Читать книгу Abnormal Psychology - William J. Ray - Страница 184

The classification system used by DSM–I divided disorders into two broad categories. The first category was those disorders such as Huntington’s chorea or neurocognitive disorders (then called dementias) resulting from brain pathophysiologies. These were disorders that resulted from hereditary origins, infections, long-term drug addictions, tumors of the brain, and other such factors. The second category was those disorders that included an environmental component in which the individual found it difficult to cope with his or her world. This second category was further divided into three different types of disorders. The first was psychosis, including schizophrenia and other psychotic disorders. The second was neurosis, such as anxiety disorders. The third was referred to as character disorders such as psychopathy, which were involved in forensic decisions. As you will see later, those individuals who demonstrate psychopathic tendencies often find themselves accused of crimes such as cheating others. In general, it was assumed that the neurotic disorders would be more amenable to psychological treatment.

During World War II, mental health professionals realized that environmental stress associated with combat was related to the expression of mental disorders.

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DSM–II was released in 1968. Although it did not differ greatly from DSM–I, it did offer an opportunity for the mental disorder categories of ICD-8 and DSM–II to be almost identical. This allowed for a worldwide classification system, which increased the ability to collect statistics on particular mental disorders. One difference that did exist was that the ICD manual just listed the disorders, whereas the DSM included brief definitions.

During the 1970s, there were a variety of changes in issues of importance to both the scientific and larger lay community that influenced the next version of the DSM. In the scientific study of psychopathology, there was an increased emphasis on greater precision in describing the signs and symptoms associated with a particular psychopathology. In addition, there was an emphasis on differentiating one disorder from another as well as on using experimental research to inform these definitions. There was also an understanding that some individuals manifest a particular disorder in different ways. For example, as noted earlier in this chapter, some individuals with schizophrenia will hear voices, while others will have visual hallucinations.

When DSM–III was released in 1980, it included a number of major changes from DSM–I and DSM–II (see Blashfield et al., 2010). One major change was that it sought to rely on observable evidence to create a scientific system rather than just focus on the interpretations of experts in the field. Another change was that DSM–III described disorders in terms of specific criteria rather than the more general descriptions of a disorder seen in DSM–I and DSM–II. DSM–III also introduced a five-level system or axes to give a more complete picture of the person. Axis I described the individual’s psychopathological symptoms. Axis II described the person’s personality or mental retardation. Axis III described any medical disorders that the person had. Axis IV described significant environmental factors in the person’s life. Lastly, Axis V described the person’s level of functioning and any significant role impairment. Overall, DSM–III sought to be theory neutral and only use observable terms. DSM–III was adopted in a number of countries and translated into 16 languages. In 1987, DSM–III was revised in terms of diagnostic criteria and referred to as DSM–III–R.

In 1994, DSM–IV was released. One goal of this release was to coordinate this revision with ICD-10. There was also an attempt to increase the scientific evidence underlying the diagnostic criteria for each specific disorder. To achieve this goal, a steering committee composed of 27 members oversaw the work of 13 different work groups. The task of the work groups was a three-step process. The first step was to extensively review the scientific literature related to a particular disorder. The second step was to utilize and reanalyze descriptive data from researchers who studied particular disorders. The third step was to conduct a series of field trials using the diagnostic criteria and to modify the criteria based on these trials. DSM–IV was expanded in 2000 with the publication of DSM–IV–TR (TR stands for text revision). DSM–IV–TR did not make major changes to the diagnostic criteria but did expand the text information describing each disorder.