Master of Clinical Psychology Module 1: Abnormal Psychology Notes PDF

**Master of Clinical Psychology** **Module :1 Introduction to Clinical Psychology** **Hand out -- Material from different sources** **How Psychologists Define and Study Abnormal Psychology** **By** [[Saul McLeod, PhD]](https://www.simplypsychology.org/author/saulmcleod) **Updated on** Novembe...

**Master of Clinical Psychology** **Module :1 Introduction to Clinical Psychology** **Hand out -- Material from different sources** **How Psychologists Define and Study Abnormal Psychology** **By** [[Saul McLeod, PhD]](https://www.simplypsychology.org/author/saulmcleod) **Updated on** November 9, 2023 **Reviewed by** [[Olivia Guy-Evans, MSc]](https://www.simplypsychology.org/author/olivia-guy-evans) Abnormal psychology is a branch of psychology that studies, diagnoses, and treats unusual patterns of behavior, emotions, and thoughts that could signify a mental disorder. Abnormal psychology studies people who are "abnormal" or "atypical" compared to the members of a given society. Remember, "abnormal" in this context does not necessarily imply "negative" or "bad." It is a term used to describe behaviors and mental processes that significantly deviate from statistical or societal norms. Abnormal psychology research is pivotal for understanding and managing mental health issues, developing treatments, and promoting mental health awareness. **Defining Abnormality** The definition of the word abnormal is simple enough, but applying this to psychology poses a complex problem: What is normal? Whose norm? For what age? For what culture? The concept of abnormality is imprecise and difficult to define. Examples of abnormality can take many different forms and involve different features, so that, what at first sight seem quite reasonable definitions, turns out to be quite problematic. There are several different ways in which it is possible to define 'abnormal' as opposed to our ideas of what is 'normal.' **Statistical Infrequency** Under this definition of abnormality, a person's trait, thinking or behavior is classified as abnormal if it is rare or statistically unusual. With this definition, it is necessary to be clear about how rare a trait or behavior needs to be before we class it as abnormal. For instance, one may say that an individual who has an IQ below or above the average level of IQ in society is abnormal. Statistical Infrequency: IQ shown in a normal distribution graph **Strength** The statistical approach helps to address what is meant by normal in a statistical context. It helps us make cut--off points in terms of diagnosis. **Limitations** However, this definition fails to distinguish between desirable and undesirable behavior. For example, obesity is statistically normal but not associated with healthy or desirable. Conversely, a high IQ is statistically abnormal but may well be regarded as highly desirable. Many rare behaviors or characteristics (e.g., left-handedness) have no bearing on normality or abnormality.  Some characteristics are regarded as abnormal even though they are quite frequent.  [[Depression]](https://www.simplypsychology.org/depression.html) may affect 27% of elderly people (NIMH, 2001).  This would make it common, but that does not mean it isn't a problem. The decision of where to start the "abnormal" classification is arbitrary. Who decides what is statistically rare, and how do they decide? For example, if an IQ of 70 is the cut-off point, how can we justify saying someone with 69 is abnormal, and someone with 70 is normal? This definition also implies that abnormal behavior in people should be rare or statistically unusual, which is not the case. Instead, any specific abnormal behavior may be unusual, but it is not unusual for people to exhibit some form of prolonged abnormal behavior at some point in their lives, and mental disorders such as depression are very statistically common. **Violation of Social Norms** Violation of social norms is a definition of abnormality where a person's thinking or behavior is classified as abnormal if it violates the (unwritten) rules about what is expected or acceptable behavior in a particular social group. Their behavior may be incomprehensible to others or make others feel threatened or uncomfortable. Every culture has certain standards for acceptable behavior or [[socially acceptable norms]](https://www.simplypsychology.org/social-roles.html). Norms are expected ways of behaving in a society according to the majority, and those members of a society who do not think and behave like everyone else break these norms and are often defined as abnormal. With this definition, it is necessary to consider the degree to which a norm is violated, the importance of that norm, and the value attached by the social group to different sorts of violations, e.g., is the violation rude, eccentric, abnormal, or criminal? There are a number of influences on social norms that need to be taken into account when considering the definition of the social norm: +-----------------------------------+-----------------------------------+ | **Culture** | Different cultures and | | | subcultures are going to have | | | different social norms. | | | | | | For example, it is common in | | | Southern Europe to stand much | | | closer to strangers than in the | | | UK.  Voice pitch and volume, | | | touching, the direction of gaze, | | | and acceptable subjects for | | | discussion have all been found to | | | vary between cultures. | +===================================+===================================+ | **Context and Situation** | At any one time, a type of | | | behavior might be considered | | | normal, whereas, at another time, | | | the same behavior could be | | | abnormal, depending on both | | | context and situation. | | | | | | For example, wearing a chicken | | | suit in the street for a charity | | | event would seem normal, but | | | wearing a chicken suit for | | | everyday activities, such as | | | shopping or going to church, | | | would be socially abnormal. | +-----------------------------------+-----------------------------------+ | **Historical Context** | Time must also be taken into | | | account, as what is considered | | | abnormal at one time in one | | | culture may be normal at another | | | time, even in the same culture. | | | | | | For example, one hundred years | | | ago, a pregnancy outside of | | | marriage was considered a sign of | | | mental illness, and some women | | | were institutionalized, whereas | | | now this is not the case | +-----------------------------------+-----------------------------------+ | **Age and Gender** | Different people can behave in | | | the same way, and some will be | | | normal and others abnormal, | | | depending on age and gender (and | | | sometimes other factors). | | | | | | For example, a man wearing a | | | dress and high heels may be | | | considered socially abnormal as | | | society would not expect it, | | | whereas this is expected of women | +-----------------------------------+-----------------------------------+ **With this definition, it is necessary to consider the following:** 1. The degree to which a norm is violated, 2. The importance of that norm, 3. The value attached by the social group to different sorts of violations, e.g., is the violation rude, eccentric, abnormal, or criminal? **Limitations** The most obvious problem with defining abnormality using social norms is that there is no universal agreement over social norms. Social norms are culturally specific -- they can differ significantly from one generation to the next and between different ethnic, regional, and socio-economic groups. In some societies, such as the Zulu, for example, hallucinations and screaming in the street are regarded as normal behavior. Social norms also exist within a time frame and therefore change over time.  Behavior that was once seen as abnormal may, given time, become acceptable and vice versa. For example, drunk driving was once considered acceptable but is now seen as socially unacceptable, whereas homosexuality has gone the other way.  Until 1980 homosexuality was considered a psychological disorder by the World Health Organization (WHO), but today is socially acceptable. Social norms can also depend on the situation or context we find ourselves in. Is it normal to eat parts of a dead body? In 1972 a rugby team who survived a plane crash in the snow-capped Andes of South America found themselves without food and in sub-freezing temperatures for 72 days. To survive, they ate the bodies of those who had died in the crash. **Failure to Function Adequately** Failure to function adequately is a definition of abnormality where a person is considered abnormal if they are unable to cope with the demands of everyday life, or experience personal distress. They may be unable to perform the behaviors necessary for day-to-day living, e.g., self-care, holding down a job, interacting meaningfully with others, making themselves understood, etc. Rosenhan & Seligman (1989) suggest the following characteristics that define failure to function adequately: - Suffering - Maladaptiveness (danger to self) - Vividness & unconventionality (stands out) - Unpredictably & a loss of control - Irrationality/incomprehensibility - Causes observer discomfort - Violates moral/social standards **Limitations** One limitation of this definition is that apparently abnormal behavior may actually be helpful, functional, and adaptive for the individual. For example, a person who has the obsessive-compulsive disorder of hand-washing may find that the behavior makes him cheerful, happy, and better able to cope with his day. Many people engage in behavior that is maladaptive/harmful or threatening to self, but we don't class them as abnormal: - Adrenaline sports - Smoking, drinking alcohol - Skipping classes **Deviation from Ideal Mental Health** Abnormality can be defined as a deviation from ideal mental health. This means that rather than defining what is abnormal, psychologists define what normal/ideal mental health is, and anything that deviates from this is regarded as abnormal. This requires us to decide on the characteristics we consider necessary for mental health. Jahoda (1958) defined six criteria by which mental health could be measured: - A positive view of the self - Capability for growth and development - Autonomy and independence - Accurate perception of reality - Positive friendships and relationships - Environmental mastery -- able to meet the varying demands of day-to-day situations According to this approach, the more satisfied these criteria are, the healthier the individual is. **Limitations** It is practically impossible for any individual to achieve all of the ideal characteristics all of the time.  For example, a person might not be the 'master of his environment' but be happy with his situation. The absence of this criterion of ideal mental health hardly indicates he is suffering from a mental disorder. **Ethnocentric** [[Ethnocentrism]](https://www.simplypsychology.org/ethnocentrism.html), in the context of psychology, refers to the tendency to view one's own culture or ethnic group as the standard or norm, and to judge other cultures, values, behaviors, and beliefs based on those norms. I White, middle-class men devise most definitions of psychological abnormality. It has been suggested that this may lead to disproportionate numbers of people from certain groups being diagnosed as "abnormal." For example, in the UK, depression is more commonly identified in women, and black people are more likely than their white counterparts to be diagnosed with schizophrenia. Similarly, working-class people are more likely to be diagnosed with a mental illness than those from non-manual backgrounds. **DSM-IV Definition of Mental Disorder** a. b. c. d. e. Other Considerations f. g. **DSM-V Proposal for the Definition of Mental/Psychiatric Disorder** Features a behavioral or psychological syndrome or pattern that occurs in an individual b\) the consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) c\) must not be merely an expectable response to common stressors and losses (for example, the loss of a loved one) or a culturally sanctioned response to a particular event (for example, trance states in religious rituals) d\) that reflects an underlying psychobiological dysfunction e\) that is not solely a result of social deviance or conflicts with society f\) that has diagnostic validity using one or more sets of diagnostic validators (e.g., prognostic significance, psychobiological disruption, response to treatment) g. Other Considerations h. i. j. HIPPOCRATES Rejecting the idea of demonic possession, Greek physician, Hippocrates (460-377 B.C.), said that mental disorders were akin to physical disorders and had natural causes. Specifically, he suggested that they arose from brain pathology, or head trauma/brain dysfunction or disease, and were also affected by heredity.  it is based on the four personality types that [***Hippocrates***](https://www.psicoactiva.com/blog/80-frases-de-hipocrates-sobre-salud-y-medicina/), one of the best-known physicians of ancient Greece, established based on human behaviors. This typology was based on an ancient medical concept that proposed that people **have four different types of "humor".** When they spoke of "humor" they meant the bodily fluids that are present in the human body. Different people have different proportions of these fluids; The predominance of a fluid defines its temperament and psychological type. These are the four temperaments and their predominant humors (body fluids): · **Sanguine:** blood · **Phlegmatic**: phlegm · **Choleric**: yellow bile · **Melancholic**: black bile The predominance of a humor is said to affect one's own personal appearance and behavior. However, most people do not possess a pure temperament, but a type of mixed temperament in which one of the four types predominates. Modern medicine rejects this typology, but many new **theories of personality** develop from this ancient concept, often disguised under different names. For example, Dr. [***Helen Fisher's***](https://www.psicoactiva.com/blog/frases-de-helen-fisher/) personality types --- Explorer, Negotiator, Director, and Builder --- bear a striking resemblance to **blood, phlegmatic, choleric, and melancholic** types, respectively. Luckily this doesn't minimize the value of your original research. Modern psychology doesn't get much kinder to the concept of the four temperaments, and in general, most personality theories dismiss them altogether. Despite this, the use of terms --- sanguine, phlegmatic, choleric and melancholic --- persists in the scientific language of psychology. Sanguine temperament It is characteristic of lively, cheerful, optimistic, kind, communicative, warm but thoughtless people with a fairly variable mood. They love adventure and have a high tolerance for risk. Usually, sanguine people do not know how to tolerate boredom and will avidly seek variety and entertainment. Needless to say, this trait can negatively affect your romantic relationships at times. Because this temperament is prone to pleasure-seeking behaviors. Their constant cravings can lead to overeating or substance abuse. These people are very creative and can become great artists. In addition, they are fantastic entertainers and will naturally do well if they choose careers in the entertainment industry. Their natural abilities will also serve them, if they wish, for work related to: · marketing · travel · fashion · kitchen · sport. Phlegmatic temperament Someone with the phlegmatic personality type is usually a person in search of interpersonal harmony and close relationships. Phlegmatic people are faithful spouses and loving parents. They retain their relationships with old friends, distant relatives and neighbors. They tend to avoid conflicts and always try to mediate among others to restore peace and harmony. They are generous and inclined to help others. Ideal professions for personality types are usually related to: · infirmary · teaching · psychology · child care, · social services. Choleric temperament Someone with pure choleric temperament would be a basically goal-oriented person. People with this personality type are very intelligent, analytical and logical. They are not usually very good companions. They don't like chatting for the sake of chatting, they enjoy deeper and meaningful conversations more. They prefer to be alone than in the company of shallow, shallow people. Ideally, they want to spend time with people who have similar career interests. The ideal jobs for the personality type are related to the following sectors of activity: · administration · technology · statistics · engineering · programming · business. Melancholic temperament People with melancholic personalities are [***introverted***](https://www.psicoactiva.com/blog/caracteristicas-y-fortalezas-de-los-introvertidos/) and cautious. They are quite reserved and always remain attentive to anything that happens around them. They take their time to calculate each and every move and prefer to act on their own. They love life with family and friends and, unlike sanguine temperament, do not seek novelty and adventure. In fact, they avoid it at all costs. A person with a melancholy temperament is very unlikely to marry a foreigner or leave his homeland to live in another country. They are very social and try to contribute to the community. They are also usually extremely orderly and fantastic managers. The perfect trades for the melancholic personality type are usually in: · management · accounting · social work · administration. What did Hippocrates view as the cause of physical and psychological disorders? It was around 400 BC that Hippocrates (460--370 BC) attempted to separate superstition and religion from medicine by systematizing the belief that a deficiency in or especially an excess of one of the four essential bodily fluids (i.e., humors)---blood, yellow bile, black bile, and phlegm---was responsible for physical and.Hipppocrates suggested that an excess or lack of body fluids, called \'\'humors,\'\' ( blood, yellow bile, black bile, and phlegm), affected our moods, emotions, and behaviors. His theory was later rejected due to advances in modern medical sciences. What are the theories of Hippocrates? Hippocrates argued that the brain is the organ responsible for mental illnesses and that intelligence and sensitivity reach the brain through the mouth by breathing. Hippocrates believed that mental illnesses can be treated more effectively if they are handled in a similar manner to physical medical conditions (23). What are the 4 humors of Hippocrates? Greek physician Hippocrates (ca. 460 BCE--370 BCE) is often credited with developing the theory of the four humors---blood, yellow bile, black bile, and phlegm---and their influence on the body and its emotions. His treatise on Airs, Waters, and Places describes the influence of geography on the body and its humoral makeup. What did Hippocrates believe caused illness? He separated the discipline of medicine from religion, believing and arguing that disease was not a punishment inflicted by the gods but rather the product of environmental factors, diet, and living habits. There is not a single mention of a mystical illness in the entirety of the Hippocratic Corpus. PLATO What were Platos main views? Plato: Political Philosophy \| Internet Encyclopedia of Philosophy Especially in the Laws he makes clear that freedom is one of the main values of society (701d). Other values for which Plato stands include justice, friendship, wisdom, courage, and moderation, and not factionalism or terror that can be associated with a totalitarian state. What are the famous ideas of Plato? Plato\'s central doctrines\ \ Among the most important of these abstract objects (as they are now called, because they are not located in space or time) are goodness, beauty, equality, bigness, likeness, unity, being, sameness, difference, change, and changelessness.20 Mar 2004 What are the 4 elements of Plato? The four elements Earth, Air, Fire and Water were already considered as the basic elements that produce all things. Plato merely represented these elements in geometrical structures so that they fit together forming all the structures of everything as he assumed. IBN SINA Ibn Sina (Avicenna) is primarily known for his philosophy and medicine, but there is almost no scientific discipline in which this great man didn\'t leave a significant mark. This paper gives a brief review of his contributions to medicine, especially to psychiatry. Medical works of Ibn Sina represent a pinnacle of most important medical achievements of his time. These works contain synthesis of all Greek, Indian and Iranian medical schools, but also new breakthroughs achieved by Muslim scholars through their own experimentation and practice. Although he wrote many medical works, his most important one is El-Kanun fit-tib, which can be translated as The Canon of Medicine. It\'s made out of five books which systematically show everything known in the area of medicine up until that point in time. In it, Ibn Sina discusses, among other things, the structure of psychological apparatus of human being and the connection of psychological functions with the brain as well as the role of psyche in etiology of somatic diseases. He also describes certain psychiatric diseases along with the explanation of their etiology and recommended therapy. He considered psychology to be very important for medicine, so in his psychological works he discusses, in great detail, the essence of human soul, consciousness, intellect and other psychological functions. Ebu Ali Husein Ibn Ali Ibn Sina (or Avicenna) was primarily a philosopher with amusing knowledge, who dealt in all aspects of art of medicine, astronomer, poet, musician and psychologist. He has knowledge in almost all scientific branches or praxis with the great success. Numerous statements of his have been cornerstone of many sciences for centuries; and some of them are (in the era of computers and Internet) still current. The best known treatise on medicine of his is El-Kanun, consisting of five volumes, wherein all medical achievements (including psychology, psychiatry and neurology) of that period were described clearly. In his psychology, Ibn Sina (Avicenna) analyses the essence of human soul, mind, psychical streams, intellectum, dreams and prophecy, man\'s desires etc. in details. It is unnecessary to point out how much these items are actual in the contemporary psychology. Ibn al-Nefis has described systematically the symptoms and recovery of \"head sick\" (including headaches, cerebral sick like cranitis, letargy, coma, demency, melancholy, insomnia, nightmares, epilepsy, appoplexy, paralysis, spasm and many others) in his Mujez al-Kanun, that is synopsis of Ibn Sina Kanun. We need much time to see magnificance of this philosopher, that is best known as the great one among the physicians. His writings could be found in whole Bosnia, but there were many few that would study him and his works. It is our task to enable the future generations not only to know those works exist, but, also, to realize the essence of this marvelous genius; because there are very few people that can be compared to him.. TRIGUNAS  the trigunas are integral constituents of the mind. (Sattva, Rajas and Tamas). These 3 also known as Mansa dosha or the psychic constitution. a.Tamas is underactive state which is the lowest. It is lazy, confused, possessive, dull and greedy, ignorance, attachment.\ b. Rajas is the activity state which is overactive. The characteristic is restless, workaholic, self cantered, achiever, aggressive, restlessness, ambitious.\ c. Sattva is the balance between activity and inertia. Sattva state is happiness, calm, kindred, meditative, content , and caring. Everything and everyone will have these 3 qualities, living and non living. The continuous moving of blood within our body is Raja guna in act.Our mind sometimes swing wildly and this is Raja gunas, and when we can stop that fluctuation, it is the Tamas gunas. During deep meditation, when we feel self love and joy, this is Sattva guna which is balance. Triguna shapes the characteristic in material and immaterial in us. The proportion of the 3 different trigunas will lead us to behave, react, conceptualize, and comprehend the nature around differently. The inherited guna can be changed due to physical, phychological and social influence. The behaviour is shaped by the prominent of the qualities at a given time. The dominant guna will influence the personality when the 5 elements are perceived by our 5 senses and process through the mind and modified by the dominant guna. Therefore, gunas is the final elements that influence the personality of a person. Each person has the ego to support their intellect from the perceived data. Triguna which stem from ego will determine the personality through which is dominant at a particular time. The Sattva person is pure and positive with spiritual quality. When it comes to work, one is calm differentiating between desirable and undesirable situations. The more sattva nature, the more love, compassion, kindness and attachment to happiness. The state of good health is here. The Rajasic person are full with desires and attachments. As they are very self centered, they sometimes, can't differentiate right and wrong. One is in the balance Raja state when one is enthusiast, deeply interested, dedicated to work, achiever. It is the bridge for sattva and tama, and balance them. As it refers to passion, it creates motivation, movement, right action, creativity for a better change. If it is imbalance, one will have anger, anxiety and agitation.\ The Tamas is related to darkness. Its clouded with illusion, negative, dullness and inactive. In a balance Tama state, one will have timely sleep, balance diet, appreciation of nature, concern about others. However, if it is imbalance, one is possessive , desire to harm others, short-lived happiness. The presence of triguna can be observed through action we perform, intention behind the action, and reaction. For the action and intention, we have to ask ourselves for every action : why am I doing this (intention) and how do I do this (manifestation). It could be different guna that dominant both intention and manifestation, and we can balance the predominant if you pay attention to it. As for the reaction is the result of the action done, how do you feel or react. We need to always balance. From Tama to Raja, we can engage in more physical asana activities, mixing with positive people, traveling to new places, eating light food. These will lift our energy level and turn to Raja state. From here, to proceed to Sattva, we can perform meditation, reading and non profit work. comparison of trigunas PANCHAKOSHAS Yoga teaches us about the mechanism of body, mind, and spirit called Pancha Kosha Viveka (पंच कोष विवेक), which means knowledge of the five layers of our existence.  Vedanta (वेदान्त) explores the human individuality into five layers/sheaths (koshas) (कोश) or levels. It reveals the basic elements that give the macrocosm and the microcosm framework. It teaches us about the mechanism of the body, mind, and spirit, from the gross elements that make up the physical body to the more subtle aspects of the mind and consciousness. It identifies each element, teaches us its function, and shows us the relationship of all the elements with each other. Essentially, it can be called the model of the human being or the conceptualization of the human being, which is called Pancha-kosha-vishleshana (पंच-कोश-विश्लेषण), i.e., analysis of the five sheaths and is based on the Taittiriya Upanishad.  The human individual is comprised of certain layers or sheaths. The outermost sheath is the annamaya kosha (अन्नमय कोष), or the physical body, which is sustained and nourished by our food. The next layer, internal to the physical body, is the pranamaya kosha (प्राणमय कोष), or the vital body, which is maintained by the water that we drink. The vital body, or the mental body called manomaya kosha (मनोमय कोष), is located inner to the pranamaya kosha and is sustained by the subtle elements of the diet we take. Internal to the mind is the buddhi (बुद्धि) or understanding, the highly purified form of thought. Internal to the intellect is the last kosha, or sheath, called the causal body---through which we experience a kind of bliss when we are fast asleep.  The Pancha Kosha theory Annamaya Kosha - - Pranamaya kosha  - - - - - - - - - - - - Manomaya Kosha  - - - - - - - - - Vijnanamaya Kosha  - - - - - - Anandamaya Kosha  - - - In his inward journey towards the Ultimate, Man crosses these koshas of existence one by one. Through analysis called \'Pancha Kosha Viveka\' (knowing through experience one\'s five koshas of existence) and the associated practices called \'tapas\' or internal research, Man gradually becomes relieved from the bondages and constrictions of each kosha. It is one of the methods of reaching the ultimate goal, which is to get freedom from the cycle of death and birth, as enumerated and described in the Upanishads.  Classification of Pancha Koshas Koshas and their Characteristics  A person having consciousness of the specific kosha would exhibit characteristics of the respective kosha. For example, a person having consciousness regarding Manomaya Kosha will have the willpower to act.  A healthy body is the key to maintain homeostasis of the different systems within Pranamaya Kosha (vital life force). The practices for this Kosha are Asana (आसन): A stable and comfortable posture, which gives deep relaxation to internal organs by massaging them thoroughly, all organs of the body start functioning harmoniously, and the mind becomes tranquil Diet: Simple vegetarian wholesome food that calms down the mind (Sattvic diet) (सात्विक) is recommended as it helps maintain internal harmony in the body and the mind. Loosening exercises: Reduce joint stiffness, strengthen the body\'s muscles, and increase physical stamina. The secret to happiness, according to scriptures, is conquering the mind through knowledge. Happiness is within us, a state of inner silence. Taittiriya Upanishad describes how a student, Bhrugu, realizes that all layers of our existence emerge from Änandamaya Kosha. It leads to the insight that happiness is within us, and each one of us in our causal state is Ananda (bliss) embodied. At Änandamaya Kosha, action-in relaxation, selflessness and service attitude is practised to experience bliss continually.  https://static.vikaspedia.in/mediastorage/image/pnchtt.JPG CLASSIFICATION OF DISORDERS -A historical Perspective: who gave the first classification system of mental disorder? Hippocrates classified mental illness into one of four categories---epilepsy, mania, melancholia, and brain fever---and like other prominent physicians and philosophers of his time, he did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior. There are several classification systems used in clinical psychology to diagnose and categorize mental disorders. The two most prominent systems are: 1. - - - 2. - - - What is the DSM system for classifying mental disorders? The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms and other criteria for diagnosing mental disorders. he DSM-5 is the classification system of psychological disorders preferred by most U.S. mental health professionals, and it is published by the American Psychiatric Association (APA). It consists of broad categories of disorders and specific disorders that fall within each category. **Historical development of The DSM Classification systems**: **Developments in various versions of the *Diagnostic and Statistical Manual of Mental Disorders (DSM)*.** ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- **Version** **Year** **Major purpose** **Revisions** **Criticism received** -------------- ---------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- *DSM-I* 1952 Uniformity in\ Strong psychoanalytic influence. Terms\ clinical diagnosis and gathering prevalence data. used deviated significantly from prevailing\ definitions.  *DSM-II* 1968 Stabilize diagnostic nomenclature\ A more atheoretical position by change in nomeclature.  Lack of empirical research evidence.  No major conceptual update from *DSM-I* , strong influence of psychoanalysis persists.  Lack of well-\ in textbooks and professional\ defined criteria for diagnosis resulting in\ literature. overdiagnosis (eg, schizophrenia).  *DSM-III* 1980 Atheoretical approach based on the Feighner criteria.  To reduce the gap between psychiatry and rest of medicine. Provide valid and reliable diagnosis for empirical research. It provided a new hierarchical, multiaxial system for diagnosis utilizing exclusion criteria and introduced the formal operationalization of psychiatric diagnosis with established reliability The existing criteria had low validity, taking\ on a reductionist and adynamic approach as\ well as not adequately distinguishing between trait and state.  *DSM-III-TR* 1987 Improve clinical utility of diagnosis based on inputs from practising clinicians and researchers. Eliminated diagnostic hierarchy. Higher rates of comorbidities due to elimination of hierarchy. Gender-biased, especially for\ personality disorders.  Lack of conceptual clarity of the term "dysfunction."  *DSM-IV* 1994 To increase congruence between *DSM*\ Modified previous criteria, and replaced the abstract concept of "dysfunction" to "clinically significant distress or impairment." Lack of clarity in the definition for threshold resulting in overdiagnosis. High rates of\ and *ICD-10* . Use empirical data to modify diagnostic criteria. comorbidity in personality disorder diagnosis.  *DSM-IV-TR* 2000 Update research literature. Detailed the\ Little revision to criteria was made.  associated features of disorders.  *DSM-5* 2013 Incorporate\ Discarded the multiaxial system. Reclassification of some disorders in a dimensional rather than categorical approach. Increased social sensitivity in\ Low reliability across disorders. Poor validity leading to increased comorbidity and lack of specificity in selection of treatment options. Poor correlation between genetic findings and psychiatric diagnosis. Observed syndromes, especially culture-specific, don't fit any diagnostic criteria. Lowered thresholds and new categories may result in overdiagnosis. Increasing number of disorders provide little assistance to clinicians in providing optimal treatment.  neurobiological and etiological research in the\ terminology.  criteria of\ disorders.
 Improve clinical utility. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Note: refer to the slides for DSM IV Multiaxial Classification and its assumptions and limitations which gave rise to the DSM V version of classification of disorders.