2-Diagnosis & klasifikasi masalah psikologis Aska Primardi

What is abnormal behavior? 10 different people have 10 different definition of ‘abnormal behavior’. Why? No single descriptive feature is shared by all forms of abnormal behavior, & no one criterion of “abnormality” is sufficient No discrete boundary exists between normal & abnormal behavior Abnormal behavior : bizarre behavior, dangerous behavior, shameful behavior

Conformity to norms (1) Statistical infrequency or violation of social norms When a person’s behavior tends to conform to prevailing social norms or when this particular behavior is frequently observed in other people, the individual is not likely to come to the attention of mental health professionals When a person behavior becomes patently deviant, outrageous, or otherwise nonconforming, then he/she is more likely to be categorized as “abnormal”

Conformity to norms (2) Advantages : Cutoff points : the statistical infrequency approach is appealing because it establishes cutoff points that are quantitative in nature Intuitive appeal : those behaviors we ourselves consider abnormal would be evaluated similarly by others

Conformity to norms (3) Problems with this definition: Choice of cutoff points The number of deviations Cultural relativity

Subjective distress (1) The perceptions of observer >< the perceptions of the affected individual The basic data of behavior that are not observable : subjective feelings & sense of well-being

Subjective distress (2) Advantages : Every person can assess whether they are experiencing emotional or behavioral problems and can share this information when asked to do so ( ex. Self-report inventories) Problems : The judgment depends on one’s criteria or values

Disability or Dysfunction First step : create some degree of social (interpersonal) or occupational problems for the individual. Advantages : individuals come to realize the extent of their emotional problems, when these problems affect their family & social relationship, their performance at work/school Problems : Who should establish the standards for social or occupational dysfunction? The patient? The therapist? Friends? Or the employer?

Mental Illness Like abnormal behavior, the term ‘mental illness’ or ‘mental disorder’ is difficult to define Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)

Mental disorder Is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with 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...............whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g. religious, political, or sexual) nor conflicts that are primarily between the individual and society are mental disorders, unless the deviance or conflict is a symptom of the dysfunction in the individual as described above

The Importance of diagnosis Why? Categorization is essential to our survival because it allows us to make important distinctions Function : Information/communication Empirical research in psychopathology Research into etiology (causes) May suggest which mode of treatment is most likely to be effective

Classification systems (1) DSM-I (1952), DSM-II (1968), DSM-III (1980), DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000) : Axis I : indicate the presence of any clinical disorders, or other relevant conditions, with the exception of the personality disorders & mental retardation. Axis II : personality disorders and mental retardation

Classification Systems (2) Axis III : is used to highlight any current medical condition that may be relevant to the conceptualization or treatment of an individual on Axis I or II Axis IV : Diagnosis, treatment, & prognosis of psychosocial and environmental problem Axis V : a quantitative estimate (1 to 100) of an individual’s overall level of functioning.

General issues in classification Categories vs dimensions Bases of categorization Pragmatics of classification Description Reliability Validity Bias Coverage

Causes of abnormal behavior & mental illness Model Explanation Example of abnormal behv Biological Processes in central nervous system have gone awry Schizophrenia is caused by an excess of dopaminergic activity Psychodinamic Intrapsychic conflict Specific phobia is due to displacement of an intraphysic conflict onto an external object that can be avoided Learning Learned the same way normal behavior is learned Specific phobia is learned Cognitive Due to maladaptive cognitions Depression results from negative views Humanistic Relative neglect of one’s own self-view and overreliance on the appraisals of others when the two are incongruous Generalized anxiety disorder reflects this overreliance and incongruity