Dysfunctional behaviour; Comparison between the DSM-5 and The ICD-10

THE DSM -5 and the ICD 10 are the most renowned classifications for mental illness used today.  As time goes on there is a ‘convergence’ between the two classification systems, however, there are still some key differences.  The Chinese Classification of Mental Disorders-3  is also becoming a significant force but like the earlier versions of the  DSM tends to be used primarily in its country of origin.  In the article cited below written by Professor Peter Tyrer the notion of a new American project for diagnosis based more on current genetic, neuroscience and behavioural science research called the Research Domain Criteria (RDoC) is discussed.

Tyrer explains ‘The absence of a zone of rarity indicates that the threshold for psychiatric diagnosis is usually arbitrary. When psychiatrists make a decision about a clinical diagnosis they, therefore, have no guidance in deciding on the cut-off point between disease and wellness. Almost all psychiatrists create an artificial boundary between disorder and normality. Increasingly, it has been recognised that a dimensional system of diagnosis is, therefore, superior to a categorical one, but this is only beginning to penetrate into diagnostic systems.

Key question

Does the DSM suffer from ‘Over diagnosis‘ (validity) or does the increase in mental health issues relate to inconsistent diagnosing (reliability) or are people suffering more in  a consistently more competitive and difficult world?

These are the subgroups of disorders where the two systems are similar in their main categorisation;

Here are the key differences between the two systems.

‘The above is cited from an article written by Professor Peter Tyrer who is Chair of the ICD-11 Working Group for the Revision of Classification of Personality Disorders and has also been a member of the DSM–ICD Harmonisation Coordination Group. The fascinating article discussing both the history and issues relating to both the current two systems can be viewed here.

Source; Tyrer P (2014) A comparison of DSM and ICD classifications of mental disorder BJPsych Advances The Royal College of Psychiatrists

Dysfunctional Behaviour; Classification, explanation and treatment

Mental illness, atypical behaviour, psychopathology and dysfunctional behaviour are just some of the terms used to describe one of the most difficult areas to define both in Psychology as part of the human experience.  Issues that surround the study of ‘dysfunctional behaviour’ are probably the most important as they can be the difference to some in terms of quality of life or even a threat to life itself.  All the debates that academically are discussed within the context of Clinical Psychology are well trod however still as fiercely debated.  Read this chapter for an overview of studies and issues relating to classification, explanation and treatment.  Want to test yourself on your knowledge of Dysfunctional behaviour – click me?

Some examples of debates are;

Nature Vs Nurture – To what extent is dysfunctional behaviour caused by our experiences or dominated by a genetic predisposition.  Consider depression, as one of the most diagnosed disorders is it due to traumatic life experience or are some people carrying a genetic predisposition which will arise irrespective of circumstance.  This question feeds directly in peoples often poor judgements ‘She has everything anyone could want..what has she got to be depressed about…….?‘

Reductionism Vs Holism – Can the explanation of human experience be over simplified and reduced down to basic processes.  Consider the study of Little Albert.

Should abnormality be defined by statistical infrequency, consider the implications of such an approach?

 Issues such as ethics, validity and reliability of diagnosis, effectiveness of psychological treatments Vs drug therapy, before we even get to an agreement of what dysfunctional behaviour actually is.

What is a Clinical Psychologist?

The rise of the anti-psychiatry movement; Szasz, Laing and Rosenhan- ‘The Normal Are Not Detectably Sane’.

“Who in the rainbow can draw the line where the violet tint ends and the orange tint begins? Distinctly we see the difference of the colours, but where exactly does the one first blendingly enter into the other? So with sanity and insanity.”

Herman Melville – Author (Billy Budd, Moby Dick)

The 1960’s and 1970’s were a huge time for social and political change.  One such change that was at the very core of the Psychological community was the role of psychiatry.  Psychiatry  attempts to diagnose and treat mental health conditions but at the very heart there is still a raging argument today about what can be considered normal and thus define abnormality in particular the dangers that can arise from the medicalisation of normal experience.  Is psychiatry there to help or has it now or historically had a more sinister agenda, to control people through stigmatisation?

If you talk to God, you are praying;
If God talks to you, you have schizophrenia.

–Thomas S. Szasz, The Second Sin, Anchor/Doubleday, Garden City, NY. 1973, p. 113.

Thomas Szasz is central to what is known as the anti-psychiatry movement which took the view that Psychiatry was a form of dangerous social control. Watch the video below to hear him briefly discussing his views on  psychiatry.

As part of the British Anti-Psychiatry movement R.D. Laing  shared the concerns of Szasz, taking the view from a more existentialist perspective providing case studies of schizophrenia rather than traditional  ‘flawed’  notions such as psychoanalysis or behaviourist perspectives in his famous text ‘The divided self’  in 1960.  Watch the video of Laing below.

David Rosenhan was present and inspired by Laing at one of his lectures.  Could there be experimental evidence to support the view that psychiatrists were unable to distinguish ‘Sane from insane’?  Thus leading to one of the most important studies of all time.  Read the original study by Rosenhan here.

Watch the video below for an overview of the study.

The Diagnostic and Statistical Manual of Mental Disorders 5 published by the APA is arguably the most influential text in mental health.  It is used almost exclusively within the USA (most of the rest of the world use the ICD 10 published by the World Health Organisation and the Chinese have the Chinese Classification of Mental Disorders CCMD -3).  Review this document that discusses the history and provides an overview for all classification systems used. 

Did Psychiatry heed the warnings of Rosenhan?  Read and listen to the links from Tea Break Psychology 2

 

read an overview of the study with a critique/evaluation of Rosenhan’s conclusions. here.

The 1975 film ‘One flew over the cuckoo’s nest‘ dealt with many of the themes that Rosenhan and the anti-psychiatry movement were interested, it was very much a film of its time. Provocative, insightful and very well observed it still stands as one of the best films of the 20th century.

Here is a statement from the APA regarding the DSM 5

What was the process that led to the new manual?

The APA prepared for the revision of DSM for nearly a decade, with an unprecedented process of research evaluation that included a series of white papers and 13 scientific conferences supported by the National Institutes of Health. This preparation brought together almost 400 international scientists and produced a series of monographs and peer-reviewed journal articles.

The DSM-5 Task Force and Work Groups, made up of more than 160 world-renowned clinicians and researchers, reviewed scientific literature and garnered input from a breadth of advisors as the basis for proposing draft criteria.

The APA Board of Trustees, which approved the final criteria for DSM-5 on Dec. 1, appointed a Scientific Review Committee of mental health experts to review and provide guidance on the strength of evidence of proposed changes. The Scientific Review Committee evaluated the strength of the evidence based on a specific template of validators. In addition, a Clinical and Public Health Committee reviewed proposed revisions to address difficulties experienced with the clinical utility, consistency and public health impact of DSM-IV criteria.

Read an article here on the current DSM 5 F.A.Q from the APA

And finally….a more individualised view on the difficulties and dangers of labelling people based upon subjective criteria…