Chapter 7 Lecture Notes: Diagnosis and Classification Issues
Chapter 7 Lecture Notes: Diagnosis and Classification Issues PSYC 3339
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This 16 page Class Notes was uploaded by lambdalambdalambdas on Sunday June 28, 2015. The Class Notes belongs to PSYC 3339 at University of Houston taught by Noblin in Spring2015. Since its upload, it has received 326 views. For similar materials see Intro to Clinical Psychology in Psychlogy at University of Houston.
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Date Created: 06/28/15
Clinical Psychology Science Practice and Culture IIIII ON Chapter 7 Diagnosis and Classification Issues Andrew M Pomerantz Diagnosis and Classification Issues a Defining abnormality has been a primary task of clinical psychologists since the inception of the field What defines abnormality Who defines abnormality Why is the definition of abnormality important Whot Defines Abnormality n Various theories have suggested Personal distress Deviance from cultural norms Statistical infrequency Impaired social functioning Others I Harmful Dysfunction a current theory Jerome Wakefield Considers both scientific data dysfunction and social context harmful a Can behaviors be culturally typical yet also abnormal Who Defines Abnormality n Authors of DSM make official definitions of disorders a Leading researchers in psychopathology n Many of these authors have been psychiatrists DSM published by American Psychiatric Association lVIedicaI model of psychopathology Categorical definitions with specific symptoms Increasing cultural diversity among these authors in more recent editions of DSIVI Why Is the Definition of Abnormality Important n Labeling an experience as a disorder can affect professionals and clients Professionals Facilitate research awareness and treatment Clients Demystify difficult experience Feel like quotnot the only one Acknowledge significance of problem Access treatment Stigma damages selfimage Legalconsequences Before the DSM n Abnormal behavior was recognized and studied in ancient civilizations n In 19th century asylums in Europe and U S arose see Chapter 2 n Around 1900 Emil Kraepelin put forth some of the first specific categories of mental illness I Some early categorical systems were for statisticalcensus purposes DSMl dnd DSMll n DSIVII published in 1952 n DSIVIII published in 1968 Similar to each other but different from later editions Not scientifically or empirically based Based on quotclinical wisdom of leading psychiatrists PsychoanalyticFreudian influence Contained three broad categories of disorders Psychoses neuroses character disorders No specific criteria just paragraphs with somewhat vague descriptions DSMlll n Published in 1980 a Very different from DSIVII and DSIVIII IVIore reliant on empirical data less reliant on clinical consensus Specific criteria defined disorders Atheoretical no psychoanalyticFreudian influence lVIuItiaxial assessment 5 axes lVIuch longer included many more disorders In DSIVIIIIR minor changes from DSlVIIII was published in 1987 DSM Recent Editions n DSIVIIV was published in 1994 n DSIVIIVTR was published in 2000 TR stands for quottext revision Only text not diagnostic criteria differ between DSIVIIV and DSIVIIVTR So these two editions are essentially similar DSM Recent Editions cont n DSlVlIV included significant cultural advances Text describing disorders often includes culturally specific information CultureBound Syndromes are listed Not official diagnostic categories but experiences common in some cultural groups Outline for Cultural Formulation Helps clinicians appreciate impact of culture on symptoms DSM Future Editions n DSIVIS planned release in 2013 a Current changes under consideration Addition of some provisional disorders as official diagnoses Premenstrual dyshporic disorder binge eating disorder attenuated psychosis syndrome DSM Future Editions cont a Current changes under consideration cont Changes to current disorder criteria Eg lower threshold for binging and purging in bulimia nervosa removing bereavement exception from major depressive disorder Elimination of some disorders including some types of personality disorders Criticisms of the Current DSM n Despite advances eg empiricism diagnostic criteria some have criticized the current DSIVI Breadth of coverage Too many disorders Some not actually forms of mental illness Too many people stigmatized Concept of mental illness becoming trivialized Controversial cutoffs How many symptoms should be necessary for a particular disorder What constitutes quotsignificant distress and impairment Cultural issues Some progress but still dominated by nonminority authors and traditional Western values Criticisms of the Current DSM cont Gender bias Do some diagnostic categories pathologize one gender more than the other Consider premenstrual dysphoric disorder a provisional disorder as a possible example Nonempirical influences Despite increased empiricism do other nonempirical factors eg politics finances influence decisions about abnormality Limitations on objectivity Even with increased empiricism do opinion and judgment still play significant roles in decisions about abnormality Alternate Directions in Diagnosis and Classification I Categorical approach The current approach of DSM An individual falls in the yes or no category for having a particular disorder quotBlack and white approach no shades of gray May correspond well with human tendency to think categorically Facilitates communication Alternate Directions in Diagnosis and Classification cont n Dimensional approach quotShades of gray rather than quotblack and white Place clients symptoms on a continuum rather than into discrete diagnostic categories Fivefactor model of personality could provide the dimensions Neuroticism extraversion openness conscientiousness and agreeableness More difficult to efficiently communicate but more thorough description of clients May be better suited for some disorders eg personality disorders
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