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Chapter 3

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Abnormal psych chapter 3  Diagnostic and statistical manual of mental disorders (DSM) now in its 4 edition, commonly referred to as DSM –IV or DSM –IV-TR. The DSM is published by the American psychiatric association A BRIEF HISTORY OF CLASSIFICATION  Bloodletting was part of treatment of all physical problems 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 of diseases, injuries and causes of death (ICD) a comprehensive listing of all diseases including a classification of ab beh. Metal disorders section was not widely accepted  American psychiatric association published its own diagnostic and statistical manual (DSM) in 1952  In 1969 the WHO published a new classification system that was more widely accepted. A 2 version of the American psychiatric associations DSM, DSM-II was similar to the WHO system  The WHO classifications were simply a listing of diagnostic categories; the actual beh or symptoms that were the bases for the diagnoses were not specified  In 1980 the American psychiatric association published an extensively revised diagnostic manual; a somewhat revised version DSM-III – R appeared in 1987  DSM –IV is used throughout the U.S and Canada is becoming widely accepted around much of he world THE DIAGNOSITIC SYSTEM OF THE AMERICAN PSYCHITIARTC ASSOCIATION (DSM-IV AND DSM-IV-TR)  The term mental disorder is problematic and that no definition adequately specifies precise boundaries for the concept. DSM-IV-TR provides the following definition:  A clinically significant beh or psychological syndrome or pattern that occurs in an indiv and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom Five dimensions of classification  Most sweeping change in the use of multiaxal classification whereby each indiv is rated on 5 separate dimensions or axes  The five axes are:  1) axis I- all diagnosis categories except personality disorder and mental retardation  2) axis II- personality disorders and mental retardation  3) axis III- general medical conditions  4) axis IV- psychological and environmental problems  5) axis V – current level of functioning  most ppl consult a mental health professional for an Axis I condition  although the remaining three axes not needed to make the actual diagnosis their inclusion in the DSM indicates that factors other than a persons symptoms should be considered in an assessment so that the persons overall life situation can be better be understood  axis III conditions may be quite common. A recent study in Toronto found that more tan half of the inpatients had an identifiable medical condition and that having an infectious disease was associated with disruptive beh  these include occupational problems, economic problems, interpersonal difficulties with family members and a verity of problems in other life areas that may influence psychological functioning  life areas considered are social relationships, occupational functioning are supposed to give info about the need for treatment Diagnostic Categories  the DSM indicates that the disorder may be due to a medical condition or substances abuse  DSM-III there has been a dramatic expansion of the # of diagnostic categories Issues and possible categories in need of further study BOX  Caffeine withdrawal- caffeine withdrawal results in significant distress or impairment in occupational or social functioning. Symptoms include headache, fatigue, anxiety, depression, nauseas and impaired thinking  Premenstrual Dysphoric disorder- this proposed syndrome occurs a week or so before menstruation for most months in a given year and is marked by depression, anxiety, anger, mood swings, and decreased interest in activities usually engaged in with pleasure. The symptoms are severe enough to interfere with social or occupational functioning. This category is to be distinguished from premenstrual syndrome which is experienced by many more women and is not nearly as debilitating  Daily charting or symptoms for at least two menstrual cycles  On the plus side inclusion might alert ppl to the hormonal bases of monthly mood changes linked to the menstrual cycle and thereby foster more tolerance and less blame. On the minus side listing such mood changes in a manual of mental disorders could convey the message that women who experience these psychological changes are mentally disordered  Mixed anxiety- depressive disorder- in mixed anxiety depression disorder, a person would have depressed for at least a month and have had at the same time at least four of the following symptoms: concentration or memory problems, sleep disturbances, fatigue or low energy, irritability, worry, crying easily, hypervigiliance, anticipating the worst, pessimism about the future and feelings of low self esteem.. the person must not be diagnosable as having a major depressive disorder, dysthymic disorder, panic disorder, or generalized anxiety disorder  Passive aggressive personality disorder (negativistic personality disorder)  Not attributable to depression, symptoms include resenting, resisting, and opposing demands and expectations by means of passive activities such as lateness, procrastination, forgetfulness and intentional inefficiency. The inference is that the person is angry or resentful and is expressing these feelings by not doing certain things rather than by being assertive or aggressive. Such ppl often feel mistreated, cheated or under appreciated  Depressive personality disorder- ppl whose general lifestyle is characterized by chronic gloominess, lack of cheer, and a tendency to worry a lot. This trait like long term disorder may be a precursor to a full blown major depressive disorder. Its very difficult to distinguish between depressive personality disorder (DPD) and the main depressive disorders  Its possible on a statistical basis to distinguish DPD and dysthymia which is a milder bu long lasting form of depression. However they also found that 95% of the ppl who meet diagnostic criteria for DPD also meet the diagnostic criteria for dysthymia  DPD is a subtype of dysthymia  Another disorder listed in the DSM-IV-TR is minor depressive disorder which may be distinguishable only by virtue of its not being as long lasting as depressive personality disorder  Proposed axes in need of further study---- defence mechanisms defined as automatic psychological processes that protect the indiv against anxiety and from the awareness of internal or external dangers or stressors.  Defence mechanisms are divided intyo groups called defence levels and are measured by a proposed defensive functioning scale  There are 7 defence levels each with a set of defence mechanism. The levels range from high adaptable level to level of defensive dysregulation  High adaptive level- this most adaptive healthy defence level contains coping efforts that are realistic ways of handlings tress and are conducive to achieving a good balance among conflicting motives  The following are some ex:  Anticipation- experiencing emotional reaction before a stressful event occurs and considering realistic altenbrative courses of action ex: planning for an upcoming meeting with an employer who is unhappy with your performance  Sublimination- dealing with a stress by channelling negative feelings into socially acceptable beh ex: working out at the gym  Disavowal level- this middle level is characterized by defences that keep troubling stressors or ideas out of conscious awareness  Denial- refusing to acknowledge a degree of discomfort or threat that is obvious to an observer ex: maintaining that your marriage is fine despite the obvious and repeated conflicts noticed by friends  Projection- falsely attributing to another person ones own unacceptable feelings or thoughts ex: believing that your professor is angry with you rather than the reverse  Level of defensive dysregulation- this is the lowest level and is marked by the failure to deal with stress leading to a break with reality  Psychotic denial- denial that is so extreme as to be marked by a gross impairment in reality testing; for ex maintaining that the results of three biopsies showing a cancerous growth are wrong Disorders usually first diagnosed in infancy, childhood, or adolescence  Intellectual, emotional, and physical disorders that usually begin in infancy, childhood or adolescence  The child with separation anxiety disorder has excessive anxiety about being away from home or parents  Children with conduct disorder repeatedly violate special norms and rules]  Indiv with attention deficit/hyperactivity disorder have difficulty sustaining attention and are unable to control their activity when the situation calls for it  Indiv with mental retardation (listed axis II) show subnormal intellectual functioning and deficits in adaptive functioning  The pervasive developmental disorders include autistic disorder, a severe condition in which the indiv has problems in acquiring communication skills and deficits in relating to other ppl  Learning disorders refer to delays in the acquisition of speech, reading, arithmetic and writing skills Substance related disorders  A substance related disorder is diagnosed when the ingestion of some substance- alcohol, opiates, cocaine, amphetamines and so on has changed beh enough to impair social or occupational functioning  These substances may also contribute to the development of other Axis I disorders such as mood or anxiety disorders Schizophrenia  For indiv with shitzo contact with reality is faulty. Their language and communication are distorted and they may shift from one subject to another in ways that make them difficult to understand. They commonly experience delusions such as believing that thought are not their own have been placed in their heads. They are sometimes plagued by hallucinations commonly hearing voices that come from outside themselves. Their emotions are blunted, flattened or inappropriate and their social relationships and ability to work show marked deterioration Mood disorders  Ppl whose moods are extremely high or low  Major depressive disorder- person is deeply sad and discouraged and is also likely to lose weight and energy to have suicidal thoughts and feelings of self reproach  The person with mania may be described as exceedingly euphoric, irritable, more active than usual, distractible, and possessed of unrealistically high self esteem  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.  Indiv with 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  Panic disorder the person is subject to student but brief attacks of intense apprehension so upsetting that they tremble and shake, feel dizzy, and have trouble breathing. May be accompanied by agoraphobia when the person is also fearful of leaving unfamiliar surroundings  In ppl with generalized anxiety disorder fear and apprehension are pervasive, persistent and uncontrollable. They worry constantly, feel generally on edge and are easily tired  A person with OCD is subject to persistent obsessions or compulsions. An obsession is a recurrent thought, idea or image that uncontrollably dominates a persons consciousness. A compulsion is an urge to perform a stereotyped act with the usually impossible purpose of warding off an impending feared situation. Attempts to resist a compulsion create so much tension that the indiv usually yields to it  Experiencing anxiety and emotional numbness in the aftermath of a very traumatic event is called post traumatic stress disorder. Patients 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 PTSS but the symptoms don’t last as long Somatoform disorders  The physical symptoms of somatoform have no known physiological cause but seem to serve a psychological purpose  People with this have a long history of multiple physical complainants for which they have taken medicine or consulted doctors  Ppl with conversion disorder report the loss of moor or sensory function such as paralysis, an anaesthesia (loss of sensation) or blindness  In
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