Classification Part 1 Flashcards
Classification
- Important activity in clinical work and research
- Basic part of science
- Information made more accessible, meaningful, and less cumbersome
Defining abnormal vs. normal
we have more information about abnormal behaviour than normal (easier to say what’s abnormal than what’s normal)
Steps in defining abnormal
- into subclasses
- starts out as binary (ie. abnormal vs. normal)
- then can break it down further (ie. Mushrooms: flower vs. mushroom -> poisonous vs. not)
Paradigms and classification
- 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
Philosophical Issues in Abnormal Behaviour Paradigms
- Nature of psychopathy, normalcy, belief in paradigm
- Historical
- Emil Kraeplin and Neo-Kraeplians
- Freud
- Contemporary
- DSM & International Classification of Diseases (ICD)
- PDM & OPDS
Back Masking
Believing that something is in an ambiguous stimulus, and finding it because you’re looking for it
2 major classification trends/philosophies
- Symptom as Focus (Kraeplin)
- Underlying Cause as Focus (Freud)
Symptom as Focus
- 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)
Underlying Cause as Focus
- 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
7 Purposes of Classification
- 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)
Diagnosis and treatment
- Diagnosis does not always lead to proper treatment:
- Ex. Alzheimer’s -> only correct diagnosis happens post-mortem
DSM
- 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
2 categories of Diagnostic Manuals
- Ones used for diagnosis -> DSM, ICD: descriptive, categorical (Kraeplinian)
- Ones used for formulation -> Psychodynamic Diagnostic Manual (PDM) and Operationalized Psychodynamic Diagnosis (OPD)
Diagnosis vs. Formulation
- 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
PDM (Psychodynamic Diagnostic Manual)
- 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
DSM vs. PDM
- 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
Rationale of PDM
- 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
PDM Dimensions
- Personality Patterns & Disorders (P Axis)
- Mental Functioning (M Axis)
- Manifest Symptoms & Concerns (S Axis)
PDM: P Axis
- 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
PDM: M Axis
- Detailed look at emotional functioning
- ex. Information processing, self‐regulation, relationships, emotional
expression, learning, coping/defenses, etc.
PDM: S Axis
- Using many of the DSM categories, focus on personal experience of
difficulties - Need to be seen in context of personality and mental functioning
Kraeplin’s work (T)
- 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
4 major paradigms (T)
- biological paradigm
- cognitive-behavioural paradigm
- psychoanalytic paradigm (less influential)
- humanistic paradigm (less influential)
biological paradigm
- 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