Mental Health and Ageing

This paper analyzes age-related mental disorders and the differences in diagnosis using DSM-IV-TR and DSM-5. It discusses the importance of psychopathological studies and the need to understand the causes of mental disorders in the elderly. The paper also explores the diagnostic processes and the structural differences between DSM-IV-TR and DSM-5.

Running head: MENTAL HEALTH AND AGEING 1
Medical: Mental Health and Ageing
Student’s Name
Institutional Affiliation

MENTAL HEALTH AND AGEING 2
Introduction
Every human being needs to live a complete life. The completeness of human life
entails the pleasures and comforts arising from the lack of diseases, enough food, and
resources, peaceful coexistence with neighbors, mental and emotional stability among other
factors. However, to attain complete life requirements, there is a need to undertake the
psychopathological studies on a person’s health. The definition of Psychopathology is the
study of a person’s mental illnesses and the required classifications that would help come up
with the preferable methods to prevent and control the disorders and their effects (Steptoe,
Deaton & Stone, 2015). Under psychopathology, there are many other issues which need to
be addressed. The items include but not limited to making an effort to understand the
psychological, genetic, biological and social causes of mental disorders. It is based on the
issues presented that the performance on psychopathology would be regarded as successful.
The elderly in society may be vulnerable to several mental illnesses that may adversely affect
the quality of their lives (Arokiasamy et al. 2015). Therefore, it is equally essential for
physicians to diagnose and ascertain the causes of their ill-health and prescribe the most
appropriate treatment measures. With the increased need to collect statistical data of mental
disorders, there was the development of Diagnostic and Statistical Manual (DSM) for the
mental disorders.
The motive of this paper analyzes and give an understanding of the age-related mental
disorders and the possible differences that occur in the diagnosis of mental disorders via the
application of DSM-IV-TR and DSM-5. A proper and detailed analysis of both the
ideological and structural differences between the two methods of diagnosis are included.
Life in the old age is mostly regarded as late life, and it’s faced with several issues.
Several diagnostic processes are performed to ensure that the victims are exposed to standard

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developments of their late lives. The achievement of the healthy development of late-life
requires that high-level attention should be taken to address both the stability and changes in
the biological, cognitive, emotional and social aspects of life. The elements of late-life
discussed can be expanded to entail changes in the Central Nervous System, the abilities to
remember and reason sensibly as examples of biological and cognitive aspects respectively.
The emotional and social aspects also contain bereavement, retirement and family issues
among other cases. Based on the various methods of diagnosis that have been performed,
there is a realization that there are several mental disorders that significantly contribute to the
reduction of a person’s lifespan especially when they reach the late life. The diseases are
categorized into anxiety, substance use, mood, schizophrenia, personality, suicide, dementia,
and sleep disorders.
Diagnosis of Mental Disorders
Acquiring relevant information based on the conditions of the elderly is not very easy.
The reason is that such people are faced with a lot of old-age related problems, therefore,
getting to understand the real root of their problems has been deemed difficult. For this
reason, the Diagnostic and Statistical Manual (DSM) was developed to help the doctors
understand the specific issues that face the victims of old age. The forms of DSM are used to
collect information regarding various mental disorders including anxiety, dementia,
schizophrenia, changes in moods and the effects of substance use among other psychological
issues. The most recognized forms of DSM are DSM-IV-TR and DSM-5. In as much as the
two methods perform some similar functions, they have been viewed to have substantial
differences in both their theoretical model of operations and the structural build –up. United
States of America is recognized as the most prominent user of the DSM. In the US, the use of
DSM has not limited to the collection of information regarded mental disorders but also
assists in the recommendation for treatments and the purposes of insurance coverage. DSM is

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operational and mostly does not rely on theoretical assessments but instead is aimed at
analyzing the symptoms related to the mental disorders in question and providing relevant
statistics about them.
DSM-IV-TR
This is a tool that was developed from the original DSM-IV and which form a base
for the development of DSM-5. It was launched in the year 2000, and one of the features was
the containment of mirror text revisions whose primary role was to describe each mental
disorder under diagnosis which enabled the mental health providers to understand better the
needs of a prospective client and the relevant assessment tools to pursue (Maddux &
Winstead, 2012). In its operation, the DSM-IV-TR followed a multiaxial approach which
was characterized by several five axes which are all directed into providing profound
knowledge on how to deal with the mental conditions of their clients. The other notable
feature of DSM-IV-TR was the use of Roman numerals as part of the primary language. The
axes are described below.
Axis I: The Clinical Syndromes – The axis played a vital role in the presentation of
clinical syndromes which led to the significant mental impairments in the patients. Therefore,
some of the categories of the disorders were based on changes in moods and behaviors,
feeling of anxiety and even problems brought as a result of the consumption of some types of
food (Goldstein et al. 2016).
Axis II: Personality and Mental Retardation- the motive of the axis was to outline the
long-term effects related to the disorders underdiagnosis and which were viewed to be
connected in axis I disorders. The spindle is also very important in helping the patients to
have an accurate understanding of the world with regards to their social and theatrical
personalities (Demartini, D'Agostino & Gambini, 2016). Finally, the axis takes charge in

MENTAL HEALTH AND AGEING 5
addressing the mental impairments and deficits of the patients which arise as a result of the
mental retardation. The impairments addressed are aimed at improving both interpersonal
skills and the self-care of the patients.
Axis III: Medical Conditions- the performance of the first two axes I and II is highly
dependent on both the physical and medical conditions of the third axis. The most recognized
causes of disturbances in this axis are HIV/AIDS conditions and cases of brain operation
impairments.
Axis IV: Psychological and Environmental Problems- the mental disorder syndromes
and the personality and mental retardation found in axes 1 and II respectively are affected on
either positive or negative basis by both psychological and environmental factors (Van der
Kolk, 2017). To achieve the best result from the diagnosis then, axis IV was included to
address all the issues related to a patient’s psychology and their living surrounding. The
problems include but not limited to the death of loved ones, unemployment cases, relocation
and family separation due to divorce and migrations.
Axis V: Global Assessment and Functioning- to understand the problems faced by the
patients and which contribute to their mental impairments, it is equally important to assess
their overall body function. The Global assessment and service, therefore, provides clinicians
and doctors with sufficient knowledge on the interaction of all the four axes and how they can
help improve the conditions of a person’s life based on problems of mental impairments
(Tong, Phillips & Conner, 2016). The next level of DSM was developed from the features of
DSM-IV-TR and was thus called DSM-5. It did not have much-unrelated features but the
only improvement of quality of operation while taking into account most of the elements
derived from DSM-IV-TR.

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DSM- 5
DSM-5 was not a new device. Instead, it was an advancement of the prior assessment
devices and especially DSM-IV-TR. Two significant changes that were done on DSM-IV-TR
to come up with DSM-V included the complete transformation of primary language from the
use of Roman numerals to Arabic. The second change was the total abolition of the axis
system, and an immediate replacement was made which included the listing of the major
disorders in numbers together with related effects (Demartini, D'Agostino & Gambini, 2016).
However, in as much as the disorders and their associated impacts are listed on this platform,
it does not include any guidelines or any information that can be followed to treat the
disorders in question.
The structural performance of DSM-5 is based on the sections that contribute to the
whole process. DSM-5 has three parts which act as a perfect replacement to the multiaxial
system that was used in the former diagnostic tool; DSM-IV. Each section has a role to
perform with the first presenting a lower level of superiority compared to the next two. The
first section plays a significant role in the general introduction. It gives a glimpse on how to
operate the updated manual in an attempt to perform the duties. Section II, however,
according to Cosentino & Bagby, (2019), provides the categorical procedures to follow while
undertaking diagnostic operations for any form of mental disorder. However, as addressed
earlier, DSM-5 does not give any proceedings for the treatment of mental disorders even after
their presence have been ascertained through diagnostic processes.
Section III plays a vital role in the diagnostic performance of DSM-5. All issues that
have not been understood in the provisions of part II are taken to section three for cases of
further research. For this reason, many people have referred to section III as a dumping site
for materials that fail to fit into section II and where anything beyond people’s understanding

MENTAL HEALTH AND AGEING 7
is dropped (Demartini, D'Agostino & Gambini, 2016). The section also contains a group of
useful tools whose motive is to allow for the effective diagnostic processes of all the
disorders appearing in part III of DSM-5. Apart from its function as a base for further
research to the categories that lack meaning in section II, there are other contents of section
III that makes it very important for the diagnosis of various disorders. The first content is the
inclusion of Disability Assessment Procedure as provided by the World Health Organization
WHO as discussed by Rojas & Widiger, (2017). This inclusion ensures that mental
impairments which emanate from cases of disabilities are also diagnosed and treated.
Additional inclusions of up to eight diagnoses are found in section III and not part II. The
additions include a diagnosis for Neurobehavioral Disorder due to Parental Alcohol Exposure
(ND-PAE), internet gaming disorder, caffeine use disorder, nonsuicidal self-injury and
attenuated psychosis syndrome among other complications.
Differences between DSM-IV and DSM-5
The differences that are registered between DSM-IV and DSM-V are dependent on
various factors. The factors range from the years of developments, the contents, the modes of
operation and even the anticipated results that the two may give based on the patient's
conditions. The discussions on the significant differences between the two are outlined
below.
Years of installation and purpose: - DSM-IV was initially introduced in 2000
launched by Mr Sathish Rajamani who was a psychiatrist. In contrary, DSM-5 was a
development made on DSM-IV and was presented in the year 2013 by the American
Psychiatric Association (APA).the main reason for the publishing of DSM-IV was to classify
prospective mental i9mpairments in a patient in a particular manner (Cossrow et al. 2016).
This intention is, however, different from the motive of the DSM-5 whose primary goal was

MENTAL HEALTH AND AGEING 8
to complement researchers, clinicians and other related people with the guidelines on how to
come up with proper treatment of the mental implications found on patients.
Differences Based on Changes
Some differences arise because of the transformations made on DSM-IV to come up
with DSM-5. The first change was the abolition of the axis system of assessment in DSM-IV.
DSM-5, therefore, uses what is commonly referred to as artificial categorization which
automatically presents the relationships amongst the disorders present in a person (Rojas &
Widiger, 2017). The importance of the transformation is to ensure complete abolition of
process disturbances arising from the problems arising from the ensuing axes as in the case of
DSM-IV.
The second transformation was made to differentiate similar problems. Concerning
the autism spectrum, DSM-IV was developed in such a way that the four related issues of
autism, Asperger’s, disintegrative and childhood disorders were analyzed as different entities.
However, with the adjustments that have come up with DSM-5, the four issues have been
united which makes it easy to interpret them as a single entity (Dawkins, Meyer & Van
Bourgondien, 2016). The results are the best as DSM-5 provides a relationship that is existent
amongst all the four disorders.
The development of DSM-IV allowed it to assess the Childhood Bipolar Disorder
(CBD) which was done in response to the situations arrived due to extensive diagnosis and
treatment of childhood bipolar disorder. In contrast, DSM-5 was fitted with assessment tools
which eliminated the assessment of Childhood Bipolar Disorder and replaced it with
Disruptive Mood Dysregulation Disorder (DMDD (Stinchfield et al. 2016)). The evaluation
of DMDD provides reliable results and better ways to sustain the situations. The reason
behind the argument is that the assessment offers a broader approach to understand Attention-

MENTAL HEALTH AND AGEING 9
Deficit/Hypertension Disorder (ADHD) diagnosis (Lu et al. 2016). The evaluation is also
viable in the diagnosis of adults because they already have a well-developed brain system and
active impulse control measures. Therefore, their signs and symptoms are fewer than those of
the children; they can be diagnosed with ADHD.
Intellectual Disability: - the need to show a similarity in language led to the factors
diagnosed under the broad term of mental retardation in DSM-IV transformed and diagnosed
under the general name of intellectual disability in DSM-5. While making changes that suit
language similarity, not only the mode of assessment changed; however, the criterion used to
do the classification was also changed. In DSM-IV, the classification criteria were based on
the score of IQ (Cosentino & Bagby, 2019). Conversely, DSM-5 does its classification while
focusing strongly on adaptive functioning.
The reclassification of Dementia: - DSM-IV referred to all cases related to memory
loss, poor learning abilities, and constant absentmindedness as amnestic disorders. However,
the name has been transformed into a newer group known as Neurocognitive Disorders
(Kessler et al. 2015). The new classification is essential as it allows for the detection of new
cases of the conditions. The early stages are realized by the fact that the analysis is
differentiated into major and mild severities which also help in determining the treatment
methods that should be offered to the two levels of severities.
The Suitability of DSM-5 Based On Gender, Age and Ethnicity
Cultural Issues Related to DSM-5
The assessment and diagnosis of some old age related disorders may not be successful
or may be done in the wrong way depending on the prejudices of the physicians. One of the
examples that can be cited s related to culture or ethnicity and involves schizophrenia as a
disorder. Some people have religious cultures and are staunch believers. When people speak

MENTAL HEALTH AND AGEING 10
to themselves in low tones in the hospitals, the situation should be taken literally as a
schizophrenic-related and would need diagnosis based on that. However, some physicians
who happen to be so religious especially in Christianity would assume that the victim is
communicating with God and may consequently fail to perform any diagnosis based on that
notion (Aggarwal et al. 2015).
There is a requirement that the level of severity of distress is diagnosed based on the
cultural beliefs and norms. Different people believe in different things and feel that the causes
of their brain impairments may be a result of some activities from the ethnic groups. The
language in the DSM-5 method of assessment is mostly in Arabic (Aggarwal et al. 2015).
The issue behind this language is that most of the physicians may not know how to read and
analyze the results. In that case, they would either recommend unrelated medications or fail
to do anything further than the diagnosis.
DSM-5 and Gender
Several revisions have been made on the DSM moving from DSM-IV to DSM-IV-
TR, and the latest which is currently used is the DSM-5 which is considered to be more
superior to the two according to its mode of assessment and the anticipated results. One of the
latest revisions was gender-based and was called Gender Dysphoria. The new name in DSM-
5 replaces the old one which was initially known as Gender Identity Disorder (GID) as
highlighted by Lev, (2017). The primary purpose of both GID and Gender Dysphoria is that
they address conditions in the assessment that may make the patients uncomfortable based on
their biological affiliations and differences. The evaluation also takes into account those who
happen to be in opposition to their body parts and wish to have different components. In that
case, DSM-5, under the latest revision, allows for a surgery aimed to exchange the body parts
as requested by the clients.

MENTAL HEALTH AND AGEING 11
The main issues that need to be understood are that if the birth gender of a person
does not disagree with their current identities, then there is no need for psychopathology as
long as they do not cause distress to the person in question. An individual’s culture also plays
a vital role in the attainment of transgender-based distress. Culture brings about the
stigmatization of gender especially to those who do not conform to their cultural gender roles
(Carmassi et al. 2017). In that case, many people who are from a particular gender may be in
distress with their original biological qualities and may yearn to be of the opposite gender.
DSM-5 and Age
One of the critical qualities of DSM-5 as per the latest revision is that it allows for the
assessment of people with distinct ages. It also provides guidelines on how such people
should be diagnosed but not the treatment methods (Slade et al. 2016). Not all assessment
criteria apply for all ages, but the specificity of ages and standards is a significant concern of
the process. The DSM-5 approach of mental health assessment recognizes the changes and
symptoms that are experienced by children and which may have adverse impacts on their
psychological conditions. The assessment guidelines for children are included, and they are
not limited to parental guidance and interviews, invitation s of clinicians into homes to
perform diagnosis on children and many others ways (Chandra, S., Biederman & Faraone,
2016). However, for related mental disorders such as autism, ADHD and Posttraumatic Stress
Disorder (PTSD) among others, there is a provision in the manual that means DSM-5 takes
into account the age differences and provides assessment methods for both children,
adolescents, and adults.
Mental Disorders in the Late Life

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Anxiety Disorders: - Anxiety or otherwise referred to as distress is usually viewed as
a regular component of old age. It is accompanied by general body weakness and
vulnerability to injuries which cause severe pains and the commencement of high-level loss
of some of the brain cells. The medication requirements of this disorder are not easy to spot
because in the elderly, depression may arise from several factors (Mänty et al. 2017).
Therefore, it is equally important for the physicians to have a profound knowledge of the
primary causes of anxiety disorder through diagnosis and start the treatment based on the
primary objectives. The disease is understood to affect the average orientation of both
physiological and cognitive process and may lead to various forms of fear (Maddux &
Winstead, 2012). The kinds of anxiety caused by the disorder include social phobia, simple
phobia, agoraphobia and it may also lead to other situations including but not limited to
posttraumatic stress, obsessive compulsion, and several cases of panic.
Autism Spectrum Disorder (ASD): - this is another form of mental impairment which
significantly affects people of distinct ages including children, adults and mostly the elderly.
The disorder contains four other related impairments including autistic, Asperger’s,
disintegrative and childhood diseases ((Maddux & Winstead, 2012). The latest revision
addresses the four disorders as a single unit by outlining their relationships and other related
effects.
There are many other disorders which are addressed and diagnosed by the use of
DSM-5. The diseases include but not limited to Specific Learner Disorder, Attention-
Deficit/Hypertension Disorder (ADHD), Disruptive Mood Dysregulation Disorder (DMDD)
and Childhood Bipolar Disorder (Slade et al. 2016). The performance and criteria used in the
diagnosis by DSM-5 are high compared to those in DSM-IV-TR due to the adjustment that
was made during the latest revision.

MENTAL HEALTH AND AGEING 13
Conclusion
In conclusion, mental disorders have been and are still regarded as one of the most
significant problems facing the world today. In that case, there is a high need for better
diagnosis methods that would help find results and recommend the most viable treatment
options. DSM was introduced, and it works best although it did not take into account, very
many factors. For that reason, people saw it better to make improvements and changes that
would ensure everything needed is put in place. The latest version is DSM-5 which is viewed
to function in a better way ensuring that the factors of gender, age and culture are all
addressed in their acceptable manners. Several changes that were made are also responsible
for the significant differences that have been viewed between DSM- IV and DSM-5. A
recommendation that could be made is to devise DSM-5 in a way that, other than containing
the guidelines for the diagnosis of mental disorders, it should also have instructions for the
prevention and treatment of the diseases in question.

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