Psychiatric Classification
There is a natural human predilection to categorize
and classify for simplifying and organizing the wide range of observable
phenomena and experiences that one is confronted with, thus facilitating both
their understanding and their predictability. The current system for the
diagnosis of mental disorders, the Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association, 1994), is just
the latest example from the long and colorful history of psy-chiatric classification.
Although there was a more recent text revi-sion, DSM-IV-TR (American
Psychiatric Association, 2000), we will refer to DSM-IV as the “current’’
version since DSM-IV-TR primarily differs with respect to the textual
descriptions of the disorders. The classification, diagnostic terms and
virtually all of the diagnostic criteria are identical (First and Pincus,
2002).
Perhaps the most important goal of a psychiatric
classification is to allow mental health practitioners and researchers to
commu-nicate more effectively with each other by establishing a conven-ient
shorthand for describing the mental disorders that they see (First, 1992). For
example, saying to a colleague that a patient has major depressive disorder can
convey a great deal of information in only a few words. First of all, it
indicates that depressed mood or loss of interest is a central aspect of the
presenting problem and that the depression is not the kind of “normal’’ mood
fluctuation that lasts for only a few days but rather that it persists every
day for an extended period of time, for at least 2 weeks. Furthermore, one can
expect to find a number of additional symptoms occur-ring at the same time,
like suicidal ideation and changes in appe-tite, sleep, energy and psychomotor
activity. Finally, information is also communicated about what is not to be
found in this patient – specifically, that the depression is not caused by the
direct phys-iological effects of alcohol, other drugs, medications, or a
general medical condition; that substance use and general medical condi-tions
have been ruled out as etiological factors; and that there is no history of
schizophrenia or manic or hypomanic episodes.
DSM-IV also facilitates the identification and
management of mental disorders in both clinical and research settings. Most of
the DSM-IV diagnostic labels provide considerable and important predictive
power. For example, making a diagnosis of bipolar disor-der suggests the choice
of treatment options (e.g., mood stabilizers), that a certain course may be
likely (e.g., recurrent and episodic), and that there is an increased
prevalence of this disorder in family mem-bers. By defining more or less
homogeneous groups of individu-als for study, DSM-IV can also further efforts
to understand theetiology of mental disorders. The classifications of the
manual have been a reflection of, and a major contribution to, the development
of an empirical science of psychiatry. DSM-IV also plays an important role in
education. In its organization of disorders into major classes, the system
offers a structure for teaching phenomenology and dif-ferential diagnosis.
DSM-IV is also useful in psychoeducation by showing patients that their pattern
of symptoms is not mysterious and unique but rather has been identified and
studied in others.
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