DSM - 5 Flashcards
Describe FOUR organisational elements that most diagnoses listed in DSM-V include;
Each disorder has a set of criteria (A, B, C D etc.)
The criteria typically cover
- ### Time frame (course and trajectory)
- ### Qualifying symptoms
- ### Disqualifying symptoms
- ### Differential diagnosis (parsimony)
- ### Severity (disability)
- ### Social and Occupational disturbance
- ### **Not better explained by a Medical condition
Describe the alternative framework for assessing the presence of personality disorder contained in section III of the DSM - 5;
6 Personality Disorders include;
- Antisocial/Psychopathic Type;
- Avoidant Type;
- Narcissistic Type;
- Obsessive-Compulsive Type;
- Schizotypal Type; and
- Borderline Type.
Core Criteria
Moderate + Disturbances in ;
- Self (Identity & Self-direction) functioning
- Interpersonal (Empathy & Intimacy) functioning
Meets criteria for relevant pathological traits
5 broad domains –
- Negative Affectivity
- Detachment
- Antagonism
- Disinhibition and
- Psychoticism
Each of these trait domains is comprised of a number of trait facets
What are the strengths an limitations of using of using diagnosis with clients requiring psychological therapy?
Strengths
- help orient to evidence based interventions;
- help access service access or funding;
- helps client to feel like having a name is reassuring;
- forensic could be both;
- communication between practitioners easier
Limitations
- Feel Stigmatised;
- Labelled; e.g. travel insurance incompatible; assumes people present or suffer in the same
- Diagnosis is only the what not the why….can detract from the understanding of the individual
What are the core differences between DSM - IV and DSM -5
- Axial Assessment (Axis I - V)
- Assessment of functioning (GAF) Axis V
- Doesn’t have the Alternative method for diagnosing PD
What is the Axial Assessment Framework?
Axis I - Clinical disorders. Any mental health conditions, other than personality disorders or mental retardation, would have been included here. Disorders which would have fallen under this axis include: eg substance; mood; anxiety disorders
Axis II - Personality disorders and mental retardation. Disorders which would have fallen under this axis include: anitsocial; borderline; histrionic
Axis III - Medical conditions that were present which might impact the patient’s mental disorder or its management.
Axis IV - Psychosocial and environmental factors affecting the person. Factors which might have been included here were: eg edcational; occupational; housing problems
Axis V - was a rating scale called the Global Assessment of Functioning; the GAF went from 0 to 100 and provided a way to summarize in a single number just how well the person was functioning overall. A general outline of this scale would be as follows:
100: No symptoms
90: Minimal symptoms with good functioning
80: Transient symptoms that are expected reactions to psychosocial stressors
What does Axis 1 include in DSM -IV Assessments?
Axis I provided information about clinical disorders. Any mental health conditions, other than personality disorders or mental retardation, would have been included here. Disorders which would have fallen under this axis include:
- Disorders Usually Diagnosed in Infancy, Childhood or Adolescence
- Delirium, Dementia and Amnestic and Other Cognitive Disorders
- Mental Disorders Due to a General Medical Condition
- Substance-Related Disorders
- Schizophrenia and Other Psychotic Disorders
- Mood Disorders
- Anxiety Disorders
- Somatoform Disorders
- Factitious Disorders
- Dissociative Disorders
- Sexual and Gender Identity Disorders
- Eating Disorders
- Sleep Disorders
- Impulse-Control Disorders Not Else Classified
- Adjustment Disorders
- Other Conditions That May Be a Focus of Clinical Attention
Why introduce the alternative personality approach?
Becasue there are too many disorders that have overlapping criteria which make it difficult for diagnosis and treatment planning.
What is the alternative PD assessement based on in the DSM -V?
Personality disorders are characterised by;
Impairments in personality functioning and
Pathological personality traits.
This approach also includes a diagnosis of;
Personality Disorder - Trait Specified (PD-TS)
that can be made when a personality disorder is considered present but the criteria for a specified disorder is not met.
What are the general criteria for personality disorder in the Alternative PD model?
A; Moderate or greater IMPAIRMENT in personality (self/interpersonal) FUNCTIONING
B: One or more PATHOLOGICAL personality traits
C: Impairments in personality functioning and personality traits are INFLEXIBLE and PERVASIVE across a broad range of personal and social situations.
What is ther WHODAS and what does ICF stand for;
Likewise, the WHO Disability Assessment Schedule (WHODAS), a
standard method for assessing global disability levels for mental disorders that is based on the International Classification of Functioning, Disability and Health (ICF) and is applicable in all of medicine, has been provided to replace the more limited Global Assessment of Functioning scale
Taking one psychological disorder as an example; outline the structure typically used within DSM-V to assess and diagnose a mental disorder
Each disorder has a set of criteria (A, B, C D etc.)
Social Anxiety Disorder (Social Phobia)
Qualifying Symptoms
A. Marked fear or anxiety about one or more social situation in which the individual is exposed to possible scrutiny by others.
B. The individual fears that he or she will act in a way that will be negatively evaluated (i.e. humiliating and lead to rejection)
C. The social situations almost always provoke anxiety.
D. The social situations are avoided or endured with intense fear and anxiety
E. the fear or anxiety is out of proportion to the actual threat posed by the social situation and sociocultural context
F. Fear & Anxiety is persistent and generally lasts for 6 months or more (Time)
G. Fear & Anxiety causes clinincally significant distress or imapirment in social; occupational; and other important areas of functioning
H. Effects are not attributable to substance abuse
Differential Diagnosis
I. Fear is not better explained by symptoms of another disorder ; e.g. panic disorder, body dysmophic disorder; autism spectrum disorder
J. If another medical condition is present
Specifiy if; Performance only - fear is restricted to speaking or performing in public
- Time frame (course and trajectory)
- Qualifying symptoms
- Disqualifying symptoms
- Differential diagnosis (parsimony)
- Severity (disability)
- Social and Occupational disturbance
- Not better explained by a medical condition
Additional Sections;
- Specifiers
- Diagnostic Features
- Associated Features Supporting Diagnosis
- Prevalence
- Development & Course
- Risk & Prognostic Factors
- Culture Related Diagnostic issues
- Gender Related Diagnostic Issues
- Functional Consequences of Social Anxiety Disorder
- Differential Diagnosis
- Comorbidity
