PSY100H1 Lecture Notes - Lecture 10: Autism Spectrum, Clinical Formulation, Dsm-5

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27 Apr 2018
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PSY100 - Lecture 10 - Psychological Disorders
Psychological Disorders What is a disorder?
The four Ds of disorder:
They follow the 4 heuristics to diagnose a disorder
Deviance - behaviors, thoughts, and feelings that are not in line with generally accepted
standards, either statistically or culturally based
Looking for behaviour that does not seem to follow a statistical and/or cultural
norm
Distress - behaviors, thoughts, and feelings that are upsetting and cause pain, suffering,
and/or sorrow
Are they causing distress, suffering to the individual
Dysfunction - behaviors, thoughts, and feelings are disruptive to one’s regular routine or
interfere with day-to-day functioning
Is the deviant, distressing behaviour also disruptive to them in carrying out goals
that they have chosen for themselves
Also to how the functioning contributes to long term goals
Dangerous- behaviors, thoughts and feelings may cause harm to oneself and/or others
Has to the real potential to cause harm to the person and/or others
Typically if individual is exhibiting behaviour where all 4 are met, it is a psychological
disorder
Book on how to diagnose mental disorders
Source: Prof. Vervaeke’s lecture 10 slideshow slide 6
DSM-I was the first version of the manual published in 1952, 132 pages long, 128
diagnosis, deeply affected by the prevailing psychodynamic approach of the time
psychodynamic approach that was dominated then
It is laded w. Freud terms and influences
DSM-II was published in 1968, 119 pages, 193 diagnoses, still strongly influenced by
psychodynamic approach and therefore focused on personality disorders, 1974 printing
began the process of removing homosexuality from the list of disorders
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Under freud, homosexuality was considered to be a psychological disorder thus
heavily influenced by psychoanalysis and freud
DSM-III was published in 1980, 494 pages, 228 diagnoses, responded to criticisms of the
previous manuals by including precise definitions and explicit diagnostic criteria for
mental disorders and a multiaxial system to provide a more comprehensive view of
disorders, sexual orientation was no longer a mental disorder because it was clear it did
not satisfy the 4 Ds, it was more due to social and historical reasons for it potentially
being a disorder in the past
There was a lot of self criticism demand for clarity, better diagnostic systems
Operationalizing and make more coherent the classification and diagnosis of
mental disorders
DSM-III-R: In response to research sparked by the release of DSM-III, the manual was
updated in 1987 with revisions and corrections. This edition also included more
significant changes, such as inclusion of new diagnostic categories like sleep disorders.
DSM-III-R had a total of 253 diagnoses and the page count was now up to 567
Many psych disorders are comorbid (2 psych disorders are found together) w. 2
disorders
There was now a period of extensive evaluation of research on mental disorders
Work groups comprised of psychiatrists and psychologists reviewed the literature
and analyzed data to determine which diagnostic categories needed changing
Huge project of self critique and self revision
DSM-IV: The fourth edition of DSM was published in 1994
DSM-IV grew to 383 diagnoses across 886 pages. Additionally, the manual
included an appendix of 17 diagnostic categories that required further study
As ppl become more careful, as they try to remove confusion, they study more
criteria, and it gets bigger, more fine grained, precise analysis
Finally, this edition introduced a clinical significance criterion, which required that
symptoms cause "clinically significant distress or impairment in social, occupational, or
other important areas of functioning"
All of the symptoms have to satisfy all the 4 Ds in a significantly destructive
manner
DSM-IV-TR: A text revision of the DSM-IV was published in 2000. The intention of this
edition was to provide more comprehensive descriptions of each diagnostic category. No
categories were added, though the length increased to 943 pages
In attempt to get all errors and clarifications in
DSM-5: The latest version of the DSM is a 947-page volume that includes 541 diagnoses
It is important to note, however, that in terms of distinct diagnostic categories,
that number is closer to 237
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DSM-5 was the first major overhaul of the manual in 20 years, and similar to DSM-IV,
relied on work groups of mental health professionals to take charge of classifying mental
disorders (Sanders)
However, these work groups had a new task of incorporating significant
advances in genetics, neuroimaging, molecular biology, cognitive
neuroscience, and psychometrics into the traditional classification system
Attempt to integrate diagnostic criteria w. All the dif areas of
psych so there was a need to expand manual
Another important difference in the development process was the launch of the
Prelude Project, which posted drafts of DSM-5 online and invited the public to
provide feedback
Increased research base of receiving feedback, greater sampling pop.
DSM-5 has a different organizational structure
It follows the course of the lifespan, and replaces the multiaxial system, instead of
five domains of a mental disorder, DSM-5 requires documentation of one domain
“with separate notations for important psychosocial and contextual factors
(formerly Axis IV) and disability (formerly Axis V).”
Does not try to cover all 5 domains but requires documentation of 1
domain with important notations for to how important psychosocial and
contextual factors (formerly Axis IV) and disability..etc
There are also significant changes to diagnostic categories, including more
streamlined categories of autism and schizophrenia spectrum disorders
Asperger syndrome is no longer a thing
subTypes of schizophrenia is reduced
Finally, in an attempt to be more responsive to new and evolving research
findings, editions of DSM will be noted by Arabic rather than Roman numerals.
Incremental updates will be marked by decimals (e.g., DSM-5.1) and new
editions will be marked by whole numbers (e.g., DSM-6)
Clinicians DO NOT use the DSM as just a checklist when they are diagnosing a patient
The manual is intended and always should be used in conjunction with an
extensive clinical interview that attempts to assess the patient’s developmental
background, current context, degree of the four Ds, relationship status (how is the
relationship is going), physical health, and cultural background
Based on the 4 Ds the clinical significance of the case is determined: how
much disruption, distress etc. is the patient experiencing
All of this information gathered from the interview forms what is called a case
formulation which is the clinicians best attempt to explain the patient’s case in
terms from the DSM but based on the information gathered in the interview
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Document Summary

They follow the 4 heuristics to diagnose a disorder. Deviance - behaviors, thoughts, and feelings that are not in line with generally accepted standards, either statistically or culturally based. Looking for behaviour that does not seem to follow a statistical and/or cultural norm. Distress - behaviors, thoughts, and feelings that are upsetting and cause pain, suffering, and/or sorrow. Are they causing distress, suffering to the individual. Dysfunction - behaviors, thoughts, and feelings are disruptive to one"s regular routine or interfere with day-to-day functioning. Is the deviant, distressing behaviour also disruptive to them in carrying out goals that they have chosen for themselves. Also to how the functioning contributes to long term goals. Dangerous- behaviors, thoughts and feelings may cause harm to oneself and/or others. Has to the real potential to cause harm to the person and/or others. Typically if individual is exhibiting behaviour where all 4 are met, it is a psychological disorder. Book on how to diagnose mental disorders.

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