Chapter 3 - Classification and Diagnosis Flashcards
Classification: Validity vs Utility
Validity: the effectiveness of the classification scheme in capturing the nature of the entity (e.g. assessment of an anxiety disorder); low validity = not measuring what it says it should be
Utility: the usefulness of the classification scheme (i.e. does the classification scheme actually help us provide adequate treatment/intervention?)
What are the two types of classification systems?
Categorical: an entity is determined as either a member of the category or not (e.g. meeting criteria threshold for a diagnosis or not); qualitative differences between members and non-members, rigid
- e.g. the DSM is a categorical classification system for disorders
Dimensional: members within an entity differ in the extent to which they demonstrate characteristics; can be arranged on a continuum
- e.g. severity scales
The purpose of a diagnostic classification system
-Provides a concise description for conditions and its collection of related symptoms
- Provides a common language for trained professionals (e.g., diagnostic acronyms)
- Can contain information about etiology, comorbidity, and prognosis of a disorder
- Informs treatment (importance of accuracy in diagnosis!
- A diagnosis can allow some people to receive accommodations and reimbursements
Define “abnormal” behaviour
experiences that are not as common, causes distress (to self and/or others) and disrupts functioning
- depends on developmental phase; some behaviours considered more developmentally normal at one age but abnormal at another
- depends on cultural norms and prevailing norms
What is the DSM-5’s definition of a mental disorder?
a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour that reflects a dysfunction in the physiological, biological, or developmental processes underlying mental functioning. Usually associated with significant distress or disability in social, occupational, or other important activities.
What are the similarities and differences between physical and mental disorders
Similarities:
- Based on a cluster of symptoms
Differences:
- Physical disorders most often have a clear etiological path; not often clear for mental disorders due to different pathways that can lead to one
- Physical disorders can be confirmed by “markers” through objective testing (e.g., X-rays); no physical markers for most mental disorders
What does research on the vulnerability to mental disorders say?
Biopsychosocial model: mental disorders are a combination of biological, psychological, and environmental factors
- Biological vulnerabilities: some disorders have high genetic transmission (i.e., bipolar disorder)
- Exposure to stressors: Adverse Childhood Events (ACEs), chronic stress (preventable)
- Absence/disruption of protective factors
DSM-I (1952)
- Created shortly after WWII (1952)
- Emphasized psychodynamic etiological factors
- vague diagnostic descriptions
- 128 categories, only 132 pages, cheap
DSM-II (1968)
-Similar in structure to the DSM-I
- Less emphasis on psychoanalysis, incorporation of biological perspectives
- Psychopharmacological treatments (medication to treat mental disorders)
- Created subcategories (more precise than DSM-I)
i. schizophrenia + subtypes
ii. mood disorders
iii. neuroses (outdated term for anxiety)
iv. personality disorders
DSM-III (1980)
- Essential change: no more psychoanalysis, atheoretical approach (= not driven by theories, only evidence based form empirical research)
- Diagnostic/Feigner Criteria: provided a more objective method of diagnosis through creating a “threshold” for clinically significant cases
- New diagnoses: ADD, PTSD, new anxiety disorders
DSM-III-R (1987)
- Made changes to the diagnosis criteria and some new diagnostic categories
- Changed the order of the classification system
-Added sleep disorders
DSM-IV (1994) & DSM-IV-TR (2000)
- Developed in a collaborative and scientifically informed matter
- Added the Global Assessment of Relational Functioning Scale and Social Occupational Functioning and Assessment Scale that is not used anymore
- DSM-IV-TR corrected errors and updated scientific info
DSM-5 (2013) & DSM-5-TR (2022)
-Development began in 1999
- Public involvement (could watch the development online and add comments)
- Most heavily criticized because it pathologizes normal behaviours (e.g., grief)
- DSM-5-TR added cultural and gender specific information, added ICD codes, lifespan oriented, comorbidity (rule outs), course, and prognosis info, and suicide risk for each diagnosis
What did Dr. Allen Frances say about the DSM-5?
He said that it pathologizes otherwise normal beahviours (i.e., temper tantrums, grief, forgetfulness). People will become overmedicated, ignores cultural differences in “normal” behaviour
International Statistical Classification of Diseases and Related Health Problems (ICD)
- Covers all health conditions, including mental and behavioural disorders
- May better capture a diagnosis for an individual than the DSM can (e.g. ICD covers C-PTSD but DSM does not)
- Published by the World Health Organization (WHO)
- Not as comprehensive as DSM
- Published in 42 languages
- Available online for free (digital transcript easier to edit)
- Assesses prevalence
