Lesson 1: Diagnosis and Classification (NOTES)

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B.A (HONS.) PSYCHOLOGY SEMESTER IV – UNDERSTANDING MENTAL DISORDER | UNIT 1, Lesson 1: Diagnosis and Classification | Simplified Notes

Introduction

One of the biggest challenges in psychology is defining what is “normal” and what is “abnormal.”

The textbook gives the example of Shabana, who became excessively preoccupied with cleanliness and contamination. Over time:

  • Her self-esteem decreased
  • She became socially isolated
  • Academic performance declined
  • She experienced hopelessness and distress

The question arises:

Is Shabana mentally ill or simply different?

Psychologists agree that no single behavior alone defines abnormality. Instead, abnormality is identified through several indicators together.

Indicators of Abnormality

There are 7 major indicators.

1. Suffering (Personal Distress)

A person may experience:

  • Anxiety
  • Sadness
  • Fear
  • Emotional pain
Example:
  • A depressed person constantly feels hopeless.
  • An anxious student worries excessively before exams.

However:

  • Distress alone is not enough to define abnormality.
  • Normal people also suffer in stressful situations.
Important Point:

Some mentally ill individuals may not feel distress.

Example:

  • A manic person may feel extremely happy and energetic and may not believe anything is wrong.
Conclusion:

Suffering is:

  • Not necessary
  • Not sufficient
    for diagnosing abnormality.

2. Maladaptiveness

Behavior is abnormal if it interferes with:

  • Daily functioning
  • Relationships
  • Work
  • Health
  • Well-being
Example:
  • A person with anorexia starves themselves dangerously.
  • A severely depressed person stops working and isolates socially.
Important Note:

Some abnormal individuals may appear successful.

Example:

  • Con artists
  • Criminal psychopaths

Even if they function effectively, their behavior harms society.

Conclusion:

Maladaptive behavior is important but not always present.

3. Statistical Deviancy

Behavior is abnormal if it significantly deviates from average behavior.

This means:

  • Rare or unusual behavior may be considered abnormal.
Example:
  • Very low IQ may indicate intellectual disability.

But:
Not all unusual behavior is abnormal.

Examples of unusual but positive traits:
  • Genius intelligence
  • Extraordinary talent
  • Exceptional beauty
  • Great wealth

Thus:

  • Statistical rarity alone does not define abnormality.
Key Idea:

Society makes value judgments.

We tend to label behaviors abnormal when they are:

  • Rare
    AND
  • Undesirable

4. Violation of Social Norms

Every society has rules about acceptable behavior.

Behavior becomes abnormal when it:

  • Violates social expectations
  • Breaks cultural standards
  • Goes against moral values
Example:
  • Public nudity
  • Talking loudly to oneself
  • Extreme aggression
Important:

Context matters.

Example:

  • Illegal parking is common → often ignored.
  • A mother harming her children → considered highly abnormal.
Conclusion:

Abnormality depends on:

  • Severity of violation
  • Frequency in society
  • Cultural context

5. Social Discomfort

When behavior makes others uncomfortable, it may be considered abnormal.

Example:

Imagine:

  • A stranger sits extremely close in an empty theatre.
  • Someone discusses suicide within minutes of meeting you.

Such behavior creates:

  • Uneasiness
  • Anxiety
  • Social discomfort

Thus, society may label it abnormal.

6. Irrationality and Unpredictability

Abnormal behavior may appear:

  • Illogical
  • Incomprehensible
  • Unpredictable
Example:

A person suddenly:

  • Screams at invisible objects
  • Talks incoherently
  • Behaves bizarrely

Such symptoms are common in:

  • Schizophrenia
  • Mania
Key Idea:

Loss of self-control is a major sign.

7. Dangerousness

Behavior may be abnormal if the person:

  • Harms self
  • Harms others
  • Creates serious risk
Example:
  • Suicidal attempts
  • Violent attacks
Important Limitation:

Not all dangerous people are mentally ill.

Examples:

  • Soldiers in war
  • Extreme sports participants

Similarly:
Most mentally ill individuals are not dangerous.

Conclusion:

Dangerousness alone cannot define abnormality.

DSM Definition of Mental Disorder

According to DSM:

A mental disorder is:

A clinically significant behavioral or psychological syndrome associated with distress, disability, pain, death risk, or loss of freedom.

Important Features:

  • Causes distress or impairment
  • Not simply socially deviant behavior
  • Not merely a culturally accepted response
  • Involves dysfunction in:
    • Behavior
    • Psychology
    • Biology

Cultural Relativity of Abnormality

Culture strongly influences definitions of abnormality.

Example:
  • Homosexuality was once classified as mental illness.
  • Today it is not considered a disorder.

Another example:

  • Honor killing may be justified in some societies but condemned in others.
Key Point:

Normality and abnormality change across:

  • Time
  • Culture
  • Society

Classification of Mental Disorders

Meaning of Classification

Classification means:

  • Grouping disorders systematically
  • Giving them names
  • Organizing symptoms scientifically

Psychology uses classification to:

  • Improve communication
  • Conduct research
  • Plan treatment

Need for Classification

Classification is important because it:

1. Provides a Common Language

Psychologists worldwide can communicate effectively.

2. Helps in Diagnosis

Clinicians identify disorders accurately.

3. Helps in Research

Scientists study causes and treatments systematically.

4. Assists Treatment Planning

Different disorders require different treatments.

Example:

  • Schizophrenia treatment differs from substance abuse treatment.
5. Has Social and Administrative Importance

Used for:

  • Hospitals
  • Insurance
  • Government statistics
  • Mental health policy

Types of Classification

There are 3 approaches.

1. Categorical Approach

Used mainly in DSM.

Features:
  • Disorders are placed into distinct categories.
  • A disorder either exists or does not exist.
Example:

A person either has:

  • Depression
    OR
  • Does not have depression
Problems:
  • Two people with same diagnosis may have different symptoms.
  • Overlap between disorders occurs.
2. Dimensional Approach

Behavior exists on a continuum.

Features:

Symptoms vary in:

  • Degree
  • Severity
  • Frequency
Example:

Anxiety can range from:

  • Mild
    to
  • Severe
Advantages:
  • More flexible
  • Reduces rigid categories
Disadvantages:
  • Difficult diagnosis
  • Expensive assessment
3. Prototypical Approach

Combination of categorical and dimensional approaches.

Features:
  • Disorders have core characteristics.
  • Some variation is allowed.
Example:

Dogs differ in:

  • Size
  • Color
  • Breed

But all share “dog-like” features.

Similarly:
Mental disorders may vary while still fitting a prototype.

Problem:

Categories become “fuzzy.”

Drawbacks of Classification Systems

1. Loss of Personal Information

Diagnosis simplifies complex individuals.

Example:
Knowing someone has schizophrenia does not explain:

  • Personality
  • Life history
  • Relationships
2. Stigma

Mental illness labels may cause:

  • Discrimination
  • Shame
  • Social rejection

Example:
People may avoid someone labeled “mentally ill.”

3. Stereotyping

People form assumptions about mentally ill individuals.

Examples:

Believing:

  • All mentally ill people are violent
  • All schizophrenics are dangerous

These stereotypes are often incorrect.

Emile Kraepelin’s Contribution

Kraepelin is considered the father of modern psychiatric classification.

He:

  • Grouped symptoms systematically
  • Linked disorders with:
    • Course
    • Outcome
    • Biological causes

His work influenced:

  • DSM
  • ICD

Evolution of DSM

DSM = Diagnostic and Statistical Manual of Mental Disorders

Published by:
American Psychiatric Association

Used mainly in:

  • United States
  • Clinical diagnosis
  • Research

DSM-I (1952)

Features:
  • 106 disorders
  • Psychoanalytic orientation
  • Used term “reaction”
Criticism:

Too influenced by Freud and psychoanalysis.

DSM-II (1968)

Features:
  • 182 disorders
  • Removed term “reaction”
  • Continued psychodynamic influence
Limitation:

Symptoms were poorly defined.

DSM-III (1980)

Major revolution in diagnosis.

Led by:
Robert Spitzer

Important Changes:

1. Non-theoretical approach

Focused on symptoms rather than theories.

2. Specific diagnostic criteria

Improved:

  • Reliability
  • Accuracy

3. Multiaxial system

Considered:

  • Personality
  • Medical issues
  • Stressors
  • Functioning

DSM-III became highly influential worldwide.

DSM-IV and DSM-IV-TR

Features:
  • Greater scientific evidence
  • Better compatibility with ICD-10
  • Removed distinction between:
    • Biological disorders
    • Psychological disorders

Recognized that:

  • Biological
  • Psychological
  • Social
    factors all interact.

DSM-IV-TR later revised and clarified criteria.

DSM-5 (2013)

Current major version.

Major Features:

1. Three Sections

  • Introduction
  • Diagnostic criteria
  • Conditions needing further research

2. Dimensional Assessment

Measures:

  • Severity
  • Frequency
  • Duration

Example:

  • Anxiety severity scales

3. Impairment is Essential

Symptoms must significantly impair functioning.

Without impairment:

  • Diagnosis is not given.

4. Cultural Formulation

DSM-5 recognizes:

  • Cultural differences
  • Social influences
  • Ethnic backgrounds

Criticism of DSM-5

1. Overdiagnosis

Too many new disorders added.

2. Arbitrary Criteria

Example:
How many symptoms are “enough”?

3. Comorbidity Problem

One person may receive multiple diagnoses simultaneously.

4. “NOS” Problem

Many people do not fit neatly into categories.

NOS = Not Otherwise Specified

International Classification of Diseases (ICD)

ICD = International Classification of Diseases

Published by:
World Health Organization

Purpose of ICD

Used worldwide for:

  • Diagnosing diseases
  • Health statistics
  • Mortality records
  • Research
  • Insurance
  • Public health

Unlike DSM:
ICD covers:

  • Physical illnesses
  • Mental disorders

Historical Development of ICD

Early Beginnings

Started from efforts to classify causes of death.

Important contributors:

  • John Graunt
  • William Farr
  • Bertillon
ICD Revisions

Several revisions improved:

  • Disease classification
  • International health reporting

ICD-10

Included:

  • 28 common mental disorders

Examples:

  • Depression
  • Anxiety
  • Psychosis
  • Eating disorders
  • Sleep disorders

ICD-11

Officially adopted in 2022.

Features:
  • Better global applicability
  • 43 language translations
  • Cultural adaptability
  • Improved international comparison

DSM vs ICD

BasisDSMICD
Full FormDiagnostic & Statistical ManualInternational Classification of Diseases
PublisherAmerican Psychiatric AssociationWHO
ScopeMental disorders onlyAll diseases
UseMainly USAWorldwide
FocusClinical diagnosisGlobal health statistics
CodingUses ICD codesOfficial coding system
ApprovalAPA controlledInternational governmental approval

Similarities Between DSM and ICD

Both:

  • Provide diagnostic guidelines
  • Improve communication
  • Help research and treatment
  • Use scientific classification systems