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Chapter 3

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 3 PSYB32 Chapter 3 Classification and Diagnosis  Diagnostic and Statistical Manual of Mental Disorders (DSM): A publication of the American Psychiatric Association that is an attempt to delineate specific and discrete syndromes or mental disorders. It has been through several revision and the current one is the fourth edition (DSM-IV) A Brief History of Classification  By the end of the 19 century, medicine had progressed far beyond its practice during the Middle ages o People realized bloodletting was not suitable for all diseases  Diseases started to be classified Early Efforts at Classification  19 , 20 century there was great inconsistency classifying abnormal behavior o led to problems with communication among people in the field  Different countries had different systems Development of the WHO and the DSM Systems  1969 – WHO (World Health Organization) published a new classification system  1968 - APA made a second version of the DSM, DSM II and was similar to the WHO version o UK a glossary of definitions was produced to accompany it  Still no consensus  1980 – APA made DSM III and a revised version in 1987 – DSM III – R  1994 – DSM IV  2000 – DSM IV-TR o Sections are rewritten to enhance clarity and incorporate recent research finding related to issues such as the prevalence, course, and etiology of disorders  To many clinical scientists and practitioners it is not the “book of truth” about psychological problems o Has a medical model to the diagnosis  Categories of DSM are controversial as to whether they actually correspond to real underlying entities of the illness The Current Diagnostic System of the American Psychiatric Association (DSM-IV and DSM-IV-TR) Definition of Mental Disorders  Mental disorder: A behavioralor psychological syndrome associated with current distress and/or disability  DSM-IV-TR: provides following definition for mental disorder o A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g. painful symptom) or disability (i.e. 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 In addition this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event (e.g. the death of a loved one). Whatever its original cause, it must currently be considered a manifestation of a behavior, psychological, or biological dysfunction in the individual Five Dimensions of Classification  Many innovation distinguish the third edition and subsequent version of the DSM  Multiaxial classification: Classification having several dimensions, each of which is employed in categorizing (Ex. DSM – IV) o Each individual is rated on five separate dimensions/axes o Five axes include  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  Separation of Axis I and Axis II is to encourage clinicians to be attentive to the possibility of having an Axis II condition after the onset of an Axis I condition  The other three axes help physicians understand people’s life conditions better Chapter 3 PSYB32  Axis Iv codes psychosocial and environmental problems that the person has been experiencing and that could contribute to the disorder o Social relationships occupational functioning, use of leisure time Diagnostic Categories  For many disorders the DSM indicates that the disorder may be due to a medical condition or substance abuse  Therefore clinicians must be therefore be sensitive not only to the symptoms of their clients’ conditions  DSM-III has a dramatic expansion of the number of diagnostic categories Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence  This category contains the intellectual, emotional and physical disorders that usually begin in infancy, childhood or adolescence o The child with separation anxiety disorder has excessive anxiety about being away from home or parents o Children with conduct disorder repeatedly violate social norms and rules o Individuals with attention deficit hyperactivity disorder have difficulty sustaining attention and are unable to control their activity when the situation calls for it o Individual with mental retardation (listed on Axis II) show subnormal intellectual functioning and deficits in adaptive functioning o The pervasive development disorders include autistic disorder, a severe condition in which the individual has problems in acquiring communication skills and deficits in relating to other people o Learning disorders refer to delays in the acquisition of speech, reading, arithmetic, and writing skills Substance-Related Disorders  Diagnosed when the ingestion of some substance (alcohol, opiates, cocaine, amphetamines etc.) has changed behavior enough to impair social/occupational functioning  Discontinuation of ingestion may lead to withdrawal symptoms  Substances may also cause or contribute to development of other Axis I disorders Schizophrenia  Contact with reality is faulty  Language and communication are disordered and may shift from one subject to another in a way that makes it difficult to understand  Experience delusions, hallucinations and commonly hearing voices that come from outside themselves  Emotions are blunted, flattened or inappropriate  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 is also likely to lose weight and energy and have suicidal thoughts and feelings of self-reproach o Mania: described as exceedingly euphoric, irritable, more active than usual, distractible, and possessed of unrealistically high self-esteem o Bipolar disorder: diagnosed if the person experiences episodes of mania or of both mania and depression Anxiety Disorders  Some form of irrational or overblown fear as the central disturbance o Phobia: fear an object or situation so intently 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 but brief attacks of intense apprehension, so upsetting that he or she is likely to tremble and shake, feel dizzy, and have trouble breathing  Might be accompanied by agoraphobic: when the person is also fearful of leaving familiar surroundings o Generalized anxiety disorder: fear and apprehension are pervasive, persistent, and uncontrollable.  Worry constantly, feel generally on edge, and are easily tired o Obsessive-Compulsive disorder: subject to persistent obsessionsor compulsions  Obsession: a recurrent thought, idea, or image that uncontrollably dominated a person’s consciousness Chapter 3 PSYB32  Compulsion: is an urge to perform a stereotyped act that usually wards of an impending feared situation o Post-traumatic stress disorder: experiencing anxiety and emotional numbness after a traumatic event  Painful intrusive recollections by day and bad dreams by night  Difficult to concentrate and feel detached from others and from ongoing affairs o Acute Stress Disorder: similar to PTSD but symptoms do not last long Somatoform Disorders  Physical symptoms of somatoform disorders have no known physiological cause but seem to serve a psychological purpose o Somatization disorder: long history of multiple physical complaints for which they have taken medicine or consulted doctors o Conversion disorder: report the loss of motor or sensory function (paralysis, anesthesia, blindness) o Pain disorder: suffer from severand prolonged pain o Hypochondriasis: misinterpretation of minor physical sensations as serious illness o Dysmorphic disorder: preoccupied with an imagined defect in their appearance Dissociative Disorders  Psychological dissociation is a sudden alteration in consciousness that affects memory and identity o Dissociative amnesia: may forget their entire past or lose their memory for a particular period of time o Dissociative fugue: the 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 (formerly known as multiple personality disorder): possesses two or more distinct personalities, each complex and dominant one at time o Depersonalization disorder: sever and disruptive feeling of self-estrangement or unreality Sexual and Gender Identity Disorders  Paraphilias: sources of sexual gratification-as in exhibitionism, voyeurism, sadism, masochism – are unconventional  Sexual dysfunctions: unable to complete the usual sexual response cycle. Inability to maintain an erection, premature ejaculation, inhibition of orgasm  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, quality or timing  Parasomnias: an unusual event occurs during sleep Eating Disorders  Anorexia nervosa: the person avoids eating and becomes emaciated, usually because of an intense fear of becoming fat  Bulimia nervosa: frequent episodes of binge eating are coupled with compensatory activities such as self- induced vomiting and heave use of laxatives Factitious Disorder  Applied to people 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 Disorders  Involves the development of emotional or behavioral symptoms following the occurrence of a major life stressor  The depression/anxiety they experience is not enough to diagnose as an Axis I problem Impulse-Control Disorders  Include a number of conditions in which the person’s behavior is inappropriate and seemingly out of control o Intermittent explosive disorder: person has episodes of violent behavior that result in destruction of property or injury to another person o Kleptomania: the person steals repeatedly, but not for the monetary value or use of the object o Pyromania: the person purposefully sets fires and derives pleasure from doing so Chapter 3 PSYB32 o Pathological gambling: the person is preoccupied with gambling, is unable to stop, and gambles as a way to escape from problems o Trichotillomania: diagnosed when the person cannot resist the urge to pluck out his or her hair, often resulting in significant hair loss Personality Disorders  Enduring, inflexible and maladaptive patterns of behavior and inner experience o Schizoid personality disorder: the person is aloof, has few friends and is indifferent to praise and criticism o Narcissistic personality disorder: an overblown sense of self-importance, fantasizes about great successes, requires constant attention and is likely to exploit others o Anti-social personality disorder: surfaces as conduct disorder before age 15 and is manifested in truancy,
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