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Chapter 3

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 3: Classification and Diagnosis Diagnosis can seem tedious because it sometimes relies on fine distinctions Ex: anxiety in social situations (being tense around others) is a symptom of both schizotypal and avoidant personality disorders. A person with schizotypal personality disorder, the anxiety doesn’t decrease as the individual becomes more familiar with people, whereas a person with avoidant personality disorder, exposure does tend to reduce social anxiety A BRIEF HISTORY OF CLASSIFICATION In 1939, the World Health Organization (WHO) added mental disorders to the International List of Causes of Death In 1948, the list was expanded to become the international Statistical Classification of disease, Injuries, and Causes of death The DSM was developed originally by physicians who applied 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 CURRENT DIAGNOSTIC SYSTEM OF THE AMERICAN PSYCHIATRIC ASSOCIATION (DSM-IV & DSM-IV-TR) The DSM-IV-TR provides the following definition for ``mental disorder``: 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 1 or more vital areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or important loss of freedom 5 dimensions of classification:  Axis I- all diagnostic categories except personality disorders and mental retardation (most people consult a mental professional because of depression or an anxiety disorder)  Axis II- personality disorders and mental retardation  Axis III- general medical conditions (conditions may be quite common)  Axis IV- psychosocial and environmental problems (occupational problems, economic problems, and interpersonal difficulties with family members)  Axis V- current level of functioning (use of leisure time) Disorders usually diagnosed in infancy, childhood, or adolescence:  Separation anxiety disorder- child has excessive anxiety about being away from home or parents  Conduct disorder- 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- (listed on Axis II) 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 other people  Learning disorders- delays in the acquisition of speech, reading, arithmetic, and writing skills Substance-related disorder: ingestion of some substance (alcohol, cocaine, opiates, amphetamines…) has changed behaviour enough to impair social/occupational functioning, and individual can’t control it Schizophrenia: thought disturbances, hallucinations, anxiety, emotional withdrawal, and delusions language and communication are disordered may shift form one subject to another in ways that make them difficult to understand means “split mind” but doesn’t imply a split or multiple personality Mood disorders (moods are extremely high or low): Major depressive disorder- person is deeply sad and discouraged and is also likely to lose weight and energy and to have suicidal thoughts and feelings of self-reproach Mania- exceedingly euphoric, irritable, more active than usual, distractible, and possessed of unrealistically high self-esteem Bipolar disorder- person experiences episodes of mania or of both mania and depression Anxiety Disorders (irrational or overblown fear as the central disturbance): Phobia- fear an object or situation so intensely they must avoid it, even though they know their fear is unreasonable and disrupts their lives Panic disorder- sudden but brief attacks of intense apprehension, so upsetting that he/she is likely to tremble and shake, feel dizzy, and have trouble breathing (may be accompanied by agoraphobia- person is fearful of leaving familiar surroundings) Generalized anxiety disorder- fear and apprehension are pervasive, persistent, and uncontrollable. They worry constantly, feel generally on edge, and are easily tired Obsessive compulsive disorder- persistent obsession (recurrent thought, idea, or image that uncontrollably dominates a person’s consciousness) or compulsions (urge to perform a stereotyped act, with the purpose of warding off an impending feared situation) Post-traumatic stress disorder- experiencing anxiety & emotional numbness after a very traumatic event. Individuals have painful, intrusive recollections by day and bad dreams at night, they find it difficult to concentrate and feel detached from others and from ongoing affairs Acute stress disorder-similar to post-traumatic stress disorder, but symptoms don’t last as long Somatoform disorders (no known psychological cause but seem to serve a psychological purpose):  Somatization disorder- long history of multiple physical complaints for which they have taken medicine or consulted doctors  Conversion disorder- loss of motor or sensory functions, such as paralysis, an anaesthesia (loss of sensation), or blindness  Pain disorder- suffer from severe and prolonged pain  Hypochondriasis- misinterpretation of minor physical sensations as serious illness  Dysmorphic disorder- preoccupied with an imagine defect in their appearance Dissociative disorders (sudden alteration in consciousness that affects memory and identity):  Dissociative amnesia- may forget their entire past or lose memory for a particular time period  Dissociative fugue- individual suddenly and unexpectedly travels to a new locale, starts a new life, and can’t remember his or her previous identity  Dissociative identity disorder- posses 2 or more distinct personalities, each complex and dominant one at a time  Depersonalization disorder- severe and disruptive feeling of self-estrangement or unreality Sexual and gender identity disorders: Paraphilias- sources of sexual gratification- as an exhibitionism, voyeurism, sadism, and masochism, are unconventio
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