chap 1 online lecture Flashcards
Mental disorders can be difficult to identify and classify, Theories have evolved over the years-
-Demon Possession
-Humoral imbalance resulting in evil spirits and mental disorders
-Social cultural Factors (today) sociocultural theories
Neurological/Medical Disorders, (lower socioeconomic status is linked to higher levels of behavioral, emotional cognitive distress/behavior)
mental disorder back then
In the past if a person was acting unusually they used mental illness to explain their behavior without diagnosis.
Mental disorder, definition
a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
Goal of DSM- (5)
Provide clear, common definition of disorder
Foster communication among discipline
Promote study of disorders
Clarify treatment options
Inform payment structures
DSM 1 (1952)
first comprehensive volume of describing mental disorders, general description.
DSM 2 (1968)
the difference is between 1 and 2, minor changes, clarifying names of syndromes and their descriptions.
DSM 3 (1980)
-major change of diagnostic process in mental health, became more specific and detailed,
-more people being diagnosed since they knew the details. categories were hierarchical
Number of diagnoses was expanded to more than a hundred diagnoses in DSM3 (150). Provided a multiaxial approach system, to identify if there was a
Axial 1- psychiatric diagnosis,
Axial 2-personality disorder,
Axial 3-any medical condition
Axial 5- social streesers
-level of functioning. (from most important to least)
DSM 4 (1987)
looked at cultural differences, cultural factors and how they influence. Also included an appendix applied to mental disorder and culture.
DSM 5 (1994)
-got rid of the multiaxial system,
-Empirical/research intensive revision.
-Added consideration of culture,
-documents evolve since societal values change (eg.transgender population).
Concerns Leading to Move for DSM-5
-Process intended to be empirical(based on experience rather than logic), to address vital questions.
-Acknowledge political aspect of diagnosis (eg. how to think ab transgender individuals)
-Resolve the question of categorical vs dimensional elements of disorders. Acknowledges the dimensional nature of mental disorders (e.g., ASD).
-Elimination of axial structure, replacement with modifiers for various diagnoses, if so, what should they be?
-Medicalization/elimination of atheoretical stance. Concern that DSM is excessively focused on biologically-based explanations of disorder (elimination of Atheoretical stance)
Evidence-Based Practice
-Intended to be objective and identify best practice (unbiased
-Increasingly valued in research, practice, and purpose for reimbursement
-Has some significant limitations, (only describes what is “average”, no one is average, therefore many individuals do not fit the evidence.
-Needed more evidence, research, and what will be done with mental illness.
DSM 5 Process- Goals
-a manual to be used by clinicians, and changes must be achievable in routine specialty practices.
-Recommendations should be guided by research evidence.
-Continuity with previous editions should be maintained when possible (to avoid unnecessary disruption for clinicians, we should use research evidence to support maintaining the good qualities of DSM-IV, as well as to make revisions that will lead to better clinical diagnostic practice)
-Unlike in DSM-4, there will be no a priori constraints (limitations) on the degree of change between DSM-IV and DSM-5. changes can happen freely.
-Used working groups to develop new structure
-Included disciplines in addition to psychiatry and psychology
DSM process (continued)-
Still Widely Criticized!
-Potential that millions of people would now be added to the rolls of those with mental illness, and affected by the accompanying stigma (negative judgment)
-Concern about excessive prevalence given broad criteria/modifiers (the diagnosis of mental illness being too common=more people labeled as having a condition.)
-Concern that some diagnoses were being eliminated (especially Asperger’s syndrome), making some ineligible for services, no longer a diagnosable condition instead falls under mild ASD.
-Concern about closed process in spite of efforts at openness, (critics felt key decisions in DSM-5 were made by a small, closed group of experts)
-Concern about cultural insensitivity (may overlook cultural differences in how mental health is experienced and understood.
Medicalization- might lead to over diagnosis, when not informed the expectations, (just bc ur homeless doesnt mean u have mental illness)
-Lack of clinical utility (won’t always help clinicians make accurate diagnoses or treatment decisions.)
DSM-5 structure
-Elimination of axial structure(to simplify diagnosis)
-Addition of spectrum structure (autism spectrum disorder) (where conditions are seen as a range, not just separate categories.)
-Addition of modifiers to further describe (mild, moderate, severe (to describe the severity of disorders when diagnosing)
-Functional deficits included as symptoms (difficulty at work, school, relationships)
Definitions for me
Selection
Drift
Empirical
Atheoretical
Medicalization
Humoral Imbalance
Objective
Priori
Sigma
Selection: People with lower socioeconomic status are more likely to develop mental disorders due to stressors associated with poverty.
Drift: Individuals with mental disorders may fall into lower socioeconomic status due to emotional, cognitive, and behavioral difficulties.
Both factors may play a role, but neither theory provides a definitive explanation, suggesting that mental disorders may not only be viewed as medical illnesses.
(mental disorder, how you think, feel, and act. (ex- bipolar, anxiety)
Empirical- based on observation or experience rather than theory or logic.
Atheoretical- not based on or concerned with theory
Medicalization- view (something) in medical terms; treat as a medical problem.
Humoral Imbalance: An ancient theory that mental disorders were caused by an imbalance in body fluids (blood, phlegm, bile).
Objective- not influenced by personal feelings or opinions
Priori- knowledge that’s true without being based on previous experience/observation.
Sigma- negative attitudes or false beliefs associated with circumstances/ health symptoms.
