DSM: Classifying Mental Disorders

The DSM uses what model to decide whether or not criteria for symptom presentation is met?

"medical model" or categorical classification

What disorders are diagnosed far too often in males:

-alcohol use disorder -conduct disorder -adhd -antisocial personality disorder

What disorders are diagnosed far more often in females:

-depression -anxiety -eating disorders -borderline personality disorder -histrionic personality disorder

Strengths of the DSM: (5)

-emphasis on empirical research -use of explicit diagnostic criteria -strong inter-rater reliability -atheoretical language -facilitates communication between researchers and clinicians

What is included in the DSM?

-provides diagnostic criteria for all mental disorders -Includes recent statistics about disorders (ex. epidemiology).

What were 3 proposals for new disorders:

1-Attenuated Psychosis Syndrome: hallucinations, delusions, and disorganized speech characteristics of schizophrenia but less intense. Do not lose touch with reality in a persuasive way. 2-Mixed anxiety-depressive disorder: some symptoms of anxiety, some depression, but not enough to either qualify for any existing disorder 3-Internet Gaming Disorder: excessive and disruptive 3-internet game-playing behavior (considered non-substance addictive related behaviors such as shopping, exercise, work, and sex).

What were some changes proposed, but not implemented in the DSM 5:

1-Authors considered significantly overhauling the manual to emphasize neuropsychology, or the biological roots of mental disorders. Problem: there are many disorders that involve biological factors, but they lack definitive biological markers. 2-Considered shift towards dimensional. 3-Dimensional approach was considered for a subset of mental disorders: personality disorders. Research suggests that PDs best fit with dimensional, but would be too complex. 4-Considered removing 5 of the 10 personality disorders (paranoid, schizoid, histrionic, dependent, and narcissistic personality disorder). Decided to retain them.

Describe the 3 diagnostic objectives when using the DSM5:

1-Clinician determines if symptom presentation meets criteria for any mental disorder(s). Through history taking, other disorders (relevant medical problems) are also listed. 2-Psychosocial & Contextual Factors are identified and listed. These include: -loss of primary support group or changes to home environment -educational disability -occupational disability -economic/financial problems -limited or not access to health care -legal and/or criminal issues 3- The Patient's level of disability is assessed across several domains. Level of disability is indicated in the DSM-5 using the WHODAS or World Health Organization's Disability Assessment Schedule

List the New Disorders in DSM 5: (6)

1-Premenstrual Dysphoric Disorder (PMDD) 2-Disruptive Mood Dysregulation Disorder (DMDD) 3-Binge Eating Disorder (BED) 4-Mild Neurocognitive Disorder 5-Somatic Symptom Disorder 6-Hoarding Disorder

Operational definitions of psychopathology include: (6)

1-personal distress (ex. depression) 2-violation of social norms (ex. schizophrenia) 3-disability (ex. rare disorders like dissociative identity disorder) 4-harmful dysfunction 5-developmental (inability to meet social, cognitive, and behavioral milestones) 6-Dyscontrol (pathological behavior is involuntary: cannot be controlled)

Describe 2 points to keep in mind about defining mental illness:

1-there is no single definition of mental illness 2-Our views (and definitions) change over time

DSM Disability Assessment: WHODAS 2.0 Domains (1-6)

1-understanding and communicating 2-getting around/mobility 3-self-care 4-getting along with people 5-life activities: home, school, work 6-participation in society

____% of people diagnosed with one disorder will meet criteria for a second disorder

45%

Premenstrual Dysphoric Disorder (PMDD)

A severe version of premenstrual syndrome (PMS), with a combination of at least 5 emotional and physical symptoms occurring in most menstrual cycles during the last year that causes significant distress or interferes with work, school, social life, or relationships.

Changes in ADHD criteria

Age symptoms must first appear is 7 to 12 years old. Number of symptoms for adults=5 and for kids=6

Why was the Multiaxial Assessment system dropped from DSM 5?

Brings a number of important changes to the way clinicians diagnose clients. ex) the tradition of separating axes for disorders that persist long-term vs. short-term is dropped. This could result in different conceptualizations of disorders. ex) Axis 5: Global Assessment functioning (GAF) scale was dropped. There is no longer a single numeric scale for describing a clients' level of functioning across all disorders

DSM is based on what form of classification?

Categorical

Describe the difference between categorical and dimensional classification?

Categorical: Presence/absence of a disorder. Either you have it or you do not. Ex) Yes you have anxiety vs. no you do not have anxiety Dimensional: Rank on a continuous quantitative dimension. Degree to which a symptom is present. Ex. How anxious are you on a scale of 1 to 10?

Somatic Symptom Disorder

Combination of at least one significantly disruptive bodily (somatic) symptoms with excessive focus on the symptom. Perceiving it as more serious than it really is. High anxiety about it.

Hoarding Disorder

Continuing difficulty to discard possessions no matter how objectively worthless they are. Live in congested home and experiences impairment in important areas such as work, socialization, or safety. (used to get the diagnosis of OCD, but it didn't match perfectly so hoarding is now distinct).

Multitaxial Assessment System

Described psychiatric problems in 5 distinct axis Axis 1-more episodic disorders (beginning and endpoints Axis 2- disorders thought to be more long lasting and stable Axis 3 & 4- place to list medical conditions and psychosocial/environmental problems Axis 5- global assessment of functioning scale (GAF), provided clinicians an opportunity to place the client on a 100 point continuum describing the overall level of functioning.

Assessing the nature and degree of impairment is not just important for ____, but this information is essential for _______.

Diagnosis; treatment planning

Who is considered the founding father of the current diagnostic system? Why?

Emil Kraepelin: labeled specific categories like manic-depressive psychosis and dementia praecox→ this led to the reputation of him as the founding father of the current diagnostic system.

Disruptive Mood Dysregulation Disorder (DMDD) -why drafted?

Frequent temper tantrums in children 6 to 18. ( at least 3 per week over the course of a year). Below the level of maturity and occur in 2 settings with irritable mood in between tantrums. Drafted due to the increased diagnosis of bipolar disorder in children.

_______wrote extensively about abnormality, but unlike most of his predecessors, he did not offer supernatural explanations, but rather emphasized natural causes.

Hippocrates -His accent on natural causes of psychopathology was a significant early step towards more current definitions

The DSM is compatible with the _______ of World Health Organization

ICD

Problem with Categorical Classification:

If you have minimum number of symptoms, you are diagnosed with the disorder. If one symptom short... you are not! -Little research support for this diagnosable threshold!

Mild Neurocognitive Disorder

Less intense version of major neurocognitive problems of dementia and amnesia. Modest decline in cognitive functioning. But nothing serious enough it interferes with the ability to live independently.

DSM III also included the _________ that remained until the DSM 5 dropped it

Multitaxial Assessment System

Were there symptoms present?

No, individual paragraphs per disorder with vague descriptions of clinical conditions

Is a culturally-approved response to a common stressor or loss (ex. death of loved one) OR socially deviant behavior considered a mental disorder?

Only if it meets the conditions of the DSM definition for mental disorder

Which disorder has an extreme controversy towards females?

Premenstrual Dysphoric Disorder (PMDD)

Describe changes made for the DSM III

Relied with greater extent on empirical data Used specific diagnostic criteria to define disorders. Paragraphs followed by lists. Described in greater detail the symptoms that must be present for an individual to qualify for diagnosis Psychoanalytic language of previous editions was dropped and replaced by terminology that reflected no single school of thought.

Binge Eating Disorder (BED)

Resembles the part of bulimia nervosa in which the person overindulges in food, but lacks the part in which the person tries to subtract the calories through compensatory behaviors like excessive exercise. At least once per week for 3 months. Lack of control over the easing. Symptoms of rapid eating until full, eating alone to avoid embarrassment, feelings of guilt afterwards.

Changes in mood disorders

Split into 2: Depressive disorders (moods singularly sad) & Bipolar and Related Disorders (mood alternates between sadness and mania).

Describe changes with Autism

The DSM Diagnosis of Autistic disorder, Asperger's disorder, and related developmental disorders were combined into a single DSM 5 diagnosis: Autism Spectrum Disorder. Now seen as mild, moderate, and severe versions of the same problem.

What is the official diagnostic system for mental disorders? It is subject to?

The Diagnostic & Statistical Manual of Mental Disorders (DSM5) -subject to periodic revisions

Define Diagnosis:

The determination that a set of symptoms or patient problems indicate a particular disorder.

Criticisms of DSM

Too many diagnoses? -too many diagnostic categories (over-pathologizes common behaviors and difficulties?) -Cutoffs for meeting criteria are not universally agreed upon Reliability issues in everyday practice... -high comorbidity among disorders

Impact the VA had on the first edition of the DSM?

U.S. Army and Veterans (VA) developed their own categorization system in an effort to facilitate the diagnosis and treatment of soldiers returning from World War II. This was different than the recent DSM editions, but had a significant impact on the creation of the first edition of the DSM.

How does culture impact the definition of mental illness?

Views and definitions vary across cultures and cultural differences can affect symptom presentation, diagnostic accuracy, and treatment response.

Levels of disability is indicated in DSM5 using the ______

WHODAS (World Health Organization's Disability Assessment Schedule)

Who published the International Classification of Diseases (ICD)? Purpose?

World Health Organization -Primary way that diseases including mental disorders are coded and categorized in many countries outside of the US. Greater consistency between the DSM and ICD will allow for better communication between countries and improved research design.

Changes with Substance Abuse and Substance Dependence

combined into a single diagnosis: Substance Use Disorder.

_______ is an important first step in patient care. Why?

diagnosis -A diagnosis should guide treatment, implying the most appropriate course of care.

Change in Bulimia Nervosa criteria

frequency dropped from 2 times a week to once a week. The requirement that menstrual cycle stops has been omitted and low body weight has been changed to numeric definition (less than 85% expected body weight) to a less specific description taking into accoun age, sex, development, and physical health.

Hippocrates pointed to _____ as the underlying reason for various forms of mental illness

imbalance in bodily fluids (blood, phlegm, black bile, and yellow bile)

A valid diagnosis allows health care providers to:

make important predictions (ex. response to treatment, typical course, prognosis for recovery).

A dimensional classification for ________ disorders was proposed, but not included in the DSM5

personality disorders

What language was used for DSM II

psychoanalytic approach

DSM I and DSM II were extremely similar to one another. Contained how many broad categories. Problem?

psychoses (ex. schizophrenia), neuroses(ex. Depression, bipolar, anxiety), and character disorders (ex. Personality disorders). Not scientifically or empirically based.

Changes with OCD -also contains what 3 disorders?

removed from anxiety disorders category and placed in its own category: OCD and related disorders which also contains Trichotillomania (hair pulling), excoriation(skin-picking), and body dysmorphic disorder.

The DSM is published by:

the American Psychiatric Association