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Chapter 5

Clinical Psychology Chapter 5.docx

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John Stephens

Chapter 5- Diagnosis and Classification of Psychological Problems Diagnosis - The classification of disorders by symptoms and signs Psychopathology - Psychopathology examines the nature and development of abnormal o Behavior o Thoughts o Feelings o Biology - Definitions of abnormality vary widely and may not capture all aspects of psychopathology Characteristics of Abnormal Behavior - Disability o Impairment in a key area  Chronic alcohol consumption results in job loss - Personal Distress o Emotional pain and suffering  Helplessness and hopelessness of depression - Violation of Social Norms o Makes others uncomfortable or causes problems  Antisocial behavior of the psychopath - Dysfunction o Biological, social, occupational  Some overlap with disability - Statistical Infrequency o Suggests that rare behaviors are abnormal o Normal curve indicates that some behaviours are common while others are rare  Common behaviours are at middle of normal curve  Rare behaviours fall at the tails of the curve Statistical Infrequency or Violation of Norms - When a person’s behavior becomes patently deviant, outrageous, or otherwise nonconforming, then he or she is more likely to be categorized as abnormal - Advantages o Cutoff points can be established and used o Intuitive appeal: we tend to think we know abnormal behavior when we see it - Problems o Choice of cutoff points: how to decide? o Number of deviates required o Cultural relativity – deviance differs for different groups  Judgments can vary depending on whether family, school officials, or peers are making them o Developmental relativity  We must compare behavior to that of the same-aged peers Subjective Distress - Subjective/personal stress: behaviours that are accompanied by distress are abnormal - It is important to know how a person is feeling in certain situations - Advantages o Sees reasonable to expect that person can assess whether or not she/he is experiencing distress - Problems o Can think of a number of exceptions: Antisocial Personality Disorder, mania, psychosis o Not everyone whom we consider “disordered” reports subjective distress o The amount of subjective distress necessary to be considered abnormal Disability/dysfunction - Impairment of life function can be a component of abnormal behavior - Social: interpersonal relationships are affected - Occupational: job is disrupted, perhaps even lost - Personal: day to day functioning is impaired - Advantages o Relatively little inference is required: dysfunction is apparent o Often prompts people to seek treatment because their life is abnormal - Disadvantages o No one definition is sufficient o Abnormal behavior does not necessarily indicate mental illness Mental Illness The term mental illness refers to a large class of frequently observed syndromes that are comprised of certain abnormal behaviours or features - The syndrome (cluster of abnormal behaviours) must be associated with distress, disability, or increased risk of problems - A mental disorder is considered to represent a dysfunction within an individual - Not all deviant behaviours or conflicts with society are signs of mental disorder Diagnosis (pulls everything together) - the diagnosis of mental disorders is an expert level f categorization used by mental health professionals that enables us to make important distinctions - Advantages o Communication- a wealth of information can be conveyed in a single diagnostic term o Enables and promotes empirical research o Research on etiology possible (we can look at hindsight… how someone was years ago) o Diagnosis suggests which treatment procedure to use Diagnostic Systems - Diagnostic systems assume that abnormality can be detected and classified by clusters of symptoms and signs o Each cluster is thought to reflect a different disorder o Each cluster may require a different treatment History of DSMs - DSM-I (1952) o Glossary o Used term “reaction” o For the most part was ignored - DSM-II (1968) o Attempted to be more theory-neutral o Encouraged multiple diagnoses - DSM-III (1980) o Defined mental disorder o Descriptive approach/criteria sets o Etiology unknown, rarely referenced o Narrowed definition of Schizophrenia o Broadened definition of Affective disorder o Multiple diagnoses allowed on Axis I and II - DSM-III-R (1987) - DSM-IV (1994) - DSM-IV-TR (2000) - DSM-5 (2013) DSM-IV-TR Diagnostic System - Diagnostic and Satistical Manual of Mental Disorder (DSM-IV-TR) o 4 edition, text revision o Published by American Psychiatric Association - Multiaxial System o A complete diagnostic assessment based on 5 axes or dimensions Axis I - All diagnostic categories except personality disorder and mental retardation Axis II - Personality disorders and mental retardation Axis III - General Medical Conditions Axis IV - Psychosocial and environmental problems Axis V - Global assessment of functioning scale (GAF) - Scale from 0-100 Axis VI - Hypothetical- Presenting Strengths Selected Axis I Diagnostic Categories • Disorders usually first diagnosed in infancy, childhood or adolescence – Learning Disorders – Pervasive Developmental Disorders • Substance-related disorders – Alcohol-related and Amphetamine-related Disorders • Schizophrenia and other Psychotic Disorders • Anxiety disorders – Panic, Generalized Anxiety, Obsessive-Compulsive Disorders • Mood disorders – Major Depressive and Bipolar Disorders • Eating Disorders – Anorexia Nervosa and Bulimia Nervosa Improvements in the DSM-IV-TR 1. Specific diagnostic criteria • Less vague, more explicit and concrete than DSM-II 2. More extensive descriptions • Essential features • Associated features (e.g., lab findings) • Differential diagnosis 3. Increasing number of diagnostic categories • Comorbidity - the presence of one or more disorders 4. Issues and possible diagnostic categories in need of further study • Caffeine withdrawal or Premenstrual Dysphoric Disorder Ethnic and Cultural Considerations • Culture can influence: – Risk factors – Types o
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