History of the Diagnostic classification of mental health disorders
The recent years have seen the attractive development in the Diagnostic classification of mental health. The first DSM Edition in 1952 has become multi-Axis classification and even DSM-PC a useful guidebook for the patients and professionals
- History of the Diagnostic classification of mental health disorders
- Multi-axis Classification
- The classification of Disorders from WHO
- DSM-PC- handbook for the children and minor
1. History of the Diagnostic classification of mental health disorders
Until the first DSM Edition in 1952, history of the diagnostic system for mental disorders in the United States still lacks consistency. Several early attempts were encouraged by a statistical rather than clinical factors. When the u.s. Census was made in 1840, it consists of a simple classification of mental diseases (” crazy sickness ” : “Idiocy/Insanity”) to describe the components of ill in the population of the USA. This is the first-time data are collected in a systematic way through the Census for this purpose. In the Census of 1880, 7 classifications of mental diseases are combined, many types of Pathology which is named that now seems to have been dropped (e.g. monomania, dipsomania, melancholia). Not long ago, a Committee within the American Psychiatric Association (APA) started to cooperate with the Census Bureau to gather more facts. But the focus is still primarily in a statistical rather than clinically (APA, 1952, 2000).
The official diagnostic classification of mental health disorders for clinical purposes very uncommon before the 20th century. In the 19th century, many large hospitals and training centers have developed their own systems themselves in order to name and record patient for mental illness. These systems were created by himself to satisfy the needs of the environment in the Cabinet of that Institute. When the number of incremental systems, communication between mental health professionals and agencies are limited by the lack of common aims to describe the mental health disorders.
At the end of the 1920s, the attempt appears to produce a standard name, although we have lost dozens of years to achieve this goal. Some of the diagnostic classification systems individually was retained as the system of the United States military and the hospitals of the veteran. The little system remains competitive with every other system until the first DSM replaced them in 1952.
From DSM-I to DSM-III-R:
The first edition of the DSM, is made by the American Psychiatry Association in 1952, mostly versions of ICD (International Classification of Diseases: international classification of diseases, are the World Health Organization (WHO) published). ICD at that time was the 6th Edition and for the first time this classification consists of a classification of mental diseases (APA, 2000). DSM-I was editing in 1968 and the DSM-II. Two published are similar and also completely different than the DSM edit after that. The language used in the DSM-I and DSM-II showed much emphasis to psychoanalysis, in fact, reach the distraction is the primary approach in all fields of clinical work at that time.
DSM-Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association compiled. Books are the latest edits in 2000: DSM-IV-TR (fourth). This is the product of 13 working groups, each group is responsible for editing a part of the manual. A working group consisting of at least 5 members and often more. For example, the compilation of these disorders usually first diagnosed in age groups and children’s teens or adolescence including 12 medical doctors and four psychologists.
2. Multi-axis Classification: according to five axes
– Axis I: Clinical Disorders. This is the top-level of the ASM multiaxial system of diagnosis. – Axis I diagnoses are the most familiar ad widely recognized. Below are the some categories of Clinical Disorders:
- Adjustment disorders with: anxiety, depressed mood, disturbance of conduct, mixed disturbance of emotion and conduct.
- Dissociative disorders: depersonalization disorders, dissociative amnesia and dissociative disorders Not Otherwise Specified (NOS).
- Eating Disorders
- Mood Disorders
- Schizophrenia and other psychotic disorders
- Sexual and Gender Identity disorders: sexual Dysfunctions, paraphilia and Sexual Pain Disorders.
- Sleep disorders
- Somatoform Disorders
- Substance-related Disorders.
+ Axis II: Personality Disorders; mental retardation, this axis in relation to the situation affecting the function in a way merge, including personality disorders and mental retardation. It can also be used to indicate the character of the personality issues that do not qualify for a diagnosis of antisocial personality disorder to the full, as the use of defense mechanisms in responding to distortions and hard.
The disorders in the second axis are life-long problems arising from childhood. For example, an adult patients might have depression (an Axis I disorders) is likely to have a paranoid personality disorders– Axis II disorder). Axis II disorders are accompanied by considerable social stigma because they are suffered by people who fail to adapt well to society. It seems to be untreatable and difficult to pinpoint Axis II. The causes of the Axis II still are confusing. Some professionals say they are from the genetic primarily, the others believe in the environments. There are some common diagnosed Axis II Disorders:
- Paranoid personality disorders
- Borderline personality disorders
- Antisocial personality disorders
- Dependent personality disorders
- Mental retardation
– Axis III: Problems of General Medicine: this axis in relation to the problems of General Medicine corresponds to the ability to understand and process, such as: the trauma, infections, diseases of the nervous system or digestive system and the complications of pregnancy or birth.
– Axis IV: Issues of social and environmental psychology: this Axis includes the negative events in life and the weakness of the environment creates a situation in which the problems of the child development.
The classification consists of:
- The problems related to primary support group (such as death of a family member, divorce, child abuse);
- Social environment (such as inadequate social assistance, the difficulties in changing the culture, discrimination);
- Education (such as illiteracy, argue with your teacher or your classmates);
- Housing (as there are no houses, no neighborhood safe);
- Career (as of time of work stress, argue with superiors or colleagues);
- Health (such as difficulty in movement, inadequate medical insurance);
- Economy (such as poverty, inadequate social support);
- Legal system (such as prisoners, victims of crime);
- Some problems of social and psychological environments (such as exposure to disaster or war).
– Axis V: The amount of the whole function: this is the evaluation of the clinical severity of the whole functional. Such information is useful in planning the treatment and measuring its effectiveness. Assessment scale full function can come from high-functionality (100 points) to the constant danger to harm themselves or others, does not have the constant ability to self-clean for yourself (1-10 points).
3. The classification of disorders from WHO
ICD 10 classification of disorders of behavior and mental health in children and adolescents (by WHO, the World Health Organization compilation, 1996) based on the international classification of diseases, diagnostic systems are widely used outside the United States, are also classified according to the shaft but most children are evaluated according to 6 axes. (There are adult classified section).
+ Axis I: Psychiatric syndrome: clinical, like the axis I of the DSM, this axis includes the disorders of behavior and mental health can be seen in children or adults.
+ Axis II: Specific disorders of psychological development: beginning from DSM, ICD 10 also separate assessment of the delay in a child’s development. This can happen in areas such as language, tone, language, study skills (like reading, spelling, do calculations, etc.) and the motor function.
+ Axis III: Intellectual level, this axis provides a review of the level of intellectual functioning of a person on a scale order is limited to a very high intelligence to severe mental retardation.
+ Axis IV: Issues in Medicine: similar to the axis III of the DSM, the medical problems not related to mental as physical illness or trauma are evaluations here.
+ Axis V: Social psychological situations accompanying anomalies, this axis includes the situations in the social psychology of the child may be relevant to understanding the cause of the child’s psychiatric syndrome clinically or may correspond to the planned treatment.
+ Axis VI: The amount of the whole about disability social psychology, as well as the DSM, clinical home is asked to evaluate the whole function of psychological, social and career of patients, 9 points in order of scale is used, the limit from 0 = high society functions to 9 = disability on social merge and heavily.
DSM-PC: Diagnostic and Statistical Manual for Primary Care – a guide for children and minors. Diagnostic and Statistical Manual for the Primary Care pediatricians, pediatric medical doctor, expert child psychology jointly written out to help the clinical home health initially identified the psychosocial factors that can affect the older treatment at their clinic. The children and adolescent version can facilitate psychologist’s abilities to conduct research related to the prevalence of behavioral and developmental problems, describe collaborative practice in primary care and train pediatricians to recognize and manage common behavioral and developmental problems.
The DSM-PC is developed with some distinctive features of DSM-PC. The first one is the usefulness to primary care pediatricians. DSM-PC aims to develop a manual which is useful to primary care pediatricians in describing the problems. DSM-PC characterizes of the complexity of the visit much better and allows comprehensive consideration of biopsychosocial matters. Moreover, the manual provides an expanded vocabulary and differential diagnosis as well as a sense of understanding the problem by knowing its components parts.
The second is that effectiveness in making distinction among problem severity. It gives primary care pediatricians a way to differentiate among the severity of behavioral problems of children by defining three groups: developmental variations, problems and disorders. The development variations mean the behaviors that parents raise as a concern to their primary care clinician but are within the range of what is expected for a child of a particular age. On the other hand, the problems are defined as behavioral symptoms which are serious enough to disturb the child’s function in any contexts as family situation, peer relations or relationship at school. The last major category is disorders. Disorders are symptoms that respond criteria for various conditions listed in the DSM-IV.
The final feature is utility in describing potentially traumatic environment situations. This characteristic might have impact on children’s behavioral symptoms. DSM-PC codes are encouraged to identify situations in which children are exposed to environmental stressors that might be expected to their psychological development. Furthermore, uses of environmental situations codes can be of help to the primary care pediatricians identify the risk to the child which is associated with the environmental stressors.
Beyond the clinical utility, one of the important uses of the DSM-PC is in giving pediatricians an over view and conceptual framework concerning the range of behavioral and development problems that present in primary care. Psychologists and pediatricians who work with pediatric residents as preceptors of their primary care patients can also instruct them to use the DSM-PC to code cases that they present for guidance in management. Didactic presentations of topic areas such as depression, toilet training problems and psychological reactions to chronic physical illness can also be structured around the relevant sections of the DSM-PC. Case descriptions can be used in such presentations to illustrate the wide range of severity in clinical problems such as depression.
Despite the great promise of the DSM-PC as a coding system, it is not widely used by pediatricians for some reasons. The initial is the lack of thorough knowledge of the DSM-PC and its potential clinical utility. The second problem is the time pressures of clinical practice. The practitioners who have used the manual have pointed out the need to develop user-friendly guides and materials to facilitate its use in practice setting. Last but not least, the obstacle to pediatrician’s use of the DSM-PC is the inconsistent level of reimbursements for provision of services for children who have developmental and behavioral problems. Limitations in reimbursement are of widespread concern in the field of behavioral pediatrics. Consequently, the use of DSM-PC has not gained the striking results in any widespread improvements in improved reimbursement rates.
There are two major assumptions: 1)The child’s environment has a significant impact on the mental health of the child. 2) Young expressionist’s symptoms are located under a limited progress from normal variations to these disorders.