be added
through the revision period. When finalized, ICD-11 will be ready to use with
electronic health records and information systems.

WHO encourages broad participation in the 11th revision so that the final
classification meets the needs of health information users and is more
comprehensive.
 2) Diagnosis and classification of abnormal behavior: DSM V and ICD 10.

Clinical Diagnosis & Classification Systems

▪ Before starting any type of treatment, the client/patient must be clearly diagnosed with
a mental disorder.
▪ Clinical diagnosis = A process of using assessment data to determine if the pattern of
symptoms the person presents with is consistent with the diagnostic criteria for a
specific mental disorder outlined in an established classification system such as the
DSM-5 or ICD-10
▪ Diagnosis should have clinical utility = It must aid the mental health professional in
determining prognosis, the treatment plan, & possible outcomes of treatment (APA, 2013).
▪ Receiving a diagnosis doesn’t necessarily mean the person requires treatment.
▪ It’s based upon –
- How severe the symptoms are,
- Level of distress caused by the symptoms,
- Symptom salience, like expressing suicidal ideation,
- Risks and benefits of treatment,
- Disability, and other factors (APA, 2013).
▪ Also = A patient may not meet the full criteria for a diagnosis but require treatment
nonetheless.
▪ Symptoms that cluster together regularly are called a syndrome.

▪ Classification systems provide mental health professionals with an agreed-upon list of

disorders falling into distinct categories for which there are clear descriptions & criteria for
making a diagnosis.
 ▪ People presenting with a
primary clinical deficit in
cognitive functioning that is not
▪ People suffering from developmental but has been
delusions, hallucinations, are different from
acquired (a decline in cognitive
disorganized speech, functioning over time).
catatonia, and/or negative ▪ Suffers from a neurocognitive
symptoms. disorder (NCD).
▪ Suffers from a ▪ These can be further
schizophrenia spectrum distinguished from
neurodevelopmental disorder –
disorder.
that manifest early in
development + involve
developmental deficits that
cause impairments in social,
academic, or occupational
functioning.
● The most widely used classification system in the United States is the Diagnostic

and Statistical Manual of Mental Disorders [5th edition], produced by the American

Psychiatric Association (APA, 2013).

● The World Health Organization (WHO) publishes the International Statistical

Classification of Diseases and Related Health Problems (ICD) [10th edition, with an

11th edition expected to be published in 2018].

A brief history of the DSM.
DSM-5
● DSM-5 was published in 2013 in place of the DSM IV-TR (TR = Text Revision; published in 2000).

● History of DSM goes back to 1944 when the American Psychiatric Association published a
predecessor of the DSM which was a “statistical classification of institutionalized mental patients” and
“…was designed to improve communication about the types of patients cared for in these hospitals”

● DSM evolved through four editions after World War II into, a diagnostic classification system
to be used by psychiatrists & physicians, but also other mental health professionals.

● Revision of DSM began in 1999 when – APA took up, evaluation of the strengths & weaknesses of the
DSM, in coordination with WHO Division of Mental Health, the World Psychiatric Association, & the
National Institute of Mental Health (NIMH).
● Result =

“Common language for communication between clinicians about the diagnosis of

disorders” along with a realization that the criteria and disorders contained within were

based on current research and may undergo modification with new evidence gathered

“both within and across the domains of proposed disorders” (APA, 2013).

▪ Some disorders = not included within the main body of the document – because they

didn’t have the scientific evidence to support their widespread clinical use.
Key Elements of a diagnosis. DSM 5 (APA, 2013):
● Diagnostic Criteria & Descriptors –
- Diagnostic criteria = Guidelines for making a diagnosis. When the full criteria is
met, mental health professionals can add severity & course specifiers to indicate the
patient’s current presentation.
- If the full criteria are not met, designators such as “other specified” or “unspecified”
can be used.
- If applicable, an indication of severity (mild, moderate, severe, or extreme),
descriptive features, and course (type of remission – partial or full – or recurrent) can
be provided with the diagnosis.
- Final diagnosis = based on the clinical interview, text descriptions, criteria, and
clinical judgment.
● Subtypes and Specifiers –
- Subtypes = “mutually exclusive & jointly exhaustive phenomenological subgroupings within a
diagnosis” (APA, 2013).
- Eg:- Non-Rapid Eye Movement (NREM) sleep arousal disorders – can have either a sleepwalking or
sleep terror type.
- Enuresis is nocturnal only, diurnal only, or both.
- Specifiers = are not mutually exclusive or jointly exhaustive & so more than one specifier can be
given.
- Eg:- Binge Eating Disorder – has remission & severity specifiers.
- Somatic Symptom Disorder – has a specifier for severity, if with predominant pain, and/or if
persistent.
✔ The fundamental distinction between subtypes and specifiers is that there can be only one
subtype but multiple specifiers.
● Principle Diagnosis – [the focus of treatment] Used when more than one diagnosis
is given for an individual.

- It’s the reason for an admission in an inpatient setting or the basis for a visit resulting
in ambulatory care medical services in outpatient settings.

● Provisional Diagnosis – If not enough information is available for a mental health

professional to make a definitive diagnosis, but there is a strong presumption that
the full criteria will be met with additional information/time, then
the provisional specifier can be used.
DSM-5 Classification System of Mental Disorders
ICD-10 ICD-10
● 1893 = The International Statistical Institute adopted the International List of Causes of
Death which was the first international classification edition.
● The World Health Organization was entrusted with the development of the ICD in 1948 and
published the 6th version (ICD-6).
● The ICD-10 was endorsed in May 1990 by the 43rd World Health Assembly.
WHO states:
● ICD = the foundation for the identification of health trends & statistics globally,
& the international standard for reporting diseases and health conditions.
● It’s the diagnostic classification standard for all clinical & research purposes.
● It defines the diseases, disorders, injuries & other related health conditions, listed in a
comprehensive, hierarchical manner like:
- Easy storage, retrieval & analysis of health information for evidence-based decision-making;
- Sharing & comparing health information between hospitals, regions, settings & countries;
- And data comparisons in the same location across different time periods.
 ICD lists many types of diseases & disorders to include Chapter V: Mental & Behavioral
Disorders as follows:

1. Organic, including symptomatic, mental disorders

2. Mental and behavioral disorders due to psychoactive substance use
3. Schizophrenia, schizotypal and delusional disorders
4. Mood (affective) disorders
5. Neurotic, stress-related and somatoform disorders
6. Behavioral syndromes associated with physiological disturbances and physical factors
7. Disorders of adult personality and behavior
8. Mental retardation
9. Disorders of psychological development
10. Behavioral and emotional disorders with onset usually occurring in childhood &
adolescence
11. Unspecified mental disorder
Professions Within Abnormal
Psychology

Psychiatrists
Clinical psychologists
Clinical social workers
Psychiatric nurses
Marriage and family therapists