Classification of mental disorders
Encyclopedia
The classification of mental disorders, also known as psychiatric nosology or taxonomy, is a key aspect of psychiatry
and other mental health professions
and an important issue for consumers and providers of mental health services. There are currently two widely established systems
for classifying mental disorders—Chapter V of the International Classification of Diseases (ICD-10) produced by the World Health Organization
(WHO) and the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) produced by the American Psychiatric Association
(APA). Both list categories of disorders thought to be distinct types, and have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain. Other classification schemes may be in use more locally, for example the Chinese Classification of Mental Disorders
. Other manuals have some limited use by those of alternative theoretical persuasions, such as the Psychodynamic Diagnostic Manual
.
The widely used DSM and ICD classifications employ operational definition
s. There is a significant scientific debate about the relative validity
of a "categorical" versus a "dimensional" system of classification, as well as significant controversy about the role of science and values in classification schemes and the professional, legal and social uses to which they are put.
of mental disorders, one extreme argues that it is entirely a matter of value judgements (including of what is normal
) while another proposes that it is or could be entirely objective
and scientific (including by reference to statistical norms); other views argue that the concept refers to a "fuzzy prototype
" that can never be precisely defined, or that the definition will always involve a mixture of scientific facts (e.g. that a natural or evolved function isn't working properly) and value judgements (e.g. that it is harmful or undesired). Lay concepts of mental disorder vary considerably across different cultures and countries, and may refer to different sorts of individual and social problems.
The WHO and national surveys report that there is no single consensus on the definition of mental disorder/illness, and that the phrasing used depends on the social, cultural, economic and legal context in different contexts and in different societies. The WHO reports that there is intense debate about which conditions should be included under the concept of mental disorder; a broad definition can cover mental illness, mental retardation, personality disorder and substance dependence, but inclusion varies by country and is reported to be a complex and debated issue. There may be a criterion that a condition should not be expected to occur as part of a person's usual culture or religion. However, despite the term "mental", there is not necessarily a clear distinction drawn between mental (dys)functioning and brain (dys)functioning, or indeed between the brain and the rest of the body.
Most international clinical documents avoid the term "mental illness", preferring the term "mental disorder". However, some use "mental illness" as the main over-arching term to encompass mental disorders. Some consumer/survivor movement
organizations oppose use of the term "mental illness" on the grounds that it supports the dominance of a medical model
. The term "serious mental illness" (SMI) is sometimes used to refer to more severe and long-lasting disorders while "mental health
problems" may be used as a broader term, or to refer only to milder or more transient issues. Confusion often surrounds the ways and contexts in which these terms are used.
Mental disorders are generally classified separately to neurological disorders, learning disabilities or mental retardation
.
focuses on "mental and behavioural disorders" and consists of 10 main groups:
Within each group there are more specific subcategories. The ICD includes personality disorders on the same domain as other mental disorders, unlike the DSM. The ICD-10 states that mental disorder is "not an exact term", although is generally used "...to imply the existence of a clinically recognisable set of symptoms or behaviours associated in most cases with distress and with interference with personal functions." (WHO, 1992).
The WHO is revising their classifications in this section as part of the development of the ICD-11 (scheduled for 2014) and an "International Advisory Group" has been established to guide this.
-IV, produced by the American Psychiatric Association
, characterizes mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual,...is associated with present distress...or disability...or with a significant increased risk of suffering" but that "...no definition adequately specifies precise boundaries for the concept of 'mental disorder'...different situations call for different definitions" (APA, 1994 and 2000). The DSM also states that "there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder."
The DSM-IV-TR (Text Revision, 2000) consists of five axes (domains) on which disorder can be assessed. The five axes are:
The main categories of disorder in the DSM are:
sometimes uses specific manuals in addition to the DSM and ICD. The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3) was first published in 1994 by Zero to Three to classify mental health and developmental disorders in the first four years of life. It has been published in 9 languages. The Research Diagnostic criteria-Preschool Age (RDC-PA) was developed between 2000 and 2002 by a task force of independent investigators with the goal of developing clearly specified diagnostic criteria to facilitate research on psychopathology in this age group. The French Classification of Child and Adolescent Mental Disorders (CFTMEA), operational since 1983, is the classification of reference for French
child psychiatrists.
(e.g. general or family physician) version of the mental disorder section of ICD-10 has been developed (ICD-10-PHC) which has also been used quite extensively internationally. A survey of journal articles indexed in various biomedical databases between 1980 and 2005 indicated that 15,743 referred to the DSM and 3,106 to the ICD.
In Japan
, most university hospitals use either the ICD or DSM. ICD appears to be the somewhat more used for research or academic purposes, while both were used equally for clinical purposes. Other traditional psychiatric schemes may also be used.
(causation). These classification schemes have achieved some widespread acceptance in psychiatry and other fields, and have generally been found to have improved inter-rater reliability
, although routine clinical usage is less clear. Questions of validity
and utility
have been raised, both scientifically and in terms of social, economic and political factors—notably over the inclusion of certain controversial categories, the influence of the pharmaceutical industry, or the stigmatizing effect of being categorized or labelled
.
Classification may instead be based on broader underlying "spectra
", where each spectrum links together a range of related categorical diagnoses and nonthreshold symptom patterns.
Some approaches go further and propose continuously-varying dimensions that are not grouped into spectra or categories; each individual simply has a profile of scores across different dimensions. DSM-5
planning committees are currently seeking to establish a research basis for a hybrid dimensional classification of personality disorders. However, the problem with entirely dimensional classifications is they are said to be of limited practical value in clinical practice where yes/no decisions often need to be made, for example whether a person requires treatment, and moreover the rest of medicine is firmly committed to categories, which are assumed to reflect discrete disease entities. While the Psychodynamic Diagnostic Manual
has an emphasis on dimensionality and the context of mental problems, it has been structured largely as an adjunct to the categories of the DSM.
Nevertheless, non-categorical clinical formulation
approaches are commonly employed in clinical psychology
and some areas of psychiatry, where there may be limited or no reference to diagnostic categories. One such approach advocates taking each specific complaint reported by an individual on its own merits, treated as a phenomenon with its own causes.
Somatic nosology, on the other hand, is based almost exclusively on the objective histologic and chemical abnormalities which are characteristic of various diseases and can be identified by appropriately trained pathologists. While not all pathologists will agree in all cases, the degree of uniformity allowed is orders of magnitude greater than that enabled by the constantly changing classification embraced by the DSM system.
or anthropology
.
and his followers are generally credited with the first classification system for mental illnesses, including mania
, melancholia
, paranoia
, phobias and Scythian disease (transvestism
). They held that they were due to different kinds of imbalance in four humors.
Najab ud-din Unhammad. His nosology included nine major categories of mental disorders, with 30 different mental illnesses in total. Some of the categories he described resembled obsessive-compulsive disorder
s, delusional disorder
s, degenerative disease
s, involutional melancholia
, and states of abnormal excitement. Avicenna
(980−1037 CE) in the Canon of Medicine listed a number of mental disorders, including "passive male homosexuality".
Laws generally distinguished between "idiots" and "lunatics".
Thomas Sydenham
(1624–1689), the "English Hippocrates", emphasized careful clinical observation and diagnosis and developed the concept of a syndrome
, a group of associated symptoms having a common course, which would later influence psychiatric classification.
(literally referring to diseases of the mind) took hold in the late 18th and 19th centuries following the Renaissance
and Enlightenment
. Individual behaviors that had long been recognized came to be grouped into syndromes.
Boissier de Sauvages
developed an extremely extensive psychiatric classification in the mid-18th century, influenced by the medical nosology of Thomas Sydenham
and the biological taxonomy
of Carl Linnaeus. It was only part of his classification of 2400 medical diseases. These were divided in to 10 "classes", one of which comprised the bulk of the mental diseases, divided into four "orders" and 23 "genera". One genus, melancholia
, was subdivided into 14 "species".
William Cullen
advanced an influential medical nosology which included four classes of neuroses: coma, adynamias, spasms, and vesanias. The vesanias included amentia, melancholia, mania, and oneirodynia.
Towards the end of the 18th century Pinel
, influenced by Cullen's scheme, developed his own, again employing the terminology of genera and species. His simplified revision of this reduced all mental illnesses to four basic types. He argued that mental disorders are not separate entities but stem from a single disease that he called "mental alienation".
Attempts were made to merge the ancient concept of delirium
with that of insanity, the latter sometimes described as delirium without fever.
The concept of partial insanity developed, and attempts were made to distinguish it from total insanity by criteria such as intensity, content or generalization of delusions.
His successor, Esquirol
, extended Pinel's categories to five. Both made a clear distinction between insanity (including mania and dementia) as opposed to mental retardation
(including idiocy and imbecility). Esquirol developed a concept of monomania
—a periodic delusional fixation or undesirable disposition on one theme—that became a broad and common diagnosis and a part of popular culture for much of the 19th century.
. French and German psychiatric nosology was in the ascendency. The term "psychiatry" ("Psychiatrie") was coined by German physician Johann Christian Reil
in 1808, from the Greek "ψυχή" (psychē: "soul or mind") and "ιατρός" (iatros: "healer or doctor"). The term "alienation" took on a psychiatric meaning in France, later adopted in to medical English. The terms psychosis
and neurosis
came in to use, the former viewed psychologically and the latter neurologically.
In the second half of the century, Karl Kahlbaum and Ewald Hecker
developed a descriptive categorizion of syndromes, employing terms such as dysthymia, cyclothymia
, catatonia
, paranoia and hebephrenia. Wilhelm Griesinger
(1817–1869) advanced a unitary
scheme based on a concept of brain pathology. French psychiatrists Jules Baillarger
described "folie à double forme" and Jean-Pierre Falret
described "la folie circulaire"—alternating mania and depression.
The concept of adolescent insanity or developmental insanity was advanced by Scottish psychiatrist Thomas Coulston in 1873, describing a psychotic condition which generally afflicted those aged 18–24 years, particularly males, and in 30% of cases proceeded to "a secondary dementia".
The concept of hysteria
(wandering womb) had long been used, perhaps since ancient Egyptian times, and was later adopted by Freud. Descriptions of a specific syndrome now known as somatization disorder
were first developed by the French physician, Briquet
in 1859.
Early 19th century psychiatrists also began to categorize personality disorders. The diagnosis of "moral insanity" became popular; those with the condition did not seem psychotic but seemed to have no ability to comprehend moral principles. In the late 19th century, Koch referred to "psychopathic inferiority", and in the 20th century the disorder became known as "psychopathy" or "sociopathy". Related studies led to the DSM-III category of antisocial personality disorder
.
An American physician, Beard, described "neurasthenia
" in 1869. German neurologist Westphal
, coined the term "obsessional neurosis" now termed obsessive-compulsive disorder
, and agoraphobia
. Alienists created a whole new series of diagnoses that highlighted single, impulsive behavior, such as kleptomania
, dipsomania
, pyromania
, and nymphomania. The diagnosis of drapetomania
was also developed in the Southern United States to explain the perceived irrationality of black slaves trying to escape what was thought to be a suitable role.
The scientific study of homosexuality
began in the 19th century, informally viewed either as natural or as a disorder. Kraepelin included it as a disorder in his Compendium der Psychiatrie that he published in successive editions from 1883.
advanced a new system. He grouped together a number of existing diagnoses that appeared to all have a deteriorating course over time—such as catatonia
, hebephrenia and dementia paranoides—under another existing term "dementia praecox
" (meaning "early senility", later renamed schizophrenia). Another set of diagnoses that appeared to have a periodic course and better outcome were grouped together under the category of manic-depressive insanity (mood disorder). He also proposed a third category of psychosis, called paranoia, involving delusions but not the more general deficits and poor course attributed to dementia praecox. In all he proposed 15 categories, also including psychogenic neurosis, psychopathic personality, and syndromes of defective mental development (mental retardation). He eventually included homosexuality in the category of "mental conditions of constitutional origin".
The neuroses were later split into anxiety disorders and other disorders.
Freud wrote extensively on hysteria and also coined the term, "anxiety neurosis", which appeared in DSM-I and DSM-II. Checklist criteria for this led to studies that were to define panic disorder
for DSM-III.
Early 20th century schemes in Europe
and the US reflected a brain disease model that had emerged during the 19th century, as well as some ideas from Darwin
's theory of evolution
and/or Freud's psychoanalytic theories.
Psychoanalytic theory did not rest on classification of distinct disorders, but pursued analyses of unconscious conflicts and their manifestations within an individual's life. The concept of borderline personality disorder
developed from psychoanalytic theories.
The philosopher and psychiatrist Karl Jaspers
made influential use of a "biographical method" and suggested ways to diagnose based on the form rather than content of beliefs or perceptions. In regard to classification in general he prophetically remarked that: "When we design a diagnostic schema, we can only do so if we forego something at the outset ... and in the face of facts we have to draw the line where none exists... A classification therefore has only provisional value. It is a fiction which will discharge its function if it proves to be the most apt for the time".
Adolph Meyer
advanced a mixed biosocial scheme that emphasized the reactions and adaptations of the whole organism to life experiences.
In 1945, William C. Menninger
advanced a classification scheme for the US army, called Medical 203, synthesizing ideas of the time into five major groups. This system was adopted by the Veterans Administration
in the US and strongly influenced the DSM
.
The term stress, having emerged out of endocrinology
work in the 1930s, was popularized with an increasingly broad biopsychosocial meaning, and was increasingly linked to mental disorders. The diagnosis of post-traumatic stress disorder
was later created.
The Feighner Criteria group described fourteen major psychiatric disorders for which careful research studies were available, including homosexuality
. These developed as the Research Diagnostic Criteria
, adopted and further developed by the DSM-III.
The DSM and ICD
developed, partly in sync, in the context of mainstream psychiatric research and theory. Debates continued and developed about the definition of mental illness, the medical model
, categorical vs dimensional approaches, and whether and how to include suffering and impairment criteria. There is some attempt to construct novel schemes, for example from an attachment
perspective where patterns of symptoms are construed as evidence of specific patterns of disrupted attachment
, coupled with specific types of subsequent trauma.
are being developed at the start of the 21st century. Any radical new developments in classification are said to be more likely to be introduced by the APA than by the WHO, mainly because the former only has to persuade its own board of trustees whereas the latter has to persuade the representatives of over 200 different countries at a formal revision conference. In addition, while the DSM is a bestselling publication that makes huge profits for APA, the WHO incurs major expense in determining international consensus for revisions to the ICD. Although there is an ongoing attempt to reduce trivial or accidental differences between the DSM and ICD, it is thought that the APA and the WHO are likely to continue to produce new versions of their manuals and, in some respects, to compete with one another.
and reliability
of psychiatric diagnostic categories and criteria even though they have been increasingly standardized to improve inter-rater agreement in controlled research. In the United States, there have been calls and endorsements for a congressional hearing
to explore the nature and extent of harm potentially caused by this "minimally investigated enterprise".
Other specific criticisms of the current schemes include: attempts to demonstrate natural boundaries between related syndromes, or between a common syndrome and normality, have failed; the disorders of current classification are probably surface phenomena that can have many different interacting causes, yet "the mere fact that a diagnostic concept is listed in an official nomenclature and provided with a precise operational definition tends to encourage us to assume that it is a "quasi-disease entity" that can be invoked to explain the patient's symptoms"; and that the diagnostic manuals have led to an unintended decline in careful evaluation of each individual person's experiences and social context. Psychodynamic schemes give this latter phenomenological
aspect more consideration, but in psychoanalytic terms that have been long criticized on numerous grounds.
Reliance on operational definition
demands that intuitive concepts, such as depression need to be operationally defined before they become amenable to scientific investigation. However, John Stuart Mill
pointed out the dangers of believing that anything that could be given a name must refer to a thing and Stephen Jay Gould
and others have criticized psychologists for doing just that. One critic states that "Instead of replacing 'metaphysical' terms such as 'desire' and 'purpose', they used it to legitimize them by giving them operational definitions. Thus in psychology, as in economics, the initial, quite radical operationalist ideas eventually came to serve as little more than a 'reassurance fetish' (Koch 1992, 275) for mainstream methodological practice."
Psychiatrist Joel Paris argues that psychiatry is sometimes susceptible to diagnostic fads. Some have been based on theory (overdiagnosis of schizophrenia
), some based on etiological (causation) concepts (overdiagnosis of post-traumatic stress disorder
), and some based on the development of treatments. Paris points out that psychiatrists like to diagnose conditions they can treat, and gives examples of what he sees as prescribing
patterns paralleling diagnostic trends, for example an increase in bipolar
diagnosis once lithium
came into use, and similar scenarios with the use of electroconvulsive therapy
, neuroleptics, tricyclic antidepressants, and SSRIs. He notes that there was a time when every patient seemed to have "latent schizophrenia" and another time when everything in psychiatry seemed to be "masked depression", and he fears that the boundaries of the bipolar spectrum
concept, including in application to children, are similarly expanding.
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
and other mental health professions
Mental health professional
A mental health professional is a health care practitioner who offers services for the purpose of improving an individual's mental health or to treat mental illness. This broad category includes psychiatrists, clinical psychologists, clinical social workers, psychiatric nurses, mental health...
and an important issue for consumers and providers of mental health services. There are currently two widely established systems
Medical classification
Medical classification, or medical coding, is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers...
for classifying mental disorders—Chapter V of the International Classification of Diseases (ICD-10) produced by the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) and the Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
(DSM-IV) produced by the American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
(APA). Both list categories of disorders thought to be distinct types, and have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain. Other classification schemes may be in use more locally, for example the Chinese Classification of Mental Disorders
Chinese Classification of Mental Disorders
The Chinese Classification of Mental Disorders , published by the Chinese Society of Psychiatry , is a clinical guide used in China for the diagnosis of mental disorders. It is currently on a third version, the CCMD-3, written in Chinese and English...
. Other manuals have some limited use by those of alternative theoretical persuasions, such as the Psychodynamic Diagnostic Manual
Psychodynamic diagnostic manual
The Psychodynamic Diagnostic Manual is a diagnostic handbook similar to the International Statistical Classification of Diseases and Related Health Problems or the Diagnostic and Statistical Manual of Mental Disorders...
.
The widely used DSM and ICD classifications employ operational definition
Operational definition
An operational definition defines something in terms of the specific process or set of validation tests used to determine its presence and quantity. That is, one defines something in terms of the operations that count as measuring it. The term was coined by Percy Williams Bridgman and is a part of...
s. There is a significant scientific debate about the relative validity
Validity (statistics)
In science and statistics, validity has no single agreed definition but generally refers to the extent to which a concept, conclusion or measurement is well-founded and corresponds accurately to the real world. The word "valid" is derived from the Latin validus, meaning strong...
of a "categorical" versus a "dimensional" system of classification, as well as significant controversy about the role of science and values in classification schemes and the professional, legal and social uses to which they are put.
Definitions
In the scientific and academic literature on the definition or categorizationCategorization
Categorization is the process in which ideas and objects are recognized, differentiated and understood. Categorization implies that objects are grouped into categories, usually for some specific purpose. Ideally, a category illuminates a relationship between the subjects and objects of knowledge...
of mental disorders, one extreme argues that it is entirely a matter of value judgements (including of what is normal
Normality (behavior)
In behavior, normal refers to a lack of significant deviation from the average. The phrase "not normal" is often applied in a negative sense Abnormality varies greatly in how pleasant or unpleasant this is for other people.The Oxford English Dictionary defines "normal" as "conforming to a standard"...
) while another proposes that it is or could be entirely objective
Objectivity (science)
Objectivity in science is a value that informs how science is practiced and how scientific truths are created. It is the idea that scientists, in attempting to uncover truths about the natural world, must aspire to eliminate personal biases, a priori commitments, emotional involvement, etc...
and scientific (including by reference to statistical norms); other views argue that the concept refers to a "fuzzy prototype
Prototype
A prototype is an early sample or model built to test a concept or process or to act as a thing to be replicated or learned from.The word prototype derives from the Greek πρωτότυπον , "primitive form", neutral of πρωτότυπος , "original, primitive", from πρῶτος , "first" and τύπος ,...
" that can never be precisely defined, or that the definition will always involve a mixture of scientific facts (e.g. that a natural or evolved function isn't working properly) and value judgements (e.g. that it is harmful or undesired). Lay concepts of mental disorder vary considerably across different cultures and countries, and may refer to different sorts of individual and social problems.
The WHO and national surveys report that there is no single consensus on the definition of mental disorder/illness, and that the phrasing used depends on the social, cultural, economic and legal context in different contexts and in different societies. The WHO reports that there is intense debate about which conditions should be included under the concept of mental disorder; a broad definition can cover mental illness, mental retardation, personality disorder and substance dependence, but inclusion varies by country and is reported to be a complex and debated issue. There may be a criterion that a condition should not be expected to occur as part of a person's usual culture or religion. However, despite the term "mental", there is not necessarily a clear distinction drawn between mental (dys)functioning and brain (dys)functioning, or indeed between the brain and the rest of the body.
Most international clinical documents avoid the term "mental illness", preferring the term "mental disorder". However, some use "mental illness" as the main over-arching term to encompass mental disorders. Some consumer/survivor movement
Psychiatric survivors movement
The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...
organizations oppose use of the term "mental illness" on the grounds that it supports the dominance of a medical model
Medical model
Medical model is the term cited by psychiatrist Ronald D. Laing in his The Politics of the Family and Other Essays , for the "set of procedures in which all doctors are trained." This set includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and...
. The term "serious mental illness" (SMI) is sometimes used to refer to more severe and long-lasting disorders while "mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
problems" may be used as a broader term, or to refer only to milder or more transient issues. Confusion often surrounds the ways and contexts in which these terms are used.
Mental disorders are generally classified separately to neurological disorders, learning disabilities or mental retardation
Mental retardation
Mental retardation is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors...
.
ICD-10
The International Classification of Diseases (ICD) is an international standard diagnostic classification for a wide variety of health conditions. Chapter VICD-10 Chapter V: Mental and behavioural disorders
- Organic, including symptomatic, mental disorders :* Dementia in Alzheimer's disease* Vascular dementia** Multi-infarct dementia* Dementia in other diseases classified elsewhere** Dementia in Pick's disease...
focuses on "mental and behavioural disorders" and consists of 10 main groups:
- F0: Organic, including symptomatic, mental disorders
- F1: Mental and behavioural disorders due to use of psychoactive substances
- F2: Schizophrenia, schizotypal and delusional disorders
- F3: Mood [affective] disorders
- F4: Neurotic, stress-related and somatoform disorders
- F5: Behavioural syndromes associated with physiological disturbances and physical factors
- F6: Disorders of personality and behaviour in adult persons
- F7: Mental retardation
- F8: Disorders of psychological development
- F9: Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
- In addition, a group of "unspecified mental disorders".
Within each group there are more specific subcategories. The ICD includes personality disorders on the same domain as other mental disorders, unlike the DSM. The ICD-10 states that mental disorder is "not an exact term", although is generally used "...to imply the existence of a clinically recognisable set of symptoms or behaviours associated in most cases with distress and with interference with personal functions." (WHO, 1992).
The WHO is revising their classifications in this section as part of the development of the ICD-11 (scheduled for 2014) and an "International Advisory Group" has been established to guide this.
DSM-IV
The DSMDiagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
-IV, produced by the American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
, characterizes mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual,...is associated with present distress...or disability...or with a significant increased risk of suffering" but that "...no definition adequately specifies precise boundaries for the concept of 'mental disorder'...different situations call for different definitions" (APA, 1994 and 2000). The DSM also states that "there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder."
The DSM-IV-TR (Text Revision, 2000) consists of five axes (domains) on which disorder can be assessed. The five axes are:
- Axis I: Clinical Disorders (all mental disorders except Personality Disorders and Mental Retardation)
- Axis II: Personality Disorders and Mental Retardation
- Axis III: General Medical Conditions (must be connected to a Mental Disorder)
- Axis IV: Psychosocial and Environmental Problems (for example limited social support network)
- Axis V: Global Assessment of Functioning (Psychological, social and job-related functions are evaluated on a continuum between mental health and extreme mental disorder)
The main categories of disorder in the DSM are:
| DSM Group | Examples |
|---|---|
| Disorders usually first diagnosed in infancy, childhood or adolescence. *Disorders such as ADHD and epilepsy Epilepsy Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases... have also been referred to as developmental disorder Developmental disorder Developmental disorders occur at some stage in a child's development, often retarding the development. These may include,psychological or physical disorders. The disorder is an impairment in the normal development of motor or cognitive skills that are developed before age 18 in which they are... s and developmental disabilities. |
Mental retardation Mental retardation Mental retardation is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors... , ADHD |
| Delirium Delirium Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior... , dementia Dementia Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging... , and amnesia Amnesia Amnesia is a condition in which one's memory is lost. The causes of amnesia have traditionally been divided into categories. Memory appears to be stored in several parts of the limbic system of the brain, and any condition that interferes with the function of this system can cause amnesia... and other cognitive disorder Cognitive disorder Most common mental disorders affect cognitive functions, mainly memory processing, perception and problem solving. The most direct cognitive disorders are amnesia, dementia and delirium. Others include anxiety disorders such as phobias, panic disorders, obsessive–compulsive disorder, generalized... s |
Alzheimer's disease Alzheimer's disease Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death... |
| Mental disorders due to a general medical condition | AIDS-related psychosis Psychosis Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"... |
| Substance-related disorders Substance abuse A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a... |
Alcohol abuse Alcohol abuse Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid... |
| Schizophrenia Schizophrenia Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social... and other psychotic disorders Psychosis Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"... |
Delusional disorder Delusional disorder Delusional disorder is an uncommon psychiatric condition in which patients present with circumscribed symptoms of non-bizarre delusions, but with the absence of prominent hallucinations and no thought disorder, mood disorder, or significant flattening of affect... |
| Mood disorder Mood disorder Mood disorder is the term designating a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature... s |
Major depressive disorder, Bipolar disorder Bipolar disorder Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or... |
| Anxiety disorder Anxiety disorder Anxiety disorder is a blanket term covering several different forms of abnormal and pathological fear and anxiety. Conditions now considered anxiety disorders only came under the aegis of psychiatry at the end of the 19th century. Gelder, Mayou & Geddes explains that anxiety disorders are... s |
General anxiety disorder General anxiety disorder Generalized anxiety disorder is an anxiety disorder that is characterized by excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry... |
| Somatoform disorder Somatoform disorder In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder . The symptoms that... s |
Somatization disorder Somatization disorder Somatization disorder is a psychiatric diagnosis applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin... |
| Factitious disorder Factitious disorder Factitious disorders are conditions in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder by proxy is a condition in which a person deliberately produces, feigns, or exaggerates symptoms in a person who is in their... s |
Münchausen syndrome Munchausen syndrome Münchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome... |
| Dissociative disorders | Dissociative identity disorder Dissociative identity disorder Dissociative identity disorder is a psychiatric diagnosis and describes a condition in which a person displays multiple distinct identities , each with its own pattern of perceiving and interacting with the environment.... |
| Sexual and gender identity disorder Gender identity disorder Gender identity disorder is the formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria . It describes the symptoms related to transsexualism, as well as less severe manifestations of gender dysphoria... s |
Dyspareunia Dyspareunia Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The symptom is reported almost exclusively by women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original... , Gender identity disorder Gender identity disorder Gender identity disorder is the formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria . It describes the symptoms related to transsexualism, as well as less severe manifestations of gender dysphoria... |
| Eating disorders | Anorexia nervosa Anorexia nervosa Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate... , Bulimia nervosa Bulimia nervosa Bulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, usually by purging and/or by laxative, diuretics or excessive exercise. Bulimia nervosa is... |
| Sleep disorder Sleep disorder A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning... s |
Insomnia Insomnia Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:... |
| Impulse control disorder Impulse control disorder Impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder, kleptomania, pathological gambling, pyromania , and three body-focused repetitive or compulsive behaviors of trichotillomania , onychophagia and dermatillomania... s not elsewhere classified |
Kleptomania Kleptomania Kleptomania is an irresistible urge to steal items of trivial value. People with this disorder are compelled to steal things, generally, but not limited to, objects of little or no significant value, such as pens, paper clips, paper and tape... |
| Adjustment disorder Adjustment disorder Adjustment disorder is a psychological response to an identifiable stressor or group of stressors that cause significant emotional or behavioral symptoms that do not meet criteria for anxiety disorder, PTSD, or acute stress disorder... s |
Adjustment disorder Adjustment disorder Adjustment disorder is a psychological response to an identifiable stressor or group of stressors that cause significant emotional or behavioral symptoms that do not meet criteria for anxiety disorder, PTSD, or acute stress disorder... |
| Personality disorder Personality disorder Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are... s |
Narcissistic personality disorder Narcissistic personality disorder Narcissistic personality disorder is a personality disorder in which the individual is described as being excessively preoccupied with issues of personal adequacy, power, prestige and vanity... |
| Other conditions that may be a focus of clinical attention | Tardive dyskinesia Tardive dyskinesia Tardive dyskinesia is a difficult-to-treat form of dyskinesia that can be tardive... , Child abuse Child abuse Child abuse is the physical, sexual, emotional mistreatment, or neglect of a child. In the United States, the Centers for Disease Control and Prevention and the Department of Children And Families define child maltreatment as any act or series of acts of commission or omission by a parent or... |
Other schemes
- The Chinese Society of PsychiatryChinese Society of PsychiatryThe Chinese Society of Psychiatry is the largest organization for psychiatrists in China. It publishes the Chinese Classification of Mental Disorders...
's Chinese Classification of Mental DisordersChinese Classification of Mental DisordersThe Chinese Classification of Mental Disorders , published by the Chinese Society of Psychiatry , is a clinical guide used in China for the diagnosis of mental disorders. It is currently on a third version, the CCMD-3, written in Chinese and English...
(currently CCMD-3) - The Latin American Guide for Psychiatric Diagnosis (GLDP).
Childhood diagnosis
Child and adolescent psychiatryChild and adolescent psychiatry
The branch of psychiatry that specializes in the study, diagnosis, treatment, and prevention of psychopathological disorders of children, adolescents, and their families, child and adolescent psychiatry encompasses the clinical investigation of phenomenology, biologic factors, psychosocial factors,...
sometimes uses specific manuals in addition to the DSM and ICD. The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3) was first published in 1994 by Zero to Three to classify mental health and developmental disorders in the first four years of life. It has been published in 9 languages. The Research Diagnostic criteria-Preschool Age (RDC-PA) was developed between 2000 and 2002 by a task force of independent investigators with the goal of developing clearly specified diagnostic criteria to facilitate research on psychopathology in this age group. The French Classification of Child and Adolescent Mental Disorders (CFTMEA), operational since 1983, is the classification of reference for French
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
child psychiatrists.
Usage
The ICD and DSM classification schemes have achieved widespread acceptance in psychiatry. A survey of 205 psychiatrists, from 66 different countries across all continents, found that ICD-10 was more frequently used and more valued in clinical practice and training, while the DSM-IV was more valued for research, with accessibility to either being limited, and usage by other mental health professionals, policy makers, patients and families less clear. A primary carePrimary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
(e.g. general or family physician) version of the mental disorder section of ICD-10 has been developed (ICD-10-PHC) which has also been used quite extensively internationally. A survey of journal articles indexed in various biomedical databases between 1980 and 2005 indicated that 15,743 referred to the DSM and 3,106 to the ICD.
In Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
, most university hospitals use either the ICD or DSM. ICD appears to be the somewhat more used for research or academic purposes, while both were used equally for clinical purposes. Other traditional psychiatric schemes may also be used.
Categorical schemes
The classification schemes in common usage are based on separate (but may be overlapping) categories of disorder schemes sometimes termed "neo-Kraepelinian" (after the psychiatrist Kraepelin) which is intended to be atheoretical with regard to etiologyEtiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
(causation). These classification schemes have achieved some widespread acceptance in psychiatry and other fields, and have generally been found to have improved inter-rater reliability
Inter-rater reliability
In statistics, inter-rater reliability, inter-rater agreement, or concordance is the degree of agreement among raters. It gives a score of how much homogeneity, or consensus, there is in the ratings given by judges. It is useful in refining the tools given to human judges, for example by...
, although routine clinical usage is less clear. Questions of validity
Validity
In logic, argument is valid if and only if its conclusion is entailed by its premises, a formula is valid if and only if it is true under every interpretation, and an argument form is valid if and only if every argument of that logical form is valid....
and utility
Utility
In economics, utility is a measure of customer satisfaction, referring to the total satisfaction received by a consumer from consuming a good or service....
have been raised, both scientifically and in terms of social, economic and political factors—notably over the inclusion of certain controversial categories, the influence of the pharmaceutical industry, or the stigmatizing effect of being categorized or labelled
Labeling theory
Labeling theory is closely related to interactionist and social construction theories. Labeling theory was developed by sociologists during the 1960's. Howard Saul Becker's book entitled Outsiders was extremely influential in the development of this theory and its rise to popularity...
.
Non-categorical schemes
Some approaches to classification do not use categories with single cut-offs separating the ill from the healthy or the abnormal from the normal (a practice sometimes termed "threshold psychiatry" or "dichotomous classification").Classification may instead be based on broader underlying "spectra
Spectrum disorder
A spectrum in psychiatry is a range of linked conditions, such that there is "not a unitary disorder but rather a syndrome composed of subgroups". The subgroups may be linked together by clinical appearance or by shared underlying causation...
", where each spectrum links together a range of related categorical diagnoses and nonthreshold symptom patterns.
Some approaches go further and propose continuously-varying dimensions that are not grouped into spectra or categories; each individual simply has a profile of scores across different dimensions. DSM-5
DSM-5
The next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders , commonly called DSM-5 , is currently in consultation, planning and preparation...
planning committees are currently seeking to establish a research basis for a hybrid dimensional classification of personality disorders. However, the problem with entirely dimensional classifications is they are said to be of limited practical value in clinical practice where yes/no decisions often need to be made, for example whether a person requires treatment, and moreover the rest of medicine is firmly committed to categories, which are assumed to reflect discrete disease entities. While the Psychodynamic Diagnostic Manual
Psychodynamic diagnostic manual
The Psychodynamic Diagnostic Manual is a diagnostic handbook similar to the International Statistical Classification of Diseases and Related Health Problems or the Diagnostic and Statistical Manual of Mental Disorders...
has an emphasis on dimensionality and the context of mental problems, it has been structured largely as an adjunct to the categories of the DSM.
Nevertheless, non-categorical clinical formulation
Clinical formulation
A clinical formulation is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an alternative approach to the more categorical approach of...
approaches are commonly employed in clinical psychology
Clinical psychology
Clinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development...
and some areas of psychiatry, where there may be limited or no reference to diagnostic categories. One such approach advocates taking each specific complaint reported by an individual on its own merits, treated as a phenomenon with its own causes.
Descriptive vs Somatic
Descriptive classifications are based almost exclusively on either descriptions of behavior as reported by various observers, such as parents, teachers, and medical personnel; or symptoms as reported by individuals themselves. As such, they are quite subjective, not amenable to verification by third parties, and not readily transferable across chronologic and/or cultural barriers.Somatic nosology, on the other hand, is based almost exclusively on the objective histologic and chemical abnormalities which are characteristic of various diseases and can be identified by appropriately trained pathologists. While not all pathologists will agree in all cases, the degree of uniformity allowed is orders of magnitude greater than that enabled by the constantly changing classification embraced by the DSM system.
Cultural differences
Classification schemes may not apply to all cultures. The DSM is based on predominantly American research studies and has been said to have a decidedly American outlook, meaning that differing disorders or concepts of illness from other cultures (including personalistic rather than naturalistic explanations) may be neglected or misrepresented, while Western cultural phenomena may be taken as universal. Culture-bound syndromes are those hypothesized to be specific to certain cultures (typically taken to mean non-Western or non-mainstream cultures); while some are listed in an appendix of the DSM-IV they are not detailed and there remain open questions about the relationship between Western and non-Western diagnostic categories and sociocultural factors, which are addressed from different directions by, for example, cross-cultural psychiatryCross-cultural psychiatry
Cross-cultural psychiatry or transcultural psychiatry is a branch of psychiatry concerned with the cultural and ethnic context of mental disorders and psychiatric services...
or anthropology
Anthropology
Anthropology is the study of humanity. It has origins in the humanities, the natural sciences, and the social sciences. The term "anthropology" is from the Greek anthrōpos , "man", understood to mean mankind or humanity, and -logia , "discourse" or "study", and was first used in 1501 by German...
.
Antiquity
In Ancient Greece, HippocratesHippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...
and his followers are generally credited with the first classification system for mental illnesses, including mania
Mania
Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression...
, melancholia
Melancholia
Melancholia , also lugubriousness, from the Latin lugere, to mourn; moroseness, from the Latin morosus, self-willed, fastidious habit; wistfulness, from old English wist: intent, or saturnine, , in contemporary usage, is a mood disorder of non-specific depression,...
, paranoia
Paranoia
Paranoia [] is a thought process believed to be heavily influenced by anxiety or fear, often to the point of irrationality and delusion. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself...
, phobias and Scythian disease (transvestism
Transvestism
Transvestism is the practice of cross-dressing, which is wearing clothing traditionally associated with the opposite sex. Transvestite refers to a person who cross-dresses; however, the word often has additional connotations. -History:Although the word transvestism was coined as late as the 1910s,...
). They held that they were due to different kinds of imbalance in four humors.
Middle ages to Renaissance
An elaborate classification of mental disorders was developed in the 10th century by Arabian psychologistIslamic psychology
Islamic psychology translates the term ʿIlm al-Nafs the science of the Nafs and refers to the medical and philosophical study of the psyche from an Islamic perspective...
Najab ud-din Unhammad. His nosology included nine major categories of mental disorders, with 30 different mental illnesses in total. Some of the categories he described resembled obsessive-compulsive disorder
Obsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...
s, delusional disorder
Delusional disorder
Delusional disorder is an uncommon psychiatric condition in which patients present with circumscribed symptoms of non-bizarre delusions, but with the absence of prominent hallucinations and no thought disorder, mood disorder, or significant flattening of affect...
s, degenerative disease
Degenerative disease
A degenerative disease, also called neurodegenerative disease, is a disease in which the function or structure of the affected tissues or organs will progressively deteriorate over time, whether due to normal bodily wear or lifestyle choices such as exercise or eating habits...
s, involutional melancholia
Involutional melancholia
Involutional melancholia or involutional depression is a traditional name for a psychiatric disorder affecting mainly elderly or late middle-aged people, usually accompanied with paranoia...
, and states of abnormal excitement. Avicenna
Avicenna
Abū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā , commonly known as Ibn Sīnā or by his Latinized name Avicenna, was a Persian polymath, who wrote almost 450 treatises on a wide range of subjects, of which around 240 have survived...
(980−1037 CE) in the Canon of Medicine listed a number of mental disorders, including "passive male homosexuality".
Laws generally distinguished between "idiots" and "lunatics".
Thomas Sydenham
Thomas Sydenham
Thomas Sydenham was an English physician. He was born at Wynford Eagle in Dorset, where his father was a gentleman of property. His brother was Colonel William Sydenham. Thomas fought for the Parliament throughout the English Civil War, and, at its end, resumed his medical studies at Oxford...
(1624–1689), the "English Hippocrates", emphasized careful clinical observation and diagnosis and developed the concept of a syndrome
Syndrome
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others...
, a group of associated symptoms having a common course, which would later influence psychiatric classification.
18th century
Evolution in the scientific concepts of psychopathologyPsychopathology
Psychopathology is the study of mental illness, mental distress, and abnormal/maladaptive behavior. The term is most commonly used within psychiatry where pathology refers to disease processes...
(literally referring to diseases of the mind) took hold in the late 18th and 19th centuries following the Renaissance
Renaissance
The Renaissance was a cultural movement that spanned roughly the 14th to the 17th century, beginning in Italy in the Late Middle Ages and later spreading to the rest of Europe. The term is also used more loosely to refer to the historical era, but since the changes of the Renaissance were not...
and Enlightenment
Age of Enlightenment
The Age of Enlightenment was an elite cultural movement of intellectuals in 18th century Europe that sought to mobilize the power of reason in order to reform society and advance knowledge. It promoted intellectual interchange and opposed intolerance and abuses in church and state...
. Individual behaviors that had long been recognized came to be grouped into syndromes.
Boissier de Sauvages
François Boissier de Sauvages de Lacroix
François Boissier de Sauvages de Lacroix was a French physician and botanist who was a native of Alès. He studied medicine and botany at the University of Montpellier, and received his doctorate in 1726. After spending a few years in Paris, he returned to Montpellier in 1734, where became...
developed an extremely extensive psychiatric classification in the mid-18th century, influenced by the medical nosology of Thomas Sydenham
Thomas Sydenham
Thomas Sydenham was an English physician. He was born at Wynford Eagle in Dorset, where his father was a gentleman of property. His brother was Colonel William Sydenham. Thomas fought for the Parliament throughout the English Civil War, and, at its end, resumed his medical studies at Oxford...
and the biological taxonomy
Taxonomy
Taxonomy is the science of identifying and naming species, and arranging them into a classification. The field of taxonomy, sometimes referred to as "biological taxonomy", revolves around the description and use of taxonomic units, known as taxa...
of Carl Linnaeus. It was only part of his classification of 2400 medical diseases. These were divided in to 10 "classes", one of which comprised the bulk of the mental diseases, divided into four "orders" and 23 "genera". One genus, melancholia
Melancholia
Melancholia , also lugubriousness, from the Latin lugere, to mourn; moroseness, from the Latin morosus, self-willed, fastidious habit; wistfulness, from old English wist: intent, or saturnine, , in contemporary usage, is a mood disorder of non-specific depression,...
, was subdivided into 14 "species".
William Cullen
William Cullen
William Cullen FRS FRSE FRCPE FPSG was a Scottish physician, chemist and agriculturalist, and one of the most important professors at the Edinburgh Medical School, during its heyday as the leading center of medical education in the English-speaking world.Cullen was also a central figure in the...
advanced an influential medical nosology which included four classes of neuroses: coma, adynamias, spasms, and vesanias. The vesanias included amentia, melancholia, mania, and oneirodynia.
Towards the end of the 18th century Pinel
Pinel
Pinel is the surname of:* Raquel Pinel, Spanish football forward currently playing for Valencia CF in the Spanish league* Marcel Pinel , French footballer* Suzanne Pinel, CM is a Canadian children's entertainer and citizenship judge...
, influenced by Cullen's scheme, developed his own, again employing the terminology of genera and species. His simplified revision of this reduced all mental illnesses to four basic types. He argued that mental disorders are not separate entities but stem from a single disease that he called "mental alienation".
Attempts were made to merge the ancient concept of delirium
Delirium
Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...
with that of insanity, the latter sometimes described as delirium without fever.
The concept of partial insanity developed, and attempts were made to distinguish it from total insanity by criteria such as intensity, content or generalization of delusions.
His successor, Esquirol
Jean-Étienne Dominique Esquirol
Jean-Étienne Dominique Esquirol was a French psychiatrist.Born and raised in Toulouse, Esquirol completed his education at Montpellier...
, extended Pinel's categories to five. Both made a clear distinction between insanity (including mania and dementia) as opposed to mental retardation
Mental retardation
Mental retardation is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors...
(including idiocy and imbecility). Esquirol developed a concept of monomania
Monomania
In 19th century psychiatry, monomania is a single pathological preoccupation in an otherwise sound mind. Emotional monomania is that in which the patient is obsessed with only one emotion or several related to it; intellectual monomania is that which is related to only one kind of delirious idea...
—a periodic delusional fixation or undesirable disposition on one theme—that became a broad and common diagnosis and a part of popular culture for much of the 19th century.
19th century
The botanical taxonomic approach was abandoned in the 19th century, in favor of an anatomical-clinical approach that became increasingly descriptive. There was a focus on identifying the particular psychological faculty involved in particular forms of insanity, although some argued for a more central "unitary" causeUnitary psychosis
Unitary psychosis refers to the 19th-century belief prevalent in German psychiatry until the era of Emil Kraepelin that all forms of psychosis were surface variations of a single underlying disease process...
. French and German psychiatric nosology was in the ascendency. The term "psychiatry" ("Psychiatrie") was coined by German physician Johann Christian Reil
Johann Christian Reil
Johann Christian Reil was a German physician, physiologist, anatomist and psychiatrist. He coined the term psychiatry or, in German, Psychiatrie in 1808....
in 1808, from the Greek "ψυχή" (psychē: "soul or mind") and "ιατρός" (iatros: "healer or doctor"). The term "alienation" took on a psychiatric meaning in France, later adopted in to medical English. The terms psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
and neurosis
Neurosis
Neurosis is a class of functional mental disorders involving distress but neither delusions nor hallucinations, whereby behavior is not outside socially acceptable norms. It is also known as psychoneurosis or neurotic disorder, and thus those suffering from it are said to be neurotic...
came in to use, the former viewed psychologically and the latter neurologically.
In the second half of the century, Karl Kahlbaum and Ewald Hecker
Ewald Hecker
Ewald Hecker was a German psychiatrist who was an important figure in the early days of modern psychiatry. He is known for research done with his mentor, psychiatrist Karl Ludwig Kahlbaum ....
developed a descriptive categorizion of syndromes, employing terms such as dysthymia, cyclothymia
Cyclothymia
Cyclothymia is a mood and mental disorder in the bipolar spectrum that causes both hypomanic and depressive episodes. It is defined medically within the bipolar spectrum and consists of recurrent disturbances between sudden hypomania and dysthymic episodes. The diagnosis of cyclothymic disorder is...
, catatonia
Catatonia
Catatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....
, paranoia and hebephrenia. Wilhelm Griesinger
Wilhelm Griesinger
Wilhelm Griesinger was a German neurologist and psychiatrist born in Stuttgart. He studied under Johann Lukas Schönlein at the University of Zurich and physiologist François Magendie in Paris....
(1817–1869) advanced a unitary
Unitary psychosis
Unitary psychosis refers to the 19th-century belief prevalent in German psychiatry until the era of Emil Kraepelin that all forms of psychosis were surface variations of a single underlying disease process...
scheme based on a concept of brain pathology. French psychiatrists Jules Baillarger
Jules Baillarger
Jules Baillarger, full name Jules Gabriel François Baillarger was a French neurologist and psychiatrist who was born in Montbazon....
described "folie à double forme" and Jean-Pierre Falret
Jean-Pierre Falret
Jean-Pierre Falret was a French psychiatrist born in Marseille.In 1811 he began his medical studies in Paris, where he was inspired by the work of Philippe Pinel and Jean Étienne Dominique Esquirol...
described "la folie circulaire"—alternating mania and depression.
The concept of adolescent insanity or developmental insanity was advanced by Scottish psychiatrist Thomas Coulston in 1873, describing a psychotic condition which generally afflicted those aged 18–24 years, particularly males, and in 30% of cases proceeded to "a secondary dementia".
The concept of hysteria
Hysteria
Hysteria, in its colloquial use, describes unmanageable emotional excesses. People who are "hysterical" often lose self-control due to an overwhelming fear that may be caused by multiple events in one's past that involved some sort of severe conflict; the fear can be centered on a body part, or,...
(wandering womb) had long been used, perhaps since ancient Egyptian times, and was later adopted by Freud. Descriptions of a specific syndrome now known as somatization disorder
Somatization disorder
Somatization disorder is a psychiatric diagnosis applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin...
were first developed by the French physician, Briquet
Briquet
Briquet may refer to:*Charles Moїse Briquet - Swiss paper merchant and scholar of watermarks.*Briquet fl. 1420, a Renaissance composer*Artois Hound or Briquet, a rare breed of dog, and a descendant of the Bloodhound...
in 1859.
Early 19th century psychiatrists also began to categorize personality disorders. The diagnosis of "moral insanity" became popular; those with the condition did not seem psychotic but seemed to have no ability to comprehend moral principles. In the late 19th century, Koch referred to "psychopathic inferiority", and in the 20th century the disorder became known as "psychopathy" or "sociopathy". Related studies led to the DSM-III category of antisocial personality disorder
Antisocial personality disorder
Antisocial personality disorder is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition , as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood...
.
An American physician, Beard, described "neurasthenia
Neurasthenia
Neurasthenia is a psycho-pathological term first used by George Miller Beard in 1869 to denote a condition with symptoms of fatigue, anxiety, headache, neuralgia and depressed mood...
" in 1869. German neurologist Westphal
Carl Friedrich Otto Westphal
Carl Friedrich Otto Westphal was a German neurologist and psychiatrist from Berlin. He was the son of Otto Carl Friedrich Westphal and Karoline Friederike Heine and the father of Alexander Carl Otto Westphal...
, coined the term "obsessional neurosis" now termed obsessive-compulsive disorder
Obsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...
, and agoraphobia
Agoraphobia
Agoraphobia is an anxiety disorder defined as a morbid fear of having a panic attack or panic-like symptoms in a situation from which it is perceived to be difficult to escape. These situations can include, but are not limited to, wide-open spaces, crowds, or uncontrolled social conditions...
. Alienists created a whole new series of diagnoses that highlighted single, impulsive behavior, such as kleptomania
Kleptomania
Kleptomania is an irresistible urge to steal items of trivial value. People with this disorder are compelled to steal things, generally, but not limited to, objects of little or no significant value, such as pens, paper clips, paper and tape...
, dipsomania
Dipsomania
Dipsomania is a historical term describing a medical condition involving an uncontrollable craving for alcohol. It was used in the 19th century to describe a variety of alcohol-related problems, most of which are most commonly conceptualized today as alcoholism, but it is occasionally still used to...
, pyromania
Pyromania
Pyromania in more extreme circumstances can be an impulse control disorder to deliberately start fires to relieve tension or for gratification or relief. The term pyromania comes from the Greek word πῦρ . Pyromania and pyromaniacs are distinct from arson, the pursuit of personal, monetary or...
, and nymphomania. The diagnosis of drapetomania
Drapetomania
Drapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused black slaves to flee captivity. Today, drapetomania is considered an example of pseudoscience, and part of the edifice of scientific racism...
was also developed in the Southern United States to explain the perceived irrationality of black slaves trying to escape what was thought to be a suitable role.
The scientific study of homosexuality
Homosexuality
Homosexuality is romantic or sexual attraction or behavior between members of the same sex or gender. As a sexual orientation, homosexuality refers to "an enduring pattern of or disposition to experience sexual, affectional, or romantic attractions" primarily or exclusively to people of the same...
began in the 19th century, informally viewed either as natural or as a disorder. Kraepelin included it as a disorder in his Compendium der Psychiatrie that he published in successive editions from 1883.
20th century
Influenced by the approach of Kahlbaum and others, and developing his concepts in publications spanning the turn of the century, German psychiatrist Emil KraepelinEmil Kraepelin
Emil Kraepelin was a German psychiatrist. H.J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, as well as of psychopharmacology and psychiatric genetics. Kraepelin believed the chief origin of psychiatric disease to be biological and genetic...
advanced a new system. He grouped together a number of existing diagnoses that appeared to all have a deteriorating course over time—such as catatonia
Catatonia
Catatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....
, hebephrenia and dementia paranoides—under another existing term "dementia praecox
Dementia praecox
Dementia praecox refers to a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood. It is a term first used in 1891 in this Latin form by Arnold Pick , a professor of psychiatry at the German branch of...
" (meaning "early senility", later renamed schizophrenia). Another set of diagnoses that appeared to have a periodic course and better outcome were grouped together under the category of manic-depressive insanity (mood disorder). He also proposed a third category of psychosis, called paranoia, involving delusions but not the more general deficits and poor course attributed to dementia praecox. In all he proposed 15 categories, also including psychogenic neurosis, psychopathic personality, and syndromes of defective mental development (mental retardation). He eventually included homosexuality in the category of "mental conditions of constitutional origin".
The neuroses were later split into anxiety disorders and other disorders.
Freud wrote extensively on hysteria and also coined the term, "anxiety neurosis", which appeared in DSM-I and DSM-II. Checklist criteria for this led to studies that were to define panic disorder
Panic disorder
Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...
for DSM-III.
Early 20th century schemes in Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
and the US reflected a brain disease model that had emerged during the 19th century, as well as some ideas from Darwin
Charles Darwin
Charles Robert Darwin FRS was an English naturalist. He established that all species of life have descended over time from common ancestry, and proposed the scientific theory that this branching pattern of evolution resulted from a process that he called natural selection.He published his theory...
's theory of evolution
Evolution
Evolution is any change across successive generations in the heritable characteristics of biological populations. Evolutionary processes give rise to diversity at every level of biological organisation, including species, individual organisms and molecules such as DNA and proteins.Life on Earth...
and/or Freud's psychoanalytic theories.
Psychoanalytic theory did not rest on classification of distinct disorders, but pursued analyses of unconscious conflicts and their manifestations within an individual's life. The concept of borderline personality disorder
Borderline personality disorder
Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...
developed from psychoanalytic theories.
The philosopher and psychiatrist Karl Jaspers
Karl Jaspers
Karl Theodor Jaspers was a German psychiatrist and philosopher who had a strong influence on modern theology, psychiatry and philosophy. After being trained in and practicing psychiatry, Jaspers turned to philosophical inquiry and attempted to discover an innovative philosophical system...
made influential use of a "biographical method" and suggested ways to diagnose based on the form rather than content of beliefs or perceptions. In regard to classification in general he prophetically remarked that: "When we design a diagnostic schema, we can only do so if we forego something at the outset ... and in the face of facts we have to draw the line where none exists... A classification therefore has only provisional value. It is a fiction which will discharge its function if it proves to be the most apt for the time".
Adolph Meyer
Adolf Meyer (psychiatrist)
Adolf Meyer, M.D., LL.D., , was a Swiss psychiatrist who rose to prominence as the president of the American Psychiatric Association and was one of the most influential figures in psychiatry in the first half of the twentieth century...
advanced a mixed biosocial scheme that emphasized the reactions and adaptations of the whole organism to life experiences.
In 1945, William C. Menninger
William C. Menninger
William Claire Menninger was a co-founder with his brother Karl and his father of The Menninger Foundation in Topeka, Kansas, which is an internationally known center for treatment of behavioral disorders.-Boy Scouts:...
advanced a classification scheme for the US army, called Medical 203, synthesizing ideas of the time into five major groups. This system was adopted by the Veterans Administration
United States Department of Veterans Affairs
The United States Department of Veterans Affairs is a government-run military veteran benefit system with Cabinet-level status. It is the United States government’s second largest department, after the United States Department of Defense...
in the US and strongly influenced the DSM
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
.
The term stress, having emerged out of endocrinology
Endocrinology
Endocrinology is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions called hormones, the integration of developmental events such as proliferation, growth, and differentiation and the coordination of...
work in the 1930s, was popularized with an increasingly broad biopsychosocial meaning, and was increasingly linked to mental disorders. The diagnosis of post-traumatic stress disorder
Post-traumatic stress disorder
Posttraumaticstress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity,...
was later created.
The Feighner Criteria group described fourteen major psychiatric disorders for which careful research studies were available, including homosexuality
Homosexuality
Homosexuality is romantic or sexual attraction or behavior between members of the same sex or gender. As a sexual orientation, homosexuality refers to "an enduring pattern of or disposition to experience sexual, affectional, or romantic attractions" primarily or exclusively to people of the same...
. These developed as the Research Diagnostic Criteria
Research Diagnostic Criteria
The Research Diagnostic Criteria are a collection of psychiatric diagnostic criteria published in late 1970s . As psychiatric diagnoses widely varied especially between the USA and Europe, the purpose of the criteria were allow diagnoses to be consistent in psychiatric research...
, adopted and further developed by the DSM-III.
The DSM and ICD
ICD
The International Statistical Classification of Diseases and Related Health Problems is a medical classification that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease...
developed, partly in sync, in the context of mainstream psychiatric research and theory. Debates continued and developed about the definition of mental illness, the medical model
Medical model
Medical model is the term cited by psychiatrist Ronald D. Laing in his The Politics of the Family and Other Essays , for the "set of procedures in which all doctors are trained." This set includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and...
, categorical vs dimensional approaches, and whether and how to include suffering and impairment criteria. There is some attempt to construct novel schemes, for example from an attachment
Attachment theory
Attachment theory describes the dynamics of long-term relationships between humans. Its most important tenet is that an infant needs to develop a relationship with at least one primary caregiver for social and emotional development to occur normally. Attachment theory is an interdisciplinary study...
perspective where patterns of symptoms are construed as evidence of specific patterns of disrupted attachment
Attachment theory
Attachment theory describes the dynamics of long-term relationships between humans. Its most important tenet is that an infant needs to develop a relationship with at least one primary caregiver for social and emotional development to occur normally. Attachment theory is an interdisciplinary study...
, coupled with specific types of subsequent trauma.
21st century
The ICD-11 and DSM-5DSM-5
The next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders , commonly called DSM-5 , is currently in consultation, planning and preparation...
are being developed at the start of the 21st century. Any radical new developments in classification are said to be more likely to be introduced by the APA than by the WHO, mainly because the former only has to persuade its own board of trustees whereas the latter has to persuade the representatives of over 200 different countries at a formal revision conference. In addition, while the DSM is a bestselling publication that makes huge profits for APA, the WHO incurs major expense in determining international consensus for revisions to the ICD. Although there is an ongoing attempt to reduce trivial or accidental differences between the DSM and ICD, it is thought that the APA and the WHO are likely to continue to produce new versions of their manuals and, in some respects, to compete with one another.
Criticism
There is some ongoing scientific doubt concerning the construct validityConstruct validity
In science , construct validity refers to whether a scale measures or correlates with the theorized psychological scientific construct that it purports to measure. In other words, it is the extent to which what was to be measured was actually measured...
and reliability
Reliability (statistics)
In statistics, reliability is the consistency of a set of measurements or of a measuring instrument, often used to describe a test. Reliability is inversely related to random error.-Types:There are several general classes of reliability estimates:...
of psychiatric diagnostic categories and criteria even though they have been increasingly standardized to improve inter-rater agreement in controlled research. In the United States, there have been calls and endorsements for a congressional hearing
Congressional hearing
Congressional hearings are the principal formal method by which committees collect and analyze information in the early stages of legislative policymaking. Whether confirmation hearings — a procedure unique to the Senate — legislative, oversight, investigative, or a combination of these, all...
to explore the nature and extent of harm potentially caused by this "minimally investigated enterprise".
Other specific criticisms of the current schemes include: attempts to demonstrate natural boundaries between related syndromes, or between a common syndrome and normality, have failed; the disorders of current classification are probably surface phenomena that can have many different interacting causes, yet "the mere fact that a diagnostic concept is listed in an official nomenclature and provided with a precise operational definition tends to encourage us to assume that it is a "quasi-disease entity" that can be invoked to explain the patient's symptoms"; and that the diagnostic manuals have led to an unintended decline in careful evaluation of each individual person's experiences and social context. Psychodynamic schemes give this latter phenomenological
Phenomenology (psychology)
Phenomenology is an approach to psychological subject matter that has its roots in the philosophical work of Edmund Husserl. Early phenomenologists such as Husserl, Jean-Paul Sartre, and Maurice Merleau-Ponty conducted their own psychological investigations in the early 20th century...
aspect more consideration, but in psychoanalytic terms that have been long criticized on numerous grounds.
Reliance on operational definition
Operational definition
An operational definition defines something in terms of the specific process or set of validation tests used to determine its presence and quantity. That is, one defines something in terms of the operations that count as measuring it. The term was coined by Percy Williams Bridgman and is a part of...
demands that intuitive concepts, such as depression need to be operationally defined before they become amenable to scientific investigation. However, John Stuart Mill
John Stuart Mill
John Stuart Mill was a British philosopher, economist and civil servant. An influential contributor to social theory, political theory, and political economy, his conception of liberty justified the freedom of the individual in opposition to unlimited state control. He was a proponent of...
pointed out the dangers of believing that anything that could be given a name must refer to a thing and Stephen Jay Gould
Stephen Jay Gould
Stephen Jay Gould was an American paleontologist, evolutionary biologist, and historian of science. He was also one of the most influential and widely read writers of popular science of his generation....
and others have criticized psychologists for doing just that. One critic states that "Instead of replacing 'metaphysical' terms such as 'desire' and 'purpose', they used it to legitimize them by giving them operational definitions. Thus in psychology, as in economics, the initial, quite radical operationalist ideas eventually came to serve as little more than a 'reassurance fetish' (Koch 1992, 275) for mainstream methodological practice."
Psychiatrist Joel Paris argues that psychiatry is sometimes susceptible to diagnostic fads. Some have been based on theory (overdiagnosis of schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
), some based on etiological (causation) concepts (overdiagnosis of post-traumatic stress disorder
Post-traumatic stress disorder
Posttraumaticstress disorder is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity,...
), and some based on the development of treatments. Paris points out that psychiatrists like to diagnose conditions they can treat, and gives examples of what he sees as prescribing
Medical prescription
A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....
patterns paralleling diagnostic trends, for example an increase in bipolar
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
diagnosis once lithium
Lithium
Lithium is a soft, silver-white metal that belongs to the alkali metal group of chemical elements. It is represented by the symbol Li, and it has the atomic number 3. Under standard conditions it is the lightest metal and the least dense solid element. Like all alkali metals, lithium is highly...
came into use, and similar scenarios with the use of electroconvulsive therapy
Electroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
, neuroleptics, tricyclic antidepressants, and SSRIs. He notes that there was a time when every patient seemed to have "latent schizophrenia" and another time when everything in psychiatry seemed to be "masked depression", and he fears that the boundaries of the bipolar spectrum
Bipolar spectrum
The bipolar spectrum refers to a category of mood disorders that feature abnormally elevated or depressed mood. These disorders range from bipolar I disorder, featuring full-blown manic episodes, to cyclothymia, featuring less prominent hypomanic episodes, to "subsyndromal" conditions where only...
concept, including in application to children, are similarly expanding.
See also
- Abnormal psychologyAbnormal psychologyAbnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion and thought, which may or may not be understood as precipitating a mental disorder...
- DiagnosisDiagnosisDiagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
- Diagnostic classification and rating scales used in psychiatryDiagnostic classification and rating scales used in psychiatryThe following diagnostic systems and rating scales are used in psychiatry and clinical psychology.-Diagnostic Criteria:*Diagnostic and Statistical Manual of Mental Disorders *ICD-10 Chapter V: Mental and behavioural disorders...
- Medical classificationMedical classificationMedical classification, or medical coding, is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers...
- DSM-IV CodesDSM-IV CodesDiagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as DSM-IV-TR, is a manual published by the American Psychiatric Association that includes all currently recognized mental health disorders...
- Structured Clinical Interview for DSM-IVStructured Clinical Interview for DSM-IVThe Structured Clinical Interview for DSM-IV Axis I Disorders is a diagnostic exam used to determine DSM-IV Axis I disorders and Axis II disorders . There are at least 700 published studies in which the SCID was the diagnostic instrument used...
(SCID)
- DSM-IV Codes
- Nosology
- Operationalism
- PsychopathologyPsychopathologyPsychopathology is the study of mental illness, mental distress, and abnormal/maladaptive behavior. The term is most commonly used within psychiatry where pathology refers to disease processes...
- Relational disorderRelational disorderAccording to Michael First, MD, of the DSM-5 working committee the locus of a relational disorder, in contrast to other DSM-IV disorders, "is on the relationship rather than on any one individual in the relationship."...
(proposed DSM-5 new diagnosis)
External links
- Dalal PK, Sivakumar T. (2009) Moving towards ICD-11 and DSM-V: Concept and evolution of psychiatric classification. Indian Journal of Psychiatry, Volume 51, Issue 4, Page 310-319.