Developmental Psychopathology. Группа авторов

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Developmental Psychopathology - Группа авторов


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      What is psychopathology? How do we know when a child or adolescent has clinically significant symptoms of a psychological or behavioral disorder? How do we ensure that medical and mental health professionals, patients, and other stakeholders assess for, and communicate about, mental illness in a consistent way? Formal diagnostic systems and other approaches to the classification of psychopathology allow us to answer these questions to varying degrees. In this chapter, we will discuss different approaches to understanding, classifying, and diagnosing psychopathology in children and adolescents. We conclude with a summary of the limitations of each approach and introduce the benefit of a developmental psychopathology approach to conceptualizing psychopathology.

      Classification is the act of categorizing things according to a set of criteria. Things in the same category tend to share similar characteristics or features. For example, biologists interested in taxonomy, the science of classification, might classify sea creatures according to dimensions such as size, diet, or gestation process. Classification systems for psychopathology aim to organize the observed symptoms of psychological disorders. The most commonly used and well‐known classification system for mental disorders in the United States (US) is the Diagnostic and Statistical Manual of Mental Disorders (DSM). The most recent version of the DSM, the DSM‐5, contains 22 classes of disorders. Within each class, specific diagnoses are listed and most of these diagnoses list a set of criteria and number of symptoms that must be met for an individual’s functioning to be considered abnormal and for a diagnosis to be given. The diagnoses in each class share similar features. For example, one class of disorders in the DSM‐5 is the anxiety disorders. These disorders “share features of excessive fear and anxiety and related behavioral disturbances” (APA, 2013, p. 189). Diagnoses within the anxiety disorder class differ from one another in the types of situations and objects that cause fear, anxiety, and avoidance behavior, and all the diagnoses within the anxiety disorder class differ from diagnoses in the other classes in important ways. According to the DSM‐5, the organization of symptoms into disorders and disorders into classes based on their shared features is “a historically determined cognitive schema imposed on clinical and scientific information to increase its comprehensibility and utility” (APA, 2013, p. 10). In other words, historical scientific research and clinical wisdom was utilized to organize and classify symptoms in a way that would allow for easier communication between mental health providers, patients, and other stakeholders.

      It is important to note that although individuals with the same diagnosis experience some of the same symptoms, they often present with very heterogeneous symptom profiles. Additionally, there is no one etiology underlying the symptoms of these disorders. Therefore, a psychological disorder diagnosis, as described in the DSM‐5, is only a list and description of symptoms that appear to occur together, resulting in a phenotype or set of observable characteristics. This phenotype is often associated with specific outcomes, suggesting that intervention on the phenotype is necessary. But why should we use a classification and diagnostic system, like the DSM‐5, if there are sometimes large differences between individuals with the same diagnosis or uncertainty regarding the cause of diagnoses? In short, it is because diagnoses are useful to us (Frances & Widiger, 2012). They help us do all the things already discussed in this chapter, such as communicate with other professionals and patients, conceptualize patient problems, and identify the most effective interventions possible.

      Psychopathology classification and diagnostic systems are, however, not infallible (Frances & Widiger, 2012) nor definitive. They are simply our best attempt to describe and organize the psychological, behavioral, and emotional phenomena that clinicians and researchers observe in their practices, laboratories, and in the real world. We will now review the history and content of two of the most well‐known and widely used psychological disorder classification and diagnostic systems – the DSM and the International Classification of Diseases (ICD).

      The publication of DSM‐III was significant because it aimed to bring psychiatry in line with the rest of medicine by ensuring that more information was provided in the text about the symptomology, demographics, etiology, and course of each disorder, basing this information on available empirical evidence.


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