1. Abnormal Psychology PSYC 303 Fall 2013
Diagnosis
Abnormal Psychology
PSYC 303
Fall 2013

2. The Historical Roots of Diagnosis…
American Psychiatric Association (APA, 1952)
Diagnostic and Statistical Manual of Mental Disorders (DSM, current edition DSM-V, 2013)
Multiaxial system of diagnosis and classification
International Classification of Diseases (ICD-10, 1992) published by WHO

3. 91-100 Excellent functioning in all aspects of life
Global Assessment of Functioning (GAF) a way for clinician’s to use a rating system to assess one’s functioning.
Excellent functioning in all aspects of life
81-90 Good functioning, only everyday problems like traffic
71-80 Starting to shows slight impairment in Axis IV areas
61-70 Starting to show mild symptoms and social supports still intact
51-60 Starting to show moderate symptoms and an increase in the level of distress and impairment in Axis IV areas

4. Global Assessment of Functioning (GAF) continued…
41-50 Symptoms are severe and obvious and there is severe impact on one’s Axis IV areas
31-40 Major difficulties in reality orientation, judgment, and communication, as well as extreme difficulties in Axis IV areas
21-30 One is actively having delusions and hallucinations and an inability to function in all aspects of life
11-20 One is experiencing thoughts of DTO/DTS (e.g., danger to others and danger to self) behaviors and poor hygiene
1-10 Actively suicidal and homicidal with a current plan and continued poor hygiene

5. Comorbidity The presence of more than one disorder
50% of people who meet diagnostic criteria for one mental disorder meet criteria for at least one other disorder
With each new edition of the DSM new diagnostic categories arise
The DSM has tripled in size since the 1st edition
Why do you think so many individuals meet diagnostic criteria for more than one mental disorder? How do you feel about the increasing number of disorders with each new DSM?

6. Developmental and Cultural Considerations
Diagnostic criteria may need to vary across the life span
Differences in prevalence (men vs. women)
-Women and depression vs. men and substance abuse disorders
Differences in symptoms and disorders (based on ethnicity and race)
Culture-bound syndrome (sets of symptoms that occur together uniquely in certain ethnic or racial groups)

7. When is a diagnostic system harmful?
Stereotypes & labels
Premature or inaccurate assumptions by clinicians
Self-fulfilling prophecies
Prevention of a thorough evaluation or comprehensive treatment plan
Stigma
DSM (limited knowledge of an era and too many disorders)
Over-medicalization

8. Common issues related to DSM
Distinction between what is normal and not normal or mental disorder and problem of living
Mind-body dualism (mental vs. physical disorders)
Limited understanding of mental disorders
Mostly descriptive rather than explanatory
Categorical and prototypical approach vs. dimensional approach
Gender biases and too much emphasis on culturally accepted norms

9. Dimensional Systems vs. Categorical Systems
Dimensional (suggests that people with disorder are not qualitatively distinct from people without disorders)
-Psychiatric illness conceptualized as dimensions of functioning versus discrete clinical conditioning
Features that support the value of dimensional approaches
-High frequency of comorbidity and within category variability
-“Common language” of classification
Cons of dimensional system

10. Issues with the DSM-IV-TR: Criticism
Lacks an overarching conceptual base (theory)
No consistent rationale for different diagnoses
Emphasis on reliability over validity
No vision for a better society
Lacks treatment specificity
Comorbidity still an issue
Complex, long, and not user-friendly
Same issues are true for DSM-V. Due to lack of research, a true dimensional approach was not able to be adapted.
Changes in trauma, psychosis, asperger’s became a part of autism

11. Issues with the DSM-IV-TR Support
Based on empirical data – empirical review carefully done and further tests are on their way
Complex due to the inherent nature of mental disorders
Gender biases have been a concern, but the differences in ratio may just reflect differences in men and women traits

12. DSM-5: REVISIONS: Removal of the multiaxial system
All disorders are in one section
Replaced Axis IV with significant psychosocial and contextual features and discarded Axis V (the GAF).
ADHD is now a part of neurodevelopmental disorders
Changes in the names of certain disorders
Autistic disorder – autism spectrum disorder; includes autism, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder NOS
Mental retardation changed to intellectual developmental disorder
Substance use disorder name adapted for substance abuse or dependence

13. DSM-5: REVISIONS: Addition of new disorders
behavioral addictions – gambling; binge eating disorder; temper dysregulation with dysphoria
Changes in diagnostic criteria
Schizophrenia– all sub-types are deleted; catatonia is no longer a Criterion A; no need for 2 or more conversing voices.
Bereavement exclusion is not included in the diagnosis of depressive episode anymore

14. DSM-5: REVISIONS: Proposal of a dimensional system
Severity ratings (mild, moderate, severe, very severe) for disorders
Quantitative cross-cutting measures of the presence of symptoms that cut across the boundaries of any specific diagnoses or disorders– stepwise evaluation
Level 1 assessment: cross-cutting symptoms on a 4-rating scale (none, slight, mild, moderate, severe)
Level 2 assessment: for those symptoms that are scored higher than a certain cutoff – in a clinically significant range.

15. Issues with the DSM-IV-TR: Criticism
Revisions and additions lack empirical support (i.e. inter-rater reliability is low for many disorders)
Several sections contain poorly written, confusing, contradictory information
Psychiatric drug industry influenced the content
Not that different from the previous version of the DSM

16. DSM 5
The DSM-V Task Force: 27 members, including a chair and vice chair, collectively represent research scientists from psychiatry and other disciplines. Scientists experienced in research, clinical care, biology, genetics, statistics, epidemiology, public health and consumer advocacy.