Defining clinical psychology

Clinical psychology is a branch of psychology that applies scientific theories and methods to understand, prevent, and treat psychological distress or dysfunction. This field focuses on promoting mental wellbeing and personal development for individuals experiencing mental health challenges.

Clinical psychologists work to reduce distress and enhance the psychological wellbeing of their clients. They achieve this by using psychological methods, research, and various forms of treatment to bring about positive changes in clients' lives. Although clinical psychologists may hold different views on the causes of abnormal behaviour, their shared goal is to address these issues effectively.

Diagnosis of mental disorders using the four 'Ds'

Psychologists often use a framework known as the four 'Ds' to guide the diagnosis of mental disorders.

The four 'Ds' in diagnosis

• Deviance - This refers to behaviour that significantly deviates from social norms, which are the expected ways people act in a given society. For example, actions like chronic lying or stealing are seen as deviant because they go against societal expectations. Context is crucial here; behaviour that seems normal in one setting might appear abnormal in another.
• Distress - This involves behaviours or feelings that cause significant emotional pain to the individual or those around them. The key focus is on the person's subjective experience of distress, rather than how it appears to outsiders. Distress is linked to dysfunction but can occur independently; someone might feel intense anxiety without it fully disrupting their daily life.
• Dysfunction - This criterion looks at how behaviour impairs a person's ability to function in daily life or integrate into society. For instance, extreme fear of crowds might prevent someone from using public transport to get to work, affecting their employment and social interactions.
• Danger - This indicates behaviours that pose a risk to the individual's own safety or that of others, often due to carelessness, poor judgement, hostility, or misinterpretations of situations. Dangerous patterns can signal severe psychological problems and require immediate attention.

Key classification systems for mental disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM)

The DSM is a handbook primarily used by healthcare professionals to diagnose mental disorders. It has evolved through several versions to reflect new research and clinical insights.

Key versions and features of DSM:

• DSM-IV and DSM-IV-TR - Released in 1994 and updated in 2000, these versions used a multiaxial system. This approach required clinicians to evaluate patients across five different axes (or scales) for a complete assessment.
• DSM-5 - Introduced in 2013, this current version eliminated the multiaxial system and is organised into three main sections for simpler use.

Structure of DSM-5:

• Section I - Provides an overview of changes from previous versions, explains the organisation of the manual, and offers instructions on how to use it effectively.
• Section II - Lists the main mental disorders with diagnostic criteria and codes. This includes conditions such as schizophrenia, obsessive-compulsive disorder (OCD), anorexia nervosa, and depression.
• Section III - Serves as a developmental area for emerging measures and potential new diagnoses that require further research before full inclusion in Section II. Examples include caffeine-use disorder and internet-gaming disorder, which need more clinical evidence to confirm their validity. This section provides useful information for current practice and is expected to influence future updates.

The International Classification of Diseases (ICD-10)

The ICD-10 is a broader classification system that covers all diseases and health-related conditions, not just mental disorders.

Key features of ICD-10:

• Each disorder includes a description of its main features and any important associated features.
• Disorders are assigned codes starting with a letter (e.g., 'F' for mental and behavioural disorders), followed by numbers for further subclassification. For example, F20 represents schizophrenia, F20.0 is paranoid schizophrenia, and F20.00 specifies paranoid schizophrenia, continuous course.

Categories in ICD-10 mental disorders: