Diagnosing Mental

Disrders with DSM-IV

DSM-IV 1
 Why Diagnose?
• Communiction
• Etiology (Reasons)
• Treatment
• Help in scientific research
• Insurance claim

DSM-IV 2
 Progress of Clinical Treatment
• Assessment
• Diagnosis
• Treatment

DSM-IV 3
 Diagnosis - Etiology
• Normally, diagnostic category contains
certain etiologies
• Reasons for mental problem may be
similar for every disorder in that particular
category
• Diagnosis may explain some of known
reasons

DSM-IV 4
 Diagnosis - Communication
• Normally, client has several symptoms
• Difficult to communicate among mental
health professionals if they have to list all
the symptoms
• Easier to state syndrom, ie a set of
symptoms

DSM-IV 5
 Diagnosis – Help for Science
• Diagnosis group people who have similar
symptoms
• This enables systematic research
• From syndrome can study etiology and
treatment

DSM-IV 6
 Diagnosis - Treatment
• Diagnosis enables the clinical professional
to focus on treatment
• Example, paranoid symtom cannot be
treated just by talking
• Needs anti-psyhotic treatment in this type
of case

DSM-IV 7
Diagnosis – Payment to Third Party

• People who experience mental disorder

need treatment
• Treatment is expensive
• Patients need to be diagnosed so that
third party pay cost of treatment

DSM-IV 8
 Classification System
• ICD – International Classification of
Disesaes
• DSM – The Diagnostic and Statistical
Manual for Mental Disorders
• History – not relevant

DSM-IV 9
 Issue of Classification
• Chronic vs acute problem
– Chronic problem continues for a long duration
– Acute problem is response to change of
significant life change
• Continuous vs episodic
– Continuous problem retains intensity
– Episodic symptoms up and down

DSM-IV 10
 DSM-IV
• Definition of mental disorder
– Psychological syndrome related with distress
or disability as an individual

DSM-IV 11
 DSM - IV
• Five dimensions in classification
• Axis I – clinical symptom
• Axix II – personality disorder & mental
retardation
• Axis III – general medical condition
• Axis IV – psychosocial & environment
problems
• Axis V – current functional level
DSM-IV 12
 Axis I
• Disorder associated with dependency
• Alcohol
• Amphatamine
• Canabis
• Cocaine
• Halisynogen
• Nicotine

DSM-IV 13
 Axis I, ctd…
• Disorder diagnosed during infancy, early
childhood or adolescence
– Attention deficit / hyperactivity disorder
– Pervasive developmental disorder
– Separation anxiety disorder
– Behaviouyarl disorder
– Learning disorder
– Tic disorder

DSM-IV 14
 Axis I, ctd…
• Schizophrenia
– Paranoid
– Untidy / disorganised teratur
– Catatonic

DSM-IV 15
 Axis I, ctd…
• Mood disorder
– Major depression disorder
– Dysthemic disorder
– Double depression
– Mania
– Bi-polar disorder

DSM-IV 16
 Axis I, ctd…
• Somatoform disorder
– Somata disorder
– Conversion disorder
– Pain disorder
– Hipochondriasis
– Body dysmorphic disorder

DSM-IV 17
 Axis I, ctd…
• Anxiety disorder
– Phobia
– Panic disorder
• Agoraphobia
– Genealized anxiety disorder
– Obssesive-compulsive disorder
– Post-trauma stress disorder
– Acute stress disorder

DSM-IV 18
 Axis I, ctd…
• Dissociative disorder
– Dissociative amnesia
– Dissociative fugue
– Dissociative identity disorder
– Depersonalisation disorder

DSM-IV 19
 Axis I, ctd…
• Sexual and gender identity disorder
– Paraphilia
– Sexual malfunction
– Gender identity disorder
• Eating disorder
– Anorexia nervosa
– Bulimia nervosa

DSM-IV 20
 Axis I, ctd…
• Impulsive-control disorder
– Explosive behavioral disorder
– Cleptomania (eg. shop lifting)
– Pyromania (Likes to burn)
– Gambling

DSM-IV 21
 Axis I, ctd…
• Sleeping disorder
– Dissomnia
– Parasomnia
• Adjustment disorder
• Delirium, Dementia, Amnesic, & other
cognitive disorders

DSM-IV 22
 Axis II
• Personality disorder (Funny)
– Paranoid
– Schizoid
– Schizotypal

– (All associated with schizophrenia)

DSM-IV 23
 Axis II
• Personality disorder (Dramatic-Erratic)
– Borderline
– Histrionic
– Narssistic
– Antisocial

DSM-IV 24
 Axis II
• Personality disorder (Anxiety-Fear)
– Avoidance
– Dependent
– Obssessive-compulsive personality disorder
• Mental retardation

DSM-IV 25
 Axis III
• General medical condition – problem
relevant with psychological problem
• Caused by certain disorder – eg. Dental
problem because of drug abuse
• It contributes toward disorder – Cancer
causes depression

DSM-IV 26
 Axis IV
• Psychosocial and Environmental Problem
– Education
– Social
– Support group
– Work
– Housing
– Economy
– Legal

DSM-IV 27
 Axis V
• Global assessment on functionality
• Evaluate one’s current functional level & highest
level for the previous year. This method assists
the clinical professional understand how the four
axis affect the individual concerned & what are
the expected outcomes
• Give number between 0 and 100
• 0 means no information
• 1 – low; 100 - high

DSM-IV 28
 Critiques on DSM
• Evaluated based on reliability and validity
• Good for certain fields, but problematic in
other areas

DSM-IV 29
 Reliability among Raters for DSM
• Bipolar - .84
• Major Depression - .64
• Schiizophrenia - .65
• Alcohol Abuse - .75
• Aneroxia Nervosa - .75
• Bulimia Nervosa - .85
• Panic Disorder - .58
• Social Phobia - .47

DSM-IV 30
 Whole Life Mental Sickness
• Major depression episod 17.1 (F)
• Panic disorder 3.5 (F)
• Agoraphobia 5.3 (F)
• Social phobia 13.3 (F)
• Simple Phobia 11.3 (F)
• General Anxiety Disorder 5.1 (F)
• Alcohol Dependency 14.1 (M)
• Antisocial 3.5 (M)

DSM-IV 31