L10 Issues in Diagnosis?

參考文獻/圖片來源：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.

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10.1 Defining Abnormality

What is Abnormality?

? In clinical and counseling psychology:

- Focus of work is often on psychopathology

- Rely on DSM-based diagnoses as the indicators of?mental disorders

? The quality of our research, diagnostic system, and?treatments hinges on a solid definition of what?constitutes abnormal behavior

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What is Abnormality??Hard to define, examples:

To Engage in “Self Harm:”?Tattoos? But what about body modification and non-suicidal self-injury?

To “Hear Voices:”?from dead People? God? Persecutory voices?

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Definitions of Abnormality (4 D’s)

? Abnormality characterized by:?(Subjective) Distress?/ Deviance from?Cultural Norms?/ Statistical?Infrequency (Deviance)?/ Impaired Social Function (Dysfunction)

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? Jerome Wakefield (1992)

Propose: A disorder is a harmful dysfunction

? Harmful (a value term): Based on?social norms

? Dysfunction (a scientific term): The?failure of a mental mechaniSM to?perform the function for which it was?designed via evolution

??His theory has become?increasingly popular in recent years for?incorporating both social context and?scientific data

? DSM-5 (2013)?- most wildly used definition of Abnormality

Mental disorders?- not expected reactions or simply any behavior

? Clinically significant disturbances in?cognition, emotion regulation, or?behavior

? Indicate a problem?(dysfunction)?in mental?functioning

? Produce significant distress or?disability in work, relationships,?and/or other areas of functioning

? Impact of Definitions:

For professionals: clinically, research, organizations’?focus (eg workshops)

For individuals: own experiences, find resources, stigma, discrimination

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Rosenhan: Being Sane in Insane Places

? Study published in 1973

? General Study Procedures:

- 8 people without mental health problems?tried to get admitted psychiatric hospitals?(“pseudopatients”)

[Reported hearing voices that were often unclear.?They seemed to say, “empty,” “hollow,” and “thud.”]

- All other information provided was?accurate

- Typical behavior after admission; denied?to have symptoms?anymore

? Primary Findings

- All participants were hospitalized?(between 1969-1972)

- Stays ranged from 7-52 days (M = 19)

- No “pseudopatients” were discovered by staff

- Some other patients suspected the “pseudopatients”

? Follow-up study

- Skeptical hospital informed that one or more pseudopatients would?attempt to gain admission

- Staff asked to identify (rate likelihood) which patients were pseudopatients

? 41/193 admitted were thought to be pseudopatients by?≥1 staff

- In reality, none were pseudopatients!

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10.2 DSM-5

10.2.1 Current edition: DSM-5 (2013)

? Process of revision was a major undertaking

Work groups created for each disorder?- review last edition, consider changes

Scientific Review Committee assembled?- data support for work group changes

Field trials for proposed changes to the DSM?- reliability & clinical utility

? Updates for the public?starting in 2010?at DSM5.org, thousands of comments

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Change in Name: from IV to 5

? From Roman numerals to Arabic numerals

? Done to make naming the DSM easier following?revisions, more frequently SMall revisions: DSM 5.1, DSM5.2, etc.?DSM - a living document

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New Diagnoses in DSM-5

? Several new disorders added

- Binge Eating Disorder

- Disruptive Mood Dysregulation Disorder

- Hoarding Disorder

- Mild Neurocognitive Disorder

- Premenstrual Dysphoric Disorder

- Somatic Disorder

? Several existing disorders revised

- New names, different diagnostic criteria, changes in?category

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10.2.2 Controversy & CriticiSMs

Controversy around DSM-5

? Transparency in the revision process

- Only vague information was provided on the website

- Many many decisions were made behind closed doors

? Membership of work groups

- Most of the people involved were researchers (not clinicians, lack practices)

? Field trial problems

- Poor reliability in new diagnoses?(eg consistence, second-stage)

? Cost of the manual

- Jumped from $65 (DSM-IV) to $199 (DSM-5)

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CriticiSMs of DSM-5

? Categorical approach with arbitrary cut-offs

? Too many disorders, including some disorders that may be?medical conditions; eg sexual disorders, substance-use disorders, sleep disorders, etc.

? Historical lack of diversity?(many white male)?among members of work?groups

? Lack of diversity in?(US participants)?empirical studies used to make decisions

? Gender differences in diagnoses for some disorders may?reflect biases

? Diagnostic Validity: Do diagnoses accurately reflect?phenomenon of interest?

- Heterogeneity of symptom profiles within the single diagnosis

- Comorbidity?(overlap, co-occur)?of diagnoses and symptoms substantial

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10.2.3 Alternative to the DSM-5 Approach

? DSM-5 is a primarily categorical approach?- decision is yes or no

- An individual either does or does not meet criteria for each disorder

? Some psychologists have argued for a dimensional?approach

- Presence or absence of a disorder is not determined

- Continuum of symptoms are considered

Dimensional Model Example

? Personality disorders?(10 disorders in DSM-5)

? A dimensional model for personality disorders?(right)

? Five factor model of personality (Big Five)

??Maybe change for next revision