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Psychiatric Diagnoses
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Should psychiatric diagnoses be made?
The "Pro’s & Con’s" are summarised in the table below:
"Pro's" |
"Con's" |
Allows rational treatment |
They are not always possible |
Enables prognostication |
Most are not based on pathology |
Essential for meaningful research |
They may ignore individuality |
Used to justify resources |
Pejorative |
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Labels deviant behaviour as illness |
How are psychiatric diagnoses made?
Psychiatric diagnoses are generally not based on pathology and there are no diagnostic tests. Instead they are empirically based on symptom clusters. The main problems with this are validity and reliability.
Reliability of psychiatric diagnoses.
As already mentioned diagnostic categories are based on symptom clusters. To try and ensure that diagnoses are reliable diagnostic classification guidelines and schedules have been developed. The World Health Organisation has produced the International Classification of Diseases (ICD-10). Current psychiatric diagnostic categories from this include:
- Organic
- Psychoactive substance use
- Schizophrenia, schizotypal and delusional disorders
- Mood disorders
- Neurotic, stress-related and somatoform disorders
- Behavioural syndromes associated with physiological disturbances
- Disorders of adult personality
- Mental retardation
- Disorders of psychological development
- Child and adolescent disorders
The American Psychiatric Association has produced the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) which uses an axial classification; the axes of which are:
- Clinical disorders
- Personality disorders and mental retardation
- General medical conditions
- Psychosocial and environmental problems
- Global assessment of functioning
These diagnostic tools largely overlap with each other and may overlap to a greater or lesser extent with diagnostic practices of a psychiatrist who doesn't rigorously apply either of these. The area of maximal overlap clearly has maximal validity.
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