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University of Toronto Scarborough
Connie Boudens

CHAPTER #3 – Classification and Diagnosis Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)  American Psychiatric Association  There is nothing statistical about this, actually.  It is the text that psych professionals use to formulate diagnosis about disorders Why is this book important? It has labels that cause stigma and discrimination.  Provides descriptions about disorders  Provides reliability: inter-relator reliability (allows health care professionals to communication.  Treatment - However, it is good for diagnosis that can lead to treatment plans. This provides a background for being able to render a diagnosis  Allows differentiation between disorders - a differential diagnosis is where they measure all possibilities and decide which one it is more likely to be.  Research DSM-IV Definition of Mental Disorder A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual Psychological syndrome: a construct that we cannot see (e.g. anxiety) Behavioral disorder: a syndrome that is observable (e.g. head banging) No one specific symptom equals a disorder. A collection of syndromes might add up to a disorder.  includes present distress or disability, or  a significantly increased risk of suffering death, pain, disability, or an important loss of freedom  Excludes o an expectable and culturally sanctioned response to a particular event- o deviant behavior (e.g., political, religious, or sexual) o conflicts that are primarily between the individual and society (unless the deviance or conflict is a symptom of a dysfunction in the individual)- Occupy movement Diagnostic System of the American Psychiatric Association (DSM-IV) Five dimensions of classification  Axis I – All diagnostic categories (Front inside cover of your Textbook)  Axis II – Personality disorders and retardation (Front inside cover of your Textbook)  Axis III – General medical conditions o Important because of prescribing medication. You don’t want to make someone’s medical condition worse.  Axis IV – Psychosocial and environmental problems (Back inside cover of your Textbook) o Academic, home, family etc. issues  Axis V – Current level of functioning- (Back inside cover of your Textbook) o Global Assessment of Functioning (GAF): numerical score of functioning to measure the levels of symptoms. The disorder is more severe the lower the numbers go. Can have limitations:  Example: for depression you need 5 symptoms for 2 weeks, according to DSM. What happens if you have 4 symptoms that are: I want to kill myself, I know how I want to kill myself, I will kill myself, I have a plan to kill myself. o This sounds like pretty straight-forward depression. However it is not the definition in the DSM.  The fifth DSM is more about dimensional categorization – it’s less about how many symptoms and more about what symptoms. Diagnostic Categories Comorbidity: having one or more disorders. Makes diagnosis/treatment more difficult. Axis I Disorders Disorders usually first diagnosed in infancy, childhood, or adolescence Separation anxiety disorder Conduct disorder  A disorder in which the child violates social norms and has problems with the law. o A conduct disorder diagnosis is necessary for an Anti-Social Personality disorder or Psychopathy disorder diagnosis. Attention-deficit/hyperactivity disorder Mental retardation Pervasive developmental disorders Learning disorders Substance-related disorders This only becomes a formal diagnosis when the substance abuse or dependence results in behavior that is severe enough to interfere with normal behavior. Schizophrenia People with schizophrenia are those that have lost touch of reality especially with their positive symptoms (something in the personality that has been added and shouldn’t be there – delusions, hallucinations). Negative disorders are those that are the absence of a personality trait – catatonia, lack of motivation, lack of pleasure in life etc. Schizophrenics kind of swing between psychotic episodes (positive symptoms) and periods of remission (negative symptoms) Mood disorders Major depressive disorder  Suicidality, suicidal ideas/ attempts, lack of motivation/appetite, bizarre sleep patterns, hopelessness, sadness/depression  People with depression may not say they are depressed but will agree that they feel hopeless, worthless etc. They may be in denial or avoiding social stigma Mania  Have a euphoric sense of ability, unrealistic expectations – they’re still within the realms of reality but they still take it bit further than other people. Unlikely but no implausible. Bipolar disorder  Shift between states of depression to states of mania Anxiety disorders Very prevalent, common type of disorder Phobia  A fear that causes avoidance of whatever causes the fear  Fear is grounded in rational belief – they may know that their fear is irrational but they are still afraid Panic disorder  Heart-racing, tremors, perspiration  Come on when people feel they cannot control the situation  Agoraphobia: fear of leaving the home because they are afraid of having a panic attack Generalized anxiety disorder  Overwhelming belief that something bad is going to happen Obsessive-compulsive disorder  An obsession is a recurrent thought/idea/image that continuously dominates a person’s consciousness. This causes anxiety.  This leads to the compulsion: the urge to perform a stereotyped act with the purpose of stopping the anxiety from the obsession. Post-traumatic stress disorder  Behaviour that is caused by a traumatic experience: depression; flashbacks; fear of the event happening again; anxiety; nightmares of the event o Motor vehicle accidents; combat Acute stress disorder  The traumatic event just occurred and doesn’t last for a very long time (chronic) Somatoform disorders The physical symptoms that the patient presents with have no known physiological cause. Symptom may serve some sort of psychological issue. Somatization disorder  Person has a lot of the unknown physiological complaints. Will visit professiona
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