CLIN

• What Defines Abnormality? 4D'S

  • Distress
  • Deviance from Cultural Norms
  • Dysfunction
  • Statistical Infrequency
  • Danger
• 4P Factor Model

  • Predisposing
  • Perpetuating
  • Precipitating
  • Protective
• DSM I (1952)


  Psychoses, Neuroses, & Character Disorders
• DSM II (1968)


  Psychoses, Neuroses, & Character Disorders
• DSM I & II: "Accumulated clinical wisdom of the small number of senior academic psychiatrists who staffed DSM task forces"
• Psychoanalytic Approach

  One paragraph per disorder
• DSM III


  • Dropped a particular theory of therapy or psychotherapy
  • Moved from psychoanalytic to no single psychological perspective
  • Introduced Multiaxial Assessment system (dropped in DSM-5)
  • Extended description, checklists
  • 265 from 182—retained until DSM 5 but with certain changes of its own
• Multiaxial Diagnosis of Carol S.


  • Axis I: Major Depressive Disorder (Clinical)
  • Axis II: Borderline Personality Disorder (Personality Disorders)
  • Axis III: Thyroid Disease (Medical Conditions)
  • Axis IV: Problems with a Primary Support Group: Marital Separation (Psychological Problems)
  • Axis V: GAF= 60 Moderate difficulty in social and occupation functioning (Global Assessment of Functioning)
• DSM 5 - The Current Edition


  Published in May 2023 after 20 years, 12 years in the making led by David Kupfer and Darrel Regier
• Dsm5.org - Public Communication
• W.H.O who publishes ICD (International Classification of Diseases 11)
• Changes in DSM-5 - Considered but did not make

  • Neurological & Biological underpinnings not yet strong
  • Continuum (Dimensional) rather than dichotomous
  • Removing % to the 10 personality disorders
  • "Emerging Measures Models" – Proposed criteria sets
• Internet Gaming Disorder


  Condition to future study
• New Features in DSM-5

  • From Roman to Arabic
  • Dropped Multiaxial Assessment
  • New Disorders - (Premenstrual Dysphoric Disorder, Disruptive Mood DD< BED, mild NCD, Somatic Symptom Disorder, Hoarding)
  • Revised Disorders - (Person's own history and culture, single DS-5 diagnosis Autism Spectrum Disorder, substance abuse and substance dependence to substance use disorder (tolerance/withdrawal), ADHD form 7-12 y.o)
• Types of Eating Disorder


  • Anorexia Nervosa
  • Avoidance / Restrictive Food Intake Disorder
  • Bulimia Nervosa
  • Binge Eating Disorder
  • Pica
  • Rumination
• Premenstrual Dysphoric Disorder (PMDD)


  Severe PMS (Premenstrual Syndrome)
• Causes of Premenstrual Dysphoric Disorder

  • The causes are NOT KNOWN
  • Hormones play some sort of role
  • Symptoms disappear if ovaries are removed
  • Ovarian function may affect changes in brain chemistry
• Examples of Premenstrual Dysphoric Disorder

  • Disinterest in ADL's
  • Fatigue or Low Energy
  • Suicidal Thoughts
  • Binge Eating
  • Panic Attacks
  • Persistent Irritability
  • Sleeplessness
  • Trouble Concentrating
  • Headaches and/or joint or more muscle pain
• No physical exam or lab test can diagnose PMDD
• Psychiatric evaluation used to rule out other condition
• Keep a calendar or dairy of symptoms when they occur to help with a diagnosis and best course of treatment
• Treatment of Premenstrual Dysphoric Disorder


  • Eat a balanced diet
  • Get sufficient sleep
  • Keep a track of your symptoms
  • Exercise
• Quantitative Perspective (Dimensional Model)


  If the amount of the cookie ingredients differs, the abnormality within the cookie would be quantitative
• Qualitative Perspective (Categorical Model)


  Assume you have a big jar full of various shaped, sized, and taste cookies. The abnormality lies each different cookie.
• The Interviewer


  • The most pivotal element of a clinical interview
  • A skilled interviewee not only is a master of the technical and practical aspects of the interview but also demonstrates broad-base wisdom about the human interaction interviewing entails
• General Skills


  • Quieting Yourself
  • Being Self-Aware
  • Developing Positive Working Relationships
• Specific Behaviors

  • Eye Contact
  • Body Language
  • Vocal Qualities
  • Verbal Tracking
  • Referring to the Client by the Proper Name
  • Observing Client Behaviors
• Rapport


  A positive, comfortable relationship between interviewer & client; it is how an interviewer is w/ client
• Specific efforts interviewers can make to enhance the client's experience of rapport


  • Make an effort to put the client at ease, especially early in the interview session
  • Interviewers can acknowledge the unique, unusual situation of the clinical interview
  • Recognize position and appreciate willingness, and invite them to ask questions
  • Interviewers can enhance rapport by noticing how the clients use language and then following the client's lead
• Directive Versus Nondirective Styles

  • Directive-style interviewers get exactly the information they need by asking clients specifically for it
  • Nondirective-style allows clients to determine the course of the interview
• Specific Interviewer Responses


  • Open- and Closed-Ended Questions
  • Clarification
  • Confrontation
  • Paraphrasing
  • Reflections of Feeling
  • Summarizing
• Note Taking


  • Written notes are certainly more reliable than the interviewer's memory
  • Many clients will expect the interviewer to take notes and may feel as though their words will soon be forgotten if the interviewer is not taking notes
• Drawbacks to taking notes: it can be a distraction for both the interviewer and the client
• The effect of note-taking is likely highly dependent on the particular situation, including exactly how a client interprets the use of any particular mode of note-taking and exactly how an interviewer uses that mode
• Audio and Video Recordings can, with some clients, hinder openness and willingness to disclose information
• The Interview Room


  When choosing a room [for interviews], it is useful to strike a balance between professional formality and casual comfort; the interview room should subtly convey the message to the client that the interviewer is a professional who is also approachable and caring
• Note Taking


  Written notes are more reliable than the interviewer's memory. Many clients expect the interviewer to take notes and may feel their words will be forgotten if the interviewer does not take notes
• Drawbacks to note taking

  • It can be a distraction for both the interviewer and the client
  • The effect of note-taking is highly dependent on the particular situation, including how the client interprets it and how the interviewer uses it
• Audio and Video Recordings


  Recording can, with some clients, hinder openness and willingness to disclose information
• Interview Room


  Should strike a balance between professional formality and casual comfort, conveying the message that the clinical interview is a professional activity but one in which warmth and comfort are high priorities