ch 3 (week 1) Flashcards
what are 5 methods for defining abnormality? explain
- Statistical concept: how frequently would we see these behaviors? (freq defines abnormality)
-issues: sometimes unusual behavior isn’t problematic (eg athletes, high IQ) - Personal distress: is the person distressed by their behaviors/thoughts?
- Personal dysfunction: to what extent is it impacting their ability to function?
- violation of norms: is this behavior considered part of the ‘norm’?
- Diagnosis by an expert: application of the criteria outlined in major classification systems
what are 6 reasons for diagnosing?
- Organization of clinical info - provides essentials of a patient’s condition coherently + concisely
- Shorthand communication - enhances the effective interchange of info by clearly transmitting important features of a disorder + ignoring unimportant ones
- Prediction of natural development - allows accurate short and long term prediction of an indiv’s development
- Treatment recommendations - allows accurate predictions of the most effective interventions
-provides important info for effective clinical intervention (eg panic disorder diagnosis should inform the type of treatment he receives) - Heuristic value - allows investigation + clarification of issues related to a problem area; also enhances theory building
- Guidelines for financial support - provides guidelines to services needed, incl payment of caregivers
what is etiology?
history of the development of the symptoms and underlying causes of a disorder
what are 3 qualities of a perfect diagnostic system? what is the reality?
- classify disorders on the basis of a study presenting symptoms, etiology, prognosis, and response to treatment
-hard to get a large sample + trace them over a long period of time - different symptoms would signal different disorders with limited overlap; each symptom only found in one diagnostic category
-humans are very complex/rapidly changing; many interacting events/processes contribute to behavior - a cure would be available for each disorder
-difficult to implement interventions that follow strict scientific principles
what are 2 characteristics of a strong diagnostic system? what are some types of these characteristics?
- reliability: must give same msmt every time
-inter-rater reliability: extent to which 2 clinicians agree on a diagnosis - validity: whether a diagnostic category is able to predict disorders accurately
-concurrent validity: ability of diagnostic category to estimate an individual’s present standing on factors related to the disorder but not themselves as part of the diagnostic criteria
-predictive validity: ability of a test to predict the future course of an indiv’s development
what is considered a milestone in the modern development of a comprehensive diagnostic scheme? what did this inspire?
-the WHO’s decision to add MH disorders to the International List of the Causes of Death (1948)
-in response to perceived inadequacies of the ICD system, APA published its own classification system (DSM) in 1952
describe the history and development of the DSM
-original DSM (1952) and DSM-2 (1968) was v brief + vague; proved wholly unreliable
-1980: DSM-III; 1987: DSM-III-R
-1994: DSM-IV; 2000: DSM-IV-TR
-2013: DSM-5
describe innovations improvements with each edition of the DSM
-DSM I and II: brief, vague, very heavily based on psychoanalytic theory (which lacks empirical evidence)
-DSM III: were more empirically based and atheoretical w respect to causal factors; operationally defined req # of symptoms + how long symptoms should last to meet diagnostic criteria
-DSM III-R also polythetic (an indiv can meet diagnostic criteria without having all of the symptoms listed), and multiaxial (in addition to primary diagnoses, diagnosticians are required to provide addl info regarding indivs fnxing)
-DSM IV: kept multiaxial approach
-DSM 5: revised organizational structure (move disorders to diff classes), create sections 2 (official diagnostic criteria) and 3 (optional dimensional, cultural, alternative personality disorder model), deleted multiaxial system, global assessment of function deleted, “not otherwise specified” replaced, greater emphasis on dimensionality, cultural consideration elaborated
what are the 5 axes of the DSM-IV?
-Axis I: major mental disorders (eg mood disorders, EDs, schizophrenia)
-axis II: personality disorders + intellectual disability
-axis III: relevant medical conds (HIV, cancer, diabetes which are relevant in a person’s health, treatment, understanding of person)
-axis IV: relevant life circumstances (relationships, employment, housing)
-axis V: general functioning
what are reasons for the development of the DSM 5?
-Include new knowledge
-Fix diagnostic problems in DSM-IV-TR
-Improve reliability of DSM diagnoses
-Correct diagnostic categories that were too narrow or too broad
-Greater harmonization between DSM and ICD-11
-Enhance clinical utility
what was the process of developing the DSM5?
-eval of DSM-IV
-work groups
-field trials
-post and receive feedback on DSM 5
-“summit committee” vote: experts in the area make final decision
what are 6 critiques of the DSM?
- discrete vs continuum: the DSM is categorical; you either have it or you don’t
- reliability + validity
- gender bias: argue that descriptions of disorders make it more likely that women will be diagnosed
- cultural bias: doesn’t give a guideline of what to expect in diff cultures
- process issues: decisions often come down to a “panel of experts”; politics: decisions influenced by other criteria
- clinical utility: will “new” diagnoses lead to overdiagnosis? Do clinicians use the DSM-5 accurately?
what are 3 reasons against classification? what are counters for each?
- Adherence to the medical model: shouldn’t adhere to it bc medical disorders have a clear indication; mental disorders don’t
Counter: many medical disorders w no known anatomical abnormalities - Stigmatization: diagnoses will come w stigma in society
Counter: the issue is with people’s rxns, not the classification system – providing educ abt MH can ↓ stigma - Loss of information: boil it down to 2 or 3 word terms; give us a false sense of confidence in understanding the person + making assumptions abt their personhood that aren’t valid
Counter: such info is often needed when MH professionals speak to each other + patients report that knowing the name of a disorder helps them understand their experience / provides some relief
