PSYC 301 Final - Dysfunction Associated with Psychiatric Disorders 1

Psychiatric Dysfunction

Why classify psychiatric dysfunction (mental illness) into types?

To seek similarities + differences amongst patient groups 

1. Guide treatment choices

2. Allow clinicians to communicate 

3. To serve parties who require a diagnosis (ex. Insurance, legal system) 

4. To permit research (via categorization)

   • into causes

   • Into treatment responsiveness

   • into prognosis

What version of the DSM do we use?

Version 5-TR

What are 3 properties of the DSM?

• Atheoretical (does not take any position) 

• Operationalist 

• Categorical 

Name the three components a condition must have to be included in the DSM

1. Clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour 

2. Dysfunction in the psychological, biological, or development process underlying mental functioning 

3. Associated with significant distress/disability in social, occupational, academic, or other important activities

What are the explicit exclusions of the DSM-5?

1. An expectable/culturally approved response to a common stressor/loss (ex. death of a loved one) is not a mental disorder

2. Socially deviant behaviour (ex. political, sexual) and conflicts that are bw individual + society (unless the deviance/conflict results from a dysfunction in the individual)

What are some criticisms of the DSM criteria?

Major criticism is the heterogeneity of the criteria

• Level of Detail 

  • Ex. nearly 24,000 possible symptom combinations for panic disorder, with one possible combination for social phobia

• Overlap 

  • For many diagnoses, 2 people could be diagnosed with no overlapping symptoms 

  • High overlap between some diagnoses (ex. PTSD and MDD) 

• Authority (Who judges the distress/impairment?) 

  • Clinician vs. self vs. unclear… inconsistent 

• Comparator

  • Sometimes compare a person to themself (ex. More talkative than usual) 

  • Sometimes comparing a person to a normal/typical person (Ex. excessive/inappropriate levels of guilt) 

  • Some cases there is no comparator (ex. Feelings of worthlessness) 

Normative Assumptions

• Normative: Evaluation of right or wrong (ex. Ought, should) 

• Descriptive (What is/what would be) 

In Classification Criteria:

• Manic or hypomanic episodes

  • “excessive involvement of activities in …”

• ADHD

  • “often fails to … when it is expected”

• Homosexuality 

  • Classified as a disorder in DSM-I and DSM-II

  • Removed for DSM-III following protests by gay activists at the American Psychiatric Association’s annual meetings

Deinstitutionalization

• Movement starting in 1950s-60s to replace long stay psychiatric facilities with community mental health services 

• Possible with antipsychotic drugs (ex. chlorpromazine) 

• Balloon theory - without support, ppl w/ mental illness are more likely to be held in prisons/unhoused

What is the relationship between mental illness and violence?

• Mental illness is not associated with violence!!! 

• In the absence of substance abuse disorder, people with mental illnesses are not more violent than others from their same neighbourhoods

• More likely to be victims