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Chapter 5 Diagnosis and Classification of Psychological Problems © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Diagnosis Diagnosis: The classification of disorders by symptoms and signs. © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Violation of Social Norms © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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?) © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. What is Abnormal Behavior? • No one definition is sufficient • Abnormal behavior does not necessarily indicate mental illness © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Diagnosis • Advantages – Communication – Enables and promotes empirical research – Research on etiology possible – Diagnosis suggests treatment © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. History of DSMs • DSM-I (1952) – glossary – used term “reaction” • DSM-II (1968) – attempted to be more theory-neutral – encouraged multiple diagnoses © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 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) © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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) © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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) © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Example: Assessment Questions © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Number of Diagnostic Categories per Edition of DSM © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. DSM-IV-TR Cultural Formulation © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Example of a Dimensional System © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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? © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Models of Psychopathology © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Continuum of Vulnerability (Diathesis) and Stress © 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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 not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.