DIAGNOSTICE AND CLASSIFICATION ISSUES OF DSM

ABNORMALITY

  • also known as mental disorders, psychiatric diagnoses, or, more broadly, psychopathology

CRITERIA

  • personal distress to the individual (severe depression or panic disorder)

  • deviance from cultural norms (schizophrenia)

  • statistical infrequency (dissociative identity disorder, rare disorders)

  • impaired social functioning (social phobia, antisocial personality disorder)

HARMFUL DYSFUNCTION THEORY

  • a theory that put forth a more simplified definition of mental disorders.

  •  to determine what is abnormal, we consider both scientific data and social values in the context in which the behavior takes place

  •  a disorder is a harmful dysfunction based on the social norms of one’s culture

    THE DSM

  • utilized to determine the diagnosis of dysfunction and distress that an individual experiences

  • MADE BY: TASK FORCE

    • consisted primarily of psychiatrists, and a relatively small number of psychologists and other mental health professionals

IMPORTANCE OF DEFINING ABNORMALITY

  • DIAGNOSIS

    • essential for effective treatment plans

    • understanding the differences between normal psychological functioning and disorders that require intervention

  • REDUCING STIGMA

    • it can promote greater acceptance and understanding of those who experience mental health challenges

  • Education and Awareness

    • It helps in early identification and intervention, and in understanding when and how to seek help.

  • Personal Insight and Help

    • It can guide people in seeking appropriate support and resources.

CRITICISM OF THE DSM

  1. Breadth of Coverage

    • rapid expansion may include experiences that should not be classified as mental illnesses, suggesting an over-pathologization of normal human experiences.

    • It is said that sexual disorders, substance-related disorders, and sleep disorders are not entirely disorders.

    • As psychological diagnoses multiply = overlap with one another increase, leading to a likelihood of comorbidity

  2. Controversial Cutoffs

    • third-party payers (e.g., health insurance companies) typically pay for treatment only if it is for a diagnosed disorder

    • “upcoding” can become an ethical issue for psychologists who want to ensure that their clients receive their health insurance benefits even if they do not technically qualify for a DSM category

  3. Cultural Issues

    • revising an established manual that was originally created by a group of authors that was white and male.

  4. Gender Bias

    • diagnostic categories are biased toward pathologizing one gender more than the other

  5. Nonempirical Influences

    • masochistic personality disorder have been strongly and publicly opposed by political organizations

Limitations on Objectivity

  •  “although based on empirical data, DSM-IV decisions were the results of expert consensus on how best to interpret the data”


INTELLECTUAL AND NEUROPSYCHOLOGICAL ASSESSMENTS

Intelligence Tests

  • Measure a client’s intellectual activities

Achievement Tests

  • Measure what a client has accomplished with those intellectual activities

Neuropsychological Tests

  • Focuses on issues of cognitive or brain dysfunction, including the effects of brain injuries and illnesses

Classic Theories of Intelligence

  1. Charles Spearman

    • singular intelligencfe or the general intelligence.

    • acknowledges specific abilities but as minor role.

  2. Louis Thurstone

    • multifactor analysis, identifying factor in large data set

  3. Hierarchical Model of Intelligence

    • the combination of the two, but it stems from g.

  4. James Cattell

    • fluid intelligence: abstract thinking, ability to reason novel problems

    • crystallized intelligence: reason out based on existing knowledge.

  5. Three-Stratum Theory of Intelligence

    • 3 levels of intelligence:

      • g at top

      • 8 broad factors from g

      • 60 highly specific abilities from these factors

  6. General Ability

    • provide a broad and comprehensive assessment of cognitive functioning (problem-solving, adaptability, learning ability)

    • it may not provide detailed insights into specific skills or aptitudes.

  7. Specific Ability

    • provide a detailed and focused assessment of an individual's proficiency in a particular area (strength and weakness)

    • less applicable in contexts that require a broad understanding or adaptability

  8. Wechsler Intelligence Tests

    • demands of measuring intelligence at different ages, one on one

  9. Stanford-Binet Intelligence Scale

    •  employs a hierarchical model of intelligence and therefore yields a singular measure of full-scale IQ (or “g”), one on one

      • Fluid Reasoning: ability to solve novel problems

      • Knwoledge: general info accumulated overtime via experiences

      • Quantitative Reasoning: ability to solve numerical problems

      • Visual-Spatial Processing: ability to analyze visually presented information

      • Working Memory: ability to hold and transform information in short-term memory

  10. Achievement Testing

    • typically produce age or grade equivalency scores as well as standard scores, quizzes or exams.

      • before dsm: intelligence test vs achievement = learning disabilities

      • dsm: person’s achievement vs norm achievement of the same age = learning disorder

  11. Wechsler Individual Achievement Test—Third Edition

    • Oral Language Composite

      • Listening Comprehension: oral recitation

      • Oral Expression: use of speech for repetition or storytelling

    • Reading Composite

      • Word Reading: reading isolated words

      • Pseudoword Decoding: phonetic skills to sound out nonsense words

      • Reading Comprehension: read and answer

    • Mathematics Composite

    • Written Language Composite

  12. Neuropsychological Assessments

    •  specialized assessments designed to measure a person's cognitive, behavioral, and emotional functions

    • to evaluate brain function and identify potential neurological deficits or impairments

    • TEST FOR COGNITIVE FUNCTIONS:

      • Memory: short-term memory, long-term memory, verbal memory, and visual memory.

      • Attention and Concentration: attention span, focus, and the ability to concentrate on tasks.

      • Language: verbal fluency, comprehension, and expression.

      • Executive Functioning: planning, problem-solving, decision-making, and organization.

      • Visuospatial Skills: perceive and interpret visual information

      • Motor Skills: Evaluation of fine motor skills and coordination.

      • Emotional and Behavioral Functioning: mood, personality traits, and emotional regulation.

PERSONALITY AND BEHAVIORAL ASSESSMENTS

3 THEMES IN ASSESSING


Multimethod Assessment

  • not to rely exclusively on any single assessment method.

Evidence-Based Assessment

  • elect only those methods that have strong psychometrics, including reliability, validity, and clinical utility

Culturally Competent Assessment

  • every culture has its own perception of “normal” and its own variations of “abnormal” as well

Objective Personality Tests

  1. Minnesota Multiphasic Personality Inventory-2

    • empirical criterion keying: list of items that empirically elicit different responses from people in these normal and abnormal groups

    • CLINICAL SCALE

 

Scale Number

Scale Name

Abbreviation

Description of High Scale Scores

1

Hypochondriasis

Hs

Somatic problems, excessive bodily concern, weakness, ailments, complaining and whining

2

Depression

D

Depressed, unhappy, low confidence, pessimistic

3

Hysteria

Hy

Vague medical reactions to stress, somatic symptoms, denial of conflict and anger

4

Psychopathic Deviate

Pd

Antisocial, rebellious, blaming others, poor consideration of consequences of actions

 

Scale Number

Scale Name

Abbreviation

Description of High Scale Scores

5

Masculinity-

Femininity

Mf

Rejection of traditional gender roles, effeminate men, masculine women

6

Paranoia

Pa

Suspicious, guarded, hypersensitive, belief that others intend to harm

7

Psychasthenia

Pt

Anxious, nervous, tense, worrisome, obsessive

 

Scale Number

Scale Name

Abbreviation

Description of High Scale Scores

8

Schizophrenia

Sc

Psychotic, disorganized, or bizarre thought process, unconventional, hallucinations, delusions, alienated

9

Mania

Ma

Manic, elevated mood, energetic, overactive, accelerated movement and speech, flight of ideas

10

Social

Introversion

Si

Introverted, shy, reserved, more comfortable alone than with others

  • Test-Taking Attitudes in MMPI-2

    • L-Scale: Lying, “faking good” which means the test-taker is intentionally minimizing his/her symptoms.

    • K-Scale: Defensiveness, “faking good” which means the test-taker is intentionally minimizing his/her symptoms

    • F-Scale: Infrequency, “faking bad” which means the test taker is intentionally exaggerating his/her symptoms to appear more impaired that they really are

  1. Personality Assessment Inventory

    • Uniquely tied to specific diagnoses or problems, like Borderline Features, Antisocial Features, Anxiety- Related Disorders, Alcohol Problems, and Drug Problems.

  2. Millon Clinical Multiaxial Inventory-IV

    •  a comprehensive personality test in a self-report, pencil-and paper, true/false format, emphasis on personality disorders

  3. NEO Personality Inventory-3

    • assesses “normal” personality characteristics.

    • FIVE PRIMARY SCALES

 

Trait/Scale

Description of High Score

Description of Low Score

Neuroticism

Prone to emotional distress, negative affect, anxiety, sadness

Emotionally stable, even tempered,

secure even under stressful conditions

Extraversion

Sociable, talkative, outgoing, prefer to be with others

Introverted, reserved, shy, prefer to be

alone

Openness

Curious about novel ideas and values, imaginative, unconventional

Conventional, conservative, traditional,

prefer familiar ideas and values

Agreeableness

Sympathetic, cooperative,

accommodating, prefer to avoid conflict

Hardheaded, competitive, egocentric,

uncooperative, unsympathetic

Conscientiousness

Organized, purposeful, disciplined,

methodical, tend to make and carry out plans

Easygoing, spontaneous, disorganized,

spur-of-the-moment, laid-back

  1. Beck Depression Inventory

    • assesses depressive symptoms in adults and adolescents

    •  Each item is a set of four statements regarding a particular symptom of depression, listed in order of increasing severity

  2. Projective Personality Tests

    • People will “project” their personalities if presented with unstructured, ambiguous stimuli and an unrestricted opportunity to respond

  3. Rorschach Inkblot Method

    •  “response” or “free association” phase: one inkblot card at a time, asks, “What might this be?” and writes down the client’s responses verbatim. 

    • “inquiry” phase: reads the client’s responses aloud, asks the client to describe where the response was located and why was that your response

  4. Thematic Apperception Test

    •  create a story to go along with each scene

  5. Sentence Completion Tests

    •  beginnings of sentences

    • clients’ personalities are revealed by the endings they add and the sentences they create

Behavioral Assessment

  • behavior is the problem itself, not a sign of some deeper, underlying problem


ECOTHERAPY


NATURE THERAPY

  • practice of being in nature to improve health

EXOPSYCHOLOGY

  • develop and understand ways of expanding the emotional connection between individuals and the natural environment

EXISTENTIAL ANXIETY

  • being aware of climate change and its effects in our lives may lead feelings of hopelessness

ECO-ANXIETY

  • severe anxiety due to negative changes in nature

HORTICULTURAL THERAPY

  • in some form of gardening and spending time with plants

WILDERNESS THERAPY

  • by camping and hiking while taking part in survival-skills training.

GREEN EXERCISE

  • partaking in physical activity while in nature.

FORENSIC PSYCHOLOGY

DOPAMINE: high dopamine = aggression, suicide risk

SEROTONIN: low serotonin = aggression, self-harm

CORTISOL: low cortisol = reduced stress

TESTOSTERONE: high testosterone = aggression

FRONTAL LOBE: injuries = aggression

PREFRONTAL CORTEX: damage = poor impulse control and violence

CRIMINAL PROFILING

  • produces a description of the characteristics of an offender

TOP-DOWN APPROACH

  • starts with template, they classify them as organized and disorganized

BOTTOM-UP APPROCH

  • data-driven approach, find relationships behind crimes— patterns

  • interpersonal coherence - how criminals behaved at crime scene = how they behave in real lives