PSYC 360 Exam 2

What defines abnormality?

Various theories: Personal distress, Deviance from cultural norms, Statistical infrequency, & Impaired social functioning, others

What is the "harmful dysfunction" theory of abnormality?

Developed by Jerome Wakefield, this theory considers both: Dysfunction (scientific data) & Harm (social context)

Who defines abnormality?

Authors of the DSM, Leading researchers in psychopathology, & Medical professionals

Why is the definition of abnormality important?

Labeling can affect professionals and clients, Professionals: facilitates research, awareness, and treatment, & Clients: helps demystify experiences, access treatment, avoid stigma, and face legal consequences

What are the potential negative effects of labeling someone with a disorder?

Damages self-image, Stereotyping by others, & Legal consequences

What are Comer’s 4 criteria for assessing abnormality?

1. Deviance: Behavior away from cultural norms

2. Distress: Negative feelings and thoughts

3. Dysfunction: Interference with daily functioning

4. Danger: Harm to self or others

How was abnormal behavior recognized before the DSM?

• Ancient civilizations recognized and studied abnormal behavior

• 19th century saw the rise of asylums in Europe and the U.S.

• Around 1900, Emil Kraepelin proposed specific categories of mental illness

• Early categorical systems were used for statistical/census purposes

What were the characteristics of the DSM-I and DSM-II?

• DSM-I (1952) and DSM-II (1968) were similar but different from later editions

• Not scientifically or empirically based, relying on “clinical wisdom” of leading psychiatrists

• Psychoanalytic/Freudian influence

• Contained three broad categories: psychoses, neuroses, and character disorders

• No specific criteria, just vague descriptions in paragraphs

What were the key changes in DSM-III?

• Published in 1980, very different from DSM-I and DSM-II

• More reliance on empirical data

• Specific criteria defined disorders

• Atheoretical (no psychoanalytic/Freudian influence)

• Multi-axial assessment (5 axes)

• Included many more disorders

• DSM-III-R (1987) was a minor revision

What were the changes between DSM-IV and DSM-IV-TR?

• DSM-IV was published in 1994, and DSM-IV-TR in 2000 (TR = Text Revision)

• Only the text, not the diagnostic criteria, differed between the two

• Essentially similar editions

What cultural advances were included in DSM-IV and DSM-5?

• DSM-IV included cultural descriptions of disorders

• Introduced Culture-Bound Syndromes (not official diagnoses but common in certain cultures)

• DSM-5 (released in 2013) continued to emphasize cultural formulation, helping clinicians understand the impact of culture on symptoms

What were the main features of DSM-5?

• Released in 2013

• Task Force with Work Groups focused on specific mental disorder areas

• Sought greater consistency with the International Classification of Diseases (ICD)

• Focused on neuropsychology/biological roots of mental disorders

• Dimensional approach for personality disorders

• New proposed disorders: attenuated psychosis syndrome, mixed anxiety-depressive disorder, internet gaming disorders

What changes did not happen in DSM-5?

• No paradigm shift to emphasize neuropsychology/biological roots for all disorders

• Dimensional definitions for all mental disorders were not adopted

• The dimensional approach for personality disorders was not fully implemented

• Five of the 10 personality disorders were not removed

• Some proposed disorders (e.g., attenuated psychosis syndrome) were not included

Revised Disorders in DSM-5: Major Depressive Episode & Autism Spectrum Disorder

• Major depressive episode: “Bereavement exclusion” dropped

• Autism spectrum disorder: Encompasses autistic disorder, Asperger’s disorder, and related developmental disorders from DSM-IV

Revised Disorders in DSM-5: ADHD & Bulimia Nervosa

• Attention-Deficit/Hyperactivity Disorder: Age at which symptoms must first appear raised from 7 to 12

• Bulimia nervosa: Frequency of binge eating decreased from twice to once per week

Revised Disorders in DSM-5: Anorexia Nervosa & Substance Use Disorders

• Anorexia nervosa: Removed requirement for menstrual periods to stop; “Low body weight” changed from numeric definition to less specific description

• Substance use disorder: Encompasses substance abuse and substance dependence from DSM-IV

Revised Disorders in DSM-5: Intellectual Disability & Learning Disorders

• Intellectual disability disorder: Replaces mental retardation from DSM-IV

• Specific learning disorder: Covers separate learning disorders in reading, writing, and math from DSM-IV

Categorical approach (DSM)

• Individuals fall into a "yes" or "no" category for having a particular disorder

• “Black and white”—no “shades of gray”

• May correspond well with human tendency to think categorically

• Facilitates communication

Dimensional approach

• “Shades of gray” instead of “black and white”

• Symptoms placed on a continuum rather than discrete categories

• Five-factor model of personality could provide dimensions: neuroticism, extraversion, openness, conscientiousness, and agreeableness

• More difficult to communicate but provides a more thorough description of clients

• May be better suited for some disorders (e.g., personality disorders)