CLINICAL PSYCHOLOGY

• Diagnosis


  The classification of disorders by symptoms and signs
• Psychopathology


  Examines the nature and development of abnormal behavior, thoughts, and feelings
• Definitions of abnormality vary widely and may not capture all aspects of psychopathology
• Characteristics of abnormal behavior

  • Disability
  • Personal distress
  • Violation of social norms
  • Dysfunction
• Statistical infrequency


  Suggests that rare behaviors are abnormal
• Normal curve indicates that some behaviors are common while others are rare
• Violation of social norms


  Abnormal behavior that makes others uncomfortable or causes problems
• Subjective distress


  Behaviors that are accompanied by distress are abnormal
• Disability/dysfunction definition argues that impairment of life function can be a component of abnormal behavior
• Abnormal behavior does not necessarily indicate mental illness
• Mental illness


  The syndrome (cluster of abnormal behaviors) must be associated with distress, disability, or increased risk of problems
• Diagnosis


  • Enables and promotes empirical research
  • Research on etiology possible
  • Diagnosis suggests treatment
• Diagnostic systems


  Assume that abnormality can be detected and classified by clusters of symptoms and signs
• History of DSMs


  • DSM-I (1952)
  • DSM-II (1968)
  • DSM-III (1980)
  • DSM-III-R (1987)
  • DSM-IV (1994)
  • DSM-IV-TR (2000)
• DSM-IV-TR


  Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision
• Five axes of DSM-IV


  • Axis I: All diagnostic categories except personality disorders and mental retardation
  • Axis II: Personality disorders and mental retardation
  • Axis III: General medical conditions
  • Axis IV: Psychosocial and environmental problems
  • Axis V: Global assessment of functioning scale (GAF)
• Selected Axis I diagnostic categories

  • Disorders usually first diagnosed in infancy, childhood or adolescence
  • Substance-related disorders
  • Schizophrenia and other Psychotic Disorders
  • Anxiety disorders
  • Mood disorders
  • Eating Disorders
• Axis I Diagnostic Categories

  • Disorders usually first diagnosed in infancy, childhood or adolescence
  • Substance-related disorders
  • Schizophrenia and other Psychotic Disorders
  • Anxiety disorders
  • Mood disorders
  • Eating Disorders
• Improvements in the DSM-IV-TR: Specific diagnostic criteria, more extensive descriptions, increasing number of diagnostic categories, issues and possible diagnostic categories in need of further study
• Number of Diagnostic Categories per Edition of DSM has increased over time
• Culture can influence


  Risk factors, Types of symptoms experienced, Willingness to seek help, Availability of treatments
• DSM-IV-TR includes enhanced cultural sensitivity and an appendix of culture-bound syndromes (Koro, Amok)
• Categorical system


  Presence/absence of a disorder
• Dimensional system


  Rank on a continuous quantitative dimension, Degree to which a symptom is present
• Dimensional systems may better capture an individual's functioning, Categorical approach has advantages for research and understanding
• Inter-Rater Reliability is the extent to which clinicians agree on the diagnosis, and for most DSM diagnostic categories, reliability is good
• Construct validity


  A construct is an abstract concept or inferred attribute, Involves correlating multiple indirect measures of the attribute, Important method for evaluating diagnostic categories
• Construct validity of highest concern for validity of diagnostic categories, as for most disorders, no lab test available to diagnose with certainty
• General Issues in Classification

  • Categories vs. dimensions, Bases of classification, Description and coverage, Validity, Bias
• Major models of psychopathology

  • Biological, Developmental, Psychodynamic, Learning, Cognitive, Humanistic
• Diathesis-Stress Model


  Diathesis = predisposition or vulnerability, Stress = external/environmental factors, The combination of a genetic predisposition and an external stressor may produce psychological problems
• Criticisms of Classification: Stigma against those classified with a mental illness, Categories do not capture the uniqueness of a person, Classification may emphasize trivial similarities