Chapter 3 Classification and Diagnosis INTRODUCTION TO CLINICAL PSYCHOLOGY 2E HUNSLEY & LEE PREPARED...
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Transcript of Chapter 3 Classification and Diagnosis INTRODUCTION TO CLINICAL PSYCHOLOGY 2E HUNSLEY & LEE PREPARED...
Chapter 3Classification and Diagnosis
INTRODUCTION TO CLINICAL PSYCHOLOGY 2EHUNSLEY & LEE
PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UWO
Introduction – Topics
Important Aspects of a Classification Scheme
Defining Abnormal Behaviour Diagnosis and Defining Disorder The Development of a Disorder The DSM Approach to Diagnosis: History The DSM Approach to Diagnosis The DSM Approach to Diagnosis
Problems/Limitations Other Classification Schemes
Classification: a way for scientists to organize, describe, and relate the subject matter of their discipline
Validity: whether a classification scheme is accurately capturing reality
Utility: how useful a classification scheme is
Diagnosis system: a classification based on rules used to organize and understand diseases and disorders
Important Aspects of a Classification Scheme
Categorical approach: an object is determined to be a member of a category or not (e.g., depressed or not depressed)
Dimensional approach: an object differs in degree from others – a continuum (e.g., mildly depressed, moderately depressed, severely depressed)
Prototype model: members of a category may differ in degree to which they represent a common example (used in DSM)
Important Aspects of a Classification Scheme
What is abnormal? Many factors need to be considered including: The cultural and societal context Whether there is distress or discomfort Whether the problem is harming others How common the problem is How much it is interfering with a person’s ability
to function If it is common for that person’s developmental
stage (developmental psychopathology)
Defining Abnormal Behaviour
No diagnosis is based on a single symptom DSM-IV-TR defines disorder in a complicated
fashion including Symptoms associated with distress or
impairment/disability Increased risk of suffering Culturally atypical Not just deviant behaviour (unless there is also
dysfunction)
Diagnosis and Defining Disorder
Wakefield – Harmful Dysfunction: the problem must be clear and there must be harm to person or others
Dyscontrol: impairment must be involuntary or not readily controlled
Diagnosis and Defining Disorder
Most all contemporary models are biopsychosocial – but different theories represent different emphases
Some models emphasize biological aspects while others emphasize psychological or social aspects
Life stress model – important impact of the number of life stressors on the development of disorders
The Development of Disorders
First edition of DSM (1952) had fairly vague terms and emphasized psychodynamic contributions
DSM-II (1968) was less psychodynamically focused as medications were more commonly being used
DSM-III (1980) guided by Robert Spitzer, was atheoretical (revision done in 1987)
Focus on diagnostic criteria, multiaxial, increase in focus on reliability
The DSM Approach to Diagnosis: History
DSM-IV (1994) Further focus on reliability ‘Work groups’ worked on clusters of disorders Text revision (diagnostic criteria unchanged) DSM-
IV’TR’ completed in 2000
DSM-V planned for 2012
The DSM Approach to Diagnosis: History
The DSM-IV uses a multiaxial classification approach. Axis I and II are the mental disorders and III-V provide the medical and psychosocial contexts
The DSM Approach to Diagnosis: History
Axis I: Clinical Disorders and Other Conditions That May Be a Focus of Clinical Attention All the mental disorders in the DSM-IV except for
Personality Disorders and Mental Retardation. Multiple disorders can exist on Axis I
Axis II: Personality Disorder and Mental Retardation These were placed on another axis so that they
were not overlooked
The DSM Approach to Diagnosis
Axis III: General Medical Conditions Current medical conditions that may be relevant to
the understanding or treatment of Axis I or II
Axis IV: Psychosocial/Environmental Problems Psychosocial and environmental information that
may influence the diagnosis, treatment, and prognosis of Axis I or II, including educational, economic, housing, legal problems, etc.
Axis V: Global Assessment of Functioning Score of 1-100 indicating their functioning level
The DSM Approach to Diagnosis
Importance of considering culture Information in the text on cultural variation Cultural bound syndromes Diagnosis should not occur if symptoms are
culturally typical Diagnosis must be done in a culturally sensitive
context
The DSM Approach to Diagnosis
Comorbidity: when a person receives two diagnoses at once DSM attempts to decrease the likelihood of this
with several exclusionary rules However, comorbidity is very common in the DSM
(often >40%)
Diagnoses do not account for normal reactions to life stressors (e.g., divorce, terminal illness)
The DSM Approach to Diagnosis Problems/Limitations
Diagnostic criteria seem to include too much of the population (sometimes 25-30% of the population)
Although better than the earlier versions DSM diagnoses are not as reliable as hoped
Heterogeneity of symptom profiles is problematic
Many of the subtypes and features of a disorder are not based on empirical data
The DSM Approach to Diagnosis Problems/Limitations
Validity of some disorders is questionable (i.e., that the diagnosis is a discrete entity)
Current research indicates that some disorders may be both a category and a continuum (e.g., depression)
Resilience is often not included in understanding disorders, yet is a common aspect of human functioning
The DSM Approach to Diagnosis Problems/Limitations
International Statistical Classification of Diseases and Related Health Problems (ICD-10) – developed by World Health Org. Mental and behavioural disorders subsection
(compatible with the DSM-IV) Companion “International Classification of
Functioning, Disability and Health (ICF)” focused on overall functioning and health
Achenbach System of Empirically Based Assessment
(ASEBA)– internalizing/externalizing problems
Other Classification Schemes
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