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(Cкачать работу)exploring the relationships between psychological disorders and ICD depressive dispositions noted that depressive neurosis was a primary factor in 42 % of all patients presenting to an outpatient treatment clinic. This led to Fishbain (1987) exerting that perhaps within ICD, the primary diagnostic criteria of ‘impulsion’ is not a direct psychological construct, but rather a facilitator or consequence of a much larger psychological continuum. The continuum described places kleptomania as part of the psychosocial reaction model. In this model, kleptomania and the ICD’s in general are again placed in the spectrum of disorders that are representative of a continuum approach to viewing mental illness.
In applying findings to Wakefield’s (1992) original analysis of the overconclusivness of the DSM and the cause and consequence debate, distinction is not always evident in classification. Goldman (1997), argues that kleptomania within the adolescent population is indicative not of dysfunction, but rather is a response to a troublesome childhood. Therefore, kleptomania becomes a response to an affective environment in the teen, and is a demonstrative way of exhibiting dissatisfaction with lifestyle (Goldman, 1997). Harm then, is not a direct indictor of pathology but rather kleptomania is a consequence of the broader psychosocial spectrum. Moreover, Sarasalo (1996) further adds to this argument by expanding through a psychosocial model of viewing kleptomania. Sarasalo (1996) maintains that although the diagnostic criteria for kleptomania is defined according the DSM as: “recurrent failure to resist impulses to steal items even though the items are not needed for personal use or monetary value (DSM-IV, 1997); low socialisation of the individual can be a reinforcement of over stepping social boundaries. This indeed is plausible when one considers the commodity of kleptomania that includes depression and anxiety, as well as prognosis that begins in early childhood and adolescents. If this is the case, etiology of kleptomania becomes a social rather than psychological dysfunction. As the ICD -10 indicates that kleptomania is a response to a maladaptive environment, classification should therefore focus not what is the psychological underpinnings of kleptomania, but rather what is socially constructing it.
In summary, reports of discussed authors in relation to the criticism of the DSM classification system argue that:
Diagnostic criteria is too broad, therefore comorbidity is high
Comorbidity and differential diagnosis indicates that when treating kleptomania it should be regarded as a secondary symptom of a major psychological or psychosocial dysfunction.
Conclusions:
Contrary to the overconclusivness argument, Livesley et al., (1994) argue that in any classification system there must be some overlap or common thread running through sub-groups of a particular category. Therefore Livesley’s et al., (1994) counter-argument that evidence of discontinuity between different diagnoses and normality would support the DSM’s proposal of distinct diagnostic categories. According to these authors, there may of course, be a wide range of attribute’s within a category, but for the DSM to exist, it is essential that each of the classification subtype’s must be clearly defined and applied only to that specific disorder. Livesley et al., (1994) therefore reject the notion of a spectrum disorder and the overconclusiveness of the DSM. Further support for the exactitude of the current DSM classification system is ascertained in a study by Wittenborn (1981), describing individuals who shared a common diagnosis from one diagnostic category to another. It was found that clients differed greatly from each other in terms of symptom patterns that according to diagnosis had placed then in the same Impulse control disorder category. More simply what Wittenborn (1981) proposes is that overconclusivness is not a result of fault in DSM classification, but rather it is an inevitable process, as many persons share common complaints but their precise symptomolgy that places them within a distinct category is what separates them.
These authors contrary to many perspectives previously presented, argue that the presumed fundamental distinctions between one diagnostic criteria to another, in general has proven elusive for those committed to the current classification system. However, justification for overconclusivness is that most people experience all of the symptoms associated with each disorder in the DSM over some period of time. The difference between the subcategories however, despite the levels of overlap in symptomology, is seen to lie in the degree of persistence of the symptoms which in one subcategory (Wittenborn1981). It is therefore clinical judgement and appropriate use of any classification system that is used to determine the degree of severity, not what or how many categories can be placed upon the one individual. Perhaps this leads one to conclude that although overconclusivness is apparent in many diagnoses, it may be a question of who is over-conclusive, the DSM or user.
In summary however, in terms of the overconclusiveness of DSM criteria for kleptomania, as described by Wakefield (1992), it can be argued that the diagnostic criteria is too broad, reflected through high levels comorbididity with other disorders described. Hence comorbididity and differential diagnosis may include kleptomania and a secondary rather than primary condition. Moreover, the elusiveness of clients who fit neatly into one or another diagnostic category is perhaps most clearly illustrated in previously discussed overlapping subcategories. Thus clients that are described as having, for example Kleptomania with depressive tendencies may alternatively be Depressive with Kleptomaniac tendencies, but such a construct is not described in the DSM-IV