1. abnormal PSYCHOLOGY Fourth Canadian Edition Chapter 3 Classification and Diagnosis Prepared by: Tracy Vaillancourt, Ph.D. Modified by: Réjeanne Dupuis, M.A.

2. Diagnostic System of APA Five Dimensions of Classification –Axis I. All diagnostic categories except personality disorders and mental retardation –Axis II. Personality disorders and mental retardation –Axis III. General medical conditions –Axis IV. Psychosocial and environmental problems –Axis V. Current level of functioning

3. Example

4. Classification of Disorders (cont.) Substance-Related Disorders Schizophrenia Mood Disorders –Major depressive disorder –Mania –Bipolar disorder Anxiety Disorders –Phobia –Panic disorder –Generalized anxiety disorder –Obsessive-compulsive disorder –Post-traumatic stress disorder –Acute stress disorder Somatoform Disorders –Somatization disorder –Conversion disorder –Pain disorder –Hypochondriasis –Body dysmorphic disorder Dissociative Disorders –Dissociative amnesia –Dissociative fugue –Dissociative identity disorder –Depersonalization disorder

5. Classification of Disorders (cont.) Sexual and Gender Identity Disorders –Paraphilias –Sexual dysfunctions –Gender identity disorder Sleep Disorders –Dyssomnias –Parasomnias Eating Disorders –Anorexia nervosa –Bulimia nervosa –Binge eating disorder Factitious Disorder Adjustment Disorders Impulse-Control Disorder –Intermittent explosive disorder –Kleptomania –Pyromania –Pathological gambling –Trichotillomania Personality Disorders –Schizoid personality disorder –Narcissistic personality disorder –Anti-social personality disorder, etc. Delirium, Dementia, Amnestic, and Other Cognitive Disorders

6. Gambling in Canada Increases in gambling problems due to legalized gambling in several provinces Prevalence rate of 2%; 2-4% for those ‘at risk’ Opening a casino increases gambling activities and negative consequences of gambling Low-risk gambler: gambling 2-3 times / month; no more than 500-1000$ / year, or less than 1% of annual family income On-line problem gamblers have more problems than social gamblers

7. Gambling in Canada (cont.) Who is likely to gamble? –Problem gamblers are more likely to be male, single, under the age of 30, and to have begun gambling before age 18 –Those with ‘gambler fallacy,’ the belief that one is more likely to win after a series of losses –Youth are at greater risk than adults; –Characteristics of youth gamblers in Toronto: male, out of school, working for pay, alcohol / marijuana use, severe dating violence, carrying a weapon –Prevalence rates in students in Atlantic provinces are 8.2% for ‘at risk’ and 6.4% for problem gamblers

8. Gambling in Canada (cont.) Consequences of gambling –For families: dysfunctional relationships, violence and abuse, financial pressure, disruption of growth and development in children –Male & female adolescent severe problem gamblers hare similar rates of depression, substance use, and weekly gambling –Linked to attempted suicide –Positive note: gambling is not always progressive and enduring, contrary to conventional and professional wisdom

9. Gambling in Canada (cont.) Treatments for pathological gamblers –CBT; Impulsivity interferes with staying in treatment –Controlled gambling has shown efficacy in 35% of problem gamblers in 2-yr follow-up –Only 20% of adolescents problem gamblers admit having a gambling problem Prevention –www.youthgambling.com, International Centre for Youth Gambling Problems and High-Risk Behaviorswww.youthgambling.com –www.knowthescore.ca, Responsible Gaming Council and Canadian / U.S. universitieswww.knowthescore.ca

10. Classification of Disorders Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence –Separation anxiety disorder –Conduct disorder –Attention-deficit/hyperactivity disorder –Mental retardation (listed on Axis II) –Pervasive developmental disorders –Learning disorders

11. Important Concepts Epidemiology Prevalence Lifetime prevalence Comorbidity

12. Prevalence of Mental Disorders in Canada in 2002 1/10 people w/ symptoms of depression, or anxiety, or alcohol/drug dependence 1/20 people met criteria for depression or bipolar disorder 1/20 with panic disorder, agoraphobia, or social phobia 1/30 met criteria for substance dependence (alcohol/drug) 1/50 met criteria for ‘at risk’ problem gambling Eating disorders and agoraphobia 5x higher for women than for men 2/3 of young people ages 15-24 w/ depression and anxiety stated that their symptoms started before age 15 ½ people ages 45-64 and 1/3 of seniors reported that their symptoms began before age 25

13. Criticisms of Classification General Criticisms –Loss of information about person –Stigmatizing Specific Criticisms –Discrete Entity vs. Continuum –Dimensional Classification vs. Categorical Classification DSM represents a categorical classification –Yes–No approach to classification –Continuity between normal and abnormal behaviour not taken into consideration

14. Reliability Reliability is the cornerstone of any diagnostic system Inter-rater reliability

15. Validity Validity of diagnostic categories? –Construct validity

16. Diagnosing at a Crossroads The DSM revision process evaluated 2 alternatives: –Reorganizing the diagnostic classes –Implementation of fully dimensional schemes A hybrid system : The DSM-V will be a mixed categorical- dimensional system Axes I, II, and III will be collapsed Changes to Axes IV and V are being considered Some diagnostic criteria are being revised to include gender, race, culture ‘Meta-structure’ including shared risks (e.g., genetic, environmental) and clinical factors (e.g., comorbidity, treatment response) are evaluated

17. Internet Addiction Disorder IAD is considered for inclusion in the DSM-V Includes excessive gaming and email/text messaging Shared components: excessive use, withdrawal symptoms, tolerance, negative repercussions In Block’s (2008) study 86% of IAD cases also had another DSM diagnosis In Asia, therapists are trained to screen for IAD –In South Koria, 2.1% of children ages 6-12 –80% of those requiring treatment need psychotropic medication, 20% require hospitalization –1.2 billion are considered at risk as they spend 23 hrs/w

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