Advanced Psychopathology Defining the Phenomena

Example 30 y/o male 30 y/o male Experiences depressed mood every day for 1 month (sad, cries for no reason) Experiences depressed mood every day for 1 month (sad, cries for no reason) Wakes up two hours before his alarm goes off and can’t get back to sleep Wakes up two hours before his alarm goes off and can’t get back to sleep Has lost 12 pounds because he doesn’t eat consistently Has lost 12 pounds because he doesn’t eat consistently Has forgotten three meetings at work and can’t concentrate Has forgotten three meetings at work and can’t concentrate Reports that he would be better off dead Reports that he would be better off dead

Psychopathology Statistical Deviance Statistical Deviance Conceptual Definition? How Deviant? Conceptual Definition? How Deviant? Maladaptive Behavior Maladaptive Behavior Context Context Distress/Dysfunction Distress/Dysfunction Social Deviance Social Deviance Harmful Dysfunction Harmful Dysfunction Harmful according to culture Harmful according to culture Failure of a mental mechanism Failure of a mental mechanism

Psychopathology What is real when it comes to psychopathology? What is real when it comes to psychopathology? Suffering Suffering Is suffering pathological? Is suffering pathological? The problem of subjectivity The problem of subjectivity Theory vs. Conception Theory vs. Conception Explanation vs. A Description of that to be explained Explanation vs. A Description of that to be explained

Psych Disorders The accepted descriptions of our society representing agreed-upon abstractions of psychopathology The accepted descriptions of our society representing agreed-upon abstractions of psychopathology Social Constructionism vs. Essentialism Social Constructionism vs. Essentialism Why do we diagnose? Why do we diagnose? Professional/Client Communication Professional/Client Communication Sick role Sick role Research Research Reimbursement Reimbursement

Psychopathology vs. Disorder DSM-5 Mental Disorder DSM-5 Mental Disorder … a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation or behavior that reflects a dysfunction in psychological, biological or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities. An expectable or culturally approved response to a common stressor or loss such as death of a loved one is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual as described above. … a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation or behavior that reflects a dysfunction in psychological, biological or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational or other important activities. An expectable or culturally approved response to a common stressor or loss such as death of a loved one is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual as described above.

DSM-5 A list and description that we believe to fit the proposed definition of a mental disorder. A list and description that we believe to fit the proposed definition of a mental disorder. DSM IV is a “prototypical” system DSM IV is a “prototypical” system Categorical vs. Dimensional Categorical vs. Dimensional Many manifestations of disorders Many manifestations of disorders

Diagnosis How do we come by a diagnosis? How do we come by a diagnosis?ASSESSMENT

Diagnostic Assessment Structured vs. Unstructured Structured vs. Unstructured Inventories Inventories Structured Interviews Structured Interviews Almost always done w/a clinical interview Almost always done w/a clinical interview

Clinical Interview Presenting Problem Presenting Problem What is their perception of why they have come in? What is their perception of why they have come in? What’s the problem behavior, thoughts, or emotions What’s the problem behavior, thoughts, or emotions History of Presenting Problem History of Presenting Problem When did it start, how severe, what is the functional impact? When did it start, how severe, what is the functional impact? Developmental History Developmental History Family of origin Family of origin Academic Academic Employment Employment Personal relationships Personal relationships Alcohol/Drug Alcohol/Drug Medical History – Major or recent medical issues/illnesses Medical History – Major or recent medical issues/illnesses Treatment History – Therapy, medication, hospitalizations Treatment History – Therapy, medication, hospitalizations

Clinical Interview Within each content area your job is not only to get the info put to ask questions that allow you to differentiate “symptoms” so that a diagnosis emerges Within each content area your job is not only to get the info put to ask questions that allow you to differentiate “symptoms” so that a diagnosis emerges Addressing these areas paints a picture of that person. Addressing these areas paints a picture of that person. From that picture you abstract a diagnosis From that picture you abstract a diagnosis

Bias in Diagnosis Biased Constructs Biased Constructs Ethnocentric Construction of Idealized Self Ethnocentric Construction of Idealized Self Self- Control (Very Western) Self- Control (Very Western) Biased Application Biased Application Based on race, class, gender Based on race, class, gender Biased Sampling Biased Sampling Influence of bias factors on presentation to assessment/treatment Influence of bias factors on presentation to assessment/treatment The importance and the problem of BASE RATES The importance and the problem of BASE RATES Biased Instruments Biased Instruments DIF DIF Biased Criteria Biased Criteria Why don’t we have “delusional dominating PD?” Why don’t we have “delusional dominating PD?”

Your goal To learn the system well enough so that during an interview you will hear info that will allow you to generate a list of possible disorders To learn the system well enough so that during an interview you will hear info that will allow you to generate a list of possible disorders With that list you then ask questions to rule out disorders until you come to the one that best describes their suffering. With that list you then ask questions to rule out disorders until you come to the one that best describes their suffering.