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Lecture 3

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York University
PSYC 3140
James Alcock

January 21, 2013 Tahreem Mahmood Lecture 3 Abnormal Psychology -Psych 3230 What is Diagnosis?  What does it mean to “diagnose”?  A diagnosis is an identification of a condition or disease state  This is a medical notion that may or may not apply to psychological problems  Need a diagnostic system – a collection of rules for guiding us in our determination of a diagnosis o A “cold” is different from pneumonia in that… o Depression is different from anxiety in that… What do we want in a Diagnostic System?  Need descriptions that allow different clinicians to recognize the same disorder (reliability)  Need descriptors such that if present, they indicate the presence of a disorder, and if absent, the disorder is absent (validity) Diagnosis  Recall: o Hippocrates: beginnings of a diagnostic system o Kraeplin (19 century)  First comprehensive diagnostic system based on which characteristics occur together  Yet, that is not so easy o How do you know if someone is depressed?  It is enough for someone to say “I am depressed?”  Does the person have to cry a lot or talk of suicide?  Is loss of appetite?  Is it a unified thing?  A problem with depression and suicide is that a lot of depressed people don’t have the energy to commit suicide  1948: World Health Organization o Extended “International List of the Causes of Death” to include psychological abnormalities o The list was renamed the International Statistical Classification of Diseases, Injuries and Causes of Death (ICD)  1952 – American Psychiatric Association published its own diagnostic system, the Diagnostic and Statistical Manual of Mental Disorders January 21, 2013 Tahreem Mahmood Lecture 3 Abnormal Psychology -Psych 3230  Diagnostic categories were: o Poorly defined o Heavily psychoanalytic – manuals focused on unobservable internal states o Not based in empirical research o Did not involve objective criteria  Consequently it was not very useful, and different clinicians would come up with different diagnosis for the same person  1968: DSM-II o Suffered from many of the same problems as the original DSM  1980: DSM – III o Radically different from DSM – II  Focus on descriptive features that allow identification of the problem rather than interpretation based on invalidated theories o Axis:  1. Clinical disorder and then  2. personality disorder  3. Clinical problem  4. Psychosocial stressors  5. Global assessment of function  1987 DSM – III R – a minor revision  1994 DSM – IV – major revision, still using multiaxial approach o Development team searched for an empirical basis for each disorder, and carried out extensive field trials using the classification system  Evaluated more than 6000 subjects, using hundreds of clinicians looking at reliability and validity o Developers took more international approach; Cooperated with developers of ICS-10 which is widely used outside North America  ICD = used around the world  DSM: North American o Helps communicate  For both DSM and ICD diagnosis are defined purely in terms of symptoms o Quite different from diagnosis in physical medicine o In physical medicine, data not available from the patient is gathered by tests – blood tests, x-rays, etc o Medical diagnosis add new information about the disorder – causation, course, treatment, etc  In DSM – IV, each mental disorder is conceptualized as: January 21, 2013 Tahreem Mahmood Lecture 3 Abnormal Psychology -Psych 3230 o “A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (e.g., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom”  Excluding simple deviance from societal norms e.g., Squeegee kid  Excluding expected or culturally sanctioned responses – as to the death of a loved one  In DSM – IV NOT assumed that all categories are mutually exclusive, that there is no overlap.  Because of the continuum between normal and abnormal functioning, often only need to fill a subset of conditions to warrant the diagnosis  Aim is to describe accurately the various disorders rather than interpret them. Major Axes in DSM – IV  Axis 1 – Clinical Syndromes (partial list) o Disorders usually first diagnosed in infancy, childhood & adolescence o Delirium, dementia, amnesic and other cognitive disorders o Substance—related disorders o Schizophrenia and other psychotic disorders o Mood disorders o Somatoform disorders o Sexual and gender disorders o Dissociative disorders o Eating disorders o EXAMPLE : Diagnostic Criteria,  Obsessive – Compulsive Disorder A. Either obsessions or compulsions B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable (note: this does not apply to children) C. The obsessions or compulsions caused marked distress, are time consuming (take more than hour a day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence January 21, 2013 Tahreem Mahmood Lecture 3 Abnormal Psychology -Psych 3230 of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder)  Obsessions are defined by (1), (2), (3), and (4): 1. Recurrent and persistent thoughts, impulses, or Images that are experienced at some time during disturbance, as intrusive and inappropriate and that cause marked anxiety or distress 2. The thoughts, impulses, or images are not simply excessive worries about real-life problems 3. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action 4. The person recognizes that the obsession thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)  Compulsi
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