CHAPTER 3 – ABNORMAL
A diagnosis consists of a determination or identification of nature of a person’s disease or condition
or a statement of that finding.
A diagnosis is made on the basis of a diagnostic system, a system of rules for recognizing and
grouping various types of abnormalities.
Accurate diagnosis provides important information for effective clinical intervention
An Assessment is a procedure thru which info is gathered systematically in the evaluation of a
condition; this assessment procedure thru which information is gathered systematically in the
evaluation of a condition; this assessment procedure yields information that serves as the basis for
THE PERFECT DAGNOSTIC SYSTEM
The perfect diagnostic system would classify disorders on the basis of a study of presenting
symptoms, etiology , prognosis and response to treatment.
Diagnostic categories would then be established by determining exactly which patterns of
presenting problems, with what kind of history, developed in which particular manner and
responded differentially to various treatments.
THE HISTORY OF CLASSIFICATION
Classification is a fundamental activity of all humans
From a very early age we learn to classify objects by their colors, shapes and sizes.
As we get older, our understanding of these objects becomes more sophisticated and we refine our
Classification is also of viral importance to science . the ability to categorize information allows
scientist to better identify and understand various phenomena, from molecular structures , to
personality to galaxies.
Unfortunately the classification of ppl and their difficulties has a long history of complexity and
The international statistical classification of diseases, injuries and causes of death (ICD), a
comprehensive listing of all diseases, including abnormal behavior, in response to perceived
inadequacies of the ICD system.
The original DSM ( diagnostic and statistical manual ) and its second edition (DSM-II) proved highly
These two volumes were very brief and contained only descriptions of the diagnostic categories.
Eg DSM-I contained 106 categories of disorders that fell under the rubric of 3 categories.
( organic brain syndromes, functional disorder, and mental deficiency.
the two DSM were greatly influenced by psychoanalytic theory, focused on internal unobservable
processes, were not empirically based and contained few objective criteria.
In 1980, the psychiatric association published a newly revised and transformed diagnostic manual.
DMS-III which was contained revisions of DSM-I and DSM-II
They placed greater emphasis on empirical research to make it more reliable.
Furthermore these versions of the manual became theoretical; that is they moved away from
endorsing any one theory of abnormal psychology, become more pragmatic as they moved to more
precise behavioral description.
To increase precision, they operationally defined the required number of symptoms and specified
how long the symptoms had to last in order to meet diagnostic criteria. DSM-III-R was developed by polytheism, meaning that an individual could be diagnosed with a
certain subset of symptoms without having to meet all criteria.
The greatest innovation was prob the multiaxial requirement.
o For the first time diagnosticians were required to provide substantial patient info .
There was a minor revision in 2000 and called it DSM-IV-TR
Currently DSM-IV is used in Canada and the US
DSM-IV-TR: A MULTIAXIAL APPROACH
One of the major innovations from DSM-III was the use of muliaxial classification.
Beginning with SDM_iii the system acknowledged that a person’ life circumstances as a whole need
to be considered, diagnosis’s were required to evaluate an individual under 5 axis
Axis I – records the obvious disorders.
Axis II – focuses on less severe long-term disturbances, which interfere with a person’s life.
o it describes who the patient is.
o These patients can usually functioning jobs, and relationships.
Axis III- covers any medical disorder that might be relevant to understanding or managing the case.
o it recognizes that medical disorders may cause psychological disorders, so they may affect
future development or treatment.
Axis IV- is significant to DSM classification system. This axis collects inform on the patient’s life
circumstances, recognizing that individuals live within a social setting ( milieu) and that stressful
Axis V- this is also sign to DSM - it measures how well a person is able to cope with the
circumstances related to his or her problems.
This info can be indicative of the need for treatment and of the person’s coping mechanisms and an
assist in planning intervention.
See table 3.2
CATEGORIES OF DISORDER IN DSM-IV-TR
This groups all of the disorders listed on either acid I or axis II into 15 categories.
Disorders usually diagnosed in infancy, childhood, or adolescence
These categories of disorders include: intellectual, emotional and physical disorders that typically
begin before maturity.
Under the general classification of “attention deficit and disruptive beh disorders) are attention
deficit/hyperactivity disorder which the individual displays maladaptive levels of hyperactivity, or
combination with of these oppositional defiant disorder, in which there is a recurrent pattern of
negativistic, defiant, disobedient, and hostile beh toward authority figures. And conduct disorder in
which children persistently violate societal norms, rules or the basic rights of others.
Other diagnostic categories include
o separation anxiety disorder, in which the child becomes excessively anxious over the
possibility of separation from patens or significant others;
o mental retardation , below avg level of intelligence with impairment in social adjustment,
identified at an early age;
o autistic disorder, in which the child shows severe impediments in several areas of
development, including social interactions and communication;
o learning disorders, in which the person’s functioning in particular academic skill areas is
significantly below avg o motor skills or communication disorder- in which the individual experiences significant
development problems with coordination or has difficulty with the reception or expression
o feeding and eating disorder- eating substances with no nutritional value eg sand
o tic disorder- in which the body moves repeatedly, quickly or uncontrollably
o elimination disorder- which refer to the repeated passage of urine at inappropriate times on
Children may develop disorders that are most commonly seen in adults eg depression
Delirium, dementia amnesia and other cognitive disorders.
Delirium- is wandering attention. It may be caused by several medical conditions as well as poor
diet and substance abuse.
Dementia – is a deterioration of mental capacities, that is irreversible, usually associated with
Alzheimer’s disease , stroke
Amnestic syndrome – involves impairment in memory when there is no delirium or dementia,
usually linked with alcohol abuse.
Substance –related disorders
These disorders are brought about by the excessive use of a substance, which can be defined as
anything that is ingested in order to produce a high, alter one’s sense or affect functioning.
Individuals with such diagnoses may be unable o control or stop their use of substance and may be
physically addicted to them
Schizophrenia and other psychotic disorders
The disorder known as schizophrenia is marked by severs delibiliation in thinking and perception.
They suffer from a state of psychosis often characterized by delusions ( false beliefs, such as
believing that ppl are trying to hurt them)
They lose the ability to care for themselves. The loose contact with the world and with others
The major prevalent mood disorder- is major depressive disorder, in which a person is extremely
sad and discouraged and displays a marked loss of pleasure from usual actives.
They have severe problems sleeping , experiences with weight loss or gain, lack energy to do things,
and sometimes suicidal
Another mood disorder is mania, a condition which a person seems extremely active , need less
sleep and displays flight of somewhat disconnected idea.
In bipolar conditions both depression and mania are exhibited.
Less sever mood disorders include , dysthymia, in which is more chronic low graded depression; and
cyclothymic, in which the person fluctuates between more md bouts of mania and less severe
Ppl with anxiety disorder are often fearful, worry, or experience apprehension,
The fear produces patterns of a