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Many mental health disorders have similar symptoms and not all patients will show these symptoms which means that it can be tremendously difficult to classify and diagnose mental disorders. 
One of the most common disorders that will be discussed in this essay is the major depressive disorder (MDD). An individual most commonly is diagnosed with this when they’re experiencing intense feelings of sadness for a long period of time. 

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The Diagnostic and statistical manual (DSM) is a tool/book used by psychiatrists/therapists to help with diagnosing mental disorders. The DSM is American but there are other tools such the ICD (International Classification of Diseases). 

Classification of mental disorders involves taking sets of symptoms and putting them together into various categories. For example, low self-esteem, depressed mood, too much or too little sleep or having a hard time concentrating, lack of energy, lack of interest in hobbies, worthlessness, suicidal thoughts would all be symptoms that are commonly grouped together. These symptoms are then further categorised into a wider spectrum of disorders, in this case, major depressive disorder. 
Furthermore, diagnosis involves assessing a patients symptom and deciding if they meet the criteria for one or more mental disorders. Typically diagnosis consists of a certain number of symptoms present for a particular time. 

The DSM is updated very regularly. The first version was released in 1952, and since then there have been so many more disorders added to the DSM Manuel, as well as many taken away. The fourth version was updated in 1994, and clinicians are currently using DSM-5 which was published in 2000. 

The reason the DSM needs to be updated regularly is that the society is constantly changing over time, and thus it has to comply with the social norms. In addition to this, new information is always discovered about a vast variety of illnesses and thus this information needs to be included in the diagnosis and abnormalities. 

The DSM-5 is multi-axial, which means it considers a number of factors including health and social factors when making a diagnosis. There are five axes considered when diagnosing mental disorders; axis one, clinical syndromes (This is a diagnostic category with appropriate sub-classification. e.g., major depressive disorder). Axis two, personality disorders (personality and developmental disorders are listed here if present.). Axis three, general medical conditions (a list of any current physical disorders that may be relevant to understanding and treating the person).Axis four, psychosocial and environmental problems (documentation of proceeding stressful events). Finally axis five, global assessment of functioning scale (evaluation of how well the individual has functioned socially and occupationally prior to the onset of the illness. 
The first two axes are concerned with the diagnosis of mental disorders, whereas the third to fifth axes look at other factors which may affect the mental disorder and its treatment. 

The treatments for MDD are anti-depressant medication such (selective serotonin reuptake inhibitors, Trycyclic antidepressants, monoamine Oxidase) and psychotherapy. By increasing the amount of serotonin in a patient diagnosed with MDD, there is a better chance of making their mood more positive, and therefore taking away some of their negative symptoms that contribute to MDD.
The problems however with treatments are that it doesn’t work for everyone. Drug treatments may be more effective than therapy when reducing symptoms (Dimidjian et al. 2006.), however, patients cannot be forced to take them, even if they’re suicidal, as this would breach the ethics of consent and deception. The patient may not feel comfortable with taking medication, but would be forced to do so by the psychiatrist. 

Studies such as Rosenhan 1973 highlight the difficulties in providing an accurate diagnosis of mental health disorders. Diagnostic tools such as DSM-5 aim to make this process more scientific and accurate. However, its important that the appropriateness of diagnostic tools is regularly assessed, and the strengths and their limitations are known. 

Furthermore, the reliability of DSM is concerned with consistency if a diagnosis is consistent it is known to be reliable in nature. Test-retest reliability involves assessing the same patient several times. If the diagnosis is the same every time this means that the diagnosis is reliable. Similarly, inter-rater reliability of a diagnosis can be checked by getting different clinicians/psychiatrists to assess the same patient. 
Some studies have looked at the inter-rater reliability of DSM. Brown et al. (1996) found that there was a 67% agreement rate for major depression, which is classed as high reliability. However, Kendall (1975) looked at specific disorders and the reliability rate fell to 32% – 57%. In addition to this Zigler and Phillips (1961) found a 54% to 84% agreement rate when looking at broad categories for disorders, and the reliability has increased since then so depending on the disorder, the reliability is fair to good. 

Different aspects of validity have to be taken into account when evaluating the DSM-5 modal in relation to major depressive disorder. The first is the ecological validity, which is if patients are assessed in their natural environments by the clinician, often through naturalistic observations. The reason why assessing a patient in their natural environment is important, for example, their home, is because this will allow the clinicians to observe the patient closely and apply the DSM-5 criteria to diagnosing the patient correctly, rather than listening to everything the patient describes in a clinic, which isn’t the natural environment for the patient, thus they’re more likely to exaggerate their symptoms. 
The second type of validity that has to be taken into account is concurrent validity. This is a way of establishing validity that compares from other studies that have tested the same thing to see if they agree. This is important as clinicians use the DSM-5 manual to agree on treatments for individuals, so instead of blindly pursuing just what is set in the DSM-5, it would be beneficial to also research what various studies have found and agreed on to be a useful treatment. 
Lastly, predictive validity, which demonstrates the extent to which results from a test such as the DSM can predict future behaviour. 

A further issue that can affect the diagnosis of the major depressive disorder is culture. Culture is defined as “all ways of thinking, feeling, and acting that people learn from others as members of society.” 
Culture affects diagnosis because of issues such as expectations of a disorder will vary between all cultures, as well as they all have different social norms and culture-bound syndromes. 
Different cultures will portray different attitudes towards mental disorders, as causes of a particular disorder and expectations of diagnosis may be different across cultures. 

Cinnerella and Loewenthal (1999) compared cultural influences on mental disorders between different races and religions; they concluded that all groups thought depression was caused because of life events, all except white Catholics had a fear that psychiatrists would not understand them.Black Christians and Muslim Pakistani groups both felt that depression would have a social stigma, which is that depression is seen as something negative. 
This can say a lot about diagnosis of major depressive disorders, for example, it tells us that people may not want to seek help from their doctors as it may be hard to confess to major depression, consequently it makes it more difficult for the doctor to diagnose the patient correctly or efficiently as they may not accept the diagnosis. A further point to consider is that, many cultures consider visiting a psychiatrist/clinician a negative thing, so patients may be afraid of what the other members of the community or their families may say about them, for example, they may feel that they will be called crazy or mentally ill for visiting a psychiatrist, and getting diagnosed with major depression disorder.  

Overall DSM-5 provides the clinician with the criteria of the mental-illness however it does not elaborate on the treatments or alternative treatments that an individual may require. The manual does not take into account the external factors that may have contributed towards a disorder, such as the MDD. However, it only categorises individuals based on the symptoms inputted in the manual. 
There may be other symptoms that the patient portrays that do not necessarily comply with the diagnosis. Or alternatively, the patient may have certain traits to MDD however, this doesn’t necessarily mean they have MDD.
Finally, because most patients come in describing their own symptoms (which is a subjective approach), the reliability of this method is questionable. 
Although the strengths of having tools like the DSM are that, it is much easier for the psychiatrist to access the disorder in question and diagnose the patient rightfully. 
With disorders such the major depressive disorder, (which is a fairly new addition to the subcategories of depression), information from future patients and results will improve the reliability of treatments, as the DSM will be updated according to more experiences of patients with MDD.

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