Clinical Psych

• Abnormality


  Also known as mental disorders, psychiatric diagnoses, or psychopathology
• What defines abnormality


  • Personal distress to the individual
  • Deviance from cultural norms
  • Statistical infrequency
  • Impaired social functioning
• Harmful dysfunction theory


  A definition of mental disorders proposed by Jerome Wakefield, combining value (harmful) and scientific (dysfunction) components
• The DSM is the prevailing diagnostic guide for mental health professionals
• Mental disorder (DSM-5 definition)


  A clinically significant disturbance in cognition, emotion regulation, or behavior that indicates a dysfunction in mental functioning, usually associated with significant distress or disability
• The DSM task force that creates each edition consists primarily of psychiatrists, with a relatively small number of psychologists and other mental health professionals included
• Medical model of psychopathology

  Each disorder is an entity defined categorically with a list of specific symptoms
• The culture and values of those who define mental disorders can influence the definitions they produce
• Attenuated psychosis syndrome is currently listed as a proposed criteria set in the "Emerging Measures and Models" section of DSM-5, not an official diagnostic category
• Importance of defining abnormality


  • Influences research, clinical practice, and clients' lives
• Rational


  (in classical economic theory) economic agents are able to consider the outcome of their choices and recognise the net benefits of each one
• Rationality in classical economic theory is a flawed assumption as people usually don't act rationally
• If a firm increases advertising then their demand curve shifts right. This increases the equilibrium price and quantity
• Marginal utility


  The additional utility (satisfaction) gained from the consumption of an additional product
• If you add up marginal utility for each unit you get total utility
• s caused Teresa so much despair that she ultimately feared that she, too, would become irreversibly depressed
• Primary goal for work with Teresa


  Help her understand that many DSM diagnoses, including major depression, were unlikely to be permanent conditions, especially with treatment
• Julian was overly concerned with germs and cleanliness. He showered several times a day and washed his hands about 20 times per day
• These behaviors didn't prevent him from living his life—he had a long-term romantic relationship, performed well at work, and had an active social life—but there were at least occasional moments when his need to wash got in the way
• Julian needed to leave a surprise birthday party at a restaurant early to run home and shower. Another day, he missed much of his sister's wedding because he felt compelled to wash his hands twice during the ceremony
• Julian held the misconception that DSM diagnoses inevitably worsened over time
• Julian explained that he "knows what happens" to people with OCD: "They keep getting worse and worse until their symptoms totally take over. Pretty soon, I'm gonna be a prisoner in my own house. I won't be able to go out, work, or do anything. I'll turn into a total germophobe who washes himself all day every day"
• The psychologist told Julian emphatically that OCD does not inevitably get worse, and that with treatment, his OCD symptoms would actually improve significantly
• Abnormal behavior garnered attention long, long before the first version of the DSM appeared
• Hippocrates (460–377 BCE) wrote extensively about abnormality, but unlike most of his predecessors, he did not offer supernatural explanations such as possession by demons or gods. Instead, his theories of abnormality emphasized natural causes
• Hippocrates pointed to an imbalance of bodily fluids (blood, phlegm, black bile, and yellow bile) as the underlying reason for various forms of mental illness
• Around 1900, more important steps were taken toward the eventual DSM system that we currently use
• Emil Kraepelin labeled specific categories such as manic-depressive psychosis and dementia praecox (roughly equivalent to bipolar disorder and schizophrenia, respectively)
• The primary purpose of diagnostic categories in the late 1800s and early 1900s was the collection of statistical and census data
• The U.S. Army and Veterans Administration (now Veterans Affairs) developed their own early categorization system in an effort to facilitate the diagnosis and treatment of soldiers returning from World War II
• This military categorization system was quite different from the most recent editions of the DSM, but it actually had significant influence on the creation of the first edition of the DSM, which appeared less than a decade later
• DSM-I and DSM-II contained only three broad categories of disorders: psychoses, neuroses, and character disorders
• The definitions of disorders in DSM-I and DSM-II were not scientifically or empirically based. Instead, they represented "the accumulated clinical wisdom of the small number of senior academic psychiatrists who staffed the DSM task forces"
• Most of these psychiatrists were psychoanalytic in orientation, and the language of the first two DSM editions reflected the psychoanalytic approach to understanding people and their problems
• DSM-III, published in 1980, was very dissimilar from DSM-I and DSM-II
• DSM-III


  • Relied to a much greater extent on empirical data to determine which disorders to include and how to define them
  • Used specific diagnostic criteria to define disorders
  • Dropped any allegiance to a particular theory of therapy or psychopathology
  • Introduced the multiaxial assessment system
• DSM-III contained more than three times as many pages as DSM-II
• Subsequent revisions to the DSM—DSM-III-R, DSM-IV, and DSM-IV-TR—retained the major quantitative and qualitative changes instituted by DSM-III in 1980
• DSM-5 was published in May 2013. It was the first substantial revision of the manual in about 20 years
• Steps involved in creating DSM-5

  1. Early on, a task force was created

  2. The task force led work groups, each of which focused on a particular area of mental disorders

  3. A Scientific Review Committee of experts was created to ensure sufficient scientific evidence for proposed changes

  4. Field trials were conducted to determine reliability and clinical usefulness of proposed changes

  5. A website was maintained to communicate progress and solicit public comments