Diagnosis

Diagnosis: process of determining whether the particular problem afflicting the individual meets all the criteria for a disorder

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

Diagnostic & Statistical Manual of Mental Disorders 1980s: Consistent system for all Based upon research Independent field trials Less influence by psychodynamics

Diagnostic & Statistical Manual of Mental Disorders Atheoretical Medical model: Signs (external) Symptoms (internal experiences) Syndromes (disorders) - a cluster of symptoms

DSM-IV Terminology CO-MORBID CONDITIONS BASE RATE INCIDENCE PREVALENCE 3

DSM-IV Terminology Diagnoses occurring together in the same patient CO-MORBID CONDITIONS BASE RATE DYSFUNCTIONAL BEHAVIOR PERSONALLY DISTRESSING BEHAVIOR 3

DSM-IV Terminology Frequency of a disorder in the population CO-MORBID CONDITIONS Frequency of a disorder in the population BASE RATE INCIDENCE PREVALENCE 3

DSM-IV Terminology CO-MORBID CONDITIONS BASE RATE INCIDENCE % of new cases of a disorder that develop during a specific time period PREVALENCE 3

DSM-IV Terminology CO-MORBID CONDITIONS BASE RATE % of the population afflicted with a disorder over a specified period INCIDENCE PREVALENCE 3

DSM-IV Terminology LIFETIME PREVALENCE AGE OF ONSET COURSE ETIOLOGY 3

DSM-IV Terminology % of the population who will experience a disorder in their lifetime LIFETIME PREVALENCE AGE OF ONSET COURSE ETIOLOGY 3

DSM-IV Terminology The age at which a disorder (usually) develops LIFETIME PREVALENCE The age at which a disorder (usually) develops AGE OF ONSET COURSE ETIOLOGY 3

Change in symptomatology of a disorder over time DSM-IV Terminology LIFETIME PREVALENCE AGE OF ONSET COURSE Change in symptomatology of a disorder over time ETIOLOGY 3

DSM-IV Terminology The cause(s) of a disease or abnormality LIFETIME PREVALENCE AGE OF ONSET The cause(s) of a disease or abnormality COURSE ETIOLOGY 3

Multiaxial Diagnosis 5 dimensions of diagnosis Psychological disorder (e.g. anxiety) Personality disorders/ Mental Retardation Medical Conditions Psychosocial problems Global Assessment of Functioning

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

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

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

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

Criticisms of DSM Diagnosis Fuzzy categories Reliability issues (e.g., personality disorders) Labeling Inform treatment? Cultural appropriateness

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.

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

Theoretical Approaches Abnormality Theoretical Approaches Cognitive Behavioral Psychodynamic Assessment Diagnosis?