Classification and Diagnosis Flashcards
Definitions of a disorder 1
Statistical infrequency - psychological state that is statistically infrequency - issue: not all statistically infrequency states are maladaptive
Violation of social norms - case of John Mytton - also cultural issues (Niehaus, 2002: schizophrenia)
Personal distress - mental state causing personal distress - issue: some states of psychopathology may not have any personal distress
Definitions of a disorder 2
Harmful dysfunction - wider definition to encompass all previous definitions
Wakefield, 1999 - condition resulting from behavioural, psychological or biological dysfunction - affects social, occupational and other aspects of normal functioning
Classifying psychopathology
why bother if it is so hard to define?
we still want to try and provide treatment as we know some treatments are effective (Fournier, 2010 SSRIs) (Rossler, 2013 - treatments are effective)
- to create new treatment need classification as first stage of aetiology and cause
Classification systems
Development of them
Kraeplin first developed comprehensive CS for psychopathology
WHO developed this into new chapter of ICD
they are fundamental to scientific study
adequate description allows communication
similar groups can be studied
can generate general laws/theories
i.e. medical model is inappropriate for psychological disorders
Ideal classification system
divide disorders into mutually exclusive and exhaustive sub-categories
sub-categories defined by necessary and sufficient criteria - then defined as a concept
actual members are n extension of this concept
i.e. animal kingdom
APA’s DSM
comprehensive system
disorders described in terms of lists of phenomena that are found to cluster
lots of focus on personal distress
Wakefield, 1997: DSM
DSM designed to:
provide necessary/sufficient criteria for diagnosis
should provide means of defining the disorder
should provide diagnostic criteria that can be used by different clinicians in different settings
Necessary conditions for classification concepts
reliability
validity
Reliability
Beck et al., 1962
- 4 psychiatrists gave diagnosis of 123 outpatients
-poor agreement on what the individual was diagnosed with
Lobbestael Leurgans and Arntz, 2001
-reliability has shown small improvement with every revision
-Kappa values assessed - all values high (above 0.6) - but not perfect
Validity
Stengel, 1959 - lack of validity due to ambiguity of terminology (but study is old)
NIMH withdrew its support for DSM-V due to lack of validity
Cuthbert and Insel, 2013 - DSM has very Western bias - underlying validity of disease entities questioned
Comorbidity
joint occurrence of two or more disorders
has implications for how disorders are conceptualised and treated
Kessler et al., 1994 - suggests that 79%+ individuals diagnosed with a disorder will have a history of more than one disorder
Comorbidity: the traditional view
Symptoms = passive indicators of latent construct (i.e. the underlying disorder)
Comorbidity issue arises due to shared ‘liabilities’ between disorder
Comorbidity: system focused approach
if you have one symptoms, the rest will surely follow
Borsboom et al., 2011 - symptoms are active causes of further symptoms - domino effect (symptoms of one disorder may directly trigger symptoms of the other)
The medical model of psychopathology
explains psychological disorders as a result of physical impairments
implications for mental health:
- physical/biological factors underlie psychopathology
- reduction of complex aspects into simple biology
- assumes something to be wrong - influence how people view their suffering
Psychological models to psychopathology
disorders result from psychological processes primarily, rather than biological ones
mental health symptoms seen as normal reactions mediated by intact psychological/cognitive mechanisms
e.g.
-Psychodynamics
-Behavioural model
-Cognitive model
-Humanist/Existential approach
Implications of classifying for clinical practice
argument for refocus on the individual not the disorder
clinical classification/individual case formation are not mutually exclusive
recent focus on CBTs that are trans-diagnostic
Trans-diagnostic approach to treatment
because of similar problems being identifiable across disorders within a cluster (causing high co-morbidity) there is the argument that manualised treatment for each disorder is inappropriate
so this treatment selects components according to each individual case formation
Implications of diagnosis for individuals
Treatment implications (NICE guidelines)
Knowledge that others have similar experiences may be helpful
Facilitates understanding for family/friends
Labelling gives the illusion of understanding
Individuals may lose hope of recovery (Seeman, 2016)
Potential for stigmatisation
Case formulation
use of clinical information to produce a psychological explanation of clients problems and to develop plan for therapy
how this is constructed depends on the approach of the clinician
Psychodynamic Model
Freudian
functioning explained in terms of how different mechanisms work to defend against anxiety
id, ego and superego may generate psychopathology through imbalance in conflict
Behavioural model
disorders reflected in learned reactions
classical conditioning - association
operant conditioning - rewards and consequences
argues disorders are learnt behaviours
Cognitive model
pioneered by Ellis and Beck
most widely adopted model
Prochaska and Norcross, 2003 - 1/4 clinical psychologists view their approach as cognitive
disorder results from irrational beliefs, dysfunctional ways of thinking and biased information processing
this also maintains the disorder
Humanist-existential approach
to resolve psychological problems look at insight, personal development and self-actualisation
Rogerian therapy
Societal perceptions and attitudes towards mental health
Rosenhan, 1973 - labelling and stigma
Crisp et al., 2000 - those with diagnosis had major stigma attached their disorder (71% people asked thought schizophrenics were a danger to others)
Brohan et al., 2012 - employers were unlikely to employ those with depression, schizophrenia, alcoholism
mental health as a society wide concern
48% US adults will meet official criteria for a psychological disorder at some point in their lives
15% approx. of US population use mental health services every year
21% 9-16 y/o receive mental health services every year
Cuts to children’s mental health services since 2010
London – 5% North East – 12% North West – 9% East Midlands – 5% East of England – 13% South West – 0%
Caplan, 1987
diagnosis and labelling can hinder recovery
classification system gives narrow set of symptoms to focus on and ignores wider causal understanding for suffering
Timimi, 2014
diagnoses are not valid
they increase stigma
they impose Western beliefs on other cultures
doesn’t share same scientific security as rest of medicine
so we need to redefine classification systems
