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Classification of Psychological Disorders

Classification of Psychological Disorders. Learning Objectives. Importance of Classification Philosophical underpinnings of two approaches to classification Purposes of Classification. Symbols and Language. Words are symbols By convention we all agree on symbols

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Classification of Psychological Disorders

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  1. Classification of Psychological Disorders

  2. Learning Objectives • Importance of Classification • Philosophical underpinnings of two approaches to classification • Purposes of Classification

  3. Symbols and Language • Words are symbols • By convention we all agree on symbols • Why I can refer to a pen and we all know what it is I am referring to • If not, have to have pen directly in front of us. • How do we come to establish symbols or concepts that everyone can agree upon? • Nature of classification

  4. Classification • Important activity in clinical work and research • Basic part of science • Information made more accessible, meaningful, and less cumbersome

  5. Classification • Normal vs. Abnormal Charles Manson

  6. Classification • Need to further define abnormal • Divide “abnormal” into subclasses • Mushroom example

  7. Not a Mushroom Mushroom

  8. Poisonous Edible

  9. Classification Historical • Paradigms have influenced how classification done and what was classified • Hippocrates’ Four humors:

  10. Hippocrates • 1. Black Bile ---- Depression • 2. Yellow Bile ---- Tension/Anxiety • 3. Phlegm ---- Dull, Sluggishness • 4. Blood ---- Mania/Mood Swings

  11. Historical • Pre-history: Likely simply divided into normal vs abnormal • Ancient Greece: Hippocrates • Others over the ages: Jean Fernel (1497 – 1588); Feliz Platter (1536-1614); Francois Baussier de Sauvages (18thC)

  12. Philosophical Issues in Abnormal Behaviour Paradigms • Nature of psychopathology, normalcy, belief in paradigm • Historical • Emil Kraeplin and Neo-Kraeplians • Sigmund Freud • Contemporary: • DSM & ICD • PDM & OPDS

  13. Two Trends or Philosophies • Symptom as Focus (Kraeplin) • Underlying Cause as Focus (Freud)

  14. Symptom as Focus • Group of Sx or observable behaviors • Seen as cause of the difficulties • Focus of assessment and treatment is on eradicating the symptoms • Behavior school, ICD, DSM • Variant embraced by Managed Care in US (i.e., insurance company)

  15. Underlying Cause as Focus • Problems caused by underlying process • Assessment and treatment focuses on underlying process • Orientation of psychodynamic, cognitive behavioral (to degree), and PDM.

  16. Classification • Basic part of science • Want to make information more accessible, meaningful, and less cumbersome

  17. Classification - Purposes • Description and need to identify • Communication • Research • Treatment • Insurance • Theory Development • Epidemiological Information

  18. Diagnosis leads to treatment • From medical perspective: Appendicitis Gas Pains

  19. Diagnosis does not always lead to proper treatment: • Alzheimer’s Disease • Depression and “families” of drugs • ALS

  20. How to Classify? • Divide disorders into mutually exclusive and collectively exhaustive subclasses • Mutually Exclusive: disorders should be distinct and cannot belong to two different subclasses (e.g., poisonous and edible mushrooms???) • Collectively Exhaustive: all disorders must be classified

  21. How to Classify? Cont’d • Subclasses defined by necessary and sufficient conditions • Must be characteristics that are necessary for classification • Must also be set of sufficient conditions to belong to a subclass

  22. How to Classify Cont’d • Reliability: Each time you (or someone else) uses the classification system, should get the same result • Need to identify psychological problems in a clear and reliable manner • Also need agreement among mental health professionals or can have individuals referring to same term to describe different disorders • E.G., Schizophrenia and “split personality” (i.e., dissociative identity disorder)

  23. How to Classify Cont’d • Validity: Classification system should say something about the “true world”

  24. DSM – IV Text Revision

  25. DSM’S • Categorical Approach to define abnormality • Revised periodically: • DSM first published 1952 • DSM II published 1968 • DSM III published 1980 • DSM III Revised published 1987 • DSM IV published 1994 • DSM IV Text Revision 2000 • DSM V published 2014

  26. DSM • Over 400 disorders • DSM provides descriptive information not based on any one theoretical perspective (although this is debateable) • Categorical Approach • Descriptive features are based on observable features:

  27. DSM IV TR • Provides information on: • Diagnostic Features • Associated Features and Disorders • Associated Laboratory Findings • Age-related, Culture-related and Gender-related features

  28. DSM 4 & 5 • DSM 4 – 5 axes • DSM 5 - No Axes – Different Disorders

  29. Pros and Cons • Pro: • Reliability has improved over previous editions • Provides information on research and reliable and valid information • Axis IV and V very good in terms of attempting to take into account many factors

  30. Pros and Cons • Con: • Only first 3 Axes tend to used and even then Axis 2 used inappropriately • Labeling and stigma still issue • Biological tests not used • Fees paid based on diagnosis and some patients diagnosed inappropriately • Doesn’t lead to differential treatment decisions for most part • Still very subjective

  31. DSM IVTR (p. XXXIV) • “ DSM-IV is a categorical classification that divides mental disorders into types based on criteria sets with defining features….. In DSM-IV there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder”

  32. Diagnosis and Formulation • Diagnosis: Assigning diagnostic category • Formulation: Attempt to explain genesis, maintenance, and process related information for treatment • Struct. Interview  Diagnosis • Assessment  Formulation

  33. Most clinicians agree that need both, although likely majority indicate that formulation is actually more important

  34. Other Diagnostic Manuals in Use

  35. Other Diagnostic Manuals in Use

  36. Psychodynamic Diagnostic Manual (PDM)

  37. PDM • DSM provides one level of description • Some argue don’t measure some of the most important things • PDM: • there is more to people than what is described in DSM • Attempts to describe and categorize elements not found in DSM • Attempts to provide information that will improve comprehensive treatments

  38. PDM • Not developed to supplant DSM but to supplement DSM • Developed from a theoretical perspective: Current Psychodynamic Theory: • Psychoanalysis • Object Relations • Attachment Theory

  39. PDM • Diagnostic framework • Describes the whole person: • Surface and deeper levels of personality, person’s emotional and social functioning • Based on current neuroscience and treatment outcome studies

  40. PDM Developed By • American Psychoanalytic Association • American Academy of Psychoanalysis • International Psychoanalytic Association • American Psychological Association Division 39 • National Membership Committee on Psychoanalysis in Clinical Social Work

  41. PDM • The elements include: • Personality patterns • Social and emotional capacities • Unique mental profiles • Personal experiences of individuals

  42. PDM- Rationale • Human behaviour is complex • DSM simplifies behaviour too much • Want to direct focus on full range of affect, thought, behaviour in context of an individual’s own unique history

  43. PDM- Rationale Cont’d Consistent with idea that: Rather than thinking of people having discrete disorders (i.e., ego dystonic, separate, outside of self), see disorders as result of some process (personality, incorporation of upbringing, etc.) and the process is what is important

  44. PDM Dimensions • Personality Patterns and Disorders (P Axis) • Mental Functioning (M Axis) • Manifest Symptoms and Concerns (S Axis)

  45. P Axis • Person’s location on Continuum: Healthy -----------------Disordered • Ways in which person organizes mental functioning and interacts with world • Maxim: Need to understand person in order to understand problem

  46. P Axis • Includes many of the Axis II diagnoses from DSM • Adds other ones that are seen as extremely important: • Depressive Personality Disorder • Sadistic and Sadomasochistic PD • Masochistic (Self-defeating) PD • Somatizing PD • Dissociative PD

  47. M Axis • Detailed look at emotional functioning • E.G., Information processing, self-regulation, relationships, emotional expression, learning, coping/defenses, etc.

  48. S Axis • Using the DSM categories, focus on personal experience of difficulties • Need to be seen in context of personality and mental functioning

  49. PDM • Attempt to develop a thorough and comprehensive diagnostic picture • Takes whole person into account

  50. PDM • Published in 2006 so little early to evaluate • Welcomed by most clinicians as an addition to aid in treatment planning • Aids in formulation: • Diagnosis doesn’t give you all relevant information for treatment • Need to determine etiology, maintenance factors, process-related issues, history of relationships, etc. which guide treatment

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