Abnormal Psyc- Dsm5

Front 1

6 Reasons for Change in DSM-IV

Back 1

1. Revise and update classifications based on new knowledge about clinical disorders.
2. Fix many diagnostic problems associated with DSM-IV
3. Improve reliability of DSM diagnosis
4. Correct diagnostic categories that were too narrowly defined to reduce widespread use of No Otherwise Specified (NOS) diagnoses.
5. Move toward greater harmonization between DSM-5 (APA) and ICD-11 (WHO).
6. Enhance clinical usefulness (Clinical utility) of DSM diagnoses.

Front 2

Problem with posting draft of DSM-5 online for review?

Back 2

Can influence work groups to use the publics opinions as opposed to expert opinions when making important decisions.

Front 3

Why does the DSM come down to a vote?

Back 3

Because psychological disorders are based on symptom expression, not a biological basis. These symptoms can be observed in laboratory testing situations and are therefore arguable. A vote decides whether the disorder exists or doesn't.

Front 4

7 Major Structural Changes in DSM-5

Back 4

1. Revised organizational structure (22 new groupings, based on lifespan progression).
2. Sections II and III (II contains official diagnostic criteria while III has optional dimensional, cultural, alternative personality disorder model)
3. No more multiaxial system
4. No more global assessment of function
5. NOS replaced (two options, other specified disorder or unspecified disorder)
6. More dimensionality (section III offers bridge between categorical and dimensional classification
7. Cultural considerations (cultural formation interview in section III

Front 5

Charactersitics disorders should share if being categorized in the same group

Back 5

1. More symptoms in common
2. Same etiology
3. Higher co-occurrence

Front 6

GAF Scal

Back 6

Global Assessment of Functioning. Assesses individual's current level of psychological, social and occupational functioning. Ability to cope with problems.

Front 7

Reason for Elimination of Multiaxial System

Back 7

Not clear. Wanted to be more harmonious with ICD-11 which is not multiaxial. Multiaxial may have implied separation between mental disorders and medical disorders, as well as psychosocial and environmental factors that didn't exist.

Front 8

Reason for Elimination of GAF Scale

Back 8

Too general, low inter-rater reliability. Now use WHO Disability Assessment Schedule (WHODAS) which represents conceptual and empirical improvement.

Front 9

NOS Category

Back 9

Not otherwise specified. Those who did not have sufficient symptoms for a relevant diagnostic criteria.
- Those who have mild symptoms or mixed/atypical representation
- Symptoms show ditress and impairment but don't conform to recognized symptom pattern
- Uncertain whether due to medical or substance use
- Complete diagnostic info not collected

Front 10

Reason for Elimination of NOS category

Back 10

"Waste bin". Very heterogeneous and overused. Replaced with two options:
- Other Specified Category (why person doesn't meet criteria for specific diagnosis) More informative.
- Unspecified Disorder Category (clinician doesn't want to specify cause of failing to meet diagnostic threshold). Not very informative

Front 11

Cultural Issues Addressed in DSM-5

Back 11

Three new concepts:
1. Cultural Syndrome (groupd of co occurring invariant symptoms specific to cultural group)
2. Cultural Idiom of Distress (phrase, term or way of talking about distress unique to cultural group)
3. Cultural Explanation or Perceived Cause (label or attribution that provides culturally conceived cause of symptoms or distress)

Front 12

Cultural Formation Interview

Back 12

Same categories from Outline for Cultural Formulation but description of each category has been explained and clarified. In part III, so they are optional and generally will only be used for research, not for diagnosis.

Front 13

Autism Spectrum Disorder

Back 13

Used to be four separate disorders under Pervasive Developmental Disorder:
- Autistic disorder
- Asperger's disorder
- Childhood disintegrative disorder
- Pervasive developmental disorder not otherwise specified
Was poor reliability when making distinctions

Front 14

Disruptive Move Dysregulation Disorder

Back 14

Chronic, sever irritability and frequent temper outbursts that are present for at least 12 months and evident in at least two settings. Onset must be before 10 years old.

Front 15

Premenstrual Dysmorphic Disorder

Back 15

Sever form of premenstrual syndrome, Changeable mood, irritability, dysphoria and anxiety that occurs repeatedly in the final week before menses and remits in the post menses week.

Front 16

Hoarding Disorder and 4 Criteria

Back 16

Used to be symptom of obsessive compulsive personality disorder. Early research saw it as a symptom of OCD. Three criteria
1. Inability to discard possessions
2. Need to save and distress associated with discarding possessions.
3. Cluttered living spaces (must be to the point that can't use living spaces for intended use)
4. Cause significant distress and impairment
* If compulsive buying, it's an impulse control dusturbance and requires different treatment

Front 17

8 Reasons Hoarding is Different from OCD

Back 17

1. People with hoarding generally don't show signs of OCD and people with OCD don't generally show signs of hoarding.
2. Hoarding is much more prevalent than OCD
3. Less insight into irrational nature of hoarding
4. Positive or neutral emotions when acquire and store possessions.
5. More resistance when encouraged to discard
6. Absence of obsessions
7. Poor response of OCD medication and psychological treatments.
8. Worsens over each decade of life.

Front 18

Gender Dysphoria

Back 18

New diagnostic class with one disorder. Incongruence between one's assigned gender and their experienced or expressed gender. Must be evidence of distress. Used to be sexual dysfunction. Doesn't target all transgenders, only those with significant distress about gender identity.

Front 19

Somatic Symptom Disorder and Related Disorders

Back 19

Five disorders in this category
1. Somatic Symptom Disorder
2. Hypochodriasis (split between this and illness anxiety disorder)
3. Conversion Disorder
4. Pain Disorder ( split between this and Psych factors affecting other medical conditions)
5. Factitious Disorder

Front 20

Somatic Symptom Disorder

Back 20

Replaces Somatization disorder as the main disorder in a class now called "Somatic Symptom Disorder and Related Disorders" which used to be just "Somatoform Disorders". Medical condition can co occur.

Front 21

Gambling Disorder

Back 21

Was under impulse control disorders. Now it is classified as an addiction. When it was an impusle control, was seen as a behavioural problem. An addictions gives it a biological basis.

Front 22

Reasons why Gambling Disorder is an Addiction and not an Impulse Control

Back 22

- Not associated with increased co occurrence with impulse control disorders but is with addictions
- Relief from negative feelings similar to depression
- Altered states of perception
- Negative or harmful consequences
- Loss of control
- Shifts in rewards centres of brain similar in addiction
- Strong genetic basis like addiction
- Vulnerability to psychiatric disorders
- Similar model of treatment

Front 23

Main controversies and Criticisms of DSM-5

Back 23

1. Construct Validity (based on symptom expression not underlying causal processes)
2. Categorical Classification as opposed to dimensional
3. Reliability of Diagnoses (results from field tests weren't encouraging for many disorders)
4. Gender and Cultural bias problems (step back in gender neutrality in regards to PMDD in women)
5. Clinical Utility (over diagnosis? High rate of false positives? Increased stigma and medicalization?)