Although At First Sight The DSM-IV Classification System Appears To Pr

Although at first sight the DSM-IV classification system appears to provide clinicians with a useful framework of which to view their clients, on closer inspection however, the picture is somewhat less satisfactory. Criticisms of the system range from Wakefield's (1997) analysis that psychological presentation ranges from problems of living to harmful dysfunction; through to Livesley, Schroeder & Jang's (1994) counter-argument that evidence of discontinuity between different diagnoses and normality would support the DSM's proposal of distinct diagnostic categories. Since these issues involved are quite distinct, both these points of view are presented in relation to a cause and consequence debate. Finally, conclusions are reflected in terms of the classification of the impulse control disorders not else where specified (DSM-IV, 1996). Particularly, discussion is given to the sub category of Kleptomania. Criticisms of DSM -IV classification: The four major criticisms of DSM -IV classification system are (1) that categories lack independence, (2) the principles underlying them are diverse, (3) they are too heterogeneous and (4) the reliability (consistency) and conceptual validity (correctness) (Wakefield, 1997) of diagnosis is too low to be of any value. This leads to Wakefield's (1997) argument that the diagnostic criteria of the DSM encompasses too many conditions that do not adequately reflect a true indication of one psychological disorder. Wakefield (1997) further argues that a pattern labelled 'harmful dysfunction' results in confusion between boundaries along the continuum of disorder and non-disorder. Harmful dysfunction results from a lack of consistency, clarification or identification of quite simply, what should be diagnosed where. The harm in this case can result in negative evaluation of an undesirable outcome that is placed within a specific diagnostic category. According to the harmful dysfunction analysi s, a disorder only exists where there is a clear and identifiable internal mechanism resulting in harm to the individual. However it becomes apparent that when using the DSM as a major diagnostic criteria in assessment, that many clinicians in relying heavily upon criteria, over estimate the role of dysfunction in their clients, therefore misinterpreting consequences and causes. In relating this to classification of specific distress, Wakefield's (1997) analysis of harmful dysfunction, implies that the DSM is formulated within a medical model that suggests that psychological causation is involved in all DSM-IV and preceding classification systems. In so much, common argument that all mental disorders must be brain diseases is due to the fact that all mental states are regarded as brain states in classification (Wakefield, 1997). A consequence is found through the harmful dysfunction analysis that the application of medical approaches to both physical and mental disorder, contrary to common suggestion (E.g.: the mind body dualism) are not necessarily true for all instances of behaviour (Wakefield, 1997). Therefore, one must sharply distinguish between the medical concept of a disorder from the representation of behavioural consequence. According to Wakefield (1997) when a condition involves no significant harm to the individual's overall well being or the wel l being of others, there is no disorder, even if this obvious dysfunction is a naturally selected mechanism. This notion is further discussed in relation to the overconclusivness of kleptomania in classification. In exploring this debate as relating to the impulse control disorders not elsewhere specified (ICD) - kleptomania, one can see the overlap of boundaries or in diagnostic terms, classification of what acts of impulsivity are either a cause or consequence of mental illness. Specifically, many authors (Dust, 1997; Bradford Keck, 1997; McElroy, 1992) have explored the commonality between what is described as an impulse control disorder and what results in impulsivity as a consequence of another diagnostic category. Such linkages include OCD, depression and anxiety. Table 1 summarises the overlap between kleptomania and other diagnostic criteria according the literature exploring the overconclusivness of the DSM classification system. These results indicate percentages of clients who present with Kleptomania yet held differential diagnosis in both in and out patient settings. Table 1: Depression 13% (Dust, 1997 Mood Disorders 50% (Bradford & Balmaceda, (1983), 1997) Bulimia 14.79% (Bradford & Balmaceda, (1983), 1997) Dependence Disorders 4.7% (Leyjoyeux, 1997) Mania 56% (Keck, 1997) OCD 62% (McElroy, 1992) Anxiety 23% (McElroy, 1992) Kleptomania: Debate over impulsion leading to compulsion has led to the notion according to many authors such as McElroy, Hudson, Harrison, Kreck and Aizley (1992) that impulsion is