Validity with Categorization
- Does the classification scheme capture the nature of the entity?
- Does it capture what its meant to?
Utility of Categorization
- How useful is the classification scheme?
- Practical value of these categorizations
- Do they create unnecessary barriers or help with interactions
Purposes of a diagnostic classification system
- Concise description of a condition makes them easy to communicate and understand and helps everyone be on the same page
- Common language used by trained professionals
- May contain information about etiology, comorbidity, and prognosis
- For searching for treatment
- For reimbursement of costs of services
Defining normal and abnormal behaviour
- Psychology includes the study of the range of normal behaviour, thoughts, and feelings (how does a particular phenomenon develop? What facilitates it or gets in the way? What is the extent to which it varies in the population?)
In which course have you learned about the range of what is normal
Diversity of humans are in multiple psychology domains, like behavioural, social and developmental, with the presence of elements of different backgrounds and cultures in all psychology domains & helps us understand issues and diagnoses
Definitions of normality
1) Developmental phases: whether a certain behaviour enacted at a certain time is appropriate for the age (a kid vs middle aged man asking a stranger for a hug)
2) Culture’s influence for values like independence, sense of time, respect and overt or lack there of expression of feelings
3) Prevailing norms as certain elements shift in their acceptance and definition of normality like slavery, wife-beating and stigmatization of homosexuality (difference between what is and what was)
Developmental psychopathology approach
- Focuses on milestones in development
- Developmental tasks at each stage
- Heavy focus on infancy and childhood, but there is growing literature on other phases and it is being broken down in more categories
Research on vulnerability to mental disorder
- Encompasses biological vulnerability (genetic predispositions), exposure to stressors (environmental stressors) and Absence of or disruption of protective factors
- If we know all these predispositions are present and provide support early on there is a lower risk of developing disorders
Research on vulnerability following disaster
- Disaster disrupts ongoing services
- Majority do NOT develop PTSD (resilience is present in most of these individuals)
- Those with pre-existing disorders, are at greatest risk
Misconception of resilience
It is less about something big happening in childhood and moreso about facing minor setbacks which research has shown allows kids to develop resiliency and learn compared to kids who are coddled
Tracking vulnerability to depression [Sutin et al. (2013). Study started in 1958]
- 2300 adults
- Depressive symptoms highest in young adulthood (facing challenges of identifying questions, work pressures, changing relationships, etc.)
- Decrease in middle adulthood (more stable and adaptive coping techniques)
- Rises again in older adulthood (declining health, more losses and decreasing social life)
Diagnosing: definition of problem - Physical disorders
- Based on cluster of symptoms
- Often focuses on clear etiological path
- Often confirmed by marker identified in X-ray, lab test, or scan
Diagnosing: definition of problem - Mental disorders
- Based on cluster of symptoms
- Etiology less clear
- No clear physical markers for most disorders (except some neurological conditions)
The DSM
Continually changing and adjusting to figure out better treatments, adding & taking out disorders and characteristics, changing organization of categorizations, etc.
Evolution of the DSM
1) Largely psychodynamic description (limited clinical impact on treatment as there was only one type commonly available
2) More precision (greater choice among treatments)
3) Atheoretical; behavioural descriptors; focus on inter-rater reliability (improve objectivity of diagnosis)
4) Scientifically informed via work groups & literature reviews (integrated different research to make it better for categorization)
5) Expanded Consultation (more professionals integrated); Unprecedented criticism (over diagnosis, emphasis on pharmaceutical diagnosis, psychologists and psychiatrists both use this)
Concerns about DSM-5
- Lack of openness: Confidentiality agreement (developmental process lacks transparency)
- Over-representation of biological views (overshadows the psych and social aspects)
- 70% of Task Force members with links to pharmaceutical companies (potential conflict of interest towards medication)
- Poor reliability of diagnoses (some diagnoses show inconsistencies of categories ppl must meet for diagnosis, some are more flexible than others (not black or white)
Reactions to DSM-V
- Backlash open letters from APA, British Psychological Society and American Family Therapy Association (Exposed concerns, reliability & methods of diagnosis)
- Medicaid & Medicare billing in the United States use ICD (highlights DSM limited application)
- National Institute for Mental Health (concerns about validity and encourage efforts to develop new system)
Two basic approaches to classification schemes - Categorical
- You have or do not have the diagnosis
- Traditional approach in classifying adults dating back to Emil Kraepelin
- More clear cut diagnosis
Two basic approaches to classification schemes - Dimensional
- Assessed on spectrum not as black & white
- You have more or less of the characteristic
- Common approach in assessing children derived from the work of Thomas Achenbach
- Offers flexibility & more integrative of developmental & behavioural factors
DSM-5
- Categorical areas individuals either meet or not in diagnosis
- Incorporates dimensional aspect in the way it is organized: ex. Selective mutism (used to be in different categorization) now part of the anxiety disorders
DSM-V - Neurodevelopmental disorders
Intellectual disabilities (ASD; ADHD)l; typically manifest in early lifetime
DSM-V - Schizophrenia spectrum and other psychotic disorders
Delusions, hallucinations & other psychotic disorders
DSM-V - Bipolar and related disorders
Mood swings ranging from depressive lows to intense highs
DSM-V - Depressive disorders
Major depressive disorder; Pre-menstrual dysphoric disorder; pervasive feeling of sadness or loss of interest
