Critically analyse and evaluate the statement: Psychiatric diagnostic classification should
be ignored.
Follow instructions from attached files
Critical Review
For several years, clinicians have successfully utilized the psychiatric diagnostic
classification as presented in the Diagnostic and Statistical Manual of Mental Disorder (DSM)
(2013), to diagnose various mental problems. However, following a comprehensive analysis of
psychiatric diagnostic classification, it has been discovered that some diagnostic categories do
not show discrete categories of mental disorders, a factor that makes its validity and reliability
questionable (Jablensky, 2016). This paper argues that psychiatric diagnostic classification
should be ignored because it fails to consider all factors necessary for the successful diagnosis of
mental disorders. This paper first discusses the manner in which psychiatric diagnostic
classification integrates a patient’s mental state into the diagnosis process. It then explores
overreliance of the psychiatric diagnostic classification on medical categorization while
disregarding the role played by environmental factors in influencing mental problems. Finally,
this paper discusses the issue of symptoms overlap and the manner in which it affects the
successful diagnosis of mental problems using the psychiatric diagnostic classification criteria.
Clinicians should ignore psychiatric diagnostic classification due to the limited accuracy
inherent in the information provided either by patients themselves or by their caretakers. Ideally,
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the psychological state of the patient may undermine the truthfulness of information given to the
clinician at any given time in the course of diagnosis (Aboraya, Rankin, France, El-Missiry, and
John, 2016). For instance, due to affected memory and severity of the disease, some patients may
not be in a position to give reliable and useful information to their healthcare providers.
Additionally, patients who may want to avoid treatment, as well as those suffering from
personality disorders, may manipulate the information to match their interests. Since the clinician
may not be in a position to prove the accuracy of data provided by patients, they are highly likely
to make the irrational judgment that may affect the soundness of diagnosis process (Cwik, Papen,
Lemke, and Margraf, 2016).
Conversely, Regier, Kuhl, and Kupfer, (2013), argue that the DSM-V normally allows
the clinician to resort to other sources of information in case their patients are either unwilling or
incapable of providing reliable data. For example, children with severe mental problems such as
dementia may not be in a position to describe their health to the clinician. For this reason, their
healthcare providers have been given the authority to use proxy information as their source of
data (Gehlawat, Gehlawat, Singh, and Gupta, 2015). Although using third parties, as sources of
information during psychiatric diagnosis may be helpful, this approach often encourages the use
of either distorted or incomplete information, a factor that tends to undermine successful
diagnosis. It can, therefore, be concluded that psychiatric diagnostic classification should be
flouted because it does not put the psychological status of patients into consideration, thereby
encouraging the use of either distorted or manipulated data by clinicians (Kurokami, Tachibana,
Kogure, and Okuyama, 2016; & Aboraya et al., 2016).
Furthermore, clinicians should avoid using psychiatric diagnostic classification to
evaluate psychological problems because it is specifically focused on medical classification
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while ignoring the important role that environmental factors play in influencing those disorders.
According to Gambrill, (2014), the DSM has categorized all psychological disorders as medical
problems by labeling all of them as brain-related diseases. Furthermore, the DSM has failed to
consider the fact that mental problems may also occur as a result of factors that people encounter
in their social settings such as social distress and economic factors (Baer, Kim, and Wilkenfeld,
2012). As Baer, Kim, and Wilkenfeld, (2012) explain, human suffering, such as those that occur
due to poverty, has a significant role to play in controlling problem behaviors which may be
mistaken to occur as a result of brain disease. The high degree of medical classification that is
portrayed by DSM makes psychiatric diagnostic classification unethical because it undermines
human dignity (Stinchfield et al. 2015; Gambrill, 2014: Timini, 2012).
On the contrary, Jablensky (2016) argues that medical classification of psychological
disorders in the DSM is very appropriate because it helps the healthcare provider to approach the
patient’s problem from the clinical point of view. The main rationale for this argument is that
people with psychological problems are believed to be experiencing some form of illnesses, and
the best way to which their proper diagnosis and treatment of their health problems can be
achieved is through medical categorization. Furthermore, the main purpose of medical
classification in DSM is to promote quick understanding of the patients’ presenting symptoms
(Jablensky, 2016). However, in as much as medical classification in DSM and the entire
psychiatric diagnosis process help to simplify work for the clinician, it prevents the accurate
diagnosis of patients’ conditions because it solely focuses on clinical aspects while ignoring the
influence of other environmental factors (Gambrill, 2014).
Moreover, today’s clinicians should consider snubbing diagnostic classification of
psychiatric disorders because of the high degree of symptoms overlap among various disorders,
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which increases the likelihood of the wrong diagnosis. According to Aboraya et al., (2016) and
Rieger (2014), during diagnosis of psychiatric disorders using DSM, clinicians always aim at
identifying patient symptoms that match the specific criteria documented in the manual. For
example, for the presence of severe depression to be confirmed, a patient must have experienced
depressed mood for a continuous period of two weeks, in addition to at least four of other
symptoms namely; a feeling of guilt, suicide ideation, fatigue, weight loss, hypersomnia, or
limited concentration (Rieger, 2014; & American Psychiatric Association, 2013). Other
psychiatric disorders may have similar symptoms as those of severe depression. Besides, such
symptoms may occur as a result of physiological changes, but not necessarily due to a
psychiatric problem (Ghaemi, 2014).
On the other hand, Jablensky (2016), however, claims that there is always clear boundary
between and among psychiatric disorders and that there is no possibility of symptom overlap.
For this reason, the criteria that have been documented in the DSM and the International
Statistical Classification of Diseases and Related Health Problems (ICD), are discrete entities
(Regier, Kuhl, and Kupfer, 2013). However, sufficient evidence exists to support a possibility of
symptoms overlap between psychiatric disorders such as bipolar disorder and schizophrenia, as
well as between autism spectrum disorder and schizophrenia (Jablensky, 2016). This means
therefore that exclusive reliance on psychiatric diagnostic classification during patient evaluation
may influence the clinician to make the judgment that may lead to wrong diagnosis (Cwik et al.,
2016; & Seto et al., 2016).
In conclusion, clinicians should avoid relying on psychiatric diagnostic classification to
evaluate mental disorders because it omits important factors, which are crucial for fruitful and
accurate diagnosis. Various authors have contradicting views about the validity and reliability of
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psychiatric diagnostic classification. In this paper, various literatures that support the need to
ignore the DSM, as well as those that has contrary opinions have been evaluated. Ideally,
psychiatric diagnostic classification should be ignored because it fails to consider patients’
psychological status, classifies all psychiatric disorders as medical problems, and utilizes
symptoms that lack discrete entities, thereby increasing the likelihood of the wrong diagnosis.
References
Aboraya, A., Rankin, E., France, C., El-Missiry, A. & John, C. (2016). The reliability of
psychiatric diagnosis revisited. Psychiatry, 3(1): 41-50.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders, 5 th ed (DSM-5). Arlington, VA: American Psychiatric Publishing.
Baer, J. C., Kim, M., & Wilkenfeld, B. (2012). Is it generalized anxiety or poverty? An
examination of poor mothers and their children. Child and Adolescent Social Work
Journal, 29, 345–355.
Cwik, J., Papen, F., Lemke, J. & Margraf, J. (2016). An investigation of diagnostic accuracy and
confidence associated with a diagnostic checklist as well as gender biases about mental
disorders. Frontiers in Psychology, 7: 1813.
Jablensky, A. (2016). Psychiatric classifications: Validity and utility. World Psychiatry, 15(1):