Week 12 - Part 1: Assessment, Diagnosis, and the DSM

Psychopathology (Mental Illness)

A failure of adaptation to the environment.

• Conceptions:

  • Statistical rarity.

  • Subjective distress.

  • Impairment.

  • Societal disapproval.

  • Biological dysfunction.

Abnormal Psychology

Study of mental illness.

Diagnosis

Act of identifying a disease from its symptoms.

• Stems from a medical model.

Culture and Mental Health

• Higher risk of mental health issues.

  • Certain ethnic groups experience discrimination and/or stigma surrounding mental health.

  • Immigrants and refugees experience language barriers, difficulties fitting in, previous trauma, etc.

  • Different cultures have different explanations of mental health.

Early Classification Systems

• In the 1800s, most mental illnesses were classified as mania or melancholia. Mental and physical illness were diagnosed in the same way.

• Adopted the medical model, allowing psychological disorders to be approached the same way as conventional medicine.

• Emil Kraepelin diagnosed patients, published a textbook that divided psychological disorders into 13 groups, and determined whether a disorder was curable or not.

• In the early 20th century, the American Psychiatric Association published the Statistical Manual for the Use of Institutions for the Insane, which included basic description of common psychological disorders. Only ~10% of clinical cases matched descriptions.

DSM (Historical Background of Diagnostic Statistics Manual)

A standardized manual that aids in the diagnosis of disorders.

Historical Background of DSM

• After WWII, the DSM-I (1952) was created in relation to the ICD (International Classification of Mental and Behavioural Disorders) to collect data on mental disorders in psychiatric hospitals.

• The DSM-1 (1952) included 128 mental illnesses, was 132 pages, and cost $3.00.

• DSM-I (1952)

• DSM-II (1968)

• DSM-III (1980)

• DSM-III-R (1987)

• DSM-IV (1994)

• DSM-IV-TR (2000)

• DSM-5 & DSM-5-TR (2013)

DSM-5-TR

• Includes 541 diagnostic categories and 947 pages.

• Contains diagnostic criteria and decision rules for each condition.

• “Think organic” (rule out physical causes of symptoms first).

• Uses a biopsychosocial perspective.

• Contains information on prevalence.

Maladaptive Coping or Behaviour

Causes distress to oneself or others, impair daily functioning, or increase the risk of harm to oneself or others.

Critiquing the DSM

• Subjective.

• Different disorders share symptoms.

• Fine, arbitrary line between having a disorder and not having a disorder.

Power of a Diagnosis

• Likely to seek treatment.

• Indicates symptoms, causes, and treatments.

• Changes personal and outside views.

• Can be associated with low self-esteem or helplessness.

• May cause more destructive behaviours.

• Stigma.

Positives of Labels

• Service: Only entry into a system.

• Identification: Sense of clarity and understanding.

• Benefits: Financial aid.

• Interventions

• Communication: Starting point.

Challenges of Labels

• Blinders: Disregarding other reasons.

• Biases: Categorizing individuals, stigmatization.

• Self-fulfilling: ‘Wearing’ the label.

• Collateral Damage: Side effects of medication.

• Impacting rights to employment, education, insurance, and mortgages.

Mental Disorder (DSM-5)

A syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.

Language of Mental Illness

• Can hinder or help individuals and families.

Assessment Outside the Medical Model

• Ongoing, dynamic, and multidimensional.

• Strays away from the medical model and modernist to postmodernist and post structural.

• Incorporates local knowledge, strengths, resources, positive factors supporting individuals.

• Beginning of therapeutic interventions.

Psychological Diagnoses in the Classroom

• ADHD (Attention-Deficit Hyperactivity Disorder) was added to the DSM-III (1980).

• Increase in ADHD in Canada.

  • 4-6% of adults.

  • 5-7% of children.

Psychological Diagnoses in the Courtroom - Mental Disorder Defence

People should not be held legally responsible for their actions if they were not of “sound mind” when committing them.

• Requirements:

  • Individual did not know what they were doing at the time of the crime.

  • Individual did not know what they were doing was wrong.

• >1% successful in Canada, >25% successful.

Psychological Diagnoses in the Courtroom - Involuntary Commitment

A procedure that protects the public from people with significant mental disorders and protects them from themselves.

• Requirements:

  • Individuals pose a clear threat to themselves or others.

  • Individual is so impaired they cannot care for themselves.

Psychological Diagnoses in the Courtroom - CTO (Community Treatment Orders)

An order issued by a physician and agreed to by an individual (and/or their Substitute Decision Maker) under the Ontario Mental Health Acts. Allows the individual to receive care and treatment in the community of detention at a hospital or psychiatric facility.