Introduction to Clinical Psychology: Science, Practice and Ethics Classification & diagnosis Assist. Prof. Merve Topcu Department of Psychology, Çankaya University 2016-2017, Fall

Classification Validity Utility Categorical approach The extent to which the principles used in classifying an object are effective in capturing the nature of reality Utility The usefulness of the resulting classification scheme Categorical approach Dimensional approach Diagnostic system A classification based on rules used to organize & understand disease & disorders Yield diagnosis & describe individuals’ condition Stigmatization Potential for an inaccurate diagnosis

Q What is normal?

What is abnormal? Rare, unusual, or bizarre behavior is not always abnormal Context is very important Age Cultural heritage Gender Role Expectations Diagnosis for children vs adults Developmental psychopathology Examines problem behavior in relation to milestones specific to each stage of developement Milestones based on emprical evidence Interested in course of the problem E.g., In many cultures, family members sleep together in one room, often in the same bed. In the U.S., it is considered normal for a baby to sleep in her own bed in her own room.

Diagnostic criteria Diagnosis based on diagnıstic criteria Cirteria include cluster of symptoms that go together Rely on literature findings

Definition of “Mental Disorder” DSM-IV-TR: ‘... a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, and death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction of the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above.’ (APA, 2000 p. xxxi)

Definition of “Mental Disorder” Harmful dysfuntion / impairment Dyscontrol Prevalence of mental disorders Still unipolar depressive disorder leading cause Substance use, Alzeimer’s Biopsychosocial model in understanding mental disorders

Historical overview of psychiatric classification The science of classifying abnormal patterns of behavior and experience is called nosology The root of nosology can be traced back to Hippocrates, who established a classification scheme that remained influential throughout ancient Greece and Rome Diagnostic categories included mania, melancholia and hysteria

DSM-I DSM, in 1952 Multiaxial diagnostic system Relying mostly on psychoanalytic etiology The first official manual of mental disorders to contain a glossary of descriptions of the diagnostic categories Used the term “reaction,” reflecting Adolph Meyer’s psychobiological view that mental disorders represented reactions of the personality to psychological, social and biological factors Multiaxial diagnostic system

Multiaxial diagnostic system

DSM-II ICD-6 (1948) had been the first ICD to include a subdivision on mental disorders, but had only been adopted by 6 countries by 1959. Stengel (1959) found many diagnostic systems in use around the world. This led to the need for a consensual system for all WHO countries, which was to be included in the ICD-8. The resulting system was adopted, with minor revisions, and published as DSM-II in 1968.

DSM-II (cont.) Like DSM-I, each disorder represented a categorical entity, with diagnosis based on a brief general description E.g., Anxiety Neurosis This neurosis is characterized by anxious over-concern extending to panic and frequently associated with somatic symptoms. Unlike phobic neurosis, anxiety may occur under any circumstances and is not restricted to specific situations or objects. This disorder must be distinguished from normal apprehension or fear, which occurs in realistically dangerous situations. The main problem with DSM-II was the lack of an objective and reliable system for describing psychopathology and determining diagnoses 1970’s, operational criteria for making diagnostic decisions

DSM-III In 1974, the APA appointed the Task Force on Nomenclature and Statistics to begin work on DSM-III Emphasis was placed on increasing reliability and clinical utility Represents a “dramatic departure” from previous DSM’s What is new? Provided a definition of the term “mental disorder” Presented diagnostic criteria for each disorder Introduced the multiaxial diagnostic format Redefined a number of major disorders (e.g., elimination of “neurosis”) Added new diagnostic categories (e.g., personality disorders) Presented a hierarchical organization of diagnostic categories Presented a systematic description of each disorder Provided decision trees for differential diagnosis Provided a glossary of technical terms Published reliability data from field trials Utilized a descriptive, a theoretical approach

DSM-III-R, DSM IV & DSM V DSM-III-R in 1987 DSM IV-R changes, including a revision of the multiaxial system (especially Axis II, which was broadened to include mental retardation, and Axis V, which introduced a more comprehensive rating scale) DSM IV-R By the American Psychiatric Association Primarily used in the United States Classifies mental illnesses into different types of disorders (Mood disorders, psychotic disorders, eating disorders, etc.) Subtypes and/or Specifiers

DSM-III-R, DSM IV & DSM V (cont’d) DSM IV-R (cont’d) Recording Procedures Associated Features and Disorders Associated descriptive features and mental disorders Associated laboratory findings Associated physical examination findings and general medical conditions Specific Culture, Age and Gender Features Prevalence Course Familial Pattern Differential Diagnosis Comorbidity

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