Chapter 3: Classification and Diagnosis

Question 1

Classification Validity

Answer 1

the extent to which the principles used in classifying an entity are effective in capturing the nature of the entity

Question 2

Classification Ultility

Answer 2

the usefulness of a classification scheme

Question 3

Categorical Approach to Classification

Answer 3

an entity is determined to be either a member of a category or not

Question 4

Dimension Approach to Classification

Answer 4

classified entities differ in the extent to which they possess certain characteristics or properties

Question 5

Diagnostic System

Answer 5

a classification based on rules used to organize and understand diseases and disorders

Question 6

Diagnosis

Answer 6

the result of applying the decision-making rules of a diagnostic system to the symptoms of a specific individual

Question 7

Prototype Model

Answer 7

members of a diagnostic category may differ in the degree to which they represent the concepts underlying the category

Question 8

Developmental Psychopathology

Answer 8

a framework for understanding problem behavior in relation to the milestones that are specific to each stage of a person’s devlopment

Question 9

Harmful Dysfunction

Answer 9

the behaviors associated with a mental disorder are dysfunctional, and the dysfunction causes harm to the individual or to those around them

Question 10

Dyscontrol

Answer 10

the impairment resulting from a disorder must be involuntary or not readily controlled

Question 11

Comorbidity

Answer 11

when a person receives diagnoses for two or more disorders at the same point in time

Question 12

Why do we classify and diagnose?

Answer 12

concise description

common language used by trained professionals

may contain information about etiology, comorbidity, and prognosis

for searching for treatment

important for theoretical development

guides assessment practices

knowing something about a given clinical/patient type informs the psychologist about relevant areas of inquiry

guides treatment practices

sometimes required to establish funding/program eligibility

Question 13

Is there a downside to classifying and diagnosis?

Answer 13

important individual differences may be obscured

knowledge base concerning group or type may be irrelevant to the patient in question

may preempt more meaningful diagnostic exploration

categorization (“labeling”) is often seen as pejorative; especially true in a psycholegal context

Question 14

What is validity in a classification system?

Answer 14

how well a system reflects the true nature of people, disorders, or other things being classified

Question 15

What is utility in a classification system?

Answer 15

how useful a classification system is in understanding those things, and in advancement of science

Question 16

What kind of classification is prominent in psychology?

Answer 16

the roots of psychology are in the social sciences, testing, and measurement; this has led to preference for dimensional approaches to classification

based on the assumption that groups and individuals are separated as a matter of degree, or quantitatively, from one another (e.g., heigh, intellectual ability, years of experience, introversion vs. extroversion)

dimensions can be rearranged into categories by setting dividing points

Question 17

What kind of classification is prominent in psychiatry?

Answer 17

psychiatry, with its roots in the biological sciences, has tended to adopt categorical approaches to classification

based on the view that categories are separated largely by qualitative differences (e.g., male versus female)

Question 18

What is a prototype model to classification?

Answer 18

for some conditions, e.g. psychpathy, a prototype model has more recently been employed

in many respects a combination of categorical and dimensional approaches

defines a perfect member of a given population and classifies others according to their degree of correspondence to that individual

Question 19

What are empirically-derived classification systems?

Answer 19

there are statistical procedures, primarily factor analysis and cluster analysis, which allow us to analyze data from groups of people that allow natural categories, groups, or factors to emerge

these may give important clues concerning underlying dimensions

Question 19

How is diagnosis different from classification?

Answer 19

diagnosis is a special case of classification applied to disorders and those who exhibit them

a diagnostic system can be based either on a dimensional or categorical model

it is always a system of rules used to organize signs, symptoms, and disorders

Question 20

What are signs?

Answer 20

indicators of illness observable by another individual, and often the person themself

Question 21

What are symptoms?

Answer 21

indicators of illness observable only to the individual experiencing them

Question 22

What are the ways of defining abnormality and mental illness?

Answer 22

departure from social norms

functional maladjustment

subjective distress

correspondence to an ideal/cultural hero

the presence of unusual signs/symptoms

the absence of requisite attributes or abilities

Question 23

What are the three things should a definition of a mental disorder encompass?

Answer 23

that the signs/symptoms are unusual

that they are potentially harmful

that they are non-deliberate (dyscontrol)

Question 24

Why do most individuals seek services of psychologists and diagnosis?

Answer 24

many individuals seek the services of psychologists with the express purpose of knowing whether they are “sick” or “crazy”

may be reasonable to offer an opinion as to whether certain thoughts, feelings, or behaviors fall within a “normal” range in a given context, but it’s not responsible to offer an opinion about one’s overall mental health in the absence of a proper assessment

one should also have an appreciation of the client’s motivation for asking that question

often simple reassurance and education is adequate

Question 25

Why is developmental psychopathology important to diagnosis?

Answer 25

one of the key dimensions to be considered is life stage

for example, our behavioral expectations of an infant are markedly different than those of a toddler, adolescent, young adult, middle-aged adult, and senior

possible signs and symptoms of mental illness at one point could be perfectly normal at another

likewise, the supports, interventions, and general treatment of an individual are life stage dependent

vulnerabilities to environmental stressors such as abuse, that lack, and stress vary with developmental stage

Question 26

What is diagnosis?

Answer 26

interestingly, diagnosis is not a protected (“dangerous”) activity under HPA; this may be because greater potential to do harm is thought to rest with intervention

the process of diagnosis must be scientifically-based; it should never rest on value judgements, the subjective experience of the psychologist, or idiosyncratic theories

in practice, patients, care givers, and third-party referral sources frequently offer their own opinions, even expressing indignation when they are not adopted by professionals

Question 27

What is the prevalence of mental disorders?

Answer 27

Statistics Canada (2003): one out of every 10 Canadians (adolescent and older) report symptoms consistent with a disorder such as substance abuse, mood disturbance, or anxiety

Question 28

What were the conclusions of the WHO (2004) data?

Answer 28

WHO (2004) data compared the prevalence of various mental disorders by country

there is significant variability within all classes of mental disorder from one country to another

anxiety and mood disorders appear to be the most prevalent in all areas

regrettably, major mental illness such as schizophrenia appears not to have been considered

mental disorders were viewed as being more disabling than physical disorders, including chronic pain, heart disease, cancer, and diabetes

Question 29

What is the treatment of mental disorders compared to physical disorders?

Answer 29

mental disorders, low income: 8%

mental disorders, high income: 24%

physical disorders, low income: 53%

physical disorders, high income: 65%

Question 30

What is etiology?

Answer 30

manifestation of mental disorders depends on the confluence of biological (often genetic), individual, and social factors

how these factors combine varies across disorders, individuals, circumstances, and time

Question 31

What is resilience?

Answer 31

one’s ability to cope with adverse events

includes traits inherent to that individual, as well as the availability and tendency to make use of external supports including professional services

Question 32

What is the stress-diathesis model?

Answer 32

the likelihood of developing a mental disorder is a product of vulnerability and adversity

numerous individuals who seek professional services for mood and anxiety issues report experiencing an abundance of traumatic events

conversely, the majority of victims of large-scale natural disasters will not be diagnosable as suffering from a mental disorder, even though they may experience significant grief

Question 33

What is a longitudinal study?

Answer 33

follow cohorts of individuals over time

Question 34

What are the prevalence rates of depression at different stages of life?

Answer 34

significant increase in symptoms between grades six and seven

fairly consistent before and after that interval

more pronounced for girls than boys

Question 35

What are recovery rates?

Answer 35

Eaton et al. (2008) studied changes in depressive symptoms (n = 3500 US adults)

followed up 23 years

about 50% had further occurrences

15% had not had a single year of normal mood following first episode

Question 36

What is the DSM?

Answer 36

originally published in 1952

strong psychodynamic influence

now up to DSM-V-TR, published 2022

became explicitly atheoretical with DSM-III (1980)

added multiaxial diagnosis

large scale field trials

Question 37

What is a multiaxial diagnosis?

Answer 37

requires consideration of an individual’s psychological functioning in the context of their physical well-being, psychosocial stressors, and overall (global) level of functioning

oddly, this was removed in DSM-5

Question 38

What are the complaints about the DSM-5?

Answer 38

lack of openness: confidentiality agreement with the researchers who developed it

over-representation of biological views

70% of task force members with links to pharmaceutical companies

poor reliability of diagnoses and concerns about validity

drew reactions from APA members

Question 39

In what way is the DSM a categorical system?

Answer 39

dimensional constructs, such as intelligence, are divided into categories

categorical systems do not preclude the possibility of diagnostic overlap, nor membership in multiple groups

can contribute to diagnostic unreliability: discrepancy between UK and US with diagnosing schizophrenia

ca organize disorders according to symptom similarity

Question 40

How does a diagnostic system interact with research?

Answer 40

a central advantage of any diagnostic system is the potential for facilitating research

grouping individuals on the basis of an agreed-upon system improves the comparability of research findings

fosters development of evidence-based practice

Question 41

What is a monothetic diagnostic definition?

Answer 41

clinical presentation of a given disorder is highly homogenous, and individuals receiving that diagnosis meet the same criteria

everyone in the group looks the same

Question 42

What is a polythetic diagnostic defintion?

Answer 42

there are multiple diagnostic criteria ascribing to a given disorder, and there are various constellations of those criteria that can qualify an individual for diagnosis within that category

have core features in common, but can look different

Question 43

Why is culture relevant to the DSM?

Answer 43

cultural relevance must be carefully considered when making a diagnosis

DSM-IV was the first to provide good information to enhance this area

there are a number of “disorders” that are diagnosed in some cultures but relatively unheard of in others

cultural sensitivity is therefore not just a matter of political correctness

Question 44

How do comorbid conditions impact diagnosis?

Answer 44

the prevalence of comorbid conditions must also be recognized in order to facilitate adequate planning for the management of more complex presentations

it is sometimes difficult to know whether comorbid symptoms truly represent the presence of a seperate disorder, or simply a subtype of the central disorder

eg., FASD, RAD, ADHD

exacerbated by the use of specifiers

Question 45

In what way does the DSM not distinguish between normal and serious pathology?

Answer 45

e.g., are depressive symptoms normal reactions to an acute stressor, or do they herald the onset of a true mood disorder?

sometimes thus can only be answered with time; this criticism is not unique to mental disorders, nor the DSM

Question 46

What are the disadvantages of the DSM?

Answer 46

doesn’t always adequately distinguish between normal reactions and more serious pathology

may be overly sensitive and insufficiently specific

diagnostic reliability is suboptimal

Question 47

What is sensitivity in a diagnostic system?

Answer 47

reflects an instruments ability to avoid false negatives

usefulness and how good it is at picking up the disorder

Question 48

What is specificity in a diagnostic system?

Answer 48

reflects that instrument’s ability to avoid false positives

picking up what you’re looking for and nothing else

Question 49

In what ways is the diagnostic reliability of the DSM suboptimal?

Answer 49

significant gains over previous versions of DSM

can be formally evaluated by calculating interrater reliability

results tend to be best across broad categories, but lower with higher levels of specificity; indeed, these are often below acceptable levels

to the extent that categorical systems artificially dichotomize certain attributes, this was a predictable problem

exacerbated by polythetic diagnostic defintions

Question 50

What is the ICD-11?

Answer 50

International Statistical Classification of Diseases and related Health Problems

published by WHO (2019)

covers all health conditions, including mental and behavioral disorders

42 languages (vs English only in DSM)

available free online (vs DSM: major revenue for APA)

diagnostic criteria only

used to assess prevalence