Classification Part 1

Question 1

Classification

Answer 1

• Important activity in clinical work and research
• Basic part of science
• Information made more accessible, meaningful, and less cumbersome

Question 2

Defining abnormal vs. normal

Answer 2

we have more information about abnormal behaviour than normal (easier to say what’s abnormal than what’s normal)

Question 3

Steps in defining abnormal

Answer 3

• into subclasses
• starts out as binary (ie. abnormal vs. normal)
• then can break it down further (ie. Mushrooms: flower vs. mushroom -> poisonous vs. not)

Question 4

Paradigms and classification

Answer 4

• Paradigms are sets of assumptions that outline the universe of scientific inquiry
• Paradigms have influenced how classification done and what was classified
• Ex. Hippocrates’ Four humors

Question 5

Philosophical Issues in Abnormal Behaviour Paradigms

Answer 5

• Nature of psychopathy, normalcy, belief in paradigm
• Historical
• • Emil Kraeplin and Neo-Kraeplians
• • Freud
• Contemporary
• • DSM & International Classification of Diseases (ICD)
• • PDM & OPDS

Question 6

Back Masking

Answer 6

Believing that something is in an ambiguous stimulus, and finding it because you’re looking for it

Question 7

2 major classification trends/philosophies

Answer 7

• Symptom as Focus (Kraeplin)

- Underlying Cause as Focus (Freud)

Question 8

Symptom as Focus

Answer 8

• Group of symptoms or observable behaviours (ie. Knee pain)
• Seen as cause of difficulties
• • Issue: what if pain is not the problem?
• Focus of assessment & treatment is on eradicating the symptoms
• • Collect symptoms, call it something (ie. Depression), try to get rid of the symptoms and your job is done
• Approach done by Behaviourism school, ICD, DSM
• Variant embraced by Managed Care in US (insurance companies)

Question 9

Underlying Cause as Focus

Answer 9

• Problems caused by underlying process (ie. Broken knee bone)
• Assessment and treatment focuses on underlying process (ie. Focus on healing broken bone and pain will go away too)
• • Issue: based on what are thought to be the causes
• Orientation of psychodynamic, cognitive behavioural, and PDM
• • Today, there’s been a shift from symptom as focus to underlying cause as focus

Question 10

7 Purposes of Classification

Answer 10

• Description and need to identify
• Communication (by classifying a “depressive episode”, we can communicate what it is to others)
• Research (by classifying PTSD, we can design studies about PTSD)
• Treatment (leads to it)
• Insurance (some things covered, others aren’t)
• Theory development (theories based on class. systems)
• Epidemiological info (classification helpful for figuring out increases vs. decreases)

Question 11

Diagnosis and treatment

Answer 11

• Diagnosis does not always lead to proper treatment:

- Ex. Alzheimer’s -> only correct diagnosis happens post-mortem

Question 12

DSM

Answer 12

• Categorical/binary approach to define abnormality (you either have it or you don’t)
• Revised periodically
• Over 400 disorders
• DSM provides descriptive information not based on any one theoretical perspective (although this is debatable)
• Descriptive features are based on observable features

Question 13

2 categories of Diagnostic Manuals

Answer 13

• Ones used for diagnosis -> DSM, ICD: descriptive, categorical (Kraeplinian)
• Ones used for formulation -> Psychodynamic Diagnostic Manual (PDM) and Operationalized Psychodynamic Diagnosis (OPD)

Question 14

Diagnosis vs. Formulation

Answer 14

• Diagnosis: Assigning diagnostic category (assigning a label)
• • structural interview -> diagnosis
• Formulation: Attempt to explain genesis, maintenance, and process related information for treatment (unique model of how a particular person functions)
• • Assessment -> formulation

Question 15

PDM (Psychodynamic Diagnostic Manual)

Answer 15

• States that DSM provides one level of description, but the PDM describes elements not found in DSM; providing info to improve comprehensive treatments
• Supplements DSM
• Developed from a theoretical perspective (Current Psychodynamic Theory)
• • Ex. Psychoanalysis
• • Ex. Object Relations
• • Ex. Attachment Theory

Question 16

DSM vs. PDM

Answer 16

• DSM describes disorders; PDM helps to understand people (surface & deeper levels of personality; person’s emotional and social functioning; based on current neuroscience)
• Ex. Personality patterns, social & emotional capacities, unique mental profiles, personal experiences of individuals
• DSM = problem; PDM = person

Question 17

Rationale of PDM

Answer 17

• Human behaviour is complex
• DSM simplifies behaviour too much
• Want to direct focus on full range of affect, thought, behaviour in context of an individual’s own unique history
• Rather than thinking of people having discrete disorders (i.e., ego dystonic, separate, outside of self), see disorders as result of some process (personality, incorporation of upbringing, etc.) and the process is what is important

Question 18

PDM Dimensions

Answer 18

• Personality Patterns & Disorders (P Axis)
• Mental Functioning (M Axis)
• Manifest Symptoms & Concerns (S Axis)

Question 19

PDM: P Axis

Answer 19

• Figuring out person’s location on the continuum between Healthy—Disordered
• Ways in which a person organizes mental functioning and interacts with the world
• Maxim: need to understand person in order to understand problem

Question 20

PDM: M Axis

Answer 20

• Detailed look at emotional functioning
• ex. Information processing, self‐regulation, relationships, emotional
  expression, learning, coping/defenses, etc.

Question 21

PDM: S Axis

Answer 21

• Using many of the DSM categories, focus on personal experience of
  difficulties
• Need to be seen in context of personality and mental functioning

Question 22

Kraeplin’s work (T)

Answer 22

• realized that mental disorders had a tendency for groups of symptoms (aka: syndrome) to appear together regularly enough that they had an underlying physical cause
• Proposed 2 groups of mental diseases: dementia praecox (schizophrenia today) due to chemical imbalance & manic-depressive psychosis (BPD today) due to metabolism irregularity

Question 23

4 major paradigms (T)

Answer 23

• biological paradigm
• cognitive-behavioural paradigm
• psychoanalytic paradigm (less influential)
• humanistic paradigm (less influential)

Question 24

biological paradigm

Answer 24

• mental disorders are caused by biological processes (continuation of somatogenic hypothesis)
• aka medical model or disease model
• comprised of behaviour genetics, molecular genetics, and biochemistry
• ex. using DBS to alleviate depression

Question 25

biological paradigm: behaviour genetics

Answer 25

• study of individual differences in behaviour that are attributable to differences in genetics
• genotype is fixed at birth, phenotype changes
• predisposition to disorders (diathesis) may be inherited (genotype), but the expression of the disorder (phenotype) depends on environmental factors too
• includes family method (taking people with disorders “index cases/probands” and looking at their relatives to see if they have them too), twin method (if 1 twin has disorder, greater concordance should be found with MZ than DZ twins), adoptees method (if child of panic disorder parent raised by someone else and still has panic disorder, we can assume it’s more genetic), and linkage analysis

Question 26

biological paradigm: molecular genetics

Answer 26

• trying to specify the particular gene involved in disorders
• uses linkage analysis (studying families with many cases of a disorder to look for genetic markers)

Question 27

genetics and temperament

Answer 27

• temperament is largely genetically determined
• 3 categories: difficult, easy, and slow-to-warm-up
• 3 categories of US boys: resilient, overcontrolling (shy/lonely), undercontrolling (delinquency, low IQ)

Question 28

neuroscience

Answer 28

• study of brain and neurotransmitters
• some theories propose that disorders are caused by too much or too little of a neurotransmitter (ex. mania is to much norepinephrine, ADHD due to lack of dopamine)

Question 29

reductionism

Answer 29

the view that whatever is being studied can and should be reduced to its most basic elements -> should be avoided

Question 30

cognitive-behavioural paradigm

Answer 30

• a type of action/behavioural therapy (changes person’s actions)
• behavioural/learning perspective: abnormal behaviour is a learned response; focus on observable behaviour (ex. classical conditioning, operant conditioning, modelling, cognitive behaviour therapy)
• • behaviour modification/therapy: changing abnormal behaviour using the above methods (ex. counterconditioning, systematic desensitization, aversive conditioning, etc.)
• cognitive perspective: how people structure and make sense of expectations (ie. schemas)
• • ex. Beck’s cognitive therapy persuades depressed clients to alter negative schemas of themselves; Rational-Emotive Behaviour Therapy (eliminating self-defeating beliefs)
• CBT restructures patterns of thought that cause disturbed emotions/behaviours
• based on abstract concepts, doesn’t necessarily tell us WHY/HOW people have negative thoughts

Question 31

psychoanalytic paradigm

Answer 31

• psychopathology results from unconscious conflicts in the individual
• a type of insight therapy (helping people gain insight to why they think/behave the way they do)
• developed by Freud
• includes neurotic anxiety (fear not connected to true threat) and moral anxiety (“perfection principle”); defence mechanisms, free association, dream analysis, etc.
• evolved into ego analysis (greater emphasis on person’a bility to control environment and select how to satisfy drives)
• contemporary includes structural theory, self-psychology, object-relations theory, interpersonal-relational (between client and environment/others), and attachment theory
• anecdotal, not always scientific
• BUT childhood experiences do shape adult personality, unconscious influences on behaviour exist, and people use defence mechanisms to control anxiety/stress

Question 32

Humanistic Paradigm

Answer 32

• abnormal behaviour can be treated by increasing one’s awareness of motivations and needs; based more in free will than psychoanalytic
• insight-focused
• ex. Rogers’ Client-Centered therapy (client directs course of therapy session) -> unconditional positive regard; empathetic therapies (which are very useful)

Question 33

electicism

Answer 33

• employing ideas and therapeutic techniques from a variety of schools
• very common, esp. for treating things like eating disorders

Question 34

Psychosocial factors that influence mental health

Answer 34

• Familial factors (ex. parenting styles, marital discord, parental mental illness)
• • ex. privileged parents who have high expectations but aren’t involved have kids more likely to have mental health issues (“affluenza”)
• Peers (ex. peer status, peer victimization)
• Cultural Context (ex. cultural diversity, minority groups)
• • ex. no differences between Anglo- and French-Canadians, but major differences between Aboriginal people and other Canadians - ex. PTSD, depression, etc. with the exception of Cree people); Hutterites have lowest rates of schizophrenia; immigrants have lower depression and alcohol dependence, but higher mood disorders)
• Individual factors (ex. temperament, prematurity, brain damage)
• Life Events (ex. abuse, homelessness)
• School context (ex. school failure)

Question 35

diathesis-stress model

Answer 35

• integrative approach
• says mental illness is due to genetic predisposition AND stressful life event that triggers it
• ex. BPD triggered by a personal childhood vulnerability and the stressful life event of moving away to college)

Question 36

biopsychosocial paradigm

Answer 36

• An integrative paradigm that suggests that all normal and abnormal behaviour is caused by an interaction of biological (ex. genes, hormones), psychological (ex. personality, social skills), and social factors (ex. poverty, marital conflict)
• ex. person with genetic predisposition, low social skills, and living in poverty would have higher likelihood of mental illness