Lecture 5: Dimensional taxonomies and hiTOP

Question 1

essentialism=

Answer 1

Essentialism refers to the belief that individuals from a distinct category, such as class, gender, sex, or ethnicity, possess an unchanging characteristic that causes their behavior and appearance.

Question 2

implicit essentialism in the dsm 5

Answer 2

• A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognitive, emotion regulation, or behavior…
• that reflects a dysfunction in …
• the psychological, biological, or developmental process…
• underlying mental functioning…

Question 3

core ideas =

Answer 3

1. An underlying cause explains the occurrence of all symptoms of a cluster of symptoms,
2. Mental disorders are defined by a set of symptoms that are caused by essences,
3. Clusters of symptoms are independent from each other because they have a different cause

Question 4

what are the blinding effects

Answer 4

• Alternative perspectives
• Context
• Meaning
• Social construction
• Individual variation
• Personal understanding

Question 5

welke symptomen bij borderline

Answer 5

5 out of 9:

affect lability
instability of relations
avoid abandonment
identity instability
paranoia or dissociation in distress
feeling empty
self-harm
impulsivity
anger/agression

Question 6

within syndromes: high … of causes
between syndromes: high … of causes

Answer 6

within syndromes: high heterogeneity of causes
between syndromes: high similarities of causes

Question 7

borderline has a high heterogeneity of causes:

Answer 7

trauma
difficult current context
disinhibition problems
substance abuse

Question 8

wat zijn dus 4 moeilijkheden bij borderline

Answer 8

raar dat er zo’n cut off is van 5/9 symptomen
heterogeneity
co-occurence of other syndromes
continuïty of personality and psychopathology

Question 9

met welke syndromen komt borderline best veel overeen

Answer 9

dependent PD
major depression
post-traumatic stress

Question 10

wat dachten ze vroeger over het continuïty of personality and psychopathology

Answer 10

syndromen (MDD, PTSS) -> momentary, episode, changeable, what you have

personality -> pervasive, persistent, unchangeable, who you are

Question 11

hoe denken we nu over personality disorders

Answer 11

we weten dat personality meer veranderbaar is dan we in eerste in stantie dachten, en dat de momentary/episodic etc meer stabiel is dan wij dachten.

Question 12

how did we get to hiTOP?

Answer 12

1. Psychiatric epidemiology
2. Questionnaire research in clinical and developmental psychology
3. Personality trait research
4. Psychometrics

Question 13

waarom willen we meer dimensies gebruiken

Answer 13

omdat in de klinische praktijk co-occurence heel normaal en veelvoorkomend is, maar in research gebruiken we maar 1 diagnose. dit komt dus niet goed met elkaar overeen

Question 14

wat zijn de 4 stappen van hiTOP

Answer 14

1. dimensionalizing a syndrome (low vs high depressivity)
2. factor analysing multiple syndromes (internalising -> social anxiety, mdd, ptsd, etc)
3. factor analysing large sets of symptoms (dmv hierarchical factor analysis)
4. joint factor analysis of personality and problems (FFM vs AMPD vs hiTOP)

Question 15

model: FFM vs AMPD vs HiTOP

Answer 15

emotional stability - negative affectivity - somatoform & internalising
extraversion - detachment - detachment
openness - psychoticism - thought disorder
agreaableness - antagonism - antagonistic externalising
conscientiousness - disinhibition - disinhibited externalising

Question 16

lossen dimensions al onze problemen op?

Answer 16

nee;

• Arbitrary cut-offs (wanneer is het dan hoog genoeg?)
• Heterogeneity of symptoms (iets minder in hokjes plaatsen, dus je houdt er wel iets meer rekening mee; maar nog steeds weten we niet waarom die heterogeneity er is. dus wel meer genuanceerd, maar geen oplossing)
• Heterogeneity of causes (iets beter overzicht, maar nog steeds geen idee van wat de etiologie is)
• Co-occurence of syndromes
• Common causes
• Continuïty of personality and psychopathology (iets beter represented in dit system)

Question 17

did we move beyond essentialism?

Answer 17

no. even if you use dimensions, you still give them a name and therefore still implies bv “underlying vulnerability for internalizing problems” -> weer een underlying thing that causes the problems.

Question 18

other directions in science nowadays

Answer 18

• networks
• narratives
• transdiagnostic mechanisms

Question 19

tools bij personal recovery

Answer 19

• Intersubjective understanding
• Collaboration
• First person perspective
• Promote personal recovery
• Hope, meaning, identity

Question 20

tools bij DSM

Answer 20

• Continuity with research tradition
• Communication with society
• Status as a medical profession
• Reïmbursement

Question 21

tools bij HiTOP

Answer 21

• Empirically grounded taxonomy
• More adequate representation of
  dimensionality and heterogeneity
• Continuity with epidemiological
  research

Question 22

tools bij case conceptualisation

Answer 22

• explanatory hypotheses
• applying psychological theory
• using clinical expertise
• developing a treatment rationale
• learn clinical reasoning (