PSYC 337 Lecture Notes - Lecture 2: Asperger Syndrome, Revised Version, Paradigm Shift
7 May 2018
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Lecture 2
●Questions from last class?
○Disorder can be etiologically heterogeneous, meaning that is emerges from different
sources...the process by which this occurs is called equifinality
●Comorbidity
○Of those who currently meet the criteria for one disorder, 50% qualify for more than one
at any given time (75% over the course of their lifetime)
○Comorbidity affects the course, development, presentation, treatment response, etc. of the
disorder
○Comorbid patients tend to have poorer outcomes
○In terms of research, anything that you find may be associated with one disorder or may
manifest as a result of the comorbid disorders
○For people with any mood disorder (e.g. depression, anxiety
○Why does comorbidity exist?
■Chance
●The odds of having major depressive disorder (MDD) in females = 20%
●Odds of anxiety disorder for adult females = 20%
●So, 4% will have both → however, most percentages are much higher, so
something other than chance is at play
■Sampling bias
●Each disorder is associated with a chance of being treated; individuals
with more disorders are more likely to seek treatment
●Therefore, clinical samples are likely biased
○However, we do find high rates of comorbidity in community
samples → sampling bias doesn’t account for it all either
■*Problems with diagnostic criteria
●Many criterion sets overlap (e.g. shared symptoms)
○Suicidal ideation is a symptom of MDD, schizophrenia, bipolar
disorder, etc.
○Sleeplessness in MDD and GAD
●However, this still can’t totally account for high rates of comorbidity
■Poorly-drawn diagnostic boundaries
●Multiformity → disorders can express themselves in different ways,
while still featuring the same latent underlying construct
○E.g. people with MDD often have panic attacks; is that a case of
comorbid depression and anxiety, or just someone with
depression who happens to have panic attacks
○Perhaps comorbid disorders may in fact reflect a third,
independent disorder
■Causal explanation → one disorder is a risk factor for another disorder
●E.g. conduct disorder in youth may lead to adult substance use disorder
■Shared etiological risk factors
●E.g. child abuse or traumatic childhood experiences could lead to
multiple disorders
●Classification
○It’s good to be critical of the DSM system; however, that’s the system we have right now
and it’s important to know about
○History of the DSM
■The first DSM was published in 1952; before that, we had no real collection of
diagnoses
●It arose from a desire to have a scientifically-grounded set of criteria for
mental disorders; at the time, clinicians were arriving at wildly different
diagnoses
○Also posed research and epidemiological problems → if a
researcher in Canada and one in England don’t have the same
criteria for schizophrenia, how can the research be effective
■DSM-II → 1968
●With DSM-I, very theoretically-oriented (less grounded in science)
○I.e. at the time, psychoanalysis was the dominant form of
study/theory
●Had very few categories and no requirements for number of symptoms
■DSM-III → 1980
●A major paradigm shift in thinking; a demand for a more
biological/empirical approach
○Huge arguments in the field; and it continues to be controversial
in the field - one of the loudest groups of critics were the
psychoanalysts, who felt their theories were being pushed away
●Inclusion criteria → what symptoms do you need to have, and how
many?
●Duration criteria → how long do you need to exhibit these symptoms
for?
●Exclusion criteria → what symptoms rule out a diagnosis?
○This was phased out
○E.g. if you have Cushing's disorder (a hormonal problem), you
may have similar symptoms to depression - you’d want to rule
out one or the other
●Multi-Axial classification
○Was taken out of DSM-5
○Axis 1 - Major clinical disorders → e.g. MDD, PTSD, OCD,
etc.
■The primary diagnosis or problem to address
○Axis 2 - Personality disorders → e.g. borderline personality
disorder, narcissistic personality disorder, etc.
■Chronic problems with living, but not considered major
clinical disorders (you should treat the primary disorder,
but also consider the effects of these disorders in their
comorbidity)
○Axis 3 - Medical conditions that may contribute or be relevant to
treatment
○Axis 4 - Psychosocial stressors; something with which to record
environmental contexts
○Axis 5 - GAF (Global Assessment of Functioning) → a simple
rating of function/summary score for severity
●Assumptions introduced in DSM-III
○Symptoms are the most useful basis for assessment
○Nosology (the way we describe cases) is based on behaviour and
symptoms → drawn from idea of a syndrome
Document Summary
Disorder can be etiologically heterogeneous , meaning that is emerges from different sourcesthe process by which this occurs is called equifinality. Of those who currently meet the criteria for one disorder, 50% qualify for more than one at any given time (75% over the course of their lifetime) Comorbidity affects the course, development, presentation, treatment response, etc. of the disorder. Comorbid patients tend to have poorer outcomes. In terms of research, anything that you find may be associated with one disorder or may manifest as a result of the comorbid disorders. For people with any mood disorder (e. g. depression, anxiety. The odds of having major depressive disorder (mdd) in females = 20% Odds of anxiety disorder for adult females = 20% So, 4% will have both however, most percentages are much higher, so something other than chance is at play. Each disorder is associated with a chance of being treated; individuals with more disorders are more likely to seek treatment.
