Ch 3: Classification and Diagnosis

Question 1

Why is classification/categorization useful? Who did it begin with?

Answer 1

• important in all science and social science
• helps us manage complexities of life by organizing phenomena into patterns
• attempts to classify and diagnose abnormal human behaviour started with Kraepelin

Question 2

What is validity and utility?

Answer 2

• validity: does the classification scheme capture the nature of the entity
• utility: how useful is the classification scheme

Question 3

What are the purposes of a diagnostic Classification System?

Answer 3

• reflects current scientific knowledge
• common language
• info on etiology, comorbidity and prognosis
• guidance on treatment
• key terms for searching literature
• eligibility for costs of services

Question 4

What are the drawbacks of diagnostic systems?

Answer 4

• stigmatization
• misdiagnoses
• prototype model (people may differ and require different treatments)
• questionable inter-rater reliability
• overdiagnosis

Question 5

How do we define normal and abnormal behaviour?

Answer 5

• study of the range of normal behaviour

- anything that falls outside of norm, is likely causing difficulties

Question 6

What factors must be considered when looking at norms?

Answer 6

• developmental phase
• culture
• prevailing norms (slavery, domestic violence, sexual orientation)

Question 7

What is the Developmental Psychopathology approach?

Answer 7

• examines problem behaviours in relation to developmental tasks specific to each stage of development
• assumes that biological and psychological systems are constantly changing

Question 8

How are mental disorders diagnosed? How does this compare to physical disorders?

Answer 8

• based on cluster of symptoms
• etiology less clear than physical disorders
• no clear physical markers
• diagnosis relies on observation of symptoms

Question 9

How does the DSM-5 outline the core components of mental disorder?

Answer 9

• clinically significant disturbance in cognition, emotion regulation or behaviour
• dysfunction in psychological, biological or developmental processses
• significant distress or disability

Question 10

What is harmful dysfunction?

Answer 10

• behaviours associated with a mental disorder cause harm to the individual or those around them

Question 11

What is dyscontrol?

Answer 11

• suggested component of mental disorder definition that posits impairment resulting from a disorder must be involuntary or not readily controlled
• related to the law and if someone is not criminally responsible
• behaviours or distress is out of clients control

Question 12

What can increase vulnerability to mental disorders?

Answer 12

• biological vulnerability
• exposure to stressors
• absence of or disruption of protective factors
• none of these alone ‘cause’ mental disorders but increase the risk altogether

Question 13

How do developmental periods and vulnerability interact?

Answer 13

• the incidence of certain disorders rise during certain developmental periods
• ex. depressive symptoms are highest in young adulthood and older adulthood

Question 14

What has been found in research on vulnerability following disaster?

Answer 14

• majority of people do not develop PTSD
• those with pre-existing disorders are at the greatest risk
• resilience is the norm

Question 15

What are the two basic approaches to classification schemes?

Answer 15

• categorical: have or do not have diagnosis, traditional approach, DSM-5
• dimensional: spectrum, common in assessing children, ASEBA, can compare before and after treatment

Question 16

How does the ASEBA work?

Answer 16

• if below dashed lines: functioning at normal range
• between: at higher risk
• cue us or allow us to administer more measures to come up with a possible diagnosis

Question 17

What characterizes DSM-1?

Answer 17

• largely psychodynamic

- limited impact on treament because only one type commonly available

Question 18

What characterizes DSM-2?

Answer 18

• more precision

- greater choice among treatments

Question 19

What characterizes DSM-3?

Answer 19

• atheoretical (not tied to a specific type of theory)
• behavioural descriptors
• focus on inter-rater reliability (consistency)
• described as changing the entire focus of the mental health field

Question 20

What characterizes DSM-4?

Answer 20

• scientifically informed via work groups (health professionals doing research on specific disorder) and literature reviews

Question 21

What characterizes DSM-5?

Answer 21

• expanded
• consultation (1 psychologist in work groups)
• unprecedented criticism
• categorical in diagnosis
• dimensional in organization (prevalence, course, familial pattern)

Question 22

Why was the DSM-5 heavily criticized?

Answer 22

• lack of openness and transparency
• growth in new disorders planned for inclusion
• over-representation of biological views
• 70% of task force members with links to pharmaceutical companies
• poor reliability of diagnoses (no-better-than-chance)
• Saving normal: about how normal people are diagnosed and given medication

Question 23

What is the ICD?

Answer 23

• by the World Health Organization
• covers all health conditions, including mental and behavioural disorders
• good compatibility with DSM-5
• 42 languages
• free on-line

Question 24

What are the challenges with diagnosis?

Answer 24

• keeping up with science
• medicalization
• inadequate reliability and validity
• polythetic nature of disorders (people with same diagnosis and different symptoms)
• dimensional may be more useful than categorical
• comorbidity