The document discusses the history and evolution of defining and diagnosing abnormality and mental disorders. It covers early definitions, the development of diagnostic manuals including the DSM, controversies surrounding the DSM-5, and alternatives to the categorical diagnostic approach such as dimensional models. The DSM transitioned over time from vague psychoanalytic descriptions to the current empirically-based approach using specific diagnostic criteria.

1. Diagnosis and Classification Issues
Chapter 7

2. Defining Normality and
Abnormality (1 of 6)
What Defines Abnormality?
• Personal distress to the individual
• Deviance from cultural norms
• Statistical infrequency
• Impaired social functioning
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3. Defining Normality and
Abnormality (2 of 6)
What Defines Abnormality?
• Harmful Dysfunction Theory
– Disorder a harmful dysfunction
• Harmful: value term based on social norms
• Dysfunction: failure of mental mechanism to
perform a function naturally
– Concept combines value and scientific
components
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4. Defining Normality and
Abnormality (3 of 6)
Who Defines Abnormality?
• Diagnostic and Statistical Manual of Mental
Disorders (DSM)
– Defines mental disorder as a clinically significant
disturbance in cognition, emotion regulation, and
behavior
– Indicates a dysfunction in mental functioning
– Expectable reactions to common stressors are
not mental disorders
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5. Defining Normality and
Abnormality (4 of 6)
Who Defines Abnormality?
• Diagnostic and Statistical Manual of
Mental Disorders (DSM)
– Reflects a medical model of psychopathology
– Each disorder categorically listed and defined
with a list of specific symptoms
– Culture and values of those defining disorders
play influential role in the definitions produced
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6. Defining Normality and
Abnormality (5 of 6)
Why Is the Definition of Abnormality
Important?: Importance for Professionals
• Presence or absence of a diagnostic label
strongly impacts attention it receives from
clinical psychologists
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7. Defining Normality and
Abnormality (6 of 6)
Why Is the Definition of Abnormality
Important?: Importance for Clients
• No diagnosis in absence of label
• Label could
– Lead to stereotyping of individuals
– Have an effect on outcome of legal issues
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8. Diagnosis and Classification of
Mental Disorders: A Brief History
(1 of 30)
Before the DSM
• Discussions of abnormal behavior appear
in ancient Chinese, Hebrew, Egyptian,
Greek, and Roman texts
• Hippocrates’ theories of abnormality
emphasized natural causes
– Was a significant early step to current
definitions
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9. Diagnosis and Classification of
Mental Disorders: A Brief History
(2 of 30)
Before the DSM
• Mental asylums established in Europe and
U.S. in the 19th century
• Helped to categorize disorders
• Evolution of common terminology
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10. Diagnosis and Classification of
Mental Disorders: A Brief History
(3 of 30)
Before the DSM
• Emil Kraepelin founding father of current
diagnostic system
– Labeled specific categories, such as manic-
depressive psychosis and dementia praecox
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11. Diagnosis and Classification of
Mental Disorders: A Brief History
(4 of 30)
Before the DSM
• Late 1800s and early 1900s
– Collection of statistical and census data primary
purpose of diagnostic categories
• Mid-1900s Veterans Affairs developed own
early categorization system
– To facilitate diagnosis and treatment of soldiers
returning from World War II
– Had significant influence on creation of first DSM
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12. Diagnosis and Classification of
Mental Disorders: A Brief History
(5 of 30)
DSM—Earlier Editions (I and II)
• DSM-I published by APA in 1952
• Revision published as DSM-II in 1968
• Both similar to each other
• Different from subsequent DSM editions
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13. Diagnosis and Classification of
Mental Disorders: A Brief History
(6 of 30)
DSM—Earlier Editions (I and II)
• Defined only three categories
– Psychoses
– Neuroses
– Character disorders
• Definitions of disorders not scientifically
or empirically based
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14. Diagnosis and Classification of
Mental Disorders: A Brief History
(7 of 30)
DSM—Earlier Editions (I and II)
• Language reflected psychoanalytic approach
to understanding people and their problems
• Vague descriptions of clinical conditions
described in prose
• Specific symptoms or criteria not listed
• Very limited generalizability or utility for
clinicians
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15. Diagnosis and Classification of
Mental Disorders: A Brief History
(8 of 30)
DSM—More Recent Editions (III, III-R, IV,
and IV-TR
• DSM-III (1980)
– Dissimilar to DSM-I and DSM-II
– Relied on empirical data
– Used specific diagnostic criteria to define
disorders
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16. Diagnosis and Classification of
Mental Disorders: A Brief History
(9 of 30)
DSM—More Recent Editions (III, III-R, IV, and
IV-TR
• DSM-III
– Psychoanalytic language replaced by terminology
that reflected no single school of thought
– Multiaxial assessment system
– Longer and more expansive than predecessors
– Included many new disorders
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17. Diagnosis and Classification of
Mental Disorders: A Brief History
(10 of 30)
DSM—More Recent Editions (III, III-R, IV,
and IV-TR
• DSM-III-R, DSM-IV, DSM-IV-TR
– Retained major changes introduced by DSM-
III
– Introduced significant other changes
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18. Diagnosis and Classification of
Mental Disorders: A Brief History
(11 of 30)
DSM-5: The Current Edition
• Published in 2013
• First substantial revision after 20 years
• Led by David Kupfer and Darrel Regier
• Researched over 12 years
• Coordinated efforts with WHO
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19. Diagnosis and Classification of
Mental Disorders: A Brief History
(12 of 30)
DSM-5: The Current Edition
• Steps
– Creation of Task Force
– Work groups
– Scientific Review Committee
– Field trials
– Website dsm5.org to communicate progress
to public
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20. Diagnosis and Classification of
Mental Disorders: A Brief History
(13 of 30)
DSM-5: The Current Edition—Changes
DSM-5 Did Not Make
• Changes considered but not made
– Use of biological markers as diagnostic tools
– Rating of disorders/symptoms on a scale
– Dimensional approach toward a disorder
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21. Diagnosis and Classification of
Mental Disorders: A Brief History
(14 of 30)
DSM-5: The Current Edition—Changes
DSM-5 Did Not Make
• Rejections of new disorders
– Attenuated psychosis syndrome
– Mixed anxiety-depressive disorder
– Internet gaming disorder
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22. Diagnosis and Classification of
Mental Disorders: A Brief History
(15 of 30)
DSM-5: The Current Edition—New Features
in DSM-5
• Title change to DSM-5
• Dropped multiaxial assessment system
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23. Diagnosis and Classification of
Mental Disorders: A Brief History
(16 of 30)
DSM-5: The Current Edition—New
Disorders in DSM-5
• Premenstrual dysphoric disorder
• Disruptive mood dysregulation disorder
• Binge eating disorder
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24. Diagnosis and Classification of
Mental Disorders: A Brief History
(17 of 30)
DSM-5: The Current Edition—New
Disorders in DSM-5
• Mild neurocognitive disorder (mild NCD)
• Somatic symptom disorder (SSD)
• Hoarding disorder
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25. Diagnosis and Classification of
Mental Disorders: A Brief History
(18 of 30)
DSM-5: The Current Edition—Revised
Disorders in DSM-5
• Bereavement exclusion
• Autism spectrum disorder
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26. Diagnosis and Classification of
Mental Disorders: A Brief History
(19 of 30)
DSM-5: The Current Edition—Revised
Disorders in DSM-5
• Attention-deficit/hyperactivity disorder
– Increased age of symptoms from 7 to 12
– Minimum number of symptoms in adults
increased to 5
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27. Diagnosis and Classification of
Mental Disorders: A Brief History
(20 of 30)
DSM-5: The Current Edition—Revised
Disorders in DSM-5
• Bulimia nervosa
– Frequency of binge eating reduced to
once/week
• Anorexia nervosa
– Reduction of less than 85% of the body
weight
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28. Diagnosis and Classification of
Mental Disorders: A Brief History
(21 of 30)
DSM-5: The Current Edition—Revised
Disorders in DSM-5
• Substance use disorder
• Mental retardation renamed intellectual
disability or intellectual development
disorder
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29. Diagnosis and Classification of
Mental Disorders: A Brief History
(22 of 30)
DSM-5: The Current Edition—Revised
Disorders in DSM-5
• Learning disabilities in math, reading, and
writing combined as specific learning
disorder
• Obsessive Compulsion Disorder removed
from Anxiety Disorders to new category
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30. Diagnosis and Classification of
Mental Disorders: A Brief History
(23 of 30)
DSM-5: The Current Edition—Revised
Disorders in DSM-5
• Mood Disorders split into two
– Depressive Disorders
– Bipolar and related disorders
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31. Diagnosis and Classification of
Mental Disorders: A Brief History
(24 of 30)
DSM-5: The Current Edition—Controversy
Surrounding DSM-5
• Many “work group” members quit midway
• Leaders of mental health organizations
boycotted DSM-5
• Most vocal critic was Allen Frances
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32. Diagnosis and Classification of
Mental Disorders: A Brief History
(25 of 30)
DSM-5: The Current Edition—Controversy
Surrounding DSM-5
• Allen Frances’ criticism
– Changes unsafe and scientifically unsound
– Medical illnesses diagnosed as somatic
symptom disorder
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33. Diagnosis and Classification of
Mental Disorders: A Brief History
(26 of 30)
DSM-5: The Current Edition—Controversy
Surrounding DSM-5
• Allen Frances’ criticism
– DSM-5 will mislabel normal people, promote
diagnostic inflation, encourage inappropriate
medication use
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34. Diagnosis and Classification of
Mental Disorders: A Brief History
(27 of 30)
DSM-5: The Current Edition—Controversy
Surrounding DSM-5
• Specific criticism by others
– Diagnostic overexpansion
– Transparency of the revision process
– Membership of the Work Groups
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35. Diagnosis and Classification of
Mental Disorders: A Brief History
(28 of 30)
DSM-5: The Current Edition—Controversy
Surrounding DSM-5
• Specific criticism by others
– Field trial problems
– Price
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36. Diagnosis and Classification of
Mental Disorders: A Brief History
(29 of 30)
Criticisms of the DSM
• Recent editions of DSM widely used by all mental
health professions
• Strengths
– Emphasis on empirical research
– Use of explicit diagnostic criteria
– Interclinician reliability
– Atheoretical language
– Facilitated communication between researchers and
clinicians
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37. Diagnosis and Classification of
Mental Disorders: A Brief History
(30 OF 30)
Criticisms of the DSM
• Breadth of coverage
• Controversial cutoffs
• Cultural issues
• Gender bias
• Nonempirical influences
• Limitations on objectivity
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38. Alternative Directions in
Diagnosis and Classification
• Categorical Approach
• Dimensional Approach
– Five-factor model of personality
• Neuroticism
• Extraversion
• Openness to experience
• Agreeableness
• Conscientiousness
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