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Chapter 3

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 3: Classification and Diagnosis - Diagnostic system widely employed by mental health professions: Diagnostic and Statistical Manual of Mental Disorder (DSM) [BRIEF HISTORY OF CLASSIFICATION] - Early Efforts of Classification: o During 1800 and early 1900 there was great inconsistency in classification of abnormal behaviour o By end of 1900 the diversity of classification recognized as 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 systems: o 1939: World Health Organization(WHO) added mental disorders to the International List of Causes of Death o 1948: list expanded to become International Statistical Classification of Diseases, Injuries and Causes of Death (ICD): list of all diseases including classification of abnormal behaviour o 1952: American Psychiatric Association published its own Diagnostic and Statistical Manual (DSM) o WHO classification simply a listing of diagnostic categories; actual behaviour or symptoms that were the bases of diagnoses were not specified o DSM-II and the British Glossary of Mental Disorders provided some of the crucial info but did not specify the same symptoms for a given disorder o DSM-IV used throughout USA and Canada and accepted around much of the world [Diagnostic System of the American Psychiatric Association (DSM-IV and DSM-IV-TR)] - Definition of mental disorder: o A clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (painful symptom) or disability (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 o Syndrome or pattern must not be an expectable and culturally sanctioned response to a particular event (death of a loved one); it must be a manifestation of a behavioural, psychological or biological dysfunction in the individual - Five Dimensions of Classification: o Multiaxial Classification (MAC): each individual is rated on five separate dimensions or axes  Axis I: all diagnostic categories except personality disorder and mental retardation  Axis II: Personality disorders and mental retardation  Axis III: general medical conditions  Axis IV: psychosocial and environmental problems  Occupational problems, economic problems, interpersonal difficulties with family members and a variety of problems in other life areas that may influence psychological functioning  Axis V: current levels of adaptive functioning  Life areas considered are social relationships, occupational functioning and use of leisure time  Give info about need of treatment o The MAC forces diagnostician to consider broad range of info o Axis I and II are separated to ensure that the presence of long-term disturbances is not overlooked o Axis III-V are not needed to make actual diagnosis but they are invaded to indicate that factors other than a person’s symptoms should be considered in an assessment so that person’s overall life situation can be better understood - Diagnostic Categories: o DSM indicates that disorder for axis I and II may be due to medical conditions or substance abuse o Clinicians must be sensitive not only to the symptoms of their patients, but also to the possible medical causes of their patient’s conditions  Disorders usually first diagnosed in infancy, childhood or adolescence: o Separation anxiety disorder: excessive anxiety about being away from home or patents o Conduct disorder: repeatedly violate social norms and rules o Attention-deficit/hyperactivity disorder: difficulty sustaining attention and are unable to control their activity when the situation calls for it o Mental retardation: subnormal intellectual functioning and deficits in adaptive functioning o Pervasive developmental disorders: autistic disorder, severe condition in which individual has problems in acquiring communication skills and deficits in relating to other people o Learning disorder: refers to delay in acquisition of speech, reading, arithmetic and writing skills  Substance-related disorders o Diagnosed when ingestion of some substance (alcohol, opiates, cocaine, amphetamine) has changed behaviour enough to impair social or occupational functioning o Individual unable to control or discontinue ingestion of the substance and my develop withdrawal symptoms if they stop using it o Contribute to development of other Axis I disorders i.e. mood or anxiety disorder  Schizophrenia: o Contact with reality is faulty o Language and communication is disordered, may shift from one subject to another in ways that make them difficult to understand o Experience delusions (believing that thoughts that are not their own have been placed in their head) o Plagued by hallucinations (hearing voices that come from outside themselves) o Emotions are blunted, flattened or inappropriate and social relationships and ability to work show marked deterioration  Mood disorders: applied to people whose moods are extremely high or low o Major depressive disorder: person is deeply sad and discouraged and likely to lose weird and energy and have suicidal thoughts ad feelings of self-reproach o Mania: exceedingly euphoric, irritable, more active than usual, distractible and possessed of unrealistically high self-esteem o Bipolar disorder: diagnosed if person experiences episodes of mania or of both mania and depression  Anxiety disorders: have some form of irrational or overblown fear as the central disturbance o Phobia: fear an object or situation so intensely that they must avoid it, even though they know that their fear is unwarranted and unreasonable and disrupts their lives o Panic disorder: person is subject to sudden brig attacks of intense apprehension, so upsetting that he or she is likely to tremble, shake, feel dizzy and have trouble breathing; can be accompanied by agoraphobia when person is also fearful of leaving familiar surroundings o General anxiety disorder: fear and apprehension are pervasive, persistent and uncontrollable; worry constantly, feel generally on edge and are easily tired o OCD: subject to persistent obsessions or compulsions; attempts to resist a compulsion create so much tension that individual usually yields to it o Posttraumatic stress disorder (PTSD): experiencing anxiety and emotional numbness in aftermath of very traumatic event; individual has painful, intrusive recollections by day and bad dreams by night; difficult to concentrate and feel detached from others and from on going affairs o Acute stress disorder: similar to PTSD but symptoms do not last as long  Somatoform disorders: o Somatisation disorder; Long history of multiple physical complaints for which they have taken medicine or consulted doctor o Conversion disorder: report loss of motor or sensory function such as paralysis and anaesthesia or blindness o Pain disorder: suffer from severe and prolonged pain o Hypochondriasis: misinterpretation of minor physical sensations as serious illness o Body Dysmorphic disorder: preoccupied with an imaged defect in their appearance  Dissociative disorders: sudden alteration in consciousness that affects memory and identity o Dissociative amnesia: may forget their entire past or lose their memory for 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: possesses two or more distinct personalities, each complex and dominant one at a time o Depersonalization disorder: severe and disruptive feeling of self-estrangement or unreality  Sexual and Gender Identity disorders: o Paraphilias: sources of sexual gratification- exhibitionism, voyeurism, sadism and masochism- are conventional o Sexual dysfunction: unable to complete usual sexual response cycle. Inability to maintain an erection, premature ejaculation and inhibition of orgasm are examples of their problem o Gender identity disorder: feel extreme discomfort with their anatomical sex and identify themselves as members of opposite sex  Sleep disorders: o Dyssomnias: sleep is disturbed in amount (person is not able to maintain sleep or sleeps too much), quality (person does not feel rested after sleep) or timing (person experiences inability to sleep during conventional sleep times) o Parasomnias: unusual events occur during night (sleep walking or nightmares)  Eating Disorders: o Anorexia nervosa: person avoids eating and becomes emaciated, usually because of an intense fear of becoming fat o Bulimia nervosa: frequent, episodes of binges eating are coupled with compensatory activist such as self-induced vomiting and heavy use of laxatives  Faticious disorder: o People who intentionally produce or complain of psychical or psychological symptoms because of psychological need to assume the role of a sick person  Adjustment disorders o Development of emotional or behavioural symptoms following occur
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