LESSON 2 – SOCIAL SCIENCES, MENTAL HEALTH, DIAGNOSIS AND

CLASSIFICATION OF MENTAL ILLNESS

INTRODUCTION

A first step in the study of mental disorders is carefully and systematically discerning
significant signs and symptoms. How do mental health professionals ascertain whether or not a
person’s inner states and behaviors truly represent a psychological disorder? Arriving at a
proper diagnosis—that is, appropriately identifying and labeling a set of defined symptoms—is
absolutely crucial. This process enables professionals to use a common language with others in
the field and aids in communication about the disorder with the patient, colleagues, and the
public. A proper diagnosis is an essential element to guide proper and successful treatment. For
these reasons, classification systems that organize psychological disorders systematically are
necessary.

LEARNING OUTCOMES: At the end of this lesson, you should be able to:

1. Know the different ways of classifying mental health and diagnosis of mental illness
2. Appreciate the different etiologies of mental illnesses

COURSE MATERIALS

Diagnosing and Classifying Mental Disorders

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Although a number of classification systems have been developed over time, the one
that is used by most mental health professionals in the United States is the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric
Association (2013). (Note that the American Psychiatric Association differs from the American
Psychological Association; both are abbreviated APA.) The first edition of the DSM, published in
1952, classified psychological disorders according to a format developed by the U.S. Army
during World War II (Clegg, 2012). In the years since, the DSM has undergone numerous
revisions and editions. The most recent edition, published in 2013, is the DSM-5 (APA, 2013).
The DSM-5 includes many categories of disorders (e.g., anxiety disorders, depressive
disorders, and dissociative disorders). Each disorder is described in detail, including an
overview of the disorder (diagnostic features), specific symptoms required for diagnosis
(diagnostic criteria), prevalence information (what percent of the population is thought to be
afflicted with the disorder), and risk factors associated with the disorder.

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 The DSM-5 also provides information about comorbidity; the co-occurrence of two
disorders. For example, the DSM-5 mentions that 41% of people with obsessive-compulsive
disorder (OCD) also meet the diagnostic criteria for major depressive disorder. Drug use is
highly comorbid with other mental illnesses; six out of 10 people who have a substance use
disorder also suffer from another form of mental illness (National Institute on Drug Abuse
[NIDA], 2007).

The DSM has changed considerably in the half-century since it was originally published.
The first two editions of the DSM, for example, listed homosexuality as a disorder; however, in
1973, the APA voted to remove it from the manual (Silverstein, 2009). While the DSM-3 did not
list homosexuality as a disorder, it introduced a new diagnosis, ego-dystonic homosexuality,
which emphasized homosexual arousal that the patient viewed as interfering with desired
heterosexual relationships and causing distress for the individual. This new diagnosis was
considered by many as a compromise to appease those who viewed homosexuality as a mental
illness. Other professionals questioned how appropriate it was to have a separate diagnosis that
described the content of an individual’s distress. In 1986, the diagnosis was removed from
the DSM-3-R (Herek, 2012).

Additionally, beginning with the DSM-3 in 1980, mental disorders have been described in
much greater detail, and the number of diagnosable conditions has grown steadily, as has the
size of the manual itself. DSM-1 included 106 diagnoses and was 130 total pages,
whereas DSM-3 included more than twice as many diagnoses (265) and was nearly seven
times its size (886 total pages) (Mayes & Horowitz, 2005). Although DSM-5 is longer than DSM-
4, the volume includes only 237 disorders, a decrease from the 297 disorders that were listed
in DSM-4. The latest edition, DSM-5, includes revisions in the organization and naming of
categories and in the diagnostic criteria for various disorders (Regier, Kuhl, & Kupfer, 2012),
while emphasizing careful consideration of the importance of gender and cultural difference in
the expression of various symptoms (Fisher, 2010).

Some believe that establishing new diagnoses might over pathologize the human
condition by turning common human problems into mental illnesses (The Associated Press,
2013). Indeed, the finding that nearly half of all Americans will meet the criteria for
a DSM disorder at some point in their life (Kessler et al., 2005) likely fuels much of this
skepticism. The DSM-5 is also criticized on the grounds that its diagnostic criteria have been
loosened, thereby threatening to “turn our current diagnostic inflation into diagnostic
hyperinflation” (Frances, 2012, para. 22). For example, DSM-4 specified that the symptoms of
major depressive disorder must not be attributable to normal bereavement (loss of a loved one).
The DSM-5, however, has removed this bereavement exclusion, essentially meaning that grief
and sadness after a loved one’s death can constitute major depressive disorder.

The current organization of the DSM-5 begins with neurodevelopmental disorders and
then proceeds through internalizing problems (depression, anxiety, social anxiety, somatic
complaints, post-traumatic symptoms, and obsession-compulsion) to externalizing
problems (disruptive, impulse-control, conduct disorders and substance use, etc.). 

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These are the categories of the mental disorders.

 Neurodevelopmental disorders
 Schizophrenia spectrum and other psychotic disorders
 Bipolar and related disorders
 Depressive disorders
 Anxiety disorders
 Obsessive-compulsive and related disorders
 Trauma- and stressor-related disorders
 Dissociative disorders
 Somatic symptom and related disorders
 Feeding and eating disorders
 Elimination disorders
 Sleep-wake disorders
 Sexual dysfunctions
 Gender dysphoria
 Disruptive, impulse-control, and conduct disorders
 Substance-related and addictive disorders
 Neurocognitive disorders
 Personality disorders
 Paraphilic disorders
 Other mental disorders

Overview of the Major Disorder categories

Anxiety disorders.  Any anxiety or fear that interferes with normal functioning may be
classified as an anxiety disorder. Commonly recognized categories include specific phobias: a
specific unrealistic fear; social anxiety disorder: extreme fear and avoidance of social
situations; panic disorder: suddenly overwhelmed by panic even though there is no apparent
reason to be frightened; agoraphobia: an intense fear and avoidance of situations in which it
might be difficult to escape; and generalized anxiety disorder: a relatively continuous state of
tension, apprehension, and dread. 

Obsessive-compulsive and related disorders and trauma- and stressor-related

disorders. While similar to anxiety disorders, obsessive-compulsive disorders and
posttraumatic stress disorders now have their own distinct categories of classification within the
DSM-5 because symptoms of anxiety are not necessarily present. With obsessive-compulsive
disorder, a person is obsessed with unwanted, unpleasant thoughts and/or compulsively
engages in repetitive behaviors or mental acts, perhaps as a way of coping with the
obsessions. Post-traumatic stress disorder is a similar disorder, although classified as a trauma-
and stressor-related disorder.

Post-traumatic stress disorder is a disorder in which the experience of a traumatic or

profoundly stressful event, such as combat, sexual assault, or natural disaster, produces a

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constellation of symptoms that must last for one month or more. These symptoms include
intrusive and distressing memories of the event, flashbacks, avoidance of stimuli or situations
that are connected to the event, persistently negative emotional states, feeling detached from
others, irritability, proneness toward outbursts, and a tendency to be easily startled.

Dissociative disorders, Somatic symptom, and Related disorders. The main

characteristics of dissociative disorders are that people become dissociated from their sense
of self, resulting in memory and identity disturbances. Dissociative disorders listed in the DSM-5
include dissociative amnesia, depersonalization/derealization disorder, and dissociative identity
disorder. A person with dissociative amnesia is unable to recall important personal information,
often after a stressful or traumatic experience. Depersonalization/derealization disorder is
characterized by recurring episodes of depersonalization (i.e., detachment from or unfamiliarity
with the self) and/or derealization (i.e., detachment from or unfamiliarity with the world). A
person with dissociative identity disorder exhibits two or more well-defined and distinct
personalities or identities, as well as memory gaps for the time during which another identity
was present. Dissociative identity disorder has generated controversy, mainly because some
believe its symptoms can be faked by patients if presenting its symptoms somehow benefits the
patient in avoiding negative consequences or taking responsibility for one’s actions. The
diagnostic rates of this disorder have increased dramatically following its portrayal in popular
culture. However, many people legitimately suffer over the course of a lifetime with this disorder.

Somatic symptom disorders were previously known as “somataform disorders.” These

include somatic symptom disorder, illness anxiety disorder, conversion disorder, and fictitious
disorder. You will read about the various symptoms, epidemiology, how individuals present with
these problems, and a brief overview of possible causes. These disorders relate to a person
experiencing physical ailments that are not fully explained by a medical condition.

Mood disorders. A mood disorder involving unusually intense and sustained sadness,
melancholia, or despair is known as major depressive disorder. Milder but still prolonged
depression can be diagnosed as dysthymia. Bipolar disorder is characterized by mood states
that vacillate between sadness and euphoria; a diagnosis of bipolar disorder requires
experiencing at least one manic episode, which is defined as a period of extreme euphoria,
irritability, and increased activity. Mood disorders appear to have a genetic component, with
genetic factors playing a more prominent role in bipolar disorder than in depression. Both
biological and psychological factors are important in the development of depression. People
who suffer from mental health problems, especially mood disorders, are at heightened risk for
suicide.

Feeding and Eating disorders. Disordered eating can have significant health
consequences, and eating disorders are a major health concern. Anorexia nervosa is an
eating disorder characterized by the maintenance of a bodyweight well below average through
starvation and/or excessive exercise. Individuals suffering from anorexia nervosa often have a
distorted body image, referenced in literature as a type of body dysmorphia, meaning that they
view themselves as overweight even though they are not. People suffering from bulimia nervosa
engage in binge eating behavior that is followed by an attempt to compensate for a large
amount of consumed food. Avoidant/restrictive food intake disorder is an eating or feeding

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disturbance associated with an apparent lack of interest in eating or food. Pica is a disorder
characterized by an appetite for substances that are largely non-nutritive, such as ice, soap,
hair, paper, metal, soil, stones, glass, or chalk.

Sleep-wake disorders involve problems with the quality, timing, and amount of sleep,
which result in daytime distress and impairment in functioning. Sleep-wake disorders often
occur along with medical conditions or other mental health conditions, such as depression,
anxiety, or cognitive disorders.

Substance–related disorders are discussed in a separate module. They result when a

craving for, the development of, a tolerance to, and difficulties in controlling the use of a
particular substance or a combination of different substances, as well as withdrawal syndromes
when a person ceases to use the substance(s). Other addictive disorders also include gambling
disorder and other behavioral addictions.

Gender dysphoria, paraphilic disorders, and sexual dysfunctions. Today more than

ever before, mental health professionals are seeing patients seeking treatment in response to
dissatisfaction with their sexual functioning. Such dissatisfaction most commonly stems from a
sexual dysfunction, but may also be the result of a sexual deviation.  Sexual dysfunction
disorders include sexual desire disorders, arousal disorders, orgasm disorders, and pain
disorders. From a clinical perspective, there has been some effort to define sexual
deviation under the umbrella of the sexual paraphilias. Dissatisfaction can also stem from
gender dysphoria, or the distress a person feels due to a mismatch between their gender
identity and their biological sex.

The DSM-5 classifies psychotic disorders that involve psychosis, or a break in reality,

like in schizophrenia, delusional disorder, brief psychotic disorder, schizophreniform disorder,
schizoaffective disorder, substance/medication-induced psychotic disorder, and psychotic
disorder due to another medical condition. The most common psychotic disorder in this domain
is schizophrenia, which is a severe disorder characterized by delusions and hallucinations, often
causing a breakdown in one’s ability to function in life.

The DSM-5 recognizes 10 personality disorders, organized into three clusters. The
disorders in Cluster A include those characterized by a personality style that is odd and
eccentric. These include paranoid, schizoid, and schizotypal personality disorders. Cluster B
includes personality disorders characterized chiefly by a personality style that is impulsive,
dramatic, highly emotional, and erratic (antisocial, histrionic, narcissistic, and borderline) and
those in Cluster C are characterized by a nervous and fearful personality style (avoidant,
dependent, and obsessive-compulsive).

Neurodevelopmental disorders. The neurodevelopmental disorders are a group of

disorders that are typically diagnosed during childhood and are characterized by developmental
deficits in personal, social, academic, and intellectual realms; these disorders include attention-
deficit/hyperactivity disorder (ADHD) and autism spectrum disorder. The major features of
autism spectrum disorder include deficits in social interaction and communication and repetitive
movements or interests. ADHD is characterized by a pervasive pattern of inattention and/or

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hyperactive and impulsive behavior that interferes with normal functioning. Genetic and
neurobiological factors contribute to the development of ADHD, which can persist well into
adulthood and is often associated with poor, long-term outcomes. 

Disruptive, impulse–control, and conduct disorders refer to a group of disorders that

include oppositional defiant disorder, conduct disorder, intermittent explosive disorder,
kleptomania, and pyromania. These disorders can cause people to behave angrily or
aggressively toward people or property.

Finally, Neurocognitive disorders—disorders that describe decreased mental function

due to a medical disease other than a psychiatric illness. It is often used synonymously (but
incorrectly) with dementia. Although Alzheimer’s disease accounts for the majority of cases of
neurocognitive disorders, several other conditions can similarly affect memory, thinking, and
reasoning, and the motor system. In addition to Alzheimer’s, these conditions include
frontotemporal degeneration, Huntington’s disease, Lewy body disease, traumatic brain
injury (TBI), Parkinson’s disease, prion disease, and dementia/neurocognitive issues due to HIV
infection.

Causes of Mental Illness

What are the causes of mental illness? Although the exact cause of most mental
illnesses is not known, it is becoming clear through research that many of these conditions are
caused by a combination of biological, psychological, and environmental factors.

What Biological Factors Are Involved in Mental Illness?

Some mental illnesses have been linked to abnormal functioning of nerve cell circuits or
pathways that connect particular brain regions. Nerve cells within these brain circuits
communicate through chemicals called neurotransmitters. "Tweaking" these chemicals --
through medicines, psychotherapy or other medical procedures -- can help brain circuits run
more efficiently. In addition, defects in or injury to certain areas of the brain have also been
linked to some mental conditions.

Other biological factors that may be involved in the development of mental illness
include:

Genetics (heredity): Mental illnesses sometimes run in families, suggesting that people
who have a family member with a mental illness may be somewhat more likely to develop one
themselves. Susceptibility is passed on in families through genes. Experts believe many mental
illnesses are linked to abnormalities in many genes rather than just one or a few and that how
these genes interact with the environment is unique for every person (even identical twins). That
is why a person inherits a susceptibility to a mental illness and doesn't necessarily develop the
illness. Mental illness itself occurs from the interaction of multiple genes and other factors --
such as stress, abuse, or a traumatic event -- which can influence, or trigger, an illness in a
person who has an inherited susceptibility to it.

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 Infections: Certain infections have been linked to brain damage and the development of
mental illness or the worsening of its symptoms. For example, a condition known as pediatric
autoimmune neuropsychiatric disorder (PANDAS) associated with the Streptococcus bacteria
has been linked to the development of obsessive-compulsive disorder and other mental
illnesses in children.

Brain defects or injury: Defects in or injury to certain areas of the brain have also been
linked to some mental illnesses.

Prenatal damage: Some evidence suggests that a disruption of early fetal brain
development or trauma that occurs at the time of birth -- for example, loss of oxygen to the brain
-- may be a factor in the development of certain conditions, such as autism spectrum disorder.

Substance abuse: Long-term substance abuse, in particular, has been linked to

anxiety, depression, and paranoia.

Other factors: Poor nutrition and exposure to toxins, such as lead, may play a role in the
development of mental illnesses.

What Psychological Factors Contribute to Mental Illness?

 Psychological factors that may contribute to mental illness include:

 Severe psychological trauma suffered as a child, such as emotional, physical, or sexual
abuse
 An important early loss, such as the loss of a parent
 Neglect
 Poor ability to relate to others

What Environmental Factors Contribute to Mental Illness?

Certain stressors can trigger an illness in a person who is susceptible to mental illness.
These stressors include:

 Death or divorce
 A dysfunctional family life
 Feelings of inadequacy, low self-esteem, anxiety, anger, or loneliness
 Changing jobs or schools
 Social or cultural expectations (For example, a society that associates beauty with
thinness can be a factor in the development of eating disorders.)
 Substance abuse by the person or the person's parents

SUGGESTED READINGS/REFERENCES:

Diagnosing and Classifying Mental Disorders. https://courses.lumenlearning.com/wm-

abnormalpsych/chapter/diagnosing-and-classifying-psychological-disorders/

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Causes of Mental Illness. https://www.webmd.com/mental-health/mental-health-causes-mental-
illness

ACTIVITIES/ASSESSMENT: (Group Work)

1. Are classifications reliable and valid?

2. Can diagnosis and labeling cause harm?

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