TOPIC 3.

Classifications, assessment, diagnosis & the DSM

 Meaning of classification, assessment and diagnosis

 Classifying mental disorders
 Assessment methods
 Basic elements in assessment
 The major diagnostic Categories
 Clinical interviewing

Diagnosing and Classifying Psychological Disorders

A first step in the study of psychological disorders is carefully and systematically discerning
significant signs and symptoms. How do mental health professionals ascertain whether or not a
person’s inner states and behaviors truly represent a psychological disorder? Arriving at a proper
diagnosis (i.e. appropriately identifying and labeling a set of defined symptoms) is absolutely
crucial. This process enables professionals to use a common language with others in the field and
aids in communication about the disorder with the patient, colleagues and the public. A proper
diagnosis is an essential element to guide proper and successful treatment. For these reasons,
classification systems that organize psychological disorders systematically are necessary.

Classification is a process by which complex phenomena are organized into categories, classes
or ranks so as bring together those things that most resemble each other & to separate those that
differ. Classification is the act or method of distributing into a class or category according to
characteristics

The classification of mental disorders is also known as psychiatric nosology or psycho-nosology.

Psychiatric classification or psychiatric nosology is the classification and scientific study of
mental disorders.

There are currently two widely established systems for classifying mental disorders:

i. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and
the
ii. International Classification of Diseases, 11th edition (ICD-11) are widely used in the
diagnosis and study of mental disorders.

The DSM-5 is authored by the American Psychiatric Association while the ICD is authored by
the World Health Organization (WHO).

Importance of classification;

1. Allows professionals to recognize patterns among the symptoms that people present (i.e.,
syndromes).
2. Serves as an agreed upon authority that determines a threshold for impairment and/or
distress that warrants a diagnosis as well as recovery from the diagnosis.
3. Provides a set of nouns, which may aid quick and efficient communication among
professionals, patients, families, insurance companies, public health officials, researchers,
and the general public.
4. Organizes mental health conditions and disorders into groups and structures that allow users
of the diagnostic manual to find a disorder for which they are looking.
5. Informs treatment planning, target of treatment, and clinical management of people with
mental health conditions.
6. Defines which behaviors a society is willing to accept and which are not tolerated (e.g.,
antisocial behavior).
7. According to WHO's vision for the ICD-11 (for all diseases, conditions, and disorders), the
most superior purpose of assigning a diagnosis is to ease suffering

Assessment is the systematic evaluation and measurement of psychological, biological, and

social factors in an individual presenting with a possible psychological disorder

Diagnosis is the process of determining whether the presenting problem(s) fit the criteria for a
particular mental disorder. The process of identifying a disease, condition, or injury from its
signs and symptoms.

Comorbidity occurs when people who suffer from one disorder also suffer at the same time
from other disorders.

 Clinical assessment is used to determine how and why a person is behaving abnormally
and how that person may be helped.
 Assessment is an ongoing process and may be important at various points during
treatment not just at the beginning
 It also enables clinicians to evaluate people’s progress after they have been in treatment
for a while and decide whether the treatment should be changed.
 The specific tools that are used to do an assessment depend on the clinician’s theoretical
orientation

Methods of assessment
Methods of Clinical Assessment in Psychology
Clinicians use a variety of assessment methods to evaluate clients and arrive at diagnoses. Each
method provides different types of information, and often multiple methods are combined for a
comprehensive assessment.
1. Interviews
Clinical Interviews are the most widely used assessment tool – essentially a face-to-face
conversation where the clinician gathers information about the client’s history, symptoms, and
behavior. Interviews can be conducted in several formats: unstructured, structured, or semi-
structured, each with its own advantages. The Mental Status Examination (MSE) is often part
of the interview.
  Unstructured Interviews: These have no fixed set of questions. The clinician asks open-
ended questions and lets the conversation flow like a normal dialogue.
 Structured Interviews: These follow a predetermined set of questions and order.
 Semi-Structured Interviews: These blend both approaches – there is a guided outline of
important topics or questions.
2. Psychological Tests
Psychological testing involves standardized instruments to quantitatively measure different
aspects of a person’s mental functioning. These tests have been normed on large populations, so
an individual’s scores can be compared to established benchmarks. Tests can assess traits,
symptoms, cognitive abilities, or personality characteristics in an objective way. Below are key
types of psychological tests commonly used in clinical assessment:
 Intelligence Tests: These assessments evaluate general cognitive ability or “IQ”
(intelligence quotient). They measure domains such as verbal comprehension, reasoning,
memory, and processing speed. Common examples include the Wechsler Adult
Intelligence Scale (WAIS) for adults and the Stanford-Binet Intelligence Scales (which
can be used for children and adults).
 Objective Personality Tests: These are standardized self-report questionnaires
designed to assess personality traits, behaviors, and psychopathology with a fixed set of
response options (such as true/false or rating scales). Example is the Minnesota
Multiphasic Personality Inventory (MMPI-2), Millon Clinical Multiaxial Inventory
(MCMI-IV).
 Projective Tests: Projective techniques present ambiguous stimuli (like inkblot images
or vague scenes) and ask the client to interpret them or tell a story, under the assumption
that people will project their own unconscious feelings and conflicts onto the ambiguous
material. Example, The Rorschach Inkblot Test, and Thematic Apperception Test
(TAT).
3. Behavioral Assessments
Behavioral assessment involves the direct observation and measurement of a client’s behavior
in real-life settings or in simulated environments. Instead of relying on self-report or diagnostic
labels, this approach zeroes in on specific behaviors, the events that precede them, and the
consequences that follow. The goal is to understand the functional relationships between
environment and behavior – essentially, to figure out what triggers a problematic behavior and
what might be reinforcing it. Example; ABC model.
4. Self-Monitoring
Self-monitoring is a technique where the client themselves collects data on their own thoughts,
behaviors, or emotions. The clinician provides instructions and often a structured form or diary
for the client to record specific information each time a target behavior occurs. Self-monitoring
effectively turns the client into an observer of their own behavior, which can both provide
valuable assessment data and serve as an intervention (because paying attention to a behavior can
sometimes lead to changes in that behavior).
5. Cognitive Assessment
Cognitive assessment refers to testing a client’s thinking abilities – essentially, evaluating
aspects of brain function such as memory, attention, language, problem-solving, and orientation.
Examples can be; brief screening tests administered as part of a mental status exam, or common
quick screening is the Montreal Cognitive Assessment (MoCA) or the Mini-Mental State
Examination (MMSE).

Basic elements in assessment

The main components of a mental health assessment are;

1. General appearance and behavior

The appearance of a patient may give clues about his or her mental state. Key factors such as
chronological age and whether patients look their age, what their dressing style says, and
whether they are well-groomed or can maintain eye contact are informative. In addition,
assessment of appearance and behavioral can help identify problems with alcohol and substance
use.

2. Mood and affect

Mood and affect are both related to emotion. The subjective and objective aspects of mood must
be assessed; affects are the expressions reflected in movements or changes in voice tone, posture,
or stance. It’s important that both affect and mood are aligned.

3. Thought content
A health provider must ask direct questions to better determine and assess a patient's train of
thought. Are their thoughts logical or consistent? Are they blocking any thoughts? Through the
process of assessing thought content, providers can often detect negative feelings, such as
hopelessness.

4. Cognitive functioning
Cognitive functioning relates to intellectual abilities. This mental health assessment checks the
capacity to read, write, and immediately remember significant events in the recent past.
Furthermore, a provider may use this assessment to determine if a patient can recognize familiar
people and places. Cognitive functioning also includes the ability to focus or perform simple
calculations.

5. Judgment and insight

While judgment is determined by how well a patient solves problems and makes informed
choices, insight is evaluated by gathering as much information as possible from the patient's
perspective. Topics can include the reasoning for a visit to a behavioral health specialist and an
understanding of the challenges that have led to the visit.

The DSM (Diagnostic and Statistical Manual of Mental Disorders)

This is the classification of mental disorders by the American Psychiatric Association (APA). It
describes the diagnostic features—or, in medical terms, symptoms—of abnormal behaviors; it
does not attempt to explain their origins or adopt any particular theoretical framework, such as
psychodynamic or learning theory.

The DSM (History)

 DSM I-1952, 106 diagnoses
 DSM II-1968, 182 diagnoses
 DSM III-1980, 265 diagnoses
 DSM III-R 1987,292 diagnoses
 DSM -IV 1994,374 diagnoses
 DSM IV-TR 2000, 374 diagnoses
 DSM-5 (2013)
 DSM 5-TR (2022)

In the DSM, abnormal behavior patterns are classified as “mental disorders. “Mental disorders
involve either emotional distress (typically depression or anxiety), significantly impaired
functioning (difficulty meeting responsibilities at work, in the family, or in society at large), or
behavior that places people at risk for personal suffering, pain, disability, or death (e.g., suicide
attempts, repeated use of harmful drugs).

 DSM describes the patterns of thinking, emotion, and behavior that define various mental
disorders.
 For each disorder, DSM provides specific criteria outlining the conditions that must be
present before a person is given that diagnostic label.

The major diagnostic categories

a. Neurodevelopmental Disorders
b. Schizophrenia Spectrum and Other Psychotic Disorders
c. Bipolar and Related Disorders
d. Depressive Disorders
e. Anxiety Disorders
f. Obsessive-Compulsive and Related Disorders
g. Trauma- and Stressor-Related Disorders
h. Dissociative Disorders
i. Feeding and Eating Disorders
j. Elimination Disorders
k. Sleep-Wake Disorders
l. Sexual Dysfunctions
m. Disruptive, Impulse-Control, and Conduct Disorders
n. Substance-Related and Addictive Disorders
o. Neurocognitive Disorders
 p. Personality Disorders
q. Paraphilic Disorders
r. Other Mental Disorders

Clinical interviewing/psychiatric interview

A clinical interview is a fundamental component of the assessment process in mental health

care. It is a structured or semi-structured conversation between a clinician (such as a
psychologist, psychiatrist, or counselor) and a patient aimed at gathering information to
diagnose, understand, and treat mental health disorders. The clinical interview serves as the
foundation for developing an individualized treatment plan and is crucial for establishing rapport
with the patient.

Purpose of the clinical interview

 Diagnosis; identify any underlying mental health disorders
 Understanding symptoms: The clinician seeks to understand the nature, severity,
duration, and impact of the patient's symptoms on their daily life.
 Case formulation: the interview helps clinicians form a comprehensive understanding of
the patient’s background, including medical history, family dynamics, social
environment, and coping mechanisms.
 Treatment planning: The information obtained guides treatment decisions, including
psychotherapy, medication, or other interventions.

Key components of a clinical interview

a. Presenting problem
The interview begins with an exploration of the patient's presenting problem, or the
reason they sought help. This includes identifying the specific symptoms the patient is
experiencing (e.g., anxiety, depression, hallucinations) and understanding when these
symptoms began and how they have evolved.
b. History of the present illness
The clinician gathers detailed information about the onset, duration, and progression of
the symptoms. This helps in understanding the timeline of the disorder and identifying
any triggering events (such as stress, trauma, or significant life changes).
c. Mental Status Examination (MSE)
The Mental Status Examination (MSE) is a systematic evaluation of the patient’s
current mental functioning. It assesses areas such as appearance, mood, thought
process, speech, cognition, and insight.
d. Psychiatric and medical history
A thorough understanding of the patient’s psychiatric history (including previous
diagnoses, treatments, hospitalizations, and medication use) is crucial. Additionally, the
 clinician will inquire about medical history, as some physical conditions (such as thyroid
disorders or chronic pain) can affect mental health.
e. Family and social history
Family history: The clinician gathers information about any family history of mental
health disorders, which can indicate genetic predispositions.
Social history: The patient’s current social circumstances, including relationships,
occupation, financial status, and social support, are assessed. This helps the clinician
understand potential stressors and resources in the patient’s life.
f. Substance use
Substance use (including alcohol, recreational drugs, or prescription medication misuse)
is often a contributing factor to mental health disorders. Understanding the patient's
substance use patterns helps in assessing risk factors and treatment needs.
g. Risk assessment
The clinician conducts a risk assessment to determine if the patient is at risk for self-
harm, suicide, or harm to others. This is crucial for ensuring the patient's safety and
deciding if immediate intervention is required.