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History of the DSM

History of the DSM. Class Assignment. What does it mean to have a “mental disorder”?. History of DSM. International Classification of Diseases (ICD) World Health Organization Est. 1900 to track deaths by disease Updated every 10 years 1950, included mental disorders

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History of the DSM

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  1. History of the DSM Created by Todd Lengnick, PsyD

  2. Class Assignment What does it mean to have a “mental disorder”? Created by Todd Lengnick, PsyD

  3. History of DSM • International Classification of Diseases (ICD) • World Health Organization • Est. 1900 to track deaths by disease • Updated every 10 years • 1950, included mental disorders • APA creates DSM in 1952 Created by Todd Lengnick, PsyD

  4. DSM History • 1952: The DSM-I • 1968: The DSM-II • 1974: The DSM-II Reprint • 1984: The DSM-III • 1987: The DSM-III-R • 1994: The DSM-IV • 2000: The DSM-IV-TR Created by Todd Lengnick, PsyD

  5. DSM-I (1952) • All disorders are a failure to adapt to the environment • Used term “reaction” (e.g., Schizophrenic Reaction) Created by Todd Lengnick, PsyD

  6. DSM-II (1968) • Based in psychodynamic psychiatry • Listed 302.0 Homosexuality • Revised in 1974 due to protests • Non-specific regarding symptoms • “301.82* Inadequate personality* This behavior pattern is characterized by ineffectual responses to emotional, social, intellectual and physical demands. While the patient seems neither physically nor mentally deficient, he does manifest inadaptability, ineptness, poor judgment, social instability, and lack of physical and emotional stamina.” Created by Todd Lengnick, PsyD

  7. Rosenhan experiment • Challenged psychiatric diagnosing • 1973 • Sent professionals to 12 psychiatric hospitals • Reported auditory hallucinations for admission • Denied any recurring psychiatric symptoms • Were kept months, diagnosed with schizophrenia, given medications, and had to admit their illness before being discharged • Challenged by a prominent hospital to send they pseudopatients • Agreed that would send over next 3 months • Hospital reported 41 pseudopatients (of 191) • None had been sent • Led to deinstitutionalization and reform Created by Todd Lengnick, PsyD

  8. DSM-III (1980) • Multiaxial Approach • More specific criteria • Pschodynamic model abandoned • Bio-Medical model adapted Created by Todd Lengnick, PsyD

  9. DSM-IV (1994) • Criteria clarified • Improvements in research base Created by Todd Lengnick, PsyD

  10. DSM-IV-TR • Improvements and clarifications to the text (paragraph) sections of the book; criteria and codes were not changed. Created by Todd Lengnick, PsyD

  11. Created by Todd Lengnick, PsyD

  12. Multiaxial Approach • Axis I: major mental disorders, developmental disorders and learning disabilities • Axis II: underlying pervasive or personality conditions, as well as mental retardation • Axis III: any nonpsychiatric medical conditions • Axis IV: social functioning and impact of symptoms • Axis V: Global Assessment of Functioning (on a scale from 100 to 0) Created by Todd Lengnick, PsyD

  13. 5 Axes • Axis I • Depression, Anxiety, Bipolar, ADHD, Autism, etc. • Axis II • Borderline Personality Disorder, Mental Retardation • Axis III • Hypertension, Diabetes • Axis IV • Problems with primary support group • Axis V • 55 Created by Todd Lengnick, PsyD

  14. Global Assessment of Functioning GAF • 91 - 100 No symptoms. Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. • 81 - 90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members). • 71 - 80 If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). • 61 - 70 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. • 51 - 60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). Created by Todd Lengnick, PsyD

  15. Global Assessment of Functioning GAF (cont.) • 41 - 50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). • 31 - 40 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school). • 21 - 30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment, in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends) • 11 - 20 Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute). • 1 - 10 Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death. Created by Todd Lengnick, PsyD

  16. Issues with DSM-IV-TR • Categorical Approach (DSM-IV-TR) • Criteria are not discreet • Same diagnosis->different manifestation • Clinical judgment needed • For more information, see pp xxxii - xxxv • Dimensional Model • Reports sub-threshold symptoms • Less vivid descriptions • Still needs more research Created by Todd Lengnick, PsyD

  17. Homework DSM-IV-TR • READINGS • Read page xxx – Definition of Mental Disorder • Read introduction to Substance-Related Disorders (p. 191) • TURN IN • Define the following: • Substance Abuse • Substance Dependence • Substance Withdrawal Created by Todd Lengnick, PsyD

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