Advanced Psychopathology

1. Advanced Psychopathology Defining the Phenomena

2. Example • 30 y/o male • Experiences depressed mood every day for 1 month (sad, cries for no reason) • Wakes up two hours before his alarm goes off and can’t get back to sleep • Has lost 12 pounds because he doesn’t eat consistently • Has forgotten three meetings at work and can’t concentrate • Reports that he would be better off dead

3. Psychopathology • Statistical Deviance • Conceptual Definition? How Deviant? • Maladaptive Behavior • Context • Distress/Dysfunction • Social Deviance • Harmful Dysfunction • Harmful according to culture • Failure of a mental mechanism

4. Psychopathology • What is real when it comes to psychopathology? • Suffering • Is suffering pathological? • The problem of subjectivity • Theory vs. Conception • Explanation vs. A Description of that to be explained

5. Psych Disorders • The accepted descriptions of our society representing agreed-upon abstractions of psychopathology • Social Constructionism vs. Essentialism • Why do we diagnose? • Professional/Client Communication • Sick role • Research • Reimbursement

6. Psychopathology vs. Disorder • DSM-5 Mental Disorder • … a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation or behavior that reflects a dysfunction in psychological, biological or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities. An expectable or culturally approved response to a common stressor or loss such as death of a loved one is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual as described above.

7. DSM-5 • A list and description that we believe to fit the proposed definition of a mental disorder. • DSM IV is a “prototypical” system • Categorical vs. Dimensional • Many manifestations of disorders

8. Diagnosis • How do we come by a diagnosis? ASSESSMENT

9. Diagnostic Assessment • Structured vs. Unstructured • Inventories • Structured Interviews • Almost always done w/a clinical interview

10. Clinical Interview • Presenting Problem • What is their perception of why they have come in? • What’s the problem behavior, thoughts, or emotions • History of Presenting Problem • When did it start, how severe, what is the functional impact? • Developmental History • Family of origin • Academic • Employment • Personal relationships • Alcohol/Drug • Medical History – Major or recent medical issues/illnesses • Treatment History – Therapy, medication, hospitalizations

11. Clinical Interview • Within each content area your job is not only to get the info put to ask questions that allow you to differentiate “symptoms” so that a diagnosis emerges • Addressing these areas paints a picture of that person. • From that picture you abstract a diagnosis

12. Bias in Diagnosis • Biased Constructs • Ethnocentric Construction of Idealized Self • Self- Control (Very Western) • Biased Application • Based on race, class, gender • Biased Sampling • Influence of bias factors on presentation to assessment/treatment • The importance and the problem of BASE RATES • Biased Instruments • DIF • Biased Criteria • Why don’t we have “delusional dominating PD?”

13. Your goal • To learn the system well enough so that during an interview you will hear info that will allow you to generate a list of possible disorders • With that list you then ask questions to rule out disorders until you come to the one that best describes their suffering.