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 CONDITIONSCO-MORBID CONDITIONS

BASE RATEBASE RATE

INCIDENCEINCIDENCE

PREVALENCEPREVALENCE

Diagnoses Diagnoses occurring occurring together in the together in the same patientsame patient

DSM-IV Terminology

CO-MORBID CONDITIONSCO-MORBID CONDITIONS

BASE RATEBASE RATE

DYSFUNCTIONAL DYSFUNCTIONAL BEHAVIORBEHAVIOR

PERSONALLY PERSONALLY DISTRESSING BEHAVIORDISTRESSING BEHAVIOR

Frequency of a Frequency of a disorder in the disorder in the populationpopulation

DSM-IV Terminology

CO-MORBID CONDITIONSCO-MORBID CONDITIONS

BASE RATEBASE RATE

INCIDENCEINCIDENCE

PREVALENCEPREVALENCE

% of new cases of % of new cases of a disorder that a disorder that develop during a develop during a specific time specific time periodperiod

DSM-IV Terminology

CO-MORBID CONDITIONSCO-MORBID CONDITIONS

BASE RATEBASE RATE

INCIDENCEINCIDENCE

PREVALENCEPREVALENCE

% of the % of the population population afflicted with a afflicted with a disorder over a disorder over a specified periodspecified period

DSM-IV Terminology

CO-MORBID CONDITIONSCO-MORBID CONDITIONS

BASE RATEBASE RATE

INCIDENCEINCIDENCE

PREVALENCEPREVALENCE

DSM-IV Terminology

LIFETIME PREVALENCELIFETIME PREVALENCE

AGE OF ONSETAGE OF ONSET

COURSECOURSE

ETIOLOGYETIOLOGY

•% of the % of the population who population who will experience a will experience a disorder in their disorder in their lifetimelifetime

DSM-IV Terminology

LIFETIME PREVALENCELIFETIME PREVALENCE

AGE OF ONSETAGE OF ONSET

COURSECOURSE

ETIOLOGYETIOLOGY

•The age at which The age at which a disorder a disorder (usually) develops(usually) develops

DSM-IV Terminology

LIFETIME PREVALENCELIFETIME PREVALENCE

AGE OF ONSETAGE OF ONSET

COURSECOURSE

ETIOLOGYETIOLOGY

•Change in Change in symptomatology symptomatology of a disorder over of a disorder over timetime

DSM-IV Terminology

LIFETIME PREVALENCELIFETIME PREVALENCE

AGE OF ONSETAGE OF ONSET

COURSECOURSE

ETIOLOGYETIOLOGY

•The cause(s) of a The cause(s) of a disease or disease or abnormalityabnormality

DSM-IV Terminology

LIFETIME PREVALENCELIFETIME PREVALENCE

AGE OF ONSETAGE OF ONSET

COURSECOURSE

ETIOLOGYETIOLOGY

Multiaxial Diagnosis

5 dimensions of diagnosis

I. Psychological disorder (e.g. anxiety)

II. Personality disorders/ Mental Retardation

III. Medical Conditions

IV. Psychosocial problems

V. 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

Abnormality Theoretical Approaches

Cognitive Behavioral Psychodynamic

Assessment Diagnosis?