Chapter 7 (Lecture) Flashcards
what is nosology?
The study of how medicine classifies illnesses
Nosology classification methods
- one method of classification is by cause - often used for physical/medical illnesses, but difficult to use in mental health (due to lack of biomarkers)
- DSM concentrates on symptoms and clusters of symptoms (rather atypical in medicine)
- mental disorders are classified according to symptoms (the patterns of thoughts, moods, and behaviours) that people exhibit
- this is a descriptive or symptom-based approach: key assumption is that symptom typical of a particular disorder stem from the same underlying condition (or disorder) - this has been the approach since the DSM-III (1980)
Symptom-based classification - two key issues that represent a challenge to this approach
two key issues that represent a challenge to this approach to classification include:
1. symptom overlap
2. heterogeneity
What is Symptom Overlap?
some symptoms (like anhedonia) are common to many mental illness (like schizophrenia, MDD) - some are especially common (anxiety/tension)
What is heterogeneity?
Individuals with the same diagnosis may display very different symptoms and present differently (wide variety of symptoms for each disorder)
- DSM criteria usually require only some of the noted criteria (MDD diagnosis based on 5/9 potential markers)
Implications of symptom-based classification
- symptom overlap - poses a challenge in discerning the dividing lines between different mental disorders (are the distinctions accurate or meaningful?)
- may cause us to question definitions and distinctions between disorders - heterogeneity - diversity of presentations/behaviours/symptoms makes it difficult to explain behaviours and determine the best treatments
- Diagnoses are short-hand (like a label) and sometimes approximate: given range of symptoms and variation, are these two cases or individuals experiencing the same disorder?
OCD and PTSD are both similar and different
- distinct disorders, separate chapters in the DSM-5, different core symptoms that differ meaningfully
- some underlying similarities (anxiety, worry, fear)
What is OCD?
OCD can be described as a manifestation of anxiety revolving around obsessive and intrusive thoughts
- widely misunderstood, partially due to media depictions
Two primary components:
1. Obsessions: disruptive, anxiety producing thoughts and/or mental images - uncontrollable thoughts - common themes related to contamination, sex, religion, precision violence, harm
2. Compulsions: repetitive actions or thoughts which are performed in order to help relieve anxieties stemming from obsessions - these could be repetitive cleaning, counting, checking on things
- when severe, can prevent individuals from completing normal routines, and can result in serious impairment
7 types of obsessions + misc
- Aggressive obsessions
- fear might harm self or others
- violent or horrific images
- fear of blurting out insults - Contamination obsessions
- concerns or disgust w bodily waste or secretions
- excessive concern w environmental contamination
- excessive concern w household items
- excessive concerns w animals
- concerned will get ill - Sexual obsessions
- forbidden or perverse sexual thoughts, images, or impulses
- content involves children or incest
- content involves homosexuality - Somatic obsessions
- concern with illness or disease
- excessive concern w body part or aspect of appearance (body dysmorphia) - Religious obsessions
- excess concern w right/wrong - morality - Obsession w need for symmetry or exactness
- Hoarding/saving obsessions
- Miscellaneous obsessions
- need to know or remember
- fear of saying certain things
- fear of not saying just the right thing
- fear of losing things
- lucky and unlucky numbers
- bothered by certain sounds
6 compulsions + misc
- cleaning/washing compulsions
- excessive cleaning of things or cleaning self - checking compulsion
- checking locks, stoves
- checking that nothing terrible will happen
- checking that did not make mistake
- checking tied to somatic obsessions - Repeating rituals
- rereading or rewriting
- need to repeat routine activities (in and out door, up and down from chair) - Counting Compulsions
- Ordering/Arranging Compulsions
- Hoarding/Collecting Compulsions
- Miscellaneous compulsions
- mental rituals (other than checking/counting)
- excessive list making
- need to tell, ask, or confess
OCD prevalence and tendencies
- estimated to affect 1-3% of US population
- OCD often thought as chronic (or persistent) - lasting throughout a person’s lifetime, rather than being episodic
- people with OCD may avoid people, places, things that trigger obsessive thoughts (avoidance is part of the disorder, similar to anxiety)
What is PTSD?
Similar to OCD due to the intense sensations of anxiety and tension (but not the same at all)
- typically arises following a single traumatic event or repeated trauma over a period of weeks, months, or years (diverse route to emergence)
- these events involve experiencing or witnessing severe harm, injury, danger, or death
- symptoms brought on by trauma, including second-hand experience of trauma (a loved one experiencing trauma)
- we are familiar with combat-related PTSD, but accidents, abuse, and violent crime can also trigger PTSD (a wider range of experiences are now understood to be traumatic)
PTSD Symptoms
- “dissociative” episodes (flashbacks, nightmares) associated with triggers
- nightmares
- negative moods
- sleep disruption
- constantly feeling tense
Reliving trauma is a key component, which may bring on or intensify symptoms
Similarities between OCD and PTSD
- anxiety (symptoms of worry or fear)
- attempts to avoid triggers (avoidance)
- OCD may also manifest following experiences of trauma (or may emerge independently)
- similar treatments for both: psychotherapy (CBT) and exposure-based therapies
- both are similar to anxiety, and were previously grouped within anxiety disorders in earlier DSM editions
Differences between OCD and PTSD
- core features are distinct: obsessions and compulsions are very different experiences than “flashbacks”
- OCD is not always triggered by a traumatic incident
Somatic Symptom and Illness Anxiety Disorder
- These two disorders involve concerns about one’s health, substantial anxiety, excessive worry, rumination (repetitive thinking or dwelling on negative feelings and distress) and avoidance
Somatic Symptom Disorder: describes individuals who have anxiety and/or a fixation on somatic symptoms such as headache and pain
- was previously “conversion disorder” (distress or internal conflict “converted” into physical dysfunction) before that “hysteria”
- people may or may not have a diagnosis for a physical illness that is causing their symptoms
- the diagnosis of this disorder is related to an “excessive and abnormal” psychological reaction to the physical symptoms
Illness Anxiety Disorder: this disorder is characterised by excessive worry about the possibility of becoming ill, previously known as hypochondriasis
- “easily alarmed about personal health status” may perform excessive health-related behaviours (checking for signs of illness)
- may extensively use health system, but concerns are rarely alleviated through care/visits, often feel medical assessments has been inadequate
- may be extra-sensitive to bodily sensations, including more likely to report side effects of medications
Clinical Perspectives (positivist and constructivist)
Study of assumptions about knowledge are often based on two broad frameworks:
- Positivist Framework: sees scientific knowledge as always improving, assumes that we can acquire concrete knowledge about a topic using technology and reason (THERE IS AN OBJECTIVE TRUTH)
- Constructivist Perspective: sees knowledge as fluid and contextual. Our understanding of a phenomena is influenced by our social position and experiences. Our decisions about what to study and how we think about it are influenced by culture, politics, scientific trends, and other factors (“TRUTH” IS SUBJECTIVE, AND DEPENDENT UPON SOCIAL CONTEXT AND EXPERIENCE, AND WILL EVOLVE/CHANGE)
