PSY7B_Diagnosis & Classification of Psychological Problems

1. What Is Abnormal Behavior?

a) Definition Challenges

  • Hard to define due to:

    • No single feature defines all abnormal behavior.

    • No one rule is sufficient for determining "abnormality."

b) Common Myths

  • Abnormal behavior is often viewed as bizarre, dangerous, or shameful.

c) Three Definitions of Abnormal Behavior

  1. Statistical Infrequency or Violation of Social Norms

    • Statistical Infrequency: Behavior that is rare or uncommon in the general population.

    • Violation of Social Norms: Behavior that breaks societal expectations.Example: The case studies of Dmitri and Juanita illustrate these concepts.

  2. Subjective Distress

    • Definition focuses on those with a poor sense of well-being and/or high levels of distress.Example: The case studies of Cynthia and Kwame exemplify this definition.

  3. Disability, Dysfunction, or Impairment

    • Disability: Loss or limitation of functioning affecting daily tasks and roles.

    • Dysfunction: Inability to perform societal roles in social, occupational, or educational contexts.

    • Impairment: Loss of normal functioning in specific domains, resulting from a disorder.Where does this leave us? The definitions present strengths and weaknesses; abnormal behavior does not always indicate mental illness.

2. Mental Illness

a) Importance of Diagnosis

  • Critical for identifying specific conditions, guiding treatment, enhancing communication among professionals, and informing prognosis.

    • Correct diagnosis is vital for ensuring appropriate care that improves quality of life.

b) Early Classification Systems

  • Developed by Emil Kraepelin in the late 19th century; categorized mental illnesses based on symptom patterns, influencing the DSM.

  • Historical roots trace back to the first mention of depressive syndrome around 2600 B.C.

c) Key Developments in Classification

  • 1889: Congress of Mental Science adopted a classification system.

  • 1948: WHO included abnormal behavior in the International Classification of Diseases.

  • DSM Evolution:

    • First edition published in 1952 (DSM-I)

    • Revised through editions up to DSM-V (2013).

  • Kraepelin's Influence: Regarded as the father of modern psychiatric classification.

3. Evolution of DSM

a) Changes in DSM Systems

  • DSM-III: Introduced clear criteria and a multiaxial system.

  • DSM-IV-TR: Comprehensive reviews led to an emphasis on empirical support.

b) Multiaxial System Breakdown

  1. Axis I: Clinical disorders (e.g., Major Depressive Disorder, Schizophrenia).

  2. Axis II: Personality disorders and Intellectual Disabilities (e.g., Borderline Personality Disorder).

  3. Axis III: General medical conditions affecting mental health (e.g., diabetes, neurological conditions).

  4. Axis IV: Psychosocial and environmental problems impacting mental health (e.g., job loss).

  5. Axis V: Global Assessment of Functioning (GAF) score, assessing overall functioning.

c) DSM-V Revisions

  • Eliminated multi-axial system, adopting a dimensional approach focusing on severity.

  • Introduced flexible diagnostic criteria, integrating cultural considerations comprehensively.

4. General Issues in Classification

a) Categories vs Dimensions

  • Categories: Discrete classifications (presence or absence of disorder).

  • Dimensions: Individuals assessed across a continuum of severity instead.

b) Methods of Diagnosis

  • Varied processes, including behavior assessment and self-reports, leading to complex diagnoses.

c) Reliability and Validity in Diagnosis

  • Importance of consistent diagnostic judgments and meaningful correlates (Robins and Guze method).

d) Bias and Coverage Issues

  • The need to avoid biases related to gender, race, and socioeconomic status; DSM-IV-TR includes nearly 400 diagnoses, raising concerns about overreach.

5. Causes of Abnormal Behavior

a) Major Models of Psychopathology

1. Biological Model

  • Chemical imbalances, genetics, or brain abnormalities causing mental illness.Example: Schizophrenia may result from excess dopamine activity.

2. Developmental Model

  • Interaction with the environment shapes mental health; maladjustment can result from early life stressors. Example: Depression linked to interpersonal stressors in early life.

3. Psychodynamic Model

  • Unresolved intrapsychic conflicts lead to mental illness. Example: Phobia displacement from unconscious conflict.

4. Learning Model

  • Mental illness learned through experiences. Example: Phobia developing from a negative childhood experience.

5. Cognitive Model

  • Maladaptive thoughts contribute to mental illness. Example: Depression from negative self-perceptions.

6. Humanistic Model

  • Ignoring personal feelings creates mental illness. Example: Generalized anxiety from seeking others' approval.

6. Diathesis-Stress Model

a) Explanation

  • Mental illness develops through a combination of vulnerability and life stressors.

1. Diathesis:

  • Biological or psychological predisposition.

2. Stress:

  • External factors triggering potential mental illness.

b) Importance

  • Explains why individuals respond differently to stress.

  • Guides treatment through understanding unique vulnerabilities.

7. The Value of Classification

  • Helps organize mental health information.

  • Facilitates effective communication among clinicians and researchers.

  • Aids in creating a coherent understanding of mental health.