How has the DSM changed over the years?
- increase in the number of pages
- increase in number of diagnostic categories (more diagnosis’s)
- cost more to buy the manuals
What is Section I about in the DSM?
Introduction and Information regarding organisational features of the text, revisions, field trials and public, professional and expert reviews.
What is section II about in the DSM?
- Text on conditions
- diagnostic criteria
- codes
What is section III about in the DSM?
- Assessment measures
- cultural formulations
- a glossary
- conditions that warrant further study
What does the DSM -5 hope to add to the original DSM. (what changes are there in the DSM-5 compared to the original?)
To comprehensively update the descriptive text that is provided for each DSM disorder based on reviews of the literature”
- Other changes: the addition of small no. of diagnostic entities, and modifications; updated terminology in diagnostic criteria & specifier definitions .
What are the imperfections/Flaws of the DSM?
- Process criticisms (field trials, composition of task force).
- The lowering of diagnostic thresholds
- The introduction of new disorders without a clear scientific basis
- Failure to test/demonstrate validity of diagnostic categories
- Reification of ‘disorders’
- Failure to deliver on the promise of neuroscience
- The reduced ‘reliability’ of many diagnoses
Why do we use DSM?
- Widely used*
- Long history
- An exemplar of an approach
- we use it critically (we think about the manual’s strengths and limitations)
What other diagnostic systems are used to diagnose psychopathology?
- The World Health Organisation’s International Classification of Diseases, with ICD-11 released 2022.
- US NIMH Research Domains Criteria
What is psychopathology?
- The science/study of mental disorders
- generally a term used to describe abnormal behaviour or functioning
What are the 7 possible indicators of psychopathology?
- statistical deviance (abnormal behaviour - breaking the conventions of society)
- violation of social norms
- social discomfort
- Irrational/unpredictable
- Dangerous
- Maladaptive (emotions that interfere with a person’s ability to function effectively in daily life)
- Subjective distress
What is a challenge for 7 possible indicators of psychopathology)
- the role of insight. some people might not recognise that they have abnormal behaviour (when talking about subjective destress)
- Many of people need adjustments to perform daily tasks (some people may be able to do their day-to-day tasks but doesn’t mean they don’t have psychopathology. (the indicator of impaired daily functioning has challanges) –> sometimes cant even see impairment
- If statistical rarity is used
* How rare should it be?
* Is a rare behaviour necessarily harmful/deviant/distressing?
* Are common behaviours necessarily unharmful etc?
* Social & cultural values change and they require a reference point (is this the ‘dominant’ culture? Is it related to the culture with which the clinician and the client identifies) – what do these factors mean for the definition of psychopathology
What is Wakefields view on psychopathology?
Not every dysfunction is a disorder — it only becomes one if it also causes harm.
What is the DSM reliant on?
Heavily reliant on the harmful consequences (either subjective distress or impairment) & utilises the notion of a syndrome (a cluster of associated features that are recognised through the evaluation of signs and/or symptoms)
What are signs?
Signs are observed in the ‘patient’ by the diagnostician
(e.g., the diagnostician observes: “this person has usually
slow speech”)
What are symptoms?
Symptoms are reported by the person to the diagnostician
(e.g., the person says to the diagnostician: “I feel down all
the time”)
In accordance to the DSM-5, what is psychopathology?
“A mental disorder is a syndrome characterized by clinically
significant disturbance in an individual’s cognition, emotion
regulation or behavior that reflects a dysfunction in the psychological, biological, or developmental processes
underlying mental function.”
In accordance to the DSM-5, what is abnormal behaviour?
“Mental disorders are usually associated with significant distress or disability in social,occupational, or other important activities” (p.20)
AND NOT
“an expectable or culturally sanctioned response”; nor the product of “social deviance or conflicts with society”
PSychopathology in cultural context
- All mental disorders are shaped, to some extent, by cultural factors
- But no mental disorders should be entirely due to cultural or social factors.
- Disorders, by their very definition, should occur across cultures
- Social and cultural context has (and continues to) influence DSM-5 content and usage
What is epidemiology?
- The scientific study of the frequency & distribution of disorders within a population.
- Epidemiological data tell us which disorders are most common. [These data are hard to ascertain (why?): when estimates vary, can they be reconciled?]
- National and international data suggest that mental illness is a staggering “health” problem
What is Incidence?
the number of new cases that appear in a population during a specific time period (e.g., per year)
What is prevalence?
the number of active cases of a disorder in a population during a specific period
What is total prevalence?
total proportion of people from a population who will have the disorder at some point in their lifetime. Other terms: point prevalence, 1-year prevalence
Examples of key studies or surveys that provide benchmark epimology data
- National Comorbidity Survey Replication (NCS-R)
- Australian Institute of Health and Welfare and ABS Surveys (Australian- specific data)
- The World Health Organisation Global Burden of Disease
