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PSY 606 (26)
Chapter 3

Chapter 3 notes

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PSY 606
Thomas Hart

Chapter 3 Classification & Diagnosis May 20, 2008 • Diagnostic and Statistical Manual of Mental Disorders: DSM – IV The Brief History of Classification • People realized different illnesses required different treatments • There was a lot of diversity of classification in the end of the 19 century Development of the WHO and DSM systems • In 1969 the WHO published a new classification system that was more widely accepted • The WHO classifications were just lists of diagnostic categories but the actual behaviour or symptoms that were the basis for the diagnoses were not specified • DSM 11 provided some crucial information, but did not specify symptoms • 1988 DSM IV – the reasons for diagnostic changes were in it; published in 1994 The Diagnostic System of the American Psychiatric Association (DSM-IV and DSM-IV-TR) Definition of Mental Disorder • It recognizes that no definition adequately specifies precise boundaries for the concept • But is conceptualized as a significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress, disability or increased risk of suffering death, pain, disability or loss of freedom • It can’t be an expectable and culturally sanctioned response to an event (like death of a loved one) • It can’t be deviant behaviour nor conflicts that are primarily between the individual and society Five dimensions of classification • Multiaxial classification • Axis 1: all diagnostic categories except personality disorders and mental retardation • Axis 2: Personality disorders and mental retardation • Axis 3: General medical condition • Axis 4: Psychosocial and environmental problems (occupational, economic, interpersonal and family problems) • Axis 5: Current level of functioning (social relationships, occupational function and use of leisure time) Diagnostic Categories • Intellectual, emotional and physical disorders usually begin in infancy, childhood or adolescence • Separation anxiety, conduct disorder (violate social norms repeatedly), ADHD, mental retardation, pervasive developmental disorders (problems in acquiring communication skills and deficits in relating to other people), and learning disorders (speech, reading, arithmetic, and writing skills) • Substance-related disorders: ingesting some substance that impairs social or occupational functioning. They may not be able to stop ingestion and have withdrawal symptoms. It may contribute to other Axis 1 disorders (mood or anxiety disorder) • Schizophrenia: language and communication are disordered, delusions, hallucinations, their emotions are blunted, flattened or inappropriate, and their social relationships and ability to work show marked deterioration • Mood disorders: moods that is extremely high or low. o Major depressive disorder: deeply sad and discouraged (lose weight and energy), and have suicidal thoughts and feeling of self-reproach o Mania: exceedingly euphoric, irritable, more active than usual, distractible, and possessed of unrealistically high self esteem o Bipolar disorder: both mania and depression • Anxiety disorders: some form of irrational or overblown fear of the central disturbance o Phobia: fear an object or situation so intensely that they must avoid it, even when they know it’s unreasonable. It disrupts their lives o Panic disorder: sudden but brief attacks of intense apprehension. They will tremble and shake, feel dizzy and have trouble breathing  Agoraphobia: when person is fearful of leaving familiar surroundings o Generalized anxiety disorder: fear and apprehension are pervasive, persistent and uncontrollable. Feel on the edge and easily tired. o Obsessive-compulsive disorder: obsessions or compulsions. Recurrent thought, idea, or image that dominates their consciousness o Posttraumatic stress disorder: anxiety and emotional numbness after a very traumatic event. They have painful intrusive recollections by day and bad dreams at night and feel detached from others o Acute stress disorder: like posttraumatic stress disorders, but the symptoms do not last as long • Somatoform disorders: the physical symptoms have no physiological cause but seem to serve a psychological purpose o Somatisation disorder: long history of multiple physical complains for which they have taken medicine or consulted doctors o Conversion disorder: loss of motor or sensory function, such as paralysis, an anaesthesia or blindness o Pain disorder: suffer from severe and prolonged pain o Hypochondriasis: misinterpretation of minor physical sensations as serious illness o Dysmorphic disorder: preoccupied with an imagined defect in their appearance • Dissociative Disorder: psychological dissociation is sudden alteration in consciousness that affects memory and identity o Dissociative amnesia: may forget their entire past or lose their memory for a particular time period o Dissociative fugue: individual suddenly and unexpectedly travels to a new locale, starts a new life, and cannot remember his or her previous identity o Dissociative identity disorder: possess two or more distinct personalities, each complex and dominant one at a time o Depersonalization disorder: a severe and disruptive feeling of self-estrangement or unreality • Sexual and Gender Identity disorders o Paraphilias: sources of sexual gratification (exhibitionist, voyeurism, sadism) o Sexual dysfunctions; unable to complete usual response cycle, inability to maintain erection ,premature ejaculation, and inhibition of orgasm o Gender identity disorder: extreme discomfort with the anatomical sex and identity themselves as members of the opposite sex • Sleep disorders o Dyssomnias: sleep is disturbed in amount, quality or timing o Parasomnias: unusual events occur during sleep (nightmare, sleepwalking) • Eating disorders o Anorexia nervosa: person avoids eating and emaciated, because they fear of becoming fat o Bulimia nervosa: binge eating and self induced vomiting and heavy use of laxatives • Factitious disorder: people who intentionally complain of physical or psychological symptoms, apparently because of a psychological need to assume the role of a sick person • Adjustment disorder: development of emotional or behavioural symptoms following the occurrence of a major life stressor (do not meet diagnostic criteria for any other Axis 1 diagnosis) • Impulse-Control Disorder: persons behaviour is inappropriate and seemingly out of control o Intermittent explosive disorder: episodes of violent behaviour that result in destruction of property or injury to another person o Kleptomania: person steals repeatedly, but not for monetary value or use of the object o Pyromania: purposefully sets fires and derives pleasure from it o Pathological gambling: p
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