Psychopathology
Chapter 2: Classification and Assessment in Clinical Psychology
2.1 CLASSIFYING PSYCHOPATHOLOGY
2.1.1 The Development of Classification Systems
German psychiatrist Emil Kraepelin (1883–1923)
psychopathology, like physical illness, could be classified into different
and separate pathologies, each of which had a different cause and could
be described by a distinct set of symptoms that he called a syndrome
Diagnostic and Statistical Manual (DSM) First published in 1952 by the
American Psychiatric Association (APA), the DSM extended the World
Health Organisation’s (WHO) International List of Causes of Death (ICD)
classification system to include a more widely accepted section on mental
disorders.
2.1.2 Diagnostic and Statistical Manual (DSM)
Defining and diagnosing psychopathology
puts the emphasis on distress and disability as important defining
characteristics
Distress relates to the chronic experience of pain or distressing
emotions
disability refers to the fact that distress can lead to impairment in one
or more important areas of functioning, such as education, employment,
and dealing with family and social responsibilities
DSM has four basic objectives
1. it must provide necessary and sufficient criteria for correct
differential diagnosis
2. it should provide a means of distinguishing ‘true’ psychopathology
from non‐disordered human conditions that are often labelled as
everyday ‘problems in living’
3. it should provide diagnostic criteria in a way that allows them to be
applied systematically by different clinicians in different settings
4. the diagnostic criteria it provides should be theoretically neutral, in
the sense that they do not favour one theoretical approach to
psychopathology over another
DSM classification systems also provide the following information
1. essential features of the disorder
2. associated features
3. diagnostic criteria
4. information on differential diagnosis
diagnostic categories in DSM are descriptive constructs based on groups
of symptoms that define a diagnostic category, and they are not
definitions of diseases nor do they have any explanatory significance
General problems with classification
does not classify psychopathology according to its causes but does so
merely on the basis of symptoms. diagnosis on the basis of symptoms
gives the illusion of explanation, when it is nothing more than a re‐
description of the symptoms
stigmatising and harmful
tends to define disorders as discrete entities (either yes/no). may
be dimensional rather than discrete
DSM conceptualises psychopathology as a collection of hundreds of
distinct categories of disorders, but what happens in practice provides
quite a different picture
comorbidity The co-occurrence of two or more distinct psychological
disorders.
hybrid disorders Disorders that contain elements of a number of different
disorders.
disorder spectrum The frequency of comorbidity suggests that most
disorders as defined by DSM may indeed not be independent discrete
disorders, but may represent symptoms of a disorder spectrum that
represents a higher-order categorical class of symptoms.
Mixed anxiety-depressive disorder An example of a hybrid disorder
whereby people exhibit symptoms of both anxiety and depression, yet do not
meet the threshold for either an anxiety or a depression diagnosis.
can be conceived as a ‘hodgepodge’ collection of disorders that have
been developed and refined in a piecemeal way across a number of
revisions. makes it almost impossible to frame a definition of what a
mental health problem actually is
2.1.3 DSM‐5
many of the diagnostic changes in DSM‐5 have reduced the number of
criteria necessary to establish a diagnosis
DSM‐5 has introduced disorder categories that are designed to identify
populations that are at risk for future mental health problems
mild neurocognitive disorder DSM-5 has introduced disorder categories
that are designed to identify populations that are at risk for future mental
health problems, and these include mild neurocognitive disorder, which
diagnoses cognitive decline in the elderly.
attenuated psychosis syndrome DSM-5 has introduced disorder categories
that are designed to identify populations that are at risk for future mental
health problems. Attenuated psychosis syndrome is seen as a potential
precursor to psychotic episodes.
there are concerns that changes in diagnostic criteria will result in
lowered rates of diagnosis for some particularly vulnerable populations
DSM‐5 has continued the process of attempting to align its diagnostic
criteria with developments and knowledge from neuroscience. but
neuroscience may never be able to provide a comprehensive basis for
diagnosis because its approach is too reductionist and by its very nature
it will be unable to capture the social and cultural factors that
indisputably contribute to the symptoms of mental health problems
most mental health problems (and psychological distress generally) are
now viewed as dimensional, so any criteria defining a diagnostic cut‐off
point will be entirely arbitrary
2.1.4 Developing Alternatives to DSM
Both DSM and ICD take a very medically oriented approach to
diagnosing psychopathology by splitting mental health problems into
numerous discrete diagnostic categories each defined on the basis of
different clusters of symptoms.
Research domains criteria (RDoC)
classifying psychopathologies in terms of their causes would be to start
from scratch by researching causes and then relating them to
observable symptoms
represents an attempt to understand the causes of psychopathology in
terms of the neurological, biological, psychological, social, and cultural
structures and processes that underlie mental health problems
conceives of psychopathologies as “disorders of brain circuits” that can
be experimentally explored using the tools of neuroscience
two‐dimensional matrix that offers a basis for guiding research
potential limitations to the RDoC initiative
1. based on the assumption that psychopathologies are ‘disorders of
brain circuits’
2. focuses almost entirely on intra‐individual variables to the detriment
of extra‐individual variables such as the social, developmental, or
cultural context of mental health problems
3. long‐term project requiring detailed and intensive research at many
different levels of analysis, and so a classification system based on
RDoC is still a long way off
Hierarchical Taxonomy of Psychopathology (HiTOP)
helps to predict comorbidity and also higher‐order dimensions that
reflect associations between lower‐order dimensions
evidence‐based consensual model of symptom taxonomy
The model deals with comorbidity by identifying higher‐order
dimensions that predict associations between disorders and symptoms
on lower levels and can encompass both narrowly defined symptoms
(e.g., obsessions) and broader clusters of psychological conditions (such
as internalising)
still relies on DSM/ICD diagnostic categories at the level of syndromes
and disorders.
Network analyses
assumes that disorders emerge from the causal interactions between
symptoms themselves, and understanding the causal relationships
between symptoms will enable us to define individual clusters of
symptoms that define individual disorders. In this way, depression is
not a causal entity but merely a name for the network of symptoms that
interact to cause the syndrome we call ‘depression’.
provides an objective measure of how symptoms are interrelated and
can identify symptoms that are centrally important in defining a
disorder and affecting other symptoms
does not provide information on causal relationships between
symptoms that may occur over different time scales
FOCUS POINT 2.2 A NETWORK ANALYSIS OF DEPRESSION
SYMPTOMS
Network analyses can be created by collecting data about symptoms in
a variety of ways and subjecting these data to statistical analyses that
provide information about the connectedness between symptoms
Nodes represent symptoms, and edges represent associations between
symptoms
The centrality of a node can then be calculated by such details as the
number of edges connected to it and the strength with which it will
activate associated nodes.
The Power Threat Meaning (PTM) framework
takes a broad view of the causes of psychopathology and views people
as social beings whose experiences of distress and troubling behaviour
are inseparable from their material, social, environmental, socio‐
economic, and cultural contexts.
2.1.5 Conclusions
case formulation The use of clinical information to draw up a psychological
explanation of the client’s problems and to develop a plan for therapy.
