Dsm History
-
Upload
danny-gomez -
Category
Documents
-
view
224 -
download
0
Transcript of Dsm History
-
7/28/2019 Dsm History
1/15
Chapter Three:
Clinical Assessment, Diagnosisand Research Methods
Rick Grieve, Ph.D.
Department of Psychology
Western Kentucky University
DSM-IV-TR
zDiagnostic and Statistical Manual, FourthEdition, Text Revision
zTaxonomy of behavioral, mental, andpsychiatric disorders
{Atheoretical
{Nomothetical
History of DSM-IV
zBased on work of Emil Kraepelin{Late 1800s to early 1900s
zDSM published in 1945 at 120 pages
zDSM-IV-TR is the sixth revision at over 900pages
zWhile there are problems with DSM-IV, it stillhas had a great impact on the field.
zDSM-IV has engendered a lot of research
-
7/28/2019 Dsm History
2/15
DSM-IV
zDefinition of mental disorder:
{Clinically significant behavior orpsychological syndrome or pattern which isassociated with 1) present distress or 2)disability
{Must be associated with a significantlyincreased risk of suffering, death, pain,disability, or loss of freedom
{Must not be an expected response to aparticular event
DSM-IV Disorders
zNo sharp dividing line between onedisorder and another
zNo sharp dividing line between having adisorder and not
General Features of DSM-IV
zDisorders grouped by shared clinicalfeatures
zDescriptive and atheoretical approach
zSystematic description of each disorder{Essential and associated features
{Age and gender variables
{Course of the disorder
{Impairment from disorder
{complications
-
7/28/2019 Dsm History
3/15
General Features of DSM-IV
{Predisposing factors
{Prevalence rates{Familial pattern
{Differential diagnoses
zDiagnostic Criteria
Diagnostic Criteria
z Diagnostic Cri teria for 307.1 Anorexia
Nervosa
{A. Refusal t o maint ain body weight at or abov e a
minimally nor mal weight for age and height (e.g.,
weight loss leading to maintenance of body weight
less than 85% of that expected; or failur e to make
expected weight gain during period of growth,
leading to body weight l ess than 85% of that
expected).
Diagnostic Criteria
{B. Intense fear of gaining weight orbecoming fat, even though u nderweight.
{C. Disturbance in the way in which onesbody weight or shape is experienced,undue influence of body weight or shape
on self-evaluation, or denial of theseriousness of the current low bodyweight.
{D. In postmenarcheal females,amenorrhea, i.e., the absence of at leastthree consecutive menstrual cycles. (Awoman is considered to have amenorrheaif her periods occur only followinghormone, e.g., estrogen administration.)
-
7/28/2019 Dsm History
4/15
Multi-Axial SystemzAxis I{Clinical syndromes and V-Codes
z
Axis II{Developmental and Personality Disorders
zAxis III{Physical disorders
zAxis IV{Severity of Psychosocial Stressors
zAxis V{Global Assessment of Functioning
Appendices
zAppendix A
{Controversial new disorders
zAppendix B
{Decision Trees
zAppendix C
{Glossary of Technical Terms
Cautions in Using DSM-IV
zDiagnosis is only the initial step
zNeed specialized training to use DSM-IVto make diagnosis
zDSM-IV diagnosis is not necessarily alegal document
zNeed to consider norms of culturesoutside of western culture
-
7/28/2019 Dsm History
5/15
Criticisms of the DSM-IV
zQuestionable reliability
zQuestionable validityzImplies homogeneity
zNot enough flexibility
zImplies qualitative difference rather than aquantitative continuum
zCreated by psychiatrists
{Too much medical model
Criticisms of the DSM-IV
zChild and adolescent disorders notadequately covered
zPromotes cookie cutterapproach
zFalse impression about sophistication ofunderstanding of mental disorders
zFocuses on signs and symptoms to theexclusion of other facets of the disorder
How to Fix the DSM
zEmphasize environmental influences
zMove from disorder to discorder
-
7/28/2019 Dsm History
6/15
Why Use the DSM-IV
zProvides appropriate terminology
zCommon language among health serviceproviders
z500-lb gorilla
DSM-V
zChanges to expect:
{Conform with ICD
{Maybe change diagnosis
{Maybe change theoretical orientation
{Maybe increased emphasis on testing andassessment
New WHO Diagnostic Schematic
zTwo parts, each with two components:
{Functioning and Disability
zBody functions and structures
zActivities and Participation
{Contextual Factors
zEnvironmental Factors
zPersonal Factors
-
7/28/2019 Dsm History
7/15
Diagnoses
zPractice comes from medicine
zDiagnosis is the assignment of a labelthat serves as shorthand for a cluster ofrelated behavioral features which mayor may not be related to demonstrableorganic varibles
zPsychological diagnoses arent yet tothe level of medical diagnoses
Categorical versus DimensionalCategorical versus Dimensional
ConditionsConditions
20
60
40
0
1 3 5 7 9 11 1 3 15 1 7 1 9
Frequency
Scores
(A)(A) DichotomyDichotomy
There are only twoThere are only two
levels, and all peoplelevels, and all people
are at one of thoseare at one of those
two levelstwo levels
20
60
40
0
1 3 5 7 9 11 1 3 15 1 7 1 9
Frequency
Scores
20
60
40
0
1 3 5 7 9 11 1 3 15 1 7 1 9
Frequency
Scores
(B) Dimensional(B) Dimensional
Considerable varietyConsiderable variety
across populationacross population
Categorical versus DimensionalCategorical versus Dimensional
ConditionsConditions
-
7/28/2019 Dsm History
8/15
20
60
40
0
1 3 5 7 9 11 1 3 15 1 7 1 9
Frequ
ency
Scores
20
60
40
0
1 3 5 7 9 11 1 3 1 5 1 7 19
Frequency
Scores
20
60
40
0
1 3 5 7 9 11 1 3 15 1 7 1 9
Frequency
Scores
(C) Bimodal(C) Bimodal
DistributionDistribution
Variability withinVariability within
each categoryeach category
Categorical versus DimensionalCategorical versus Dimensional
ConditionsConditions
Problems With/Abuses of Diagnostic Terms/Labels
zSelf-fulfilling prophesy
zDistorting diagnoses to get insurancecoverage
zLabel viewed as immutable
zCircular use of label
zDisagreement of diagnoses
zInconsistency in the definition of the label
Problems With/Abuses of Diagnostic Terms/Labels
zCareless assignment of labels
zPotentially harmful effects on a person
zPolitical and economic exploitation
zconfidentiality
-
7/28/2019 Dsm History
9/15
Positive Uses for Diagnostic Labels
zFacilitate communication
zPrevent confusionzClassify clients for definition of
treatment issues
zUsed in:{Clinical communities
{Insurance companies
{Research
{Statistical purposes
Methods of Assessment
zClinical Interview
{Most widely used method
{Covers:
zIdentifying data
zPresenting Problem
zPsychosocial History
zPsychiatric History
zMedical History
Methods of Assessment
{Interview Formats:
Computer admin & scoring
Used in research & clinicalsettings
Creates favorable changesAllows comparability
Increases rapportMay increase defensiveness andresistance
Picks up idiosyncratic infoMay miss idiosyncratic info
Increased flexibilityDecreased flexibilityDecreased reliability and validityIncreased reliability and validity
UnstructuredUnstructuredStructuredStructured
-
7/28/2019 Dsm History
10/15
Methods of Assessment
{Interview vs. Conversation
zInterview designed to achieve certain goalszInterview may require discussion of unpleasant
things
zInterviewer directs and controls the flow of theinterview
zOne-sided
zTime Limited
Methods of Assessment
zMental Status Exam
{Appearance and behavior
{Thought processes
{Mood and affect
{Intellectual functioning
{Sensorium
zPhysical Exam
Methods of Assessment
-
7/28/2019 Dsm History
11/15
Methods of Assessment
z
Psychological Tests{Used to evaluate reasonably stable traitssuch as intelligence and personality
{Standardized
{Two important concepts:zValidity
The extent to which a test measures what itpurports to measure
zReliabilityThe extent to which a test obtains comparable
scores across time
Three Concepts Determine the Valueof Assessment
Methods of Assessment
{Intelligence Tests
zStanford Binet
zWechsler Scale
zDeviation IQ score
{Self-Report Personality Tests
zObjective tests
zEmpirically derived
zMMPI-2
zMCMI
-
7/28/2019 Dsm History
12/15
Methods of Assessment
Methods of Assessment
This inkblot resembles the ambiguous figures presented in theRorschach test
Methods of Assessment
{Projective Personality Tests
zRationale for these
zValidity
zRorschach Inkblot TestzThematic Apperception Test
{Neuropsychological Assessment
zBender Visual Motor Gestalt Test
zHalstead-Reitan Neuropsychological Battery
zLuria Nebraska Battery
-
7/28/2019 Dsm History
13/15
Methods of Assessment
{Behavioral Assessment
zFunctional analysiszSelf-monitoring
Reactivity
zAnalogue Measures
zBehavioral Rating Scales
{Cognitive Assessment
{Physiological Measurement
zGSR
Methods of Assessment
zEEG
zEMG
zBrain Imaging
CT Scan
PET Scan
MRI
fMRI
BEAM
Science and Abnormal Behavior
zNature of Science{Way of knowing the world unlike normal everyday ways
of knowing
{Science values empiricism, objectivity, and replicability
{Science demands rigorous standards of proof{Science is a means for testing hypotheses and
theoretical claims
{Science as a human enterprise is often value laden, notvalue free
-
7/28/2019 Dsm History
14/15
Science and Abnormal Behavior
zQuestions Driving a Science of
Psychopathology{What problems cause distress or impair
functioning?
{Why do people behave in unusual ways?
{How can we help people behave in moreadaptive ways?
Basic Components of Research
z Starts with a Hypothesis or Educated Guess{Not all hypotheses are testable
{Hypotheses in science are formulated so that they aretestable
zResearch Design{A method to test hypotheses
{ Independent variable The variable that causes orinfluences behavior
{Dependent variable The behavior influenced by theindependent variable
Considerations in Research Design
zBalancing Internal vs. External Validity{ Internal validity Confidence that effects are due to the
independent variable
{External validity Extent to which the findings are
generalizablezWays to Increase Internal Validity by Minimizing
Confounds{Use of control groups
{Use of random assignment procedures
{Use of analog models
zRelation Between Internal and External Validity
-
7/28/2019 Dsm History
15/15
Statistical Methods and ClinicalMeaningfulness
z Statistical Methods{Branch of mathematics
{Helps to protect against biases in evaluating data
z Statistical vs. Clinical Significance{Statistical significance Means that the results are
beyond chance or coincidence
{Clinical significance Refers to whether the results areclinically meaningful
{Statistical significance does not imply clinicalmeaningfulness
Statistical Methods and ClinicalMeaningfulness
zBalancing Statistical vs. ClinicalSignificance
{Evaluate effect size
{Evaluate social validity
zGeneralizability and the PatientUniformity Myth
Types of Research
zCase Study
zCorrelational Study
zExperimental Study{Single Case Experimental Design
{Genetic Studies
{Studying Behavior Across Time
{Studying Behavior Across Cultures