Psychology 2310A/B Lecture Notes - Mania, Etiology, Chartered Management Institute

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Classification and Diagnosis (cont’d)
Advantages of a Classification System
Communication: among clinicians, between science and practice
oAllows people in the mental health field to communicate about different kinds of
mental disorders
oThere wouldn’t be a language that can be used to describe certain people’s disorders
Clinical Practice: facilitate identification, treatment, and prevention of mental disorders
oAllows you to identify the problems and focus on the issues of a given patient
oWithout a diagnostic system, every clinician would end up developing their own
classification system
Research: test treatment efficacy and understand etiology
oWithout a diagnostic system making progress in research would not be possible
oHelps clinicians to see what kind of treatments have been most effective
Education: teach psychopathology
oThis course would be impossible to teach without a diagnostic system
Information Management: statistical records and payment for care
oWe need to keep records and have statistics on symptoms, treatments that are being
done, and diagnoses
DSM: Diagnostic and Statistical Manual of Mental Disorders
DSM-I – 1952 – 60 disorders
DSM-II – 1968 – 145 disorders
o145 categories
oVague descriptions, poor reliability
DSM-III – 1980 – 200+ disorders
oA theoretical approach
oMore precise diagnostic criteria
oMulti-axial system
DSM-IV – 1994 – 300+ disorders
oExtensive field trials – reliability, validity
DSM-IV-TR – 2000
DSM-5 – May, 2013 - 300+ disorders
With the release of each DSM revision, disorders have increased dramatically
oThis may because there is a desire to define diagnoses more specifically with the use of
subcategories, etc
oCould also be because more and more “problems” that didn’t used to be thought of as
mental disorders are now defined as mental disorders in the DSM
DSM-5 Definition of a Mental Disorder
A syndrome
oA group of symptoms that tend to cluster together in certain individuals and follow a
similar course over time
Characterized by clinically significant disturbance
oSerious enough that the person needs professional help
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In an individuals
oOnly an individual can be diagnosed with a mental disorder (not a group)
Cognition, emotion regulation, or behavior
oHow does this disorder effect the persons way of thinking, controlling their
emotions, or acting within society
That reflects a dysfunction in the psychological, biological, or developmental processes
underlying mental functioning
oSomething is not working properly
Usually associated with significant distress
oOne of the major criteria for identifying a mental disorder is the persons distress
about their mental health
oHowever, there are some cases (mania) where distress does not occur but disability
does
Or disability in social, occupational, or other important activities
oUnable to form relationships with others within society
oA person can be disabled without being distressed and vice versa
Definition (cont’d)
An expectable or culturally approved response to a common stressor or loss (eg, death of a loved
one) is not a mental disorder
oIf someone is really sad because they are grieving over a loved one, they are not mentally
disordered
Socially deviant behavior (eg, political, religious, sexual) and conflicts between the individual
and society are not necessarily mental disorders
oJust because a person is very unusual, for whatever reason, does not mean they
necessarily have a mental disorder
Classification of DISORDERS, not PEOPLE
o“Person with schizophrenia”, not “schizophrenic”
oif we call someone the former, we are still acknowledging that they are a person with
many other characteristics than schizophrenia
“Fuzzy” boundaries of categories
Variability between people within a category
Criticisms of DSM
Categorical vs. dimensional issue
oIn the medical field either a person has a disorder or they don’t
oA lot of people argue that the problems dealt with in the mental health field are much
more dimensional
Some people can be more depressed than others, some less
Could use a scale (1-10)
Heterogeneity within groups
oPolythetic approach to diagnosis
oThe DSM may show a list with 10 criteria of the disorder and say that a person only
needs 4 out of 10 to be diagnosed as having that disorder
Problem may be that two people could be diagnosed with the same disorder but
have none of the same symptoms
Gender bias
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