1. Diagnosis

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

3. 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

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

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

6. DSM-IV Terminology CO-MORBID CONDITIONS BASE RATE INCIDENCE PREVALENCE3

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

8. 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

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

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

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

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

13. 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

14. 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

15. 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

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

17. 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

18. 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

19. 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

20. 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

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

22. 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.

23. 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

24. Theoretical Approaches
Abnormality
Theoretical Approaches
Cognitive
Behavioral
Psychodynamic
Assessment
Diagnosis?