How are mental health conditions classified?

Mental heath conditions are the least understood of all medical conditions. They are also subject to the most stigma and judgment. The vast majority of people have no idea what the differences are between diagnoses, severity, causes, treatments and how they are classified. I cannot begin to address all of these things in one post. I’m going to break down the categories of mental health diagnoses and explain a bit about their severity and how they are classified. My knowledge is not based solely on personal experience. I have a BA in psychology and spent 15 years working in licensed mental health facilities under the direction of therapists and psychiatrists.

I’m going to refer back to the DSM IV (Diagnostic and Statistical Manual IV) utilizing the 5 Axis of Diagnosis to help explain how mental health conditions are classified. In 2013 the DSM V was published and became the standard of use circa 2015. There are some changes between the two versions, but for the purposes of this post DSM IV is sufficient.

The 5 Axis Diagnosis gives a clinician information about overall health conditions which may impact psycho-social functioning, environmental factors/stressors, existing mental health diagnosis and a global assessment of functioning (GAF) number. I will leave out Axis IV and V as they are not directly related to how mental health conditions are classified.

Axis I- Clinical disorders, including anxiety disorders, mood disorders, schizophrenia and other psychotic disorders.

Axis II- Personality disorders and mental retardation (clinical term). Personality disorders are maladaptive coping skills which have become ingrained into the core personality of the person throughout their developmental years. They can be treated, but are a permanent part of the individual. Mental retardation is the clinical term for a person who does not develop intellectually and/or emotionally at the rate of a healthy person. There is also a point at which development stops creating a functional deficit. ADD/ADHD, traumatic brain injuries (TBI), learning disorders and autism spectrum disorders fall under this umbrella. A diagnosis must be made prior to age 18 to be included on axis II aside from TBI and personality disorders.

Axis III- Eating disorders and other health conditions

The mental health conditions most commonly talked about are depression, anxiety, PTSD, bipolar disorder and schizophrenia. There are a number of others and classifications within those listed, but I’m going to keep it fairly simple.

First off, there is a substantial difference between having a single episode of clinical depression or anxiety and having an anxiety disorder or major depressive disorder. The severity of the episode is not indicative of the difference, but a pattern of repeated episodes. Life stressors like a death in the family, job loss, a traumatic event such as a serious car accident can create a single episode of clinical depression or serious anxiety. The vast majority of people experience an episode of clinical depression or anxiety and do not have another in their lifetime after successful treatment.

The difference between being down in the dumps and clinically depressed is how long it lasts, changes in thinking and behavior coupled with whether or not changes in activity and time end the episode. Once a person goes into a clinical depression it is no longer a choice of being positive, pulling themselves up by the bootstraps or getting over it. In order to move through it professional help is required. Medication is typical but not the only treatment.

Conditions such as schizophrenia, psychotic disorder, schizoaffective disorder and bipolar disorder fall into a classification of being “Severe and Persistent”. All of these conditions are brain disorders meaning they are caused by chemical imbalances in the brain. Neurons are not firing correctly creating imbalances in neurotransmitters. They are medical conditions which require medication to stabilize just as type 1 diabetes. Lifestyle changes can help with maintaining stability, however medication is a required component. They are deemed severe and persistent because they will no go away. They are managed through medication and lifestyle, but relapse will occur despite medication compliance and have a major impact on the persons overall life in several areas. As with any chronic medical condition there are ups and downs no matter how diligent the person is with managing the condition.

Major depressive disorder and anxiety disorders are typically well managed with medication and behavioral therapies. This is not always the case, but by and large most people with these conditions can and do live pretty functional lives with periods of increased difficulty. PTSD is a very severe anxiety disorder and is way too complex to begin to address here.

I’m going to lightly touch on personality disorders because they are a class all their own. Generally speaking, personality disorders start in childhood as coping mechanisms to deal with very difficult, unhealthy situations. They served the person in surviving very bad circumstances. Having dysfunctional coping skills does mean you have a personality disorder. A personality disorder is when the ways of thinking, viewing the world and coping with the world become ingrained elements of the core personality. Just as being an introvert or extrovert are fundamental parts of your personality, so is a personality disorder. Medication will not change a personality disorder. Anti-depressants and anxiolitics are sometimes needed to help deal with the emotional fall out from disordered thinking and behaviors. Personality disorders often co-exist with other mental health conditions which do require medication. The personality disorder isn’t medicated or changed with the medications, though the other condition likely will be. With long term therapy directed towards the specific areas of difficulty one can learn to better manage the symptoms of a personality disorder. As with any mental health condition a personality disorder is not a choice.

I will be going into more detail about the persistent and severe conditions in the near future.

I’m open to questions and comments. If you’re a therapist, psychiatrist or currently working in the field and have information which trumps mine… PLEASE fill me in!

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