Diagnosis. Diagnosis: process of determining whether the particular problem afflicting the...
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Diagnosis
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Diagnosis: process of determining whether the particular problem afflicting the individual meets all the criteria for a disorder
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The DSM-IV Definition of Abnormality
Mental disorder = Clinically significant impairment Associated with current distress Not an expected or sanctioned response Is a manifestation of dysfunction Neither deviant behavior nor societal conflicts
qualify alone
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Diagnostic & Statistical Manual of Mental Disorders
1980s: Consistent system for all Based upon research Independent field trials Less influence by psychodynamics
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Diagnostic & Statistical Manual of Mental Disorders
Atheoretical Medical model:
Signs (external) Symptoms (internal experiences) Syndromes (disorders) - a cluster of
symptoms
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DSM-IV Terminology
CO-MORBID CONDITIONSCO-MORBID CONDITIONS
BASE RATEBASE RATE
INCIDENCEINCIDENCE
PREVALENCEPREVALENCE
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Diagnoses Diagnoses occurring occurring together in the together in the same patientsame patient
DSM-IV Terminology
CO-MORBID CONDITIONSCO-MORBID CONDITIONS
BASE RATEBASE RATE
DYSFUNCTIONAL DYSFUNCTIONAL BEHAVIORBEHAVIOR
PERSONALLY PERSONALLY DISTRESSING BEHAVIORDISTRESSING BEHAVIOR
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Frequency of a Frequency of a disorder in the disorder in the populationpopulation
DSM-IV Terminology
CO-MORBID CONDITIONSCO-MORBID CONDITIONS
BASE RATEBASE RATE
INCIDENCEINCIDENCE
PREVALENCEPREVALENCE
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% of new cases of % of new cases of a disorder that a disorder that develop during a develop during a specific time specific time periodperiod
DSM-IV Terminology
CO-MORBID CONDITIONSCO-MORBID CONDITIONS
BASE RATEBASE RATE
INCIDENCEINCIDENCE
PREVALENCEPREVALENCE
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% of the % of the population population afflicted with a afflicted with a disorder over a disorder over a specified periodspecified period
DSM-IV Terminology
CO-MORBID CONDITIONSCO-MORBID CONDITIONS
BASE RATEBASE RATE
INCIDENCEINCIDENCE
PREVALENCEPREVALENCE
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DSM-IV Terminology
LIFETIME PREVALENCELIFETIME PREVALENCE
AGE OF ONSETAGE OF ONSET
COURSECOURSE
ETIOLOGYETIOLOGY
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•% of the % of the population who population who will experience a will experience a disorder in their disorder in their lifetimelifetime
DSM-IV Terminology
LIFETIME PREVALENCELIFETIME PREVALENCE
AGE OF ONSETAGE OF ONSET
COURSECOURSE
ETIOLOGYETIOLOGY
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•The age at which The age at which a disorder a disorder (usually) develops(usually) develops
DSM-IV Terminology
LIFETIME PREVALENCELIFETIME PREVALENCE
AGE OF ONSETAGE OF ONSET
COURSECOURSE
ETIOLOGYETIOLOGY
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•Change in Change in symptomatology symptomatology of a disorder over of a disorder over timetime
DSM-IV Terminology
LIFETIME PREVALENCELIFETIME PREVALENCE
AGE OF ONSETAGE OF ONSET
COURSECOURSE
ETIOLOGYETIOLOGY
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•The cause(s) of a The cause(s) of a disease or disease or abnormalityabnormality
DSM-IV Terminology
LIFETIME PREVALENCELIFETIME PREVALENCE
AGE OF ONSETAGE OF ONSET
COURSECOURSE
ETIOLOGYETIOLOGY
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Multiaxial Diagnosis
5 dimensions of diagnosis
I. Psychological disorder (e.g. anxiety)
II. Personality disorders/ Mental Retardation
III. Medical Conditions
IV. Psychosocial problems
V. Global Assessment of Functioning
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Examples of Multiaxial Diagnosis
Axis I: Specific Phobia
Axis II: no diagnosis
Axis III: none
Axis IV: none
Axis V: 50
Axis I: Major Depression
Axis II: Avoidant Personality Disorder
Axis III: none
Axis IV: academic stress
Avis V: 75
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Categorical vs. Dimensional?
Medical model = categories E.g. HIV+ or HIV- Relevant for psychopathology? E.g. depression
An “extreme” of bad mood
Many disorders in DSM-IV likely dimensional
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What Are the Pros & Cons of Diagnosis?
Bob is a 53-year old male who reports a number of life stressors that he is having problems coping with, including financial troubles and marriage problems. In addition, he is grieving the suicide of a close friend.
Possible diagnosis = Depression
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What are the pros & cons of diagnosis?
Mary is a 5-year old female who has come to therapy due to a number of behavior problems. She disobeys her parents and often throws tantrums when asked to do something she does not want. She also refuses to sit still in preschool and bites/hits other children when she is angry.
Possible diagnosis = Oppositional Defiant Disorder
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Criticisms of DSM Diagnosis
Fuzzy categories Reliability issues (e.g., personality disorders) Labeling Inform treatment? Cultural appropriateness
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Virgil is a 55-year-old African American man whose wife died of cancer 2 years ago. He has become sullen & withdrawn, spending less time at his hobbies and speaking less to coworkers at his job at a supermarket. He still attends the church to which his wife always accompanied him, and he is still very well-liked, but he tends to arrive in time for the service and leave soon afterward, politely nodding at friends who wish him well.
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Virgil’s daughter and coworkers are the first to notice the lapses in concentration and the more-frequent occasions where Virgil’s memory fails him. At first these are of little consequence – forgetting to add milk to his coffee, or forgetting to sign a form at work. But soon these lapses become more problematic – missing his heart medication with some regularity, or misplacing a box of a shipment of perishables. Concerned, his daughter convinced Virgil to seek professional help
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Abnormality Theoretical Approaches
Cognitive Behavioral Psychodynamic
Assessment Diagnosis?