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Chapter 3

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University of Toronto Scarborough
Konstantine Zakzanis

Abnormal Psychology - Chapter 3: Classification and Diagnosis  official diagnostic system widely employed by mental health professionals, the Diagnostic and Statistical Manual of Mental Disorders (DSM) A Brief History of Classification Early Efforts at Classification  during the 19th and early 20th centuries, there was great inconsistency in the classification of abnormal behaviour  by the end of 19th century, the diversity of classifications was recognized as a serious problem that impeded communication among people in the field and several attempts were made to produce a system of classification that would be widely adopted Development of the WHO and DSM System  1939- the World Health Organization (WHO) added mental disorders to the International List of Causes of Death  the mental disorders section was not widely accepted  the American Psychiatric Association published its own Diagnostic and Statistical Manual (DSM) - 1952  1969- WHO published a new classification system that was more widely accepted  a second version of DSM, DSM-II(1968), was similar to the WHO system and in the /united Kingdom a glossary of definitions was produced to accompany it  the WHO classifications were simply a listing of diagnostic categories; the actual behaviour or symptoms that were the bases for the diagnoses were not specified  DSM-II and the British Glossary of Mental Disorders provided some of this crucial information but did not specify the same symptoms for a given disorder  1980- American Psychiatric Association published an extensively revised diagnostic manual (DSM- III), 1987- somewhat revised version appeared which was DSM-III-R  DSM-IV was published in 1994 and the American Psychiatric Association completed a text revision  DSM is controversial, it is not the "book of truth"  it was originally developed by physicians who applied a medical model to the diagnosis of presumed psychiatric illnesses and assumed that categorical diagnoses correspond to actual underlying diseases entities with specific symptoms, treatments and prognoses  most psychiatric diagnoses are not identical to medical diagnoses where the basic cause is frequently known and the presence of the disease can usually be objectively determined The Current Diagnostic System of the American Psychiatric Association (DSM-IV & DSM-IV-TR) Definition of a Mental Disorder  A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (ex. painful symptom) or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom 1 Abnormal Psychology - Chapter 3: Classification and Diagnosis  this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event (ex. death of loved one) - its original cause, must be considered a manifestation of a behavioural, psychological or biological dysfunction in the individual Five Dimension of Classification  multiaxial classification: each individual is rated on five separate dimensions or axes - the 5 axes are:  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 - Psychological and environmental problems  Axis V - Current level of functioning  axes I and II compose the classification of abnormal behaviour, they are separated because to ensure that the presence of long term disturbances is not overlooked  most people consult a mental health professional for an axis I condition (ex. depression), but prior to the onset of their axis I condition, they may have had an axis II condition (ex. dependent personality disorder) - the separation is so that clinicians can be attentive to this possibility  the other 3 axes indicates that factors other than a person's symptoms should be considered in an assessment so that the person's overall life situation can be better understood  axis IV codes psychosocial and environmental problems such as occupational problems, economic problems, interpersonal difficulties with family members  axis V - indicates the person's current level of adaptive functioning Diagnostic Categories Disorders usually First diagnoses in Infancy, Childhood or Adolescence  separation anxiety - excessive anxiety about being away from home or family  conduct disorder - children repeatedly violate social norms and rules  attention deficit hyperactivity disorder - have difficulty sustaining attention and are unable to control their activity when the situation calls for it  mental retardation - show subnormal intellectual functioning and deficits in adaptive functioning  pervasive developmental disorders - include autistic disorder - a severe condition in which the individual has problems in acquiring communication skills and deficits in relating to others  learning disorders - delays in the acquisition of speech, reading, arithmetic and writing skills Substance-Related Disorders  it is diagnosed when the ingestion of some substance has changed behaviour enough to impair social or occupational functioning  may become unable to control or discontinue ingestion of the substance  may develop withdrawal symptoms if he/she stops using the substance  may also cause or contribute to the development of other Axis I disorders (mood/anxiety disorders) 2 Abnormal Psychology - Chapter 3: Classification and Diagnosis Schizophrenia  contact with reality is faulty  language and communication are disordered and they may shift from one subject to another  commonly experience delusions (ex. believing that thoughts that are not their own have been placed in their heads)  sometimes plagued by hallucinations (hearing voices)  emotions are blunted, flattened or inappropriate  social relationships and ability to work show marked deterioration Mood Disorders  major depressive disorder - deeply sad and discouraged & likely to lose weight & energy & have suicidal thoughts and feelings of self-approach  mania - described as exceedingly euphoric, irritable, more active than usual, distractible & possessed of unrealistically high self-esteem  bipolar disorder - experiences episodes of mania or both mania and depression Anxiety Disorders  phobia - fear of an object or situation so intensely they must avoid it, even though their fear is unwarranted & unreasonable and disrupts their lives  panic disorder - person is subject to sudden, brief attacks of intense apprehension, so upsetting person is likely to tremble & shake, feel dizzy and have trouble breathing  agoraphobia - may be accompanied by panic disorders; when person is fearful of leaving familiar surroundings  generalized anxiety disorder - fear and apprehension are pervasive, persistent and uncontrollable, worry constantly, feel on edge and are easily tired  obsessive-compulsive disorder - subject to persistent obsessions or compulsions  obsession is a recurrent thought, idea or image that uncontrollably dominates a person's consciousness  compulsion is an urge to perform a stereotyped act, with usually impossible purpose of warding an impending feared situation  posttraumatic stress disorder - experiencing anxiety & emotional numbness in the aftermath of a traumatic event - they have painful, intrusive recollections by day and bad dreams  acute stress disorder - similar to post-traumatic stress disorder, but symptoms do not last as long Somatoform Disorders  somatization disorder - have a long history of multiple physical complaints for which they have taken medicine  conversion disorder - the loss of motor or sensory function (paralysis, blindness or anaesthesia - loss of sensation)  pain disorder - suffer from severe and prolonged pain  hypochondriasis - the misinterpretation of minor physical sensations as serious illness 3 Abnormal Psychology - Chapter 3: Classification and Diagnosis  dysmorphic disorder - preoccupied with an imagined defect in their appearance Dissociative Disorders  psychological dissociation - sudden alteration in consciousness that affects memory and identity  dissociative amnesia - may forget their entire past or lose their memory for a particular time period  dissociative fugue - person suddenly & unexpectedly travels to a new locale, starts a new life and cannot remember pervious identity  dissociative identity disorder - possesses two or more distinct personalities, each complex and dominant one at a time  depersonalization disorder - a severe and disruptive feeling of self-estrangement or unreality Sexual and Gender Identity Disorders  paraphilias - the sources of sexual gratification - as in exhibitionism, voyeurism, sadism, and masochism - are unconventional  sexual dysfunction - unable to complete the usual sexual response cycle, inability to maintain an erection, premature ejaculation and inhibition of orgasm are examples  gender identity disorder - feel extreme discomfort with their anatomical sex and identify themselves as members of the opposite sex Sleep Disorders  dyssomnias - sleep is disturbed in amount (ex. person is not able to maintain sleep or sleeps a lot), quality (person does not feel rested after sleep), or timing (person experiences inability to sleep during conventional sleep time)  parasomnias - an unusual event occurs during sleep (nightmares, sleepwalking) Eating Disorders  anorexia nervosa - person avoids eating and becomes emaciated, because of intense fear of becoming fat  bulimia nervosa - frequent episodes of binge eating are coupled with compensatory activities such as self-induced vomiting and heavy use of laxatives Factitious Disorders  people who intentionally produce or complain of physical or psychological symptoms, because of a psychological need to assume the role of a sick person Adjustment Disorders  the development of emotional or behavioural symptoms following the occurrence of a major life stressor  the symptoms do not meet diagnostic criteria for any other axis I diagnosis 4 Abnormal Psychology - Chapter 3: Classification and Diagnosis Impulse - Control Disorders  number of conditions in which the person's behaviour is inappropriate and seemingly out of control  intermittent explosive disorder - person has episodes of violent behaviour that result in destruction of property/injury to another person  kleptomania - personal steals repeatedly, but not for the monetary value or use of the object  pyromania - person purposefully sets fires and derives pleasure from doing so  pathological gambling- person is preoccupied with gambling, unable to stop and gambles as a way to escape from problems  trichotillomania - person cannot resist the urge to pluck out their hair, often resulting in hair loss Personality Disorders  defined as enduring, inflexible and maladaptive patterns of behaviour and inner experience  schizoid personality disorder - person is aloof, has few friends and is indifferent to praise & criticism  narcissistic personality disorder - overblown sense of self-importance, fantasizes about great successes, requires constant attention and is likely to exploit others  anti-social disorder - surfaces as conduct disorder before the person reaches age 15 & is manifested in truancy, running away from home, & general belligerence --- adulthood; person is indifferent about holding a job, being a responsible partner, planning for future or tomorrow and following laws ---people do not feel guilt or shame for transgressing social mores Other Conditions That May be A Focus of Clinical Attention  these conditions are not regarded as mental disorders  if an individual's medical illness appears
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