User:Classifying mental disorders

Classifying mental disorders
1. General aspects about the classification of mental disorders

According to WHO (2019) there are a great variety of mental disorders which are different, with different presentations. They are generally characterized by being a combination of elements such as thoughts, perceptions, emotions, behaviors and abnormal relationships with others.

In addition, they affect various areas of individual functioning, such as interpersonal relationships, work, health, among others. Therefore, it is important that there is a treatment for these mental disorders, either with psychological or psychiatric therapy, pharmacological treatments, psychoeducation, among others. However, "in low- and middle-income countries, between 76% and 85% of people with mental disorders receive no treatment for their disorder" (WHO, 2019).

Finally, mental disorders can have various origins or reasons for them to develop, but the most usual ones are inheritance or family genetics, family history, traumas, stressful experiences, abuse of drugs, brain injury, among others.

2. What is classification?

According to Ivanovic-Zuvic (2021), a classification is a process in which the complexity of the phenomenon is reduced to categories that are based on criteria that have a specific purpose, such as prognosis, evolution, responses to treatments, symptomatic differences, between others. On the other hand, there will be two types of classifications that will be called taxonomies and nosologies, the first being based on the biological model and the second on the process of classifying mental disorders.

The purpose or purpose of making a classification according to Ivanovic-Zuvic (2021) is that it facilitates communication by giving a name and category to each disorder, which will have a common use among specialists. It also facilitates the collection of information by being categorized and consequently, it helps to understand each disease that makes up the classifications of mental disorders.

Finally, it can be identified that there are categorical, dimensional and current classifications. The categorical classifications are those that establish fixed categories, which are delimited and can be differentiated, since they have very precise and established limits. On the other hand, dimensional classifications are those that study traits and do not establish substantial differences. Finally, the current classifications are the DSM and ICD, which are systems used in psychiatry.

3. Origins of classifications and their evolution

Kraepelin, a psychiatrist, is considered the father of the classifications of mental disorders, since he was the one who created the DSM-I in 1899, managing to “develop a system to construct groups of patients with homogeneous symptoms that constituted a syndrome. Some 50 years later, they published the DMS-I with criteria that are too vague and with low reliability” (Perez, 2019).

However, the first to speak of mental disorders was Hipocrates, a doctor from a Ancient Greece, since before these were considered only as an eccentric type of behavior. Additionally, it is believed that he made the first classifications by identifying that there were delusions, epilepsy, panic, fear, insomnia, paranoia, phobias, sleepwalking. Thus, considering that "mental illnesses located in the brain manifest an imbalance of moods or emotions" (Ivanovic-Zuvic, 2004). It is considered that he made the first classifications, since he distinguished various mental illnesses of the time, such as delirium caused by fever, mania, melancholy and epilepsy.

Currently, the classification is based on the nosology of Kraepelin, who, in addition to creating the first DSM classification, dedicated himself to compiling psychiatric medical records and "proposed an eminently descriptive classification system" (Lara, 1996).

4. Definition of mental disorders

Mental disorders or mental illness is “a sustained alteration of an emotional, cognitive and/or behavioral type, in which basic psychological processes such as emotion, motivation, cognition, consciousness, behavior, perception, sensation are affected, learning, language, etc.”(Morer et al., 2019).

In addition, for DSM-5 it is "a syndrome characterized by a clinically significant alteration of the cognitive state, emotional regulation or behavior of an individual, which reflects a dysfunction of the psychological, biological or developmental processes that underlie their mental function" (Medrano, 2014). In addition, for psychopathology, a branch of psychology that unites psychology with psychiatry, it will be a multi-causal entity, which reduced the disputes between both disciplines because they reached a consensus.

5. Differences between the classification between DSM-5 and ICD-10

The DSM-5 and CIE-10 have in common being diagnostic manuals, however they present differences in their content or way of presenting it. DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders published by American Psychology Association in 2013 and is one of the most used manuals in the area of mental health. Secondly, CIE-10 is a diagnostic manual created by World Health Organization in 1992. It should be said that it is not its updated version, even so it is still the most used version. How you can see, their publication dates present a great distance (Castillero, s.f).

Another point to explain is that CIE-10 doesn´t maintain a specificity about mental disorders, because this manual addresses the total number of medical problems that a person may have, incorporating in chapter 5 those related with mental health. While DSM-5 is a dedicated manual only to mental disorders (Castillero, s.f.).

Regarding the objectives of the manual, it is noted that DSM-5 is oriented to an accurate description of diagnostic criteria, while CIE-10 makes a record of the characteristics of each disorder. Also, there are differences in the content of the manuals, because there is a significant difference in the total of categories  presented by both manuals. While in the DSM-5 there are 21 categories, in the CIE-10 there are only 10 categories (Castillero, s.f).

In addition, they differ in the names they give to various disorders and to the criteria used to diagnose them. Some diagnostics that exist in one manual, don´t exist in the other (Castillero, s.f.). Finally, CIE-10 presents more transculturality than DSM-5, because this last one is based in western culture, and it doesn't allow an understanding of the psyche according to other cultures (Castillero, s.f.).

6. The importance of the classification of mental disorders

The importance of classifying diagnostics consists in the impact not only of the patient, but also the professional, because only knowing the specific mental disorder, the professional can treat the disorder with the best tools and skills and consequently improve the life of the patient.

Related to that, there are mental disorders that need medicine, others only need therapy, both or in some specific cases nothing is useful to change condition of people, for example, as Doctor Rossi explain, the psychopathy can’t get better with these two elements, so people must be isolated to not be a danger to people that love them because they aren’t conscious about that.

Besides, the classification allows globalizing the information, helping to understand different mental disorders in the same way in different countries, so the treatment doesn't change to the patients.

On the other hand, it is important to mention the negative side of classify; throughout history mental disorders had meant to carry with a stigma, like something terrible, and we know that it isn’t true, people can live with normalcy in general, some of them can recover totally, etc. Next, we are going to expose some disorders and their symptoms in a general way, all the disorders are experienced by the people in different ways.

'''7. Classifications of Mental Disorders According to DSM-5. '''


 * 1) Neurodevelopmental disorders: Neurodevelopmental refers to the process of reorganization of the cerebral structures during the life. There are some external factors that can intercede in this restructuration producing disorders; examples of them are: schizophrenia, mental disability, communication disorders, etc.
 * 2)  Spectrum of schizophrenia and other psychotic disorders: Schizophrenia is part of the neurodevelopmental disorder group because of a lot of neurological factors that allow the appearance of this disorder. For example: mother stress, malnutrition, use of drugs, etc. This disorder is characterized by hallucinations and deliriums, also people experiment with affective indifference, apathy, and problems of concentration with disorganized thoughts in the cognitive ambit. All these symptoms are extremely difficult in the life of those who suffer.
 * 3) Bipolar disorder and related disorders: Within this classification, bipolarity type I and II are the best known. The first is characterized by the presence of mania, which can be identified through a persistent and abnormal increase in energy. There may be an increase in self-esteem or talk more than the regular. Also, episodes of major depression are frequent in this type of mental disorder, but they are not necessary to diagnose bipolarity type I. Secondly, bipolarity type II is relationated with the existence of a hypomanic episode and a major depression that are not attributabe to substance use.
 * 4)  Depressive disorders: Depression is definite in short as an affective disorder, in DSM-V (2013) it's clearly defined as a permanent depressed mood which can be accompanied by lose the interest in things important for the person, changes in the sleep time and weight, besides the concentration decrease all of this is living during a time of two weeks as minimum.
 * 5) Anxiety disorders: It’s referring to an extreme difficulty to control their preoccupation that triggered a lot of negative symptoms not only mental, but also biological, so people can feel fatigue, muscular tension. All of this is related to stressful situations, not drugs or other disorders like happen in other cases.
 * 6) Obsessive compulsive disorder and related disorders: Obsession talks about thoughts, images or recurrent things that people experience as an inappropriate or intrusive worry in their mind, so they try to ignore them, but it’s not easy. While compulsions involve a behavior that reacts to obsession, so it has a repetitive nature, been able to hurt the person and the objective of reducing that bad experience of the obsession.
 * 7)  Trauma and other stressor-related disorders: This is a psychological answer that happens when someone is exposed to a specific traumatic situation like acts of violence, sexual abuse, natural disaster, etc. In this case, the situation triggers a constant behavior which can end in some of these disorders: post-traumatic stress, reactive attachment, or adaptation disorder.
 * 8)  Dissociative disorders: It is defined as those disorders in which a defense mechanism called dissociation is used, in order to protect itself from a situation categorized as stressful or traumatic, in addition, it is a "disruption in the normal subjective integration of 1 or more aspects of functioning psychological, including, but not limited to, the "integrative" functions of consciousness, memory, identity, perception, and motor control” (Andrade, 2017). The DSM-V considers that there are three types of dissociative disorders, which are dissociative amnesia, dissociative identity disorder and depersonalization disorder.
 * 9)  Somatic symptom disorder and related disorders: It includes "people with a wide and florid panoply of physical symptoms (4 painful distributed, 2 gastrointestinal, 1 sexual and another pseudoneurological), which will affect meaningful to your life, with a measured persistence in years and that they were not medically explained, nor were they simulated” (Vallejo, 2014), in addition, the persistence of symptoms must be greater than six months.
 * 10)  Eating disorders: In the DSM-V according to Weinstein (s.f.), anorexia nervosa, bulimia nervosa, binge-eating disorder, other specified eating or eating disorder, pica, rumination disorder, avoidance / restriction of food intake and eating or swallowing disorder of unspecified food.
 * 11)  Sleep-wake disorders: According to the DSM-V (2013), this disorder is characterized by difficulty sleeping or staying asleep, in addition, it generates discomfort in various aspects of the person's daily life, occurring more than 3 times a week, among others.
 * 12) Sexual dysfunctions: They are a set of psychological disorders that directly affect a person's ability in the sexual sphere. According to the DSM-V (2013), they include delayed ejaculation, genito-pelvic pain disorder, substance or drug induced sexual dysfunction, among others.
 * 13) Gender dysphoria: According to the DSM-V (2013) gender dysphoria is characterized by the feeling of incongruence and discomfort that occurs in a person when the gender identity assigned at birth does not coincide with the expressed gender identity. As a result, people who suffer from it may suffer from unconformity, anxiety and depression, and may also be victims of abuse or mockery by others.
 * 14) Impulse control disorders and disruptive behaviors: As the name suggests, these are disorders related to control problems in a person's behavior, which most of the time present actions that offend, hurt, or endanger the lives of others (DSM-V, 2013).  Among these we can find the following; Pyromania, a psychological disorder with a tendency to intentionally set fires. Antisocial personality disorder, where the subject does not show feelings of concern or remorse towards others. And conduct disorder, which is characterized by non-compliance with the norms or rules of society.
 * 15)  Substance Use Disorders and Addictive Disorders: It is defined as disorders that occur as a result of excessive and uncontrolled consumption of substances, drugs or medications. For example, alcohol, cannabis, amphetamines and hallucinogens. These disorders lead to dependence on these substances and abstinence.
 * 16) Neurocognitive disorders: According to the DSM-V (2013), is a mental disorder, which directly and significantly affects the person's brain functions, such as memory and language.
 * 17) Paraphilic disorders: It is a paraphilia, that is, frequent impulses and fantasies related to objects, children or situations out of the ordinary. Which causes discomfort in the individual or whose satisfaction generates a risk of harm to others (DSM-V, 2013). According to the DSM-V (2013) among these can be found, pedophilia, fetishism disorder and voyeurism disorder.
 * 18) Personality disorders: Personality disorders are divided into three clusters: A,B y C. Cluster A group the paranoid, schizoid and schizotypal personality disorder. The cluster B includes the border, narcissistic, antisocial and histrionic personality disorder. Finally, cluster C groups the avoidant, dependent and obsessive-compulsive personality disorder. Personality disorders can be defined as a pattern of behaviors and internal experience that deviate from what is expected. This pattern is unyielding, even in different contexts, because it responds to a personality structure.



Bibliographic references

American Psychiatric Association (2013). Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5), 5ª Ed. Madrid: Editorial Médica Panamericana.

Andrade, M. (2017). Trastornos disociativos. Síntesis, biblioteca digital dinámica para estudiantes y profesionales de la salud. https://sintesis.med.uchile.cl/index.php/profesionales/informacion-para-profesionales/medicina/condiciones-clinicas2/psiquiatria/1078-5-01-1-021

Castillero, O. (s.f.) Diferencias entre DSM-5 y CIE-10. Psicología y Mente. https://psicologiaymente.com/clinica/diferencias-entre-dsm-5-y-cie-10

Ivanovic-Zuvic, F. (2004). Consideraciones epistemológicas sobre la medicina y las enfermedades mentales en la antigua Grecia. Revista chilena de neuro-psiquiatría, 42(3). https://doi.org/10.4067/s0717-92272004000300002

Lara, M. (1996). Evolución histórica de las clasificaciones en salud mental. Revista Salud Mental, (19), 7-10.

Medrano, J. (2014). DSM-5, un año después. Revista de la Asociación Española de Neuropsiquiatría, 34(124), 655–662. https://doi.org/10.4321/s0211-57352014000400001

¿Qué es la Enfermedad o Trastorno Mental? | Hospital. (07 de octubre del 2019). Clínic Barcelona. https://www.clinicbarcelona.org/asistencia/cuida-tu-salud/salud-mental-en-la-infancia-y-la-adolescencia/enfermedad-o-trastorno-mental

Vallejo, M. (2014). De los trastornos somatomorfos a los trastornos de síntomas somáticos y trastornos relacionados. Cuadernos de medicina psicosomática y psiquiatría de enlace, (110), 75-78.

Weinstein, M (s.f). Trastornos alimentarios y de la ingestión de los alimentos. Psicología, UBA. http://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/electivas/616_psicofarmacologia/material/trastornos_conducta_alimentaria.pdf

WHO (November 28, 2019). Mental disorders. https://www.who.int/news-room/fact-sheets/detail/mental-disorders

** Note: The references of this Wiki are in Spanish because the articles were translated from this language into English.