Comps - Psychopathology (Subdomain 4)

Question 1

What existed before the DSM? (APA, 2013)

Answer 1

-Focus was on practical care management, not nosology
-There was a fluid understanding of mental disorders
-After WWII, APA decided a system was needed

Question 2

Nosology

Answer 2

A branch of medical science dealing with classification of disease

Question 3

DSM-I release date

Answer 3

1952

Question 4

What was the process for the DSM-1? (Blashfield et al., 2014)

Answer 4

-Created prose descriptions of symptoms
-Strong focus on inpatient
-Focus on organic disorders (e.g., things with physical causes like neurocognitive disorders)

Question 6

What was going on in the world mental health community at the time of the DSM-1? (Stengel, 1959)

Answer 6

-All places had their own systems of diagnosis
-Stengel encouraged adopting the DSM
-WHO was prompted and they decided to develop the ICD-8

Question 7

DSM-II release date

Answer 7

1968

Question 8

What was the revision process like for the DSM-II? (Blashfield et al., 2014)

Answer 8

-Created an altered version of the ICD-8
-Introduced outpatient disorders (e.g., anxiety, depression, PDs)
-Introduced childhood/adolescent disorders
-Introduced a misc. category

Question 9

What did Feighner et al. (1972) contribute? (Blashfield et al., 2014)

Answer 9

-Feighner and colleagues operationalized 15 disorders
-They proposed specific, operational definitions for each category in the form of diagnostic criteria and urged that these criteria be used in any future research on these 15 psychiatric disorders

Question 10

DSM-III release date

Answer 10

1980

Question 11

What was the process for the DSM-III? (Blashfield et al., 2014)

Answer 11

-Introduced the axis system
-Introduced more disorders
-Removed “sexual orientation disturbance”
-Changed from a psychoanalytic view to a neo-Kraepelinian view
-More of a medical model
-Head of revision (Spitzer) created structured clinical interviews to increase the reliability of diagnoses

Question 12

Axis System

Answer 12

-Axis I: Clinical Disorders
-Axis II: Personality Disorders and what was then called “Mental Retardation”
- Axis III: Medical Conditions
-Axis IV: Psychosocial and Environmental Factors
-Axis V: The Global Assessment of Functioning (GAF) which was a Number

Question 13

DSM-III-R release date

Answer 13

1987

Question 14

What was changed with the DSM-III-R? (Blashfield et al., 2014)

Answer 14

-Added sleep disorders
-Added appendices for disorders that needed more research

Question 15

DSM-IV release date

Answer 15

1994

Question 16

What changed in the DSM-IV? (Blashfield et al., 2014)

Answer 16

-Used 13 work groups to update criteria
-Extensive literature reviews used
-Requested data from current research
-Did field trials of current diagnoses

Question 17

DSM-IV-TR release date

Answer 17

2000

Question 18

What was the process for the DSM-IV-TR?

Answer 18

-Revised the text
-No major changes

Question 19

DSM-5 releate date

Answer 19

2013

Question 20

What was the process for the DSM-5? (APA, 2013)

Answer 20

-Field studies and literature reviews conducted
-Put drafts online to receive feedback
-Removed the axis model

Question 21

What principles drove the DSM-5 revision process? (APA, 2013)

Answer 21

1. Meant to be clinician’s manual
2. Intended to guide research
3. Maintain continuity with past DSMs
4. No constraints on the degree of change for this new model

Question 22

What were the goals of the DSM-5 revision? (Blashfield et al., 2014)

Answer 22

1. Trim misc and NOS categories
2. Make dimensions (especially for PDs)
3. Align with the ICD-11
4. Reflect current research and restructure to meet the lifetime course of disorders

Question 23

How successful were the goals of the DSM-5 revision? (Blashfield et al., 2014)

Answer 23

1. Increased specificity of disorders meaning more people do not meet criteria
2. APA board rejected the PD dimension/hybrid model
3. Really just updated the ICD-10
4. Made the DSM into sections (section 1: explained revisions, section 2: criteria model, section 3: alternative personality disorder model)

Question 24

What was the response to the changes in the DSM-5? (Wakefield, 2016)

Answer 24

Outcry over axis removal

Question 25

What were the other major DSM-5 changes? (APA, 2013)

Answer 25

-Mood disorders are now 2 different chapters (bipolar and depressive)
-Anxiety disorders are now 3 chapters (anxiety, OCD, trauma-related)
-Eliminated bereavement clause in the depressive disorders diagnosis
-Added anxious distress
-Dysthymia is not PDD
-Gender identity disorder is now gender dysphoria
-Substance abuse/dependence is now substance use disorder
-Asperger’s is folded into ASD

Question 26

Bereavement Clause

Answer 26

It prevented people from being diagnosed with MDD if their symptoms began within two months of a loved one’s death

Question 27

DSM-5-TR release date

Answer 27

2022

Question 28

What changed in the DSM-5-TR? (APA, 2022)

Answer 28

-More attention to culture, racism, and discrimination
-Updates to all prevalence rates, risk, and prognostic factors for each disorder based on new research
-Switched from ICD-9 to ICD-10 codes
-Eliminated male/female checkboxes on clinical sequence measures
-Updated language
-New disorders

Question 29

Example of the attention to culture, racism, and discrimination

Answer 29

-Updating terminology and language “to challenge the view that races are discrete and natural entities”
-Including more information on cultural influences and the possibility of misdiagnosis in socially oppressed groups

Question 30

Updated Language in the DSM-5-TR

Answer 30

-Intellectual Disability –> Intellectual Developmental Disorder
-“Natal Sex” –> “Birth-Assigned Gender”
-Suicidal behavior and NSSI were added as ICD-10 codes to be used as additional descriptors

Question 31

New Disorders in the DSM-5-TR

Answer 31

-Prolonged Grief Disorder (added to trauma and stressor-related disorders section)
-Unspecified Mood Disorder