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Chapter 5
Diagnosis and Classification of
Psychological Problems
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Diagnosis
Diagnosis: The
classification of
disorders by
symptoms and
signs.
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Psychopathology
• Psychopathology examines the nature and
development of abnormal
– behavior
– thoughts
– feelings
• Definitions of abnormality vary widely and
may not capture all aspects of
psychopathology
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Characteristics of Abnormal Behavior
• Disability
– Impairment in a key area
• Chronic alcohol consumption results in job loss
• Personal Distress
– Emotional pain and suffering
• Helplessness and hopelessness of depression
• Violation of Social Norms
– Makes others uncomfortable or causes problems
• Antisocial behavior of the psychopath
• Dysfunction
– Biological, social, occupational
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Characteristics of Abnormal Behavior
• 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
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Statistical Infrequency or Violation of
Social Norms
• Advantages
– Cutoff points can be established and used
– Intuitive appeal: we tend to think we know
abnormal behavior when we see it
• Problems
– Choice of cutoff points: how to decide?
– Number of deviations required
– Cultural relativity – deviance differs for different
groups
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Violation of Social Norms
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Subjective Distress
• Subjective/personal distress: behaviors that
are accompanied by distress are abnormal
• Advantages
– Seems reasonable to expect that person can
assess whether or not s/he is experiencing distress
• Problems
– Can think of a number of exceptions: Antisocial
Personality Disorder, mania, psychosis
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What is Abnormal Behavior ?
• 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
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What is Abnormal Behavior ?
• Disability/Dysfunction
– Advantages
• Relatively little inference is required; dysfunction is
apparent
• Often prompts people to seek treatment because their
normal life is interrupted
– Problems
• In how many domains of functioning must you see
problems? (1,2, 3, more?)
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What is Abnormal Behavior?
• No one definition is sufficient
• Abnormal behavior does not necessarily
indicate mental illness
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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
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Diagnosis
• Advantages
– Communication
– Enables and promotes
empirical research
– Research on etiology
possible
– Diagnosis suggests
treatment
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Diagnostic Systems
• 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
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History of DSMs
• DSM-I (1952)
– glossary
– used term “reaction”
• DSM-II (1968)
– attempted to be more theory-neutral
– encouraged multiple diagnoses
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History of DSMs
• DSM-III (1980)
– defined mental disorder
– descriptive approach/criteria sets
– etiology unknown
– narrowed definition of Schizophrenia
– broadened definition of Affective disorder
– multiple diagnoses allowed on Axis I and II
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not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.
History of DSMs
• DSM-III-R (1987)
• DSM-IV (1994)
• DSM-IV-TR (2000)
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DSM-IV-TR
Diagnostic System
• Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR)
– 4th edition, text revision
– Published by American Psychiatric Association
• Multiaxial system
– Diagnosis based on 5 axes or dimensions
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Five Axes of DSM-IV
Axis Description
I.
All diagnostic categories except personality
disorders and mental retardation
II. Personality disorders and mental
retardation
III. General medical conditions
IV. Psychosocial and environmental problems
V. Global assessment of functioning scale
(GAF)
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Selected Axis I
Diagnostic Categories
• Disorders usually first diagnosed in infancy, childhood or
adolescence
– Learning Disorders
– Pervasive Developmental Disorders
• Substance-related disorders
– Alcohol-related and Amphetamine-related Disorders
• Schizophrenia and other Psychotic Disorders
• Anxiety disorders
– Panic, Generalized Anxiety, Obsessive-Compulsive Disorders
• Mood disorders
– Major Depressive and Bipolar Disorders
• Eating Disorders
– Anorexia Nervosa and Bulimia Nervosa
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Example: Multiaxial Diagnosis of
Michelle M.
Axis I
Dysthymic Disorder
Alcohol Abuse
Cannabis Abuse
Cocaine Abuse
Hallucinogen Abuse
Axis II
Borderline Personality Disorder
Axis III
none
Axis IV
Problems with primary support group; Educational
Problems
Axis V
GAF = 20 (some danger of hurting self or others)
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not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.
Example: Assessment Questions
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Improvements in the
DSM-IV-TR
1. Specific diagnostic criteria
•
Less vague, more explicit and concrete than
DSM-II
2. More extensive descriptions
•
•
•
Essential features
Associated features (e.g., lab findings)
Differential diagnosis
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Improvements in the
DSM-IV-TR
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
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Number of Diagnostic Categories per
Edition of DSM
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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
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DSM-IV-TR Cultural Formulation
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Categorical vs. Dimensional Systems
• Categorical
– Presence/absence of a disorder
• Either you are anxious or you are not anxious.
• 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?
• Dimensional systems may better capture an individual’s
functioning
• Categorical approach has advantages for research and
understanding
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Example of a Dimensional System
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Inter-Rater Reliability
• The extent to which clinicians agree on the diagnosis
• For most DSM diagnostic categories, reliability is
good
• Reliability in everyday settings may be lower than in
formal research settings
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Validity
• Construct validity
– A construct is an abstract concept or inferred
attribute
– Involves correlating multiple indirect measures of
the attribute
– Important method for evaluating diagnostic
categories
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Validity of Diagnostic Categories
• Construct validity of highest concern
• Diagnoses are constructs
– For most disorders, no lab test available to
diagnose with certainty
• Strong construct validity predicts wide range of
characteristics
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General Issues in Classification
• Categories vs. dimensions
– Should disorders be grouped in discrete categories or viewed
dimensionally?
• Bases of classification
– Should there be multiple ways of making diagnoses?
• Description and coverage
– Are features of the diagnostic categories described adequately?
• Validity
– Can we make meaningful predictions based on a diagnosis?
• Bias
– Are features of any DSM disorder biased against particular groups?
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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
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Models of Psychopathology
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Continuum of Vulnerability (Diathesis)
and Stress
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Criticisms of Classification
• Stigma against those classified with a mental
illness
– Treated differently by others
– Difficulty finding a job
• Categories do not capture the uniqueness of a
person.
– The disorder does not define the person.
• She is an individual with schizophrenia, not a
“schizophrenic”
• Classification may emphasize trivial similarities
– Relevant information may be overlooked
© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May
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