CH 17 NOTES
Classification and Diagnosis of Mental Disorders
• Deviation from the average, or norm, or standards of ideal mental health.
• Although there is no perfect definition of abnormality, mental disorders tend to involve
patterns of behavior (symptoms) that: (a) depart from cultural norms, (b) involve the
experience of personal distress (or elicit distress in others), and (c) impair the individual
in his or her ability to thrive in the social/occupational domains.
Perspectives on Causes of Mental Disorders
• They differ primarily in their explanation of the etiology, or origin, of mental disorders.
Psychodynamic Perspective(conflict, anxiety)
• MD originate in intrapsychic conflict made by the id, ego, and superego.
• Freudian view – the problems we show stem from anxiety we have. Symptoms are
result of unconscious conflicts and anxiety.
Medical Perspective (disease entities) from Hippocrates
• All signs and symptoms are due to underlying diseases – medical model.
• These diseases are biological in nature.
• Diseases – explains symptoms.
• Mental Illnesses cluster symptoms, but they don’t explain them.
Cognitive-Behavioral Perspective (learning, reinforcement)
• We use learning to account why ppl do what they do – learning a symptom leads to
• MD are learned maladaptive behavior- focused on environmental factors and
person’s perception of them.
Humanistic Perspective(positive regard, conditions of worth)
• The goodness of every person that comes into office – w/e problems happening –
somebody important failed to tell them that – they did not give the positive regard –
you will supply them unconditional positive regard- helps overcome conditions of worth
• MD arise when ppl perceive that they must earn the positive regard of others (highly
dependent on others)
Sociocultural Perspective (problems in living)
• Cultural variables influence the nature and extent to which ppl interpret their own beha
• Culture-bound syndrome is when MD exists appear to occur only in certain cultures.
CH 17 NOTES
Diathesis-stress model (vulnerability x exposure)
• To combine genetics and learning experiences.
• MD will develop only when ppl are confronted with stressors exceeding their coping
• Diathesis-stress models predict that symptoms should only occur when a vulnerability
factor (called the diathesis) is exposed to stress.
DSM-IV CLASSIFICATION (Diagnostic and Statistical Manual IV)
o Axis I: Clinical Disorders
Conditions requiring clinical attention
Example: Alcohol dependence, major depressive disorder
o Axis II: Personality Disorders
Life-long, inflexible, and maladaptive traits (little insight, and no memory
to when it started)
Example: antisocial personality disorder
o Axis III: General Medical Conditions
Any medical problem that could affect the Pt’s mental state
Example: alcohol cirrhosis
o Axis IV: Psychosocial & Environmental Problems
Stressful events from the last year (1–7, where 7 = “catastrophic”)
Example: severe divorce, loss of job
o Axis V: Global Assessment of Functioning
Overall performance (0–100, where 100 = “superior functioning”)
Example :GAF test (Global Assessment of Functioning)
Problems with it
Emphasizes biological factors, meaning that potential cognitive and environment
determinants may be overlooked.
Once people are labeled, they are likely to be perceived as having all characteristics
assumed to accompany that label.
Reliability(agreement with diagnosticians), cormorbility (multiple diagnoses) as one
probability goes up, the others go down, relevance to treatment (lecture note)
Clinicians care about the diagnoses, while therapists care about the symptoms(case
formulation or how you got them)
Proper classification has advantages for a patient, one is that with few exceptions, the
recognition of a specific diagnostic category precedes development of successful
treatment for that disorder.
Evaluating Scientific Issues
CH 17 NOTES
Two activities contribute to diagnoses and predictions: collection of data and
It is not the source of info that distinguishes the clinical method from actuarial method,
but the processing of that info.
Clinical judgments – are based on experts’ knowledge of symptoms that predict
particular types of outcomes.
Actuarial judgments-made by applying empirically derived rules that relate particular
indications (symptoms, test scores, personal chars) with particular outcomes.
o Actuarial judgments are right more than clinical b/c they always produce the
same judgment for a particular set of data. (the formula outperforms overtime)
o Clinical however, may take different decisions on the same set of data on
different occasions, or may allow personal bias to influence her analysis of the
data. Also, the human brain has hard time sifting through mass of data and
retaining useful info while discarding useless info. To add on, we follow heuristic
rules, we have a natural tendency to pay too much attention to info that is
consistent with our own hypotheses.
Anxiety, Somatoform, and Dissociative Mental
Anxiety – sense of doom along with physiological reactions (accelerate heart rate, sweaty
palms, tight stomach)
• Panic, fear, worry, etc. reflect an adaptive response to stressful or threatening
situations, involving vigilance, behavioral inhibition, and escape behavior (warning
system). Anxiety is only abnormal when it is disproportionate to objective circumstances
3 types of anxiety disorders: Panic, Phobic and OC Disorder.
Panic – fear with hopelessness/helplessness.
Panic Disorder – episodic attacks of acute anxiety (shortness breath, clammy sweat, irregular
Ppl with the disorder show physiological response that is biologically controlled.
What is inherited is a tendency to react with alarm to mild bodily sensations (A
Expecting to have to face stressors can overwhelm their coping abilities lead to ppl
having a sense of dread. (cognitive cause)
Anticipatory Anxiety – to fear a panic attack
Panic attacks can cause phobias (by having the attack occurring in a particular situation
They can be triggered through lactic acid injections or breathing excessive C02