Ch.7 - Diagnosis

Question 1

While one does not need to meet all 6, what 6 things define ‘Abnormal’?

Answer 1

1. Personal Distress
2. Violation of norms
3. Dysfunction
4. Unpredictability (possibly why there is so much stigma)
5. Statistical infrequency (different from average)
6. Discomfort to others

Question 2

Various theories have suggested what defines abnormality? (4)

Answer 2

o Personal distress
o Deviance from cultural norms
o Statistical infrequency
o Impaired social functioning

Question 3

Explains Jerome Wakefeild’s current theory of what defines abnormality

Answer 3

Called harmful Dysfunction
> a disorder is a harmful dysfunction, where harmful is a value term based on social norms, and dysfunction is a scientific term referring to the failure of a mental mechanism to perform a natural function for which it was designed by evolution. Thus, the concept of disorder combines value and scientific components

Question 4

What does his theory consider? (2)

Answer 4

scientific data (dysfunction) and social context (harmful)

Question 5

Why is the definition of abnormality important to professionals? (3)

Answer 5

It facilitates research, awareness, and treatment

Question 6

Why is the definition of abnormality important to clients? (6)

Answer 6

♣ Identify & Demystify an otherwise difficult and nameless experience
♣ Feel like “not the only one”
♣ Acknowledge significance of problem (you’re not crazy there is actually something wrong)
♣ Access treatment (may have been unavailable through insurance without formal diagnosis)
♣ Stigma damage self-image
♣ Legal consequences (child custody, fitness to stand trial)

Question 7

In the 19th century, before the DSM. What arose in Europe?

Answer 7

Asylums

Question 8

Around 1900 what did Emil Kraeplin do?

Answer 8

put forth some of the first specific categories of mental illness

Question 9

Some early categorical systems were for …

Answer 9

statistical/census purposes

Question 10

The DSM 1 and 2 were heavily influenced by the…

Answer 10

psychanalytic/freudian influence

Question 11

The DSM 1 and 2 were based on…

Answer 11

The clinical wisdom of leading psychiatrists rather than being scientifically or empirically based

Question 12

In the DSM 1 (‘52) and 2 (‘68) what were the three broad categories of disorder and was there specific criteria?

Answer 12

Psychoses, neuroses, character disorder

No specific criteria just paragraph with vague description

Question 13

How is the DSM 3 (‘80) different form 1 and 2? (5)

Answer 13

1. More reliant on empirical data; less on clinical consensus
2. Has specific criteria defined disorders
3. Athoeretical (not based on theory)
4. Contained multi-axial assessment
5. Much longer - including many more diagnoses

Question 14

What is the multi-axial assessment and in that edition was it removed?

Answer 14

Psychiatric problems were described on each of five distinct axes
♣ Axis 1 = disorders thought to be more episodic
♣ Axis 2 = disorders thought to long lasting
♣ Axis 3 and 4 = list medical condition and psychosocial/environmental relevant to the mental issue at hand
♣ Axis 5 = Global Assessment of Functioning Scale – provide clinicians an opportunity to place client on 100-point continuum describing their overall level of functioning

Question 15

What did the DSM IV (‘94) include

Answer 15

Significant cultural advancements

Question 16

How did the DSM IV include these cultural advancements? (3)

Answer 16

1. Test describing disorders often include culturally specific information
2. Cultural bound syndromes are listed (not diagnostic but common experiences in cultural groups)
3. Outline for cultural formulation (helps clinicians appreciate impact of culture on symptoms)

Question 17

What 2 structural changes were seen with the DSM 5 (‘13)

Answer 17

• OCD and related disorders have their own chapter

- Bipolar has its own separate chapter from Major Depression

Question 18

What are the 6 criticisms of the current DSM?

Answer 18

1. Breadth of coverage
2. Controversial cutoffs
3. Cultural Issues
4. Gender bias
5. Non-empirical influences
6. Limitations on objectivity

Question 19

Breadth of coverage

Answer 19

♣ Too many disorders? Some not actually forms mental illness? Too many people stigmatized? Concept of mental illness becoming trivialized?
• Need to diagnose something if it’s helpful to the client, we wouldn’t be saying this if there was too much cancer diagnosis. Also mental illness is not either or, it’s on a spectrum.

Question 20

Controversial cutoffs

Answer 20

♣ How many symptoms should be necessary for a particular disorder, and for how long?
♣ What constitutes “significant distress and impairment?”

Question 21

Cultural Issues

Answer 21

♣ Some progress, but still dominated by non-minority authors and traditional Western values?

Question 22

Gender Bias

Answer 22

♣ Do some diagnostic categories pathologize one gender more than the other?
♣ Consider premenstrual dysphoric disorder (a provisional disorder) as a possible example

Question 23

Non-empirical influences

Answer 23

♣ Despite increased empiricism, do other non-empirical factor (e.g., politics, public opinion) influence decisions about abnormality?

Question 24

Limitations on objectivity

Answer 24

♣ Even with increased empiricism, do opinion and judgment still play significant roles in decisions about abnormality? Since they are just interpreting data

Question 25

What approach does the current DSM use?

Answer 25

The categorical approach

Question 26

What is the categorical approach?

Answer 26

o An individual falls in the “yes” or “no” category for having a particular disorder
o “black and white” approach – no “shades of gray”
o May correspond well with human tendency to think categorically
o Facilitates communication

Question 27

What is the dimensional approach?

Answer 27

o “shades of gray” rather than “black and white”

o Place client’s symptoms on a continuum rather than into discrete diagnostic categories

Question 28

What might the dimensional approach be better suited for?

Answer 28

personality disorders

Question 29

What makes someone abnormal is the unusually high or low levels of these fundamentally shared characteristics, but what are the shared characteristics?

Answer 29

The five factor model = OCEAN