Clinical Psychology

1980. These changes included the use of explicit
      diagnostic criteria for mental disorders, a multiaxial
      system of diagnosis, a descriptive approach to diag-
      nosis that attempted to be neutral with regard to

theories of etiology, and a greater emphasis on the

clinical utility of the diagnostic system. Because these

innovations have been retained in subsequent edi-

tions of theDSM(DSM-III-R, DSM-IV, DSM-IV-

TR), they will be described in the following section.

DSM-IV-TR

The text revision of the fourth edition of the

Diagnostic and Statistical Manual of Mental Disorders

(DSM-IV-TR) was published in 2000. Revisions

to the previous diagnostic manual (DSM-III-R)

were guided by a three-stage empirical process.

First, 150 comprehensive reviews of the literature

on important diagnostic issues were conducted.

These literature reviews were both systematic and

thorough. Results from these reviews led to recom-

mendations for revisions and served to document

the rationale and empirical support for the changes

made inDSM-IV. Second, 40 major reanalyses of

existing data sets were completed in cases where the

literature reviews could not adequately resolve the

targeted diagnostic issue. Third, 12DSM-IVfield

trials were conducted to assess the clinical utility

and predictive power of alternative criteria sets for

selected disorders (e.g., antisocial personality disor-

der). In summary, the changes made inDSM-IV

(and maintained inDSM-IV-TR) were based on

empirical data to a much greater extent than was

true in previous editions of theDSM. A condensed

version of theDSM-IV-TRappears in Table 5-2.

A completeDSM-IV-TRdiagnostic evaluation

is amultiaxial assessment. The multiaxial assessment

also is used in theDC 0–3R. Clients or patients are

evaluated along five axes, or domains of informa-

tion. Each of these axes/domains should aid in

treatment planning and prediction of outcome.

Axis Iis used to indicate the presence of any of

the clinical disorders or other relevant conditions,

with the exception of the personality disorders

and mental retardation. These two classes of diag-

noses are coded on Axis II.Axis IIIis used to

highlight any current medical condition that may

be relevant to the conceptualization or treatment

of an individual’s Axis I or Axis II clinical disorder.

T A B L E 5-1 Classifications of Mental
Disorders in Use by the Royal
Medico-Psychological
Association in the Late 1940s

PART I
A. Oligophrenia (amentia, mental deficiency)

1. Idiocy


2. Imbecility


3. Feeblemindedness (moron)


4. Moral deficiency
   B. Neuroses and psychoneuroses


5. Exhaustion states (including neurasthenia)


6. Anxiety states


7. Compulsions, obsessions, and phobias


8. Hysteria


9. Mixed and other forms
   C. Schizophrenic psychoses


10. Dementia praecox
    a. Simple
    b. Hebephrenic
    c. Katatonic
    d. Paranoid


11. Paraphrenia


12. Other forms
    D. Psychopathic constitution (including paranoia)
    E. Affective psychoses:


13. Manic-depressive psychosis (cyclothymia)
    a. Elation
    b. Depression
    c. Stupor


14. Involutional melancholia
    F. Confusional states
    G. Epileptic psychoses
    H. General paralysis
    I. Other psychoses associated with organic brain disease
    J. Dementia
    K. Indeterminate types

SOURCE: Adapted from Henderson and Gillespie (1950, pp. 20–21).

144 CHAPTER 5