Download SECTION I: PROFESSIONAL ORIENTATION

Chapter 10
Abnormal Development, Diagnosis,
& Psychopharmacology
© 2016. Cengage Learning. All rights reserved.
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Why Study Abnormal
Behavior, Diagnosis, and Medication?
 Read vignettes, middle of p. 313
 Reasons to study abnormal developmental, diagnosis, &
medication—see 11 reasons p. 314
 You can’t have one without the other (abnormal behavior,
diagnosis, and medication)
 If you believe in extreme deviations from the norm (mental disorders
and abnormal behavior), then you are going to want to understand
it—classify it
 If you classify it (diagnose disorders), then you (or the clients) are
going to want to be treated
 One form of treatment is medication
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Personality Development
and Abnormal Behavior
* Genetic and Biological Explanations
* Genetics subset of biology
* If disorders are biologically based, it would make sense to treat
them biologically
* Treating biologically can be broad-based, such as:
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Medication
Stress reduction
Exercises
Amount of light we receive
Proper amount of sleep
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Personality Development
and Abnormal Behavior (Freud)
 Born all id; Develop ego and superego as we pass through the
psychosexual stages
 Experiences through the stages effects personality development
 Extremely poor parenting leads to development of maladaptive
behaviors as our defense mechanism attempt to control the
impulses of our id
 Discuss how various parenting styles may affect development
 Parents who are obsessively strict
 Parents who extensively praise
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Personality Development and Abnormal
Behavior (Learning Theory)
 Learning occurs through operant conditional, classical conditioning,
or modeling
 Principles of operant conditioning explains many of the ways that
individuals develop (see p. 320)
 Major factors that lead to healthy or dysfunctional personality:
 Born capable of multiple personality characteristics
 Behaviors and cognitions continually reinforced
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Reinforcements can be very complex and subtle
Abnormal behavior result of reinforcement
Analysis of reinforcements leads to understanding of person
New behaviors learned by applying principles of learning
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Personality Development and Abnormal
Behavior (Humanistic Approach)
 Maslow and Rogers most influential
 Maslow: We exhibit characteristics based on our placement in
need hierarchy (See Figure 10.1, Page 322)
 Rogers: How significant others treat us results in our
personality development (and placement on Hierarchy)
 We all need to be loved
 Conditions or worth placed on us
 To gain love, we respond to others based on conditions of worth—
leads to false self
 With empathy, genuineness, and unconditional positive regard we
can rediscover our “true” selves
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Post-modernism and Social
Constructionism’s View of Development
 Post-modernism
 Questioning of modernism
 “Truth” is a construction
 Social Constructionism
 Language creates reality through discourse
 Thus, our realities are created through our discourses with others and
how “reality” is passed down through society
 Conclusion
 Abnormal behavior is simply a social construction
 Perhaps, the mental health field plays a part in continuing
this deception
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Comparing and Integrating Models
 See Comparison of How Different Models View
Psychopathology
 Table 10.1, p. 326
 Today, many clinicians integrate the models
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Diagnosis and Abnormal Behavior:
What Is DSM-5?
 Greek words: Dia (apart) and gnosis (to perceive or know)
 DSM-I: 1952
 DSM-IV-TR: Five Axes
 Axis I: All Disorders Except Personality Disorders or Mental
Retardation
 Axis II: Mental Retardation and Personality Disorders
 Axis III: General Medical Conditions
 Axis IV: Psychosocial/environmental Problems
 Axis V: Global Assessment of Functioning
 Advantages and Disadvantages of DSM
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The DSM-5
 Under development since 1999; first published in May of 2013
 Single-Axis vs. Multiaxial Diagnosis
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Making and Reporting Diagnosis
Ordering Diagnoses
Subtypes, Specifiers, and Severity
Provisional Diagnosis
 Rule-out, traits, by history, by self-report
 22 Specific Diagnostic Categories
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DSM-5 Diagnostic Categories
 Neurodevelopmental
disorders
 Schizophrenia Spectrum and
Other Psychotic Disorders
 Bipolar and Related Disorders
 Depressive Disorders
 Anxiety Disorders
 Obsessive-Compulsive and
Related Disorders
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 Trauma- and Stressor-Related
Disorders
 Dissociative Disorders
 Somatic Symptom and
Related Disorders
 Feeding and Eating Disorders
 Elimination Disorders
 Sleep-Wake Disorders
 Sexual Dysfunctions
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DSM-5 Diagnostic Categories (cont’d)
 Gender Dysphoria
 Disruptive, Impulse Control,
and Conduct Disorders
 Substance-Related and
Addictive Disorders
 Neurocognitive Disorders
 Personality Disorders
 Cluster A, Cluster B, Cluster C
 Paraphilic Disorders
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 Other Mental Disorders
 Medication-Induced
Movement Disorders and
Other Adverse Effects of
Medications
 Other Conditions That May
Be a Focus of Clinical
Assessment
 “Other specified” and
“Unspecified” Disorders
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Psychopharmacology
 Antipsychotics (neuroleptics)
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1950s: First wave of antipsychotics
Today: Many different kinds
Today, three types: conventional, atypical, 2nd generation
See Table 10.5, p. 334
Side effects are many: anticholinergic, extrapyramidal, tardive dyskinesia,
blood disorders, other effects
 Mood-Stabilizing Drugs (e.g., for bipolar disorder)
 1950s: Lithium
 Today: Lithium, anticonvulsant drugs, benzodiazepines, other
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Psychopharmacology
 Antidepressants
 1930s: amphetamines
 1950s: MAOIs and Tricyclics
 More recently: SSRIs and atypical anti-depressants
 Anti-anxiety Medications
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1960s: Librium, Valium
Later, more benzodiazepines (e.g., Valium, Librium, Xanax)
Nonbenzodiazepines: Buspar, Gepirone
For generalized anxiety disorder, obsessive-compulsive disorder, etc.
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Psychopharmacology
 Stimulants
 Later 1800s: Cocaine and amphetamines for diet aid, emotional
disorders
 Today: Mostly used for ADHD
 Also used for narcolepsy
 Most common: Ritalin, Cylert, and Dexedrine
 Warning: All have side affects
 Many different drugs today exist
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Multicultural/Social Justice Focus
 DSM-5 and Cultural Sensitivity
 Symptomatology may differ as a function of culture
 DSM tends to diagnose from an individual perspective
 APA has attempted to combat some of these problems
 “Culturally patterned differences in symptoms”
 Clinicians need to have some understanding of differences in
cross-cultural expression of symptoms
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Ethical, Professional, & Legal Issues
 Ethical Issues
 ACA’s 2014 code addresses a number of important issues relative to
diagnosis (Standard E.5: Diagnosis of Mental Disorders)
 Proper diagnosis: Be careful to ensure proper diagnosis
 Cultural Sensitivity: Be sensitive to how cultural background can affect the
manner in which the client expresses self
 Historical and Social Prejudice: Counselors should understand and
recognize that some groups have been misdiagnosed and pathologized
 Refraining from Making a Diagnosis: Refrain from diagnosing if you think if
making a diagnosis will harm client
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Ethical, Professional, & Legal Issues
 Professional Issues
 Challenging Abnormality and Diagnosis
 Some say mental illness is a normal response to a stressful situation
(e.g., Laing and Szasz)
 Ivey and Ivey suggest diagnosis may be a normal response to
developmental issues (see Box 10.3, p. 340)
 Corey: reasons why clinicians should be careful when diagnosing (see
bottom of p. 350)
 Glasser believes psychopathology is a client’s clumsy attempt at
meeting his or her needs
 Overdiagnosis of Mental Illness
 Because we have DSM, do we naturally overly diagnose?
 See Box 10.3, p. 340: On Being Sane in Insane Places
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Ethical, Professional, & Legal Issues
 Legal Issues
 Confinement Against One's Will
 Donaldson v. O’Connor (1975): People can’t be held against their will
unless there is danger to self or others
 Today, usually need a hearing to have people confined against their
will
 Insurance Fraud
 Some diagnoses may not be paid by insurance companies
 Some clinicians give alternative diagnoses in order to get paid
 Giving an alternative diagnosis is illegal
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The Counselor in Process
 Dismissing Impaired Graduate Students
 Should we dismiss students at all?
 Should we view students from DSM?
 Should we take a developmental perspective and assist
students to strive toward wellness?
 ACA code (Section F.9.b) suggests:
 Assist students in securing remedial assistance
 Seek professional consultation and document decision to dismiss or
refer students
 Ensure students have recourse in a timely manner to address issues of
referral or dismissal
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