1. Military Psychology Gerhard Ohrband – ULIM University, Moldova
6th lecture
Clinical Psychology

2. Course structure Clinical Psychology
Introduction: Historical Overview, main applications
Environmental Stressors
Leadership
Team Effectiveness
Individual and Group Behaviour
Clinical Psychology
Selection and Classification
Training
Human Factor Engineering
Psychotherapy and Counseling
Terrorism
Trauma Therapy
Psychological Warfare
Ethical Issues for a Psychologist in the Armed Forces
Review: Preparation for the exams

3. Content S-O-R-C-K model
bio-psycho-social etiological model of psychological disorders
classification of disorders (ICD-10 and DSM-IV
mental disorders

4. S-O-R-C-K model
Situation
Organism
Response
Contingency
Conditioning

5. A bio-psycho-social model of psychological disorders
Increased
vulnerability
Stressful life-events
Non-adaptive behaviour
Chronic psychological disorder
reinforcement

6. Classification of disorders
DSM-IV: Diagnostic and Statistical Manual (of Mental Disorders) IV by the American Psychiatric Association
ICD-10: International Classification of Diseases 10 by the World Health Organization
the two more alike than different (Andrews et. al., 1999)

7. DSM-IV Five axes: Axis I: Major clinical syndromes
Axis II: Personality disorders
Axis III: Physical disorders
Axis IV: severity of experienced stress (usually within the last year)
Axis V: overall level of psychological, social or occupational functioning, on a 100-point global assessment of functioning (GAF) scale, with 100 representing the absence or near absence of impaired functioning, 50 representing serious problems in functioning, and 10 representing impairment that may result in injury to the individual or others

8. DSM-IV Example: Axis I: Alcohol dependance
Axis II: Antisocial personality disorder
Axis III: Alcoholic cirrhosis of the liver
Axis IV: Severe – divorce, loss of job
Axis V: GAF evaluation = 30 (a very serious impairment of functioning

9. DSM-IV Axis I – Major clinical syndromes
Disorders usually first appearing in infancy, childhood or adolescence
Delirium, dementia, amnestic and other cognitive disorders
Psychoactive substance abuse disorders
Schizophrenia and other psychotic disorders
Mood disorders
Anxiety disorders
Somatoform disorders
Factitious disorders
Dissociative disorders
Sexual and sex identity disorders
Eating disorders

10. DSM-IV
Factitious disorders: fake mental disorders, such as Munchhausen syndrome, in which the individual is frequently hospitalised because of their claims of illness
Dissociative disorders: loss of personal identity and changes in normal consciousness, including amnesia and multiple personality disorder, in which there exists two or more independently functioning personality systems

11. Anxiety, somatoform and dissociative mental disorders
Anxiety disorders
Generalised anxiety disorder (GAD)
Panic disorder
Phobic disorders
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Somatoform disorders
Somatisation disorder
Conversion disorder
Dissociative disorders

12. Name and description of some common phobias
Object or situation feared
Acrophobia
Heights
Agoraphobia
Open spaces
Ailurophobia
Cats
Algophobia
Pain
Astraphobia
Storms, thunder, lightning
Belonophobia
Needles
Claustrophobia
Enclosed spaces
Haematophobia
Blood
Monophobia
Being alone
Mysophobia
Contamination or germs
Nyctophobia
Darkness
Ochlophobia
Crowds
Pathophobia
Disease
Pyrophobia
Fire
Siderophobia
Railways
Syphilophobia
Syphilis
Taphophobia
Being buried alive
Triskaidekaphobia
Thirteen
Zoophobia
Animals, or a specific animal

13. Social phobia
American Psychiatric Association, 1994: ‘fear of one or more situations … in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing.’
Most people with social phobia only mildly impaired
Social phobics, like patient with GAD, seem to bias their attention towards threat-related stimuli

14. Personality disorders
Abnormalities in behaviour that impair social or occupational functioning (DSM-IV)
DSM-IV, Axis II personality disorders, 3 clusters:
Cluster A (‘eccentric’): schizotypal and paranoid personality disorders
Cluster B (‘dramatic’): narcissistic and antisocial personality disorders
Cluster C (‘anxious’): avoidant and dependent personality disorders (Van Velzen and Emmelkamp, 1996)

15. … Psychoactive substance use disorders Schizophrenic disorders
Mood disorders: mania and depression
Season affective disorder (SAD)
Sexual disfuctions
Paraphilia

16. Discussion Points
What are the advantages and disadvantages of classifying psychological disorders?
Could you think of developing other systems for classification?

17. Literature
Andrews, G., Slade, T., and Peters, L. (1999). Classification in psychiatry: ICD 10 versus DSM-IV. British Journal of Psychiatry, 174, 3-5.
Langer, E.J. and Abelson, R.P. (1974). A patient by any other name … Clinician group difference in labeling bias. Journal of Consulting and Clinical Psychology, 42, 4-9.
Wakefield, J.C. (2001). The myth of DSM’s invention of new categories of disorder: Hout’s diagnostic discontinuity thesis disconfirmed. Behaviour Research and Therapy, 39,

18. Journals American Journal of Psychiatry Annals of Psychiatry
Archives of General Psychiatry
Behaviour Research and Therapy
British Journal of Clinical Psychology
British Journal of Psychiatry
Clinical Psychology and Psychotherapy
Cognitive Neuropsychiatry
Current Opinion in Psychiatry
Journal of Abnormal Psychology
Journal of Clinical Psychology
Journal of Psychotherapy Practice and Research
Psychotherapy

19. Internet resources
A link to a collection of full-text articles on mental health
A collection of links about mental health/clinical psychology
A collection of links on mental health resources