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Chapter 3

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Health Studies

Chapter 3 – Classification and Diagnosis BRIEF HISTORY OF CLASSIFICATION:  19 & 20 centuries – great inconsistency in classification of abnormal behaviour, end of 19 century this was recognized as a serious issue  1882 – in the UK, the Statistical Committee of Royal Medico-Psychological Association created a classification system, revised several times but never adopted by associate members  1889 – in Paris, Congress of Mental Science, adopted a single classification system, never widely used  In the USA, the Association of Medical Superintendents of American Institutions for the Insane (forerunner of American Psychiatric Association), revised British version in 1886 then again in 1913 to incorporate ideas from Emil Kraeplin DEVELOPMENT OF WHO AND DSM SYSTEMS:  1939 – steps towards classification uniformity, the World Health Organization added mental health disorders to International List of Causes of Death, list expanded in 1948 to International Classification of Diseases, Injuries, and Causes of Death (ICD)  American Psychiatric Associated did not follow mental health section of ICD and published the DSM  Revision of DSM-IV (published 1994) by Allen Frances by reviewing sections of DSM-III-R, prepared literature reviews, analyzed previously collected data, and collecting new data if needed; important changes: adoption of conservative approach to making changes in diagnostic criteria  Paula Caplan, a Canadian psychologist, is known for being critical of the DSM. There are two types of groups critical of the DSM, one group feels that the DSM classification is irrelevant to abnormal psychology and the second group finds deficiencies in the manner of diagnoses  DSM originally developed by physicians applying a medical model to the diagnosis of presumed psychiatric illnesses and assumed that categorical diagnoses correspond to actual underlying disease entities with specific symptoms, treatments, and prognoses (basically seen as an oversimplification and overgeneralization) FIVE DIMENSIONS OF CLASSIFICATION (DSM-IV-TR): DSM (Diagnostic and Statistical Manual of Mental Disorders) – classification system employed my mental health professionals, currently using DSM-IV-TR  Uses multi-axial classification; each individual is rated on five separate dimensions (axes), Axes I and II are separated to ensure the presence of long-term disturbances is not overlooked  Axis I – All diagnostic categories except personality disorders and mental retardation  Axis II – Personality disorders and mental retardation  Axis III – General medical conditions  Axis IV – Psychosocial and environmental problems  Axis V – Current level of functioning DIAGNOSTIC CATEGORIES: Mental disorder – clinically significant behavioural or psychological syndrome or pattern occurring in an individual associated with present distress or disability impairment in one or more important areas of functioning, or with significantly increased risk of suffering death, pain, disability, or an important loss of freedom (cannot be the result of a syndrome/pattern expected or culturally sanctioned such as death of loved one).  Disorders usually first diagnosed in infancy, childhood, or adolescence: o Separation anxiety – child has excessive anxiety about being away from home or parents o Conduct disorder – child repeatedly violates social norms and rules o Attention deficit hyperactivity disorder – difficulty in sustaining attention and unable to control activity when situation calls for it o Mental retardation – shows abnormal intellectual functioning and deficits in adaptive functioning o Pervasive developmental disorder - includes autistic spectrum disorders, a severe condition in which the individual has problems in acquiring communication skills and deficits in relating to other people o Learning disorders – refers to delays in acquisition of speech, reading, arithmetic, and writing skills  Substance-related disorders – diagnosed when ingestion of some substance (alcohol, opiates, cocaine, amphetamines etc.) changes behaviour enough to impair social and/or occupational functioning  Schizophrenia – described as being out of touch with reality, language and communication disordered, often shifting from one subject to another, experiences delusions, can be plagued by hallucinations and hearing voices, emotions are often blunted, flattened, or inappropriate  Mood disorders: o Major depressive disorder – individual is deeply sad and discouraged, tendency toward suicidal thoughts and feelings of self-reproach o Mania – described as exceeding euphoric, irritable, more active than usual, distractible, and possessed with unrealistically high self-esteem o Bipolar disorder – diagnosed if the person experiences episodes of mania or of both mania and depression  Anxiety disorders: o Phobia – fear of an object or situation so intensely that it must be avoided albeit the fear is unwarranted or unreasonable and can disrupt the lives of others o Panic disorder – described as being subject to sudden but brief attacks of intense apprehension, so upsetting that he or she is likely to tremble and shake, feel dizzy, and have trouble breathing o Generalized anxiety disorder – fear and apprehension are pervasive, persistent, and uncontrollable; constantly worrying, generally feelings of being on edge, easily tired o Obsessive-compulsive disorder – subject to persistent obsession or compulsions; obsessions are recurrent thoughts, ideas, or images that uncontrollably dominate a person’s consciousness, a compulsion is an urge to perform a stereotyped act o Post-traumatic stress disorder – experience of anxiety and emotional numbness in the aftermath of a very traumatic event o Acute stress disorder – similar to post-traumatic stress disorder but the symptoms do not last long  Somatoform disorders: o Somatization disorder – people with this disorder often have a long history of multiple physical complaints for which they have taken medicine or consulted doctors o Conversion disorder – a loss of motor or sensory function, such as paralysis, an anaesthesia, or blindness o Pain disorder – described as prolonged suffering from severe pain o Hypochondriasis – misinterpretation of minor physical sensations as serious illness o Dysmorphic disorder – described as having an obsessively imagined defect in their appearance  Dissociative disorders: o Dissociative amnesia – a person may forget their entire past or lose part of their memory for a particular time period o Dissociative fugue – the individual suddenly and unexpectedly travels to a new locale, starts a new life, and cannot remember his/her own previous identity o Dissociative identity disorder – possessed two or more distinct personalities, each complex and dominant one at a time o Depersonalization disorder – is a severe and disruptive feeling of self-estrangement or unreality  Sexual and gender disorders: o Paraphilias – unconventional sources of sexual gratification (exhibitionism, voyeurism, sadism, masochism) o Sexual dysfunctions – unable to complete the usual sexual response cycle (inability to maintain an erection, premature ejaculation, and inhibition of orgasm) o Gender identity disorder – feelings of extreme discomfort with their anatomical sex and identify 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 such as nightmares and sleepwalking  Eating disorders: o Anorexia nervous – avoidance of eating and becoming emaciated usually because of an intense fear of becoming fat o Bulimia nervosa – frequent episodes of binge eating are coupled with compensatory activities such as self-induced vomiting and heavy use of laxatives  Factitious disorder – applies to individuals who intentionally produce or complain of physical or psychological symptoms, apparently because of a psychological need to assume the role of a sick person  Adjustment disorder – involved the development of emotional or behavioural symptoms following the occurrence of a major life stressor but do not meet the diagnostic criteria for any other Axis I diagnosis (ex. a person can have an adjustment disorder with a depressed or anxious mood but the depression/anxiety is not significant enough to warrant a diagnosis of depression or anxiety)  Impulse-control disorders: o Intermittent explosive disorder – episodes of violent behaviour that result in destruction of property or injury to another person o Kleptomania – compulsion to steal repeatedly but not for the monetary value or use of the object o Pyromania – compulsion to purposefully set fires and derives pleasure from doing so o Pathological gambling – persistent and recurrent maladaptive gambling behaviour; youth are at a greater risk for problem gambling than adults, 12-month prevalence of moderate risk/problem gambling for youth aged 15-24 at 2.2%; cognitive-behavioural treatments most effective o Trichotillomania – unable to resist the urge to pluck out hair, often results in significant hair loss  Personality disorders: o Schizoid personality disorder – individual is aloof, has few friends, indifferent to praise and criticism o Narcissistic personality disorder – individual has an overblown sense of self-importance, fantasizes about great successes, requires constant attention, likely to exploit others o Anti-social personality disorder – surfaces as a conduct disorder before adolescence, in adulthood the individual suffers from significant indifference to relationships, occupation, the law, and one’s future; also called psychopathy, no feelings of guilt or shame for transgressing social norms  Other conditions that may be a focus of clinical attention: an all-encompassing category composed of conditions that are not regarded as a true mental disorder but still warrant attention or treatment such as academic problems (underachievement), anti-social behaviour, malingering, relational problems, occupational problems, physical or sexual abuse, bereavement, noncompliance with treatment, religious or spiritual problem, phase-of-life problem  Delirium, dementia, amnestic, and other cognitive diso
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