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29 Cards in this Set
- Front
- Back
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Abnormality
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Mental disorders, psychiatric diagnoses, and psychopathology
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What defines abnormality? (Criteria used by many, and Harmful Dysfunction Theory)
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Criteria acknowledged by a wide variety of people:
- Personal distress - Deviance from cultural norms - Statistical Infrequency - Impaired social functioning Jerome Wakefield and the Harmful dysfunction theory: - Harmful is based on social norms and dysfunction is a scientific term referring to the failure of a mental mechanism to perform a natural function for which it is designed Combines social context (harmful) and science (dysfunction) |
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Who Defines Abnormality?
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Diagnostics and Statistical Manual of Mental Disorders (DSM): prevailing diagnostic guide for mental health professionals
DSM defines: clinically significant disturbance in cognition emotion regulation or behavior that indicates a dysfunction in mental functioning that is usually associated with significant distress or disability |
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Who is apart of the DSM/ the medical model of psychopathology
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Scholarship and expert individuals based in psychiatry and a small number of psychologists who refer to the "MEDICAL MODEL OF PSYCHOPATHOLOGY"
Typically white male, psychiatrists who are middle aged and middle class There have been some inclusions of minority members to committees though |
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Why is the definition of Abnormality important for professionals?
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yields very real consequences for those involved with psychology
By listing a certain disorder people will be diagnosed and it will be conceptualized. It will also be researched and used as a label - has a powerful impact on the attention it receives from those who wish to study disorders specifically on it's research, awareness, and treatment |
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Why is the definition Abnormality important for clients? (positive and Negative)
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On the positive side:
Demystify experiences and gives a feeling of belonging to a group Can also give acknowledgement to the seriousness of the problem allowing them to realize they need treatment On the negative side: A label can stigmatize the self image of someone, as well as leading to legal consequences such as court rulings and ability to get medical insurance |
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Rosenhann study on "being sane in an insane world"
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8 pseudopatients claimed to hear voices
they were admitted to a psychiatric hospital, then stopped reporting the symptoms The normal behaviors were then interpreted as pathological and doctors would rarely respond to questions The only people who could tell they were faking were the real patients |
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How these issues were solved before the creation of the DSM
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Hippocrates wrote extensively about abnormality, but he did not offer supernatural explanations. Instead wrote about four humors that were physically based
Phillipe Pinel created specific categories Emil Kraeplin some of the first in what we use today for our diagnostic system Some early systems like in the census were used for early categorical purposes and statistics Asylums in 19th century arose |
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DSM 1 and 2 and the changes
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Both were very similar:
contained three categories of diagnosis: neuroses, psychoses, and character disorders not scientific but based off of accumulated knowledge from the psychoanalytic approach No list of specific disorders just paragraph descriptions |
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DSM 3 changes from 1 and 2
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Relied more on empirical data to determine conclusions
used specific diagnostic criteria to define disorders it denied allegiance to a specific method of treatment introduced the multi axial system (removed later): where someones severity or type of illness severity was placed into a five level group |
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DSM 4
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published in 1994 and revised 2000 for TR or text revision
Only the text differs between 4 and it's revised version text describing disorders included cultural specific info culture bound syndromes listed Outline for cultural formulation: helping clinicians appreciate impact of culture on symptoms |
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DSM 5
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Task force which lead work groups
Work groups: each focused on a particular area of mental disorders _ Reviewed disorders listed and considered proposals for revision Also created a scientific review committee whose job was to make sure sufficient scientific data existed to support changes Then asked for field trials, asking clinicians to use them in practice |
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Changes DSM 5 didn't make
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Paradigm shift to neurobiology/biological roots
Dimensional definition: or defining disorders along a continuum Dimensional Approach to personality disorders: seeing them as apart of a certain area and not as a category Removing 5 of the 10 personality disorders: paranoid, schizoid, histrionic, dependent, and narcissistic Proposed disorders |
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Proposed disorders in the DSM
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Attenuated psychosis syndrome: hallucinations, dellusions, disorganized speech, but much less intense
Mixed anxiety depressive disorder: symptoms of anxiety and depression but not either one or both Internet gaming disorder: excessive or disruptive internet gaming behavior |
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New features in DSM 5
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Name shift from roman to arabic numerals. 5 instead of V
Multiaxial system was dropped (could result in health insurance issues) Minor updates will be denoted as new versions |
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New disorders 1-3
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Premenstrual dysphoric disorder: severe version of premenstrual syndrome
Disruptive Mood regulation disorder: frequent temper tantrums 6-18 yrs Binge eating disorder: overindulging on food |
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New disorders 4-6
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Mild Neurocognitive disorder: mild loss in memory, language use, attention, or executive function
Somatic Symptom disorder: one bodily symptom, and a high level of anxiety about it Hoarding disorder: difficulty discarding possessions |
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Revised Disorders in DSM 5 1-4
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Major depressive episode: bereavement exclusion dropped (sadness should not be a mental disorder, but if someone exceeds normality it can be given)
Asperger's disorder/inclusion of Autism Spectrum disorder: aspergers gone, because it just represents a similar symptom to things on the symptom scale of autism spectrum Attention deficit Hyperactivity Disorder: age at which symptoms must appear raised from 7 to 12, and number of symptoms needed is now 5 instead of 6 Binge eating disorder: just bulimia nervosa disorder when decreased from twice a week to once a week |
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Revised Disorders in DSM 5 5-8
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Substance use disorder: combination of substance use and substance dependence
Anorexia Nervosa: removed requirement that menstrual period needs to stop, low body weight changed to a less specific definition Intellectual disability disorder: used to be mental retardation Specific learning disorder: covers separate learning disorders in reading, writing, and math |
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Allen Frances criticisms of DSM 5
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changes that seem clearly unsafe and scientifically unsound
will mislabel normal people and promote diagnostic inflation and encourage inappropriate medication use Advices people to ignore DSM 5 and not use it (boycott) |
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Key areas of criticism:
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diagnostic overexpansion: it covers too many areas of normal life
Transparency of revision process is questionable: vague about sharing, decisions made behind closed doors, confidentiality agreements were signed by work group members Members of work groups: predominantly researchers were invited Field trial problems: the field trial reliability ratings were relatively low Price: very expensive |
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Breadth of Coverage
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Expansion has been too rapid, many disorders should not be disorders (many are day to day life problems)
some disorders are not entirely mental but physical as well Many people will face stigma for labels, many others will not take liberally diagnosed labels seriously when they should be |
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Controversial Cutoffs (decisions made for cutoffs needed to be diagnosed)
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arbitrary decisions made on personal feelings about how long a disorder should need to exist
criteria that decides severity is very controversial What constitutes significant distress or impairment? |
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Cultural Issues
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Allows for some:
glossary of cultural concepts of distress culturally based disorders cultural variations BUT: the biases are still there because these are revisions not rewriting Lots of the data they use does not include ethnic minorities |
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Gender Bias
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Some disorders are diagnosed far more often in females than others, and far more in males than others. Regardless of symptom congruence
representing engendered roles, not reality Premenstrual dysphoric disorder: some women experience extreme distress, but is this a mental illness? could cause problems in life |
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Non empirical influences
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Political wrangling and public opinion effect decisions:
pharamceutical companies sponsor certain decisions that increase sales for them |
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Limitations on objectivity
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Those doing the DSM even acknowledge that interpreting the data is subjective, removing the objectivity from psychology
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Categorical Approach
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Someone falls in yes or no category of a disorder
this may respond with the human perception of thinking categorically, it also facilitates communication within our culture and others |
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Dimensional Approach and Five Factor model
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Shades of gray instead of black or white, and may be better suited for some disorders rather than others
Five factor model: each of our personalities contains the same categories: neuroticism, extraversion, openness to experience, agreeableness conscientiousness |
