SOC363H1 Lecture Notes - Lecture 2: Intermittent Explosive Disorder, Scalea, Dsm-5

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SOC363: Lecture 2- Measures and Concepts
Disorder vs Distress, Category vs Continuum
Sane by fear of men (musical recommendation )
Psychiatric epidemiology vs social science then they will converge
Main Messages of this lecture
Disorder refers to two categories: ill or not ill
-Criteria from the DSM- illness designation
Distress is a gradient of symptoms. (continuity)
Some thing distress is a weak indicator of problems: “not a clinically
significant (CS)” measure
Research on distress discounted as a result.- on the epidemiology side they
think they are disting
Argument in this class:
-Distress ad certain kinds of disorder tap approximately the same content
-They are not distinct, they are on a continuum
-Only different in form: category vs continuum
Distress includes the full range of mild to serious problems
Starting Points
DSM-IV Definition of Mental disorder (Stein et al.,2010) :
-A) A clinically significant behavioral or psychological syndrome or
pattern that occurs in an individual-key element in the way
it’s treated- there is a dysfunction in the individual
-B) Associated with present distress (Eg. Painful symptom =suffering)
or disability (ie impairment in one of more important areas of
functioning) or with a significantly increased risk of
suffering death, pain, disability or an important loss of freedom
C) Must not be merely an expectably and culturally sanctioned
response to a particular event (comment: like stressors??)
-Like the stress that people go through
D) A manifestation of a behavioral, psychological or biological
dysfunction in the individual
E) Neither deviant behavior (eg. Political, religious or sexual) nor
conflicts that are primarily between the individual and the
society are mental disorders unless the deviance or conflict is a
symptom of a dysfunction in the individual
Other considerations:
-No definition adequately specifies precise boundaries for the concept of
mental disorder ie: mental disorder is never explicitly defined
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-The concept of mental disorder (like many other concepts in medicine and
science) lacks a consistent operational definition that covers all situations
Starting Points: Wakefield
4 points made by Wakefield about the definition of disorder (echoes of DSM):
It exists in the individual
The condition is a sign of dusfunction in some respect-a cognitive,
motivational, behavioral, emotional or other psychological mechanism that
does not function properly.
The requirement of real harm to self or other- forms of distress and disability
(impairment of functioning)
Not due to social disapproval
It is binary: It is either present or absent
A serious non-self limiting condition. Therefore cannot be too prevalent
Therefore; the implication since it is serious and not self limiting is this will only
happen to a relatively small portion of the population
-If this is serious then the situation is rare
-If the situation is too prevalent in the population, maybe it’s normal and not
serious at all
Starting Points: Allan Horwitz in the nature of mental disorder vs distress
Main Points:
oDisorder refers to an internal dysfunction-non-normal responses to
environment inputs
oResponse to external stress must be disproportionate
oDistress refers to “normal”, expectable response to environmental challenges
and threats
“Sociological studies usually deal with exactly the kinds of
“Expectable and culturally sanctioned responses” that the DSM
excludes from its definition of mental disorder because they
arise in response to social stressors and only persist as long as
these stressful social conditions endure”
oDistress is naturally self limiting
oDistress arises from proportionate responses to stress or threat…(who
judges this??..)
oIf removal of stressor reults in the abatement of symptoms, it is a “normal”
response, not a disorder. (WHY?)
Horwitz is a close colleague to Wakefield and they happen to share the same
ideals
There is ambiguity in these terms… What is a normal response.. better yet,
what is non normal? Who defines what normal is?
Distress is usually not defined very clearly or sometimes not even designed
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Quote is false because what is normal and expectable
Starting Points
Distress Definition by (Wheaton,1982)
oDistress [refers] to the extent of enxiety and depression sumptomatology…
indication of an affectively based impairment in social functioning capacities.
The range of impairment is…from one through lower levels of severe; that
range is sufficient to make the Langner Index useful as a proxy indicator of
variation in the probability of…a diagnosis in the realm of anxiety and
depression disorders. (1982:29)
Main Points
1. Related to certain kinds of disorders-not all
2. Is a continuum (a scale-a gradient)
3. Stable differences
4. Not “normal” or necessarily moderate
NB: If distress is persistent, and reflect sever problems at higher scores, with
behavioral impairments, then it measures important problems that overlap
with disorder
You can take the range of distress and that can be used as a proxt to indicate
whether an individual has a mental disorder (anxiety or depression etc)
Note: distress is not always applicable to mental disorder, only to certain
array of disorders
A Brief History
1950-1970s: There was a theoretical war in psychiatry. No one know exactly
what depression or main disorder really was and there was no clear defined
and university definition. There was not consisted diagnosis among different
psychiatrists (unreliable and uncredible)
Clinicians realized that this was bad and that they weren’t acting in the
patient’s best interest
There continued to be unstandardized interviews and replication was
impossible due to inconsistency
Mid 1970s: SADS a new instrument that was invented and administered by
clinicians- semi standard protocol ie interviewers would ask the same
questions  Defined diagnoses by symptom qualifications
The DIS (Diagnostic Interview Schedule), usable by lay interviewers (ie
anyone can be trained to interview)
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Document Summary

Sane by fear of men (musical recommendation ) Psychiatric epidemiology vs social science then they will converge. Disorder refers to two categories: ill or not ill. Distress is a gradient of symptoms. (continuity) Some thing distress is a weak indicator of problems: not a clinically significant (cs) measure. Research on distress discounted as a result. - on the epidemiology side they think they are disting. Distress ad certain kinds of disorder tap approximately the same content. They are not distinct, they are on a continuum. Distress includes the full range of mild to serious problems. Dsm-iv definition of mental disorder (stein et al. ,2010) : it"s. A) a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual-key element in the way treated- there is a dysfunction in the individual. No definition adequately specifies precise boundaries for the concept of mental disorder ie: mental disorder is never explicitly defined.

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