chapter 3

Abnormal psych chapter 3 Diagnostic and statistical manual of mental disorders (DSM) now in its 4 edition, commonly referred to as DSM IV or DSM IV-TR. The DSM is published by the American psychiatric association A BRIEF HISTORY OF CLASSIFICATION Bloodletting was part of treatment of all physical problems Development of the WHO and DSM systems In 1939 the world health organization (WHO) added mental disorders to the international list of causes of death In 1948 the list was expanded to become the international statistical classification of diseases, injuries and causes of death (ICD) a comprehensive listing of all diseases including a classification of ab beh. Metal disorders section was not widely accepted American psychiatric association published its own diagnostic and statistical manual (DSM) in 1952 In 1969 the WHO published a new classification system that was more widely accepted. A 2 version of the American psychiatric associations DSM, DSM-II was similar to the WHO system The WHO classifications were simply a listing of diagnostic categories; the actual beh or symptoms that were the bases for the diagnoses were not specified In 1980 the American psychiatric association published an extensively revised diagnostic manual; a somewhat revised version DSM-III R appeared in 1987 DSM IV is used throughout the U.S and Canada is becoming widely accepted around much of he world THE DIAGNOSITIC SYSTEM OF THE AMERICAN PSYCHITIARTC ASSOCIATION (DSM-IV AND DSM-IV-TR) The term mental disorder is problematic and that no definition adequately specifies precise boundaries for the concept. DSM-IV-TR provides the following definition: A clinically significant beh or psychological syndrome or pattern that occurs in an indiv and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom Five dimensions of classification Most sweeping change in the use of multiaxal classification whereby each indiv is rated on 5 separate dimensions or axes The five axes are: 1) axis I- all diagnosis categories except personality disorder and mental retardation 2) axis II- personality disorders and mental retardation 3) axis III- general medical conditions 4) axis IV- psychological and environmental problems 5) axis V current level of functioning most ppl consult a mental health professional for an Axis I condition although the remaining three axes not needed to make the actual diagnosis their inclusion in the DSM indicates that factors other than a persons symptoms should be considered in an assessment so that the persons overall life situation can be better be understood axis III conditions may be quite common. A recent study in Toronto found that more tan half of the inpatients had an identifiable medical condition and that having an infectious disease was associated with disruptive beh these include occupational problems, economic problems, interpersonal difficulties with family members and a verity of problems in other life areas that may influence psychological functioning life areas considered are social relationships, occupational functioning are supposed to give info about the need for treatment Diagnostic Categories the DSM indicates that the disorder may be due to a medical condition or substances abuse DSM-III there has been a dramatic expansion of the # of diagnostic categories Issues and possible categories in need of further study BOX Caffeine withdrawal- caffeine withdrawal results in significant distress or impairment in occupational or social functioning. Symptoms include headache, fatigue, anxiety, depression, nauseas and impaired thinking Premenstrual Dysphoric disorder- this proposed syndrome occurs a week or so before menstruation for most months in a given year and is marked by depression, anxiety, anger, mood swings, and decreased interest in activities usually engaged in with pleasure. The symptoms are severe enough to interfere with social or occupational functioning. This category is to be distinguished from premenstrual syndrome which is experienced by many more women and is not nearly as debilitating Daily charting or symptoms for at least two menstrual cycles On the plus side inclusion might alert ppl to the hormonal bases of monthly mood changes linked to the menstrual cycle and thereby foster more tolerance and less blame. On the minus side listing such mood changes in a manual of mental disorders could convey the message that women who experience these psychological changes are mentally disordered Mixed anxiety- depressive disorder- in mixed anxiety depression disorder, a person would have depressed for at least a month and have had at the same time at least four of the following symptoms: concentration or memory problems, sleep disturbances, fatigue or low energy, irritability, worry, crying easily, hypervigiliance, anticipating the worst, pessimism about the future and feelings of low self esteem.. the person must not be diagnosable as having a major depressive disorder, dysthymic disorder, panic disorder, or generalized anxiety disorder Passive aggressive personality disorder (negativistic personality disorder) Not attributable to depression, symptoms include resenting, resisting, and opposing demands and expectations by means of passive activities such as lateness, procrastination, forgetfulness and intentional inefficiency. The inference is that the person is angry or resentful and is expressing these feelings by not doing certain things rather than by being assertive or aggressive. Such ppl often feel mistreated, cheated or under appreciated Depressive personality disorder- ppl whose general lifestyle is characterized by chronic gloominess, lack of cheer, and a tendency to worry a lot. This trait like long term disorder may be a precursor to a full blown major depressive disorder. Its very difficult to distinguish between depressive personality disorder (DPD) and the main depressive disorders Its possible on a statistical basis to distinguish DPD and dysthymia which is a milder bu long lasting form of depression. However they also found that 95% of the ppl who meet diagnostic criteria for DPD also meet the diagnostic criteria for dysthymia DPD is a subtype of dysthymia Another disorder listed in the DSM-IV-TR is minor depressive disorder which may be distinguishable only by virtue of its not being as long lasting as depressive personality disorder Proposed axes in need of further study---- defence mechanisms defined as automatic psychological processes that protect the indiv against anxiety and from the awareness of internal or external dangers or stressors. Defence mechanisms are divided intyo groups called defence levels and are measured by a proposed defensive functioning scale There are 7 defence levels each with a set of defence mechanism. The levels range from high adaptable level to level of defensive dysregulation High adaptive level- this most adaptive healthy defence level contains coping efforts that are realistic ways of handlings tress and are conducive to achieving a good balance among conflicting motives The following are some ex: Anticipation- experiencing emotional reaction before a stressful event occurs and considering realistic altenbrative courses of action ex: planning for an upcoming meeting with an employer who is unhappy with your performance Sublimination- dealing with a stress by channelling negative feelings into socially acceptable beh ex: working out at the gym Disavowal level- this middle level is characterized by defences that keep troubling stressors or ideas out of consciou