JUST clinical psychology

• The Four Ds of Diagnosis

  Concepts used to decide whether a behaviour is normal or abnormal, and whether further investigation is needed to assess a mental health disorder
• Deviance


  • Refers to whether the behaviour demonstrated "deviates from the norm; the extent to which the behaviour is "rare" and "uncommon in society
  • If the behaviour is considered rare enough, and deviating from a social norm then the behaviour would be considered abnormal, suggesting a clinical disorder is present
• Dysfunction


  Refers to whether a behaviour interferes with the person's everyday life
• Distress


  Refers to the extent to which the behaviour is causing distress to the individual
• Danger


  Refers to the extent to which the behaviour presents a danger to the individual and/or to others
• Duration


  Many behaviours could be considered to be deviant, dysfunctional, distressing and dangerous in the short-term, but it is when the behaviour persists that it should be considered as a symptom of a mental health disorder that requires clinical attention
• The diagnostic process is often conducted through clinical interviews (unstructured or structured)
• The clinician has a lot of power in the diagnosis process, which can have serious implications for the individual once diagnosed
• The label of having a disorder could lead to stigma, and it is possible for individuals to be given treatment against their own consent, if they have been sectioned under the Mental Health Act and are deemed at risk to themselves or others (danger)
• Classification Systems


  Mental health disorders are defined by a set of symptoms, similar to physical illnesses
• ICD


  One of the main classification systems for mental health disorders
• DSM


  One of the main classification systems for mental health disorders
• Classification systems


  • Aim to enable professionals to make reliable (consistent over time and consistent between professionals) and valid (only when a true disorder is present) diagnoses
  • Contain classifications of disorders split into different chapters and symptoms of the specific disorders to aid accurate diagnosis
  • Diagnosis is needed so the individual can go on to receive the appropriate treatment, to restore mental wellbeing
• The World Health Organisation (WHO) created the International Classification of Diseases (ICD)


  1948
• The American Psychiatric Association (APA) created the Diagnostic and Statistical Manual of Mental Disorders (DSM)


  1952
• Both classification systems (ICD and DSM) have been revised multiple times, to add newly defined disorders, refine classifications of existing disorders and remove disorders no longer considered as valid
• Homosexuality used to be in the DSM and ICD, classified as a mental health disorder
• The ICD is currently in its eleventh edition (ICD-11), the DSM is currently in its fifth edition (DSM-5), which was published in 2013
• Classification systems


  Do not aim to explain the cause of the disorders, but just aim to describe the symptoms to aid diagnosis
• Mental health disorders do not have measurable signs such as blood pressure or temperature changes, so diagnosis is often reliant on the interpretation of behavioural symptoms, leading to issues with validity and objectivity
• DSM-5


  The Diagnostic and Statistical Manual of Mental Disorders (fifth edition)
• DSM


  A diagnostic manual used widely in America
• The DSM-5 was released in 2013 by the APA and is the fifth edition of the manual
• DSM


  Groups disorders into "families" of related disorders, enabling the professional to quickly go from a general diagnosis to a specific one, aided by information about likely combinations of symptoms and their severity
• Original DSM-I


  Created because the US armed forces wanted a guide to diagnose their servicemen, there was a need for a common system to aid consistent diagnosis
• Sections of the DSM-5


  • An introduction to the manual, with instructions on its use and overview of changes from the DSM-IV
  • The diagnostic criteria for the main mental health disorders
  • Other assessment measures, including information about cultural context, clinician-rated and patient-rated measures, and "new" conditions being assessed for possible future diagnosis
• Older versions of the DSM used to use 5 axes, which has been abolished in DSM-V
• Unnecessary and over-used diagnoses were removed in the DSM-5, e.g. Autistic Spectrum Disorder has become one category, rather than separate categories of Autism, Asperger's Syndrome etc.
• Societal changes have been reflected in the DSM-5 classifications, e.g. PTSD covers more symptoms based upon increased knowledge gained from wars, dementia has been separated into major and minor due to the increased prevalence and there is more awareness of cultural differences in mental health
• The term "mental retardation" has been replaced by "intellectual disability" in the DSM-5 to reflect contemporary attitudes towards mental health
• ICD-11


  The International Classification of Diseases (eleventh edition), released in 2019 by the WHO
• ICD


  A diagnostic manual commonly used across the world
• The ICD-11 is a comprehensive classification system, covering all areas and disorders, not just mental health disorders
• ICD-11


  Groups disorders into "families" of related disorders, enabling the professional to quickly go from a general diagnosis to a specific one, and later, to a very precise sub-type of a disorder
• The WHO aimed to improve healthcare across the world, and produce the ICD free of charge
• Structure of the ICD-11


  • Section F "mental and behavioural disorders" specific to mental health disorders
  • Disorders are grouped together into 10 different families, e.g. mood disorders
  • A numerical system is used with each "family" given a number, e.g. F3 relates to mood disorders, the next digit represents an individual specific disorder, e.g. F31 is bipolar disorder, further digits and decimal places are used for additional sub-categories
• Strengths of classification systems


  • Standardised and operationalised criteria allow for a common, consistent, reliable diagnosis across different clinicians
  • ICD: precise sub-types of disorders leading to valid and accurate diagnosis
• Weaknesses of classification systems


  • Medicalises mental health, presenting disorders as "illnesses" that need "cures" (Laing - schizophrenia is "a different way of living")
  • Labelling and stigmatisation
  • DSM: Subjective - considers the role of social norms
  • Reductionist approach to mental health
• Reliability of diagnosis


  The consistency of a diagnosis, both over time and between professionals
• Inter-rater reliability


  The extent to which two or more professionals give the same diagnosis to the patient