Ch.7 - Diagnosis Flashcards
While one does not need to meet all 6, what 6 things define ‘Abnormal’?
- Personal Distress
- Violation of norms
- Dysfunction
- Unpredictability (possibly why there is so much stigma)
- Statistical infrequency (different from average)
- Discomfort to others
Various theories have suggested what defines abnormality? (4)
o Personal distress
o Deviance from cultural norms
o Statistical infrequency
o Impaired social functioning
Explains Jerome Wakefeild’s current theory of what defines abnormality
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
What does his theory consider? (2)
scientific data (dysfunction) and social context (harmful)
Why is the definition of abnormality important to professionals? (3)
It facilitates research, awareness, and treatment
Why is the definition of abnormality important to clients? (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)
In the 19th century, before the DSM. What arose in Europe?
Asylums
Around 1900 what did Emil Kraeplin do?
put forth some of the first specific categories of mental illness
Some early categorical systems were for …
statistical/census purposes
The DSM 1 and 2 were heavily influenced by the…
psychanalytic/freudian influence
The DSM 1 and 2 were based on…
The clinical wisdom of leading psychiatrists rather than being scientifically or empirically based
In the DSM 1 (‘52) and 2 (‘68) what were the three broad categories of disorder and was there specific criteria?
Psychoses, neuroses, character disorder
No specific criteria just paragraph with vague description
How is the DSM 3 (‘80) different form 1 and 2? (5)
- More reliant on empirical data; less on clinical consensus
- Has specific criteria defined disorders
- Athoeretical (not based on theory)
- Contained multi-axial assessment
- Much longer - including many more diagnoses
What is the multi-axial assessment and in that edition was it removed?
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
What did the DSM IV (‘94) include
Significant cultural advancements
How did the DSM IV include these cultural advancements? (3)
- Test describing disorders often include culturally specific information
- Cultural bound syndromes are listed (not diagnostic but common experiences in cultural groups)
- Outline for cultural formulation (helps clinicians appreciate impact of culture on symptoms)
What 2 structural changes were seen with the DSM 5 (‘13)
- OCD and related disorders have their own chapter
- Bipolar has its own separate chapter from Major Depression
What are the 6 criticisms of the current DSM?
- Breadth of coverage
- Controversial cutoffs
- Cultural Issues
- Gender bias
- Non-empirical influences
- Limitations on objectivity
Breadth of coverage
♣ 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.
Controversial cutoffs
♣ How many symptoms should be necessary for a particular disorder, and for how long?
♣ What constitutes “significant distress and impairment?”
Cultural Issues
♣ Some progress, but still dominated by non-minority authors and traditional Western values?
Gender Bias
♣ Do some diagnostic categories pathologize one gender more than the other?
♣ Consider premenstrual dysphoric disorder (a provisional disorder) as a possible example
Non-empirical influences
♣ Despite increased empiricism, do other non-empirical factor (e.g., politics, public opinion) influence decisions about abnormality?
Limitations on objectivity
♣ Even with increased empiricism, do opinion and judgment still play significant roles in decisions about abnormality? Since they are just interpreting data
What approach does the current DSM use?
The categorical approach
What is the categorical approach?
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
What is the dimensional approach?
o “shades of gray” rather than “black and white”
o Place client’s symptoms on a continuum rather than into discrete diagnostic categories
What might the dimensional approach be better suited for?
personality disorders
What makes someone abnormal is the unusually high or low levels of these fundamentally shared characteristics, but what are the shared characteristics?
The five factor model = OCEAN
