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Lec 11.docx

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Hywel Morgan

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Lec 11  Current Perspectives Diagnostic and Statistical Manual (DSM) • DSMV  Very few changes from DSMIV-TR o Cosmetic and substantive changes o Two Major Changes  Reorganization of disorders • 5 Axes of diagnoses in DSM4, removed in DSM5 (EXCEPTION: A4 ) • Disorders are grouped by similar symptoms  Definition of disorders are much broader o DSM is clinically and empirically derived DSM5 is more dimensional than categorical • Dimensional  Different severities • Similar symptoms in same categories, with varying degree of severity • Major Changes: o 1. DSM4 containedAsperger’s Syndrome (mild form of Autism) has been removed from DSM5.  DSM5 includes Asperger’s, Retts, etc. as Autism Spectrum Disorder.  Broader definition=includes more people, over-diagnosis  RATIONALE: Diagnose people sooner to get help sooner  Negative: Misdiagnosis o 2. DSM4 had different subtypes of schizophrenia (ex. Paranoid, undifferentiated), DSM5 eliminates the subtypes  RATIONALE: most people being diagnosed as undifferentiated- showed symptoms of all subtypes.  Some schizophrenia types had more positive symptoms than negative o 3. Diagnosis of Depression  Has separate section on both DSM4 & 5.  Depression defined as sad affect, no enjoyment, over a long period of time – usually due to an environmental condition.  DSM4 excluded Bereavement (death of a loved one). • DSM5 includes bereavement as abnormal. o 4. Post-Traumatic Stress Disorder (PTSD), categorized as anxiety disorder in DSM4, separate section in DSM5.  DSM4  Have an anxious arousal in response to a past traumatic event.  On DSM4  requirement that traumatic event induced extreme fear or anxiety.  Requirement is eliminated in DSM5. DSM5 concludes that PTSD does not require anxiety or fear at the time event occurred, could have been onset afterwards. o 5. DSM5 eliminated Gender Identity Disorder o 6. Elimination of disorders of Childhood orAdolescence. Have been placed in different categories based on symptoms. • Development of DSM5 Controversial Criteria • New learning disorders & “Autistic Spectrum Disorder” (ASD) o Autism  Can’t learn, cant socialize o Learning disorders, autism, and mental retardation are the same. o Autism Spectrum Disorder  Inability to absorb information from other people. o Learning disorders andASD are separate from mental retardation (now intellectual disability). • New Category “Addiction and Related Disorder” o Redefine “Addiction” o DSM4 defined addiction as substance abuse. DSM was very specific to drugs. o DSM5 is broader to include things not considered a drug. Ex. Internet, food, gambling.  DSM5 sets out to include these things. Did not include sex. RATIONALE: Sex is a normal part of life, should not stigmatize those who have healthy sex life. • BehaviouralAddictions (Gambling) o Gambling addiction clearly included on DSM5 not DSM4 • New “Suicide Scales” o Measurement of suicidal ideation o Different types of risks for suicide o Stage 1  Depression? o Stage 2  Thought of suicide? o Stage 3  Have a plan? – Should begin to concern and diagnose o Stage 4  Have tried? • “Risk Syndromes” Category o Mood disorders of sad affect as oppose to anxious. Depression and Bipolar disorders. • Childhood bipolar disorder o Significant amount of research indicating Bipolar disorder can develop in childhood o Bi-polar  Episodes of Depression and episodes of Mania (extreme happiness) o Suggestion in past that children could not show bi-polar disorder  Significant evidence against this • Binge Eating o People who eat copious
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