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OF mental health care and mentally ill

Classification of mental disorders

When it comes to the classification of mental disorders, it may quite reasonably be expected that different therapies will be suited to different disorders. Thus it is essential to establish a reliable and valid classification system at the outset, so that we can identify a disorder and then prescribe a suitable treatment. As mentioned in the previous section, the most widely used system at present is DSM IV, which is an American system, and employs the categories detailed in Table 1.1. The system also suggests that each individual can be assessed on five axes of functioning (although only the first three are compulsory). As well as the syndromes outlined (see Table 1.1), these axes include medical, social, occupational and environmental influences on functioning.

As mentioned above, one of the main purposes of having a classification system is to establish categories of disorder which have common origins and will benefit from the same treatment. In practice, however, this has not proved to be so simple, and both the reliability and validity of the present systems have been questioned. Regarding reliability, several studies (e.g. Zigler and Phillips 1961) have found agreement between clinicians to be as low as 54 to 84 per cent. More recent research suggests that this figure may have improved, but given that subjective judgement is still required during the diagnostic process it is unlikely that agreement will become a great deal higher. When validity is considered, many categories (e.g. schizophrenia) contain individuals who appear to differ widely from one another in their behaviour, and do not respond to the same kinds of treatment. Other categories such as the anxiety disorders do not appear to have any common origins, and respond to a variety of treatments. As we shall see in later chapters, issues such as these make it very difficult to evaluate the effectiveness of treatments, or even to make treatment decisions in the first place.


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