Diagnostic Categories Or Dimensions Summary

The DSM has a lot of information pertaining to different and similar disorders. The DSM includes diagnostic criteria for mental disorders. The DSM has set criteria defined by experts for clinicians to make a diagnosis. The purpose of revising the DSM-5 was to improve diagnoses, treatment, and research. I am very impressed with the DSM-5. There are some conditions in the manual that I would have never thought were possible. However, they still have criteria and z codes to meet that diagnosis. Also, I am impressed that there are so many subtypes of disorders. For example, there are so many types of neurocognitive disorders listed in the DSM. A few of the neurocognitive disorders listed include NCD due to traumatic brain injury, HIV infection, Huntington's disease, another medical condition, and unspecified neurocognitive disorder (American Psychiatric Association, 2013).

The objective of this paper is to describe the transition from a categorical approach to a dimensional approach to the classification of mental health disorders. First, this paper will describe the DSM’s traditional categorical approach and discuss the major criticisms to this approach. Second, this paper will discuss ways in which a dimensional approach exists in the DSM-5. Lastly, this paper will describe RDoC as a response to the failures of the categorical approach, and explain how RDoC has led to a change in psychopathology research.

The diagnostic process for personality disorders currently covers a broad scope of various tests and symptoms, causing a source of frustration for psychiatrists (Aldhous). The symptoms and side effects of several personality disorders can tend to blur together, making diagnosis challenging (Aldhous). Most psychiatric patients are diagnosed with several personality disorders at once, with twenty percent of people with personality disorders simply diagnosed with a “personality disorder not otherwise specified” (Aldhous). Using the Diagnostic and Statistical Manual of Mental Health Disorders, commonly referred to as the DSM, psychiatrists attempt with great difficulty to categorize their patients into a specific disorder, only to diagnose

The DSM is a classified system used by psychiatrist and other clinical professions in order to diagnose clients and patients who show signs of some type of disorder. The two advantages of using this model or classification system ranges from the validity of an assessment used by clinicians and other health care professionals. Build around the concepts and purposes for the DSM model is that it supports a number of standard assessments of diagnosing different treatment providers. Furthermore, (Comer, J. 2016) suggest that the DSM-5 requires clinicians to provide both categorical and dimensional information which is part of being consistent in diagnosing. From a categorical perspective this refers to the name of a particular category of a disorder which is indicated on behalf of the client’s symptoms. From the dimensional perspective it is a rating of how the client symptoms and the severity of the dysfunction through various dimensions.

Within the realms of psychology, classification systems are imperative and allow for appropriate organization and proper descriptions of a patient’s psychological diagnosis. (Hunsley, J. & Lee, M. Catherine, 2010). Classification is a central element of all branches of science and social science, and is how clinicians perform their job to diagnose patients. The two, main types of classification systems are the categorical approach and the dimensional approach. In a broad view, the categorical approach is an one in which a person or object is determined to either be a member of a specific category or not, and the dimensional approach is based on the assumption that the object or person being classified differs in the extent to which they possess certain characteristics and properties (Hunsley & Lee, 2010). The controversy over dimensional versus categorical approaches to diagnosis as manifested in the recent development and publication of the DSM-V is a debate that is one to take note of. Numerous limitations and benefits to both the categorical and dimensional approaches exist, and are widely discussed by researchers when speaking of the production of the DSM-V in regards to personality disorders (PDs). This paper will mainly focus on the diagnosing of one with Narcissistic Personality Disorder (NPD), and how the changes from the categorical approach to dimensional approach in the recent

The first major controversy concerning classifications of mental disorders is the debate over dimensions vs. categories. According to the APA (2000), DSM–IV is a categorical classification that divides mental disorders into types based on criterion sets with defining features. Categories have been utilized in the past DSMs, however there has been much debate on changing to the dimensional model. The debate stems from the notion that in order for a categorical diagnosis to relate specifically to a disorder, the pathology would have to have been largely resilient to the influence of many other genetic and environmental influences (Widiger & Sankis, 2000). On the contrast, utilizing the dimensional model for a diagnosis would utilize a wide variety of neurochemical, interpersonal, cognitive, and other mediating and moderating variables that help to develop, shape, and form a particular individual’s psychopathology profile (Andreasen, 1997).

Through the application of standard diagnostic criteria and the use of diagnostic reasoning we aim to develop a better understanding of the strengths and limitations of classification systems and the methods used to define psychopathology. The information processing system of diagnostic reasoning applied to clinical diagnoses, is important for the detailed analyses of clinically gained information (Coderre Mandin, Harasym & Fick, 2003). Nurcombe and Fizthenry-Coor (1987), note researchers observe the cognitive problem and convert it into mental enquiries, which aim to elicit more diagnostic information. Clinicians using the diagnostic process make a number of diagnostic inferences in regards to the noted maladaptive behaviour (Kassirer, 1989). Deductive reasoning in the form of hypothetico-deductive reasoning is used to examine and support or reject hypothesised diagnoses (Coderre et al., 2003). This process is use to generate several hypotheses based on knowledge held by the examiner who then gathers data to support or reject these hypotheses until a prognosis can be decided upon (Nurcombe & Fitzhenry-Coor, 1987).

The categorisation of mental illness continues today with 2 main publications, the International Classification of Diseases (ICD) created by the World Health Organisation and the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by American Psychiatric Association. This form of categorisation facilities the process of medical treatment of the patient, by standardising the referral process between medical practioners and the diagnostic labels are primarily used as a, “convenient shorthand” among professionals and not for lay use”.

There hope is to diagnosis and treat the illness at hand. This article questions the validity of diagnosing each patient. If the doctors or the nurses’ diagnosis is wrong then, the treatment will also be wrong. This can create complications for all parties at hand. Most often there is protocol that most doctors have to follow when diagnosing a patient “However, it should not be forgotten that they are all using same diagnostic manual, and probability of diagnosing a person is in depression with same instructions.”(). Now this makes a person question whether the validity is of the doctor or the protocol. If it is the protocol than that is something that needs to be evaluated. At the time the DSM system was in use for diagnosing a patient. At the time of this experiment Rosenhan used the DSM-II statistical evaluation. Years later this statistical data was look over, “According to Mattison, Cantwell, Russell, Will (1979) general inter-rater reliability of DSM-II was about %57 and %54 for axis I in DSM-III. In DSM III, which is published twelve years later after first version of DSM II, reliability scores of psychosis, conduct disorder, hyperactivity, and mental retardation was slightly higher than general reliability scores; however, as it is accepted today with the circumstance of logical base, reliability under 0.7-0.8 is found questionable and possibility of error is

Early onset diagnosis of a mental illness is difficult at best. While reading the two articles it becomes apparent that not only is it difficult accurately diagnosing an individual, especially with the many different classifications of bi-polarities, it becomes more difficult for early onset diagnosis. There are many “rules” and obstacles when trying to solve the puzzle in diagnosing individuals with a mental illness.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has a number of features. First of all, every disorder is identified using a name and a numerical code. In addition, the manual provides the criteria for diagnosing each disorder as well as establishes subtypes of a disorder and examples that would illustrate the disorder. The manual goes further by addressing the typical age of onset, culturally related information, gender-related information, prevalence of a disorder, typical clinical course of a disorder, typical predisposing factors of a disorder and genetic family patterns of a disease (Summers, 2009). The DSM-IV is a tool that is used by mental health practitioners and social service workers. As has been demonstrated

Dombeck, M., Hoermann, S., Zupanick, E.C. (2011). Personality Disorders: Problems with current diagnostic system. MentalHelp. Retrieved on 14th March, 2013, from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=569

Categorical approach is important, because it can tell whether certain symptom is present or absent to help clinician decide which mental disorder it belongs to and help decide typical treatment. However, people with same disorders may not necessarily show the smae symptomes. Although they

The second part of the problem is when multiple disorders that are currently considered separate and very similar. Having people with seemingly very different patterns be classified as having the same disorder was something I also saw frequently at my work. In the case of substance dependance we would have some patients who felt they could quit a substance if not for withdrawal, and other who felt the substance controlled their life. To me these seem like different problems, and I wouldn't think of treating them in the same way. I feel the same way about persons entering treatment for major depression that began with a specific event but lasting unreasonably long compared to a person who didn't have a clear event that started the episode. For the first example it could be a lack of coping strategies, yet for the other it may be cognitive distortions, yet both would be listed as the same disorder. As I previously stated, the opposite also seems problematic. Using the previous example, the cognitive distortions resulting in a major depressive episode could also result in dysthymia. Biological theories of disorders also don't seem to support these separations, with similar neuro-chemical problems being associated with ranges of disorders. Together, these two issues call into question the accuracy in our current system of categorical diagnosis in finding discrete clusters of symptoms.

Chapter 3 During the Middle Ages some “authorities” classified abnormal behaviors into two groups, those that resulted from demonic possession and those due to natural causes. The 19th-century German psychiatrist Emil Kraepelin was the first modern theorist to develop a comprehensive model of classification based on the distinctive features, or symptoms, associated with abnormal behavior patterns (see Chapter 1). The most commonly used classification system today is largely an outgrowth and extension of Kraepelin’s work: the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. Why is it important to classify abnormal behavior? For one thing, classification is the core of science. Without labeling and organizing patterns of abnormal behavior, researchers could not communicate their findings to one another, and progress toward understanding these disorders would come to a halt. Moreover, important decisions are made on the basis of classification. Certain psychological disorders respond better to one therapy than another or to one drug than another.