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Chapter 3

chapter 3

16 Pages

Course Code
Konstantine Zakzanis

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Chapter 3-Classification and Diagnosis A disorder must be classified before its causes or treatments can be found The Diagnostic and Statistical Manual of Mental Disorders was created by the APA and is now in its fourth edition A Brief History of Classification Impressed by the success of diagnostic procedures in the field of medicine investigators of abnormal behaviour sought their own classification schemes Early Efforts in Classification The diversity of classifications was recognized as a serious problem. Several attempts were made Development of the WHO and DSM Systems The World Health Organization added mental disorders to the International Statistical Classification of Diseases, Injuries, and Causes of Death Mental disorders section not widely accepted The APA published their own Diagnostic and Statistical manual in 1952 The WHO classifications were simply a listing of diagnostic categories the actual behaviour or symptoms were not specified The DSM-II and the British Glossary of Mental Disorders provided some of this crucial information In 1988 the APA appointed Frances to begin work on the DSM-IV Working groups that included many psychologists were established to review sections of the DSM-III, prepare literature reviews, and analyze previously collected data, and collect new data if needed An important change for the process for this edition was the reasons for changes in diagnoses would be stated and supported with data www.notesolution.com The DSM-IV went through a text revision (DSM-IV-TR) which contains few big changes but some sections are rewritten for clarity and to incorporate recent research findings Caplan has been outspoken about the DSM saying that many people are excluded from the decision making process The Diagnostic System of the American Psychiatric Association (DSM-IV and DSM- IV-TR) Definition of a Mental Disorder DSM-IV-TR defines a mental disorder as a behavioural or psychological syndrome that causes personal suffering, disability (impairment in one or more areas), and an increased risk of death, pain, disability or loss of freedom Must not be expectable and culturally sanctioned response Five Dimensions of Classification The major change in the DSM is the use of a multiaxial classification, whereby each individual is rated on five separate dimensions/axes The five axes are o Axis I. All diagnostic categories except personality disorders and mental retardation o Axis II. Personality disorders and mental retardation o Axis III. General medical conditions Any conditions believed to be relevant to the mental disorder o Axis IV. Psychosocial and environmental problems Economic problems, interpersonal difficulties etc. o Axis V. Current level of functioning Social relationships, use of leisure time Ratings give info about the need for treatment www.notesolution.com Axes I and II are separated to ensure that the presence of long-term disturbances are not overlooked They may have had an Axis II condition prior to an Axis I condition The presence of an Axis II and Axis I disorder means the persons problems will be difficult to treat The remaining three Axis are not needed to make the diagnosis, factors other than a persons symptoms should be considered Issues and Possible Categories in Need of Further Study The DSM-IV-TR contains several proposals for new categories and axis The hope is to encourage professionals to consider wither a future DSM should include them Possible New Syndromes Caffeine withdrawalresults in significant distress or impairment in occupational or social functioning Premenstrual Dysphoric Disorderdepression, anxiety, mood swings, anger, decreased interest in activities usually engaged in with pleasure o Experienced by fewer women than PMS and much more debilitating o Plusfoster more tolerance and less blame o MinusWomen who experience these changes will be regarded as mentally disordered Mixed Anxiety-depressive Disorderperson is depressed for at least a month and has memory problems, sleep disturbances, worrying, pessimism, low self esteem, low energy Passive-Aggressive Personality Disorderperson is angry or resentful and is expressing these feelings by procrastination, forgetfulness, lateness etc. And is NOT attributable to depression www.notesolution.com Depressive Personality Disorderchronic gloominess, lack of cheer, and tendency to worry a lot. Is long term unlike minor depressive disorder. May be a precursor for major depressive disorder and a subtype of Dysthymia Proposed Axes in Need of Further Study Professionals are being encouraged to include defence mechanisms as an axis Some are similar to cognitive behaviour theorists coping strategies, many are derived from psychoanalytical theory There are seven defence levels each with a set of defence mechanisms High adaptive levelthe most adaptive, healthy defence level. Realistic ways of handling stress o Anticipationexperiencing emotional reactions before a stressful event occurs, and considering courses of action o Sublimation Disavowal Leveldefences that keep troubling stressors out of conscious awareness o Denial o Projection Level of Defensive DysregulationLowest level marked by failure to deal with stress so has a break with reality o Psychotic denialdenial so extreme that they lose touch with reality The axis has been rated with disappointing results Diagnostic Categories Clinicians should be not only sensitive to the symptoms of patients but also the possible medical causes of conditions DSM indicates that many diagnoses or disorders may be due to a medical condition or substance abuse www.notesolution.com
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