Classification and Diagnosis

Question 1

Definitions of a disorder 1

Answer 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

Question 2

Definitions of a disorder 2

Answer 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

Question 3

Classifying psychopathology

why bother if it is so hard to define?

Answer 3

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

Question 4

Classification systems

Development of them

Answer 4

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

Question 5

Ideal classification system

Answer 5

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

Question 6

APA’s DSM

Answer 6

comprehensive system
disorders described in terms of lists of phenomena that are found to cluster
lots of focus on personal distress

Question 7

Wakefield, 1997: DSM

Answer 7

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

Question 8

Necessary conditions for classification concepts

Answer 8

reliability

validity

Question 9

Reliability

Answer 9

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

Question 10

Validity

Answer 10

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

Question 11

Comorbidity

Answer 11

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

Question 12

Comorbidity: the traditional view

Answer 12

Symptoms = passive indicators of latent construct (i.e. the underlying disorder)
Comorbidity issue arises due to shared ‘liabilities’ between disorder

Question 13

Comorbidity: system focused approach

Answer 13

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)

Question 14

The medical model of psychopathology

Answer 14

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

Question 15

Psychological models to psychopathology

Answer 15

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

Question 16

Implications of classifying for clinical practice

Answer 16

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

Question 17

Trans-diagnostic approach to treatment

Answer 17

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

Question 18

Implications of diagnosis for individuals

Answer 18

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

Question 19

Case formulation

Answer 19

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

Question 20

Psychodynamic Model

Answer 20

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

Question 21

Behavioural model

Answer 21

disorders reflected in learned reactions
classical conditioning - association
operant conditioning - rewards and consequences
argues disorders are learnt behaviours

Question 22

Cognitive model

Answer 22

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

Question 23

Humanist-existential approach

Answer 23

to resolve psychological problems look at insight, personal development and self-actualisation
Rogerian therapy

Question 24

Societal perceptions and attitudes towards mental health

Answer 24

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

Question 25

mental health as a society wide concern

Answer 25

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

Question 26

Cuts to children’s mental health services since 2010

Answer 26

London – 5%
North East – 12%
North West – 9%
East Midlands – 5%
East of England – 13%
South West – 0%

Question 27

Caplan, 1987

Answer 27

diagnosis and labelling can hinder recovery

classification system gives narrow set of symptoms to focus on and ignores wider causal understanding for suffering

Question 28

Timimi, 2014

Answer 28

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