MODULE 3: CLINICAL ASSESSMENT,

DIAGNOSIS, AND TREATMENT

Module Overview

Module 3 covers the issues of clinical assessment, diagnosis, and treatment. Clinical
assessment in this module is focused on the processes involved in it, clinical
diagnosis is discussed in terms of the two main classification systems used around
the world – the DSM-5 and ICD-10, while treatment is all about the therapies
commonly offered by the different perspectives in understanding mental disorders.

Module Outline

 3.1. Clinical Assessment of Abnormal Behavior

 3.2. Diagnosing and Classifying Abnormal Behavior
 3.3. Treatment of Mental Disorders – An Overview

Module Learning Outcomes

 Describe clinical assessment and its process.

 Clarify how mental health professionals diagnose mental disorders in a
standardized way.
 Discuss different treatments/therapies in treating mental disorders. 

3.1. Clinical Assessment of Abnormal Behavior

Section Learning Objectives

 Define clinical assessment.

 Clarify why clinical assessment is an ongoing process.

3.1.1. What is Clinical Assessment?

In order for a mental health professional to be able to effectively help treat a client
and know that the treatment selected actually worked (or is working), he/she first
must engage in the clinical assessment of the client, or collecting information and
drawing conclusions through the use of observation, psychological tests, neurological
tests, and interviews to determine what the person’s problem is and what symptoms
he/she is presenting with. This collection of information involves learning about the
client’s skills, abilities, personality characteristics, cognitive and emotional
functioning, social context in terms of environmental stressors that are faced, and
cultural factors particular to them such as the language that is spoken or ethnicity.
Clinical assessment is not just conducted in the beginning of the process of seeking
help but all throughout the process.

 First, the need to determine if a treatment is even needed. By having a clear

accounting of the person’s symptoms and how they affect daily functioning, to
what extent the individual is adversely affected can be determined.
 Second, to determine what treatment will work best. There are numerous
approaches to treatment which include Behavior Therapy, Cognitive and
Cognitive-Behavioral Therapy (CBT), Humanistic-Experiential Therapies,
Psychodynamic Therapies, Couples and Family Therapy, and biological
treatments (psychopharmacology).
 Finally, the need to know if the treatment employed worked. This will involve
measuring before any treatment is used and then measuring the behavior
while the treatment is in place. Further, measuring of the behavior after the
treatment ends is done to make sure symptoms of the disorder do not return.

3.2. Diagnosing and Classifying Abnormal Behavior

 Section Learning Objectives

 Explain what it means to make a clinical diagnosis.

 Clarify and exemplify what a classification system does.
 Outline the history of the DSM.
 Identify and explain the elements of a diagnosis.
 Outline the major disorder categories of the DSM-5.
 Describe the ICD-10.

 3.2.1. Clinical Diagnosis and Classification Systems

To begin any type of treatment, the client/patient must be clearly diagnosed with a
mental disorder. Clinical diagnosis is the process of using assessment data to
determine if the pattern of symptoms the person presents with is consistent with the
diagnostic criteria for a specific mental disorder set forth in an established
classification system such as the DSM-5 or ICD-10. Any diagnosis should have
clinical utility meaning it aids the mental health professional determine prognosis,
the treatment plan, and possible outcomes of treatment (APA, 2013). Receiving a
diagnosis does not necessarily mean the person requires treatment. This decision is
made based upon how severe the symptoms are, level of distress caused by the
symptoms, symptom salience such as expressing suicidal ideation, risks and benefits
of treatment, disability, and other factors (APA, 2013). Likewise, a patient may not
meet full criteria for a diagnosis but require treatment nonetheless.

Symptoms that cluster together on a regular basis are called a syndrome. If they
also follow the same, predictable course, they are characteristic of a specific
disorder.  Classification systems provide mental health professionals with an
agreed upon list of disorders falling in distinct categories for which there are clear
descriptions and criteria for making a diagnosis.
The most widely used classification system in the United States is the Diagnostic and
Statistical Manual of Mental Disorders currently in its 5th edition and produced by
the American Psychiatric Association (APA, 2013). Alternatively, the World Health
Organization (WHO) produces the International Statistical Classification of
Diseases and Related Health Problems (ICD) currently in its 10th edition with an
11th edition expected to be published.

 3.2.2. The DSM Classification System

        3.2.2.1. A brief history of the DSM. The DSM 5 was published in 2013 and
took the place of the DSM IV-TR (TR means Text Revision; published in 2000) but
the history of the DSM goes back to 1844 when the American Psychiatric Association
published a predecessor of the DSM which was a “statistical classification of
institutionalized mental patients” and “…was designed to improve communication
about the types of patients cared for in these hospitals” (APA, 2013, p. 6). The DSM
evolved through four major editions after World War II into a diagnostic
classification system to be used psychiatrists and physicians, but also other mental
health professionals. After the naming of a DSM-5 Task Force Chair and Vice-Chair
in 2006, task force members were selected and approved by 2007 and work group
members were approved in 2008. What resulted from this was an intensive process
of “conducting literature reviews and secondary analyses, publishing research
reports in scientific journals, developing draft diagnostic criteria, posting preliminary
drafts on the DSM-5 Web site for public comment, presenting preliminary findings at
professional meetings, performing field trials, and revisiting criteria and text”(APA,
2013).

   3.2.2.2. Elements of a diagnosis. The DSM 5 states that the following make up

the key elements of a diagnosis (APA, 2013):

 Diagnostic Criteria and Descriptors – Diagnostic criteria are the guidelines for
making a diagnosis. When the full criteria are met, mental health professionals
can add severity and course specifiers to indicate the patient’s current
presentation. If the full criteria are not met, designators such as “other specified”
or “unspecified” can be used. If applicable, an indication of severity (mild,
moderate, severe, or extreme), descriptive features, and course (type of
remission – partial or full – or recurrent) can be provided with the diagnosis.
The final diagnosis is based on the clinical interview, text descriptions, criteria,
and clinical judgment.
 Subtypes and Specifiers – Subtypes denote “mutually exclusive and jointly
exhaustive phenomenological subgroupings within a diagnosis” (APA, 2013). For
example, non-rapid eye movement sleep arousal disorders can have either a
sleep walking or sleep terror type. Enuresis is nocturnal only, diurnal only, or
both. Specifiers are not mutually exclusive or jointly exhaustive and so more
than one specifier can be given. For instance, binge eating disorder has
remission and severity specifiers. Somatic symptom disorder has a specifier for
severity, if with predominant pain, and/or if persistent. Again the fundamental
distinction between subtypes and specifiers is that there can be only one subtype
but multiple specifiers.
 Principle Diagnosis – A principal diagnosis is used when more than one
diagnosis is given for an individual. It is the reason for the admission in an
 inpatient setting, or the reason for a visit resulting in ambulatory care medical
services in outpatient settings. The principal diagnosis is generally the main
focus of treatment.
 Provisional Diagnosis – If not enough information is available for a mental
health professional to make a definitive diagnosis, but there is a strong
presumption that the full criteria will be met with additional information or
time, then the provisional specifier can be used.

         3.2.2.3. DSM-5 disorder categories. The DSM-5 includes the following

categories of disorders:

Table 3.1. DSM-5 Classification System of Mental Disorders

Disorder Category Short Description

A group of conditions that arise in the developmental

Neurodevelopmenta period and include intellectual disability,
l disorders communication disorders, autism spectrum disorder,
motor disorders, and ADHD

Disorders characterized by one or more of the

Schizophrenia following: delusions, hallucinations, disorganized
Spectrum thinking and speech, disorganized motor behavior, and
negative symptoms

Characterized by mania or hypomania  and possibly

Bipolar and Related depressed mood; includes Bipolar I and II, cyclothymic
disorder

Characterized by sad, empty, or irritable mood, as well

as somatic and cognitive changes that affect
Depressive
functioning; includes major depressive and persistent
depressive disorders

Characterized by excessive fear and anxiety and related

Anxiety behavioral disturbances; Includes phobias, separation
anxiety, panic attack, generalized anxiety disorder

Characterized by obsessions and compulsions and

Obsessive-
includes OCD, hoarding, and body dysmorphic
Compulsive
disorders

Trauma- and Characterized by exposure to a traumatic or stressful

Stressor- Related event; PTSD, acute stress disorder, and adjustment
 disorders

Characterized by a disruption or disturbance in

memory, identity, emotion, perception, or behavior;
Dissociative
dissociative identity disorder, dissociative amnesia, and
depersonalization/derealization disorder

Characterized by prominent somatic symptoms to

Somatic Symptom include illness anxiety disorder somatic symptom
disorder, and conversion disorder

Characterized by a persistent disturbance of eating or

Feeding and Eating
eating-related behavior to include bingeing and purging

Characterized by the inappropriate elimination of urine

Elimination or feces; usually first diagnosed in childhood or
adolescence

Characterized by sleep-wake complaints about the

Sleep-Wake quality, timing, and amount of sleep; includes insomnia,
sleep terrors, narcolepsy, and sleep apnea

Characterized by sexual difficulties and include

Sexual Dysfunctions premature ejaculation, female orgasmic disorder, and
erectile disorder

Characterized by distress associated with the

Gender Dysphoria incongruity between one’s experienced or expressed
gender and the gender assigned at birth

Characterized by problems in self-control of emotions

and behavior and involve the violation of the rights of
Disruptive, Impulse-
others and cause the individual to be in violation of
Control, Conduct
societal norms; Includes oppositional defiant disorder,
antisocial personality disorder, kleptomania, etc.

Substance-Related Characterized by the continued use of a substance

and Addictive despite significant problems related to its use
 Characterized by a decline in cognitive functioning
Neurocognitive over time and the NCD has not been present since birth
or early in life

Characterized by a pattern of stable traits which are

Personality inflexible, pervasive, and leads to distress or
impairment

Characterized by recurrent and intense sexual fantasies

Paraphilic that can cause harm to the individual or others; includes
exhibitionism, voyeurism, and sexual sadism

3.2.3. The ICD-10

In 1893, the International Statistical Institute adopted the International List of

Causes of Death which was the first international classification edition. The World
Health Organization was entrusted with the development of the ICD in 1948 and
published the 6th version (ICD-6). The ICD-10 was endorsed in May 1990 by the
43rd World Health Assembly. The WHO states:

ICD is the foundation for the identification of health trends and statistics globally,
and the international standard for reporting diseases and health conditions. It is the
diagnostic classification standard for all clinical and research purposes. ICD defines
the universe of diseases, disorders, injuries and other related health conditions,
listed in a comprehensive, hierarchical fashion.

The ICD lists may types of diseases and disorders to include Chapter V: Mental and
Behavioral Disorders. The list of mental disorders is broken down as follows:

 Organic, including symptomatic, mental disorders

 Mental and behavioral disorders due to psychoactive substance use
 Schizophrenia, schizotypal and delusional disorders
 Mood (affective) disorders
 Neurotic, stress-related and somatoform disorders
 Behavioral syndromes associated with physiological disturbances and physical
factors
 Disorders of adult personality and behavior
 Mental retardation
 Disorders of psychological development
 Behavioral and emotional disorders with onset usually occurring in childhood
and adolescence
 Unspecified mental disorder