PS275 Lecture Notes - Intermittent Explosive Disorder, Truancy, Pyromania

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Factitious disorder
A diagnosis of factitious disorder is applied to ppl who intentionally produce or
complain of physical or psychological symptoms, apparently cuz of a psychological
need to assume the role of a sick person.
Adjustment disorders
Involves the development of emotional or beh symptoms following the occurrence of
a major life stressors. However the symptoms that ensue do not meet diagnostic
criteria for any other axis I diagnosis
Impulse control disorder
Include a # of conditions in which the persons beh is inappropriate and seemingly out
of control
In intermittent explosive disorder the person has episodes of violent beh that result in
destruction of property or injury to another person
In kleptomania the person steals repeatedly but not for the monetary value of the use
of the object
In pyromania the person purposefully sets fires and derives pleasure from doing so
In pathological gambling the person is preoccupied with gambling, is unable to stop
and gambles as a way to escape from problems.
Trichotillomania is when the person cannot resist the urge to pluck out his or her hair
often resulting in hair loss
Personality disorders
Defined as enduring, inflexible and maladaptive patterns of beh and inner experience
In schizoid personality disorder the person is aloof, had few friends, and is indifferent
to praise and criticism
The indiv with a narcissistic personality disorder has an overblown sense of slef
importance, fantasizes about great successes, requires constant attention and is likely
to exploit others
Anti social personality disorders surfaces as conduct disorder before the person
reaches age 15 and is manifested in truancy, running away from home, delinquency,
and general belligerence. In adulthood the person is indifferent about holding a job,
being a responsible partner or parent, planning for the future or ever for tm, and
staying on the right side of the law. Ppl with anti social personality disorder –also
called psychopathy---do not feel guilty or shame for transgressing social norms
Other conditions that may be a focus of clinical attention
If an indivs medical illness appears to be caused in part or exacerbated by a
psychological condition the diagnosis is psychological factors affecting physical
conditions. Among the other diagnoses in the category are the following
Academic problem – underachievement
Anti social beh- in professional thieves
Malingering- faking physical or psychological symptoms to achieve a goal such as
avoiding work
Relational problems – poor relationship with siblings and spouse
Occupational problems- dissatisfaction with work
Physical or sexual abuse
Bereavement
Non-compliance with treatment –refusing meds
Religious or spiritual problems – questioning ones faith
Phase of life problem- difficulties created by a life transition such as starting school
Delirium, dementia, amnestic and other cognitive disorders
Cognition is seriously disturbed
Delirium is a clouding of consciousness, wandering attention, and an incoherent
stream of thought. It may be causes by several medical conditions such as
malnutrition as well as by substance abuse
Dementia, a deterioration of mental capacities esp memory, is associated with
Alzheimer’s disease, stroke and several other medical conditions as well as with
substance abuse
Amnestic syndrome is an impairment in memory when there is no delirium or
dementia
Delirium and dementia are associated with aging. Amnesties syndrome is often
linked with alcohol abuse
ISSUES IN THE CLASSIFICATION OF ABNORMAL BEHAVIOURA
Those who are critical of the DSM, one group asserts that classification per se is
irrelevant to the filed of ab beh and a 2nd group finds specific deficiencies in the
manner in which diagnoses are made in the DSM
General criticisms of classification
Some critics of classification argue that to classify someone as depressed or anxious
results in a loss of info about that person
The existing research shows that the general public holds a relatively negative view
of mental patients esp those diagnosed with one of the psychotic disorders
The value of classification and diagnoses
For ex: mental retardation is sometimes caused by phenylketonuria. A deficiency in
the metabolism of the protein phenylalanine results in the release of incomplete
metabolites that injure the brain. A diet drastically reduced in phenylaanine prevents
some of this injury
Only after a diagnostic category has been formed can we study ppl who fit its
definition
Specific criticisms of classification
The principal ones concern whether discrete diagnostic categories are justifiable
whether the diagnostics categories are reliable and valid
Discrete entity vs continuum
The DSM represents a categorical classification, a yes-no approach to classification
Discrete (separate) diagnostic entities, does not allow continuity between normal and
abnormal beh to be taken into consideration. Those who advance the continuity
argument hold that ab and normal beh differ only in intensity or degree, not in kind;
therefore discrete diagnostic categories foster a false impression of discontinuity
In contrast, in dimensional classification, the entities or objects being classified must
be ranked on a quantitative dinension
Classification would be accomplished by assessing patients on the relevant
dimensions and perhaps plotting the location of the patient in a system of coordinates
defined by his or her score on each dimension
A dimensional approach also allows for the possibility that certain indiv may
experience a # of troubling symptoms of a disorder but not meet the # of symptoms
required for an actual diagnosis
Clearly, a dimensional system that can be applied to most of the symptoms that
constitute the diagnoses of the DSM. Anxiety, depression and the many personality
traits are included in the personality disorders are found in different ppl to varying
degrees and thus do not seem to fit well with the DSM categorical model
Reliability: the cornerstone of a diagnostic system
The extent to which a classification system or a test or measurement of any kind,
produced the same scientific observation each time it is applied is the measure of its
reliability
Inter-rater reliability refers to the extent to which tow judges agree about an event
Reliability is a primary criterion for judging any classification system. For a
classification system to be useful those applying it must be able to agree on what is
and what is not
A person diagnosed as having an anxiety disorder by one clinician should be given
the same diagnosis by another clinician
The two components of reliability---agreeing on who is a member of a class and who
is not---are termed sensitivity and specificity. Sensitivity refers to agreement
regarding the presence of a specific diagnosis; specificity refers to agreement
concerning the absence of a diagnosis
How valid are diagnostic categories?
Construct validity. The diagnoses of the DSM are referred to as constructs cuz they
are inferred, not proven, entities
Construct validity is determined by evaluating the extent to which accurate
statements and predictions can be made about a category once it has been formed
The greater the # and strength of relationship into which a diagnosis enters, the
greater the construct validity
The DSM and criticisms of diagnosis
major improvements including:
1) the characteristic and symptoms of each diagnostic category in axes I and II are
now described much more extensively than they were in DSM-II
2) much more attention is now paid to how the symptoms of a given disorder ay
differ depending on the culture in which it appears . ex: schizoid and depression are
similar cross culturally but guilt is a frequent symptom of depression in western
society but an infrequent one in Japan and Iran
3) specific diagnostic criteria- the symptoms and other facts that must be present to
justify the diagnosis—are spelled out more precisely and the clinical symptoms that
constitute a diagnosis are defined in a glossary. The bases more making diagnoses are
more detailed and concrete in DSM-OV-TR
the improved explicitness of the DSM criteria led to improved reliability
another factor in improved reliability is the use of standardized, reliably scored
interviews for collecting the information needed for a diagnosis
results of evaluation of reliability of DSM-III-TR determined that reliabilities vary
but are acceptable for most of the major categories.
The study used a statistic called “kappa” which measures the proportion of agreement
over and above what would be expected by chance
Generally kappa’s over 70 are considered good. The kappa ranged between .47 and .
86 for the selected diagnosis
But a # of problems still remain:
1) The discrete entity vs continuum issue has not been resolved
2) it is unclear whether the rules for making diagnostic decisions are ideal
3) the reliability of axes I and II may not always be as high in everyday practise as it
is in formal research studies for diagnostics may not adhere as precisely to the criteria
as do those whose work is being scrutinized
4) although the improved reliability of the DSM may lead to more validity there is no
guarantee that it will. The diagnoses made according to the DSM criteria may not
reveal anything useful about the patients