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many disorders are
ego-dystonic (ex: OCD) rather than ego-syntonic (OCPD)
many diagnoses have
overlapping criteria
Ego-dystonic
Person knows that they have a disorder/that something is wrong.
Ego-syntonic
Person doesn't know that they have a disorder/that something is wrong.
Diagnostic/classification systems
Lists of terms for conventionally accepted concepts used to describe psychopathology; generally called classification (ex: DSM-5 & ICD-10).
Classification
The activity of forming groups.
Diagnosis
The process by which individuals are assigned to already existing groups.
Taxonomy
The study of how groups are formed; a metalevel concept looking at different theoretical ways classifications can be organized, studied, and changed.
Psychopathology
Anything diagnosable.
Two Classification Systems
Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).
unresolved issues
the nature of the entities being classified
the definition of what a mental disorder is
the nosological principles for organizing psychiatric classifications
distinction b/w normality and pathology
validity of many diagnoses
Classification defines boundaries and ultimately defines
the field of psychopathology
Nomenclature
A list of names or terms of the categories within a classification system; allows psychologists to “talk to each other” and provides a short-hand for psychologists talking to other people
Information Retrieval
Knowing a diagnosis helps the clinician retrieve info about etiology, treatment, and prognosis.
Classification establishes a
descriptive basis for a science of psychopathology which is required to transform individual cases into principles and generalizations
Prediction
Info about a diagnosis gives the clinician info relevant to the person's clinical course and response to treatment.
The Development of Theories
theories of the relationship between diagnoses can be helpful to our understanding of etiology, treatment, etc
Symptoms
Self-reported issues.
Signs
Issues observed by others.
Syndrome
When signs and symptoms co-occur frequently; the term is silent regarding causes and is only descriptive.
Disorder
A pattern of symptoms and signs that includes an implied impact on the functioning of an individual.
Disease
A condition with a known etiology and known path from the causal agent to the symptoms and signs.
Stigmatization
The classification of mental disorders classifies the disorders people have, not the people themselves, to avoid stigmatization.
First definition of a mental disorder came in DSM-lll
“mental disorders are a subset of medical disorders” (Spitzer, Sheehy, & Endicott, 1977); this became controversial as some thought it gave exclusive rights to psychiatrists
Spitzer & Endicott (1978)
“… a mental disorder is a medical disorder whose manifestations are primarily signs and symptoms of a psychological (behavioral) nature, or if physical, can be understood only using psychological concepts”
Wakefield (1993)
argued that Spitzer & Endicott’s definition failed to operationalize the role of dysfunction inherent to mental disorders
Wakefield (1999)
Considered mental disorders 'failures of internal mechanisms to perform naturally selected functions' resulting in impairment; this is an evolutionarily influenced view and it is reflected in the DSM-V with the term “clinically significant disturbance”
Dimensions Vs Categories
Advantages and disadvantages of categorical system; advantages include ease of use and consistency with biological and medical classification systems. Disadvantages include the loss of some information and boundaries which may be arbitrary or ill-defined
Jaspers (1963)
Suggested that categories might be best for conditions traditionally described as organic disorders and similar to those in physical medicine while dimensions might be best for affective disorders or personality disorders
Committee members of DSM-lll decided it should be atheoretical
classification is more accessible to all mental health professionals, but there is no overarching theory of mental disorders
of those in the general population who meet criteria for a disorder
half meet criteria for two or more disorders
about 95% of patients meeting criteria for borderline personality disorder meet
criteria for another personality disorder
Diagnostic Overlap
Epidemiological studies have found that mental disorders co-occur much more often in the population than expected by chance.
