Classification and Diagnosis
No taxonomy/classification
system of all human behavior
No universal criteria for
abnormal behavior
-rare
-non-normative
-unexpected
-distressful
-disabling
All terms referring to
abnormal behavior are tautologies (e.g., psychopathology)
Only taxonomy of abnormal
behavior is based upon subjective opinion and not scientific criteria
Diagnostic and Statistical
Manual of Mental Disorders –IV (DSM-IV) by American Psychiatric
Association (2000)
Levels of Analysis of A Taxonomy
SYMPTOM
SYNDROME
DISORDER
DISEASE
History
of the DSM Diagnoses (Dx's)
1840: 1 dx: idiocy/insanity (U.S. Census)
1880: 7 dx's: (U.S. Census)
1940 26 dx's (ICD-6; WHO)
1952
26
dx's (DSM-I)
1968 26 dx's (DSM-II)
1980 297 dx's (DSM-III)
1987 297 dx's (DSM-IIIR)
1994 374 dx's
(DSM-IV)
2000 374 dx's
(DSM-IVTR)
2011 DSM-V
Five Axes of DSM-IV
I:
All categories except personality disorder & mental retardation
II: Personality disorders and mental
retardation
III: General medical conditions
IV: Psychosocial and environmental problems
V: Current level of functioning
Prevalence of Major DSM Dx's
(e.g., excluding caffeine dependence)
á
lifetime prevalence
50%
á
prevalence in past year
30%
á
point prevalence 20%
á
most people meet at
least one dx
á
is anyone normal by DSM
criteria?
á
5 - 10% if self-reported
criteria used rather than DSM criteria [poor mental health for 14 of the past
30 days] (CDC, 2004)
Inclusion of "Mental Disorders" in the
DSM
á
purely subjective
á
working groups assigned
to each major dx category
á
neglect most or all
available research
á
group makes
recommendations to Assembly of 225 members who vote
á
Assembly give vote to a
25 member Board of ApA who makes final decision
Weaknesses of the DSM
Loss
of information
Stigma
Categorical
Poor
Reliability
Poor
Validity
Weaknesses of the DSM conÕd
á
most research is on
reliability and not validity
á
interrater reliability
for all dx's averages 54%
á
only 30 of 374 dx's have 70% or greater
agreement
á
higher interrater
reliability estimates based on only a few people or are easy to identify [e.g.,
alcohol intoxication]
á
Pavkov et al. (1989)
á
Rosenhan (1973)
What Motivates the Authors of the DSM?
1-
STATUS
2 -
TAUTOLOGIES
3
– INSENSITIVITY
4
– POWER
5 -
MONEY for ApA
6 -
MONEY for pharmaceuticals
7 -
COMPETITION
8-
HEGEMONY
George
Albee:
"Unfortunately,
psychologists and social workers accepted meekly the DSM diagnostic system.
Instead of fighting it as scientifically dishonest and logically defective, they
fell on their knees and begged to be included for reimbursementÉAbnormal
psychology textbook writers also yielded"
Critiques of DSM
Caplan, P.J. (1995) They
Say You're Crazy: How the World's
Most Powerful Psychiatrists Decide Who's Normal.New York: Addison-Wesley Pub. Co.
Horowitz, A.V. (2002. Creating
Mental Illness. Chicago,
IL: University of Chicago Press.
Kirk and Kutchins (1992). The Selling of DSM: The Rhetoric of Science in
Psychiatry NY: Walter de
Gruyter, Inc.