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Chapter 4

PSY100H1 Chapter Notes - Chapter 4: Phenylalanine, Mood Swing, Agreeableness


Department
Psychology
Course Code
PSY100H1
Professor
Connie Boudens
Chapter
4

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Chapter 4 Classification and Diagnosis
Diagnosis is a critical aspect of the field of abnormal psychology. It is essential for professionals to be able to
communicate accurately with one another about the types of cases they are treating or studying.
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 revisions and the current one is the fifth edition (DSM-5
Joel Paris, THE CONSTITUENCIES OF THE DSM-5
Constituency Related Question(s)
Research To what extent does the classification system advance research? Do the
people in clinical trials who meet prescribed criteria have clinical
problems representative f typical clinical problems?
Clinical practice Does the system advance clinical practice in terms of guiding treatment
and understanding of the disorder?
The pharmaceutical
industry
To what extent does the pharmaceutical industry influence how
disorders are defined? Is the recognition of new disorders guided by a
profit-driven goal of providing more drugs to more people?
The legal system Do biases and inadequacies in how disorder is determined get reflected
skewed legal decisions?
The general public How does the classification and description of disorders relate to general
beliefs about mental disorder among people in general?
A BRIEF HISTORY OF CLASSIFICATION
Bloodletting was part of treatment of all physical problems
EARLY EFFORTS AT CLASSIFICATION
In the United Kingdom in 1882, for example, he Statistical Committee of the Royal Medico-Psychological
Association produced a classification scheme; however, even lough it was revised several times, it was never
adopted by the association’s members
In the United States, the Association f Medical Superintendents of American Institutions for the insane, a
forerunner of the American Psychiatric Association, adopted a somewhat revised version of the British system in
1886.
1913, this group accepted a new classification scheme that incorporated some of Emil Kraepelins ideas.
New York State Commission on Lunacy, for example, insisted on retaining its own system
DEVELOPMENT OF THE WHO AND DSM SYSTEMS
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 e Diseases, Injuries, and
Causes of Death (ICD), a comprehensive listing of all diseases, including a classification of abnor3ial behaviour.
In 1969, the WHO published a new classification systern that was more widely accepted. A second version of the
American Psychiatric Association's DSM, DSM-II (1968), was similar to the WHO system, and, in the United
Kingdom, a glossary of definition; was p produced to accompany it
In 1980, the American Psychiatric Association published an extensively revised diagnostic manual (DSM-III); a
somewhat revised version, DSM-III-R, appeared in 1987
Most sweeping change was the use of multiaxial classification, whereby each individual is rated on five separate
dimensions, or axes
oMultiaxial classification prevailed until it was removed recently the DSM-5.
The five ax axes were:
oAxis I. All diagnostic categories except personality disorders and mental retardation
oAxis II. Personality disorders and mental retardation
oAxis III. General medical conditions
oAxis IV. Psychosocial and environmental problems
oAxis V. Current level of functioning

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Axis I included all diagnostic categories except personality disorders and mental retardation, which made up Axis
II.
oComposed the classification of abnormal behaviour.
Axis III the clinician indicated any general medical conditions believed to be relevant to the mental disorder
question.
Axis IV was created to code psychosocial and environmental problems that the person has been experiencing and
it may be contributing to the disorder.
oIncluded occupational problems, economic problems, interpersonal difficulties with family members, and
a variety of problems in their life areas that may influence psychological functioning.
Axis V, the clinician had to indicate the person’s current level of adaptive functioning. Life areas considered
included social relationships, occupational functioning, and use of leisure time
oLife areas considered included social relationships, occupational functioning, and use of leisure time.
Ratings of current functioning are supposed to give information about the need for treatment.
DSM-IV was published in 1994 and the American Psychiatric Association subsequently completed a “text
revision” (DSM-IV-TR; American Psychiatric Association, 2000).
Revised version contained very few substantive changes to the different diagnostic categories and criteria,
although some sections were rewritten to enhance clarity and incorporate recent research findings related to issues
such as the prevalence, course, and etiology of disorders.
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.
THE DIAGNOSTIC SYSTEM OF THE AMERICAN PSYCHIATRIC ASSOCIATION (DSM-S)
DEVELOPMENT OF THE DSM-5
DEVELOPMENT PROCESS
Major objective was to initiate a renewed focus on the validity of diagnosis.
Another objective was to eliminate disparities between the DSM and the World Health Organization’s ICD
Revisions were designed to address gaps in the diagnostic and classification system and update the system based
on research developments, including new developments in the neuroscience field.
Another clear goal was to reduce the proportion of diagnoses falling in the “otherwise not specified” diagnostic
category by making changes to symptom criteria where necessary.
Another stated goal of the DSM-5 committee was to supplement the categorical approach with a greater number
of dimensional ratings. Kupfer et al. (2013), a key overarching goal was to streamline and simplify the DSM-5 in
order to increase the clinical usefulness of it when used by doctors in primary care.
The DSM-5 PC is a simplified version of the manual for primary care physicians that will involve straightforward
descriptions of the 32 disorders deemed to be most commonly seen in their primary care practices.
There were four themes that were re-examined in DSM-5 for ADHD: (1) the age of onset; (2) the presence of
ADHD subtypes; (3) age-related variability in the sensitivity of symptoms and symptom threshold; and (4)
whether to retain autism as an exclusion criterion in order to allow for the comorbid experience of ADHD and
autism.
OVERVIEW OF CHANGES IN DSM-5
Decided for conceptual reasons to separate ADHD from conduct disorder and oppositional defiant disorder by
putting them in separate chapters in the DSM-5.
Remove the ADHD subtypes, but still allow specifiersto reflect heterogeneity.
Elaborating the symptom lists in Criteria Al and A2 (ADHD Overview) and removing autism as an exclusion
criterion.
Changes were actually made when the SRC evaluated the existing empirical evidence for ADHD?
oExclusion criterion was removed, the subtypes were removed, examples were provided to illustrate
ADHD in adults, and the criterion Vof being present before the age of 7 was changed to before the age of
12.
oThreshold for adults was changed to five symptoms instead of six symptoms within the inattenticion and
hyperactivity and impulsivity to reflect the significant impairment that is typically associated with a fewer
number of symptoms among older people.

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oRevision process is that changes are based on empirical data.
The DSM-5 was published in May 2013 but only after Kupfer and his colleagues withstood a barrage of criticism
and commentary prior to its publication.
Changes .in symptoms’ descriptions have also occurred, usually in response to new empirical findings that help
with the fine-tuning process.
Manual itself has been reformulated in various chapters with the order of chapters representing the life cycle:
disorders for children are at the beginning and disorders primarily for older adults are toward the back of the
manual
Dimensional ratings have been added to allow for ratings of the severity of a disorder, because several disorders
require severity ratings (mild, moderate, or severe)
An important addition is a greater focus on heightening awareness in diagnosing suicidal tendencies.
DSM-5 CRITERIA FOR ADHD
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or
development, as characterized by (1) and/or (2).
1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that
is inconsistent with developmental level and that negatively impacts directly on social and
academic/occupational activities:
a) Often fails to give close attention to details or makes careless mistakes in schoolwork, at work,
or during other activities (e.g., overlooks or misses details, work is inaccurate).
b) Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining
focused during lectures, conversations, or lengthy reading).
c) Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the
absence of any obvious distraction).
d) Often does not follow through on instruction and fails to finish schoolwork, chores, or duties in
the workplace (e.g. starts tasks but quickly loses focus and is easily sidetracked).
e) Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks-
difficulty keeping materials and belongings in order; messy, disorganized work; has poor time
management; fails to meet deadlines).orkr
f) Often avoids, dislikes, or is reluctant to engage in tasks that required sustained mental effort
(e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing
forms, reviewing lengthy papers).
g) Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools,
wallets, keys, paperwork, eyeglasses, mobile telephones).
h) Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include
unrelated thoughts).
i) Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents
and adults, returning calls, paying bills, keeping appointments).
2. Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at least 6
months to a degree that is inconsistent with developmental level and that negatively impacts directly on
social and academic/ occupational activities:
a) Often fidgets with or taps hands or feet or squirms in seat.
b) Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place
in the classroom, in the office or other workplace, or in other situations that require remaining
in place).
c) Often runs about or climbs in situations where it is inappropriate (Note: in adolescents or adult,
may be limited to feeling restless).
d) Often unable to play or engage in leisure activities quietly.
e) Is often “on the go,” acting if “driven by a motor.
f) Often talks excessively.
g) Often blurts out an answer before a question has been completed (e.g., completes people’s
sentences, cannot wait for turn in conversation).
h) Often has difficulty waiting his or her turn.
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