IB Docs (2) Team
Classification systems
Classification systems identify patterns of behavioural or mental symptoms that consistently occur together to form a disorder. In the USA, psychiatrists and other healthcare professionals use the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association (DSM-5). This is a standardized system for diagnosis based on factors such as the person’s clinical and medical conditions, psychosocial stressors and the extent to which a person’s mental state interferes with his or her daily life. The DSM is developed for American psychiatrists and is used mainly in the USA. It contains descriptions, symptoms, and other criteria for diagnosing mental disorders.
In addition to the DSM, the World Health Organization has published the International Classification of Diseases [ICD]. This system is developed by a global health agency and it is distributed as broadly as possible at a very low cost.
The two major classification systems used by western psychiatrists today are based largely on abnormal experiences and beliefs reported by patients, as well as agreement among a number of professionals as to what criteria should be used. A Chinese Classification of Mental Disorders [CCMD] has also been developed but Chinese psychiatrists also use the ICD-10 manual. A key difference between the CCMD and the Western classification systems is that it contains diagnostic criteria for disorders that are specific to Chinese culture.
ATL: Research and critical thinking
One of the disorders specified by the CCMD-2 is qigong deviation syndrome – also called zou huo ru mo.
Do some research on this disorder. To what extent is this disorder rooted in Chinese culture? What are the similarities between this disorder and Western disorders?
Teacher only boxQuestions: To what extent is this disorder rooted in Chinese culture? What are the similarities between this disorder and Western disorders?
The symptoms
Qigong is a system of coordinated body posture and movement, breathing, and meditation used for the purposes of health, spirituality, and martial arts training
In the second edition of the Chinese Classification of Mental Disorders (CCMD-2) the diagnosis of “Qigong Deviation Syndrome” is based upon the following criteria:
- The subject being demonstrably normal before doing qigong exercises
- Psychological and physiological reactions appearing during or after qigong exercises (suggestion and autosuggestion may play an important role in these reactions)
- Complaints of abnormal sensations during or after qigong exercises
- Diagnostic criteria do not meet other mental disorders such as schizophrenia, affective disorder, and neurosis.
Unlike most Western diagnoses, this disorder is linked to spiritual practice. The roots of the disorder are about "incorrect" qigong practices. The disorder has some similarities to anxiety disorders, which often have some trigger for feelings of panic or anxiety.
Overall, diagnostic systems provide a set of templates that the clinician can use to compare information about disorders to the condition of a particular client. In this way, clinicians can use the same standards for diagnosis. The purpose of such manuals is first and foremost to provide a common language for psychiatrists to communicate about patients and to establish consistent and reliable diagnoses. This is important in terms of finding a correct treatment for specific disorders as well as for research purposes.
Key differences between the ICD-11 and the DSM 5
- The ICD is produced by the World Health Organization, while the DSM is produced by the American Psychiatric Association.
- The ICD's approach is multidisciplinary and multilingual with the intent that it will be used globally to increase mental health; the primary users of the DSM are American psychiatrists.
- The ICD is more likely to indicate causes rather than purely symptoms.
- The ICD is approved by the health ministers of all 193 WHO member countries; the DSM is approved by the assembly of the American Psychiatric Association.
- The ICD is distributed at a very low cost, with substantial discounts to low-income countries, and available free on the Internet; the DSM generates a very substantial portion of the American Psychiatric Association's revenue.
Diagnosing psychological disorders
When an individual seeks help for a potential psychological disorder, how do psychiatrists go about making a diagnosis? A doctor looks for biological markers of disease - for example, using brain imaging technology or blood tests - as well as observable symptoms. A psychiatrist will often rely on the patient’s subjective description of the problem as well as assessment tools to evaluate a person for a disorder. Diagnosis is accomplished through a formal standardized clinical interview—a checklist of questions to ask each patient. This interview can be supplemented by interviews with the patient’s relatives. After the interview, a mental health status examination is completed, based on the clinician’s evaluation of the patient’s responses.
There are several limitations of relying on a clinical interview for diagnosis:
- The individual is automatically labeled as a “patient.”This means that the psychiatrist is “looking for evidence of abnormal behaviour.” This assumption that if a person is seeking assistance, s/he must have a mental disorder is known as sick role bias.
- The fact that the person is being observed or asked personal questions may increase anxiety and therefore change or intensify behaviour. This is called reactivity. This may then be seen by the psychiatrist as further evidence of dysfunctional symptoms.
- A clinician’s unique style, degree of experience, and the theoretical orientation will definitely affect the interview.
Reactivity occurs when individuals change behaviour due to the awareness that they are being observed. The change may be positive or negative.
When carrying out a clinical interview or observation, psychiatrists refer to the ABCS when describing symptoms of a disorder.
Affective symptoms: emotional elements, including fear, sadness, anger
Behavioural symptoms: observational behaviours, such as crying, physical withdrawal from others, and pacing
Cognitive symptoms: ways of thinking, including pessimism, personalization, and self-image
Somatic symptoms: physical symptoms, including facial twitching, stomach cramping and changes in weight.
Checking for understanding
How is the CCMD different from the DSM or ICD?
What is an advantage of using a classificatory system for diagnosis?
When psychiatrists use a standardized set of criteria, they should be able to come to the same diagnosis; this should increase the level of reliability of diagnosis. However, as we wlll see, this is not always the case.
Which of the following is not a key difference between the ICD and the DSM?
The ICD is distributed at a very low cost, with substantial discounts to low-income countries, and available free on the Internet; the DSM generates a very substantial portion of the American Psychiatric Association's revenue.
What is meant by the term “sick role bias?”
This is actually quite logical. If a person comes into a hospital and asks for help due to symptoms, it is logical to think that they must then be sick. Be a psychiatrist needs to stay objective; even though the person is seeking assitance, it does not mean that they have mental illness. It is a bias that means that the doctor will try to figure out "which disorder" the patient has, rather than "if" the patient truly has a disorder.
What is one disadvantage of using interviews in the diagnostic process?
When patients have to speak about their problems, they may exhibit anxiety which could then be seen as a symptom. This could be a confounding variable in the diagnosis. It is irrelevant how long an interview may take - and the cost is not higher than most physiological tests. The data collected is not solely self-reported. During an interview, the psychiatrist also observes the behaviour of the patient. In addition, we have to rely on self-reported data. It is important, for example, to know if the patient is having intrusive thoughts, difficulty concentrating or nightmares.
Which of the following is not an example of a somatic symptom?
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