Diagnosis and Classification of Psychological Problems

Psychopathology

_______examines the nature and development of abnormal

• behavior

• thoughts

• feelings

Definitions of abnormality vary widely and may not capture all aspects of psychopathology

Definitiond of Abnormal Behavior

A. Statistical Infrequency or Violation of social norms.

B. The experience of subjective distress.

C. Disability, dysfunction or impairment.

Statistical infrequency

• suggests that rare behaviors are abnormal

• Normal curve indicates that some behaviors are common while others are rare

  • Common behaviors are at middle of normal curve

  • Rare behaviors fall at the tails of the curve

Advantages of Statistical Infrequency or Violation of Social Norms

• Cut off points can be established and used

• Intuitive appeal: we tend to think we know abnormal behavior when we see it

Disadvantages of Statistical Infrequency or Violation of Social Norms

• Choice of Cutoff Points

  • Conformity-oriented definitions are limited by the difficulty of establishing agreed-upon cutoff points.

• The Number of Deviations

  • The number of behaviors that one must evidence to ear label “deviant”

• Cultural and Developmental Relativity

  • Judgements can vary depending on whether family, school officials, or peers are making them

Cultural relativism

• perspective holds that there are no universal standards or rules for labeling a behavior as abnormal.

• Instead, behavior can only be abnormal relative to cultural norms.

Subjective/ personal distress

behaviors that are accompanied by distress are abnormal

Advantages of subjective distress

Seems reasonable to expect that person can assess whether or not s/he is experiencing distress

Disadvantages of subjective distress

• Can think of a number of exceptions: Antisocial Personality Disorder, mania, psychosis

Disability/dysfunction

definition argues that 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 of Disabity/Dysfunction

Relatively little inference is required; dysfunction is apparent

Often prompts people to seek treatment because their normal life is interrupted

Disadvantage of Disability/Dysfunction

• In how many domains of functioning must you see problems? (1,2, 3, more?)

DSM 5 Definition of Abnormal behavior

• describes behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and impairment in functioning, or increased risk of suffering, death, pain, or impairment

4 Categories:

a. Behavior that is harmful to the self or that is harmful to others

b. Poor reality contact

c. Emotional reactions inappropriate to the person’s situation.

d. Erratic behavior – shifts unpredictably

• Abnormal behavior does not necessarily indicate mental illness

Mental Illness

• The syndrome (cluster of abnormal behaviors) 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 behaviors or conflicts with society are signs of mental disorder

Diagnosis

• type of expert-level categorization.

  It enables us to make important distinctions.

  Advantages

• Communication

• Enables and promotes empirical research

• Research on etiology possible

• Diagnosis suggests treatment

Diagnostic Systems

___________ assume that abnormality can be detected and classified by clusters of symptoms and signs

• Each cluster is thought to reflect a different disorder

• Each cluster may require a different treatment

Emil Kraeplin

• He is regarded as the father of modern systems of psychiatric diagnosis and classification

Early Classification systems

• The earliest refernce to a depressive syndrome appeard as far as 2600 B.C.

• Congress of Mental Science, 1889 (Paris)

• World Health Organization and its 1948 International Statistical Classification of Diseases, Injuries, and Causes of Death

• In 1952, the American Psychiatric Association published its own classification system in the Diagnostic and Statistical Manual

• Th first edition, known as DSM-I, was followed by revision in 1968 (DSM-II), 1980 (DSM-III), 1987 (DSM-III-R), and 1994 (DSM-IV), 2000 (DSM-IV-TR), 2013 (DSM-5), 2022 (DSM – 5 TR)

DSM

• classifies mental disorders into categories

• it describes each disorder and provides diagnostic criteria to distinguish one from another

DSM I

• 1952

• contained a glossary of descriptions of the diagnostic criteria

• classified disorders as various “reactions” to stressors

DSM II

• 1968

• similar to DSM I but it dropped the reactions concept, but maintained a perspective strongly influenced by psychodynamic theory;

  (1975) – homosexuality was removed from the list of sexual disorders

• attempted to be more theory-neutral

• encouraged multiple diagnoses

DSM III

• 1980

• marked a watershed in the development of the classification system, in that it outlined a research-based, empirical, and phenomenological approach to diagnosis.

• narrowed definition of Schizophrenia

• broadened definition of Affective disorder

• multiple diagnoses allowed on Axis I and II

DSM III-Multi-axial classification system

• Axis I: Schizophrenia

• Axis II: Personality disorders specific to developmental problems

• Axis III: medical/physical disorder

• Axis IV: severity of psychosocial factors

• Axis V: highest level of functioning during the previous year

DSM IV

1994

• Axis I: clinical disorders, other conditions that may be a focus of clinical attention

• Axis II: personality disorders, mental retardation

• Axis III: general medical conditions

• Axis IV: psychosocial and environmental problems

• Axis V: global assessment of functioning (GAF)

Improvements in the DSM IV-TR

1. Specific diagnostic criteria

• Less vague, more explicit and concrete than DSM-III

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

Specific Diagnostic Criteria

1. Essential features: those that “define it”

2. Associated features: those that are usually present

3. Diagnostic criteria: a list of symptoms that must be present for the patient to be given this diagnostic label

4. Information on differential diagnosis

Ethnic & Cultural Considerations

• Culture can influence:

  • Risk factors

  • Types of symptoms experienced

  • Willingness to seek help

  • Availability of treatments

• DSM-IV-TR includes:

  • Enhanced cultural sensitivity

  • Appendix of culture-bound syndromes

    • Koro

    • Amok

DSM V

• May 2013

• Led by two prominent mental health researchers, David Kupfer and Darrel Regier, it involved hundred of experts from over a dozen countries contributing their time and expertise over a 12-year period

Anxiety Neurosis/GAD as Defined in DSM –II and DSM- 5

This neurosis is characterized by anxious over-concern extending to panic and frequently association with somatic symptoms. Unlike Phobic neurosis, anxiety may occur under any circumstances and is not restricted to specific situations or objects. This disorder must be distinguished from normal apprehension or fear, which occurs in realistically dangerous situations.

Categorical

• Presence/absence of a disorder

• Either you are anxious, or you are not anxious.

• has advantages for research and understanding

Dimensional

• Rank on a continuous quantitative dimension

• Degree to which a symptom is present

• How anxious are you on a scale of 1 to 10?

• may better capture an individual’s functioning

Bases of Categorization

Should there be multiple ways of making diagnostic judgements? Does this create too much heterogeneity within a diagnostic category?

Pragmatics of Classification

How do we decide whether a condition is included in the diagnostic manual?

Description

Are the features of the diagnostic categories adequately described? Are the diagnostic criteria specific and objective?

Reliability

Are diagnostic judgements reliable? Can different diagnosticians agree on the classification of an individual?

Validity

Can we make meaningful predictions based on our knowledge of an individual’s diagnosis?

Five –stage process:

1. Clinical Description

2. Laboratory studies (including psychological tests)

3. Delimitation from other disorders

4. Follow-up studies

5. Family studies

Bias

Are the features of the disorders in DSM-IV biased against particular individuals because of their gender, race, or socioeconomic background? Are diagnosticians biased in their interpretation or application of the diagnostic criteria?

Coverage

Do the DSM-IV diagnoses apply to the people who present for psychological or psychiatric treatment? Is the DSM-IV too naoow in its coverage, or is it too broad?

Causes of Abnormal Behavior and Mental Illness

Major models of psychopathology: Biological, Developmental, Psychodynamic, Learning, Cognitive, Humanistic

Diathesis Stress Model

• Diathesis = predisposition or vulnerability

• Stress = external/environmental factors

The combination of a genetic predisposition and an external stressor may produce psychological problems

Value of classification

• Clinical Psychology is very much concerned with the diagnosis, classification, and treatment of mental illness.

• Classification systems are necessary; otherwise, our experience and our consciousness become a chaotic array of events